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ENRP II > Fetal Surveillance During Labor + Powerpoint ECGs! > Flashcards

Fetal Surveillance During Labor + Powerpoint ECGs! Flashcards

1
Q

what is fetal heart monitoring?

A

this is monitoring of the fetal heart that was developed to detect fetal heart rate patterns that may be associated with poor outcomes of an infant

in hopes that was an interves on such patterns and prevent irreversible damage

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2
Q

most studies reveal the incidence of neurologic damage and perinatal death with the use of electronic FHR monitoring is _ (IS/ IS NOT) significantly lower than that documented with older methods (like auscultation with a stethoscope or doppler)

A

is not

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3
Q

does FHR monitoring have a decrease incidence of cerebral palsy

A

no; however magnesium sulfate has show to decrease risk

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4
Q

why dont we just go back to more traditional ways of monitoring the fetus like doppler or auscultation?

A

FHR monitoring is good reasssures that there will be good fetal outcomes

expensive to have someone intermittently checking via ascultation

can provide potential problems and allows you to take action to improve fetal condition if necessary

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5
Q

what are the types of fetal monitoring available?

A

external fetal monitoring: continuous or intermittent

internal fetal monitoring (most acurate in tracings)

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6
Q

external intermittent monitoring if pregnancy is uncomplicated ?

A

monitor every 30 minutes in active phase of first stage of labor

monitor every 15 minutes in second stage of labor

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7
Q

external intermittent monitoring if pregnancy is complicated

A

monitor every 15 minutes in active phase
monitor every 5 mintues during the second stage of pregnancy

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8
Q

what are the options of external electronic fetal monitoring

A

doppler ultrasound transducer

pressure sesitive tocodynamometer

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9
Q

how does a doppler ultrasound transducer work

A

it is placed on the mothers abdomen above the fetuses heart and records sound waves from the fetal heart back to the transducer

measures fetal heart rate

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10
Q

how does a pressure sensitive tocodynamometer work?

A

detects and records contractions

detects frequency of contractions NOT strength

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11
Q

external fetal monitoring may not be recorded acurately if that mother is _ (skinny/obese)

A

obese

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12
Q

what are the options of internal electronic fetal monitoring?

A

Feta Scalp Electrode (FSE)

Intrauterine Pressure Catheter (IUPC)

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13
Q

how does a fetal scalp electrode work?

A

it is an internal feta heary monitor that determines the rate from the R waves on the fetal echocardiogram

the maternal or fetal movement will not alter the signal

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14
Q

FSE must be avoided in _ patients and rare cases have been associated with fetal pustules on scalp

A

HIV

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15
Q

how does IUPC work

A

a soft plastic catheter is placed inside the cervix and it gives strength of contractions (down to the milimiter)

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16
Q

internal fetal monitoring requires _ to be ruptured

A

membranes

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17
Q

fetal oxygen reserve is only enough to meet its metabolic needs for approximately _ minutes

A

1-2 minutes

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18
Q

blood flow from the maternal circulation that supplies the fetus with coxygen through placental exchage of respiratory gases is interrupted during a _

A

contraction

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19
Q

normal fetus can tolerate the termporary reduction in _ to the placenta during contractions without suffering hypoxia because adequeate _ exchange occurs during intervals between contractions

A

blood flow

oxygen

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20
Q

fetal heart rate is determied by the _ (atrial, ventricle) pacemaker

A

atrial

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21
Q

the vagus _ (decelerates/accelerates) the heart

A

decelerates (parasympathetic)

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22
Q

sympathetic nerves _ (decelterate/accelerate) the heart

A

accelerate

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23
Q

a fetus whose oxygen supply is marginal cannot tolerate the stress of contractions and will be _

A

hypoxic

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24
Q

under hypoxic conditions chemoreceptors and baroreceptors in the peripheral arterial circulation of the fetus influence the _ by giving risk to contraction related or periodic changes in the FHR

A

fetal heart rate

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25
Q

hypoxia when severe in an infact will result in _ (aerobic/anerobic) metabolism resulting in the accumulation of what 2 acids?

resulting in fetal _ (acidosis/alkalosis)

A

anerobic

lactic and pyruvic acid

fetal acidosis

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26
Q

pH of fetal scalp blood is normally?

A

7.25-7.30

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27
Q

pH less that _ is considered fetal acidosis

A

less than 7.20

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28
Q

with each contraction blood flow from the mother to the baby initally ceases as the unterine _ vessels are compressed

A

myometrial

during contraction the mom and baby are briefly physiologically seperated

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29
Q

how can uterine contractions affect fetal heart rate

A

contractions can increase or decrease fetal heart rate

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30
Q

as a contraction begins to subside the unterine myometrial arteries _ allowing oxygenated blood and nutrients to flow from mother to baby. Uterine veins reopen and allow blood carrying fetal waste products to flow from _ to _.

A

reopen

baby to the mother

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31
Q

on a fetal monitoring strip what is the upper and lower tracings?

A

upper tracing : monitors fetal heart rate
lower tracing: measures uterine contactions

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32
Q

normal uterine contractions are?

A

5 contractions or less in a 10 minute period averaged over a 30 minute period

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33
Q

tachysystole in uterine contractions is?

A

greater than 5 contraction in 10 minutes averaged over a 30 minute window

can have associated decelerations

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34
Q

contractions can be measured from _ to _

A

peak to peak

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35
Q

how do you meausure the strength of contractions

A

with montevideo units (MVU)

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36
Q

MVUs are taken with an ? (internal monitoring technique)

A

Intrauterine pressure catheter (IUPC)

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37
Q

montevideo units should be greater than _ for the sum of contractions in a 10 minute period for at least 2 hours

A

200

38
Q

what is the baseline of fetal heart rate?

A

the mean fetal heart rate rounded to increments of 5 beats per minute during a 10 minute segment

39
Q

normal fetal heart rate bpm?

A

110-160

40
Q

tachycardia FHR bpm

A

greater than 160

41
Q

bradycardia fetal heart rate bpm

A

less than 110

42
Q

Causes of bradycardia fetal heart rate

A

**late sign of fetal hypoxia

anesthesia

pitocin (oxytocin)

maternal hypotension

compression of the umbilical cord

heart block

43
Q

causes of tachycadia fetal heart rate

A

**early sign of fetal hypoxia
** fetal infections

arrythmias, prematurity, maternal fever, fetal infection

44
Q

what fetal infection is the most common cause of tachycardia

A

chorioamnionitis

45
Q

fetal heart rate is under constant _ from baseline

A

variation

46
Q

chemorectpros produce _ in response to hypoxia

A

tachycardia

47
Q

baroreceptors influence fetal heart rate via the _ in response to changes fetal _ _

A

vagus nerve

blood pressure

48
Q

what is baseline variability in fetal heart rate

A

these are fluctuations in the baseline fetal heart rate that are irregular in amplitude and frequency

49
Q

fetal heart rate variability is visually quantified as the?

A

amplitude of peak to trough in bpm of change in baseline rate

50
Q

absent baseline variabilty means

A

amplitude from peak to trough is undetected

51
Q

minimal basline variability means

A

amplitude from peack to trough is detectable byt less than 5 beat per minute

52
Q

moderate baseline variability means

A

normal amplitude from peak to trough that ranges from 6-25 beats per minute

53
Q

marked baseline variability means?

A

amplitude from peak to trough is greater than 25 beats per minute

54
Q

decreased variability in baseline is an indicator of possible fetal _

A

stress

55
Q

decreased variability is ominous if associated with perisitent _ (early/late) decelerations

A

late

56
Q

decreased variability is associated with _ (hypoxia, adequate oxygen) and _ (alkalosis/acidemia)

A

hypoxia and acidemia

the lack of oxygen and buildup of acid in the fetus depresses the fetal heart rate and CNS

57
Q

the fetal heart rate may vary with uterine contractions by slowing or accelarating: these responses are catagorized how?

A
  1. no change
  2. acceleration (prolonged)
  3. deceleration (early, variable, late, prolonged deceleration)
58
Q

what is a fetal heart rate acceleration

A

an abrupt increase in FHR that is a normal reassuring response

59
Q

what is an expected FHR acceleration at greater than 32 weeks

what about less than 32 weeks

A

> 32 weeks: heart rate of greater than 15 bpm above baseline for 15 or more seconds

<32 weeks: heart rate greater than 10 bpm above baseline for more than 10 seconds

both accelerations dont last longer than 2 minutes

60
Q

a prolonged acceleration is if it lasts longer than _ minutes

A

2

61
Q

an acceleration that is a CHANGE in baseline is?

A

if the acceleration lasts longer than 10 minutes

62
Q

causes of accelerations in FHR of babies

A

spontenous fetal movements
fetal scalp stimulation
vaginal examination

63
Q

decelerations are when the FHR _ in response to uterine contractions

A

decreases

64
Q

early decels are secondary to ?

A

head compression

fetal autonomic response to increased intracranial pressure caused by transient comporession of the fetal head

65
Q

are early decels associated with fetal distress?

A

no

66
Q

what does an early decel look like?

A

the begining (nadir) of the deceleration occurs at the same time as the peak of the uterine contraction

it is a mirror image of a uterine contraction

67
Q

describe the physiology of early decels

A
  1. compression of fetal skull raises intracranial pressure
  2. there is a reduction in cerebal bloow flow
  3. the vagus nerve is activated
  4. nerve stimulates decrease in heart rate

recovry happens as soon as pressure is relieved

68
Q

variable decelerations are secondary to?

A

umbilical cord compression

69
Q

what are variable decelerations

A

aburpt decreases in FHR that can occur before, during, or after contraction starts

v shaped

70
Q

in variable decelerations decrease in FHR is greater than _ bpm lasting greater than _ seconds and less that 2 minutes in durations

A

15 bpm

15 seconds

71
Q

variable deceleration physiology

A
  1. umbilical cord compresson
  2. collapse of umbilical vein
  3. occludes umbilical artery
  4. hemodynamic changes
  5. baroreceptors and chemoreceptors activate
  6. vagus nerve stimulated
  7. slow fetal heart rate
72
Q

in variabel decelerations if the umbilical cord is only slightly compressed this will obstruct the umbilical _ which returns re-oxygenated blood to the fetal heart

A

vein

73
Q

the inritial normal fetal response to this variable decelerations is a slight _ in fetal heart rate to compensate for the lack of blood return and the slowly diminishing oxygen supplies

A

increase

74
Q

if a slight increase in FHR is followed by a major drop in FHR this phenomenon is called a ?

A

shoulder

75
Q

late decelerations are caused by?

A

uterine placental insufficiency (UPI)

76
Q

late decelerations are the most _ (harmless/ominous)

A

ominous

77
Q

repetitive LATE decelerations usually indicate fetal metabolic _ and _ arterial pH

A

acidosis

low

78
Q

in late decelerations nadir of the deceleration occurs _ (after/before) the peak of the contraction

A

after

79
Q

potential causes of late decelerations

A

excessive uterine activity

materal supine hypotension

80
Q

prolonged decelerations are caused by?

they are commonly seen during?

A

caused by: disruption of oxygen transfer

seen during maternal pushing

81
Q

prolonged decelerations are when there is a decrease in FHR from baseline that is greater than _ bpm lasting more than _ minutes

A

15bpm

2 minutes

82
Q

a change in baseline in a deceleration is if the deceleration lasts more than _ minutes

A

10

83
Q

sinusoidal FHR pattern is seen with fetal _

A

anemia

84
Q

category I fetal heart rate tracing ?

A

normal tracing

**- normal baseline 110-160
- no late or variable decelerations

  • accelerations may be present**
85
Q

category II fetal heart tracing

Iintermediate stge)

A

intermittent variable decelerations- usually associated with normal outcomes

**recurrent variable decelerations **- umbilical cord compression- want to alleviate cord compression

86
Q

how can we treat cord compression?

A

amnioinfusion in the first stage of labor

(normal saline infused through a transcervical IUPC)

87
Q

how do we increase fetal oxygenation ?

category II

A

lateral positioning

IV fluids

O2 administration

modifications in pushing efforts (push after a contraction)

decrease oxytocin rate

discontinue ocytocin

88
Q

how can we treat tachysystole

category II

A
  1. reduce uterine contraction is the goal
  2. lateral positioning, IV bolus, decrease oxytocin

terbutaline ***if refractory (tocolytic beta 2 agonsist)

89
Q

what does the fetal heart tracing show in category III

A

absent baseline variability
recurrent late decels
recurrent variable decels
bradycardia

sinusoidal pattern

90
Q

how do we treat category III FHR

A

prepare for delivery!!!

reposition the mother, give IV bolus, O2 supplementation
Scalp test

91
Q

in a catergory III FHR is scalp stimulation test does not result in acceleration _ is adviseable

A

delivery

92
Q

what is fetal scalp stimuation

A

the scalp is stimulated

helpful to differentiate fetal sleep from fetal acidosis when the tracing shows reduced variability but not decelerations

acceleration of 15 pbm lasting 15 seconds occurs when the pH value is 7.22 of greater (not acidotic)

ENRP II (25 decks)

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