Fetal Assessment During Labor

Question 1

Basis for Monitoring

Answer 1

Fetal response
Maintenance of oxygen supply to prevent fetal compromise
Decrease in oxygen supply d/t:
Reduction of blood flow through maternal vessels
Reduction in oxygen content in maternal blood
Alterations in fetal circulation
Reduction in blood flow to intervillous space in placenta

Question 2

Electronic Fetal Monitoring (EFM)

External Monitoring

Answer 2

FHR: ultrasound Transducer
UCs: Toco

if you have twins you have two transducers

Question 3

Electronic Fetal Monitoring (EFM)

Internal Monitioring

Answer 3

Spiral electrode - top of head in baby
IUPC- used for contractions

Question 4

Uterine Activity

**Frequency **

Answer 4

beginning of one contraction to the beginning of the next
In MINUTES

Question 5

Uterine Activity

Duration

Answer 5

beginning of contraction to end of contraction
In SECONDS

Question 6

Leopold’s Maneuvers

Answer 6

used to auscultate fetal heart rate
4 steps to palpate the uterus
Used externally to assess fetal position and location of PMI for FHT

Question 7

Variablity

Answer 7

irregular fluctuations in FHR of 2 cycles per minute or greater

Question 8

Absent

Answer 8

undetectable → NONREASSURING
Some causes:
* congential anomalies
* preexisting neurologic injury
* fetal hypoxemia and metabolic acidemia

Question 9

Minimal

Answer 9

undetectable to < 5 bpm
NONREASSURING if continues > 20 minutes
Some causes:
* tachycardic
* prematurity
* fetus is temporarily in a sleep state (no longer than 30 mins)
* Hypoxia

Question 10

Moderate

Answer 10

6-25 bpm = NORMAL
indicates that FHR regulation is not significantly affected by fetal
sleep cycles, tachycardia, prematurity, congenital anomalies,
preexisting neurologic injury, or CNS depressant medications

Question 11

Marked

Answer 11

> 25 bpm may be indicative of stress if prolonged

Question 12

Sinusoidal Pattern

Answer 12

regular smooth, undulating wavelike
pattern—is not included in the definition of FHR variability
Some causes:
* chorioamnionitis
* fetal sepsis
* administration of narcotic analgesics

Question 13

Normal FHR

Answer 13

110 - 160 bpm ( reassuring)

Question 14

VEALCHOP

VARIABLE DECELERATION

Answer 14

Cord Compression
Caused by reduced flow through the umbilical cord
Fall and rise in rate is abrupt
Shape, duration and degree of fall below baseline rate are variable (not uniform in shape)
Required nursing intervention:
Change maternal potiison (get pressure off cord)
Increase fluid/IV (increase blood flow to fetus)
Possible think about amnioinfusion

seconds

onset to nadir less than 30

Question 15

VEAL CHOP

EARLY DECELERATIONS

Answer 15

**Head Compression **
Mirror images of contraction
Return to baseline FHR by end of contraction
Maternal position changes usually have no effect on pattern
Associated w/ fetal head compression
NOT associated w/ fetal compromise
Usually occur in active labor between 4-7 cm AND in the second stage of labor

Question 16

VEAL CHOP

Accelerations

Answer 16

OK
Temporary increase in FHR
15 bpm increase for 15 seconds
Associated w/ fetal movement
reassuring

Question 17

VEAL CHOP

Late Decelerations

Answer 17

Placental Problems (uteroplacental insufficiency)
Reflect possible impaired placental exchange
Occasional late decelerations accompanied by moderate variability
Utero-placental insufficiency
Require nursing intervention to improve placental blood flow and fetal oxygen supply
* IV open/pit OFF/position change/O2 via mask
* Notify provider if recurring

Some causes:
preeclampsia
amnionitis
small for gestational age fetuses, maternal diabetes, placenta previa, placental abruption, conduction
anesthetics, maternal cardiac disease, and maternal anemia

Question 18

Uterine tachysystole

Answer 18

more than five contractions in 10 minutes over 30 minutes or contractions lasting too long and reducing oxygen supply to the fetus.

stop the pitocin to allow the fetus to recooperate