Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Appreciating Complex Midwifery Care > Monitoring Complex Labour > Flashcards

Monitoring Complex Labour Flashcards

1
Q

What can cause a complex labour think? MOTHERS

A 
Meconium 
Oxytocin 
Temperature 
Hyperstimulation/Haemorrhage
Epidural 
Rate of progress
Scar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

100-109 beats as baseline is considered as…

A

non-reassuring (continue usual care if variability is normal and there are no variable or late decelerations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

160-180 beats as baseline is considered as…

A

NO OTHER NON- REASSURING features and no maternal tachycardia or pyrexia – continue (uncomplicated tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

<100 beats or >180 as a baseline is considered as …

A

abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can the sympathetic system have an influence on the baseline rate.

A

Increase in heart rate through direct nerve impulses and indirectly through catecholamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can the parasympathetic system have an influence on the baseline rate.

A

decrease heart rate through the release of acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5-25 beats in variability is considered as…

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

5 beats for >30mins but < 50mins

A

non-reassuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5 beats for >50mins

A

abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

25 beats

A

(salutatory)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

25 beats ) for >15mins but <25mins

A

non-reassuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 3 associated factors that could influence the variability of a CTG

A 
Fetal sleep – cycling indicative of an intact CNS
Maternal opiates 
Fetal hypoxia
Pre-existing fetal brain damage 
Cardiac arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is suspected with reduced variability in conjunction with tachycardia and decelerations?

A

high suspicion of fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the basic characteristics of sinusoidal traces

A
  • Stable baseline of 120-160bpm with regular sine-wave oscillations
  • Amplitude of 5-15bpm
  • Frequency of 2-5 cycles/minute
  • Reduced or absent baseline variability
  • No accelerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What can a Smooth or typical – rounded, symmetric in shape in trace indicate?

A

fetal thumb sucking,
some narcotics,
fetal anaemia secondary to rhesus isoimmunization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can a Jagged or atypical – saw-tooth trace indicate?

A

fetal hypoxia and acidosis, sudden loss of fetal blood volume – fetomaternal haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are Accelerations?

A

An Increase of at least 15 beats for at least 15 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is Accelerations more frequent?

A

Occurs most frequently during fetal activity
–Generally a sign the baby is healthy
–Absence in an otherwise normal CTG is not indicative of acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are Decelerations?

A

Drop in the FHR of at least 15beats for at least 15 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the two types of deceleration?

A

reflex and effect of hypoxia on myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Reflex – low levels of O2 as a result of…

A

placental bed perfusion impairment – compression of uterine vessels
•Head compression
•Cord compression which increases stimulation of vagus nerve (parasympathetic nervous system),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the effect of hypoxia on heart?

A

Severe or prolonged shortage of O2 may affect myocardium which ceases to contract efficiently and the FHR falls

23
Q

Name 4 characteristics of early decelerations

A

-Uniform
–Repetitive
–Starts at beginning of contraction and returns to baseline by the end of the contraction
–Nadir of deceleration corresponds to peak of contraction
– head compression(Relatively rare – only in late 1st and 2nd stage of labour)

24
Q

Name the characteristics of Variable decelerations.

A

-Vary in shape, form and timing
–Most common >85%
–Classified as concerning and un-concerning

25
Q

Name the characteristics of un-concerning variable decelerations

A

last <60 sec & <60 bpm

have shoulders

26
Q

Name the characteristics of concerning variable decelerations

A

Lasts >60 sec, decreased variability within deceleration
•Failure to return to baseline, biphasic
•No shouldering

27
Q

What is considered as a reassuring variable decelerations ?

A

Variable decelerations with no concerning characteristics for <90mins

28
Q

What is considered as a Non-reassuring variable decelerations ?

A

Variable decelerations with no concerning characteristics for >90mins

Variable decelerations with concerning characteristics with <50% contractions for >30mins

Variable decelerations with concerning characteristics with >50% contractions <30mins

29
Q

What is considered as a Abnormal variable decelerations ?

A

Variable decelerations with concerning characteristics with >50% contractions for >30mins (less if maternal or fetal risk factors – vaginal bleeding or significant meconium)

30
Q

Name four characteristics late decelerations

A

Occurs mid to late in contraction

Nadir at least 20 seconds after peak of contraction

Return to baseline after contraction ceased

Similar shape to contraction

Related to hypoxaemia, hypercarbia and acidosis

Placental insufficiency

31
Q

What is considered as Non-reassuring late deceleration?

A

With >50% contractions and <30mins (no maternal or fetal risk factors – mec or bleeding)

32
Q

What is considered as Abnormal late deceleration?

A

With >50% contractions and >30mins

33
Q

How long does a Prolonged decelerations or acute hypoxia last for?

A

lasts at least 3mins

34
Q

Name the 4 types of ways to manage a prolonged deceleration

A

Exclude placental abruption, uterine rupture and cord prolapse

May be secondary to uterine hyperstimulation or tonic contraction or hypotension

Give IV fluids and stop oxytocin or give tocolytic

35
Q

What is the Rule of 3s?

A

3mins – call for help

6mins – prepare for transfer to theatre

9mins – in theatre

12mins – have started LSCS

36
Q

FUN FACT!!!

A

Always abnormal but action dependent on cause and assessment of CTG before and after incident

37
Q

What is considered as a NORMAL DR C BraVADO ?

A

All features reassuring

38
Q

What is considered as a SUSPICIOUS DR C BraVADO ?

A

1 feature non-reassuring and 2 features reassuring*

39
Q

What is considered as a PATHOLOGICAL DR C BraVADO ?

A

1 feature pathological OR 2 features non- reassuring*

40
Q

What are 8C’s of physiological approach to CTG interpretation?

A 
Clinical picture
Cumulative uterine activity
Cycling of FHR
Central organ oxygenation
Catecholamine surge
Chemo- or baroreceptor mediated decelerations
Cascade
Consider the next change on the CTG trace
41
Q

What is subacute hypoxia?

A

Defined as when the HR spends more time decelerating than at the baseline
Iatrogenic cause = uterine hyperstimulation

42
Q

What are the steps to a evolving hypoxia ?

A 
Normal CTG 
decelerations 
loss of accelerations catecholamines released 
raising baseline 
reduced variability 
baseline instability 
terminal bradycardia 
fetal demise
43
Q

what does Acidaemia mean?

A

low blood pH

44
Q

what does Acidosis mean?

A

low blood and tissue pH

45
Q

What does Base Excess/Deficit mean?

A

measure of how much buffer has been used

46
Q

What does Hypoxia?

A

low O2 levels in tissues

47
Q

What does Hypoxaemia mean?

A

low O2 tension in blood (low pO2)

48
Q

What does Metabolic acidosis mean?

A

low blood pH and high base excess due to the accumulation of CO2 and H+ ions using up buffers

49
Q

What does Respiratory acideamia mean?

A

low blood pH due to the accumulation of CO2

50
Q

What does Low pH and a normal BE cause?

A

respiratory acidaemia (accumulation of CO2 through impaired gas exchange)

51
Q

What does Low pH and an abnormal BE cause

A

combined respiratory and metabolic acidaemia (accumulation of CO2 through impaired gas exchange and the build up lactate and H+ ions through anaerobic metabolism)

52
Q

what does it mean If there is a large arterial – venous difference in pH?

A

acidaemia is likely to have occurred in the 2nd stage or if LSCS before full dilation an acute event or cord compression

53
Q

what does it mean If there is a small arterial – venous difference in pH?

A

acidaemia is likely to be longstanding

Appreciating Complex Midwifery Care (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions