T3: Fetal Assessment During Labor Flashcards
Leopold’s Maneuvers
method of palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds
fetal monitoring
displays the fetal heart rate (FHR) and tells us the fetal wellbeing
-palce mom on fetal monitor ASAP
External fetal monitoring
noninvasive and is performed with a tocotransducer or doppler ultrasonic transducer
Ultrasound transducer (US) tells us
FHR
where is the US transducer placed
place on the back of the baby
normal FHR
110-160 bpm
Tocotransducer (TOCO) monitors…
uterine contractions (determines duration and frequency but in order to get the intensity you have to palpate)
where is TOCO placed
placed over the fundus of the uterus
how is duration of a contraction measured
measured by beginning of contraction to the end of the same contraction
How is frequency of a contraction measured?
measured by the beginning of the first contraction to the beginning of the second contraction
when will you get the reading for variability and acceleration?
At first you will only get the reading of the FHR; after 20 minutes you will be able to document variability and acceleration
Internal fetal monitoring requires
RUPTURE OF THE MEMBRANES
internal fetal monitoring
attaching electrode to the presenting part of the fetus (needs to be on skull, not fontanelle
Intrauterine pressure catheter (IUPC):
goes up the vagina and placed on top part of uterus and gives us the exact strength of the contraction
Resting tone
after contraction is completes, note the line that the uterus is resting on
Montevideo units can only be calculated if…
an IUPC is in place
Montevideo units
determines of contractions care adequate for cervical change or of the doctor needs to order Pitocin
adequate Montevideo units is considered
> 200mmHg
how to calculate Montevideo units
peak of contraction - resting tone = strength of contraction
-Must be a 10 minute strip to get the Montevideo units
fetal bradycardia
FHR <110bpm for 10 minutes or longer
fetal tachycardia
FHR >160bpm for 10 minutes or longer
what should be done if fetal bradycardia or tachycardia occurs
change mothers’ position, administer O2, and assess mothers VS
variability
fluctuations in baseline FHR; indicates baby’s neurological system is intact
absent variability
undetected variability
what does absent variability indicate
considered nonreassuring, can indicate that the baby is dead or hypoxic
minimal variability
established when FHR fluctuation is 0-5bpm above baseline
moderate variability
established when FHR fluctuation is 5-25bpm above baseline
marked variability
established when FHR fluctuation is >25bpm (has no significant indication
sinusoidal variability
when you cannot determine the base line
what are the two main causes of sinusoidal variability
- Narcotics
- Fetal anemia
accelerations
when FHR goes at least 15 beats per minute ABOVE baseline and lasting AT LEAST 15 seconds
acceleration tells us
Gives us further reassurance that baby’s neurological system is intact
deceleration
when FHR goes 15 beats per minute BELOW baseline and lasting AT LEAST 15 seconds (this is nonreassuring)
early decelerations occur
during contractions
early decelerations indicate
head compression (tells us mom is making progress and is ready to have a baby)
intervention for early deceleration
sterile vaginal exam
variable decelerations occur
can happen at any time, with or without contraction
variable decelerations indicate
umbilical cord compression
interventions for variable decelerations
MUST INTERVENE! –Discontinue oxytocin
-Change position of mother, administer O2
-Assess mother’s VS
-Assist with amnioinfusion (to decrease compression on the umbilical cord)
late decelerations occur
after contraction and return to baseline after contraction ends
late deceleration indicate
PLACENTA INSUFFICIENCY
Prolonged deceleration
lasts more than 2 minutes but less than 10 minutes
if prolonged deceleration goes over 10 minutes it is considered
fetal bradycardia
what can prolonged decelerations indicate
Sometimes indicates the cord is around the neck
POISON
P: Position change
O: Oxygen
I: Increase IV rate
S: Sterile vaginal exam
O: Oxytocin off
N: Notify provider
amniofusion
normal saline into the uterus to cushion the umbilical cord
amniofusion can only be administered if..
patient has an IUPC
when is amniofusion used
variable decelerations and oligohydraminos (when amniotic fluid id <300mL)
Tocolytics
medications that produce uterine relaxation and suppress uterine activity
how should terbutaline be given
Never given IV push, only sub-Q
-never if mom HR >120bpm
Vibroacoustic stimulation (VAS)
- Application of sound and vibration to stimulate fetal movement
contraction stress test is done to…
determine fetal reaction to contraction (usually only ordered if patient has to be induced)
what is a contraction stress test done through
nipple stimulation or pitocin
positive CST indicates
baby has decelerations with contractions
-Have to do a C-section
negative CST indicates
baby can tolerate labor
category 1
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
category II
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
category III
o Absent variability and any of the following:
- Recurrent late decelerations;
- Recurrent variable decelerations;
- Bradycardia
o Sinusoidal pattern
