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Module 6 (Labor And Delivery) > Fetal Heart Monitoring > Flashcards

Fetal Heart Monitoring Flashcards

1
Q

What does VEAL CHOP mean?

A

Variable decelerations = Cord compression
Early decelerations = Head compression
Acceleration = Ok!
Late deceleration = Placental insufficiency

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2
Q

What is the primary goal of fetal monitoring?

A

interpretation and ongoing assessment of fetal oxygenation
- Max placental perfusion
- Max umbilical cord blood flow
- Max avail. O2
- Maintain uterine activity

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3
Q

What is low-tech surveillance for intermittent auscultation and uterine palpation?

A

Allows freedom of movement
- Fetoscope, Doppler, and uterine palpation

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4
Q

Guidelines for intermittent auscultation

A

Assess for active labor
Immediately after rupture of membranes
Preceding and following ambulation
Prior to and following pain medication and/or anesthesia
Following - vaginal exam, enema, catheterization
Events of abnormal or excessive uterine contractions

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5
Q

What is the nurse’s priority when the mother’s membranes rupture (water breaks),

A

assess fetal heart tone

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6
Q

How do you determine the baseline of the fetal heart rate?

A

auscultate FHR for 30-60 sec. btw contractions

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7
Q

How do you determine the FHR response to contractions?

A

auscultate before, during, and after a contraction

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8
Q

How do you apply a fetal heart monitor and what are the nursing interventions?

A

provide edu
pt comfort (empty bladder, left lateral side)
Leopold’s (identify and place US at point of maximum impulse
Palpate fundus for toco for uterine activity
encourage position changes
VS Temp every 2 hours after ruptured membranes

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9
Q

Where is the fetal heart monitor placed?

A

place ultrasound at the point of maximum impulse
- Identify the fetus’s position and place it on the heart/chest area

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10
Q

Where is the toco placed?

A

top of fundus (uterus)
- uterine contractions

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11
Q

If the mother has external FHM, how does the mother void?

A

ambulated to the bed
- allowed to get up and move till uncomfortable (20-30 minutes)

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12
Q

If the mother has internal FHM, how does the mother void?

A

bedpan

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13
Q

If the membranes rupture the mother needs to give birth within

A

24 hours if longer infection is possible

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14
Q

What are the maternal indications for continuous fetal monitoring?

A

Gestation diabetes
Hypertension
Kidney disease
Placenta Abruption
Placenta Previa
Induction / Augmentation
- Cervical Ripening or Oxytocin
Abnormal FHM testing
- Non-stress or Contraction Stress Test

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15
Q

What are the fetal indications for continuous fetal monitoring?

A

Multiple gestations (cord tangle)
Post-date gestation
Intrauterine growth restriction
- Baby does not grow due to poor perfusion
Meconium-stained fluid
Fetal bradycardia

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16
Q

External Fetal Monitoring includes

A

Ultrasound - placed over the fetal back
Records fetal heart rate
Tocodynamometer (Toco) - placed on the fundus
Records uterine contractions

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17
Q

Internal Fetal Monitoring includes

A

Fetal scalp electrodes (FSE) attach to the presenting part
- Requires ruptured membranes with cervical dilatation of 2-3 cm
Intrauterine pressure catheter (IUPC)
- Measures uterine pressure in mm Hg

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18
Q

A fetal scalp electrode requires what to have occurred before placing?

A

Requires ruptured membranes with cervical dilatation of 2-3 cm

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19
Q

IUPC can not be placed on what type of fetus

A

preterm

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20
Q

Intermittent Auscultation & Palpation
Benefits

A

Noninvasive
Promotes “Natural” atmosphere
Comfortable, and allows for ambulation
Outcomes comparable-EFM in low-risk

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21
Q

Intermittent Auscultation & Palpation
Limitations

A

Difficult - if obese, unable to tolerate touch
No permanent record of FHR or UA
Unable to determine UA intensity
Patterns not identified such as fetal hypoxemia
Not recommended for high-risk

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22
Q

External Fetal Monitoring
Benefits

A

Easy to apply
Noninvasive,–↓ risk for infection
ROM, cervical dilatation not required
No known risks to woman or fetus
Permanent record of the FHR & UA

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23
Q

External Fetal Monitoring
Limitations

A

Maternal movement requires repositioning
Contraction intensity is not measured
Double FHR < 60 bpm & Half FHR >180 bpm
Maternal HR may be recorded
Maternal obesity, fetal size, position or multiples

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24
Q

Internal Fetal Monitoring
Benefits

A

FHR tracing- not affected by movement, obesity or fetal position
Displays FHR between 30 - 240 bpm
Identify Fetal cardiac arrhythmias
Accurate measurement-uterine activity
Allows for use of amnioinfusion

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25
Internal Fetal Monitoring Limitations
ROM, cervical dilatation required -↑infection Risk of injury if improperly placed Record Maternal HR if fetal demise Excessive fetal hair can interfere IUPC readings vary based on IUPC types Inaccurate reading with position changes
26
What fetal heart monitoring is the most accurate?
Internal - detect arrhythmias and do amnio infusion
27
The upper graph shows the
fetal heart rate pattern
28
The lower graph shows the
uterine contraction pattern
29
The x axis shows
10 seconds
30
Y axis shows
10 bpm (FHR) or 10 (Contractions)
31
One line or box means
15 seconds
32
Duration of contraction means
length of contraction from beginning to end
33
Frequency of contraction means
beginning of one contraction tot he next contraction
34
Relaxation time means
- end of contraction to the beginning of next
35
Resting tone
uterine tone at rest
36
Relaxation time needs to be how long?
greater than or equal to 60 seconds for uterine blood flow
37
The intensity of contraction is
strength of contraction at peak
38
How do you determine the intensity of a contraction during the peak?
palpate (nose, chin, forehead)
39
Mild or 1+ (easily dented) palpation of the contraction feels like
nose
40
Moderate or 2+ (can slightly indent) palpation of the contraction feels like
chin
41
Strong or 3+ (cannot indent uterus) palpation of the contraction feels like
forehead
42
What is used for contraction strength after membranes rupture?
IUPC
43
What does an IUPC show as Mild Strong
Mild contraction - 30 mm Hg Strong contraction - 70 mm Hg
44
What is the labor average shown on an IUPC?
50-75 mm Hg, up to 110 mm Hg with pushing
45
Normal Uterine Activity is
5 or fewer contractions in 10 minutes averaged over 30 minutes Last for 45-90 seconds Intensity of 25-80 Resting = 10
46
Tachysystole
> 5 contractions in 10 minutes, averaged over 30 minutes - Hypertonic uterine activity
47
Hypertonic uterine activity
resting tone > 20-25
48
Abnormal uterine activity can be due to
spontaneous or stimulated labor
49
The hypertonic uterine activity contributes to
low uteroplacental blood flow - hypoxemia - hypoxia - metabolic acidosis - metabolic academia
50
The nurse must have at least how much of an identifiable baseline segment to determine FHR
2 MINUTES - excludes accelerations, decelerations, and marked variability
51
The fetal heart rate is a balance between the
parasympathetic = pull the pulse down and sympathetic = pulse goes up automatic nervous system
52
The baseline FHR is the most important indicator of
fetal central nervous system's health
53
Periodic is the FHR to
uterine contractions Accelerations​ **Early decelerations​ Late decelerations​** Variable decelerations​ Prolonged decelerations​
54
The episodic pattern is unrelated to
uterine contractions - Accelerations - Variable decel -Prolonged decel
55
FHR Accelerations for Term
15 bpm above the baseline lasting 15 seconds (15x15)
56
FHR Accelerations for PreTerm (<32 weeks)
10 bpm above baseline for 10 seconds (10x10)
57
FHR Accelerations caused by
sympathetic fetal response
58
FHR Accelerations occur with
with fetal movement, contractions, vaginal exams, or breech presentations
59
FHR Accelerations are what type of sign
Reassuring sign - indicative of a reactive, healthy fetus
60
FHR Accelerations Nursing Interventions
nothing is required
61
FHR Accelerations Reactive to Non-stress test
Reactive – must have 2 accelerations in 20 minutes, additional 20 minutes - good sign
62
FHR Accelerations Non-Reactive to Non-stress test
No acceleration in 40 minutes – follow up with CST
63
Early decelerations
FHR slowly decelerates as the contraction begins and returns to baseline as the contraction ends - uniform and mirror contraction
64
Early decelerations are not assosiated with
fetal compromise
65
Early deceleration nursing interventions
no interventions required - vag exam to monitor labor progress
66
Nadir
the lowest point of the contraction
67
Baseline Variability is the
normal irregularity of the rise and fall in the baseline - not accelerations and decelerations
68
What is the predictor of fetal Oxygenation and reserve
baseline variability
69
Baseline Variability absence is
0-1 bpm (flat) - not reassuring
70
Baseline Variability minimal is
< 5 bpm - possible fetal sleep cycle -32 weeks ok
71
Baseline Variability moderate is
6-25 bpm - Good sign
72
Baseline Variability marked is
>25 bpm - if not moving heart is over working
73
Baseline variability is reflective of
fetal neurological maturity - term or preterm
74
The fetal sleep cycle normally lasts for
30 minutes (#1 cause of low variability)
75
If the fetal variability is absent or minimal over 60 minutes, what is happening
Hypoxia, hypoxemia, acidosis - Persistent decreased variability > 60 minutes despite intervention Prematurity, fetal anemia, preexisting neurological injuries
76
Maternal causes of Absent/minimal variability
Medications - narcotics, CNS depressants, magnesium sulfate (preeclampsia) General anesthesia
77
Bradycardia is
<110 for 10 minutes
78
>90 bpm with variability means what for the fetus
benign and tolerated
79
<80 bpm with variability means what for the fetus
OB emergency
80
What are possible reasons maternal and fetal for bradycardia?
Maternal hypotension (supine) Medication - induced (narcotics, magnesium sulfate, anesthesia) Late manifestation of fetal hypoxia - prolonged cord compression Fetal heart block
81
Tachycardia
>160 for 10 minutes
82
If the FHR is persistent at 200-220 bpm what might occur
fetal demise
83
Fetal cause of Tachycardia
Early signs of fetal hypoxia Fetal anemia
84
Maternal cause of Tachycardia
Dehydration Maternal fever, infection - chorioamnionitis Maternal hyperthyroid disease Medication-induced (atropine, terbutaline, hydroxyzine, Illicit drugs - cocaine, meth)
85
What is a late sign of persistent tachycardia?
bradycardia
86
Uteroplacental circulation
85 % uterine blood supplies the uteroplacental circulation Intervillous space - maternal oxygen & fetal waste are exchanged ↓ Spiral artery blood flow can impact placenta & fetal blood flow
87
Fetal Placental ciculation through umbilicus consists of
1 vein - carry oxygen blood to the fetus 2 arteries - return deoxygenate blood
88
Five factors for good fetal O2
Maternal - Normal maternal oxygen saturation - Adequate exchange of O2 & CO2 - Sufficient blood flow to the placenta Fetal - Placental circulation to the fetus through the umbilical cord - Normal fetal circulatory & oxygen-carrying function
89
What barriers could affect the O2 pathway to the fetus
Environmental = smoke, wind, dust, allergies, Lungs = COPD, asthma Heart = cardiac issue Vasculature = diabetes, BP, HTN Uterus = Placenta = poor perfusion Cord = squeeze
90
Fetal adaption to stress /interruption of O2 pathway
Prolonged hypoxemia depletes reserve Decompensation Aerobic to anaerobic metabolism Accumulation of Lactic acid Metabolic acidemia Leads to cellular death
91
What are the 3 types of fetal responses in the FHM
FHR accelerations Variable deceleration Late decelerations
92
What are the 3 questions you need to answer if an FHR is interrupted by something
What do we call the pattern? What does it mean? What do we do about it?
93
What nursing interventions are needed when a stress factor interrupts O2
Assess fetal response to scalp stimulation Consider internal fetal monitoring Place patient in left lateral position Consider intrauterine resuscitation (IUR)
94
Variable Decelerations
abrupt decline and return 40% in labors **not good sign - ominous warning**
95
Severe Variable Decelerations
FHR below 70 bpm, lasting > 30-60 seconds - slow return to baseline -decrease or absent variability - IU resuscitation required
96
Severe Variable Decells require
- IU resuscitation required
97
Variable Decelerations causes
Umbilical cord compression Prolapsed cord Nuchal cord Short cord Sudden rapid descent of the fetus
98
Late Decelerations
Gradual decrease in FHR baseline that begins after the contraction & returns after the contraction is over - omnious possible danger
99
Late Decelerations associated with
with decreased or absent variability and tachycardia
100
Late Decelerations indicate
uteroplacental insufficiency - Postdates, preeclampsia, diabetes, cardiac disease, placenta abruption
101
Late deceleration nursing intervention required
Intrauterine resuscitation nursing intervention is required
102
Contraction stress test - positive
late decelerations occur - bad
103
Contraction stress test - negative
no late decelerations
104
Late deceleration causes
Uteroplacental insufficiency Maternal Hypotension Placenta abruption Preeclampsia / Hypertension Diabetes Placenta changes - abnormalities/post date Uterine hyperstimulation or Tachysystole
105
Prolonged decelerations
Decrease in FHR below baseline, lasting 2-10 minutes - sudden or long
106
Prolonged decelerations do what to the blood flow
interrupt uteroplacental perfusion
107
Prolonged decelerations nursing interventions
Intrauterine resuscitation nursing intervention is required
108
If the FHR does not return after 10 minutes, then this indicates
baseline has changed
109
Intrauterine Resuscitation (IUR) steps
“The Four Turns” **Turn patient** - maternal reposition - **left lateral 1st​** Turn **oxytocin off - reduce uterine activity** Turn IV fluid up - **IV fluid bolus - 500 ml NS or RL​** Turn O2 on - **apply Oxygen 10 L/min. non-rebreather mask** ​Notify the **provider for immediate evaluation - you are responsible until notified**
110
Additional considerations for IUR
Administer tocolytics (Terbutaline) ​Performing amnioinfusion - variable deceleration​ Modifying second stage pushing efforts​
111
What does VEAL CHOP MINE mean
Variable-Cord compression -Move pt Early-head compression - intervention no (vag exam) Accel - ok- nothing Late-placental insufficiency-emergency delivery
112
If you see late decelerations, you should
not leave or stimulate until HCP
113
Category 1 of FHR Interpretation
normal - acidbase balance good - moderate variability - 110-160 bpm - accelerations, early decelerations present - NO LATE OR VARIABLE decelerations
114
Category 1 of FHR Interpretation nursing interventions
none
115
Category 3 of FHR Interpretation
abnormal absent variable - recurrent late, variable decelerations - bradycardia or sinusoidal pattern
116
Category 3 of FHR Interpretation Nursing Interventions
**Initiate intrauterine resuscitation** based on clinical situation Category III patterns warrant **immediate provider evaluation & delivery**
117
Category 2 of FHR Interpretation
indeterminate - uncertain acid-base balance no tracings to 1 or 3
118
Category 2 of FHR Interpretation nursing interventions
Requires continued intervention, evaluation & reevaluation - mvmt to increase perfusion
119
Interventions for RHR abnormality patterns
Assess maternal vital signs - Confirm fetal heart rate vs maternal heart rate - Rule out maternal fever - Rule out maternal hypotension Assess maternal hydration status Assess abnormal uterine activity Assess for maternal anxiety and/or pain Perform vaginal exam to rule out prolapsed cord Consider Intrauterine Resuscitation (IUR)
120
121
How do determine the difference from maternal and fetal heart rate?
check the radial pulse of the mother and if different from fetal heart rate
122
Professional Organizations for clinicians nterpting and making deciosns for FHR patterns
(ACOG & AWHONN)
123
Variable, late, or prolonged decelerations means
Interruption of O2 transfer from the environment to the fetus
124
Moderate variability and/or accelerations means
Excludes ongoing hypoxic injury at the time observed
125
Latent phase of labor (0-3 cm) FHR and uterine contraction assessments need to be done every
30-60 minutes
126
Active phase of labor (4-7 cm) FHR and uterine contraction assessments need to be done every
15-30 minutes
127
Second phase of labor (10 cm and pushing) FHR and uterine contraction assessments need to be done every
5-15 minutes
128
Systematic assessment should include what for frequency and documentation
Admission evaluation of the woman and fetus Maternal-fetal assessments of FHR & UA using standard definitions Baseline, variability Presence or absence of accelerations, decelerations including type UA - frequency, duration, intensity, and resting tone Corrective measures implemented and evaluation of responses Communication with the patient and support system Communication with the provider with response & actions taken
129
Intrapartum fetal assessment nursing responsibilities
Evaluation of fetal oxygenation Implementation of measures to improve fetal oxygenation Communication between the staff, patient/family, & provider Promotes an environment of patient safety & quality care Detects and records fetal heart rate & uterine activity **Identify, intervene & immediately report all Category III FHR patterns**
130
ABCD Management of FHR Tracings
Assess the oxygen pathway - consider cause of FHR changes Begin conservative corrective measures Clear obstacles to rapid delivery Delivery plan
131
Special Monitoring for a preterm
Physiological response depends on fetal developmental stage Tolerance of stress may be different** More likely to be subject to hypoxia**
132
Special monitoring for pregnancies with
Higher baseline within normal range Accelerations may have lower amplitude Variability may be decreased
133
Multiple gestations FHR
2 US and monitoring - dual tracings 1st fetus - Twin A - darker line on FHM 2nd fetus - Twin B - lighter line on FHM
134
Following membrane rupture of multiple gestations monitoring is
Twin A monitored by FSE Twin B monitored by External US Higher multiple gestations - require additional FHM
135
Study different strips with this link
https://ncc-efm.org/game/efmgame.cfm

Module 6 (Labor And Delivery) (7 decks)

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