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Endo/Repro > Fetal Surveillance During Labor > Flashcards

Fetal Surveillance During Labor Flashcards

1
Q

What can cause adverse fetal neonatal outcomes?

A
  • Antepartum complications
  • Suboptimal uterine perfusion
  • Placental dysfunction
  • Intrapartum events
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2
Q

What was fetal heart rate monitoring developed for?

A
  • To detect FHR patterns that may be frequently associated with delivery of infants and poor outcomes
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3
Q

What are some benefits to FHR monitoring?

A
  • Most studies reveal the incidence of neurologic damage and perinatal death with the use of electronic FHR monitoring is NOT significantly lower than that documented with older methods
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4
Q

What have some studies shown is highly associated with FHR monitoring?

A
  • Increase in operative vaginal deliveries and C sections
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5
Q

Why do we not revert back to traditional fetal monitoring systems?

A
  • Reassurance that >90% of a good fetal outcome is associated with normal continuous FHR data
  • Great expense involved with 1:1 patient to nurse that is mandatory for intermittent auscultation
  • The knowledge that non reassuring continuous FHR monitoring may provide warning of potential problems and a gauge of fetal response to actions undertaken to improve fetal conditions
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6
Q

What are the different types of fetal monitoring?

A
  • External (continuous)

- Internal (will provide most accurate tracings)

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7
Q

What are some different external monitoring systems?

A
  • Doppler ultrasound inducer

- Pressure sensitive tocodynamometer transducer

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8
Q

What does a doppler ultrasound transducer do?

A
  • Placed on maternal abdomen overlying the fetal heart

- Records reflected sound waves from the fetal heart back to the transducer

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9
Q

What does a pressure sensitive tocodynamometer do?

A
  • Detects and records contractions

- Useful for measuring the frequency of contractions but NOT the strength

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10
Q

What may hinder the results of external fetal monitoring?

A
  • Maternal obesity
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11
Q

What are some internal fetal monitoring systems?

A
  • Fetal scalp electrode (FSE)

- Intrauterine pressure catheter

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12
Q

What does a fetal scalp electrode do?

A
  • Rate is computed from the R wave pekas of the fetal echocardiogram
  • Maternal and fetal movement will not alter the quality of the signal
  • Rare cases of fetal pustules have been reported
  • Avoid in HIV patients
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13
Q

What does a intrauterine pressure catheter do?

A
  • Soft plastic catheter placed transcervically

- Gives precise measurement of the intensity of the uterine contractions in mm Hg

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14
Q

What is required for internal monitoring systems?

A
  • Membranes to be ruptured
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15
Q

How big is the fetal oxygen reserve?

A
  • Only big enough to meet its metabolic needs for approximately 1-2 minutes
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16
Q

How does blood flow to the fetus changed during contractions?

A
  • Blood flow from maternal circulation is momentarily interrupted during a contraction
  • The normal fetus can tolerate the temporary reduction in blood flow to the placenta without suffering hypoxia because adequate oxygen exchange occurs during the intervals between contractions
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17
Q

What happens to the fetus under hypoxic conditions?

A
  • Chemoreceptors and baroreceptors in the peripheral arterial circulation of the fetus influence the FHR by giving rise to contraction related or periodic FHR changes
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18
Q

What does severe hypoxia result in?

A
  • Anaerobic metabolism, resulting in the accumulation of pyruvic and lactic acid causing fetal acidosis (fetal scalp blood pH <7.20)
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19
Q

What happens to the blood flow to the uterus as the contraction begins to subside?

A
  • Uterine myometrial arteries reopen, allowing oxygenated blood and nutrients to flow from mother to baby
  • Uterine myometrial veins reopen, allowing blood carrying fetal waste products to flow from the baby to the mother
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20
Q

What does the upper and lower tracings look at on a fetal monitoring strip?

A
  • Upper: monitors FHR

- Lower: monitors uterine contractions

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21
Q

What is normal uterine activity?

A
  • 5 contractions or less in 10 minutes averaged over a 30 min window
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22
Q

What is tachysystole?

A
  • > 5 contractions in 10 minutes, averaged over a 30 min window
  • Presence or absence of associated FHR decelerations
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23
Q

What is the baseline FHR?

A
  • Is rounded to increments of 5 bpm during a 10 minute segment
  • Normal is 110-160
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24
Q

What is bradycardia and tachycardia in FHR?

A
  • Bradycardia: baseline <110 bpm

- Tachycardia: baseline >160 bpm

25
Q

What are some causes of bradycardia in FHR?

A
  • Fetal hypoxia - late sign of hypoxia
  • Obstetric anesthesia
  • Pitocin
  • Maternal hypotension
  • Prolapsed or prolonged compression of the umbilical cord
  • Heart block
26
Q

What are some causes of tachycardia in FHR?

A
  • Fetal hypoxia - early sign of hypoxia
  • Medications (excessive oxytocin augmentation)
  • Arrhythmias
  • Prematurity
  • Maternal fever
  • Fetal infection (chorioamnionitis - Most common cause)
27
Q

What contributes to fetal heart changes and variability?

A
  • Opposing sympathetic and parasympathetic inputs contribute to the R-R variability from one heart cycle to the next
28
Q

What do chemoreceptors and baroreceptors do in the fetal heart rate?

A
  • Chemoreceptors: produce tachycardia in response to hypoxia

- Baroreceptors: influence FHR via the vagus n in response to changes in fetal BP

29
Q

What is baseline variability quantified as?

A
  • Amplitude of peak-to-trough in bpm of change in baseline rate
30
Q

What are the different changes in baseline variability?

A
  • Absent - amplitude range undetected
  • Minimal - amplitude range detectable but ≤5 bpm
  • Moderate (normal) - amplitude range 6-25 bpm
  • Marked - amplitude range > 25 bpm
31
Q

What could decreased variability mean?

A
  • Possible fetal stress
  • Is ominous if associated with persistent late decelerations
  • Is associated with hypoxia and acidemia
32
Q

What are some causes of decreased variability?

A
  • Prematurity
  • Sleep cycle
  • Maternal fever
  • Fetal tachycardia
  • Fetal congenital anomalies
  • Maternal hyperthyroidism
  • Maternal drugs or substance use
33
Q

What are the categories of FHR changes due to uterine contractions?

A
  1. No change
  2. Acceleration
  3. Deceleration
34
Q

What is seen during acceleration during FHR changes?

A
  • An abrupt increase in the FHR and is normal reassuring response
  • ≥32 weeks, acceleration - HR of ≥ 15 bpm above baseline for 15 sec or more
  • <32 weeks, acceleration - HR ≥ 10 bpm above baseline for 10 sec or more
35
Q

What is prolonged acceleration in FHR?

A
  • Lasts for greater than 2 minutes
36
Q

What is it called when the FHR is accelerated for more than 10 minutes?

A
  • Change in baseline
37
Q

What are some causes of FHR acceleration?

A
  • Spontaneous fetal movement
  • Scalp stimulation or vibroacoustic stimulation
  • Vaginal examination
38
Q

How can decelerations of the FHR be classified?

A
  • Early
  • Variable
  • Late
39
Q

What is early deceleration?

A
  • Secondary to head compression
  • Fetal autonomic response to increased ICP caused by transient compression of fetal head
  • Not associated with fetal distress
  • Nadir of the deceleration occurs at the same time as the peak of the contraction and thus is a mirror image
40
Q

What is variable deceleration?

A
  • Secondary to umbilical cord compression
  • Abrupt decrease in FHR; can occur before, during, or after the contraction starts
  • Decrease in FHR is ≥ 15 bpm lasting ≥15 sec and for longer than 2 min in duration
  • The onset and duration can vary with successive uterine contractions
41
Q

What happens if there is only sight compression of the umbilical cord?

A
  • Obstruct the umbilical vein which returns reoxygenated blood to fetal heart
  • Normal initial response is a slight increase in FHR to compensate for lack of blood return and the slowly diminishing oxygen supplies
  • The slight increase in FHR is followed by a major drop in FHR called a “shoulder”
42
Q

What is late deceleration?

A
  • Caused by uterine placental insufficiency
  • Most ominous deceleration
  • Repetitive decelerations usually indicate fetal metabolic acidosis and low arterial pH
  • Nadir of the deceleration occurs after the peak of the contraction
43
Q

What are some potential causes of late decelerations?

A
  • Excessive uterine activity

- Maternal supine hypotension

44
Q

What is prolonged deceleration?

A
  • Decrease in FHR from baseline that is ≥15 bpm lasting ≥2 min but < 10 min
  • Disruption of oxygen transfer from the environment to the fetus at one or more point along the oxygen pathway
  • Commonly seen during maternal pushing
45
Q

What is sinusoidal pattern seen on a FHR strip?

A
  • Smooth, sine wave-like undulating pattern in FHR baseline with a cyclic frequency of 3-5 per minute
  • Seen with fetal anemia
46
Q

What is category I for classifying FHR?

A
  • Baseline 110-160bpm
  • Moderate variability
  • No late or variable decelerations
  • Accelerations and early decelerations may or may not be present
47
Q

What is the goal and management for category I?

A
  • Intermittent or CEFM
48
Q

What are some FHR tracings in category II for classifying FHR?

A
  • Intermittent variable decelerations (<50% of contractions)

- Recurrent variable decelerations (>50% of contractions)

49
Q

What is the goal and management of intermittent variable decelerations in category II?

A
  • No intervention required
50
Q

What is the goal and management of recurrent variable decelerations?

A
  • To alleviate cord compression
  • Repositioning
  • Amnioinfusion
  • Modification of pushing efforts
51
Q

What is an amnioinfusion?

A
  • Instillation of normal saline can alleviate cor compression
  • Infused through a transcervical IUPC
52
Q

What are some causes for tachysystole in FHR tracing in category II?

A
  • Spontaneous labor

- Induction or augmentation

53
Q

What is the goal of tachysystole?

A
  • Reduce uterine activity
54
Q

What is the FHR tracing in category III?

A
  • Absent baseline variability
  • Recurrent late decels
  • Recurrent variable decels
  • Bradycardia
  • Sinusoidal pattern
55
Q

What are some causes of category III in FHR tracing?

A
  • Increased risk of fetal acidemia

- Increased risk of hypoxemia and acidemia

56
Q

What is the goal for category III?

A
  • Prepare for delivery
57
Q

What is fetal scalp stimulation? What is it used for?

A
  • When the scalp is stimulated
  • If an acceleration of 15 bpm lasting 15 seconds occurs the fetal pH is almost always 7.22 or greater
  • Used to differentiate between fetal sleep and acidosis
58
Q

What are potential logistical considerations for operative delivery with category III tracing?

A
  • Obtain informed consent
  • Assemble surgical team
  • Assess patient transit team and location for operative delivery
  • Ensure IV access
  • Review labs and assess need for availability of blood products
  • Assemble neonatal resuscitation personnal

Endo/Repro (31 decks)

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