Fetal Heart Rate Monitor

Question 1

3 types of fetal heart rate monitoring

Answer 1

Auscultation
intermittent auscultation
electronic fetal heart rate monitoring (EFM) (continuous/intermittent)
◦ noninvasive: ultrasound transducer, external
◦ invasive: electrode on fetal scalp

Question 2

noninvasive vs invasive electronic fetal heart rate monitoring:

Answer 2

◦ noninvasive: ultrasound transducer, external

◦ invasive: electrode on fetal scalp

Question 3

over what amount of time do we assess fetal HR to determine baseline?

Answer 3

10 friggin minutes yo

Question 4

You know this- normal fetal heart rate?

Answer 4

110-160

Question 5

Tachycardia in fetus = > ____ for _____ minutes

causes- preggo and fetus

Answer 5

> 160 for 10 min

◦ preggo: **infection, fever, dehydration, anemia, anxiety, meds, elicit drugs
◦ baby: infection, septic, anemia, compensate after hypoxic event

Question 6

interventions for fetal tachycardia

Answer 6

check preggo’s temp (reduce), antibiotics, position changes, oxygenation, assess for dehydration/fluids

Question 7

bracycardia in fetus + < ____ for _____

fetus and preggo causes?

Answer 7

<110 for 10 min

◦ hypoxia in fetus 
◦ preggo: supine/compressing vena cava, hypotension, abruption, bleeding, dehydration

Question 8

interventions for fetal bradycardia

Answer 8

◦ stop oxytocin, sidelying, oxygen, iv fluids, topolytic, notify provider

Question 9

do we consider delivering with fetal tachy or brady cardia?

Answer 9

bradycardia

lil nugget needs some air!

Question 10

what is most important predictor of adequate fetal oxygenation?

Answer 10

baseline fetal HR

Question 11

what does an absent baseline fetal heart rate variablity mean?

Answer 11

poor perfusion/acid base imbalanced, no detectable change in amplitude

Question 12

what does a minimal fetal heart rate baseline variability mean? (amplitude change is < _____)

Answer 12

related to pain meds for preggo, sleep state for fetus, <5 change in amplitude
◦ fetus could be asleep, analgesics, supine hypotension, cord compression

Question 13

what does a moderate baseline variability in fetal heart rate mean? what is the amplitude range?

Answer 13

Predicts a well-oxygenated fetus with normal acid-base balance (at that time)
◦ this is normal! this is what we want!
◦ 6-25 beats/min amplitude range

Question 14

what is a marked baseline fetal HR variability? (amplitude >____)

Answer 14

more up and down variation, typical to see during pushing

◦ amplitude range >25 beats/min

Question 15

what kind of baseline fetal HR do we see during pushing?

Answer 15

marked

Question 16

Ah gee, what’s an acceleration in the fetal heart rate? is it good or bad?

< ___beats for ___ seconds

Answer 16

increase in fetal heart rate above baseline by 15 beats for 15 seconds
- <2 min and returns to normal

its chill! we want to see this, means good oxygen, no fetal acidosis

Question 17

3 types of decerlations

Answer 17

Early, Late, Variable

Question 18

This type of deceleration is a gradual decrease is fetus HR that mirrors the contraction

Answer 18

early deceleration

its chill! no intervention needed

Question 19

During which stage of labor do we see early decelerations? why?

Answer 19

2nd stage– fetus head being smashed against the vagina wall

(despite all my rage I am still just a babe in a vag…smashing pumpkins is out, smashing heads against vaginal walls is in)

Question 20

early decelerations begin when the contraction _____ and return to baseline by the time the contraction _____

Answer 20

Deceleration begins when the contraction BEGINS and returns to baseline by the time the contraction ENDS

Question 21

this kind of deceleration is an abrupt decrease in fetal HR that has no pattern with uterine contractions

Answer 21

variable decerlations

Question 22

1 cause of variable decelerations- regular name and fancy name

Answer 22

cord compression (nuchal cord)

Question 23

what do variable decelerations look like on the monitor

Answer 23

a V

Question 24

nursing interventions for variable decelerations

Answer 24

1 =Reposition the client (side to side; knee-chest (on all fours) (start here for interventions)

• Discontinue oxytocin (oxytocin make contractions stronger and more frequent)
• Administer O2 via face mask 8-10L/min to increase placental perfusion
• Vaginal exam
• Amnioinfusion (if prescribed) place fluid back into cavity to give for room for cord to prevent compression

Question 25

this type of deceleration is a gradual decrease in fetal rate at the that occurs AFTER the beginning of a contraction

Answer 25

late decelerations

◦ when fetus should be recovering from contraction and coming back to normal the fetus is unable to recover

Question 26

late decelerations- chill or not chill

Answer 26

NOT chill. This is the bad one.

Question 27

cause of later decelerations?

Answer 27

Uteroplacental Insufficiency (partial abruption)

Question 28

nursing interventions for late decels?

Answer 28

• Change maternal position (side lying) (start here!- will allow all the other things we are doing to have benefit)
• Discontinue oxytocin
• IV bolus of lactated ringers to promote fetal oxygenation
• Administer O2 via face mask 8-10L/min
• Notify provider
• Fetal spiral electrode for more invasive monitoring (provider places)
• Plan for delivery and care of the neonate

Question 29

WTF is VEAL CHOP

Answer 29

V – Variable Decelerations > C – Cord Compression
E – Early Decelerations > H – Head Compression
A – Accelerations > O - OK
L – Late Decelerations > P – Placental insufficiency