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RNC OB > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

What is a normal Fetal Heart Rate Range?

A

110-160 bpm

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2
Q

What is classified as fetal tachycardia?

A

> 160 bpm

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3
Q

What are causes of fetal tachycardia?

A

Maternal:
-fever
-infection
-Beta-Synpathomimetic drugs (terb and epi)
-Parasympatholytic drugs (scopolamine, atropine, phenothiazines, hydroxyzines)
-Dehydration
-Hyperthyroidism
-Cocaine
Fetal:
-increased metabolic rate
-Anemia
-Acute blood loss
-Hyperthyroidism
-Heart Failure
-Hypoxemia
-infection/sepsis
-tachyarrhythmia

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4
Q

What is classified as Bradycardia?

A

<110 bpm

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5
Q

What are causes of fetal bradycardia?

A

Maternal:
- acute drop in oxygenation (respiratory depression, apnea, seizure)
-acute impairment of uteroplacental exchange (maternal hypotension, excessive uterine activity, loss of placental area with uterine rupture or placental abruption)
-prolonged occlusion of the umbilical cord
-profound vagal stimulation
Fetal:
-bradyarrhythmia
-head compression related to increased vagal tone

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6
Q

What is variability in the fetal heart rate?

A

this is the fluctuations in the fetal heart rate over time and is considered the most important predictor of adequate fetal oxygenation during labor
The pull between the sympathetic and parasympathetic

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7
Q

What is classified as Moderate variability?

A

This is variability with an amplitude of 6-25 bpm.

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8
Q

Which part of the nervous system is the most important for variability?

A

Parasympathetic Nervous System

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9
Q

True or False: does a decrease in variability and lack of accelerations mean there is fetal hypoxemia?

A

False: fetal sleep cycles, some maternal medications or substance use, congenital neurologic abnormalities, and cardiac conduction can also depress variability

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10
Q

What is classified as Minimal variability?

A

This is variability with an amplitude greater than undetectable but less than 5 bpm.

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11
Q

What are some causes of minimal variability?

A

centrally acting medications (opioids, tranquilizers, and other analgesics), premature gestations, and fetal sleep cycles

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12
Q

What is classified as Absent variability?

A

Absent variability has an undetectable amplitude.
this is smooth, blunted, and flat.

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13
Q

What is classified as Marked variability?

A

Marked variability has an amplitude range greater than 25 bpm.

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14
Q

What are periodic changes from the baseline?

A

These are occurring in association with uterine contractions.

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15
Q

What are episodic changes from the baseline?

A

These are not associated with uterine contractions.

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16
Q

What is an abrupt onset?

A

This is whether the onset to nadir or peak of the fetal heart rate change occurs in less than 30 seconds.

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17
Q

What is a gradual onset?

A

This is whether the onset to nadir or peak of the fetal heart rate change takes 30 seconds or longer.

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18
Q

Define Accelerations

A

These are ABRUPT increases from the fetal heart rate baseline.
-At 32 weeks and older: accelerations have to peak at least 15 beats above the baseline and last at least 15 seconds but less than 2 minutes (15x15’s)
-At less than 32 weeks: accelerations have to peak at least 10 beats above the baseline and last at least 10 seconds but less than 2 minutes (10x10’s)

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19
Q

True or False: Accelerations are predictive of adequate central fetal oxygenation

A

True: This is also an accurate predictor if a fetal pH of at least 7.19 and they rule out acidemia AT THE TIME THEY ARE OBSERVED.

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20
Q

Define Early Decelerations

A

These are GRADUAL PERIODIC decreases in the fetal heart rate.
-the onset, nadir, and recovery generally coincide with the onset, peak, and recovery of uterine contractions.
-vagal response

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21
Q

Explain how early decelerations represent a vagal response.

A

This is caused by a cerebral redistribution of blood flow caused by compression of the fetal head.
When the contraction occurs, the fetal head is subjected to pressure, stimulating the vagus nerve.

22
Q

Define Late Decelerations

A

These are GRADUAL PERIODIC decreases in the fetal heart rate.
-the onset, nadir, and recovery occur after the respective onset, peak, and resolution of the contraction.
-Response to transient or chronic uteroplacental insufficiency.

23
Q

Late Decelerations with three types of variability.

A

Lates with moderate variability:
- this is believed to reflect a chemoreceptor-mediated response to a transient hypoxemic event
Lates with minimal variability:
-this may be associated with acidemia
Lates with absent variability:
-this is associated with abnormal fetal acid-base status.

24
Q

Define Variable Decelerations

A

These are ABRUPT PERIODIC or EPISODIC decreases in the fetal heart rate.
-decrease at least 12 beats below the baseline and last for at least 15 seconds and less than 2 minutes.
-this is commonly caused by interruption of umbilical blood flow (oligo, cord prolapse, knots in the cord, nuchal cord)

25
Q

Explain how variable decelerations are an interruption of umbilical cord blood flow.

A

When the umbilical cord is compressed, the cessation of blood flow generates an increase in systemic vascular resistance and an increase in blood pressure that is detected by the fetal baroreceptors, triggering a vagal response and protective slowing of the fetal heart rate.
-Partial Occlusion: As the contraction begins, partial umbilical cord compression causes occlusion of the low-pressure vein and decreased return of blood to the fetal heart, resulting in a decreased cardiac output, hypotension, and a compensatory fetal heart rate acceleration.
-Complete Occlusion: With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden drop in fetal heart rate.
-Partial Occlusion: As the contraction dissipates the umbilical arteries open first, and a transient increase in fetal heart rate.

26
Q

True or False: if there are recurrent variables with moderate variability and a stimulated or spontaneous acceleration, is the fetus experiencing acidemia?

A

False: the decelerations are causing intermittent fetal stress
-recurrent variable decelerations that become deeper and longer are more likely to be associated with fetal acidemia.

27
Q

Define Prolonged decelerations

A

They are PERIODIC or EPISODIC decreases from the baseline that drop at least 15 beats below the baseline and last at least 2 minutes but less than 10 minutes.

28
Q

What are potential causes of Prolonged Decelerations?

A

Interruption of Uteroplacental Perfusion:
-Uterine Tachysystole
-Acute maternal hypotension
-Acute maternal hypoxia
-Placental abruption
-Uterine Rupture
Interruption of Umbilical Blood Flow:
-Cord compression
-Cord prolapse
-Ruptured vasa previa
Vagal Stimulation
-Profound head compression
-Rapid fetal descent

29
Q

Define Sinusoidal Heart Rate Pattern

A

Undulating, smooth sine wave-like pattern in the fetal heart rate pattern.
-this has a cycle frequency of 3-5 minute that persists for at least 20 minutes.

30
Q

What are the causes of sinusoidal fetal heart rate pattern?

A

Severe fetal anemia as a result of Rh isoimmunization, massive feto-maternal hemorrhage, twin-to-twin transfusion syndrome, ruptured vasa previa, fetal intracranial hemorrhage, fetal hypoxia or asphyxia, fetal infection, fetal cardiac anomalies, and gastroschisis.

31
Q

What is required per the definition of a Category 3?

A

Absent variability

32
Q

What is required per the definition of a Category 1?

A

Moderate variability

33
Q

What is the most important piece of fetal heart rate assessment?

A

Variability

34
Q

What are diagnoses that can challenge fetal reserve?

A

Hypertension, Diabetes, Oligo, Placental function, and IUGR
These are all chronic stressors

35
Q

True or False: if there are no accelerations, this is indicative of fetal acidosis

36
Q

What will a FSE pick up in the cause of a fetal demise?

A

Maternal HR

37
Q

What is variability indicative in the fetus?

A

this indicated mature neurologic system and fetal reserve.

38
Q

What is the easiest way to mistake fetal and maternal heart rate?

A

when the fetus is breech, the maternal aorta and fetal back are close to each other

39
Q

True or False: you should give scalp stimulation during a fetal deceleration

A

False: this can cause a vagal response and makes the deceleration worse.

40
Q

With fetal tachycardia, will the R-R interval be shorter or longer?

41
Q

With fetal bradycardia, will the R-R interval be shorter or longer?

42
Q

True or False: a medication induced sinusoidal pattern will break before 20 minutes?

43
Q

Which interventions are best to start with?

A

Non-invasive

44
Q

In which infections are FSE’s contraindicated with?

A

Hepatitis, Herpes (active), and HIVT

45
Q

True or False: You will still see a baseline with artifact from an FSE?

A

False: you will see a baseline with arrythmias.

46
Q

What are three causes of Dysrrythmias?

A
  1. Flow issues
  2. Automaticity
  3. Conduction
47
Q

What is the most accurate way to assess a fetal arrythmia?

48
Q

How long can a fetal sleep cycle last?

A

20-60 minutes

49
Q

What is the definition of adequate MVU’s?

50
Q

What is the best interval time to have between contractions?

A

45 sec - 1 minute

51
Q

What are three things to look for with increased tone and an IUPC?

A
  1. Abruption
  2. Amnioinfusion- decreased output
  3. Did the IUPC fall low in the uterus?

RNC OB (21 decks)

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