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N416 > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

Goals of FHR Monitoring

A

Assess fetal well-being/oxygenation

Assess fetal tolerance of labor

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2
Q

Intermittent Auscultation

A

Using fetal doppler or fetoscope

Listen before, during, and for 30 sec after a contraction, to determine how the baby responds to the contraction

Palpate contractions w/ fingertips

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3
Q

Electronic Fetal Monitoring (EFM)

A

Continuous tracing of fetal heart rate as well as contraction frequency and duration

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4
Q

EFM Indications

A

Complications of pregnancy

Induction of labor (IOL)

Preterm labor

Decreased fetal movement

Meconium (fetal BM in utero)

Concerns about fetal status

Trail of labor after cesarean section (TOLAC/VBAC)

Maternal fever (>100.4)

Placental problems

Category II or III

Previous hx of stillbirth at > or = 38 weeks gestational age

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5
Q

EFM: External

A

2 transducer placed on abd.

FHR (US) usually lower belt over fetal back

Contraction (TOCO) monitor placed at top of uterus (fungus)

Monitors FHR & contraction frequency and duration, but NOT contraction intensity

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6
Q

EFM: Internal

A

Requires membranes to be ruptured

Fetal Spiral Electrode (FSE) - monitors FHR and attaches to fetal presenting part

Intra-uterine pressure catheter (IUPC) - measures intensity of cix in addition to frequency and duration

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7
Q

FHR Baseline

A

Normal range 110-160 bpm

Rounded to 5 bpm, observed in a 10-minute period

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8
Q

FHR Variability

A

Refers to the visually apparent fluctuations in the FHR over time (only in baseline)

Considered the most important predictor of adequate fetal oxygenation during labor

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9
Q

Moderate Variability

A

Highly predictive of normal fetal acid-base status and intact nervous system, at the time it is observed

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10
Q

FHR Variability Measurements

A

Absent = undetectable

Minimal = >0 but ≤ 5 bpm

Moderate = 6-25 bpm

Marked = ≥ 25 bpm

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11
Q

When are decelerations considered repetitive?

A

If they occur with ≥ 50% of ctx

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12
Q

FHR Accelerations

A

Abrupt increase in FHR in response to:

Fetal movement (exercise)
OR
Ctx

Indicates mature ANS and absence of acidosis

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13
Q

What is counted as an acceleration?

A

FHR must increase by ≥ 15 bpm and must last ≥ 15 sec from onset to return to baseline

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14
Q

What counts as an acceleration if <32 wks gestation?

A

10 bpm / 10 sec duration

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15
Q

Types of FHR Decelerations

A

Early

Late

Variable

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16
Q

Early Deceleration

A

Gradual onset

Timing generally coincides w/ ctx - starts when ctx starts and ends when ctx ends

Vagal response to fetal head compression = baby descending into the pelvis

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17
Q

Late Deceleration

A

Gradual onset

Delayed timing so that deceleration reaches its lowest point after the peak of the ctx - starts after ctx already started and ends after ctx ends

Fetal response to chronic or transient uteroplacental insufficiency/placenta problem

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18
Q

Variable Deceleration

A

Abrupt onset of at least 15 bpm below baseline and at least 15 bpm duration

With or without relationship to ctx; vary in shape, depth, duration, and timing

Fetal response to interrupted umbilical blood flow from cord compression

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19
Q

FHR Sinusoidal

A

EMERGENCY!!!

Associated w/ fetal anemia and severe fetal acidemia

Baby needs to be delivered right away - C/S (cesarean)

20
Q

Contraction Frequency

A

Measured from the beginning of 1 ctx to beginning of next ctx

Minutes

21
Q

Contraction Duration

A

Measured from the beginning to end of one ctx

Seconds

Should not exceed 5 ctx in 10 min, averaged over 30 min

22
Q

Contraction Intensity

A

External monitoring

Internal monitoring

ALWAYS use your hands to verify the information provided by the EFM!

23
Q

External Monitoring

A

Palpation of indentability of uterus at the funds

Nose = mild ctx

Chin = moderate ctx

Forehead = strong ctx

24
Q

Categories of FHR Tracings

A

Category I

Category II

Category III

25
Q

Category I

A

Baseline 110-160 bpm

Variability: moderate

Accelerations: present or absent

Early decelerations: present or absent

Late or variable decelerations: absent

26
Q

Category II

A

All tracings not categorized as I or III

Moderate variability w/ recurrent late or variable decelerations

Minimal variability w/ recurrent variable decelerations

Absent variability WITHOUT recurrent decelerations

Bradycardia w/ moderate variability

Prolonged decelerations

27
Q

Category III

A

Either:

Absent variability WITH:
- recurrent late declarations
OR
- recurrent variable declarations
OR
- bradycardia

OR

Sinusoidal pattern

28
Q

Category I Nursing Actions

A

Routine measures to support labor progress

Laboring pt’s coping

Fetal oxygenation

29
Q

Category II Nursing Actions

A

Heightened surveillance

Interventions to promote fetal oxygenation

Reevaluation

POISONS

30
Q

Category III Nursing Actions

A

Prompt evaluation and preparation for expeditious birth, with attempts to resolve the abnormal findings

POISONS

31
Q

POISONS

A

P = Position change - improve BP move baby from compressing something

O = Oxygen (nonrebreather mask/ 8-10 L)

I = IV fluids bolus - increase volume = increase bp = fetus gets oxygenated

S = Stop ctx (terbutaline)

O = Off pitocin

N = Notify provider

S = Sterile vaginal exam (SVE)

32
Q

Assessment of Fetal Well-Being

A

Non-stress test (NST)

Biophysical profile (BPP)

33
Q

Non-Stress Test (NST)

A

Evaluate fetal well-being

May be used alone or part of more comprehensive test, BPP

34
Q

Non-Stress Test Process

A

20-40 minute duration

Pt marks fetal movement

Pt placed on fetal monitor

35
Q

Non-Stress Test Results

A

Reactive

Non-Reactive

Unsatisfactory/Equivocal

36
Q

NST: Reactive

A

Presence of at least 2 accelerations of 15 bpm above the baseline and lasting at least 15 sec in a 20-minute window

37
Q

NST: Non-Reactive

A

Accelerations are not present or do not meet the criteria

Fetus is either at risk or asleep

38
Q

NST: Unsatisfactory/Equivocal

A

Data cannot be interpreted or there was inadequate fetal activity

39
Q

A well-oxygenated fetus w/ intact NS will have what?

A

FHR accelerations with fetal movement

40
Q

Biophysical Profile (BPP)

A

Comprehensive assessment of 5 biophysical variables that reflect placental functioning

4 components evaluated by US + NST = 5 variables

41
Q

What are the 5 variables in a biophysical profile?

A

Fetal movements - 3 body or limb movements

Fetal tone - one episode of active extension and flexion of limbs

Fetal breathing movement - episode of ≥ 30 sec in 30 min; hiccups are considered breathing activity

Amniotic fluid volume - single 2 cm x 2 cm pocket

Non-Stress Test - 2 accelerations > 15 bpm of at least 15 sec

42
Q

Biophysical Profile Interpretation

A

Score of 8-10 is considered normal when amniotic fluid is normal

6 = equivocal (unsure & repeat)

4 or less = abnormal

43
Q

Amniotic Fluid

A

Production = fetus swallows and then urinates amniotic fluid

Polyhydramnios - too much fluid

Oligohydramnios - too little fluid

44
Q

Causes of Polyhydramnios

A

No apparent cause

Swallowing malformations

Neurological disorders (anencephaly)

Diabetes

Rh sensitization

45
Q

Causes of Oligohydramnios

A

Placental insufficiency (associated w/ Han, post maturity)

Fetal renal malformations

Preterm pre labor rupture of membranes

46
Q

Polyhydramnios Implications

A

Preterm birth d/t distended uterus

Cord prolapse

Malpresentation

Postpartum hemorrhage

Edema and SOB when severe

47
Q

Oligohydramnios Implications

A

Fetal skin and skeletal abnormalities d/t impaired fetal movement

Fetal pulmonary hypoplasia d/t minimal fluid for practice breathing

Cord compression

N416 (9 decks)

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