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NSG 432 - OB > T3: Fetal Assessment During Labor > Flashcards

T3: Fetal Assessment During Labor Flashcards

1
Q

Leopold’s Maneuvers

A

method of palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds

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2
Q

fetal monitoring

A

displays the fetal heart rate (FHR) and tells us the fetal wellbeing
-palce mom on fetal monitor ASAP

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3
Q

External fetal monitoring

A

noninvasive and is performed with a tocotransducer or doppler ultrasonic transducer

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4
Q

Ultrasound transducer (US) tells us

A

FHR

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5
Q

where is the US transducer placed

A

place on the back of the baby

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6
Q

normal FHR

A

110-160 bpm

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7
Q

Tocotransducer (TOCO) monitors…

A

uterine contractions (determines duration and frequency but in order to get the intensity you have to palpate)

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8
Q

where is TOCO placed

A

placed over the fundus of the uterus

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9
Q

how is duration of a contraction measured

A

measured by beginning of contraction to the end of the same contraction

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10
Q

How is frequency of a contraction measured?

A

measured by the beginning of the first contraction to the beginning of the second contraction

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11
Q

when will you get the reading for variability and acceleration?

A

At first you will only get the reading of the FHR; after 20 minutes you will be able to document variability and acceleration

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12
Q

Internal fetal monitoring requires

A

RUPTURE OF THE MEMBRANES

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13
Q

internal fetal monitoring

A

attaching electrode to the presenting part of the fetus (needs to be on skull, not fontanelle

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14
Q

Intrauterine pressure catheter (IUPC):

A

goes up the vagina and placed on top part of uterus and gives us the exact strength of the contraction

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15
Q

Resting tone

A

after contraction is completes, note the line that the uterus is resting on

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16
Q

Montevideo units can only be calculated if…

A

an IUPC is in place

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17
Q

Montevideo units

A

determines of contractions care adequate for cervical change or of the doctor needs to order Pitocin

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18
Q

adequate Montevideo units is considered

A

> 200mmHg

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19
Q

how to calculate Montevideo units

A

peak of contraction - resting tone = strength of contraction

-Must be a 10 minute strip to get the Montevideo units

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20
Q

fetal bradycardia

A

FHR <110bpm for 10 minutes or longer

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21
Q

fetal tachycardia

A

FHR >160bpm for 10 minutes or longer

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22
Q

what should be done if fetal bradycardia or tachycardia occurs

A

change mothers’ position, administer O2, and assess mothers VS

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23
Q

variability

A

fluctuations in baseline FHR; indicates baby’s neurological system is intact

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24
Q

absent variability

A

undetected variability

25
Q

what does absent variability indicate

A

considered nonreassuring, can indicate that the baby is dead or hypoxic

26
Q

minimal variability

A

established when FHR fluctuation is 0-5bpm above baseline

27
Q

moderate variability

A

established when FHR fluctuation is 5-25bpm above baseline

28
Q

marked variability

A

established when FHR fluctuation is >25bpm (has no significant indication

29
Q

sinusoidal variability

A

when you cannot determine the base line

30
Q

what are the two main causes of sinusoidal variability

A
  1. Narcotics
  2. Fetal anemia
31
Q

accelerations

A

when FHR goes at least 15 beats per minute ABOVE baseline and lasting AT LEAST 15 seconds

32
Q

acceleration tells us

A

Gives us further reassurance that baby’s neurological system is intact

33
Q

deceleration

A

when FHR goes 15 beats per minute BELOW baseline and lasting AT LEAST 15 seconds (this is nonreassuring)

34
Q

early decelerations occur

A

during contractions

35
Q

early decelerations indicate

A

head compression (tells us mom is making progress and is ready to have a baby)

36
Q

intervention for early deceleration

A

sterile vaginal exam

37
Q

variable decelerations occur

A

can happen at any time, with or without contraction

38
Q

variable decelerations indicate

A

umbilical cord compression

39
Q

interventions for variable decelerations

A

MUST INTERVENE! –Discontinue oxytocin
-Change position of mother, administer O2
-Assess mother’s VS
-Assist with amnioinfusion (to decrease compression on the umbilical cord)

40
Q

late decelerations occur

A

after contraction and return to baseline after contraction ends

41
Q

late deceleration indicate

A

PLACENTA INSUFFICIENCY

42
Q

Prolonged deceleration

A

lasts more than 2 minutes but less than 10 minutes

43
Q

if prolonged deceleration goes over 10 minutes it is considered

A

fetal bradycardia

44
Q

what can prolonged decelerations indicate

A

Sometimes indicates the cord is around the neck

45
Q

POISON

A

P: Position change
O: Oxygen
I: Increase IV rate
S: Sterile vaginal exam
O: Oxytocin off
N: Notify provider

46
Q

amniofusion

A

normal saline into the uterus to cushion the umbilical cord

47
Q

amniofusion can only be administered if..

A

patient has an IUPC

48
Q

when is amniofusion used

A

variable decelerations and oligohydraminos (when amniotic fluid id <300mL)

49
Q

Tocolytics

A

medications that produce uterine relaxation and suppress uterine activity

50
Q

how should terbutaline be given

A

Never given IV push, only sub-Q
-never if mom HR >120bpm

51
Q

Vibroacoustic stimulation (VAS)

A
  • Application of sound and vibration to stimulate fetal movement
52
Q

contraction stress test is done to…

A

determine fetal reaction to contraction (usually only ordered if patient has to be induced)

53
Q

what is a contraction stress test done through

A

nipple stimulation or pitocin

54
Q

positive CST indicates

A

baby has decelerations with contractions
-Have to do a C-section

55
Q

negative CST indicates

A

baby can tolerate labor

56
Q

category 1

A

o Baseline 110-160
o Moderate variability
o Absent variable and late decelerations
o May have early decelerations
o Accelerations may or may not be present

57
Q

category II

A

o Baseline rate bradycardia or tachycardia
o Variability: Minimal baseline variability; absent baseline variability without recurrent decelerations; marked variability
o Accelerations: no accelerations produced in response to fetal stimulation
o Periodic or episodic decelerations’: recurrent variable decelerations with minimal or moderate variability; prolonged decelerations; recurrent late decelerations with moderate variability; variable decelerations with other characteristics such as slow return to baseline, overshoots or shoulders

58
Q

category III

A

o Absent variability and any of the following:
- Recurrent late decelerations;
- Recurrent variable decelerations;
- Bradycardia
o Sinusoidal pattern

NSG 432 - OB (14 decks)

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