Fetal Monitoring Flashcards
three principles of fetal heart tracings
1) heart tones (top of strip)
2) uterine contractions (bottom of strip)
3) fetal heart tones in relationship to uterine contractions
normal heart tones of fetus
110-160 bpm lasting >10 min
what is bradycardia defined as in fetus
<110 bpm
causes of bradycardia
anything that decreases pressure to placenta (decrease O2 to fetus)
hypoxia, maternal hypotension, r/t epideral
what do you give if fetus is bradycardic
give mom oxygen (10 L of O2 on nonbreather mask)
give mom bolus of fluid (500 cc saline to increase BP)
change mother position, TURN PT (fetus cord may be compressed)
what is tachycardia defined as in fetus
> 160 bpm
cause of tachycardia in fetus
maternal/fetal INFECTION, fetal hypoxia, street drugs (meth, cocaine)
what is chorioamnionitis
infection of chorion and amnion of placenta
fetus and mom are infected- need to give them antibiotics
causes increase in HR and fever
measure of changes in fetal heart rate/ waviness
controlled by fetal brain (sympathetic and parasympathetic system)
variability
NO changes in fetal heart rate
ie/ consistently 140 bpm
Undetected
what does undetected variability mean
SEVERE brain damage
undetected or less than or equal to 5 bpm
little bit wavy, some activity
okay for 20 min/ hr
minimal variability
what is usually the cause of minimal variability and intervention
sleeping fetus (if > 20 min be concerned) intervention: give mother caffeine and sugar to wake baby up
what is moderate variability indicative of
Good parasympathetic and sympathetic nervous system
heart and brain are reacting together
describe what moderate variability looks like
squiggly line
6-25 bpm
describe marked variability
OMINOUS
early hypoxia or fetal seizures
>25 bpm
thick, wavy lines
form of long term variability
6-25 beats above baseline
periodic “hills” in EKG
accelerations
describe what type of accelerations you want
2 accelerations every 10 min
GOOD
up 15 beats, lasts 15 sec
why are accelerations good
indicates that baby gets enough Oz to supply muscles/body to move
what do no accelerations indicate
damage to cord
fetus not getting enough O2
during uterine contractions…
blood flow is REDUCED to placenta
what is the normal cycle of uterine contractions
normal flow, reduced flow, no blood flow, reduced flow, normal flow
contractions that last 5 min…
hypoxic baby
contractions=______
stress
done on high risk pts who may not supply fetus with enough Oz
non stress test
2 or more accelerations in 10-20 min
reactive NST
fetus did not meet acceleration requirement
nonreactive NST
causes of nonreactive NST
sleep: monitor for 2 hrs and give glucose
hypoxia: further testing necessary with stress test or biophysical profile
ideally, what contraction frequency do we want
contracts every 3-5 min lasting 45-90 seconds
each box is how many seconds
10
need relaxation period for what
normal arterial transfusion to gap
O2 pushed to gap
contractions…
pushes baby out and dilates cervix
resting…
gives baby O2
from the beginning of one contraction to the beginning of the next contraction
frequency
what frequency do you want
every 3-5 min
delivered to help women go into labor
starts to increase the amount of uterine contractions
Pitocin
how is Pitocin given
IV if contractions are <3 min
nurse triates med to optimal dose
if contractions are closer than 3-5 min apart lasting 45-90 sec this occurs
hyperstimulation
as resting period is decreased…
O2 to fetus is decreased
causes prolonged constriction of endometrial arteries
interventions for hyperstimulation
1) turn down or off the Pitocin
2) give a tocolytic to relax uterus
do not want contractions ______ if giving pitocin
> 3 minutes apart
types of tocolytic
brethine
terbutaline
decelerations have _______ to contractions
NO relationship
these are variable decreases in beats lasting 15 sec
decelerations
what do decelerations look like
all look different
U, V, or W shaped
what are decelerations caused by
manual cord compression
interventions for decelerations
change position to remove force on cord
O2 per 10 L non rebreather
if severe decelerations then do this
amniofusion- float away from force
discontinue Pitocin to allow fetus to rest
this is a good sign, fetal head compression
moving down for delivery
early decelerations
starts before the peak of the contractions
smooth, not shaped
no nursing interventions
early decelerations
OMNIOUS
occurs after the peak of the contraction
late decelerations
what do late decelerations indicate
uteroplacental insufficiency
presence of fetal hypoxia from the inability of the placenta to perfuse to the fetus
intervention for late decelerations
change maternal position turn of Pitocin (stop closing arterioles) O2 per 10L non rebreather LR bolus to increase pressure notify physician
pneumonic to remember for fetal monitoring
VEAL CHOP
what does the fetal monitor pneumonic stand for
Variables Cord compression(change position) Early decelerations Head compressions (no intervention) Accelerations Okay (placenta is good shape/able to give O2 to aby and take CO2 from gap) Late decelerations P-uteroplacental insufficiency (fetus is hypoxic, change position, shut off Pitocin, give O2, fluid bolus, and call provider)
