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NUNA 693 Obs/Regional > OB: FHR monitoring > Flashcards

OB: FHR monitoring Flashcards

1
Q

Historically labor puts the fetus at increased risk of ____ and _____

A

morbidity and mortality

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2
Q

Neonatal outcomes have drastically improved in the last ___ ____ in developing countries

A

40 years

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3
Q

In developing countries intrapartum stillbirths account for as many as ____ % of stillbirths

A

50

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4
Q

Developed countries ____ ____ are rare, less than 10% of stillbirths

A

intrapartum stillbirths

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5
Q

The WHO reports that ___ of all deaths in children under 5 are due to intrapartum stillbirth. (Livingston, 2014)

A

10%

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6
Q

High risk mothers constitute ____% of the pregnant population

A

20%

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7
Q

(high risk mothers) Their babies represent 50% of the cases of perinatal _____ and _____

A

morbidity and mortality

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8
Q

High risk pregnancies:

_____ complications
_____ complications
_____ complications

A

Medical complications (HTN, pre-E, diabetes, autoimmune, hemoglobinopathy)
Fetal complications (IUGR, nonlethal anomalies, prematurity, multiple gestation, post-datism, hydrops)
Intrapartum complications (bleeding, maternal fever, meconium-stained amniotic fluid, oxytocin augmented labor)

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9
Q

Intrapartum Fetal Assessment -

____ ____ ____ ____ Monitoring
Not a specific predictor of fetal wellbeing
No optimal while still practical method has been developed

A

Electronic Fetal Heart Rate

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10
Q

Intrapartum Fetal Assessment -

Neuronal and humoral factors affect the intrinsic FHR
Fetal parasympathetic outflow → ___________FHR
Fetal sympathetic activity → _________ FHR

A

decreases
increases

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11
Q

Intrapartum Fetal Assessment -

______ respond to increased BP

A

Baroreceptors

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12
Q

Intrapartum Fetal Assessment -

Chemoreceptors respond to decreased ____ and increased ____

A

PaO2
PaCO2

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13
Q

External vs Internal Monitoring -

FHT and uterine contractions are monitored _____

A

simultaneously

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14
Q

External vs Internal Monitoring -

This allows for a determination of a baseline rate and patterns of FHR compared to _______

A

contractions

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15
Q

External vs Internal Monitoring -

The external FHR transducer uses ____ _____ to detect changes in ventricular wall motion and blood flow through major vessels

A

doppler ultrasonography

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16
Q

External vs Internal Monitoring -

Alternatively, a scalp ECG lead measures the ____ interval

A

R to R

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17
Q

External vs Internal Monitoring -

Both allow for ___ ___ monitoring

A

continuous FHR

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18
Q

External vs Internal Monitoring -

The external tocodynamometer measures contractions while ____ ____ on the fundus

A

sitting externally

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19
Q

External vs Internal Monitoring -

An ____ ____ ____ (___) measures exact pressures in the uterus

A

intrauterine pressure catheter (IUPC)

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20
Q

External vs Internal Monitoring -

IUPC is more accurate regarding the ____ of contractions

A

strength

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21
Q

Methods to Improve FHR Monitoring -

Continuous FHR monitoring – requires patient to be ____ a ____ ____ of the base

A

within a few feet

22
Q

Methods to Improve FHR Monitoring -

_____ – Allows for more movement and ambulation

A

Telemetry

23
Q

Methods to Improve FHR Monitoring -

Electronic recording – eliminating the need for ____ ____ (medicolegal implications)

A

paper record

24
Q

Uterine Contraction Pattern -

A normal pattern of contractions is ___ ___ ___ in a __-____ period averaged over 30 minutes

A

5 or less
10-minute

25
Q

Uterine Contraction Pattern -

_____ is more than 5 contractions in a 10-minute period

A

Tachysystole

26
Q

Uterine Contraction Pattern -

The Toco ___________ the onset, duration, and offset of contractions

A

approximates

27
Q

Uterine Contraction Pattern -

An IUPC can measure the ____________ of contractions and __________ onset and offset of each contraction

A

strength
precise

28
Q

FHR assessment: (4)

A
  • baseline measurements
  • variability (long term and beat-to-beat)
  • accelerations
  • decelerations (and their association with uterine contractions)
29
Q

Baseline Fetal Heart Rate -

Normal baseline FHR is ___-____
Term fetuses have a ____ baseline FHR than preterm

A

110-160 bpm
lower

30
Q

Baseline Fetal Heart Rate -

_____cardia is the initial fetal response to hypoxia

A

brady

31
Q

Baseline Fetal Heart Rate -

Prolonged hypoxia may result in fetal _____cardia
Due to catecholamine _____ and SNS ____

A

tachy
secretion
activity

32
Q

Baseline Fetal Heart Rate -

Changes in baseline FHR may also be caused by fetal anatomic or functional heart pathology, maternal fever, intrauterine infections, maternally administered medications (____ ____ – terbutaline, or _______ - atropine)

A

beta agonists
anticholinergic

33
Q

Fetal heart Rate Variability -

fluctuations in FHR is ______

A

GOOD

34
Q

FHR variability -

_____ variability indicates presence of intact fetal cerebral cortex, midbrain, vagus nerve, and cardiac conduction system

A

Normal

35
Q

FHR variability -

Variability greatly influenced by _____ tone

A

parasympathetic

36
Q

FHR variability -

Hypoxemia fetal myocardial and cerebral blood flow ____ to maintain O2 delivery and a loss of FHR _____ is observed

A

increase
variability

37
Q

Accelerations -

____ changes in FHR above baseline

A

Abrupt

38
Q

Accelerations -

Defined as at least ____ beats above baseline for at least ____ seconds

A

15
15

39
Q

Accelerations -

Prolonged acceleration is >__ ____, but if it persists >__ _____ it is a change in baseline

A

2 minutes
10 minutes

40
Q

Accelerations -

______ accelerations correspond with fetal movement, _____ the significance is unclear.

A

Antepartum
intrapartum

41
Q

Accelerations -

Accelerations preclude the existence of fetal ___ ____

A

metabolic acidosis

41
Q

Decelerations - Early

A

Occur simultaneously with uterine contractions
Usually less than 20 bpm below baseline
Onset and offset mirrors contraction
Uniform in appearance
Head compression

42
Q

Decelerations - variable

A

Vary in depth, shape, duration
Abrupt onset and offset
Vagal activity
Umbilical cord occlusion (partial or complete)

43
Q

Decelerations - Late

A

Occur with each uterine contraction
Uniform appearance
Begin 10-30 seconds after contraction begins
End 10-30 seconds after contraction ends
Vary in depth according to the strength of contraction
Placental issues
Ominous when accompanied by lack of variability
Severe if decrease more than 45 bpm

44
Q

VEAL
CHOP

A

variable = cord compression
early = head compression
acceleration = okay
late = placental insufficiency

45
Q

Abnormal FHR patterns -

Saltatory pattern:
_____ alterations in variability
Acute fetal ____
Weak association to ___ Apgar scores

A

Excessive
hypoxia
low

46
Q

Abnormal FHR patterns -

_____ pattern:
Fetal anemia
Occasional maternal opioid consumption

A

Sinusoidal

47
Q

Anesthesia Implications -

Rule out _____ intervention as the cause
If it is related to anesthetic – correct _____
If epidural level is higher than necessary, let it ____

A

anesthetic
hypotension
recede

48
Q

Anesthesia Implications -

If there are ___ _____ FHR tracing during preanesthetic assessment, consider whether anesthetic intervention could worsen fetal status. Discuss with OB

A

non reassuring

49
Q

Anesthesia Implications -

When an ____ ____ ____ is called, be prepared (already ready) to move quickly

A

emergent cesarean delivery

50
Q

Anesthesia Implications -

If a labor epidural is already in place determine if it can be adequately dosed and utilized for cesarean…. ask yourself what

A

Is it patchy?
Will the patient/fetus tolerate additional local anesthetic to achieve an adequate level?
How quickly can adequate level be achieved?
What is the probability of block failure?
Would a SAB behoove the situation?
Would it make things worse?

51
Q

KEY POINTS

A _____ FHR accurately predicts fetal well being
A _____ FHR is not specific in the prediction of fetal compromise (false positive)
_____ prolonged bradycardia or late decelerations with absence of variability

A

normal
abnormal
Except

NUNA 693 Obs/Regional (13 decks)

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