Fetal Assessment Flashcards
1
Q
What is the first maneuver in Leopold’s Maneuvers
A
Checking the fundus, what is in it and where is it
2
Q
second maneuver of Leopold’s Maneuvers
A
Where is the fetal back
3
Q
third maneuver of Leopold’s maneuvers
A
verify the presenting part, is the baby’s head in pelvis or near chest
4
Q
fourth maneuver of Leopold’s maneuvers
A
how far down is the baby into the pelvis
5
Q
what would a tender abdomen indicate
A
infection
6
Q
What does Leopold’s maneuver assess and determine (8 things)
A
- fetal movement
- abdominal tenderness, temp, and color
- fundal height corresponds to gestational age?
- uterine activity
- maternal vital signs and risk factors
- presence of labor and membrane status
- fetal heart tones
- assess cervix if no contraindications
7
Q
two forms of external fetal heart rate monitoring
A
- Doppler ultrasound
- tocodynamometer
8
Q
what external fetal heart rate monitor is used to indirectly record the fetal heart rate
A
Doppler ultrasound
9
Q
which external fetal heart rate monitor has a pressure sensitive button on the transducer
A
tocodynamometer
10
Q
can the tocodynamometer assess the intensity of contractions
A
no
11
Q
how does the Doppler ultrasound work
A
detects sound waves
12
Q
how does the tocodynamometer assess what
A
when a contraction happens
13
Q
two types of internal fetal heart rate monitoring
A
- FSE (fetal scalp electrode) aka ISE (internal scalp electrode)
- IUPC (intrauterine pressure catheter)
14
Q
when would you not want to use the FSE monitor
A
- if baby was breached
- if mother has HIV, Hep B or C
15
Q
when is the FSE monitor often used
A
in obese mothers because its hard to find the baby’s heartbeat
16
Q
how does the IUPC monitor work
A
measures pressure inside the uterus in mmHg
17
Q
when would you not use the IUPC monitor
A
- if mother has HIV, Hep B or C
- placenta previa
18
Q
what does the IUPC measure
A
the strength of contractions, only if they are effective
19
Q
what would you need to watch out for with the FSE/ISE monitor
A
monitor getting caught in baby’s hair
20
Q
what is another use for the IUPC
A
to insert normal saline to help release intrauterine pressure
21
Q
how does the FSE/ISE monitor work
A
measures between the R waves through a spiral electrode screwed into fetus’ head
22
Q
benefits of FSE/ISE
A
- continuous detection of fetal heart rate
- detection of dysrhythmia
- the mother’s position doesn’t affect the reading
23
Q
limitations of FSE/ISE
A
- membrane must rupture
- electronic interference may occur
- risk of fetal hemorrhage or infection
- contraindications with placenta previa, undiagnosed vaginal bleeding, HIV, active herpes, GBS, and coagulation defects
24
Q
benefits of IUPC
A
- accuracy of contraction frequency, duration, intensity and resting tone
- can withdraw amniotic fluid for testing, amnioinfusion port, may recalibrate or flush to validate accuracy
25
limitations of IUPC
- invasive
- membrane must be ruptured
- infection and perforation risk
- maternal position may affect pressures
- catheter obstruction
- some contraindications if significant bleeding or infection
26
define uterine frequency
onset of one contraction to onset of the next (in minutes)
27
define uterine duration
from onset of contraction to end of contraction (in seconds)
28
what constitutes uterine tachysystole
- more than 5 contractions in 10 minutes
| - each contraction lasting 45-90 seconds, averaged over thirty minutes
29
what are common factors contributing uterine tachysystole
- cocaine abuse
- oxytocin
- prostaglandins
30
tachysystole can occur in both _____ and ______ contractions
induced and spontaneous contractions
31
what is considered uterine hypertonus
resting tone greater than 25 mm Hg
32
what is usual resting tone measurement
20 mm Hg
33
define uterine resting tone
the time in between contractions, when the uterus is soft
34
define contraction
occurs when uterine muscles shorten
35
fetal oxygen blood levels are much ______ than maternal levels
lower
36
how are the fetal blood oxygen levels compensated
by a higher fetal cardiac output
37
fetal heart rate baseline is
the average fetal heart rate in a 10 minute window and rounded to 5 beats per minute
38
what does fetal heart rate baseline exclude
accelerations, decelerations and periods of marked variability
39
what defines marked variability
variability greater that 25 bpm
40
the baseline is indeterminate if there is not...
at least 2 minutes of identifiable baseline segments in a 10 minute window
41
normal fetal heart rate baseline range
110-160 beats per minute
42
fetal tachycardia defined as
baseline FHR greater than 160
43
fetal bradycardia defined as
baseline FHR less than 110 bpm
44
maternal causes of fetal tachycardia
- fever/infection
- dehydration
- drugs
- anemia
- anxiety
45
fetal causes of fetal tachycardia
- infection
- activity
- response to an acute event
- chronic hypoxia
- anemia
- SVT (supraventricular tachycardia)
46
maternal causes of fetal bradycardia
- supine position
- hypotension
- cardiopulmonary compromise
- uterine rupture
47
fetal causes of fetal bradycardia
- hypoxia or acute hypoxemia
- umbilical cord compression
- complete heart block
- chronic head compression
48
how does mom's supine position risk the baby for bradycardia
laying supine on back can put pressure on vena cava and cause supine hypotension
49
the lower the fetal heart rate the ______the fetal cardiac output
lower
50
does FHR variability include accelerations and decelerations
no
51
define baseline FHR variability
baseline fluctuations that are irregular in amplitude and frequency
52
what does the FHR variability show
the interaction between the sympathetic and parasympathetic systems
53
absent FHR variability
amplitude range undetectable
54
minimal FHR variability
less than or equal to 5 bpm and greater than undetectable
55
moderate FHR variability
amplitude range of 6-25 bpm
56
marked FHR variability
amplitude range greater than 25 bpm
57
the FHR variability fluctuations are recorded as the
amplitude of the peak to trough in bpm
58
absent or minimal FHR variability can be a result of...
- fetal sleep
- drugs (narcotics, nicotine, nubain, cocaine)
- hypoxia, metabolic acidosis
- severe fetal anemia
- SVT or heart block
- chromosomal abnormalities
- fetal brain death, anencephaly
- deteriorating IUGR (intrauterine growth restriction)
- elevated temp/infection
59
when can absent or minimal FHR variability be normal
when a fetus is sleeping
60
average fetal nap time is
20-40 minutes
61
marked FHR variability is usually a result of
fetus' compensatory response to hypoxemic event such as cord compression or tachysystole
62
VEAL
CHOP
63
what effect can treating mom's hypotension with ephedrine have on baby
marked FHR variability
64
what effect can the application of forceps or vacuum extractor have
marked FHR variability
65
how is marked variability usually seen
in short bursts about 1 minute long
66
what is the single most important characteristic of FHR
variability
67
what predicts the absence of fetal metabolic acidemia
moderate fetal heart rate variability
68
FHR acceleration defined as
abrupt increase in FHR that peaks in less than 30 seconds
69
an abrubt increase in FHR that takes less than 30 seconds is an _____
acceleration
70
for fetus' older than 32 weeks an acceleration must
- peak in less than 30 sec
- have peak greater than or equal to 15 bpm
- last equal to or more than 15 seconds from onset to return
71
for fetus' less than 32 weeks an acceleration must
- have peak greater than or equal to 10 bpm
| - last equal to or greater than 10 seconds from onset to return
72
a prolonged acceleration is defined as what
-greater than or equal to 2 min but less than 10 min in duration
73
an acceleration is considered a baseline change when it last longer than what
10 minutes
74
what do accelerations indicate
a well-oxygenated fetus
75
early and late decelerations defined as a _____ decrease
- gradual decrease of FHR associated with uterine contraction
76
what is the nadir of a deceleration
the peak or lowest point of the deceleration
77
a decrease in FHR is calculated from the onset of the _____ of the deceleration
nadir
78
the _____ of the early deceleration occurs at the same time as the ______ of the contraction
the nadir....the peak
79
what is the "best" kind of deceleration or the least harmful
early deceleration
80
an deceleration must have a duration of ______ from onset of deceleration to the nadir
greater than 30 seconds
81
early decelerations are associated with
CPD (cephalopelvic disproportion)
82
what is CPD
cephalopelvic disproportion
83
what is cephalopelvic disproportion
baby's head can't fit through pelvis
84
when can early decelerations occur and be normal
when mother is dilated and between 4 and 7 cm
85
what nursing intervention should you do first for early decelerations
position changes
86
besides position changes what other interventions are there for early decelerations
- monitor deterioration of pattern or loss of variability
| - monitor descent of head, position and cervical status
87
are early decelerations a hypoxic pattern
no
88
late decelerations are defined as
the onset, nadir and recovery occur after the beginning, peak and ending of contraction
89
in early decelerations the nadir occurs at the ____ of the contraction
peak
90
early decelerations are mostly a result of
head compression
91
how does head compression result in early decelerations
- pressure on fetal head
- increase intracranial pressure
- alters cerebral blood flow
- central vagal stimulation
- FHR deceleration
92
the nadir of a late deceleration occurs ______ of the contraction
after the peak
93
how does utero-placental compromise result in late deceleration
- decrease in utero-placental oxygen transfer
- chemoreceptor stimulus
- alpha adrenergic response
- fetal hypertension
- baroreceptor stimulus
- parasympathetic response
- late deceleration
94
a late deceleration is usually caused by
placental compromise
95
uteroplacental compromise results in
impaired maternal-fetal gas exchange
96
what can cause uteroplacental insufficiency
- gestational or chronic HTN
- HTN due to drug use
- uterine tachysystole or hypertonus
- chronic maternal diseases
- cardiopulmonary disease
- placental changes
97
late decelerations can result in
decreased variability, fetal myocardial depression, and fetal acidosis
98
what can you do about late decelerations
-not much
99
if late decelerations occur for too long it will result in
fetal hypoxia
100
if mom goes into cardiopulmonary arrest you have how long to deliver baby
5 mins
101
what should you check for first if there are late decelerations
supine hypotension
102
to rule out supine hypotension as reason for late decelerations what nursing intervention is needed
position changes and reduce pitocin
103
what is the biggest side effect of epidural
lowered BP in mom and baby, could result in late decelerations
104
interventions for late decelerations
- position changes
- discontinue oxytocin or prostaglandins
- check BP
- administer oxygen, non-rebreather (8-10 L)
- give terbutaline to decrease contraction frequency
- notify anesthesia team if associated with epidural
105
difference between variable decelerations and early and late decelerations
variable is abrupt and early and late are gradual
106
an abrupt FHR decrease is defined as
onset to nadir less than 30 seconds
107
do variable decelerations correspond to uterine contractions at a certain point
no they vary
108
variable decelerations are usually caused by
cord compression
109
reassuring elements of variable decelerations
- variability
- rapid return to baseline
- accelerations before and after
- when associated with moderate variability is predictive of non-acidemic, vigorous infant
110
concerning elements of variable decelerations
- prolonged recovery
- prolonged duration
- loss of variability
- prolonged smooth overshoots
111
nursing interventions for variable decelerations if fetus is well oxygenated
position changes to alleviate cord compression
112
nursing interventions if fetus is compromised
- check for cord prolapse
- change position
- discontinue oxytocin and prostaglandins
- check BP
- give IV fluid bolus
- administer oxygen
- give terbutaline
- consider amnioinfusion
113
definition of sinusoidal fetal heart rate
smooth wave-like undulating pattern with FHR baseline with cycles of 3-5 in 1 min that lasts longer than or equal to 20 minutes
114
characteristics of sinusoidal fetal heart rate pattern
- minimal to absent variability
| - no accelerations
115
sinusoidal FHR is associated with what
- fetal hypoxia
| - severe fetal anemia and can be terminal
116
what heart rate pattern is associated with high fetal mortality and morbidity
sinusoidal FHR pattern
117
pseudosinusoidal FHR pattern defined as
- waves not uniform
| - variability is present
118
pseudosinusoidal is usually seen with
administration of narcotics, nubain or stadol
119
thumb sucking is associated with what type of FHR pattern
pseudosinusoidal FHr patern
120
VEAL-CHOP
| Variable decelerations =
cord compression
121
VEAL-CHOP
| Early decelerations =
head compression
122
VEAL-CHOP
| accelerations =
okay (everything fine)
123
VEAL-CHOP
| late decelerations =
uteroplacental compromise, impaired gas exchange
124
daily fetal movement count involves
mom paying attention to fetal movements
125
how many fetal movements should mom feel in an hour
at least 10
126
NST (non stress test) does what
reassures that baby wi;; be okay for next 24 hours
127
CST (contraction stress test) involves what
giving mom Pitocin to see if baby can tolerate contractions
128
BPP (biophysical profile) involves what
ultrasound test to see if baby can meet 5 categories
129
5 categories of BPP
movement, amniotic fluid, attempts at breathing....
130
US (ultrasonography) indicated to test for what
- fetal HR activity
- gestational age
- fetal growth
- fetal anatomy
- placental position and function
- adjunct to other invasive tests
