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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
Q

Internal Fetal Monitoring
Limitations

A

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

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26
Q

What fetal heart monitoring is the most accurate?

A

Internal
- detect arrhythmias and do amnio infusion

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27
Q

The upper graph shows the

A

fetal heart rate pattern

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28
Q

The lower graph shows the

A

uterine contraction pattern

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29
Q

The x axis shows

A

10 seconds

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30
Q

Y axis shows

A

10 bpm (FHR) or 10 (Contractions)

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31
Q

One line or box means

A

15 seconds

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32
Q

Duration of contraction means

A

length of contraction from beginning to end

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33
Q

Frequency of contraction means

A

beginning of one contraction tot he next contraction

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34
Q

Relaxation time means

A
  • end of contraction to the beginning of next
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35
Q

Resting tone

A

uterine tone at rest

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36
Q

Relaxation time needs to be how long?

A

greater than or equal to 60 seconds for uterine blood flow

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37
Q

The intensity of contraction is

A

strength of contraction at peak

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38
Q

How do you determine the intensity of a contraction during the peak?

A

palpate (nose, chin, forehead)

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39
Q

Mild or 1+ (easily dented) palpation of the contraction feels like

A

nose

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40
Q

Moderate or 2+ (can slightly indent) palpation of the contraction feels like

A

chin

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41
Q

Strong or 3+ (cannot indent uterus) palpation of the contraction feels like

A

forehead

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42
Q

What is used for contraction strength after membranes rupture?

A

IUPC

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43
Q

What does an IUPC show as
Mild
Strong

A

Mild contraction - 30 mm Hg
Strong contraction - 70 mm Hg

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44
Q

What is the labor average shown on an IUPC?

A

50-75 mm Hg, up to 110 mm Hg with pushing

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45
Q

Normal Uterine Activity is

A

5 or fewer contractions in 10 minutes averaged over 30 minutes
Last for 45-90 seconds
Intensity of 25-80
Resting = 10

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46
Q

Tachysystole

A

> 5 contractions in 10 minutes, averaged over 30 minutes
- Hypertonic uterine activity

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47
Q

Hypertonic uterine activity

A

resting tone > 20-25

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48
Q

Abnormal uterine activity can be due to

A

spontaneous or stimulated labor

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49
Q

The hypertonic uterine activity contributes to

A

low uteroplacental blood flow
- hypoxemia
- hypoxia
- metabolic acidosis
- metabolic academia

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50
Q

The nurse must have at least how much of an identifiable baseline segment to determine FHR

A

2 MINUTES
- excludes accelerations, decelerations, and marked variability

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51
Q

The fetal heart rate is a balance between the

A

parasympathetic = pull the pulse down
and sympathetic = pulse goes up
automatic nervous system

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52
Q

The baseline FHR is the most important indicator of

A

fetal central nervous system’s health

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53
Q

Periodic is the FHR to

A

uterine contractions
Accelerations​
Early decelerations​
Late decelerations​
Variable decelerations​
Prolonged decelerations​

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54
Q

The episodic pattern is unrelated to

A

uterine contractions
- Accelerations
- Variable decel
-Prolonged decel

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55
Q

FHR Accelerations for Term

A

15 bpm above the baseline lasting 15 seconds (15x15)

56
Q

FHR Accelerations for PreTerm (<32 weeks)

A

10 bpm above baseline for 10 seconds (10x10)

57
Q

FHR Accelerations caused by

A

sympathetic fetal response

58
Q

FHR Accelerations occur with

A

with fetal movement, contractions, vaginal exams, or breech presentations

59
Q

FHR Accelerations are what type of sign

A

Reassuring sign - indicative of a reactive, healthy fetus

60
Q

FHR Accelerations Nursing Interventions

A

nothing is required

61
Q

FHR Accelerations Reactive to Non-stress test

A

Reactive – must have 2 accelerations in 20 minutes, additional 20 minutes
- good sign

62
Q

FHR Accelerations Non-Reactive to Non-stress test

A

No acceleration in 40 minutes – follow up with CST

63
Q

Early decelerations

A

FHR slowly decelerates as the contraction begins and returns to baseline as the contraction ends
- uniform and mirror contraction

64
Q

Early decelerations are not assosiated with

A

fetal compromise

65
Q

Early deceleration nursing interventions

A

no interventions required
- vag exam to monitor labor progress

66
Q

Nadir

A

the lowest point of the contraction

67
Q

Baseline Variability is the

A

normal irregularity of the rise and fall in the baseline
- not accelerations and decelerations

68
Q

What is the predictor of fetal Oxygenation and reserve

A

baseline variability

69
Q

Baseline Variability absence is

A

0-1 bpm (flat)
- not reassuring

70
Q

Baseline Variability minimal is

A

< 5 bpm
- possible fetal sleep cycle
-32 weeks ok

71
Q

Baseline Variability moderate is

A

6-25 bpm
- Good sign

72
Q

Baseline Variability marked is

A

> 25 bpm -
if not moving heart is over working

73
Q

Baseline variability is reflective of

A

fetal neurological maturity
- term or preterm

74
Q

The fetal sleep cycle normally lasts for

A

30 minutes (#1 cause of low variability)

75
Q

If the fetal variability is absent or minimal over 60 minutes, what is happening

A

Hypoxia, hypoxemia, acidosis
- Persistent decreased variability > 60 minutes despite intervention
Prematurity, fetal anemia, preexisting neurological injuries

76
Q

Maternal causes of Absent/minimal variability

A

Medications - narcotics, CNS depressants, magnesium sulfate (preeclampsia)
General anesthesia

77
Q

Bradycardia is

A

<110 for 10 minutes

78
Q

> 90 bpm with variability means what for the fetus

A

benign and tolerated

79
Q

<80 bpm with variability means what for the fetus

A

OB emergency

80
Q

What are possible reasons maternal and fetal for bradycardia?

A

Maternal hypotension (supine)
Medication - induced (narcotics, magnesium sulfate, anesthesia)
Late manifestation of fetal hypoxia - prolonged cord compression
Fetal heart block

81
Q

Tachycardia

A

> 160 for 10 minutes

82
Q

If the FHR is persistent at 200-220 bpm what might occur

A

fetal demise

83
Q

Fetal cause of Tachycardia

A

Early signs of fetal hypoxia
Fetal anemia

84
Q

Maternal cause of Tachycardia

A

Dehydration
Maternal fever, infection - chorioamnionitis
Maternal hyperthyroid disease
Medication-induced (atropine, terbutaline, hydroxyzine, Illicit drugs - cocaine, meth)

85
Q

What is a late sign of persistent tachycardia?

A

bradycardia

86
Q

Uteroplacental circulation

A

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
Q

Fetal Placental ciculation through umbilicus consists of

A

1 vein - carry oxygen blood to the fetus
2 arteries - return deoxygenate blood

88
Q

Five factors for good fetal O2

A

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
Q

What barriers could affect the O2 pathway to the fetus

A

Environmental = smoke, wind, dust, allergies,
Lungs = COPD, asthma
Heart = cardiac issue
Vasculature = diabetes, BP, HTN
Uterus =
Placenta = poor perfusion
Cord = squeeze

90
Q

Fetal adaption to stress /interruption of O2 pathway

A

Prolonged hypoxemia depletes reserve
Decompensation
Aerobic to anaerobic metabolism
Accumulation of Lactic acid
Metabolic acidemia
Leads to cellular death

91
Q

What are the 3 types of fetal responses in the FHM

A

FHR accelerations
Variable deceleration
Late decelerations

92
Q

What are the 3 questions you need to answer if an FHR is interrupted by something

A

What do we call the pattern?
What does it mean?
What do we do about it?

93
Q

What nursing interventions are needed when a stress factor interrupts O2

A

Assess fetal response to scalp stimulation
Consider internal fetal monitoring
Place patient in left lateral position
Consider intrauterine resuscitation (IUR)

94
Q

Variable Decelerations

A

abrupt decline and return
40% in labors
not good sign - ominous warning

95
Q

Severe Variable Decelerations

A

FHR below 70 bpm, lasting > 30-60 seconds
- slow return to baseline
-decrease or absent variability
- IU resuscitation required

96
Q

Severe Variable Decells require

A
  • IU resuscitation required
97
Q

Variable Decelerations causes

A

Umbilical cord compression
Prolapsed cord
Nuchal cord
Short cord
Sudden rapid descent of the fetus

98
Q

Late Decelerations

A

Gradual decrease in FHR baseline that begins after the contraction & returns after the contraction is over
- omnious possible danger

99
Q

Late Decelerations associated with

A

with decreased or absent variability and tachycardia

100
Q

Late Decelerations indicate

A

uteroplacental insufficiency - Postdates, preeclampsia, diabetes, cardiac disease, placenta abruption

101
Q

Late deceleration nursing intervention required

A

Intrauterine resuscitation nursing intervention is required

102
Q

Contraction stress test - positive

A

late decelerations occur - bad

103
Q

Contraction stress test - negative

A

no late decelerations

104
Q

Late deceleration causes

A

Uteroplacental insufficiency
Maternal
Hypotension
Placenta abruption
Preeclampsia / Hypertension
Diabetes
Placenta changes - abnormalities/post date
Uterine hyperstimulation or Tachysystole

105
Q

Prolonged decelerations

A

Decrease in FHR below baseline, lasting 2-10 minutes
- sudden or long

106
Q

Prolonged decelerations do what to the blood flow

A

interrupt uteroplacental perfusion

107
Q

Prolonged decelerations nursing interventions

A

Intrauterine resuscitation nursing intervention is required

108
Q

If the FHR does not return after 10 minutes, then this indicates

A

baseline has changed

109
Q

Intrauterine Resuscitation (IUR) steps

A

“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-rebreathermask
​Notify the providerfor immediate evaluation- you are responsible until notified

110
Q

Additional considerations for IUR

A

Administer tocolytics (Terbutaline)
​Performing amnioinfusion - variable deceleration​
Modifying second stage pushing efforts​

111
Q

What does VEAL CHOP MINE mean

A

Variable-Cord compression -Move pt
Early-head compression - intervention no (vag exam)
Accel - ok- nothing
Late-placental insufficiency-emergency delivery

112
Q

If you see late decelerations, you should

A

not leave or stimulate until HCP

113
Q

Category 1 of FHR Interpretation

A

normal
- acidbase balance good
- moderate variability
- 110-160 bpm
- accelerations, early decelerations present
- NO LATE OR VARIABLE decelerations

114
Q

Category 1 of FHR Interpretation nursing interventions

A

none

115
Q

Category 3 of FHR Interpretation

A

abnormal
absent variable
- recurrent late, variable decelerations
- bradycardia or sinusoidal pattern

116
Q

Category 3 of FHR Interpretation Nursing Interventions

A

Initiate intrauterine resuscitation based on clinical situation
Category III patterns warrant immediate provider evaluation & delivery

117
Q

Category 2 of FHR Interpretation

A

indeterminate
- uncertain acid-base balance
no tracings to 1 or 3

118
Q

Category 2 of FHR Interpretation nursing interventions

A

Requires continued intervention, evaluation & reevaluation
- mvmt to increase perfusion

119
Q

Interventions for RHR abnormality patterns

A

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
Q
A
121
Q

How do determine the difference from maternal and fetal heart rate?

A

check the radial pulse of the mother and if different from fetal heart rate

122
Q

Professional Organizations for clinicians nterpting and making deciosns for FHR patterns

A

(ACOG & AWHONN)

123
Q

Variable, late, or prolonged decelerations
means

A

Interruption of O2 transfer from the environment to the fetus

124
Q

Moderate variability and/or accelerations
means

A

Excludes ongoing hypoxic injury at the time observed

125
Q

Latent phase of labor (0-3 cm) FHR and uterine contraction assessments need to be done every

A

30-60 minutes

126
Q

Active phase of labor (4-7 cm) FHR and uterine contraction assessments need to be done every

A

15-30 minutes

127
Q

Second phase of labor (10 cm and pushing) FHR and uterine contraction assessments need to be done every

A

5-15 minutes

128
Q

Systematic assessment should include what for frequency and documentation

A

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
Q

Intrapartum fetal assessment nursing responsibilities

A

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
Q

ABCD Management of FHR Tracings

A

Assess the oxygen pathway - consider cause of FHR changes
Begin conservative corrective measures
Clear obstacles to rapid delivery
Delivery plan

131
Q

Special Monitoring for a preterm

A

Physiological response depends on fetal developmental stage
Tolerance of stress may be different**
More likely to be subject to hypoxia**

132
Q

Special monitoring for pregnancies with

A

Higher baseline within normal range
Accelerations may have lower amplitude
Variability may be decreased

133
Q

Multiple gestations FHR

A

2 US and monitoring
- dual tracings
1st fetus - Twin A - darker line on FHM
2nd fetus - Twin B - lighter line on FHM

134
Q

Following membrane rupture of multiple gestations monitoring is

A

Twin A monitored by FSE
Twin B monitored by External US
Higher multiple gestations - require additional FHM

135
Q

Study different strips with this link

A

https://ncc-efm.org/game/efmgame.cfm

Module 6 (Labor And Delivery) (7 decks)

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