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ENRP Exam 1 > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

causes of adverse fetal neonatal outcomes

A

antepartum complications
suboptimal uterine perfusion
placental dysfunction
intrapartum events

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2
Q

why is fetal heart monitoring so important?

A

early recognition of changes in FHR can serve as a warning to physician to intervene and prevent irreversible brain injury or death

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3
Q

external monitoring for uncomplicated pregnancy

A

q30 minutes in active phase of stage 1

q15 minutes in stage 2

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4
Q

external monitoring for complicated preganancy

A

q15 minutes in active phase of stage 1

q5 minutes in stage 2

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5
Q

what provides the most accurate FHR tracings?

A

internal monitoring

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6
Q

components of external fetal monitoring

A

doppler ultrasound overlying the fetal heart

pressure-sensitive tocodynamometer - records contractions

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7
Q

components of internal fetal monitoring

A

fetal scalp electrode

intrauterine pressure catheter

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8
Q

what happens to placental exchange of gases during contraction?

A

temporarily stops due to:
compression of uterine myometrial vessels
compression of umbilical cord
compression of fetal head

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9
Q

how long can a fetus last without oxygen?

A

1-2 minutes due to fetal oxygen reserve

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10
Q

what is the result of severe fetal hypoxia

A

anaerobic metabolism resulting in accumulation of pyruvic and lactic acid = acidosis

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11
Q

what is a normal uterine contraction?

A

5 contractions or less in 10 minutes averaged over a 30 minute window

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12
Q

what is uterine tachysystole?

A

> 5 contractions in 10 minutes averaged over a 30 minute window

presence or absence of associated FHR decelerations

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13
Q

baseline FHR

A

110-160

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14
Q

causes of fetal bradycardia (< 100 bpm)

A 
fetal hypoxia (late sign)
obstetric anesthesia
pitocin
maternal hypotension
prolapsed or prolonged compression of umbilical cord
heart block
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15
Q

causes of fetal tachycardia ( > 160 bpm)

A 
*fetal infection (chorioamnionitis)* most common!
fetal hypoxia (early sign)
medications 
arrhythmias
prematurity
maternal fever
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16
Q

FHR variability

A

amplitude

decrease may be an indication of fetal distress

17
Q

causes of decreased variability

A 
prematurity
sleep cycle
maternal fever
fetal tachycardia
congenital anomalies
maternal hyperthyroidism
maternal drugs/substances
18
Q

are FHR changes during contractions normal?

A

yes!

acceleration or deceleration

19
Q

physiological accelerations

A

an abrupt increase in FHR is a normal and reassuring response

≥ 32 weeks FHR ≥ 15 bpm above baseline for < 2 minutes

< 32 weeks FHR ≥ 10 bpm above baseline for < 2 minutes

20
Q

causes of physiological accelerations

A

spontaneous fetal movement
scalp stimulation or vibroacoustic stimulation
vaginal exam

21
Q

physiological decelerations

A

occurs in response to uterine contractions:
head compression
umbilical cord compression

22
Q

late deceleration

A

caused by uterine placental insufficiency (UPI)

indicates fetal metabolic acidosis and low arterial pH

23
Q

what type of deceleration occurs during pushing?

A

prolonged decelerations

≥ 2 mins but < 10 mins

24
Q

sinusoidal pattern of FHR

A

smooth, sine wave-like pattern

seen with fetal anemia

25
Q

category I tracing

A

baseline 110-160 bpm
moderate variability
no late or variable decelerations
accelerations and early decelerations may be present

26
Q

tx for recurrent variable deceleration

A

amnioinfusion to reduce cord compression

normal saline instillation via transcervical IUPC

27
Q

category II tracing

A 
intermittent variable decelerations
recurrent variable decelerations 
minimal or absent variability
recurrent late decelerations
prolonged decelerations
tachy
brady
tachysystole
variable, late or prolonged during pushing
28
Q

tx for category II tracing

A 
lateral positioning
IVF bolus
O2
decreased oxytocin
modification of pushing efforts
29
Q

category III tracing

A

absent baseline variability

30
Q

tx for category III tracing

A

scalp stimulation test

if test shows no acceleration, prepare for delivery

31
Q

fetal scalp stimulation

A

used to determine fetal sleep vs acidosis

normal response is acceleration of 15 bpm lasting 15 seconds

32
Q

does FHR monitoring reduce risk of cerebral palsy?

A

nope

ENRP Exam 1 (20 decks)

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