Intrapartum Fetal Surveillance: Flashcards
What is a fetoscope used for?
auscultation and palpation
- midwife uses in community
What is a a Doppler ultrasound used for?
auscultate fetal heartbeat
Benefits of auscultation and palpation
- Easy, inexpensive and less invasive
- Results comparable to EFM in low risk women
- Comfortable and allows freedom of movement
- Can be used with hydrotherapy (water birth)
Limitations of auscultation and palpation
- Inability to perform in some situations
- No permanent record
- FHR counting is intermittent not continuous
- May not detect abnormal FHR at all, or in time for intervention- bc it’s intermittent
- Not recommended for high risk pregnancy
What are the two monitors of a bedside electronic fetal monitor (EFM)?
Where do you place them for use?
- tocometer: measures uterine contractions
— Placed at the fundus, top of uterus - Ultrasound: placed on back of fetus, must know fetal positions
- External monitor cannot determine the intensity of contraction
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LSA:
LUQ
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LOP
LLQ
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
RSA:
RUQ
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LOA
LLQ
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
ROP:
RLQ
FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
ROA:
RLQ
Benefits of Doppler and EFM:
- Noninvasive
- Ease-of-use
- No risk to mother or fetus
- Provides continuous FHR and UA readings
Limitation of Doppler and EFM
- Limits mobility of mother
- Does not assess strength or intensity of contractions
- Limited effectiveness in obese or multifetal women
What needs to happen before using an:
Intrauterine pressure catheter (IUPC)
- Mom needs to be dilated at least 2 cm
- and her membranes need to be ruptured
FHR MONITOR STRIP:
Each box = how many secs?
10 secs
6 boxes = 1 min
Assending boxes= FHR
Normal baseline FHR:
110-160 bpm
FHR Tachycardia:
> 160 bpm
FHR Bradycardia:
<110 bpm
What is Variability?
fluctuation in the FHR from the baseline FHR with irregular amplitude and frequency
- Variability: is considered normal (reassuring HR)
Minimal Variability
5 bpm or less
Moderate variability
6-25 bpm
Marked variability
25 bpm or greater
What are accelerations?
- 15 bpm above baseline for 15 seconds (normal)
- Indicates adequate fetal oxygenation and fetal pH. - Reassuring.
What are periodic accelerations?
linked with uterine contractions
What are episodic accelerations?
- fetal movement, vibroacoustic stimulation, scalp stimulation from vaginal exam
- Are not directly linked to uterine activity
- Caused by fetal or uterine stimulation
Early decelerations:
Normal
- early in the cycle of contractions the FHR starts to go down.
- Cause: head compression
- FHR goes back up after contractions
- No intervention needed. Continue to monitor. This is a normal finding. This is a reassuring FHR
Late deceleration:
- bad/ not reassuring
- FHR goes down after the contractions
Late deceleration causes:
- *Uteroplacental insufficiency
- Maternal hypotension
- Uterine hyperstimulation from Pitocin
- Bleeding disorders
Late deceleration nursing interventions
- IV fluids to correct hypotension
- Stop/slow Pitocin
- Address bleeding issue. Perhaps give PRBC
- Reposition mother on side (especially left side)
- Administer 02
- Prepare for C-section
Variable decelerations:
Causes:
- bad/not reassuring
. - *Cord compression
- Fetus on cord
- Knot in cord
- Nuchal cord
Nuchal cord:
- cord around baby’s neck
- Often occurs after membranes rupture
Variable decelerations Nursing interventions:
- Change mothers position
— Place mom in hands and knees, side lying, or Trendelenburg - Amnioinfusion
- IVF
- Oxygen
Whartons Jelly
Gelatinous substance surrounding the umbilical cord that protects it from compression
Variable deceleration=
Cord compression
Early deceleration=
Head compression
Acceleration=
Okay!
Late deceleration=
Placental insufficiency
