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R2F > Fetal Heart Monitoring > Flashcards

Fetal Heart Monitoring Flashcards

1
Q

types of monitoring

A

External
-continuous
-if uncomplicated- q 30 min in active phase of 1st stage; q 15 min in second stage of labor
-if complicated- q 15 min in active phase of 1st stage; q 5 min in second stage of labor
Internal- most accurate tracings

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2
Q

external electronic fetal monitoring

A
  • doppler US- fetal heart

- pressure sensitive tocodynamometer- detects/records contraction- measures freq of contractions

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3
Q

internal electronic fetal monitoring

A
  • FSE (fetal scalp electrode)- monitors heart
  • IUPC (intrauterine pressure catheter- intensity of contractions
  • Requires membranes to be ruptured
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4
Q

hypoxia and fetal heart rate changes

A
  • fetal oxygen reserve- enough for 1-2 min
  • during contraction, blood flow from maternal circulation is interrupted
  • fetal HR- atrial pacemaker
  • a fetus whose oxygen supply is marginal cannot tolerate the stress of contractions- becomes hypoxic- can cause anaerobic metabolism- pH <7.20 is abnormal
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5
Q

fetal monitoring strip

A
  • upper tracing- monitors FHR

- lower tracing- monitors uterine contractions

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6
Q

uterine activity- normal, tachysystole

A
  • normal- 5 contractions or less in 10 min (avg over 30 min window)
  • tachysystole- >5 contractions in 10 min (presence or absence of assoc FSH decelerations)
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7
Q

FHR- definitions

A
  • baseline- normal, tachycardia, bradycardia
  • baseline variability- absent, minimal, moderate and marked
  • accelerations
  • decelerations- early, variable, late, prolonged
  • sinusoidal pattern
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8
Q

FHR- baseline

A
  • normal- 110-160 bpm
  • tachycardia- > 160
  • bradycardia- <110
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9
Q

causes of bradycardia

A
  • fetal hypoxia- late sign
  • obstetric anesthesia
  • pitocin
  • maternal hypotension
  • prolapsed or prolonged compression of umbilical cord
  • heart block
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10
Q

causes of tachycardia

A
  • fetal hypoxia- early sign
  • medications- excessive oxytocin
  • arrhythmias
  • prematurity
  • maternal fever
  • fetal infection- chorioamnionitis- most common cause of tachycardia!!!
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11
Q

FHR baseline variability

A

fluctuations in baseline FHR that are irregular in amplitude and frequency

  • absent- amplitude range undetected
  • minimal- amplitude range detectable but < 5 bpm
  • moderate- amplitude range 6-25 bpm
  • marked- range > 25
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12
Q

Decreased variability

A
  • indicator of possible fetal stress
  • is ominous if assoc with persistent late decelerations
  • assoc with hypoxia and acidemia
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13
Q

causes of dec baseline variability

A
  • prematurity
  • sleep cycle
  • maternal fever
  • fetal tachycardia- chorioamnionitis
  • fetal congenital anomalies
  • maternal hyperthyroidism
  • maternal drugs/substances
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14
Q

Periodic FHR changes

A
  • no change
  • acceleration
  • deceleration- early, variable, late, prolonged
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15
Q

aceleration

A
  • normal reassuring response!!
  • > 32 wks- HR of > 15 bpm above baseline for 15 s or more (<2 min)
  • <32 wks- HR > 10 bpm for 10 s or more (<2 min)
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16
Q

prolonged acceleration

A
  • > 2min

- change in baseline if acceleration lasts > 10 min

17
Q

causes of accelerations

A
  • spontaneous fetal movement
  • scalp stimulation or vibroacoustic stim
  • vaginal examination
18
Q

Decelerations

A
  • early
  • variable
  • late
19
Q

early deceleratoins

A

-secondary to head compression
-not assoc with fetal distress
-occurs at the same time of the peak of the contraction- “mirror image”
(dec cerebral blood flow- act vagus n- dec HR)

20
Q

variable decelerations

A
  • secondary to umbilical compression
  • abrupt dec in FHR
  • dec in FHR is >15 bpm lasting > 15 sec (< 2 min)
21
Q

late decelerations

A
  • caused by UPI (uterine placental insuff)
  • most ominous deceleration- repetitive late decelerations indicate fetal metabolic acidosis
  • occurs after the peak of contraction
22
Q

late decelerations- potential causes

A
  • excessive uterine activity

- maternal supine hypotension

23
Q

prolonged deceleration

A
  • dec in FHR from baseline that is > 15 bpm lasting > 2 min (< 10 min)
  • disruption of oxygen transfer from environment to fetus
  • commonly seen during maternal pushing
24
Q

sinusoidal pattern

A
  • smooth, sine wave-like undulating pattern in FHR baseline with a cycle freq of 3-5 per min
  • seen with fetal anemia
25
Q

category I

A
  • baseline 110-160 bpm
  • moderate variability
  • no late or variable decelerations
  • accelerations and early decelerations may or may not be present
26
Q

category II

A
  • intermittent variable decelerations- common

- recurrent variable decelerations

27
Q

amnioinfusion

A

-instillation of normal saline can alleviate cord compression

28
Q

fetal scalp stimulation

A
  • if acceleration of 15 bpm for 15 seconds occurs- fetal pH is almost always > 7.22
  • diff fetal sleep from acidosis

R2F (18 decks)

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