FHS, Labor Support, Induction Flashcards
What is Frequency?
How often contractions occur?
Normal: <= 5 contractions in 10 mins, and averaged over a 30 minute period
Tachysystole: [More] lack of uterine rest
What is Duration?
How long the contractions are
Normal: <90seconds
Tachysysole: [Longer] baby not oxygenated
What is Strength?
How strong the contractions are
Weak, Moderate, Strong
What is Resting tone?
Uterine Relaxation
Re-oxygenation for Fetus
Normal: >= 30 seconds
What is Tachysystole?
- Frequency, Duration, Resting Tone
Frequency: >5 in 10 mins
Duration: >90seconds
Resting Tone: <30 seconds
Benefits and Limitation EFM
- External, Internal
External:
- benefits: Less invasive
- limitations: with positioning, not assessing radial pulse
Internal:
- benefits: extremely accurate, can move around
- limitations: invasive, dilated, and ROM
[EFM] Acceleration?
Abrupt increase in FHR (Onset to peak <30 secs)
[Baseline] >= 15 bpm x >= 15 seconds
Increase strength of cardiac contractions
Can be reaction to stimuli
Is OK
[EFM] Early Deceleration?
Gradual (>= 30 s from baseline to nadir)
Mirror image of contraction
Fetal Head compression
Is Normal (consider clinical picture)
[EFM] Late Deceleration?
Gradual (>=30s from baseline to nadir)
Nadir at the end of contraction
Decreased Uteroplacental Blood flow & hypoxia
Can be associated with hypotension
Placenta getting old
[EFM] Variable Deceleration?
Abrupt (< 30s from baseline to nadir)[
[Baseline] 15bpm x >= 15s
Similar to Acceleration but flipped, U shaped
Altered umbilical blood flow/Cord compression
Left Lateral, reposition
[EFM] Variability?
Fluctuation in baseline
Indicates mature CNS, oxygenated brainstem, and intact medulla
Absent: no range
Minimal: <=5 bpm
Moderate: 6-25 bpm
Marked: >25bpm
What is a Non Stress Test?
Looking at Fetal Wellbeing
20 min strip
Need 2 accelerations in 20 minutes
If not, reposition, or give some sugar
What are the goals for Intrauterine Resuscitation?
Improve uterine blood flow
Improve Umbilical Circulation
Improve maternal oxygenation
What are the actions in Intrauterine Resuscitation?
- Confirm FHR and MHR
- Position Change (left, right, then all 4s)
- Remove/Stop IOL
- Modify or pause pushing
- Maternal hydration
- Vaginal Exam
- Tocolysis
- Supportive Care
- Oxygen by mask
- Communicate/Document
What are the reasons to induce?
- Post Dates (41^3+)
- PROM
- Maternal Morbidity
- Fetal distress/IUFD
- Fetal Size
What are the reasons NOT to induce?
- No consent
- Not safe for delivery
- Complications: SD, CPD, malposition
- Placenta Previa
- STI
- Vertical Uterus Scar
What are the risk to inductions?
- Failure
- Fetal distress
- C/s
What is mechanical induction?
- At home methods (seduction. nipple stimulation)
- Stripping membrane
- AROM
- Cervical Ripening Balloon (falls out = 100% effaced)
What are the benefits to Cervidil?
- Slow Release
- Simple admin
- Easy to remove (Fetal distress, hyper stimulation)
- Easy monitoring
- Hospital pass
- Helps to ripen cervix
- Up to 3 cervidil (up to 3 days)
What is Oxytocin Induction?
- Pathos
Pathos:
- Similar to ADH
- Released from the pituitary gland
- Promotes smooth muscle contractions of myometrial cells of the uterus and myoepithelial cells of the breasts
- Uterine response to oxytocin dependent on estrogen
What are the nursing consideration for Oxytocin Induction?
- May skip early labor phase
- Role: NST, admin/titration, education, monitoring (mat q30mins BP contractions, FHR q15mins with continuous EFM)
- Increase risk for PPH d/t uterine fatigue
- Continue in PP period
- Monitor for s/s of PPH (change in v/s, bleeding, fundus)
- Must obtain order to go over 20mu/min
What is Oxygen Titration?
Start at 1mu/min and increase by 2 mu/min q30mins
Augmentation
TOLAC/VBAC
CST
8-12mu/min is usual
Ideally 5 contractions/10 mins
What is the Nursing Role in Labor Support?
- Safe environment
- Communication
- Empowerment
- Promote maternal coping
- Support mom&family
- Educate
- Reassure
- Cultural Consideration
What are the benefits of Labor Support?
- Likely to have SVD
- Shorter labors
- Less likely to: Report neg feelings, use intrapartum analgesia, require OVD, have baby with low APGAR
