Monitoring FHR & Uterine Contractions Flashcards
What is purpose of monitoring the baby with FHR monitor?
Assessing how well a baby is being oxygenated
Hypoxemia
Not enough oxygen in the blood
Hypoxia
Not enough oxygen to cells/tissues
Types of FHR monitoring
Intermittent
Continous
Intermittent
no permanent record
fetoscope
doppler
Continuous
Two different types of continuous monitoring?
permanent record is stored
External - over uterus and back w transducer
Internal - inside the uterus w scalp electrode
Fetoscope used what to monitor hr?
bone conduction
Three ways to monitor uterine contractions
Manual
External
Internal
Manual contraction monitoring
Finger tips over fundus or top of uterus during contraction
Palpate and feel firmness then relexation to pick out contraction
Different descriptions for contractions for manual monitoring
Mild
Moderate
Board
mild - cheeks
moderate - chin
board - forehead
External monitoring for contractions/activity
tocotransducer over the fundus
Internal monitoring defintion
what does it require?
IUPC going up uterine cavity to directly measure contraction
membrane must be ruptured already
some cervical dilation - 2 cm or more
Where should a FHR belt be placed on fetus? Will this be on top or bottom of belly?
On the fetus back.
Bottom
Where does the contraction monitoring system belt (external tocotransducer) go on the belly?
On fundus or top of belly
Note: has pressure button
When discussing why your patient might want to use the external electronic monitoring system for contractions , what advantages do you mention?
Where do we save the strips?
Noninvasive so no surgery
It’s relatively easy to put in place
Can be used anytime even if membrane is non-ruptured yet
You can take it off (but must be left on for 20 min) or leave it on to provide a permanent continuous recording
Saved in records and go into salt mines
What disadvantages are there to electronic monitoring of contractions?
Must compare what you feel vs what the strip says
Belt can be uncomfortable
May have to readjust
Can inhibit movement
When discussing an internal electronic contraction monitoring device, what advantages do you mention?
More accurate of uterine contractions and timing
Provides pressure measurement for contraction intensity and relaxation
Permanent record
Will they start out as internal or external?
External first but then provider will choose internal
BUT you can have a combination
Disadvantages of using an internal electronic heart monitor like the electrode?
Infection
Injury
Need membrane to be ruptured
Sufficient cervical dilation
What is the name of an external heart rate monitor?
fetal ultrasound doppler
Leopold’s Maneuvers
First
Second
Third
Fourth
First check for soft rounded area at top for baby’s butt
Second, slide hands down to feel a smooth back & then knobby edges for elbows and hands on the other side
Third, move hands down to feel round head
Feel the back and head again to know where to put the ultrasound HR transducer
Baseline FHR is what interval?
How is it baseline FHR found?
Where do you round it to?
What is normal?
RR interval of QRS complex
Found by average FHR during 10 min
Round to increments of 5 bmp
Normal is 110-160
Mistake made when trying to read FHR?
Cana accidentally take moms HR.
Clue: if the fhr shows up slower, then take moms HR too.
What can cause FHR changes?
Episodic changes not bc of contractions like exam or some form stimulation
Periodic changes that have to do with contractions
What does a strip look like?
Bold lines
squares
Upper bar is HR
Lower bar is fetal activity and contractions
mmHg
bold lines indicate 1 minute
squares are 10 seconds
How to find mean of HR strip?
So look at highest moments and lowest moments and divide by two
Are fluctuations bad when looking at the strip?
No not usually. Some fluctuation is a variability and is good.
Uterus at rest means
in between contractions
Bradycradia in fhr
Tachycardia in fhr
What if change is less than 10 min?
FHR lower than 110 for 10 minutes
FHR higher than 160 for 10 min
Just a baseline fetal hr change
Causes of bradycardia part 1
abruptio placenta
congenital heart block
Fetal arrhythmia
Late fetal hypoxia
Causes of bradycardia part 2
Maternal Hypotension
Maternal hypothermia
Prolonged umbilical cord compression that reduces vagal stimulation
causes of bradycardia part 3
Uterine hyperstimulation
uterine rupture
vagal stimulation during pushing of labor
Tachycardia causes part 1
Amnionitis or inflammation of amnion
Beta sympathatic drugs that stimulte HR
Early fetal hypoxia (HR compensates)
Tachycardia causes part 2
Fetal anemia
Fetal dysrhythmias
Tachycardia causes part 3
Maternal dehydration
Maternal fever
Maternal hyperthyroidism
Variability
Which creates
Measures the sympathetic and parasympathetic NS causing HR to rise and fall
Creates fluctuations in baseline FHR that are irregular
sympathetic ns
raises hr
parasympathetic ns
drops hr
How are variability fluctuations evaluated
Does this include acceleration and deceleration
Peak to trough
Excludes them (meaning it is period between contractions when nothing is going on… I think)
Variability classifications and ranges
absent or none
minimal or small so less than 5
moderate or normal which is 6-25
marked or greater than 25 bpm
If a strip goes from 120 to 150 then that is what type of varaibility
Marked or it should be… idk need to doube check
Causes of decreased variability
Reminder: This isn’t necessarily a bad sign - just that their activity is less.
Baby could be asleep - which is leading reason
Hypoxia and acidosis
CNS depressants drugs
immature fetus below 32 weeks
cardiac anomalies
previous neuro insult - such as certain drugs causing a stroke in the baby that is permanent and so won’t have normal HR resposne
prematurity
tachycardia - you lose varaibility of HR is too fast
Causes of marked or extremely noticeable varaibility
early mild hypoxia to compensate for something
Fetal stimulation of autonomic ns
What are accelerations of FHR?
Are they bad?
How long does it last
Abrupt increase in FHR about baseline
No, these are not bad. They’re good. Just means they’re moving.
Last less than 30 seconds
Pre-term baby under 32 weeks acceleration rule
Rule for baby over 32 weeks
Rule of tens for pre-term under 32 weeks
Rule of 15
What if you don’t see any accelerations?
Try to stimulate them
move them in uterus
drink something cold
Probably just be sleeping.
How do we count accels on graph?
Check the squares. If it is less than 15 for older babies it is just movement. (or 10 if premie)
Can an accel happen during contractoin?
Yep and before & after. No specific time.
What is a Deceleration?
Abrupt slowing of FHR
Types of decelerations
Extra type?
Early
Late
Variable
Prolonged (longer than 2 min)
And then there is a way to describe all of these which is Recurrent which just means they happen half of contractions
Early Decelerations
How are these rt contractions?
Slowing on strip and you can also hear the HR slow if listening
When the contraction is building, the HR is slow.
Nadir meaning
low point of HR
Number one cause for early decelerations? How?
Head compression
Causes vagel stem response to slow HR
When should you expect early deceleration?
Early stages of progressing labor as head comes down birth canal
Should you have to do interventions for early deceleration?
Nothing really. Just document.
Will the strip showing the deceleration coincide with anything on the graph?
Yes - the contractions. And then hr will raise when contraction is over. A fragile picture.Onset & offset will be parallel
Late decelerations cause?
What may mom’s hx look like?
There is a deceleration of HR that has something to do with the placenta
Hypertensive, diabetic, post due mother could cause this to happen since placenta can’t get oxygen. Check mom’s history
When will a late deceleration happen in relation to contractions?
What shift will occur on the strip?
Onset of deceleration in lates will happen after the contraction begins & it will only recover after the contraction ends.
The strip of the HR will be shifted to the right of the contractions
What is the state of the baby then if you’re having late decelerations? Why?
The baby is stressed but this is only specific to late decelerations.
Impaired perfusion to placenta, stimulates receptors to cause a parasympathetic response which lowers HR
Causes of Late decelerations
hypotension in mom
hypertension or diabetes in mom
Uterine tachysystole
Placenta issue such as rupture or previa
Old placenta bc fetus is past term
Interventions for Late decelerations
Stop oxytocin : If late decels are occuring & you see oxytocin on their MAR
Change maternal position - extreme side lying.
Treat hypotension with IV fluids or elevate legs
Palpate uterus for tachysytole
Administer O2 in non-rebreather mask
Alert doc
Give pt and family explanation
Assess cervical status
Consider internal monitoring
Prepare for C section if nothing else works or do a crash rescue
Prolonged Deceleration time range
Last more than 2 min but less than 10 min
Prolonged Deceleration causes (6)
Cord compression Fetal vagal stimulation maternal hypoxia maternal hypotension occult cord prolapse uterine hyperactivity
Variable Deceleration
Can these occur with contractions?
What shape on strip?
Not the same as variability
Abrupt and quick decel in HR. Very noticeable and drops more than 15 bpm.
Can happen during, before, or after contractions
Shape is U, W,V
Main cause for variable deceleration?
Cord is compressed
Could be around neck, shoulder, just compressed. Maybe they grab a hold of it.
Why is a recurrent variable deceleration a concern?
It means there are many moments when the baby can’t get oxygen
Order of interventions for variable decelerations?
Change moms position to get baby off the cord.
Get a o2 mask going
Fluid bolus
tell physician
A more invasive procedure to help with variable decels if ruptured?
Amnioinfusion- just place a tube up uterine cavity to get more fluid into sac if ruptured This way more fluid surrounds the cord and keeps it safer from compression through pressure
What if there is no improvement with variable decelerations?
Must do a c-section
Concerning tracings
abnormal FHR
Late decelerations
Variable decelerations
Absence of variability
prolonged decels
lack of accels
bradycardia
t
tachycardia
Methods to stimulate the fetus
Stimulate fetal scalp
Use sound
Use light hologen
How to go about interpreting a strip in the right steps
Determine baseline
Determine variability
Accels
Any period or episodic changes
Any decels and what kind?
Category 1 strip
A category of strip for a totally normal fetus
normal baseline moderate varaibility can have accels & no fariable or late decels early decels could be there no intervention
Category 2 strip
baseline is brady or tachy variability isn't a moderate no accels after stimulation decels are variable or late and could be prolonged
So some slight abnormalities
Category 3 strip
Absent variability no accelerations with stimulation recurrent decels brady sinusoidal pattern
Need to do intervention immediately!
Resuscitate fetus
Can only do a C section if at this point
Uterine contractions are normal if
less than 5 contractions in in 10 minutes
Tachysytole contraction defintion
Why are these bad?
More than 5 contractions in 10 minutes & this is stressful to the baby bc they can’t relax and get oxygen
Fetus holds breath during contraction
What is the nurses responsibility?
Document and report findings
Cord Blood Analysis
ph range
trend
Check pH of blood
7.25-7.40
arteries have used deoxygenated
veins are oxygenated
So flipped ABGS
VEAL CHOP
variable decels Cord compression
early decelerations head compression
accelerations OK
late decels placenta issue
