Intrapartum Management

Question 1

What kind of things do you monitor?

Answer 1

• Fetal movement (min 10 movements over 2 hr time). Decreased movement suggests baby is under stress
• Monitoring HR and fetal activity = Non Stress test. (Nonreactive = normal)
• Contraction stress test (older) - see how baby responds to induced contraction. If no stress with 3 contractions in 10 min.
• Biophysical profile: combined US with monitoring fetal HR tracing. Measure fetal HR, fluid, fetal movement, fetal tone, fetal breathing motion. Rated on a 1- pt scale, 2 pts per measurement. Good = 8-10/10
• S/D ratio

** False positives

Question 2

What does fetal monitoring measure and name the 2 types

Answer 2

Assesses baseline, variability, accelerations, decelerations

External: Indirect, doppler ultrasound
Internal: directly applied scalp electrode; need to be dilated enough

Question 3

ways to monitor contraction

Answer 3

External: Indirectly monitor via abdominal pressure electrode

Internal: Direct (IUPC)

• hollow tube next to baby’s head in space around baby’s body; measures intrauterine pressure. Membranes have to be ruptured and need to be dilated enough to fit tube in.
• assess how often and how intesnse
• increased risk of infection

Question 4

How to assess fetal heart rate

Answer 4

Rate, variability, accelerations , deceleration

Question 5

Normal baseline HR

Answer 5

110-160

- Determined based on 10 min window

Question 6

What is considered normal, moderate variability in HR?

Answer 6

6-25 variability

Question 7

Do you want variability in HR

Answer 7

you want moderate variability. Don’t really like No/minimal variability. Absent pretty bad.

Question 8

What do variable decelerations look like

Answer 8

• like “V”—abrupt decrease in HR
• usually near contraction
• can be due to cord compression/interruption in blood flow
• healthy baby can tolerate this.
• see more often if low fluids

Question 9

What is an amnioinfusion

Answer 9

hook up NS infusions into pressure catheter; may help with oligohydramnios and keep cord floating/not compressed

• too much will cause uterine rupture
• only indicated to help with variable decelerations

Question 10

What are Early decelerations

Answer 10

gradual deceleration where lowest point of deceleration correlated with peak of contraction.

Question 11

What are late decelerations

Answer 11

• gradual deceleration after contraction
• lowest HR after peak of contraction.
• fetal response to hypoxemia during contraction.
• Decreased maternal perfusion during contraction of intervillous space, so less blood to capillaries
• BP goes up due to vasoconstriction from hypoxemia, so HR goes down in resopnse

Question 12

What can you do for fetal Supraventricular tachy

Answer 12

give beta blockers, they cross placenta

Question 13

What does a sinusoidal pattern indicate on fetal HR tracings

Answer 13

anemia

Question 14

What does terbutaline do

Answer 14

Stops contractions