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OB/Community Health > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

Why do we use fetal monitoring ?

A

primary mode of intrapartum fetal assessment in the U.S
- useful took for assessing fetal response to labor and uterine activity

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2
Q

What are the goals of intrapartum fetal monitoring ?

A
  • support maternal coping and labor progress
  • maximize uterine blood flow
  • maximize umbilical circulation
  • maximize oxygenation
  • maintain appropriate uterine activity
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3
Q

What are the 3 reasons why fetal oxygen supply can decrease ?

A
  • reduction to blood flow
  • reduction of oxygen content
  • alterations in fetal circulation
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4
Q

What are the reasons of reduction of blood flow to fetus ?

A
  • poor maternal circulation
  • poor placental perfusion
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5
Q

What are the reasons for reduction of oxygen content to fetus ?

A
  • maternal hemorrhage
  • severe anemia
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6
Q

What are the reasons for alterations in fetal circulation in fetus ?

A
  • cord compression
  • head compression
  • placental abruption
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7
Q

What are the different types of monitoring techniques ?

A
  • intermittent auscultation
  • electronic external and internal
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8
Q

What is intermittent auscultation ?

A

every 30 mins going to listen with the doppler

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9
Q

What is electronic monitoring ?

A
  • External: intermittent and continuous with the Toco which is placed on the fundus because that is where all the pressure is
  • Internal: invasive
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10
Q

How does the Toco work ?

A

as the mom contract it presses on the button which produces a wave that can be seen on the computer or paper

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11
Q

Where do you place an external fetal monitor ?

A

you palpate the mom’s abdomen to feel where the baby’s position is with Leopold’ Maneuver
- US transducer should be placed on fetal back and the Toco near the fundus (top) of uterus
- smooth side is baby’s back and pointy parts are arms/legs

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12
Q

Where is the fetal heart rate best heard ?

A

along the fetal back

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13
Q

What are the 2 internal electronic fetal monitoring devices ?

A
  • fetal scalp electrode (FSE)
  • intrauterine pressure catheter (IUPC)
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14
Q

What is the fetal scalp electrode (FSE) ?

A

direct ECG monitoring of fetal heart where a thin wire is placed under the skin of the fetal head
- mom has to be dilated and water has to be broken
- Contraindications: infection (HIV, Hep B)

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15
Q

What is an intrauterine pressure catheter (IUPC) ?

A

direct measurement of uterine pressure where a catheter is placed between fetal body and uterus
- in mmHg
- membranes must be ruptured (ROM) & cervix must be dilated
- goal is to be on the side of the fundus
- can poke hole in placenta (if have abnormal placenta placement then not done)
- in IN RN’s can’t do this

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16
Q

What does the fetal heart rate baseline tell you ?

A

reflects the intrinsic rhythm of fetal heart and central nervous system functioning
- assess q30 min
- if pt is on Pitocin then q15min
- ignore any big peaks or downward beaks when counting the average

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17
Q

What is the normal fetal heart rate baseline ?

A

110-160 bpm
- baseline rate is the average during a 10 min segment

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18
Q

What is bradycardia in FHR ?

A

baseline <110 bpm for duration of 10 minutes or longer

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19
Q

What is tachycardia in FHR ?

A

baseline >160 bpm for duration of 10 mins or longer

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20
Q

What are some causes of bradycardia in FHR ?

A
  • interrupted O2 supply to fetus (occluded umbilical cord, maternal hypotension, hemorrhage)
  • medications (Nubain) (any med given to mom affects the baby through placenta)
  • post maturity
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21
Q

What are some causes of tachycardia in FHR ?

A
  • maternal fever
  • prematurity
  • medications (terbutaline)
  • abnormal fetal cardiac rhythm
22
Q

What is FHR variability ?

A

indirect measurement of fetal oxygenation & CNS functioning
- sympathetic increases the wave and parasympathetic decreases it

23
Q

What is absent variability ?

A

undetectable/0 and looks like a straight line
- ominious
- represent fetal hypoxia or metabolic acidosis, and CNS dysfunction

24
Q

What is minimal variability ?

A

1-5
- sleep cycle, sedation, sick
- represents hypoxemia, and congenital abnormality

25
Q

What is moderate variability ?

A

6-25
- normal
- represents intact CNS and good fetal oxygenation

26
Q

What is marked variability ?

A

> 25 and if not corrected it can start to look absent
- unclear significance

27
Q

What is acceleration ?

A

increase in FHR of at least 15 bpm above baseline, lasting about 15 secs or more (15x15)

28
Q

What was acceleration represent ?

A

reassuring sign of fetal well-being
- oxygenated and intact CNS
- see this when baby is moving around (kicking)

29
Q

What is early deceleration ?

A
  • benign
  • response to fetal head compression
  • gradual deceleration that mirrors the contraction
  • greater then 30 secs
30
Q

What causes early deceleration ?

A

as baby enters the pelvis there is more pressure put on the head
- decrease cerebral circulation/head compression

31
Q

What is late deceleration ?

A

response to uteroplacental insufficiency
- gradual deceleration: starts after the contraction begins
- represents not enough bloodflow or O2 to fetus
- takes >30 secs from baseline to acceleration

32
Q

What is variable deceleration ?

A

response to cord compression
- abrupt deceleration and return to baseline
- can be with or without contractions
- when increase pressure on cord then the HR drops
- artery constricts so the vein does as well

33
Q

What is prolonged deceleration ?

A

response to interrupted oxygen supply
- when is lasts >2 mins but <10 mins
- associated with hypotension or interrupted of the 02 supply

34
Q

What is VEAL CHOP ?

A
  • Variable ———–> cord compression
  • Early ————–> head compression
  • Acceleration ———> Okay !
  • Late —————-> placental insufficiency
35
Q

What is required for normal tracings ?

A
  • moderate variability
  • baseline rate 110-160
  • no late or variable decels
  • early decels present or absent
  • accels: present or absent
36
Q

What is required for indeterminate tracings ?

A

FHR tracings that do not meet the criteria for normal or abnormal

37
Q

What is required for abnormal tracings ?

A

absent baseline variability and any of the following:
- recurrent late decels
- recurrent variable decels
- bradycardia or sinusoidal pattern

38
Q

What is a category 1 tracing ?

A

strongly associated with normal acid base status

39
Q

What is a category 2 tracing ?

A

not predictive of abnormal fetal acid base status but inadequate evidence to classify as normal or abnormal

40
Q

What is a category 3 tracing ?

A

predicting of abnormal fetal acid base status

41
Q

What does frequency mean ?

A

measure shortest and longest interval between contractions (minutes)
- how often the contractions are coming

42
Q

What does duration mean ?

A

measure shortest and longest contraction (seconds)
- how long contractions are lasting

43
Q

What is intensity ?

A

measure of strength of contraction
- palpation: mild, moderate, strong (palpate on fundus and press and feel for compression)
- IUPC: mmHg & MVUs

44
Q

What is resting tone ?

A

the “tone” of uterus between contractions
- during contractions the uterus becomes taut which means it has increased tone
- palpation: soft or rigid
- IUPC: mmHg

45
Q

What is tachysystole ?

A

> 5 contractions in 10 mins
- caused by spontaneous or stimulated contractions
- intervention is necessary to reduce contractions and increase resting tone (can lead to fetal compromise if not corrected)

46
Q

What does oxytocin do ?

A

stimulates contractions

47
Q

What is intrauterine resuscitation ?

A

interventions used to maximize blood flow and oxygenation in utero when fetus is stressed
- interventions often done simultanously
- intervention is critical to maintain fetal capacity to tolerate labor

48
Q

What are the goals of intrauterine resuscitation ?

A
  • support maternal coping and labor progress
  • maximize uteroplacental blood flow
  • maximize oxygenation
  • maximize umbilical blood flow
  • maximize normal uterine activity
49
Q

What are the 4 interventions used for intrauterine resuscitation ?

A
  • increase fluid volume (bolus of lactated ringers (LR))
  • increase uterine/umbilical perfusion (reposition to L or R side)
  • increase oxygenation ( 8-10L O2 with non-rebreather face mask because during labor mouth breathing is common)
  • increase uterine resting tone (discontinue oxytocin and admin Terbutaline 0.25 mg SQ)
50
Q

What is amnioinfusion ?

A

used to increase “cushion” of fluid volume around umbilical cord in utero
- put IV fluids back into the uterus
- infusion of fluid thought IUPC (LR or NS)
- check pad for fluid return (if not risk of rupturing uterus)
- avoid overdistension of uterus

51
Q

What is amnioinfusion used for ?

A

intervention used for recurrent variable decelerations
- decreased amniotic fluid volume after ROM
- umbilical cord compression

OB/Community Health (12 decks)

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