Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S5 - Regional/OB - Test 1 > Fetal Heart Rate Monitoring > Flashcards

Fetal Heart Rate Monitoring Flashcards

1
Q

when are late decels considered “ominous”?

when are they considered severe?

A
  • ominous if accompanied with lack of variability
  • severe if decreased more than 45 bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is minimal vs. marked FHR variability?

(book)

A
  • minimal - amplitude range of 5 bpm or less
  • marked - amplitude range of > 25 bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what type(s) of decels require urgent assessment of fetal status

A

late and variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

early decels and risks of hypoxia?

A

no risk of fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do antepartum accelerations correlate with?

A
  • fetal movement
  • accelerations = happy bebe
  • book: ensures absence of fetal acidosis or hypoxemia, providing reliable reassurance of fetal well-being
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do CNS depressants given to mom generally impact the bebe?

(book)

A

decreased FHR variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what three categories qualify a patient as a high-risk pregnancy?

A
  • medical complications
  • fetal complications
  • intrapartum complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what it this and what can cause it

A

early decel

head compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what two factors have an impact on the intrinsic fetal heart rate

A
  • neuronal
  • humoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

normal baseline FHR

what is baseline FHR? (book)

A

110-160 bpm

baseline FHR is determined as the mean FHR rounded to 5bpm during a 10-minute period that has no accelerations, decels, or marked variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what type of variability is seen in this shitty picture from the book

A

marked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what do late decels usually indicate?

(book)

A

uteroplacetal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

causes of prolonged decels

(book)

A
  • uncorrected maternal hypotension
  • maternal supine position
  • uterine hyperstimulation
  • prolapsed cord
  • cord entanglement
  • uterine rupture
  • placental abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

examples of fetal complications that indicate high risk pregnancy (6)

A
  • IUGR
  • nonlethal anomalies
  • prematurity
  • multiple gestations
  • postdatism (?)
  • hydrops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what device measures pressures inside the uterus?

A

intrauterine pressure catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what can variable decels indicate?

A
  • vagal activity
  • umbilical cord occlusion (partial or complete, or occlusion from short cord stretching)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what type of receptor responds to an increase in BP in the fetus?

what type responds to decreased PaO2 and increased PaCO2?

A
  • BP - baroreceptors
  • CO2 - chemoreceptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what interventions will correct most cases of fetal bradycardia before an expedited c section is necessary?

(book)

A

prompt treatment of hypotension and uterine overactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a sinusoidal FHR pattern and what does it look like?

causes?

(book)

A
  • cycle frequency of 3-5/minute and amplitude of 5-15 bpm which persists 20+ min
  • smooth, sine, wave-like, undulating pattern (tbh looks like v tach)
  • strongly predictive of fetal asphyxia
  • also - fetal anemia, occasional maternal opioid use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what questions would you address when determining if an epidural is adequate for use in c-section?

A
  • is it patchy?
  • will the patient/fetus tolerate additional LA to achieve adequate level?
  • how quickly can adequate level be achieved?
  • what is the probability of block failure?
  • would a SAB behoove the situation? would it make things worse?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how does an external FHR transducer use doppler ultrasound

what is an alternative to this?

A

detects changes in ventricular wall motion and blood flow through major vessels

alternative - scalp ECG lead to measure R-R interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what can early decels indicate?

A

head compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is an acceleration and how long does it last?

A
  • abrupt change in fetal heart rate above baseline
    • Per book- >15 bpm if 32 weeks and 10 if < 32 weeks
  • at least 15 beats above baseline for at least 15 seconds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is a saltatory FHR pattern?

what can cause it?

what is it weakly associated with in the fetus?

A
  • excessive alterations in variability
  • caused by acute fetal hypoxia
  • weak association to low Apgar scores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how can regional anesthesia impact the baby

(book)

A

maternal hypotension is a common complication of neuraxial labor analgesia→ can lead to decreased uteroplacental perfusion, fetal hypoxemia, and fetal decels

decels can occur w/o maternal hypotension esp. with spinals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

developing countries have what percent of intrapartum stillbirths?

developed countries have what percent of intrapartum stillbirths?

A
  • developing: up to 50%
  • developed: up to 10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is this and what is it associated with

A

variable decel

umbilical cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

examples of intrapartum complications that indicate high risk pregnancy (4)

A
  • bleeding
  • maternal fever
  • meconium-stained amniotic fluid
  • oxytocin augmented labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what does an IUPC measure?

A
  • strength of contractions
  • precise onset and offset of each contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

do external FHR monitoring and scalp ECG monitor the fetal heart rate intermittently or continuously?

A

continuously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

a normal variability in fetal heart rate indicates what reassuring things?

A

intact fetal…

  • cerebral cortex
  • midbrain
  • vagus nerve
  • cardiac conduction system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

examples of medical complications that indicate high risk pregnancy (5)

A
  • HTN
  • pre-eclampsia
  • diabetes
  • autoimmune disease
  • hemoglobinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the name of the device that externally measures contractions while sitting on the fundus?

what information can this device provide? (book)

A

tocodynamometer

reveals timing and frequency of contractions - not contraction strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

commonly seen when EFM is used for nonobstetric surgery

*~clinical pearl~*

A

loss of beat to beat variability

35
Q

fetal monitoring simultaneously monitors what two factors?

combining these allows for what to be analyzed?

A
  • fetal heart tones
  • uterine contractions
  • can determine baseline rate and pattern of FHR compared to uterine contractions
36
Q

what is this insane looking thing

A

saltatoryFHR pattern (with wide variability)

37
Q

timing and appearance of late decels

A
  • occur with each uterine contraction
  • uniform in appearance
  • begin 10-30 sec after contraction begins and end 10-30 seconds after contraction ends
  • vary in depth according to the strength of the correlating contraction
  • gradual (not abrupt)
38
Q

how does the addition of clonidine to dilute bupivacaine for neuraxial labor analgesia impact FHR?

(book)

A

shown to lower baseline FHR

39
Q

does an abnormal FHR automatically mean fetal compromise?

tell me more

A
  • nope - false positives are a thing
  • abnormal FHR of prolonged bradycardia or late decels with absence of variability can indicate fetal compromise
40
Q

what type of variability does this represent

A

normal

41
Q

what qualifies as a normal pattern of contractions?

A

5 or less contractions in a 10 min period averaged over 30 min

42
Q

what might minimal/absent variability plus decels indicate?

*~clinical pearl~*

A

concurrent or impending fetal hypoxemia and metabolic acidosis

43
Q

how does GA affect the baby fetus?

(book)

A
  • decreased maternal SNS output can cause maternal hypotension and diminished fetal O2 delivery
  • CNS depressants/opioids cross placenta and depress fetal CNS
44
Q

what qualifies as a tachysystole pattern of contractions?

A

more than 5 contractions in a 10 min period

45
Q

what can late decels indicate?

A

uteroplacental insufficiency

46
Q

when might accelerations occur?

(book)

A
  • fetal movement
  • uterine contractions
  • fetal manipulation/stimulation during pelvic exam
47
Q

what is a prolonged decel?

(book)

A

decels lasting 2-10 minutes

(>10 min considered change in baseline)

48
Q

what immediately precedes and follows variable decels?

(book)

A

slight FHR acceleration

49
Q

how does maternal Mg sulfate impact FHR?

when might this be given?

(book)

A
  • decreased baseline FHR
  • decreased variability
  • no AEs for baby
  • given to prevent seizures in preeclamptic moms
50
Q

what does a scalp ECG measure?

A

R-R interval

51
Q

term baseline FHR vs preterm baseline FHR

A

term babies have lower baseline FHR

52
Q

what is this and what can cause it

A

late decel

uteroplacental insufficiency

53
Q

how does admin. of magnesium for preeclampsia impact variability?

(book)

A

can cause decreased variability

54
Q

what is this

A

sinusoidal FHR pattern

55
Q

how does terbutaline impact FHR?

A

larger dose = significant increase in baseline FHR at 20 & 40 min

smaller dose = little effect

56
Q

fetal PNS outflow effect on FHR

fetal SNS outflow effect on FHR

A
  • PNS - decreases FHR
  • SNS - increases FHR
57
Q

if doing pre-anesthetic assessment and notice nonreassuring FHR monitor tracing, what should you consider?

A
  • consider whether anesthetic intervention could worsen fetal status
  • discuss with OB
58
Q

why is it important to maintain mom’s CO and treat promptly when decreased?

(book)

A

decreased CO = decreased uterine blood flow

59
Q

describe the timing and appearance of variable decels

A
  • vary in depth, shape, and duration
  • abrupt onset and offset
  • book - abrupt increase in FHR > 15+ bpm
  • book - lasts from 15 seconds - 2 minutes
60
Q

late decels and risks of hypoxia?

A
  • risk for fetal hypoxia
  • requires urgent assessment of fetal status
61
Q

when are decels considered recurrent vs. intermittent?

(book)

A

prolonged - occur with ≥ 50% of contractions during a 20 minute period

intermittent - < 50%

62
Q

how long is a prolonged acceleration?

what would it be if it were longer than that?

A
  • prolonged acceleration is > 2 minutes of 15 beats above baseline
  • if acceleration lasts > 10 minutes it’s considered a change in baseline
63
Q

what do accelerations preclude?

*googles preclude*

A

preclude the existence of fetal metabolic acidosis

64
Q

why should you be cautious about glycopyrrolate admin. to a pregnant mom?

(book)

A

can cause significant fetal bradycardia

interesting since we learned that it doesnt readily cross the placenta

65
Q

what is the purpose of electronic FHR monitoring?

(book)

A

detect signs of fetal response to hypoxemia and acidosis (decreased movement, tone, breathing, FHR, variability)

66
Q

what type of variability is this

idk why there are such shitty pictures in the book

A

minimal

67
Q

what type of fetal HR monitoring allows for more movement and ambulation of the momma?

A

telemetry

this is hella dumb

68
Q

what causes fetal tachycardia seen with prolonged exposure to hypoxia?

A

catecholamine secretion and SNS activity

69
Q

high-risk mothers make up percent of the pregnant population?

these babies make up what percent of perinatal morbidity and mortality?

A
  • make up 20% of population
  • 50% of m&m cases
70
Q

what does the tocodynamometer approximate?

A

onset, duration, and offset of contractions

*not* contraction strength

71
Q

if it is determined that an emergent c-section is necessary, what do we need to evaluate for?

A

evaluate for if epidural is already in place, and if so, if it can be adequately dose and utilized for a cesarean

72
Q

what measurements are given with an intrauterine pressure catheter

what population is this device reserved for? (book)

A

measures exact pressures in the uterus

quantitative measurement of uterine contraction strength (book)

Only used when membranes are ruptured

73
Q

describe the timing, HR, and appearance of early decelerations

A
  • gradual decline in HR (usually < 20 bpm below baseline)
  • occur simultaneously with uterine contractions
  • uniform in appearance
74
Q

variable decels and risks of hypoxia?

A
  • risk for fetal hypoxia
  • requires urgent assessment of fetal status
75
Q

what type of variability is this

A

absent

76
Q

how does maternal use of beta-blockers impact the baby?

(book)

A

long term use assoc. with fetal bradycardia, hypoglycemia, and FGR

77
Q

tell me about the predictability of electronic fetal heart rate monitoring

A
  • it is not a specific predictor of fetal well being
  • still being used because there is no optimal yet practical method that has been developed
78
Q

how does maternal betamethasone impact FHR?

when might this be given?

(book)

A
  • 1st day of admin: decreased FHR, increased variability
  • 2-3rd day: increased FHR, decreased variability
  • given to make preemie bby lungs better
79
Q

what else can change the baseline fetal heart rate besides hypoxia? (4)

A
  • anatomic or functional heart pathology
  • maternal fever
  • intrauterine infections
  • maternally administered medications — beta-agonists (terbutaline) or anticholinergic (atropine)
  • can be a normal variant (book)
80
Q

what do normal/moderate fluctuations in FHR indicate?

(book)

A

per MBG - “good”

per book - excellent predictor of the absence of fetal metabolic acidosis

81
Q

if we see changes in the FHR monitor, what is our ultimate goal as a CRNA?

A
  • goal: rule out anesthetic intervention as the cause
  • if it is related to anesthetic - correct hypotension (#1 suspect)
  • if epidural level higher than necessary, let it recede
82
Q

interventions for nonreassuring FHR patterns

(book)

A
  • maternal O2 via face mask - increase maternal alveolar O2 tension
  • optimize maternal CO - IV bolus, vasoactive drugs, uterine displacement
  • increase uterine perfusion with a direct alpha agonist (phenylephrine), IV bolus, d/c oxytocin, uterine displacement, or terbutaline
83
Q

T/F - early decels are associated with fetal hypoxia, acidosis, and low Apgar scores

(book)

A

false

84
Q

fetal response to hypoxia?

A

initially bradycardia

tachycardia with prolonged hypoxia

S5 - Regional/OB - Test 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions