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