Fetal Assessment Flashcards
Measuring Contractions
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Small boxes on strip represent
> 10 seconds -
Bigger boxes on strip represent
> 1 minure interval
What Type of Fetal Response are we Worried about that will be Monitored
- Reduction of blood flow through maternal vessels
- Reduction of O2 content in maternal term
- Alterations in fetal circulation
- Reduction in blood flow to placenta
Uterine Activity
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Hypertonicity
> a steady contraction
> no resting tone -
Tachysystole
> too many contractions
> 5 contractions in less than 10 mins
Fetal Compromise
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Abnormal FHR patterns are associated with:
> hypoxemia
> hypoxia
> metabolic acidosis
> acidemia: incrd hydrogen ion content in blood dcr pH
Reduction of Blood Flow Through Maternal Vessels
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At risk for:
> HTN
> hypotension
> hypovolemia
Reduction of O2 Content in Maternal Blood
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At risk for
> hemorrhage
> anemia
Alterations in Fetal Circulation
- Umbilical cord compression
- Partial placental separation
- Complete abruption
- Head compression
Reduction in Blood Flow to Placenta
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Hypertonus
> too much contraction -
Damage to placenta vascular
> due to diabetes or HTN
Intermittent Auscultation
- Listening to FH sounds at periodic intervals to assess FHR
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Disadvantage
> can miss major events since its in intervals -
Intruments Used
> doppler/fetoscope
Palpation
- Monitors contractions
- Examiner should keep fingertips placed over fundus before, during, and after contractions
Contraction Monitoring
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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
Electronic Fetal Monitoring Purpose
Assess the adequacy of fetal oxygenation during labor
Ultrasound Transducer
external monitoring
- Works by reflecting high-frequency sound waves off moving interface; the fetal heart & valves
- measure FHR
Tocotransducer
external monitoring
- Measures uterine activity transabdominally
- Placed over fundus
- Measure frequency & duration but not intensity
Internal Monitoring Purpose
- Membranes must be ruptured
- Cervix dilated 2-3cm
- Presenting part low enough for placement of spiral electrode or IUPC or both
Spiral Electrode
internal monitoring
Monitors FHR
Intrauterine Pressure Catheter (IUPC)
internal monitoring
Measure frequency, intensity, and duration
Location of HR Based on Position
- Vertex HR below umbilicus
- Breech HR above umbilicus
What is Variability
Irregular waves or fluctuations in the baseline FHR of 2 cycles per minute or greater
Normal Variability
110-160bpm
Absent Variability
Scariest
Range not detected to naked eye
Minimal Variability
Detectable but less than 5bpm
Absent/Minimal Classification
Abnormal/indeterminate
Causes of Absent/Minimal Variability
- Fetal hypoxia/metabolic acidemia
- Fetal sleep cycles
- Fetal tachycardia
- Extreme prematurity
- Meds tht cause CNS depression
- Congenital anomalies
- Preexisting neurologic injury
Moderate Variability
- Its presence reliably predicts a normal fetal acid-base balance
- Well O2/neuro intact
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Intervention:
> continue to observe
Marked Variability
- Unclear likely normal
- Fluctuation of greater than 25bpm
Sinusoidal Patterns
- Sinusoidal patterns are regular, smooth, undulating wavelike pattern tht persists for at least 20 mins
- Can be caused from opioid or anemia
FHR - Tachycardia
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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
FHR - Bradycardia
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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
Periodic vs Episodic
- Periodic: refer to events tht occur at regular intervals, with contractions
- Episodic: refer to irregular events that are independent of uterine contractions
Accelerations
- Visually apparent abrupt incr in FHR above baseline rate
- Associated w/ fetal movement
- Scalp stim/ vibroacoustic stim
Accelerations Criteria
15 beats x 15 seconds
Accelerations Predictive of
Highly predictive of normal fetal acid-base balance
Accelerations Nursing Interventions
Nothing, continue to monitor
Early Decelerations
- Visually apparent, gradual dcr in & return to baseline FHR
- Associated w/ uterine contractions
- Cause deatl head compression
- No known relationshipd btwn fetal O2
Early Decelerations Nursing Interventions
Check dilation
Late Decelerations
- 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
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Caused by reflex fetal response to transiet hypoxemia due to dcr in mom’s BP, hypertonicity
> uteroplacental insufficiency = abruption of O2 transfer
Late Decelerations Nursing Interventions
- DC oxytocin
- Incr IV fluids
- Side lying position
- Admin 10L of O2 non rebreather
- Elevate legs to correct hypotension
Variable Decelerations
- 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
Variable Late Decelerations Nursing Interventions
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1st Priority:
> reposition
> then amnioinfusion
Prolonged Decelerations
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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
Prolonged Decelerations
- Must be corrected
- If it can not be fixed then c-section
Category I FHR Tracings
Normal & strongly predictive of normal fetal acid-base status at time of observation
Category II FHR Tracings
- Indeterminate
- Continue to observe/evaluate
Category III FHR Tracings
- Abnormal
- Immediate interventions are required
- Need to improve fetal O2
Pattern Recognition Interpretation - Nursing Management
these are assessments!
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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
Pattern Recognition Interpretation - Interventions
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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)
VEAL CHOP
- Variable decel
- Early decel
- Accelerations
- Late decels
- Cord compression
- Head compressions
- Oxygenation
- Placental insufficiency
