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OB Exam 2 > Fetal Assessment > Flashcards

Fetal Assessment Flashcards

1
Q

Measuring Contractions

A
  • Small boxes on strip represent
    > 10 seconds
  • Bigger boxes on strip represent
    > 1 minure interval
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2
Q

What Type of Fetal Response are we Worried about that will be Monitored

A
  • Reduction of blood flow through maternal vessels
  • Reduction of O2 content in maternal term
  • Alterations in fetal circulation
  • Reduction in blood flow to placenta
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3
Q

Uterine Activity

A
  • Hypertonicity
    > a steady contraction
    > no resting tone
  • Tachysystole
    > too many contractions
    > 5 contractions in less than 10 mins
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4
Q

Fetal Compromise

A
  • Abnormal FHR patterns are associated with:
    > hypoxemia
    > hypoxia
    > metabolic acidosis
    > acidemia: incrd hydrogen ion content in blood dcr pH
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5
Q

Reduction of Blood Flow Through Maternal Vessels

A
  • At risk for:
    > HTN
    > hypotension
    > hypovolemia
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6
Q

Reduction of O2 Content in Maternal Blood

A
  • At risk for
    > hemorrhage
    > anemia
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7
Q

Alterations in Fetal Circulation

A
  • Umbilical cord compression
  • Partial placental separation
  • Complete abruption
  • Head compression
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8
Q

Reduction in Blood Flow to Placenta

A
  • Hypertonus
    > too much contraction
  • Damage to placenta vascular
    > due to diabetes or HTN
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9
Q

Intermittent Auscultation

A
  • Listening to FH sounds at periodic intervals to assess FHR
  • Disadvantage
    > can miss major events since its in intervals
  • Intruments Used
    > doppler/fetoscope
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10
Q

Palpation

A
  • Monitors contractions
  • Examiner should keep fingertips placed over fundus before, during, and after contractions
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11
Q

Contraction Monitoring

A
  • Intensity
    > usually described as mild, moderate, or strong
  • Duration
    > contraction duration is measured in seconds, from beginning to end of contraction
  • Frequency
    > measured in minutes, from beginning of one contraction ot beginning of next
  • Resting Tone
    > evaluates relaxation btwn contractions, described as soft or hard
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12
Q

Electronic Fetal Monitoring Purpose

A

Assess the adequacy of fetal oxygenation during labor

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13
Q

Ultrasound Transducer

external monitoring

A
  • Works by reflecting high-frequency sound waves off moving interface; the fetal heart & valves
  • measure FHR
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14
Q

Tocotransducer

external monitoring

A
  • Measures uterine activity transabdominally
  • Placed over fundus
  • Measure frequency & duration but not intensity
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15
Q

Internal Monitoring Purpose

A
  • Membranes must be ruptured
  • Cervix dilated 2-3cm
  • Presenting part low enough for placement of spiral electrode or IUPC or both
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16
Q

Spiral Electrode

internal monitoring

A

Monitors FHR

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17
Q

Intrauterine Pressure Catheter (IUPC)

internal monitoring

A

Measure frequency, intensity, and duration

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18
Q

Location of HR Based on Position

A
  • Vertex HR below umbilicus
  • Breech HR above umbilicus
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19
Q

What is Variability

A

Irregular waves or fluctuations in the baseline FHR of 2 cycles per minute or greater

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20
Q

Normal Variability

A

110-160bpm

21
Q

Absent Variability

A

Scariest
Range not detected to naked eye

22
Q

Minimal Variability

A

Detectable but less than 5bpm

23
Q

Absent/Minimal Classification

A

Abnormal/indeterminate

24
Q

Causes of Absent/Minimal Variability

A
  • Fetal hypoxia/metabolic acidemia
  • Fetal sleep cycles
  • Fetal tachycardia
  • Extreme prematurity
  • Meds tht cause CNS depression
  • Congenital anomalies
  • Preexisting neurologic injury
25
Q

Moderate Variability

A
  • Its presence reliably predicts a normal fetal acid-base balance
  • Well O2/neuro intact
  • Intervention:
    > continue to observe
26
Q

Marked Variability

A
  • Unclear likely normal
  • Fluctuation of greater than 25bpm
27
Q

Sinusoidal Patterns

A
  • Sinusoidal patterns are regular, smooth, undulating wavelike pattern tht persists for at least 20 mins
  • Can be caused from opioid or anemia
28
Q

FHR - Tachycardia

A
  • Causes:
    > Premature prolonged rupture of membranes (PPROM)
    > drugs
    > FH abnormalities
    > fetal/maternal infection; incrd maternal temp
  • Early sign of fetal hypoxemia
    > associated w/ late deceleration or minimal or absent variability
29
Q

FHR - Bradycardia

A
  • Causes:
    > low maternal BO
    > prolonged umbilical cord compression
    > structural defects
    > fetal heart failure
    > maternal hypoglycemia
    > maternal hypothermia
    > viral infection
  • Late sign of fetal hypoxia
    > terminal
30
Q

Periodic vs Episodic

A
  • Periodic: refer to events tht occur at regular intervals, with contractions
  • Episodic: refer to irregular events that are independent of uterine contractions
31
Q

Accelerations

A
  • Visually apparent abrupt incr in FHR above baseline rate
  • Associated w/ fetal movement
  • Scalp stim/ vibroacoustic stim
32
Q

Accelerations Criteria

A

15 beats x 15 seconds

33
Q

Accelerations Predictive of

A

Highly predictive of normal fetal acid-base balance

34
Q

Accelerations Nursing Interventions

A

Nothing, continue to monitor

35
Q

Early Decelerations

A
  • Visually apparent, gradual dcr in & return to baseline FHR
  • Associated w/ uterine contractions
  • Cause deatl head compression
  • No known relationshipd btwn fetal O2
36
Q

Early Decelerations Nursing Interventions

A

Check dilation

37
Q

Late Decelerations

A
  • Visually apparent, gradual dcr in & return to baseline FHR
  • Associated w/ uterine contractions
  • Common after epidural
  • Begins after the contraction has started and lowest point is after peak of contraction
  • Caused by reflex fetal response to transiet hypoxemia due to dcr in mom’s BP, hypertonicity
    > uteroplacental insufficiency = abruption of O2 transfer
38
Q

Late Decelerations Nursing Interventions

A
  • DC oxytocin
  • Incr IV fluids
  • Side lying position
  • Admin 10L of O2 non rebreather
  • Elevate legs to correct hypotension
39
Q

Variable Decelerations

A
  • Visually abrupt & apparent dcr in FHR below baseline
  • Dcr is at least 15 bpm x 15 seconds
  • Returns to baseline in less than 2 mins
  • Indication of cord compression
  • Shaped like U, V, or W
  • Reoccuring is worse
40
Q

Variable Late Decelerations Nursing Interventions

A
  • 1st Priority:
    > reposition
    > then amnioinfusion
41
Q

Prolonged Decelerations

A
  • Visually apparent dcr of at least 15 bpm below baseline
    > lasting > 2mins but less than 10 mins
  • Caused by cord compression or fetal hypoxemia last for an extended period
42
Q

Prolonged Decelerations

A
  • Must be corrected
  • If it can not be fixed then c-section
43
Q

Category I FHR Tracings

A

Normal & strongly predictive of normal fetal acid-base status at time of observation

44
Q

Category II FHR Tracings

A
  • Indeterminate
  • Continue to observe/evaluate
45
Q

Category III FHR Tracings

A
  • Abnormal
  • Immediate interventions are required
  • Need to improve fetal O2
46
Q

Pattern Recognition Interpretation - Nursing Management

these are assessments!

A
  • Purpose/Goal:
    > improve fetal oxygenation
  • Interventions
    > for hypotension: O2 (non-rebreather), side-lying, IV fluid bolus (incr fluid vol), cardiac meds
    > too many contractions: reduce oxytocin/pitocin; uterine stimulant
    > abnormal FHR during 2nd stage of labor: open glottis pushing, fewer pushing efforts during each contraction, push w/ every other or every third, make pushing efforts shorter
47
Q

Pattern Recognition Interpretation - Interventions

A
  • Way to elicit an incr in FHR:
    > scalp stimulation
    > vibroacoustic: strong vibration for baby; like ab alarm clock
  • Labs
    > to access fetal well being
    > umbilical cord acid-base
  • Amnioinfusion
    > it can help w/ cord compression
    > monitor I&Os , don’t want FVE
  • Tocolytic Therapy
    > relaxation of uterus
    > pharm: Brethine (terbutaline)
48
Q

VEAL CHOP

A
  • Variable decel
  • Early decel
  • Accelerations
  • Late decels
  • Cord compression
  • Head compressions
  • Oxygenation
  • Placental insufficiency

OB Exam 2 (11 decks)

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