L&D II Flashcards by Glen McCormick

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

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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

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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)

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What is the major limitation of EFM?

reduced mobility

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how is EFM used?

can be used intermittent (hook up every hour or every couple of hours for ~20 minutes)

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what does an ultrasound transducer monitor?

fetal HR

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What doe s toco transducer monitor? and where does it monitor it?

monitors contractions at fundus of uterus.

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Where is the ultrasound transducer placed? and how is it found?

back of the baby, palpate using leopolds maneuver.

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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

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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

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what is required to place internal fetal monitoring?

ruptured membranes and cervical dilation of about 2 cm

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what are the two internal fetal monitoring devices?

fetal scalp electrode
intrauterine pressure catheter

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What helps us determine if contractions are strong enough? what do we adjust if theyre too much or inadequate?

intrauterine pressure catheter, adjust pitocin

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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.

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how much is each little box?

10 seconds

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how often do we evaluate strip if in latent stage of labor?

30 minutes

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how often do we evaluate strip if she is actively pushing (unmedicated) or if she is on pitocin?

every 15 minutes.

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What is normal fetal heart rate?
what is bradycardia?
what is tachycardia?

110-160
<110
>160

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Variability:

absent?
minimal
moderate
marked

absent straight line
minimal <6 bpm
moderate 6-25 bpm
marked >25 bpm

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What time frame is the FHR assessed over?

determined in a 10 minute period

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tachycardia is typically seen in __________________________

maternal fever or infection

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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

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what is considered the best indicator for fetal oxygenation?

variability in HR

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What type of variability do we want? and why?

moderate variability, reliably predicts absence of fetal acedemia

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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

, THIS REQUIRES IMMEDIATE INTERVENTION AND MEANS BABY IS VERY COMPROMISED AND NEEDS TO COME OUT. IS IT SHORT LIVED OR IS IT CONSISTENT? IF IT IS CONSISTENT –NOTIFY PHYSICIAN AND GET BABY OUT

sinusoidal is BAD

______________ cycles per minutes over at least 20 minutes Regular in appearance Intermittent or continuous with no accelerations, UA responses, fetal movement with or without stimulation Extremely rare

3-5,

Compromised fetus: ________________________________________________________________________________________________________________________________________________________________________________ Requires immediate attention Can be a sinusoidal appearing pattern from opioid administration Short induration and resolves

severe fetal anemia, twin-twin transfusion, intracranial hemorrhage, infection, hypoxia, gastroschisis, cardiac anomalies. sinusoidal pattern

associated with uterine contractions

periodic

episodic

NOT associated with uterine contractions

Acceleration desired point for greater than 32 weeks?

15 x 15

Acceleration desired point for less than 32 weeks?

10 x 10

accelerations are associated with?

fetal movement, vaginal examination, contractions, mild cord compression, breech presentation

what is the time frame to be considered prolonged for accelerations?

greater than 2 minutes

what is the time frame for a baseline change for accelerations required to be?

greater than 10 minutes

if mom is coming in for a NST, where do we want their cotractions to be at ?

15x15

is a great indicator to see if baby is doing well –when baby is moving ____________________ can occur –will sometimes have ___________________ during contractions

accelerations, accelerations

Are early decelerations periodic or episodic? what is the onset to nadir time frame? what causes them? should we be worried about early decelerations? do position changes affect HR?

periodic, greater than 30 seconds, fetal head compression, not indicative of fetal compromise, position changes do not affect FHR with early decels

Are late decels periodic or episodic? what is the onset to nadir? what causes late decels? when do they begin? when do they end? what do we do?

periodic. greater than 30 seconds, impaired O2 causes late decels, begin after contraction peak, return after contraction is over. requires nursing interventions

when are late decels most concerning? what do late decelerations tell us there is a problem with?

if theyre recurrent. problem with placenta.

which type of decelerations mirror contractions? is it good to be early or late?

early decels. always good to be early.

When are late decels most concerning?

if 50% or more of contrations in 20 minutes

Are variable decelerations periodic or episodic? what is the onset to nadir? what causes them? what do we do?

can be either periodic or episodic. onset to nadir is less than 30 secons with at least 15x15. caused by reduced flow through umbilical cord (compression, knot, (armpit can cut off)). might need position changes.

are prolonged decelerations periodic or episodic? what is the time criteria for prolonged deceleration? what does prolonged deceleration indicate?

can be either. 2 minutes to 10 minutes from onset to return to baseline. ord prolapse.

how are montevideo units calculated?

intensity minus resting tone

where do we want resting tone to be at?

10 mmHg

greater than ______ is considered hypertonus and we do not want this –means were not relaxing well

20-25 mmHg

tachy systoly –more than___ contractions in a ________ period

5, 10 minute

what do we want to do if there is a change in the strip?

assess cervical dilation

What is the first intervention for late decelerations?

REPOSITION MOM, check SVE, assess

What is the first intervention for a prolongued deceleration?

REPOSITION MOM, Check SVE, assess

samples of cord blood are drawn from what first and then what?

artery and then vein.

tells us status at the time of ________ will do if theyre a __________

cord blood sample delivery, category III

when should first time moms come in?

contractions less than 5 minutes apart for one hour

when should multipara mothers come in?

when contractions are 10 minutes apart for one hour

When should they come to the birth center?

Contractions regular 5 minutes apart lasting 1 minute for 1 hour ruptured membranes -gush trickle of fluid from the vagina with or without contractions bright red bleeding decreased fetal movement concerns that something may be wrong

What are signs of impending birth?

grunting sounds bearing down urgency to push screaming rocking

_________________________ amniotic fluid is concerning. ___________________________ –can indlicate coriamnioitis (infection).

green or meconium stained, yellow or cloudy or fould smelling

what labs do you want to get for a mom?

CBC, UA, UDS, type and screen

what size of IV do you want to get?

18 g

WHAT IS THE BIGGEST NURSING INTERVENTION YOU CAN DO TO HELP LABOR PROGRESS?

positioning and movement every 30 minutes to 1 hr

what are inductions associated with?

higher C section rate

what is the difference between induction and augmentation? What is special about induction?

induction –not in labor and we schedule a time to cause her to go into labor. induction is not allowed until 39 weeks. augmentation –patient was laboring –but then has stopped –then we give her meds to continue labor

how long do they have to deliver after amniotomy? when will they start antibiotic ?

24 hours, 12 hrs

what are induction and augmentation techniques?

misoprostol balloon catheter membrane stripping (48 hrs after done usually deliver) hydroscopic inserts -dried seaweed or laminaria

How is oxytocin given?

low and slow. 0.5 -2 milliunits/min and increase 1-2 increments q 15-40 minutes. given as a piggyback