T2 - Fetal Assessment EFM (Josh) Flashcards
What are the types of Fetal Heart Monitoring?
Auscultation/Intermittent Auscultation
External Fetal Monitoring
Internal Fetal Monitoring
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’
What are the disadvantages of Ausculation in regards to FHM?
Requires skill / practice
Disrupted by contractions
Unable to review/archive info
What can be done to stimulate birth?
nipple stimulation to cause oxytocin to increase
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
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)
Biophysical Profile:
What is the normal and abnormal findings for FHR via Nonstress Test?
Normal (Reactive) = 2
Abnormal (Nonreactive) = 0
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
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
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
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
Biophysical Profile:
Interpretation of scores
8-10 = normal (low risk of chronic fetal asphyxia)
4-6 = abnormal (suspect chronic fetal asphyxia)
Types of External Monitoring Devices
U/S (Ultrasound Transducer) for Fetal Monitoring
TOCO (Tocotransducer) for Maternal Monitoring
Types of Internal Monitoring Devices
ISE (Internal Scalp Electrode) for Fetal Monitoring
IUPC (Intrauterine Pressure Catheter) for Maternal Monitoring
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
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
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.
