intrapartum pt 2: maternal & fetal responses to labor

Question 1

what happens to the mom’s CV system when she’s in labor? what causes it or what happens to mom?

Answer 1

• blood volume increase by 45% –> more work on moms heart & slight cardiac hypertrophy
• progesterone helps BP stay stable with vasodilation & reduced vascular resistance
• supine hypertension

Question 2

what is happening to mom’s blood during labor?

Answer 2

• RBC increases 20-30%
• increase plasma vol –> physiologic anemia of pregnancy
• WBC increases
• blood glucose decreases

Question 3

what is happening to mom’s respiratory sys during labor?

Answer 3

• O2 consumption increases 20-40%
• diaphragm is displaced as fetus grows

Question 4

what is happening to moms renal system during labor?

Answer 4

proteinuria: bc of muscle breakdown from labor

Question 5

what is happening to mom’s GI during labor?

Answer 5

gastric motility slows –> n/v

Question 6

what is the fetus O2 affected by?

Answer 6

labor is physiologic stress on fetus
- maternal blood flow (gest. DM affects this)
- maternal O2
- fetal circulation
- uterine tone
- placental vasculature

Question 7

what will we see on the monitor is there is cord or head compression?

Answer 7

• cord compression = big V’s on monitor
• head compression = early deceleration

Question 8

what do we use to monitor FHR?

Answer 8

• fetoscope
• portable doppler: intermittent
• electronic monitor: intermittent or continuous
• fetal scalp electrode: continuous

Question 9

what do we use to monitor contractions?

Answer 9

• external toco transducer: MOST COMMON
• IUPC (intrauterine pressure catheter)

Question 10

what is something that needs to happen before using the FSE?

Answer 10

the amniotic sac needs to be ruptured first

Question 11

what else can the IUPC be used for? what med do we use?

Answer 11

• see if contractions are good
• if fetus is strong enough for labor: if not, use PITOCIN
• can push fluid in incase amnio fluid isn’t a lot

Question 12

what are Leopold’s Maneuvers? what are the steps? where can you feel the heart beat?

Answer 12

palpating different parts of mom’s abdomen to see placement of fetus
1. feel fundus
- soft = baby’s butt, head is down
2. feel sides of abdomen
- back feels firm
- heart beat can be felt through baby’s back
3. feel mom’s pubis
- firm = baby’s head
4. feel sides of abdomen
- to feel the fetus attitude

Question 13

when monitoring contractions and using the external tocometer, what do we need to measure? what do they mean?

Answer 13

TIMING
- frequency: beginning of one contraction to beginning of next, round to 30 seconds
- duration: beginning of contraction to end of same contraction, round to 10 seconds
STRENGTH
- NOT reliable, ask mom

Question 14

when monitoring contractions and using the internal IUPC, what do we need to measure? what do they mean?

Answer 14

TIMING: same as external
STRENGTH
- measure in Montevideo units (MVU)
- measuring value of height of each contraction for 10 minutes & total it
- adequate = ~200 MVU

Question 15

what does tachysystole mean?

Answer 15

five contractions or more in a 10 min period – correlate fetal heart rate with contraction to evaluate responses to labor

Question 16

what does each component of the FHR mean?

Answer 16

• baseline: range of FHR during a continuous 10 min period of monitoring (110 - 160 BPM)
• baseline variability: how much is it bouncing around? irregular fluctuations in baseline
• accelerations: abrupt increase in FHR
• decelerations: abrupt decrease in FHR
• tachycardia: rate of 160+ BPM IN 10 mins
• bradycardia: rate of 110- BPM for MORE THAN 10 mins

Question 17

how would you describe baseline variability?

Answer 17

irregular fluctuations in baseline is good! normal!
- absent = not good
- minimal = < 5 BPM
- moderate = 6-25 BPM
- marked = > 25 BPM
- sinusoidal pattern = fetal hypoxia

Question 18

what can tachycardia indicate in a FHR?

Answer 18

• early sign of fetal hypoxemia
• maternal or fetal infection: if mom has infection the baby shows signs first
• fetal anemia
• maternal hyperthyroidism
• response to drugs: epidurals can lower BP

Question 19

what can bradycardia indicate in a FHR?

Answer 19

• differentiate from decelerations
• late sign of fetal hypoxia
• drugs
• cord compression
• maternal hypothermia
• maternal hypotension
• tachysystole

Question 20

what are the different types of accelerations based on gestational age?

Answer 20

• 32 weeks & up = 15 BPM above baseline lasting 15 seconds or more
• younger than 32 weeks = 10 BPM above baseline lasting 10 seconds or more
• prolonged = longer than 2 mins less than 10 mins = tachycardia

Question 21

what are the different types of decelerations?

Answer 21

variable = abrupt & random
- this is what PUSHING looks like!

early = symmetrical & associated with contraction
- still okay because of returning back to baseline
- stays around same baseline w/ variability

late = the WORST
- uteroplacental insufficiency
- no variability
- baby is getting worn out
- begins AFTER contraction

Question 22

what are the different category interpretations?

Answer 22

• category i (normal): strong predictor of normal fetal acid base status, routine care –> no action needed
• category ii (indeterminant): not predictive of abnormal acid base status, but not evidence showing category i or iii –> continuous surveillance & re-evaluation
• category iii (abnormal): abnormal fetal acid-base status –> prompt evaluation & action

Question 23

what does VEAL CHOP MEAN?

Answer 23

Variable = Cord compression
Early decel = Head compression
Accel = Okay!
Late decel = Placental insufficiency