L&D II Flashcards
Purposes of Fetal Surveillance
How is fetus ____________ labor?
___________ status
Two approaches to intrapartum fetal monitoring
____________________________________ (low tech)
______________________ (high tech)
tolerating, Oxygenation, Intermittent auscultation with palpation of uterine activity, Electronic fetal monitoring - EFM
What are disadvantages to intermittent auscultation and palpation?
1-1 nursing care
Not always ideal
Can’t assess patterns of FHR variability, periodic or non-periodic changes
No permanent, documented visual record of FHR or UA
What type of pregnancy is appropriate for intermittent auscultation and palpation?
low risk, THIS IS ONLY APPROPRIATE FOR A MOM WHO IS LOW RISK (NOT FOR PRE ECLAMPSIA, GESTATIONAL HYPERTENSION ETC)
What is the major limitation of EFM?
reduced mobility
how is EFM used?
can be used intermittent (hook up every hour or every couple of hours for ~20 minutes)
what does an ultrasound transducer monitor?
fetal HR
What doe s toco transducer monitor? and where does it monitor it?
monitors contractions at fundus of uterus.
Where is the ultrasound transducer placed? and how is it found?
back of the baby, palpate using leopolds maneuver.
What are advantages or internal fetal monitoring?
Accurate FHR
Maternal position changes does not effect quality of tracing
Possibility of displaying ECG
Only true measurement of ctx
Allows for amnioinfusion
What are limitations of internal fetal monitoring?
Requires rupture of membranes
Cervix must be dilated
Improper insertion can cause trauma (vaginal lacerations, uterine perforation, placental abruption)
Presenting part must be identifiable
Increased risk of infection
what is required to place internal fetal monitoring?
ruptured membranes and cervical dilation of about 2 cm
what are the two internal fetal monitoring devices?
fetal scalp electrode
intrauterine pressure catheter
What helps us determine if contractions are strong enough? what do we adjust if theyre too much or inadequate?
intrauterine pressure catheter, adjust pitocin
Who places intra uterine pressure catheters? why is this? who places fetal scalp electrodes
physicians place IUPC (nurses can with training) -possibility for placental abruption and uterine rupture.
nurses place fetal scalp electrode.
how much is each little box?
10 seconds
how often do we evaluate strip if in latent stage of labor?
30 minutes
how often do we evaluate strip if she is actively pushing (unmedicated) or if she is on pitocin?
every 15 minutes.
What is normal fetal heart rate?
what is bradycardia?
what is tachycardia?
110-160
<110
>160
Variability:
absent?
minimal
moderate
marked
absent straight line
minimal <6 bpm
moderate 6-25 bpm
marked >25 bpm
What time frame is the FHR assessed over?
determined in a 10 minute period
tachycardia is typically seen in __________________________
maternal fever or infection
in order to determine a baseline rate –has to be that way for at least _________________. if you cannot get it for __________________steady, you document “indeterminant” –this is pretty rate
2 minutes, 2 minutes
what is considered the best indicator for fetal oxygenation?
variability in HR
What type of variability do we want? and why?
moderate variability, reliably predicts absence of fetal acedemia
if you have consistently absent, or minimal variablitiy –indicative of _____________________
lack of oxygen
________________can be normal response for a short period of time when o2 is interrupted –if you have is for a while it can indicate they might come out in _____________________
marked variability, respiratory distress