OBN: Fetal Assessment Flashcards
___ is caused by head compression since the vagal nerve is activated
Early deceleration
Cite 4 possible causes of uteroplacental insufficiency
- Maternal hypotension
- Excessive uterine activity
- Placental dysfunction
- Maternal diseases
Abrupt decrease in FHR is defined as decrease from onset to FHR nadir is <30seconds. This suggests ____
Cord compression
Normal baseline variability ranges from ___ beats per minute
6-25 bpm
Late deceleration is due to ____
uteroplacental insufficiency
Severe fatal anemia can lead to this type of pattern
Sinusoidal
The cut-off of value for normal uterine contraction
less than 5 contractions in 10 minutes
Determine the category.
110-160bpm, moderate variability, no decelerations, no acceleration
Category 1
Determine the category.
Absent baseline variability, with bradycardia, recurrent late decelerations, and sinusoidal pattern
category 3
A reactive NST means there are ____ accelerations within 20-40 minutes.
Reactive.
Note that NST: There should be no contraction present!
What is the normal fetal movement per hour?
10 FM up to 2 hours
[Fetal breathing]
What happens to the chest wall and abdomen of the fetus during inspiration?
- Chest wall collapses
2. Abdomen protrudes
[Fetal breathing]
What happens to the chest wall and abdomen of the fetus during expiration?
- Chest wall expands
Contraction stress test is a test of ____
uteroplacental function
What are the criteria for a satisfactory contraction stress test?
- 3 or more contractions
- 40 seconds or more
- 10 minute period
A positive contraction stress test means that there is ___ of the fetal heart
- Late deceleration following 50% or more of contraction
- late deceleration even if the contraction is fewer than 3 in 10 mins
due to uteroplacental insufficiency
this is abnormal
___ is a test of fetal condition
Non-stress test
What are the methods in conducting CST?
- Oxytocin infusion
2. Nipple stimulation
What are the components of BPP?
Remember: NST MATaBa 3 2 1 1
SCORE 2 if
- NST >/2 accel of >/15 bpm for >/15 sec
- Movement = >/3 in 30 min
- Amniotic fluid at least 2cm in 2 pockets
- Tone >/ 1 episode of extremity extension and subsequent flexion
- Breathing >/1 lasting >/ 30sec
[BPP score Recommended management]
8/10
Deliver
[BPP score Recommended management]
BPP of 6/10
Abnormal fluid volume
Deliver
[BPP score Recommended management]
BPP of 6/10
Normal fluid, favorable cervix
>36 weeks AOG
deliver
[BPP score Recommended management]
repeat testing BPP of 6/10
deliver
[BPP score Recommended management]
BPP of 7/10
repeat
[BPP score Recommended management]
BPP of 4/10
repeat testing same day
[BPP score Recommended management]
initial BPP of 4/10; repeated same day becoming 6/10
deliver
[Neural control of BPS activity]
fetal tone
cortex-subcortical area
last affected by asphyxia
[Neural control of BPS activity]
what is the first affected BPS parameter in fetal hypoxia?
HR
[Neural control of BPS activity]
fetal movement
cortex-nuclei
[Neural control of BPS activity]
fetal breathign
ventral surface of 4th ventricle
[Neural control of BPS activity]
fetal heart reactivity
Medulla and posterior thalamus
[Fetal heart rate patterns]
What is the normal HR of a fetus?
110-160; minimum 2 minutes in a 10 minute strip
[Fetal heart rate patterns]
A moderate variability of FHR mean that the amplitude is between
6-25 bpm (NORMA:)
[Fetal heart rate patterns: Acceleration]
Normal for >/32 weeks
> 15bpm from baseline
lasting 15 seconds
less than 2 minutes
[Fetal heart rate patterns: Acceleration]
< 32 weeks
> / 10 bpm from baseline
lasting 10 seconds
less than 2 mins
[Fetal heart rate patterns: Acceleration]
prolonged acceleration means ___
acceleration >2mins but <10 mins
[Fetal heart rate patterns: Acceleration]
a baseline change can be implied if the acceleration lasts
> / 10mins
[FHR abnormalities]
oncet, nadir, and recovery are coincident with the beginning and ending of contraction
Early deceleration
[FHR abnormalities]
what are the causes of early deceleration?
- Fetal head compression –> Increase ICP leading to decreased HR
[FHR abnormalities]
onset, nadir, and recovery of deceleration occur after the beginning, peak, and ending of a contraction
Late deceleration
[FHR abnormalities]
what are the causes of late deceleration?
- Uteroplacental insufficiency;
stimulation of chemoreceptor leading to stimulation of vagal nerve decreasing the HR
what is the most common deceleration pattern?
variable deceleration
Variable deceleration is due to ___
umbilical cord occlusion
[Intervention]
Recurrent late deceleration, prolonged deceleration, or bradycardia
- Lateral decubitus positioning
- Administer maternal oxygen
- Administer IV fluid bolus
- Reduce uterine contraction frequency
[Intervention]
Tachysystole with Cat II or Cat III tracing
- Discontinue oxytocin or prostaglandin
2. Give tocolytics (terbutaline, magnesium sulfate)
[Intervention]
Recurrent variable decelerations
Repositioning of the mother
[Intervention]
Prolonged deceleration or bradycardia from umbilical cord compression
- Amnioinfusion
[Intervention]
recurrent variable decelerations, prolonged decelerations, bradycardia with prolapsed cord
elevate the presenting part, prepare for delivery
