T2 - Fetal Assessment EFM (Josh) Flashcards by Josh Miller

What are the types of Fetal Heart Monitoring?

Auscultation/Intermittent Auscultation

External Fetal Monitoring

Internal Fetal Monitoring

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What are the advantages of Auscultation in regards to FHM?

Non-invasive

Fetoscope detects actual heat sound (so dysrhythmias can be heard)

No straps to hold mother down

No ‘machine error’

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What are the disadvantages of Ausculation in regards to FHM?

Requires skill / practice

Disrupted by contractions

Unable to review/archive info

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What can be done to stimulate birth?

nipple stimulation to cause oxytocin to increase

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What is a Biophysical Profile?

Real-time ultrasound that permits detailed assessment of the physical and physiologic characteristics of the developing fetus

***scored on a basis of 10 points

***normal finding = 2

***abnormal finding = 0

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Biophysical Profile Scoring:

What are the five variables that are scored?

Breathing movements

Gross Body Mvmt

Muscle Tone

Amniotic Fluid Index (vol.)

Fetal HR via Nonstress Test (NST)

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Biophysical Profile:

What is the normal and abnormal findings for FHR via Nonstress Test?

Normal (Reactive) = 2

Abnormal (Nonreactive) = 0

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Biophysical Profile:

What is the normal and abnormal findings for FETAL BREATHING MOVEMENTS?

at least 1 episode > than 30 sec duration in 30 min = 2

absent or less than 30 sec duration = 0

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Biophysical Profile:

What is the normal and abnormal findings for GROSS BODY MOVEMENTS?

at least 3 body/limb extensions w/ return to flexion in 30 min = 2

less than 3 episodes = 0

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Biophysical Profile:

What is the normal and abnormal findings for FETAL TONE?

at least 1 episode of extension w/ return to flexion = 2

slow extension and flexion, lack of flexion, or absent movement = 0

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Biophysical Profile:

What is the normal and abnormal findings for QUALITATIVE AMNIOTIC FLUID VOL?

at least 1 pocket of fluid that measures at least 2 cm in 2 perpendicular planes = 2

pockets absent or less than 2 cm = 0

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Biophysical Profile:

Interpretation of scores

8-10 = normal (low risk of chronic fetal asphyxia)

4-6 = abnormal (suspect chronic fetal asphyxia)

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Types of External Monitoring Devices

U/S (Ultrasound Transducer) for Fetal Monitoring

TOCO (Tocotransducer) for Maternal Monitoring

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Types of Internal Monitoring Devices

ISE (Internal Scalp Electrode) for Fetal Monitoring

IUPC (Intrauterine Pressure Catheter) for Maternal Monitoring

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Monitoring Strip:

Top strip =
Bottom strip =
Each vertical dark red line =
Each lighter vertical line =

Top strip = FHR

Bottom strip = Uterine Activity

Each vertical dark red line = 1 min

Each lighter vertical line = 10 sec

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What is the Resting Tone?

palpation of uterus when no contraction is taking place

***important b/c it allows fetus to recover and have O2 exchange occur

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How is Resting Tone documented?

Mild = touch nose

Moderate = touch chin

Strong = touch forehead

What is a MVU?

Montevideo Units
- measure indicating intensity of uterine contractions in mmHg

***only when using IUPC

How do you determine MVU?

Contraction intensity - Resting Tone * number of contractions in 10 mins

What is another term for the Top of the Contraction?

Acme (Peak)

How long do we measure FHR?

2 clear minutes and rounded to 5 BPM

***uterus must be at rest

***must last greater than 10 mins

When would FHR by tachycardic?

Bradycardic?

> 160 BPM for longer than 10 mins

What is FHR Variability?

EXPECTED irregular fluctuations of the baseline that are an indicator of fetal well being

Measuring FHR Variability

Absent = 0 beats or undetectable

Minimal = 0 to 5 BPM

Moderate = 6-25 BPM

Marked = > 25 BPM

--- changes happen WITH UC --- changes happen WITHOUT UC

Periodic Non-periodic (Episodic)

What is an Acceleration?

an abrupt, temporary increase in FHR taht peaks at least 15 BPM above the baseline and lasts at least 15 secs ***for fetus 33 wks or greater ***if 32 wks, it should be 10 BPM for 10 secs

What is Prolonged Acceleration?

when accelerations lasts longer than 2 mins and less than 10 *** if longer than 10 mins, the baseline has changed

Accelerations: For 33 weeks and more, what do we want to see? For 32 weeks, what do we want to see?

15 bpm x 15 secs 10 bpm x 10 secs

How many accels do we want to see in a 10 minutes strip?

at least 2

How many types of Declerations are there?

Three - Early - Variable - Late (worst b/c there is not enough profusion to baby)

What does an EARLY Decel look like?

mirror image of a contraction - gradual descent from baseline and returns to baseline by end of contraction

What are possible causes of Early Decels?

head compression on vagal nerve slowing FHR during UC ***not bad and doesn't require intervention ***periodic

What does a VARIABLE Decel look like?

abrupt rise and fall from baseline (looks like a V or W) - must be 15 x 15 and less than 2 mins

What are possible causes of Variable Decels?

Cord Compression Short Cord Knot in Cord Prolapsed Cord (Emergency) ***can be periodic or nonperiodic

Nursing Interventions for Variable Decels?

change Maternal position Increase fluid intake Put on O2

What is a LATE Decel?

FHR decreases at peak of UC and returns to baseline AFTER UC has ended ***must be periodic

What causes Late Decels?

impairment of placental/oxygen exchange - Maternal Hypo/Hypertension - Diabetes - Decrease in fetal O2 reserves - Maternal supine position - Epidural anesthesia - Placenta previa/abruption

Nursing Internventions for Late Decels?

Change maternal position Increase IV fluids Administer O2 Call MD Call delivery team if doesn't change (prepare for C-section)

What are the BIG 5 Internvetions?

1) Turn/Reposition mom 2) O2 at 8-10 L/min (facemask) 3) IV fluids of bolus 4) Stop Oxytocin 5) Call MD

Which maternal position should always be avoided?

supine **always use a wedge

Word associations for Decels: E V L

Early starts with E= Starts Early and ends when UC Ends = Ear = Ear = part of head = Head Compression Variable starts with V = V or W in shape = Can happen anywhere = V like vise. Vise cuts off O2 supplies via Cord Compression Late = Happens at the peak of UC and does not return until Later, Long after the UC has ended. Starts with L = UteroPLacental insufficiency.