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OB > Fetal Assessment > Flashcards

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

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2
Q

second maneuver of Leopold’s Maneuvers

A

Where is the fetal back

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3
Q

third maneuver of Leopold’s maneuvers

A

verify the presenting part, is the baby’s head in pelvis or near chest

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4
Q

fourth maneuver of Leopold’s maneuvers

A

how far down is the baby into the pelvis

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5
Q

what would a tender abdomen indicate

A

infection

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6
Q

What does Leopold’s maneuver assess and determine (8 things)

A
  1. fetal movement
  2. abdominal tenderness, temp, and color
  3. fundal height corresponds to gestational age?
  4. uterine activity
  5. maternal vital signs and risk factors
  6. presence of labor and membrane status
  7. fetal heart tones
  8. assess cervix if no contraindications
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7
Q

two forms of external fetal heart rate monitoring

A
  • Doppler ultrasound

- tocodynamometer

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8
Q

what external fetal heart rate monitor is used to indirectly record the fetal heart rate

A

Doppler ultrasound

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9
Q

which external fetal heart rate monitor has a pressure sensitive button on the transducer

A

tocodynamometer

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10
Q

can the tocodynamometer assess the intensity of contractions

A

no

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11
Q

how does the Doppler ultrasound work

A

detects sound waves

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12
Q

how does the tocodynamometer assess what

A

when a contraction happens

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13
Q

two types of internal fetal heart rate monitoring

A
  • FSE (fetal scalp electrode) aka ISE (internal scalp electrode)
  • IUPC (intrauterine pressure catheter)
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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

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15
Q

when is the FSE monitor often used

A

in obese mothers because its hard to find the baby’s heartbeat

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16
Q

how does the IUPC monitor work

A

measures pressure inside the uterus in mmHg

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17
Q

when would you not use the IUPC monitor

A
  • if mother has HIV, Hep B or C

- placenta previa

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18
Q

what does the IUPC measure

A

the strength of contractions, only if they are effective

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19
Q

what would you need to watch out for with the FSE/ISE monitor

A

monitor getting caught in baby’s hair

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20
Q

what is another use for the IUPC

A

to insert normal saline to help release intrauterine pressure

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21
Q

how does the FSE/ISE monitor work

A

measures between the R waves through a spiral electrode screwed into fetus’ head

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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
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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
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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
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25
Q

limitations of IUPC

A
  • invasive
  • membrane must be ruptured
  • infection and perforation risk
  • maternal position may affect pressures
  • catheter obstruction
  • some contraindications if significant bleeding or infection
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26
Q

define uterine frequency

A

onset of one contraction to onset of the next (in minutes)

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27
Q

define uterine duration

A

from onset of contraction to end of contraction (in seconds)

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28
Q

what constitutes uterine tachysystole

A
  • more than 5 contractions in 10 minutes

- each contraction lasting 45-90 seconds, averaged over thirty minutes

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29
Q

what are common factors contributing uterine tachysystole

A
  • cocaine abuse
  • oxytocin
  • prostaglandins
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30
Q

tachysystole can occur in both _____ and ______ contractions

A

induced and spontaneous contractions

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31
Q

what is considered uterine hypertonus

A

resting tone greater than 25 mm Hg

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32
Q

what is usual resting tone measurement

A

20 mm Hg

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33
Q

define uterine resting tone

A

the time in between contractions, when the uterus is soft

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34
Q

define contraction

A

occurs when uterine muscles shorten

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35
Q

fetal oxygen blood levels are much ______ than maternal levels

A

lower

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36
Q

how are the fetal blood oxygen levels compensated

A

by a higher fetal cardiac output

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37
Q

fetal heart rate baseline is

A

the average fetal heart rate in a 10 minute window and rounded to 5 beats per minute

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38
Q

what does fetal heart rate baseline exclude

A

accelerations, decelerations and periods of marked variability

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39
Q

what defines marked variability

A

variability greater that 25 bpm

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40
Q

the baseline is indeterminate if there is not…

A

at least 2 minutes of identifiable baseline segments in a 10 minute window

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41
Q

normal fetal heart rate baseline range

A

110-160 beats per minute

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42
Q

fetal tachycardia defined as

A

baseline FHR greater than 160

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43
Q

fetal bradycardia defined as

A

baseline FHR less than 110 bpm

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44
Q

maternal causes of fetal tachycardia

A
  • fever/infection
  • dehydration
  • drugs
  • anemia
  • anxiety
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45
Q

fetal causes of fetal tachycardia

A
  • infection
  • activity
  • response to an acute event
  • chronic hypoxia
  • anemia
  • SVT (supraventricular tachycardia)
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46
Q

maternal causes of fetal bradycardia

A
  • supine position
  • hypotension
  • cardiopulmonary compromise
  • uterine rupture
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47
Q

fetal causes of fetal bradycardia

A
  • hypoxia or acute hypoxemia
  • umbilical cord compression
  • complete heart block
  • chronic head compression
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48
Q

how does mom’s supine position risk the baby for bradycardia

A

laying supine on back can put pressure on vena cava and cause supine hypotension

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49
Q

the lower the fetal heart rate the ______the fetal cardiac output

A

lower

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50
Q

does FHR variability include accelerations and decelerations

A

no

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51
Q

define baseline FHR variability

A

baseline fluctuations that are irregular in amplitude and frequency

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52
Q

what does the FHR variability show

A

the interaction between the sympathetic and parasympathetic systems

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53
Q

absent FHR variability

A

amplitude range undetectable

54
Q

minimal FHR variability

A

less than or equal to 5 bpm and greater than undetectable

55
Q

moderate FHR variability

A

amplitude range of 6-25 bpm

56
Q

marked FHR variability

A

amplitude range greater than 25 bpm

57
Q

the FHR variability fluctuations are recorded as the

A

amplitude of the peak to trough in bpm

58
Q

absent or minimal FHR variability can be a result of…

A
  • 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
Q

when can absent or minimal FHR variability be normal

A

when a fetus is sleeping

60
Q

average fetal nap time is

A

20-40 minutes

61
Q

marked FHR variability is usually a result of

A

fetus’ compensatory response to hypoxemic event such as cord compression or tachysystole

62
Q

VEAL

A

CHOP

63
Q

what effect can treating mom’s hypotension with ephedrine have on baby

A

marked FHR variability

64
Q

what effect can the application of forceps or vacuum extractor have

A

marked FHR variability

65
Q

how is marked variability usually seen

A

in short bursts about 1 minute long

66
Q

what is the single most important characteristic of FHR

A

variability

67
Q

what predicts the absence of fetal metabolic acidemia

A

moderate fetal heart rate variability

68
Q

FHR acceleration defined as

A

abrupt increase in FHR that peaks in less than 30 seconds

69
Q

an abrubt increase in FHR that takes less than 30 seconds is an _____

A

acceleration

70
Q

for fetus’ older than 32 weeks an acceleration must

A
  • 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
Q

for fetus’ less than 32 weeks an acceleration must

A
  • have peak greater than or equal to 10 bpm

- last equal to or greater than 10 seconds from onset to return

72
Q

a prolonged acceleration is defined as what

A

-greater than or equal to 2 min but less than 10 min in duration

73
Q

an acceleration is considered a baseline change when it last longer than what

A

10 minutes

74
Q

what do accelerations indicate

A

a well-oxygenated fetus

75
Q

early and late decelerations defined as a _____ decrease

A
  • gradual decrease of FHR associated with uterine contraction
76
Q

what is the nadir of a deceleration

A

the peak or lowest point of the deceleration

77
Q

a decrease in FHR is calculated from the onset of the _____ of the deceleration

A

nadir

78
Q

the _____ of the early deceleration occurs at the same time as the ______ of the contraction

A

the nadir….the peak

79
Q

what is the “best” kind of deceleration or the least harmful

A

early deceleration

80
Q

an deceleration must have a duration of ______ from onset of deceleration to the nadir

A

greater than 30 seconds

81
Q

early decelerations are associated with

A

CPD (cephalopelvic disproportion)

82
Q

what is CPD

A

cephalopelvic disproportion

83
Q

what is cephalopelvic disproportion

A

baby’s head can’t fit through pelvis

84
Q

when can early decelerations occur and be normal

A

when mother is dilated and between 4 and 7 cm

85
Q

what nursing intervention should you do first for early decelerations

A

position changes

86
Q

besides position changes what other interventions are there for early decelerations

A
  • monitor deterioration of pattern or loss of variability

- monitor descent of head, position and cervical status

87
Q

are early decelerations a hypoxic pattern

A

no

88
Q

late decelerations are defined as

A

the onset, nadir and recovery occur after the beginning, peak and ending of contraction

89
Q

in early decelerations the nadir occurs at the ____ of the contraction

A

peak

90
Q

early decelerations are mostly a result of

A

head compression

91
Q

how does head compression result in early decelerations

A
  • pressure on fetal head
  • increase intracranial pressure
  • alters cerebral blood flow
  • central vagal stimulation
  • FHR deceleration
92
Q

the nadir of a late deceleration occurs ______ of the contraction

A

after the peak

93
Q

how does utero-placental compromise result in late deceleration

A
  • decrease in utero-placental oxygen transfer
  • chemoreceptor stimulus
  • alpha adrenergic response
  • fetal hypertension
  • baroreceptor stimulus
  • parasympathetic response
  • late deceleration
94
Q

a late deceleration is usually caused by

A

placental compromise

95
Q

uteroplacental compromise results in

A

impaired maternal-fetal gas exchange

96
Q

what can cause uteroplacental insufficiency

A
  • gestational or chronic HTN
  • HTN due to drug use
  • uterine tachysystole or hypertonus
  • chronic maternal diseases
  • cardiopulmonary disease
  • placental changes
97
Q

late decelerations can result in

A

decreased variability, fetal myocardial depression, and fetal acidosis

98
Q

what can you do about late decelerations

A

-not much

99
Q

if late decelerations occur for too long it will result in

A

fetal hypoxia

100
Q

if mom goes into cardiopulmonary arrest you have how long to deliver baby

A

5 mins

101
Q

what should you check for first if there are late decelerations

A

supine hypotension

102
Q

to rule out supine hypotension as reason for late decelerations what nursing intervention is needed

A

position changes and reduce pitocin

103
Q

what is the biggest side effect of epidural

A

lowered BP in mom and baby, could result in late decelerations

104
Q

interventions for late decelerations

A
  • 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
Q

difference between variable decelerations and early and late decelerations

A

variable is abrupt and early and late are gradual

106
Q

an abrupt FHR decrease is defined as

A

onset to nadir less than 30 seconds

107
Q

do variable decelerations correspond to uterine contractions at a certain point

A

no they vary

108
Q

variable decelerations are usually caused by

A

cord compression

109
Q

reassuring elements of variable decelerations

A
  • variability
  • rapid return to baseline
  • accelerations before and after
  • when associated with moderate variability is predictive of non-acidemic, vigorous infant
110
Q

concerning elements of variable decelerations

A
  • prolonged recovery
  • prolonged duration
  • loss of variability
  • prolonged smooth overshoots
111
Q

nursing interventions for variable decelerations if fetus is well oxygenated

A

position changes to alleviate cord compression

112
Q

nursing interventions if fetus is compromised

A
  • check for cord prolapse
  • change position
  • discontinue oxytocin and prostaglandins
  • check BP
  • give IV fluid bolus
  • administer oxygen
  • give terbutaline
  • consider amnioinfusion
113
Q

definition of sinusoidal fetal heart rate

A

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
Q

characteristics of sinusoidal fetal heart rate pattern

A
  • minimal to absent variability

- no accelerations

115
Q

sinusoidal FHR is associated with what

A
  • fetal hypoxia

- severe fetal anemia and can be terminal

116
Q

what heart rate pattern is associated with high fetal mortality and morbidity

A

sinusoidal FHR pattern

117
Q

pseudosinusoidal FHR pattern defined as

A
  • waves not uniform

- variability is present

118
Q

pseudosinusoidal is usually seen with

A

administration of narcotics, nubain or stadol

119
Q

thumb sucking is associated with what type of FHR pattern

A

pseudosinusoidal FHr patern

120
Q

VEAL-CHOP

Variable decelerations =

A

cord compression

121
Q

VEAL-CHOP

Early decelerations =

A

head compression

122
Q

VEAL-CHOP

accelerations =

A

okay (everything fine)

123
Q

VEAL-CHOP

late decelerations =

A

uteroplacental compromise, impaired gas exchange

124
Q

daily fetal movement count involves

A

mom paying attention to fetal movements

125
Q

how many fetal movements should mom feel in an hour

A

at least 10

126
Q

NST (non stress test) does what

A

reassures that baby wi;; be okay for next 24 hours

127
Q

CST (contraction stress test) involves what

A

giving mom Pitocin to see if baby can tolerate contractions

128
Q

BPP (biophysical profile) involves what

A

ultrasound test to see if baby can meet 5 categories

129
Q

5 categories of BPP

A

movement, amniotic fluid, attempts at breathing….

130
Q

US (ultrasonography) indicated to test for what

A
  • fetal HR activity
  • gestational age
  • fetal growth
  • fetal anatomy
  • placental position and function
  • adjunct to other invasive tests

OB (7 decks)

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