Intrapartum Care Flashcards
Before placement of epidural
What CBC labs are specifically looked into?
Platelets
(low platelets; risk for hemorrhage)
before placement of epidural
Vital signs must be checked because it can cause what?
Epidurals can cause a hypotensive reaction.
before placement of epidural
What can decrease risk of hypotension?
IV access and bolus
Reduce risk of hypotension
after placement of epidural
what instrument must be in place?
(Not IV, since this is AFTER epidural placement)
Urinary Catheter
Patient is no longer able to get up and move around.
When should APGAR be assessed?
1 and 5 minute of birth
Describe the APGAR assessment
- Appearance = Color
- Pulse Rate = HR
- Grimace = cries w/ stimulation
- Activity = Flexion and resist extension
- Respiratory effort = Strong cry observed
What APGAR score would require a further evaluation?
If < 7 on five minute assessment
What is the primary goal of external fetal heartrate monitoring?
What is it to prevent?
To continually assess fetal oxygenation
fetal acidemia and minimizing unncessary interventions
What are the contraindications for internal FHR monitoring?
Chorioamnionitis, active genital herpes, GBS+, HIV, placenta previa
Chorioamnionitis is infection of amniotic fluid and tissue
Which type type of FHR monitoring allows for objective measures of uterine contractions (mmHg)
Internal fetal heart monitoring
What does collecting umbilical cord help determine?
What does the blood from the vein and artery represent?
- severity of hypoxia during labor
- Vein assess oxygen supply and artery assess amount of oxygen used by fetus.
What is normal fetal heart rate?
110 to 160 bpm
what is fetal tachycardia baseline?
> 160 bpm for at least 10 min
what is fetal bradycardia baseline?
< 110 bpm for at least 10 min
How is normal FHR baseline assessed
Does it include accelerations and decelerations?
FHR is rounded to 5 bpm in 10-minute window of time, excludes accelerations and decelerations.
What is the following called?
Fluctuations from baseline FHR that are irregular in amplitude and frequency (excludes accelerations and decelerations)
Baseline variability
Fetal Heart Monitioring graph
Describe absent variability
Amplitutde range is undetectable
Describe minimal variability
amplitude range is ≤ 5 bpm
Which type of variability is normal?
Moderate variability
Describe moderate variability
amplitude from peak to trough is 6-25 bpm.
Describe marked variability
amplitutde > 25 bpm
What is an FH acceleration?
visually abrubt increase in FHR above baseline
≥ 15 bpm lasting for 15 sec but < 2 min
Baseline variability represents an interaction of what?
sympathetic and parasympathetic fetal system
a tear in the pernieum during labor is called what?
Laceration
____ is a purposeful incision in the pernieum to provide more space for the presenting part at delivery
Episitomy
What degree laceration is this?
tear in perineal skin and vaginal mucous membrane
1st deree laceration
What degree laceration is this?
tear in perineal skin & muscle, and vaginal mucous membrane
2nd deree laceration
What degree laceration is this?
tear in perineal skin, muscle, vaginal mucous membrane, and just before rectum.
3rd degree laceration
What degree laceration is this?
tear in perineal skin, muscle, vaginal mucous membrane, and rectum.
4th degree laceration
What is early deceleration?
When mother has a contraction babies HR drops at the SAME time.
(Mirrors Contractions)
What is late deceleration?
After mothers contractions, babies HR drops.
(U-shaped Fetal HR)
What is variable deceleration?
Variability in when the babies HR drops. The graph is non-uniform.
(Causes a V shaped fetal graph)
Which fetal HR deceleartion is reassuring?
Early decelerations
What causes early deceleration?
Contractions are causing head compression against the pelvis or soft tissue.
Just monitor it doesn’t drop below 110bpm
What causes late deceleration?
Utero-placental insufficiency.
Fetus is not getting enough oxygen
(Non-Reassuring - Req intervention)
What causes variable deceleration?
Cord compression (e.g., prolapse cord, nuchal cord, etc)
(Non-Reassuring - Req intervention)
What is VEAL CHOP?
Variable = Cord compression
Early = Head compression
Acceleration = Okay
Late = Placental insuffieciency
What is a FH category III?
Absent variability w/ either:
1. recurrent late or variable declerations
2. bradycardia.
or Sinusoidal pattern.
What is a FHR category III?
Absent variability w/ either:
1. recurrent late or variable declerations
2. bradycardia.
or Sinusoidal pattern.
Abnormal
What is a FHR category I
What type of variability?
Any decelerations?
Normal HR w/ moderate variability.
* Early decelerations present or absent
* ABSENT late or variable decelerations
What is a FHR category II
All FHR tracing that isn’t category I or II.
(*e.g., tachycardia, bradycardia w/o absent variability, minimal variability, etc. *)
Inderterminate
What is the primary goal of external fetal heartrate monitoring?
What is it to prevent?
To continually assess fetal oxygenation
fetal acidemia and minimizing unncessary interventions
Describe moderate variability
amplitude from peak to trough is 6-25 bpm.
Uterine activity is assessed for what three things?
- Frequency
- Intensity
- Duration
