Fetal Surveillance During Labor + Powerpoint ECGs! Flashcards by Deja Gause

what is fetal heart monitoring?

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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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)

is not

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does FHR monitoring have a decrease incidence of cerebral palsy

no; however magnesium sulfate has show to decrease risk

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

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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what are the types of fetal monitoring available?

external fetal monitoring: continuous or intermittent

internal fetal monitoring (most acurate in tracings)

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external intermittent monitoring if pregnancy is uncomplicated ?

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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external intermittent monitoring if pregnancy is complicated

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

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what are the options of external electronic fetal monitoring

doppler ultrasound transducer

pressure sesitive tocodynamometer

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how does a doppler ultrasound transducer work

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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how does a pressure sensitive tocodynamometer work?

detects and records contractions

detects frequency of contractions NOT strength

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

obese

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what are the options of internal electronic fetal monitoring?

Feta Scalp Electrode (FSE)

Intrauterine Pressure Catheter (IUPC)

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how does a fetal scalp electrode work?

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

HIV

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how does IUPC work

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

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internal fetal monitoring requires _ to be ruptured

membranes

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

1-2 minutes

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

contraction

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

blood flow

oxygen

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

atrial

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the vagus _ (decelerates/accelerates) the heart

decelerates (parasympathetic)

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sympathetic nerves _ (decelterate/accelerate) the heart

accelerate

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

hypoxic

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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

fetal heart rate

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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)

anerobic lactic and pyruvic acid fetal acidosis

pH of fetal scalp blood is normally?

7.25-7.30

pH less that _ is considered fetal acidosis

less than 7.20

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

myometrial ## Footnote during contraction the mom and baby are briefly physiologically seperated

how can uterine contractions affect fetal heart rate

contractions can increase or decrease fetal heart rate

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 _.

reopen baby to the mother

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

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

normal uterine contractions are?

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

tachysystole in uterine contractions is?

greater than 5 contraction in 10 minutes averaged over a 30 minute window ## Footnote can have associated decelerations

contractions can be measured from _ to _

peak to peak

how do you meausure the strength of contractions

with montevideo units (MVU)

MVUs are taken with an ? (internal monitoring technique)

Intrauterine pressure catheter (IUPC)

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

200

what is the baseline of fetal heart rate?

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

normal fetal heart rate bpm?

110-160

tachycardia FHR bpm

greater than 160

bradycardia fetal heart rate bpm

less than 110

Causes of bradycardia fetal heart rate

**late sign of fetal hypoxia anesthesia pitocin (oxytocin) maternal hypotension compression of the umbilical cord heart block

causes of tachycadia fetal heart rate

****early sign of fetal hypoxia **** fetal infections arrythmias, prematurity, maternal fever, fetal infection

what fetal infection is the most common cause of tachycardia

chorioamnionitis

fetal heart rate is under constant _ from baseline

variation

chemorectpros produce _ in response to hypoxia

tachycardia

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

vagus nerve blood pressure

what is baseline variability in fetal heart rate

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

fetal heart rate variability is visually quantified as the?

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

absent baseline variabilty means

amplitude from peak to trough is undetected

minimal basline variability means

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

moderate baseline variability means

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

marked baseline variability means?

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

decreased variability in baseline is an indicator of possible fetal _

stress

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

late

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

hypoxia and acidemia ## Footnote the lack of oxygen and buildup of acid in the fetus depresses the fetal heart rate and CNS

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

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

what is a fetal heart rate acceleration

an abrupt increase in FHR that is a normal reassuring response

what is an expected FHR acceleration at greater than 32 weeks what about less than 32 weeks

>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 ## Footnote both accelerations dont last longer than 2 minutes

a prolonged acceleration is if it lasts longer than _ minutes

an acceleration that is a CHANGE in baseline is?

if the acceleration lasts longer than 10 minutes

causes of accelerations in FHR of babies

spontenous fetal movements fetal scalp stimulation vaginal examination

decelerations are when the FHR _ in response to uterine contractions

decreases

early decels are secondary to ?

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

are early decels associated with fetal distress?

what does an early decel look like?

the begining (nadir) of the deceleration occurs at the same time as the peak of the uterine contraction ## Footnote it is a mirror image of a uterine contraction

describe the physiology of early decels

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 ## Footnote recovry happens as soon as pressure is relieved

variable decelerations are secondary to?

umbilical cord compression

what are variable decelerations

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

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

15 bpm 15 seconds

variable deceleration physiology

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

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

vein

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

increase

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

shoulder

late decelerations are caused by?

uterine placental insufficiency (UPI)

late decelerations are the most _ (harmless/ominous)

ominous

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

acidosis low

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

after

potential causes of late decelerations

excessive uterine activity materal supine hypotension

prolonged decelerations are caused by? they are commonly seen during?

caused by: disruption of oxygen transfer seen during maternal pushing

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

15bpm 2 minutes

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

sinusoidal FHR pattern is seen with fetal _

anemia

category I fetal heart rate tracing ?

normal tracing **- normal baseline 110-160 - no late or variable decelerations - accelerations may be present**

category II fetal heart tracing ## Footnote Iintermediate stge)

**intermittent variable decelerations**- usually associated with normal outcomes **recurrent variable decelerations **- umbilical cord compression- want to alleviate cord compression

how can we treat cord compression?

amnioinfusion in the first stage of labor (normal saline infused through a transcervical IUPC)

how do we increase fetal oxygenation ? ## Footnote category II

lateral positioning IV fluids O2 administration modifications in pushing efforts (push after a contraction) decrease oxytocin rate discontinue ocytocin

how can we treat tachysystole ## Footnote category II

1. reduce uterine contraction is the goal 2. lateral positioning, IV bolus, decrease oxytocin terbutaline ***if refractory (tocolytic beta 2 agonsist)

what does the fetal heart tracing show in category III

absent baseline variability recurrent late decels recurrent variable decels bradycardia sinusoidal pattern

how do we treat category III FHR

prepare for delivery!!! reposition the mother, give IV bolus, O2 supplementation Scalp test

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

delivery

what is fetal scalp stimuation

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)