Exam 4: Ch 18 Fetal Assessment during Labor Flashcards
Early Deceleration
visual apparent gradual decrease in and return to baseline FHR associated with UC
Causes of Early Deceleration
Head compression resulting from the following:
- Uterine conractions
- vaginal exam
- fundal pressure
- placement of internal mode of monitoring
No interventions needed
Late deceleration
visually apparent gradual decrease in and return to baseline FHR associated with UC
Causes of Late Decelerations
Disruption of oxygen transfer from environment to fetus caused by:
- Uterine tachysystole
- Maternal supine hypotension
- Epidural or spina hypotension
- Placenta previa
- Placental abruption
- Hypertensive disorders
- Post maturity
- Intrauterine growth restriction
- Diabetes mellitus
- Intraamniotic infection
Late Decelerations Nursing Interventions
- Change maternal position (lateral)
- Correct maternal hypotension by elevating legs
- Increase rate of maintenance IV solution
- Palpate uterus to assess for tachysystole
- Discontinue oxytocin if infusing
- Admin 8-10 L/min oxygen by non rebreather face mask
- Notify DR
- Consider internal monitoring for more accurate fetal and uterine assessment
- Assist the birth if pattern cannot be corrected
Variable Deceleration
visually abrupt decrease in FHR below the baseline.
Decrease: at least 15 beats/min or below the baseline
Lasts: at least
Leopald maneuver
abdominal palpation: help to identify
- number of fetuses
- presenting part, fetal lie, fetal attitude
- degree of presenting parts descent into the pelvis
- expected location of the point of maximal intensity of the FHR on the women abdomen
Cause of variable decelerations
umbilical cord compression
occasional have no significance, but recurrent indicates disruption of fetal oxygenation
Intervention for Variable Deceleration
- reposition (side to side or knee-chest)
- stop pitocin
- admin O2
- notify DR
- assist with vaginal exam
- assist with amnioinfusion
- assist with birth
Prolonged decelerations
visual apparent decrease in FHR
at least 15 beats/min below the baseline
-lasting more than 2 minutes but less than 10 min
Causes of prolonged decelerations
disruption in fetal oxygen supply
-NOTIFY immediately
How long do you monitor FHR
1st stage: every 30 min
2nd stage: every 15 min
Basic intervention for abnormal FHR
- admin O2 for 15-30 min
- side-lying position
- increase blood volume; by increasing the infusion of fluids
Category I (normal reassuring FHR)
baseline of 110-160
Category II (Between)
bradycardia/tachycardia
prolonged decelerations between 2-10 min
assess mom, she may have gotten meds
