Fetal Distress Flashcards
• Non-reassuring fetal heart tracing, non-
reassuring heart tones or non-reassuring fetal status
• Signs before & during childbirth indicating that the fetus is not well
Fetal Distress
____ may drop with each contraction, may be flat or may be too low or too high.
May result to cerebral palsy, seizure and MR
FHR
1.) Baseline fetal heart rate is 120-160, preserved beat to beat and long term variability. Accelerations last for 15 or more seconds above baseline and peak to 15 or more bpm
2.) Baseline fetal heart rate is above 160, possible onset of decreased variability. Usually due to fetus lacking nourishing blood supply, or resultant effects of some drugs.
3.) Fetal heart rate returns to baseline AFTER the contraction has ended. Associated with uteroplacental insufficiency or decreased uterine blood flow
4.) The onset and the return of the deceleration coincides with the start and the end of the contraction. Associated with fetal movement, stimulation, and uterine contractions.
1.) Reassuring Pattern
2.) Elevated Heart Rate: Tachycardia
3.) Late Deceleration with preserved variability
4.) Early Deceleration
Causes of Fetal Distress:
1.) Breathing Problems
2.) Low BP
3.) Uterine Infection
4.) Uterine Rupture
5.) Multiple Births
6.) Abruptio Placenta
7.) Nuchal Cord
Signs and Symptoms of Fetal Distress
1.) Decreased Fetal Movement
2.) Biochemical Signs
3.) Meconium Staining
4.) Non reassuring Patterns
Fetal Distress Management
1.) Giving extra IV fluid
2.) Administer oxygen to the mother
3.) Turning the mother to a side lying position
4.) Tocolytic Therapy
Results when the umbilical cord precedes the fetus presenting part
Prolapsed Umbilical Cord
Prolapsed umbilical cord types:
1.) The cord dropping alongside the baby but may not be seen in advanced
2.) The cord coming before the baby’s head can come out
1.) Occult Cord Prolapse
2.) Overt Cord Prolapse
Prolapsed Umbilical Cord Risk factors
1.) Malpresentation
2.) LBW
3.) Multipara
4.) Multiple gestation
5.) Presence of long cord
6.) CPD, Hydramnios
7.) PROM, Placenta Previa
Prolapsed Umbilical Cord Assessment
1.) Nursing History
2.) Bradycardia
3.) Meconium
4.) Observe Perineum
Prolapsed Umbilical Cord Fetal Risks
1.) Umbilical Cord Compression
2.) Bradycardia
3.) Persistent variable deceleration may develop and fetus may die
Prolapsed Umbilical Cord S/S
a. Variable or prolonged deceleration during uterine contractions
b. Woman reports feeling the cord after membranes rupture
c. Cord is seen or felt in or protruding from the vagina
1.) If a loop of cord is discovered, examiner’s fingers must remain in the vagina and manually _______ the fetal head off the cord
2.) Position the mother in __________, modified sim’s or in knee chest
1.) Elevating
2.) Trendelenburg
1.) If cord is protruding from vagina, wrap loosely in a sterile towel saturated with
______________
solution.
2.) Do not attempt to _______ cord into cervix
1.) Warm Sterile Normal Saline
2.) Replace
defined as difficulty in the birth of the
shoulder, or impaction of the shoulders
• may occur in 0.15% to 2.0% of all births
• If the fetus weighs more than 4500 gm, the incidence of shoulder dystocia may be as high as 35.7%
Shoulder Dystocia
Shoulder Dystocia Risk Factors
• women with DM
• maternal obesity
• excessive weight gain during this pregnancy
• multiparas
• small or borderline pelvis
NOTE: Intrapartum risk factors: Slow Descent and Prolonged 2nd Stage
1.) The problem often is not identified until head has already been born and wide anterior shoulder locks beneath_______
2.) The condition may be suspected earlier if 2nd stage of labor is ________
3.) if the head appears on the perineum (crowning), it _______ instead of protruding with each contraction (turtle sign)
1.) Symphysis Pubis
2.) Prolonged
3.) Retracts
Two main signs that shoulder dystocia is present:
(1) The baby’s body does not emerge with
standard moderate traction and
maternal pushing after delivery of the
fetal head.
(2) The “turtle sign”
Shoulder Dystocia Neonatal Risks
Asphyxia
• Brachial plexus injury
• Apgar score of 5 or < at one minute
• Fractured clavicles or humerus
• Death
Shoulder Dystocia Maternal Risks
1.) Postpartum Hemorrhage
2.) Rectal Injuries
If difficulty of extracting the shoulders occurs during the birth, the OB may direct the woman to sharply ____ her thigh up against her _______
1.) Flex
2.) Abdomen
Shoulder Dystocia Management
Apply Suprapubic pressure and using the woods screw maneuver
Woods Screw Maneuver
1.) Doctor locates impacted shoulder with fingers
2.) Doctor rotates shoulder away from pubic symphysis
3.) If successful, baby rotates is dislodged and is delivered
