fetal monitoring/search methods Flashcards
1
Q
EFM
A
electronic fetal monitoring
2
Q
Why is continuous EFM controversial?
A
- It makes the laboring mother more sedentary. Not optimal for giving birth.
- It removes healthcare workers from the presence of mom, giving them a less complete picture of the overall condition of mom and baby.
- Provides less intensive care for laboring mothers and babies.
3
Q
What is the best position for an electronic fetal monitor?
A
on the baby’s back
4
Q
tocodynamometer
A
- device for monitoring and recording uterine contractions during labor
- has button on back
5
Q
toco
A
contraction
6
Q
ctx
A
contraction
7
Q
tocolytic drug
A
drug that stops ctx
8
Q
fetal monitor
A
- smooth on the back
- measures FHR
9
Q
FHR
A
fetal heart rate
10
Q
vibroacoustic stimulator
A
- device that uses sound waves and vibration to stimulate baby in utero
- used to elicit FHR accel and ensure fetal well-being
11
Q
maternal-fetal unit
A
mom + uterus
↓
placenta
↓
cord + fetus
12
Q
uteroplacental junction
A
- place where the placenta joins the uterus
- forms chambers where maternal blood collects
- nutrients and gases are exchanged through membrane of placental blood vessels lying in those chambers
- uterus and placenta are interwoven, almost like a zipper
13
Q
umbilical cord
A
three blood vessels that carry fetal blood into and out of the uteroplacental junction for nutrient and gas exchange
14
Q
AVA
A
- artery vein artery
- the three vessels that should be found in the umbilical cord
15
Q
two-vessel umbilical cord
A
- can be indicative of genetic anomaly
- requires further investigation
16
Q
What happens to the placenta and fetus during a normal ctx?
A
- placenta is squeezed, leaving less room for blood, and reducing gas and nutrient exchange
ctx → placenta compressed → less blood to cord → less blood to fetus - baby’s head is squeezed, sometimes eliciting a vagal response and lowering FHR (early decel)
17
Q
What does a variable decel indicate?
A
cord compression
18
Q
What does a late decel indicate?
A
uteroplacental insufficiency
19
Q
What does an early decel mean?
A
baby’s head is squeezed during contraction, eliciting a vagal response and lowering FHR
20
Q
What factors affect fetal oxygenation?
A
- normal maternal blood flow to placenta (volume)
- normal maternal SpO2
- functional placenta
- functional umbilical cord
- normal fetal circulation
21
Q
interruptions to fetal SpO2
A
- changes in mom’s circulation
- drop in BP
- vena cava syndrome
- drop in maternal O2
- uterine activity
- placental problems
- umbilical cord problems
- abnormal fetal conditions
22
Q
What causes drops in maternal O2?
A
- epidural: drop in BP; IV fluid bolus prophylactic
- vena cava syndrome: compression when supine; reposition mom
- smokers, lung conditions, anaphylaxis
23
Q
What can cause placental insufficiency?
A
- small placenta
- blood clot in placenta
- part of placenta that doesn’t function
24
Q
nuchal cord
A
- umbilical cord wrapped around baby’s neck
- doesn’t strangle baby
- compresses cord, ↓ O2 delivery
25
umbilical cord problems
* nuchal: around neck
* body: around body
* true knot: actual knot in cord
26
EFM pattern components
* rate
* variability
* accels
* decels
* ctx pattern
27
assessment frequency for laboring mother
* \< 4 cm: q30min
* 4-10 cm: q15min
* pushing until delivery: document q15min, review q5min
* until delivery: q5min
28
variable decel
* caused by cord compression
* uncorrected or severe = acidosis in baby
* happens in 50% of labors, usually in 2nd stage (pushing)
* duration and depth vary
* shape: U, V, W
* look for sharp drop and sharp return
* may have shoulders
* non-uniform: usually periodic, but can be episodic
29
variability
* measures fluctuations of FHR
* 10-min block; subtract trough from peak in each one-minute block to find variability
* documentation
* absent: smooth line
* decreased/minimal: 0-5 bpm
* **average/moderate: 6-25 bpm**
* marked/saltatory: \> 25 bpm
30
ctx monitoring factors
* frequency
* duration
* peak IUP
* resting tone
* intensity
31
ctx frequency
from beginning of one ctx to beginning of next
32
ctx duration
first of ctx to end of same ctx
33
peak IUP
highest pressure recorded by tocodynanometer
34
resting tone
lowest IUP between ctx
35
ctx intensity
* external monitor: palpation required to measure intensity; mild, moderate, or strong
* internal/spiral monitor: measures IUP accurately
36
measuring baseline FHR
* 10-min block of time
* between ctx
* normal range: 110-160 bpm
37
causes of fetal tachycardia
* maternal fever (infection)
* maternal anxiety/fear/pain
* dehydration
* medications, street drugs
38
causes of fetal bradycardia
* maternal hypotension: epidural, vena cava compression, etc.
* medications (maternal sedation)
* cord compression
* uteroplacental insufficiency
39
absent variability
40
accel
* brief, temporary increase in FHR
* reassuring sign of responsive, non-acidotic fetus
* usually occur with fetal movement
* size, frequency, and occurrence increase with GA
41
documenting accels
* ++ = 15bpm x 15 sec
* + = \< 15 bpm and/or \< 15 sec
* 0 = none
42
decel patterns
* type
* early: slow and sloping with ctx
* variable: U, V, or W shaped with sharp ↓ ↑
* late: slow and sloping, starting after or lasting until after ctx
* timing
* episodic: spontaneously
* periodic: with ctx
43
VEAL CHOP
(FHR patterns)
Variable = Cord compression
Early = Head compression
Accel = OK
Late = Placental insufficiency
44
early decel
* caused by head compression, vagal stimulation
* uniform, curved shape; mirror image of ctx
* onset at beginning of ctx, FHR returns to baseline at end of ctx
* during active phase of labor (4-7 cm)
* commonly r/t cephalopelvic disproportion
* nonpathalogic/benign
* Tx: none, unless truly severe
* document
45
late decel
caused by placental insufficiency
46
What does maternal pushing look like on a strip?
obvious sawtooth pattern during contractions
47
prolapsed cord
* vag exam to confirm
* suspicious findings
* baby high in pelvis when water breaks
* variable decels
48
variable decel Tx
* stop Pitocin
* vag exam to r/o cord prolapse
* reposition mom
* O2 40% (**ATI: 8-10 L/min**) via **nonrebreather** mask
* possible amnioinfusion
49
late decel
* cause: uteroplacental insufficiency
* consistent shape, usually slow and sloping
* about 20-30 sec after ctx (not always obvious); check end of ctx against end of decel and look for gradual return to baseline
* often seen with ↓ or no variability
* leads to fetal hypoxia/acidosis
* less common
50
nadir
peak or trough of IUP or FHR on fetal monitor tracing
51
shoulder
sharp, brief increase in FHR before or after variable decel
52
placental abruption
* characterized by late decels
* placenta detaches from uterus
* causes concealed or visible bleed
* → major maternal AND fetal hemorrhage, possible sudden death for either
53
late decel Tx
* turn mom to left side
* correct hypotension with IVF bolus
* stop or ↓ Pitocin
* give tocolytic
* 40% O2 by Vinny or **8-10 L/min by nonrebreather**
