Exam 2 - Fetal Surveillance Flashcards
the two methods for fetal surveillance are ___ and ___
fetal heart rate; uterine activity recording
you can monitor fetal heart rate with ___ or ____
intermittent auscultation; continuous electronic FHR
____ tracks external uterine contractions
External tocodynamometer or pressure transducer aka “toco”
internal uterine activity recording is done with ____
intrauterine pressure catheter
the best place for the toco is the ___
top of fundus
the transducer for FHR should be placed ____ for best reading
over fetal back
internal way to monitor baby’s HR
internal fetal scalp electrode
name 3 reasons we would use an internal fetal scalp electrode
(1) pt is moving
(2) pt’s body
(3) not able to pick up baby clearly based on position
____ is monitor that passes through the vagina and attaches to the scalp of the baby
internal fetal scalp electrode
internal way to measure contractions
Intrauterine pressure catheter (IUPC)
Flexible thin tube sits alongside the baby and has a small balloon
intrauterine pressure catheter
IUPC can measure the ___ of the contraction
strength
name the 2 key purposes of fetal heart rate tracings
(1) identify reassuring signs of fetal well-being
(2) screen for non-reassuring signs of a fetus who is at risk
on FHR tracings, the top shows ___ and the bottom shows ___
HR; contractions
average FHR during a 10-minute window is the
baseline fetal HR
fetal bradycardia is
<110 bpm
normal FHR is
110-160 bpm
fetal tachycardia is
> 160 bpm
____ are fluctuations in baseline FHR
variability
absent variability means ___
absent / amplitude undetectable
minimal variability means
amplitude change of 0-5 bpm
moderate variability means
amplitude change of 6-25 bpm
marked variability means
amplitude change of >25 bpm
moderate variability indicates what?
well-oxygenated fetus with functioning autonomic nervous system
minimal or absent variability may indicate what?
hypoxia or acidemia
marked variability suggests what?
acute hypoxia or mechanical compression of the umbilical cord
marked variability is often seen during ____ stage of labor
second
Temporary increases in the FHR from baseline of at least 15 bpm, lasting for at least 15 seconds.
accelerations
a gradual decrease and return to baseline associated w/ a contraction
early deceleration
nadir means
lowest point
in an early decel nadir of decel happens at the same time as ____
peak of contraction
early decels are usually due to ____
head compression during labor
in an early decel, onset to nadir is ____
> 30 seconds
the only type of decel that we are not concerned about is
early decel
gradual decrease and return to baseline associated with a contraction
late deceleration
in a late decel, the nadir of the decel occurs ____ the peak of contraction
after
late decels may indicate
placental insufficiency
generally, ____ decels are concerning
late
an abrupt decrease below baseline. The decrease is >=15 bpm (to Nadir) lasting >=15 seconds and <2 min from onset to return to baseline
variable deceleration
variable decels are ____ in FHR d/t ____
abrupt drops; umbilical cord compression
which type of decelerations is not directly tied to contractions?
variable
a decrease in FHR below the baseline
prolonged deceleration
Decrease in fetal heart rate is 15 bpm or more and lasts for at least 2 mins but less than 10 mins from onset to return to baseline
prolonged deceleration
name 4 causes of prolonged decelerations
(1) labor progressing quickly
(2) pt getting epidural
(3) sudden position change
(4) baby has sudden position change
_____ decelerations can turn into an emergency C-section
prolonged
VEAL is an acronym to describe ____
fetal heart rate pattern
CHOP is an acronym to describe ____
causes of of FHR pattern
what does VEAL CHOP stand for?
V = variable decels
E = early decels
A = accelerations
L = late decels
C = cord compression
H = head compression
O = okay
P = placental insufficiency
_____ are Quantified as the number of contractions present in a 10-min window averaged over 30 mins
uterine contractions
what is the interval for normal contractions?
< or = 5 contractions in 10 mins, averaged over 30 mins
excessive contractions
tachysystole
tachysystole is ___ contractions in 10 min
> 5
Name 3 nursing interventions for someone in tachysystole
(1) maternal repositioning
(2) fluid bolus
(3) discontinue oxytocin / other contraction stimulators
from the start of the increase of a contraction to back in the resting tone is ____
duration
time between the start of one contraction to the start of the next is
frequency
category I / normal FHR pattern includes:
(1) normal baseline
(2) moderate variable FHR
(3) no late or variable decels
(4) early decels present or absent
category II / intermediate FHR pattern includes:
(1) minimal variability
(2) marked variability
(3) one prolonged decel
…many others
which category of FHR pattern is common in L&D?
category II
name 3 things we do to intervene in category II.
(1) IV fluid bolus
(2) maternal repositioning
(3) discontinue oxytocin/pitocin
category III / abnormal FHR pattern includes:
absent variability AND
(1) recurrent late decels
(2) recurrent variable decels
(3) bradycardia
(4) sinusoidal pattern
