Perfusions: Fetal Distress Flashcards
What are some examples of stressors for fetuses?
- uterine contractions
- medications
- Maternal position
- maternal stress response
- Ineffective pushing
- impaired placenta
What are some antepartal risk factors for electronic monitoring?
- HTN
- Diabetes
- chronic renal disease
- Congenital or rheumatic heart disease
- Sickle cell disease
- Rh isoimmunization
- Preterm infants (under 37 weeks gestation)
- Post-term infants (over 42 weeks gestation)
- Multiple gestations
- Grand-multiparity
- Anemia
- IUGR or SGA
- genital tract disorders/anomalies
- Poor obstetric hx
- Age factors (<15 years or >35 years)
What are some intrapartum risk factors for electronic monitoring?
- Prolonged rupture of membranes
- Premature ROM
- Failure to progress in labor or dysfunctional labor
- Meconium-stained amniotic fluid
- Abnormal fetal HR detected during auscultation
- Bleeding disorders (abruptio placenta, placenta previa)
- Abnormal presentations
- Pitocin augmentation/inductions
- Uterine contractions
- Possible cephalopelvic disproportion
- Previous C-section in labor
- Hypotensive episodes in labor
What are some external (noninvasive) fetal monitoring methods?
- fetoscope
- doppler-handheld
- ultrasound mode
What are some internal (invasive) fetal monitoring methods?
- spiral electrode
2. fetal scalp monitoring
How would the fetal position be assessed?
- inspection/palpation of the woman’s abdomen
- vaginal examination
- ultrasound
- Auscultation of FHR
What are Leopold’s maneuvers?
Palpating the abdomen to find the shape of the fetus. They help to determine the fetal position
Where on the fetus is the FHR most clearly heart?
the back
Before what occurs should FHR be assessed?
Before:
- AROM or other labor enhancing procedures
- periods of ambulation
- administration of meds
- Administration or initiation of analgesics/anesthetics
What occasions call for an assessment of FHR?
- Rupture of membranes
- Recognition of abnormal uterine activity patterns
- Evaluation of oxytocin
- Administration of meds
- Expulsion of enema
- Urinary catheterization
- vaginal exam
- Periods of ambulation
- Evaluation of analgesia and or anethsia
What indicates that electronic monitoring is used?
- Hx of stillbirth
- presence of complications
- Induction of labor
- preterm labor
- Decreased fetal movement
- Meconium staining of amniotic fluid
- maternal fever
What are 2 methods of electronic monitoring?
- transducer placed on the maternal abdomen
2. internal monitoring
What must occur for internal monitoring to be used?
- membranes must be ruptured
2. cervix must be at least 2 cm dilated
What is the average FHR rounded to increments of?
5 bpm
What is the normal range for FHR?
110-160 bpm
What does a wandering baseline FHR indicate must be done?
Immediate intervention to enhance oxygen
What is fetal tachycardia?
> 161 bpm
What is fetal bradycardia?
<110 bpm during 10 min
Why can electronic monitoring be controversial?
- some women react positively
- some believe it interferes with the natural processes (time could be spent providing nursing care, the discomfort of lying in one position, fear of injury to baby)
What things are reassuring during FHR monitoring?
- baseline 110-160 bpm
- variability is present
- variability at least two cycles per minute
What things are not reassuring during FHR tracings?
- Severe variable decelerations
- Late decelerations
- absence of variability
- prolonged decelerations, severe bradycardia
Define accelerations
- must be 15 bpm above within 15 seconds (FHR increase of >15 bpm for >15sec)
- Transitory increases above the Baseline, may resemble the shape of the uterine contractions
- Onset is variable, often preceding or occurring simultaneously with Uterine Contractions or fetal movement
Why can accelerations occur?
- spontaneous fetal movement
- vaginal exams
- Electrode applications
- breech presentation
- uterine contractions
- fundal pressure
- abdominal palpation
Why can accelerations be reassuring?
They are an indication of fetal CNS alertness and wellbeing
Are any interventions required for accelerations?
No. Just observe the accelerations to see if they are followed by a small deceleration that could progress into a pattern of variable or late decelerations.
Notify family that the fetus is okay
Describe early decelerations
They begin with the onset or before the peak of a Uterine contraction. The recovery occurs at the same time as the uterine contractions return to baseline. Timing is synchronous with that of the Uterine contractions
Describe late decelerations
- The late response is due to the time it takes for the uteroplacental blood flow to reach the fetal heart and brain
- Shape is uniform, symmetrical, and smooth often reflects the intensity of the contraction
- Usually begins 20-30 sec after the onset of the Uterine contraction. Usually at or after the peak of the Uterine contractions
- The nadir (bottom) of the deceleration is offset or after the acne (peak) of the uterine contractions
- The nadir common decreases 5-30 bpm and rarely 30-40 bpm below the BL (may be small or “subtle” in appearance but not in significant)
What are variable decelerations a sign of?
Umbilical cord compression
What can cause early decelerations?
- head compression
- uterine contractions
- vaginal exams
- fundal pressure
- Placement of FSE
- More frequent in primigravidas
- Occurs more often during active labor, usually 4-7 cm
What are the interventions for early decelerations?
- no immediate interventions are required
- Maternal position changes do not usually alter the pattern
- Assessment of pattern to R/O late deceleration pattern
- Reassure regarding the fetal status
What maternal factors can cause late decelerations?
- HTN
- supine position
- Maternal trauma or blood loss
- Hypotension
- regional anesthesia
- medications (illicit drugs such as cocaine and amphetamines)
- uterine contractions
- hyperstimulation
- Hypertonus with or without oxytocin administration
- Hyperventilation
- hypoventilation
- cardiopulmonary disease
What placental things can cause late delecerations?
- Post-maturity
- Premature aging, including calcification, necrosis
- Old and new abruptio sites
- Placenta previa
- Placental malformation
What are some other risk factors associated with late decelerations?
chronic maternal diseases such as diabetes, maternal smoking, poor maternal nutrition, multiple gestation anemia
What is the clinical significance of late decelerations?
- late decelerations of any magnitude should be considered a worrisome sign when they are persistent and uncorrectable
- When they are associated with tachycardia and/or minimal or absent variability they can be an ominous sign
- Persistent and uncorrectable late decelerations reflect repetitive hypoxic stress and if associated with minimal or absent variability become a sign of increasing metabolic acidosis
What are the interventions for Late decelerations?
- change maternal position, left lateral is preferred
- correct maternal hypotension, elevating legs and increase rate of IV infusion
- DC oxytocin if infusion
- Administer O2 8-12 L/min by face mask
- Fetal scalp or acoustic stimulation
Describe mild variable decelerations
decelerates to any level less than 30 sec with abrupt return to baseline
Describe moderate variable decelerations
Decelerates no less than 80 bpm, any duration with abrupt return to baseline
Describe severe variable decelerations
Decelerates below 70 bpm for greater than 45-60 sec with slow return to Base Like (BL rate may increase while BL variability decreases)
What can cause umbilical cord compression?
- maternal position; cord between fetus and maternal pelvis
- cord around neck, leg, arm, or other body parts
- short cord
- knot in cord
- prolapsed cord
Describe variable decelerations
- occur anytime during the uterine contracting phase but are often concurrent with uterine contractions.
- Variables vary in intensity and duration and frequently decelerate below the average FHR Range
- Variable deceleration patterns are the most frequently observed FHR pattern in labor
What would be considered reassuring variable decelerations?
- last no more than 30-45 seconds
- Have a rapid return to BL from the nadir of the decelerations
- Retain normal variability and normal BL rate continues
- Shouldering or a transitory acceleration of the FHR preceding and following the deceleration indicates a minor degree of cord compression and interaction of the SNS and PNS
What is the clinical significance of variable decelerations?
- severe variable decelerations just before delivery are usually well tolerated if the total time is short from the onset of the deceleration to delivery
- A progressive slower return to BL with repetitive variables indicates a gradual increase in hypoxia
- severe uncorrectable variable decelerations, particularly with a loss of variability and a rise in BL rate are associated with fetal acidosis, hypoxia, and a neurologically depressed newborn
What are the interventions for variable decelerations?
- change maternal position from side to side, Trendelenburg, or knee-chest (relieves cord compression)
- When decelerations are severe: DC oxytocin if infusing. Administer O2 at 8-12 L/face mask
- vaginal or speculum examination (check for prolapsed cord)
- Amnioinfusion
- Termination of labor is considered by the PCP if the severe variable cannot be corrected
Describe Fetal Tachycardia
- defined as a baseline heart rate above 160 bpm sustained for a duration of 10 minutes or more
- when tachycardia occurs it is generally associated with a decrease in baseline variability
What things can cause fetal tachycardia?
- early fetal hypoxia
- Maternal fever
- drug induced (atropine, scopolamin, hydroxyzine, vistaril)
- Maternal hyperthyroidism
- Fetal anemia
- Fetal heart Failrue/fetal cardiac arrhythmias
- maternal anxiety
- prematurity
- etiology unknown
What is the clinical significance of fetal tachycardia?
- tachycardia can be an ominous sign when associated with late decelerations, severe variable decelerations, or absence of variability
- Persistent tachycardia with average baseline variability or in the absence of periodic changes does not appear serious in terms of immediate neonatal outcome
What are the interventions for fetal tachycardia?
- Maternal fever-reduced with antipyretics, hydration, and cooling measures
- Oxygen at 8-12 L/min/mask, turn laboring client to the lateral position
- IV bolus
- Validate FHR with a fetoscope
- In utero treatment of cardiac arrhythmias
- Notify PCP
What things can cause fetal bradycardia?
- Fetal hypoxia
- drug induced
- Hypothermia
- Fetal cardiac dysrhythmias
- Reflex events
- Etiology unknown
What is the clinical significance of fetal bradycardia?
- When it is resulting from hypoxia it is an ominous sign when associated with loss of variability and late decelerations
- Considered benign if there is average FHR variability and the absence of late declerations
- May result in low apgar score if it is drug induced
What are the interventions for fetal bradycardia?
- dependent upon etiological factors and clinical judgment based on a variety of factors, including the stage of labor and indications of fetal stress
- change maternal position, O2 at 8-12 L/min/mask
- Perform Vaginal examination to check for cord prolapse
- IV bolus of 200 mL IV fluids
- Notify PCP immediately
- Pacemaker may be appropriate after delivery for the neonate with congenital heart block
What is a normal fetal blood pH level?
> 7.25
If a pH is lower than 7.25 then what can that indicate?
acidosis or hypoxia
