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ALSO - 2021 > Intrapartum Fetal Surveillance > Flashcards

Intrapartum Fetal Surveillance Flashcards

1
Q

What are some indications for Electronic Fetal Monitoring?

A

Any High risk condition:

  1. maternal medical conditions: DM, HTN, etc
  2. Maternal obstetric complications: hx of prior c-sections, 42+ weeks, preeclampsia, gestational DM
  3. intrapartum complications
  4. epidural use
  5. known or suspected fetal conditions
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2
Q

What functions do each of the two transducers perform with electronic fetal monitoring?

A
  1. uterine contractions

2. fetal heart rate

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3
Q

If you use structured intermittent auscultation, how often should you listen?

A

every 15-30 minutes in active first stage of labor and every 5-15 minutes in second stage of labor

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4
Q

What pnemonic describes interpreting continuous electronic fetal monitoring?

A

DR C BRAVADO

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5
Q

What does DR C BRAVADO stand for?

A 
Determine Risk
Contractions
Baseline RAte
Accelerations
Decelerations
Overall Assessment
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6
Q

What are 3 ways to monitor contractions?

A
  1. palpation
  2. external transducer
  3. intrauterine pressure catheter
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7
Q

What is considered a normal number of contractions?

A

= 5 contractions in 10 minutes averaged over 30 minutes

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8
Q

What is considered tachysystole with regards to contractions?

A

> 5 contractions in 10 minutes averaged over 30 minutes

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9
Q

How is the Baseline RAte defined?

A

Mean fetal heart rate rounded to increments of 5 BPM during a 10-minute segment

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10
Q

How is baseline bradycardia defined?

A

Baseline <110 BPM for greater than 10 minutes

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11
Q

What are 7 maternal causes of baseline bradycardia?

A
  1. supine positioning
  2. hypotension
  3. connective tissue disease, ie lupus
  4. hypothermia
  5. hypoglycemia
  6. excessive vagal stimulation
  7. tachysystole
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12
Q

What are 4 fetal causes of Baseline Bradycardia?

A
  1. prolonged cord occlusion/cord prolapse
  2. fetal hypoxia
  3. cardiac conduction or anatomic defects
  4. Post dates >42 0/7 weeks
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13
Q

How is baseline Tachycardia defined?

A

Baseline >160 BPM for greater than 10 minutes

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14
Q

How is variability defined?

A

Fluctuations in baseline FHR that are irregular in amplitude and frequency

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15
Q

What are the 4 ways variability can be characterized?

A
  1. absent: undetectable
  2. minimal: AMPLITUDE range detectable but = 5 BPM
  3. Moderate: 6 to 25 BPM
  4. Marked: >25 BPM
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16
Q

What are 6 maternal causes of Decreased Variability?

A
  1. fever
  2. CNS depressants (ie opioids, benzos, MgSO4)
  3. general anesthesia
  4. Alcohol
  5. Corticosteroids
  6. Anticholinergics/parasympathetics
17
Q

What are 6 fetal causes of decreased variability?

A
  1. fetal sleep cycles (20- to 40-minute duration)
  2. prematurity
  3. cardiac anomalies
  4. fetal tachycardia
  5. hypoxia/acidosis
  6. CNS anomalies
18
Q

How are accelerations defined?

A

visually apparent, abrupt increase in FHR above baseline
- onset to peak in <30 seconds

Peak must be >/= 15 BPM above baseline
(or =10 sec if <32 weeks gestation)

Must last >/=15 seconds
(or >/=10 seconds if <32 weeks gestation)

Must return to baseline within 2 minutes

19
Q

What are the 3 classifications of Decelerations?

A
  1. Early
  2. Variable
  3. Late
20
Q

How are decelerations defined?

A

by their rate of onset (abrupt or gradual) and their timing in relation to the contraction

21
Q

How are early decelerations defined?

A

visually apparent, gradual decrease in FHR with return to baseline in association with a uterine contraction

  • nadir coincides with the peak of contraction
  • onset to nadir >/= 30 seconds (gradual in onset)
22
Q

What is the physiology of early decelerations?

A

Fetal head compression –> local changes in cerebral blood flow –> stimulation of vagal centers in the fetus –> decelerations of FHR

23
Q

How are variable decelerations defined?

A

visually apparent, abrupt decrease in FHR below baseline

  • onset to nadir <30 seconds
  • decrease in FHR is >/= 15 BPM, with duration of >/=15 seconds (but less than 2 minutes)
24
Q

What is the physiology behind variable decelerations?

A

cord compression
–> rise in fetal peripheral resistance –> sudden fetal HTN –> parasympathetic outflow –> slowing of fetal atrial pacemaker –> variable FHR deceleration

25
Q

When are decelerations described as recurrent?

A

if decelerations occur with >/= 50% of contractions in any 20 minute period

26
Q

What is the purpose of an amnioinfusion?

A
  1. reduces cord compression
  2. reduces variable decelerations

leads to fewer cesarean deliveries

use with recurrent variable decelerations

not useful for late decelerations or meconium

27
Q

When performing amnioinfusion, what volumes of fluids are used?

A

initial infusion of 250-500 mL

maintenance rate of 50-60 mL/hour

28
Q

How are late decelerations defined?

A

onset to nadir >/=30 seconds with nadir occurring AFTER peak of contraction

Generally, onset, nadir, and recovery of the deceleration occur after the start, peak, and ending contraction, respectively

29
Q

Describe the physiology of a late deceleration

A

uteroplacental insufficiency –> fetal hypoxemia –> O2 centralized via peripheral vasoconstriction –> hypertension –> late FHR deceleration

30
Q

What is a prolonged deceleration?

A

Any deceleration that is at least 15 BPM below the baseline that lasts >/= 2 minutes, but <10 minutes

31
Q

What is the etiology of a sinusoidal pattern of FHR? (list 3)

A
  1. fetal anemia
  2. evolving asphyxia
  3. may represent a terminal pattern
32
Q

Describe the risk of fetal acidemia based of NICHD Categories.

A

Category I - No risk
Category II - Indeterminate risk (insufficient research)
Category III - High risk (Abnormal)

33
Q

Describe a Category III FHR tracing.

A 
- sinusoidal pattern 
OR
- absent FHR variability with any of the following:
 > recurrent late decelerations
 > recurrent variable decelerations
 > bradycardia
34
Q

Describe a Category I FHR Tracing.

A

Must have all of the following:

  • baseline 110 to 160 BPM
  • moderate baseline variability
  • late or variable decelerations absent
  • accelerations present or absent

ALSO - 2021 (2 decks)

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