Management Of The FIRST STAGE Of LABOR (EFM) Flashcards
Part of Patient Preparation
Admit when _____
What to hook on the patient
What to do on PE
Place the patient on ____, ____, _____, ____
Admit the patient if she is having 1) contractions and 2) cervical dilatation of 3-4 cm - nasa active phase na
Hook the patient EFM - Labor Admission Test
PE: Do an IE with Clinical Pelvimetry to assess the 3 Ps (especially adequacy of passages)
Place the patient on the ff:
NPO (6-8 hrs in rel. to anesthesia), NSS, Analgesia, Lab Tests
What PE will you do the 1st stage of labor?
IE + Pelvimetry + Assessment of the 3 Ps
This monitors changes in the fetal heart rate pattern in relation to magnitude of the strength of uterine contractions
Electronic Fetal Monitoring (EFM)
An adequate EFM strip is at least _____ minutes?
Should be checked after contractions every ______ minutes in the 1st stage of labor (cervical dilatation) and every _____ on the 2nd stage (fetal expulsion)
20 minutes
30 mins - 1st stage
15 mins - 2nd stage
EFM: Parameters to identify
For FETAL COMPONENTS*
For MATERNAL COMPONENTS*
Fetal components (fetal heart rate) BVAD
- Baseline FHR
- Variability
- Accelerations
- Decelerations
Maternal components (uterine contractions)
- Duration
- Interval
- Intensity
How would you detect the BASELINA FHR sa tracing?
The approximate mean fetal heart rate which recurs in a 10-minute segment excluding decelerations, accelerations, contractions and periods of marked variability
Look at an area of the tracing which is LEAST VARIABLE
sustained for at least 2 minutes
Normal value of BASELINE FETAL HEART RATE
For term and preterm
Term: 110-160 bpm
Preterm: 160 bpm
Fetal bradycardia is _____ bpm for _____ minutes
What is management?
Fetal tachycardia is _____ bpm for _____ minutes
What is management?
Fetal tachycardia is >110 bpm for 10 minutes
DELIVER/TERMINATE PREGNANCY
Fetal tachycardia is >160 bpm for >10 minutes
INTRAUTERINE RESCUCITATION
Most important parameter as it reflects CNS activity
Baseline Variability - fluctuations in the baseline FHR that are IRREGULAR in AMPLITUDE and FREQUENCY
Define Minimal vs. Moderate vs. Marked Variability
Change in baseline FHR
Minimal - <5 bpm
Moderate - 6 to 25 bpm
Marked - > 25 bpm
Wave-like undulating pattern with a cycle frequency of 3-5 bpm that continues for at least 20
Mins or more with loss of variability.
This would mean what?
What is the treatment?
SINUSOIDAL FHR PATTERN
Ominous sign of fetal anemia à do CS
Define Accelerations:
AOG >32 weeks: Increase in FHR of at least 15 mins or more above the baseline for at leasdt 15 secs to 2 mins
AOG <32 weeks: Increase in FHR of at least 10 mins or more above the baseline for at least 10 secs to 2 mins
What happens if Accelerations are already sustained for >10 mins?
Change in Baseline FHR
Presence of acceleration in the intrapartum period is indicative of ___________
reactive and a healthy fetus
Define “Decelerations”
Visually apparent, symmetrical & gradual decrease in baseline FHR of ≥15 bpm lasting for ≥15 seconds
Begins with the onset of a contraction, nadir occurs
with the peak of the contraction, and recovery occurs
in conjunction with the end of the uterine contraction
EARLY DECELERATION
Looks like a “mirror image” of the graph of uterine
contractions below it
What causes early decelerations?
HEAD COMPRESSION —> inc. ICP —> stimulation vagus nerve —> dec. Cardiac chronotropy —> dec. Blood flow to brain to dec. ICP
This is a normal finding especially if the fetus is descending from the pelvic canal
This is a normal finding especially if the fetus is descending from the pelvic canal
Early deceleration :)
Late deceleration is delayed (___ to ___ secs) in timing, with the nadir of the deceleration occuring AFTER the peak of contraction
Delayed 10 to 30 secs in timing
——V—— (FHR)
___/\_______(Contraction)
What causes LATE DECELERATIONS?**
Explain this really well kasi it will save you a lot in the long run
What is the management?
UTEROPLACENTAL INSUFFICIENCY
Deprivation of fetal O2 —> fetus uses up its utero-
placental reserve of O2 —> vascular chemoreceptors send signals to the heart to decrease HR to CONSERVE O2 —> late decelerations because chemoreceptors need to reach a threshold first
Intrauterine rescucitation
INTRAUTERINE RESCUCITATION
- how would you go about it?
- how many minutes?
- Left lateral decubitus
- Rapid IV infusion of 200-300 cc of non glucose crystalloid (NSS)
- Maternal o2 supplementation at highest FiO2 (high flow O2)
- Discontinue Oxytocin, give SC/IV Terbutaline 250 mcg to inihibit uterine contractions
- IE to r/o Cord Prolapse - incase of prolapse, manually elevate the presenting part while preparing for delivery
Rationale on why you would do Left Lateral Decubitus if (+) late decelerations
Relieve compression of IVC by the gravid + dextrorotated uterus
Positioning to increase blood flow
promote fetal oxygenation
When you discontinue Oxytocin on Late Decelerations, what would replace it with?
SC/IV Terbutaline 250 mcg to inhibit uterine contractions
This deceleration occurs before, during or after the contraction or even without contractions
What causes this?
Management?
Variable decelerations
-cause by CORD COMPRESSION (the baby is compressing the cord) and sudden variable cessations in umbilical blood flow.
Deliver if persistent despite resuscitative measures
