T3: Fetal Assessment During Labor

Question 1

Leopold’s Maneuvers

Answer 1

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

Question 2

fetal monitoring

Answer 2

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

Question 3

External fetal monitoring

Answer 3

noninvasive and is performed with a tocotransducer or doppler ultrasonic transducer

Question 4

Ultrasound transducer (US) tells us

Answer 4

FHR

Question 5

where is the US transducer placed

Answer 5

place on the back of the baby

Question 6

normal FHR

Answer 6

110-160 bpm

Question 7

Tocotransducer (TOCO) monitors…

Answer 7

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

Question 8

where is TOCO placed

Answer 8

placed over the fundus of the uterus

Question 9

how is duration of a contraction measured

Answer 9

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

Question 10

How is frequency of a contraction measured?

Answer 10

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

Question 11

when will you get the reading for variability and acceleration?

Answer 11

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

Question 12

Internal fetal monitoring requires

Answer 12

RUPTURE OF THE MEMBRANES

Question 13

internal fetal monitoring

Answer 13

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

Question 14

Intrauterine pressure catheter (IUPC):

Answer 14

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

Question 15

Resting tone

Answer 15

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

Question 16

Montevideo units can only be calculated if…

Answer 16

an IUPC is in place

Question 17

Montevideo units

Answer 17

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

Question 18

adequate Montevideo units is considered

Answer 18

> 200mmHg

Question 19

how to calculate Montevideo units

Answer 19

peak of contraction - resting tone = strength of contraction

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

Question 20

fetal bradycardia

Answer 20

FHR <110bpm for 10 minutes or longer

Question 21

fetal tachycardia

Answer 21

FHR >160bpm for 10 minutes or longer

Question 22

what should be done if fetal bradycardia or tachycardia occurs

Answer 22

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

Question 23

variability

Answer 23

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

Question 24

absent variability

Answer 24

undetected variability

Question 25

what does absent variability indicate

Answer 25

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

Question 26

minimal variability

Answer 26

established when FHR fluctuation is 0-5bpm above baseline

Question 27

moderate variability

Answer 27

established when FHR fluctuation is 5-25bpm above baseline

Question 28

marked variability

Answer 28

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

Question 29

sinusoidal variability

Answer 29

when you cannot determine the base line

Question 30

what are the two main causes of sinusoidal variability

Answer 30

1. Narcotics 2. Fetal anemia

Question 31

accelerations

Answer 31

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

Question 32

acceleration tells us

Answer 32

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

Question 33

deceleration

Answer 33

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

Question 34

early decelerations occur

Answer 34

during contractions

Question 35

early decelerations indicate

Answer 35

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

Question 36

intervention for early deceleration

Answer 36

sterile vaginal exam

Question 37

variable decelerations occur

Answer 37

can happen at any time, with or without contraction

Question 38

variable decelerations indicate

Answer 38

umbilical cord compression

Question 39

interventions for variable decelerations

Answer 39

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

Question 40

late decelerations occur

Answer 40

after contraction and return to baseline after contraction ends

Question 41

late deceleration indicate

Answer 41

PLACENTA INSUFFICIENCY

Question 42

Prolonged deceleration

Answer 42

lasts more than 2 minutes but less than 10 minutes

Question 43

if prolonged deceleration goes over 10 minutes it is considered

Answer 43

fetal bradycardia

Question 44

what can prolonged decelerations indicate

Answer 44

Sometimes indicates the cord is around the neck

Question 45

POISON

Answer 45

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

Question 46

amniofusion

Answer 46

normal saline into the uterus to cushion the umbilical cord

Question 47

amniofusion can only be administered if..

Answer 47

patient has an IUPC

Question 48

when is amniofusion used

Answer 48

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

Question 49

Tocolytics

Answer 49

medications that produce uterine relaxation and suppress uterine activity

Question 50

how should terbutaline be given

Answer 50

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

Question 51

Vibroacoustic stimulation (VAS)

Answer 51

- Application of sound and vibration to stimulate fetal movement

Question 52

contraction stress test is done to...

Answer 52

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

Question 53

what is a contraction stress test done through

Answer 53

nipple stimulation or pitocin

Question 54

positive CST indicates

Answer 54

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

Question 55

negative CST indicates

Answer 55

baby can tolerate labor

Question 56

category 1

Answer 56

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

Question 57

category II

Answer 57

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

Question 58

category III

Answer 58

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