Exam 2 Study Guide Flashcards
What is ‘VEAL’ evaluating in veal chop mine
FHR pattern
What is ‘CHOP’ evaluating in veal chop mine?
cause
what is ‘MINE’ telling us in veal chop mine?
management
VEAL acronym stands for?
Variable deceleration
Early deceleration
Acceleration
Late deceleration
What does CHOP acronym stand for?
Cord compression
Head compression
Okay!
Placental insufficiency
what does ‘MINE’ acronym stand for
Maternal repositioning
Identify labor progress
No interventions
Execute interventions
What are accelerations?
increase in fetal HR from baseline by 15 bpm lasting 15 seconds or more
-determinant of fetal well-being
Are accelerations on the FHR reassuring?
Yes
What are the types of decelerations seen in FHR monitoring?
-variable decelerations
-early decelerations
-late decelerations
-prolonged decelerations
Cause of variable decelerations
cord compression
interventions for variable decelerations?
-move mom to release pressure on cord
Late decelerations are caused by
utero-placental insufficiency
Interventions for late decelerations ?
- roll mom over to increase perfusion
- stop oxytocin
- IV fluids and oxygen
Early decelerations are caused by
head compression
Interventions for early decelerations?
-none
-perform labor checks
Prolonged decelerations last how long?
> 2 minutes
Interventions for prolonged decelerations?
-same as late
-prepare for c -section
-beginning, middle, and end of decelerations exactly matches uterine contractions
-beginning of deceleration aligns with the peak of uterine contraction
variable decelerations
-significant drop down
-U’s, V’s, W’s
What is FHR variability?
normal irregularity of the cardiac rhythm
Absence of variability is a sign of?
fetal compromise
FHR variability is a determinant of
fetal well-being
What is absent variability?
line almost completely flat
What is minimal variability?
very slight variability from baseline
Cause of minimal variability and nursing interventions
-sedated baby
-monitor more
Moderate variability is
a reassuring sign and what we want to see
What is sinusoidal variability?
FHR repeating cycle of upward increase in the HR followed by a decrease in the HR
What is cord compression?
Baby compressing umbilical cord which leads to decreased perfusion to baby
How is cord compression relieved?
repositioning mom
Cord compression will cause
variable decelerations
What FHR patterns are reassuring
-accelerations
-moderate variability
What FHR patters are non-reassuring?
-tachycardia
-bradycardia
-decreased / absent variability
-late decelerations
-persistent variable decelerations
What interventions are performed for absent variability?
- repositioning mom
- administering oxygen
- IV fluid bolus
- discontinue oxytocin infusion
For absent variability, what can we stimulate in the fetus to promote FHR variability/ acceleration?
the fetus’s scalp
-can be done with hands or forceps
What may have to be applied to fetus when we have absent variability on the FHR?
fetal scalp electrode
What is a normal FHR?
110-160 BPM
- average rate over 10 minutes
What is fetal tachycardia?
baseline above 160 BPM
What can cause fetal tachycardia?
- fetal hypoxia
-maternal fever
-intrauterine infection
-drugs
What is fetal bradycardia?
baseline below 110 BPM
What are causes of fetal bradycardia?
-profound hypoxia, anesthesia, beta blockers
If mom is given sedation, will this cause effects on the baby?
yes
What are interventions for late decelerations?
- reposition mom first
- oxygen therapy
- IV fluid bolus
- discontinue oxytocin infusion
What is intermittent FHR monitoring
-low technology method that is performed during labor
What instruments can be used to perform intermittent FHR monitoring?
- doppler, ultrasound stethoscope, fetoscope
What is continuous FHR monitoring
continuously monitoring FHR and uterine contractions by placing a transducer on the client’s abdomen and tocotransducer on the client’s fundus
What are advantages to continuous FHR monitoring?
-noninvasive and reduces risk of infection
-performed by a nurse
-provides permanent record of FHR and uterine contractions
Does the cervix have to be dilated OR membranes have to be ruptured for continuous FHR monitoring?
No (this is considered an advantage)
During the latent phase of labor, how often should the FHR be monitored?
q 30-60 min
During the active phase of labor, how often should the FHR be monitored?
q 15-30 min
During second stage of labor, how often should the FHR be monitored
q 5-15 min
What is an epidural?
local anesthetic injected into the epidural space at the 4th-5th vertebrae
Where does an epidural eliminate pain?
-umbilicus to thighs
-might not remove pressure sensations
What are complications of the epidural?
-maternal hypotension
-fetal bradycardia
When using an epidural, clients may lose the
- ability to feel the urge to void –> leads to urinary retention
- bearing down reflex
Can an epidural cause fever and itching?
yes
What must be inserted to help with elimination if a client receives an epidural
-Foley catheter
What must be administered to client receiving an epidural to prevent maternal hypotension
-a bolus of IV fluids
After insertion of the epidural, what position should the client be in?
side-lying
-helps prevent hypotension
Should FHR be assessed for continuously after receiving epidural?
yes due to potential for fetal bradycardia
Client’s with an epidural are at risk for ______, so client safety is a priority
falls
How can we prevent falls in patients receiving epidurals?
- do not let client get up and walk around
- assess when she can feel sensation again
- assist client with standing and walking for the first time
What is the first stage of labor?
When cervix is dilating from 0-10 cm
The first stage of labor is broken down into three stages. What are they?
-latent phase: 0-3cm
-Active phase: 4-7 cm
-Transition: 8-10 cm
The first stage of labor begins with onset of _____ contractions and ends with ______- _______
regular contractions ; complete dilation
What are contractions like during the latent phase of labor?
-irregular, mild to moderate
-q 5-30 min
-lasts 30-45 sec
During the latent phase, are mothers often talkative and eager?
yes
Some dilation and effacement will occur slowly during the
latent phase
contractions during the active phase of labor will be?
-regular and moderate to strong
-q 3-5 min
-lasts 40-70 seconds
What phase of labor will mothers begin to feel anxiety, restlessness, and helpless
active face
Rapid dilation and effacement with some fetal descent occurs during which phase?
active
Contractions during the transition phase will be?
-strong to very strong
-q 2-3 min
-45 - 90 sec duration
Which phase of labor will make the mom tired, restless and irritable?
transition phase (considered most difficult part of labor)
During the transition phase of labor, birthing mothers will often express that
‘they cannot continue’
what phase of labor will have increased rectal pressure, need for bowel movement, and increased bloody show?
transition phase
Mothers will not feel the urge to push until which phase of labor
transition
Can mothers experience nausea and vomiting during the transition phase?
they can
What happens during the second stage of labor?
-begins with complete cervical dilation and ends with DELIVERY OF FETUS
During the second stage of labor, will mothers experience contractions q 1-2 min
yes
What happens during the third stage of labor?
-begins with delivery of the neonate and ends with DELIVERY OF THE PLACENTA
-separates from uterine wall
What is Schultze presentation?
shiny fetal surface of placenta emerges first
What is Duncan presentation?
-dull maternal surface of placenta emerges first
What is the fourth stage of labor?
maternal stabilization of vital signs lasting 1-4 hours
What does locha look like during the fourth stage of labor?
scant to moderate rubra
What is VBAC?
vaginal birth after cesarean
Selection criteria for VBAC includes?
-no other uterine scars or history of previous rupture
-clinically adequate pelvis
-no current contradictions
What kind of incision must the woman have to meet VBAC criteria?
-low transverse
Can a woman qualify for VBAC if her birthing center doesn’t have providers immediately available?
NO - must be able to go into emergency c-section if it ends up being indicated
Can clients who have had dysfunctional labor, breech presentation, or abnormal FHR pattern quality for VBAC?
yes because these are considered nonrecurring events
What is OP position?
occiput posterior
What happens during occiput posterior position?
baby is head down but facing the mother’s front instead of her back
occiput posterior position can cause
-labor to be longer and more painful
-c-section
-use of forceps or vacuum
Why do women with fetuses in OP position have ‘back labor’
baby’s head is pressing up against the lower spine
What will help with back labor pain?
What is a fetal fibronectin test?
-tests the amount of fFN in vaginal fluid to assess the risk of preterm birth
-between weeks 24-34 of pregnancy
A negative test result in a fibronectin test means?
the client is not in preterm labor
A positive fibronectin test indicates?
pre-term labor may be occurring/ at high risk for one
What is a bishop score?
a score used to evaluate maternal readiness for labor and if they will need induction
What does the bishop score evaluate
-cervical dilation
-cervical effacement
-cervical consistency
-cervical position
-station of presenting part
-each have a numerical value of 0-3
a score of 5 or less on the bishop scoring indicates
unfavorable cervix; induction may be necessary for vaginal delivery
A bishop score of 6-7 indicates
unclear whether or not induction will be successful
a bishop score of 8 or greater indicates
spontaneous vaginal delivery likely; induction may not be necessary
What are objective indications of pain our patients may expereince
-behavioral changes
-increase BP, tachycardia, hyperventilation
-Nausea and vomiting
What is the gate-control theory of pain
the idea that non-painful stimuli can override and reduce painful stimuli
What can our patients do to block painful stimuli (gate - control theory of pain)
-rubbing a painful area
-being distracted
-burn incense
Child-birth classes, doulas, and hypnosis are examples of?
nonpharmacological pain interventions
What sensory stimulation strategies can we promote in our patients to reduce pain?
-aromatherapy
-breathing techniques
-imagery
-music
-use of focal points
-subdued lighting
What are cutaneous stimulation strategies based on the gate-control theory to promote relaxation and reduce pain?
-therapeutic touch and massage
-walking
-rocking
-effleurage
-sacral counter pressure
What is effleurage?
-light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm with breathing during contractions
What is sacral counterpressure?
consistent pressure is applied by the support person using the heel of the hand or fist against the clients sacral area to counteract pain in the lower back
What nonpharmacological pain management strategy increases maternal endorphin levels
hydrotherapy (whirlpool or shower)
Common positions for our mothers to promote relaxation
-semi-sitting
-squatting
-kneeling
-kneeling and rocking back and forth
What pharmacological pain management are not commonly used during labor , but MAY be used to induce sleep in the early or latent phase?
-sedatives (phenobarbital, pentobarbital)
Why are barbiturates not commonly used for pain management?
-neonate respiratory depression
-unsteady ambulation by mom
-decreases mom’s ability to cope with pain of labor
Should sedatives be prescribed if mom is feeling pains of labor?
No - may cause them to become hyperactive and disoriented
Nursing strategies when client is prescribed barbiturates?
-provide safety for mom
-dim lights and promote rest
-monitor fetal respirations
What opioids are commonly used in childbirth?
-meperidine, fentanyl, butorphanol, nalbuphine
Which opioids provide pain relief without causing significant respiratory depression in the mother or fetus?
butorphanol and nalbuphine
Adverse effects of opioids ?
-respiratory depression in mother or neonate
-reduction of gastric emptying –> nausea and vomiting
-FHR variability decreased
What part of labor are opioids given
-early part of active labor
What routes are opioids given during labor
-IM or IV (IV most common route)
Nursing actions to monitor during labor
-verify well established labor
-monitor VS,FHR,ctx, pain
What is administered during epidural and spinal regional analgesia?
-fetanyl administered as a motor block into subdural or intrathecal space without anesthesia
Epidural and spinal analgesia produce ____ pain belief while still allowing _____ of contractions an _____ to push
rapid ; sensation ; ability
Adverse effects of epidural and spinal analgesia
nausea and vomiting
hypotension
Nursing actions for epidural and spinal regional analgesia?
-safety precautions
-monitor VS and FHR
the epidural eliminates pain at the level from
the umbilicus to the thighs (may not remove pressure sensations)
When is the epidural administered?
when the client is in active labor and at least 4 cm dilated
What is patient controlled epidural analgesia
using a PCA pump to administer the epidural after initial placement
the spinal anesthesia is administered into?
the subarachnoid space into the spinal fluid at the 3rd, 4th, and 5th lumbar space
the spinal anesthesia eliminates all pain from the ____ down
nipple
Spinal anesthesia is commonly used in?
cesarean births
Adverse effects of the spinal anesthesia
-maternal hypotension
-fetal bradycardia
-potential headache from leakage of cerebrospinal fluid
Nursing actions with spinal anesthesia
-IV bolus before
-monitor FHR
-monitor for HA
Nursing actions to prevent postpartum HA from spinal anesthesia q
-supine position
-bed rest in a dark room
-oral analgesics, caffeine, and fluids
-autologous blood patch is the most beneficial and reliable measure
In what scenario would general anesthesia be used?
-contraindication to spinal or epidural
-seeing no pain relief
-delivery complications
-severe emergencies
If general anesthesia is used, is the support person allowed in the room”
No
General anesthesia will not be administered to the mom until?
everyone is in the room and ready
What is priority to monitor after a client is given general anesthesia
uterine tone –> general anesthesia can lead to hemorrhage
What does the nurse want the uterus to feel/look like after receiving general anesthesia
firm, contracting, controlled bleeding
Nursing actions for general anesthesia
-apply anti-embolic stockings
-administer antacids and H2 receptor antagonists (ranitidine)
-monitor VS and IV site
What is chorioamnionitis?
an infection of the placenta and amniotic fluid (amniotic sack)
How does chorioamnionitis present?
-yellow, malodorous discharge
-fever
-tenderness/pain
-sweating
-fetal or maternal tachycardia
How is Chorioamnionitis treated?
-Ampicillin
-obtain vaginal, urine, and blood cultures before administering antibiotics
When is a vacuum delivery indicated?
-maternal exhaustion
-ineffective pushing efforts
-fetal distress (during second stage)
-after 34 weeks
Can a vacuum assisted birth be used if the mom is not 10 cm dilated and membranes not ruptured?
no
What presentation must baby be in for provider to use vacuum assisted birth?
vertex
If mom’s pelvis is disproportionate and baby is not engaging, can vacuum assisted delivery be performed?
no
What medication is needed in room for birth, medication wise for mom and baby
naloxone ?? (thanks Aaron)
What happens during uterine rupture?
-when the uterus tears open during pregnancy (can be complete or incomplete)
A complete uterine rupture involves the uterine wall, peritoneal cavity, and or broad ligament. What does this cause?
internal bleeding
An incomplete uterine rupture is. caused by dehiscence at the sign of a prior scar. Is internal bleeding always present?
no
Is uterine rupture a life threatening emergency?
yes
What symptoms will the client report if experiencing a uterine rupture?
-sensation of ripping, tearing, and sharp pain
-abdominal pain and uterine tenderness
With uterine rupture, changes in uterine and shape occur. what assessment finding accompanies this
-fetal parts palpable
Cessation of ____ and loss of fetal _____ occurs during uterine rupture
contractions ; station
What will FHR look like during uterine rupture?
-nonreassuring FHR with indications of distress
-bradycardia, variable/late decelerations, minimal/absent variability
Manifestatiosn of hypovolemic shock, which can occur with uterine rupture, are?
-tachypnea, hypotension, pallor, cool and clammy skin
What is the biggest indicator that our client is in true labor?
-cervical changes such as dilation and effacement
Contractions in true labor vs false labor?
true: start irregular but become regular, strong, last longer, more frequent, felt in lower back and radiates to abdomen, walking increases contraction intensity. comfort measures do not work
False: can be painless, intermittent, and irregular frequency. decrease in pain and intensity with walking. felt in lower back or above umbilicus, relieved by comfort measures
The presenting part of the infant will engage in true or false labor?
true
Will bloody show occur in false labor?
no - only true labor
where should fetal heart tones be assessed if in vertex presentation?
below the umbilicus in the right or left lower quadrant
Where should fetal heart tones be assessed if in breeched position?
above the clients umbilicus in either the right or left upper quadrant of the abdomen
What are tocolytics?
medications that are used to delay or stop uterine contractions in pregnancy\
-used mostly in preterm labor (before 36 weeks and 6 days gestation)
What medications are tocolytics?
magnesium suflate and terbutaline
How does magnesium sulfate work?
-depresses central nervous system and relaxes smooth muscles
Sx of magnesium sulfate toxicity?
BURP
Blood pressure decreased
Urine output decreased
Respirations less than 12
Patella reflex absent
-decreased LOC
-cardiac dysrhythmias
What is the antidote for magnesium sulfate?
calcium gluconate
How does terbutaline work?
-beta adrenergic agonist that relaxes smooth muscles and inhibits uterine activity
If our uterus is relaxed after pregnancy, a side effect of tocolytics, what are we at risk for after delivery
hemorrhage
When is oxytocin given?
-cervical priming to increase readiness for labor
-induction of labor
-dystocia (due to atypical contractions)
(augment labor and strengthen uterine contractions)
Prior to the administration of oxytocin for induction of labor, it is important the nurse confirm what?
-that the fetus is engaged at a minimum station of 0
During induction of labor, it is important to wait for oxytocin infusion until?
-the cervix is ready after ripening
-4 h after misoprostol
-6-12 after dinoprostone gel instillation
When should oxytocin infusion be stopped?
during tachysystole/ hypertonic contractions
Sx of tachysystole include?
-contractions frequency less than 2 min apart
-duration of contraction > 90 sec
-pressure of contractions ? 90 mmhm
-uterus not relaxing between contractions
-uterine resting tone > 20 mmhg
Contraindications for using oxytocin include
What is GBS screening done for?
-culture to screen for group B streptococcus
when is the GBS screening done?
35-37 weeks
why is GBS important to know?
-we must administer ABX intravenously to prevent complications to baby
What can happen to the neonate if GBS is spread to it
-pneumonia, respiratory distress syndrome, sepsis, and meningitis
What medications are used to treat GBS?
-penicillin and ampicillin
What is fetal station?
relationship of fetal head to the mothers pelvis
How is station measured?
-station 0 being at the level of ischial spines
-above 0 is -1,-2,-3
-below 0 is +1,+2,+3
How do we facilitate descent of fetus?
by using gravity
-peanut ball bouncing
-hands and knees position
-hugging ball on floor
-squatting with chair
What isi a precipitous delivery?
labor completed in less than 3 hours when starting contractions to birth
what do we need to monitor for during precipitous delivery?
-cervcial lacerations
-uterine rupture
-pain management
What should we monitor in the fetus during precipitous delivery
-head trauma (intracranial hemorrhage or nerve damage)
-hypoxia due to rapid progression of labor
When is magnesium sulfate given?
-during preterm labor to suppress contractions
-in preeclampsia (from last exam to prevent seizures)
When is magnesium sulfate no longer safe?
When adverse reactions are present:
-hot flashes
-diaphoresis
-burning at IV site
-nausea
-vomiting
-drowsiness
-blurred vision
-headache
-non-reactive non stress test
-reduced FHR variability
What are signs of labor?
-backache
-weightloss (1-3.5lbs)
-lightening
-contractions (Braxton hicks –> regular)
-expulsion of mucous plug (brown or blood tinged)
-energy changes
-GI changes
-cervical changes
-rupture of membranes
What is lightening and what sx will occur (preceding labor)
when fetal head descends into relics about 14 days before labor
-feels like baby has ‘dropped’
-easier breathing
-urinary frequency increases again
What happens during a cord prolapse
-occurs when the umbilical cord is displaced (comes before the fetus, protruding through cervix)
What does cord prolapse result in?
cord compression and compromised fetal circulation
During a cord prolapse, the nurse should call for assistance immediately. What else should they do?
-use a sterile gloved hand, insert two fingers into the vagina and apply pressure on the fetal presenting part to elevate it off of the cord (remain until birth of baby)
What position should mom be placed in if cord prolapse occurs
knee-chest
trendelenburg
side lying with towel under clients hip
If the cord is visible outside, what should be applied to it to prevent drying and maintain blood flow?
sterile, warm, saline soaked towel
Other nursing actions during cord prolapse include?
-applying 8-10 L of oxygen via facemark
-administering IV fluid bolus
-continuous FHR monitoring
What is betamethasone used for?
-promoting lung maturity In fetus (mostly used in preterm labor)
What is a doula?
provides emotional or practical support to mother or couple before, during, and after childbrith
How do doulas assist?
-pain relief, reduced need for pain medications and delivery options (prevent vacuums, forceps, and c sections)
-emotional and physical support
-information on birth experience
What is effleurage?
light, gentle circular stroking of the client’s abdomen with the fingertips in rhythm of breathing during contractions
When is effleurage done?
during labor
What are the 5 P’s of labor?
passageway
passenger
powers
position
psyche
What does passageway mean?
the birth canal –> bony pelvis, pelvic floor, vagina, vaginal opening
What is the anatomically perfect pelvis for a baby to pass through
‘gynecoid’
What is ‘presentation’ in the Passenger P
what part of fetus is entering the pelvic inlet first
-occiput
-chin
-shoulder
-breech
What is ‘L’ in Passenger P
-transverse
-parallel
What is ‘attitude’ in Passenger P?
relationship between fetal body parts (flexion / extension)
What occurs during the Powers P?
uterine contractions
-cause effacement and dilation
Involuntary urge to push and bearing down
What position is best for fetal descent (Position P in the five P’s)
-those that use gravity as assistance
What is important to remember in the Psychological P (five P’s)
-relaxed mothers are more tolerant of pain
- anxiety and fear can divert blood flow from the placenta
What is the premature rupture of membranes (PROM)
-spontaneous rupture of amniotic membranes prior to the onset of true labor
IF gestational duration is at term, the premature rupture of membranes indicates
the onset of true labor
What is preterm premature rupture of membranes
-premature spontaneous rupture of membranes
What are the laboratory tests that are used to verify rupture of membranes
-Nitrazine paper test (blue, pH 6.5-7.5)
-positive ferning test: when amniotic fluid is placed under microscope it looks like ferns
After 37 weeks, if there is a premature rupture of membranes, it is important for the nurse to make sure
labor starts
Afte membrane ruptures, we should limit?
the amount of vaginal exams to reduce infection
If mom ruptures but contractions haven’t started ,what do we do?
send her home
With premature preterm rupture of membranes, the mom should remain on what at home? q
bedrest with bathroom privileges
What should we educate clients to do if they experience premature rupture of membranes
-monitor daily fetal kick counts and notify nurse of uterine contractions
-adhere to bed rest with bathroom privileges
What is rupture of membranes?
spontaneous rupture of members can initiate labor or occur anytime during labor, most commonly during transition phase
What should be documented following the rupture of membranes?
-assessment of amniotic fluid
-testing for presence of amniotic fluid using nitrazine paper
What should normal amniotic fluid look like/ what we should document for rupture of membranes?
-amniotic fluid should be watery, clear, and slightly yellow
-no foul odor
-volume between 700-1,000 mL
Immediately following the rupture of membranes, a nurse should assess for?
FHR decelerations that may indicate fetal distress / umbilical cord prolapse
What are leopold maneuvers?
abdominal palpation of the fetal presenting part, lie, attitude, descent, and the probable location where FHR can be detected best
What are leopold maneuvers supposed to detect?
malpresentation
C-section indications
-breech
-nonassuring FHR
-placentia previa and abruption
-previous c -section
-dystocia
-umbilical cord prolapse
What are the 7 cardinal movements?
-engagement
-descent
-flexion
-internal rotation
-extension
-external rotation (restitution)
-birth by expulsion
The 7 cardinal movements are used for what presentation of the fetus
vertex
What is engagement (7 cardinal movements)
when the presenting part passes into the pelvic inlet and is at the level of the ischial spine
-referred to as station 0
What is descent (7 cardinal movements)
the progress of presenting part throug h the pelvis
-measured by station during vaginal examination (- , 0 , + station)
What is flexion (7 cardinal movements)
when the fetal head meets resistance of the cervix, pelvic wall, or pelvic floor
-head flexes and brings chin to chest making it smaller and easier to pass
What is internal rotation (7 cardinal movements)
-the fetal occiput ideally rotates to a lateral anterior position as it progresses from the asocial spines to the lower pelvis in a corkscrew motion to pass through the pelvis
What is extension (7 cardinal movements)
the fetal occiput passes under the symphysis pubis and the head is deflected anteriorly and is born by extension of the chin away from the fetal chest
What is external rotation/restitution?
after the head is born, it rotates to the position it occupied as it enters the pelvic inlet (restitution) in alightment with the fetal bod and completes a quarter turn to face transverse as the anterior shoulder passes under the symphysis
What is birth by expulsion (7 cardinal movements)
after birth of the head and shoulders, the turn of the neonate is born by flexing it toward the symphysis pubis
How do we assess uterine labor contraction characteristics?
by palpation or external/internal monitoring
What is frequency of contractions?
established from the beginning of one contraction to the beginning of the next
What is duration of contractions
time between the beginning of a contraction to the end of THAT SAME contraction
What is contraction intensity/ strength?
strength of the contraction at its peak described as mild, moderate, or strong
Mild contractions can be compared to?
slightly tense (like pressing fingertip to tip of nose)
Moderate contraction can be compared to
firm, like pressing finger to chin
Strong contractions can be compared to
rigid, like pressing finger to forehead
What is the resting phase of contractions
tone of the uterine muscle during contractions
A prolonged contraction duration (90 seconds or greater) or too frequent contractions (more than 5 in a ten minute period) without sufficient time to rest in between (30 seconds) can result in
reduced blood flow to placenta –> fetal hypoxia and decreased FHR
