Test 2 EFM Video Flashcards by Jade Ring

AFI (Amniotic fluid index)

Measure Fluid by Ultrasound

Normal changes with GA

Slowly increasing and decrease post term

Range norm…

5 - 25

Same as Fetal heart rate variability range for moderate

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Abruption

Separation of Placenta from uterus wall

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VEAL CHOPS

Variable Decelerations from Cord Compression = (Good or Bad) / What is the cause

Bad

Pressure changes noted from Baroreceptors

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VEAL CHOPS

Early Decelerations from Head Compression = (Good or Bad)
This happens from….

Good

Vagal nerve response

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VEAL CHOPS

Accelerations from O2 reserves (extra oxygen)

Good or bad

What does it mean….

Good

Baby is active

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VEAL CHOPS

Late decelerations from utero-Placental Insufficiency (Good or bad)
How is it detected

Bad

Chemoreceptors from chemical changes

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Prolonged decelerations =

Greater than 2 but less than 10 minutes

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VEAL

CHOP

Stands for…

Variable Decelerations/ Cord Compression BAD

Early Decelerations/ Head Compression GOOD

Accelerations/ O² Reserves GOOD

Late Decelerations/ uetro-Placental Insufficiency BAD

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FHR Strip

6 small boxes = 1 large box

What length of time is 1 large box?

1 min

10 sec = small box

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Background information for FHR Strips

GA of baby

Accelerations change at GA

<32 weeks 10x10

> 32 weeks 15x15

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Background information for FHR Strips

Is mom feeling baby moving

Moving baby correlates with moving baby

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Background information for FHR Strips

Ruptured AROM/SROM or low fluid (oligohydramnios/ low AFI)

Will have this affect on variable Decelerations

Increase

Fluid acts as a cushion for the cord. When the fluid is low the effect is increasing variable Decelerations

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Background information for FHR Strips

Maternal fever

This affect on FHR

Fetal tachycardia

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Background information for FHR Strips

If fetal monitor is showing Contractions

Do this assessment to mom….

Ask if she feels the Contractions

Palpate the abdomen & simultaneously look at graph to see if they correlate

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Background information for FHR Strips

What is a normal Resting Tone for the uterus….

Soft & non-tender Between contractions

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Oxytocin/ misoprostol = this affect on contractions / Increased Risk of….

Nalbuphine (Nubain) & Butorphanol (Stadol) this affect on FHR

Magnesium Sulfate ( Used for treatment of Tocolysis for preterm labor, Preventing preterm birth, Preventing & treating eclampsia & preeclampsia

Epidural….

Narcotics

Oxytocin/ misoprostol = Longer, Stronger, Closer together

Increase risk of Tachysystole >5 in 10 minutes

Nalbuphine / Butorphanol (Analgesics) makes mom & baby feel “outta it” DECREASED VARIABILITY

Magnesium Sulfate can lower base fetal HR

Epidural decrease moms BP, resulting in less perfusion to baby (LATE DECELERATIONS)

Narcotics: Pseudosinusoidal FHR pattern:
Oscillation frequency: Synchronized with the frequency of uterine contractions
Amplitude: 19 beats per minute (bpm) or more
Frequency: 1.3 cycles per minute or less

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What condiciones in the mother may have an impact on external FHR monitoring

Obesity

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Common reason why you may have to adjust posistion on the External fetal monitor

Mother adjusted posistions

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When applying TOCO monitor perform Leopold Maneuver first to assess placement

T or F

TOCO only needs to be at top of the Fundus

Use it to determine posistion of baby for Clearest US signal

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Describe how to perform Leopold Maneuver….

Steps 1 - 3 Facing Mom / Step 4 Facing Away from mom

Place both hands in fundus and determine if it’s the head or butt. Butt will feel softer.
Slide hands down the uterus and determine which side is the back
Pawlik’s Grip: using 1 hand determine if head is engaged in the pelvis
Facing moms feet. Both hands lower abdomen to determine if babies neck is flexed or extended

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For best placement of US you are looking for this landmark with the Leopold Maneuver

Fetal back

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Which is preferred for delivery

Babies neck Flexed or Extended

Flexed. Chin towards chest

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How to tell difference between TOCO & US monitoring equipment?

Which requires gel

Both look similar

TOCO will have a pressure monitoring disc on the back

US only requires gel

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Wireless Monica has this use / advantage.

Fetal/ maternal ECG & Uterine electromyogram

Better on obese patients

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ISL/ FECG/ FSE

Work how?

Nursing considerations…

Corkscrew into scalp of baby

Monitor for infection

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Purpose of Blue port on IUPC (Interuterine Pressure Catheter)

Instill fluids

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Fetal HR Strips

Steps 1. Baseline

Ignore Accelerations & Decelerations

Look for area in between contractions to determine baseline.

How to determine baseline using the above advice

Eyeball it. Between contractions

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Normal variation
Amniotic fluid embolism
Cord Compression
Complete/ Congenital Heart block
Fetal arrhythmias
Maternal hypoglycemia
Hypothermia
Low BP Maternal
Drugs
Hypoxemia

Have this affect in fetal HR

Bradycardia

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Fetal hydrops
Maternal Hyperthyroidism
Severe fetal anemia
Fetal heart failure
Arrhythmias
Fetal Hypoxemia
Drugs
Fetal sepsis
Chorioamnionitis
Maternal fever

Have this affect on Fetal HR

Tachycardia

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How long of a strip to assess fetal baseline

2 min minimal

2 big boxes

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How long of a change in FHR is needed to have a new baseline

10 minutes

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Serious condition where abnormal amounts of fluid accumulate in two or more fetal compartments, such as under the skin (edema), in the abdomen (ascites), around the lungs (pleural effusion), or around the heart (pericardial effusion). This fluid buildup can lead to severe complications, including heart failure, organ damage, or even fetal death.

Fetal hydrops, or hydrops fetalis

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Step 2 of FHR monitoring strips

VARIABILITY (How much the HR changes up / down)

Give ranges

Absent
Minimal
Moderate
Marked
Sinusoidal

Absent 0 BMP
Minimal 1 - 5 BPM
Moderate 6 - 25 Bpm
Marked >26
Sinusoidal: Smooth with a cycle of 3 - 5 smooth lines per minute and last >20 minutes

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Smooth, sinewave-like undulating pattern in FRH baseline with a cycle frequency of 3 - 5 per minute and last >20 minutes = Sinusoidal

Describe reason why

Sinusoidal FHR pattern

Severe fetal anemia
Rh isoimmunization
Fetal hypoxia and can indicate fetal distress.

It requires immediate evaluation and intervention, as it’s considered a sign of fetal compromise.

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Variability in FRH is due to…

Intact Nervous System

Fluctuations in Sympathetic (Increase) & Parasympathetic (Decreased)

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Steps 2 Variability

To determine Variability Ignore Accelerations & Decelerations on the strip T or F?

Minium of 2 minutes of test strip

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Etiology of (Marked or Decreased) variability

Hypoxemia/acidosis, fetal sleep cycle, drugs (Nalbuphine (Nubain) & Butorphanol (Stadol), Magnesium Sulfate, Narcotics), Premature delivery, arrhythmias, fetal tachycardia, preexisting neurological abnormalities, congenital abnormalities

Decreased variability

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Etiology of (Marked or Decreased) variability

Fetal stimulation, drugs, mild/transient hypoxemia

Marked variability

Which type of variability is desired in FHR

Moderate 6 - 25 BPM

____ is the best predictor of fetal oxygenation

Variability

Moderate 5 - 25 is best predictor of fetal oxygenation

Accelerations differ according to GA

Describe

<32 weeks
>32 weeks

<32 weeks = 10 bpm × 10 seconds

> 32 weeks = 15 bpm × 15 seconds

FHR Step 3 is….

Accelerations

FRH baseline 125

What would be the peak for Accelerations

<32 wks

> 32 wks

And time frame

<32 wks ( 135 & 10 seconds)

> 32 wks ( 140 & 15 seconds)

Etiology of Accelerations (1)

Ways to illicit Accelerations…

Oxygen reserves: Happens due to fetal movement in response to stimulation and Increased FHR

Illicit: Fetal Scalp Stimulantion, sounds, vibration, drinking cold water, juice , eating, maternal movement

What is the longest time an Acceleration can last?

10 mins

After this it’s considered a new baseline

Steps 4 of interpretation of FHR strips

Decelerations

Abrupt decrease in FHR may or may not be associated with Contractions

Distinguish between Variable Decelerations & Early Decelerations

Cause?

Which are normal findings

How can you spot the difference

Shape?

Cause:
Variable Decelerations = Cord Compression BAD

Early Decelerations = Head Compression GOOD

FHR strip:

Onset:

Variabie Decelerations: Abrupt
Onset to Nadir <30 secs

Early Decelerations: Gradual
Onset to Nadir is >30 secs

Shape:
Variable Decelerations = V,U,W
Early Decelerations = Spoon shaped

Do Variable Decelerations happen with contractions?

Yes, but they can also happen from pressure being put on the Cord (Baby grasping cord, laying on cord)

Oligohydramnios Low AFI <5 will likely cause this condition…

Variable Decelerations

Cord compression due to low fluid level

Size of Variable Decelerations

Lower 15 FHR beats for atleast 15 seconds

Etiology

Cord compression detected by pressure sensing baroreceptors

Baby grasping cord, oligohydramnios, ROM, Prolapse/ Nuchal Cord

Variable Decelerations

Nursing interventions for Variable Decelerations ( Onset to Nadir <30 seconds)….

Nursing interventions for Early Decelerations (Gradual: Onset to Nadir: Equal to or >30 seconds)

Decrease pressure on the cord

Posistion changes
Evaluate how close to delivery with SVE PRN
Amnionfusion
Evaluate Oxytocin use

Early Decelerations; Continue to monitor, SVE to evaluate imminence of delivery, Consider cephalopelvic disproportion (Failure to descend)

IUPC The cap can be used for this purpose to help this problem…

Inject amniotic fluid

Helps with Variable Decelerations / Relive pressure on the cord

Decelerations

Increase or Decreased Oxytocin

Decrease

The Nadir of decelerations and peak of UC Mirror eachother in this Decelerations.

Is it a normal finding?

Early Decelerations from baby head being compressed

Yes normal finding

Variable Decelerations vs Early Decelerations

Describe the Onset time

Variable Decelerations (Onset to Nadir <30 secs)

Early Decelerations (Onset to Nadir > or equal to 30 sec)

Compare FHR of Late and early Decelerations what is the difference in appearance.

What is the same?

Both gradual (Onset to Nadir >30 secs) and spoon shaped.

Timing is the difference.

Nadir of late decelerations doesn’t match the peak of the UC. While Nadir of early Decelerations matches the peak of UC

Which FHR is the most serious

Late decelerations

Etiology

Utero-placental insufficiency = Perfusion problems. Detected by chemoteceptors

Uterine hyperactivity
Maternal hypotension
Maternal HTN
Abruption
Previa
IUGR
DM
Chorioamnionitis
Postterm gestation
Maternal anemia
SS anemia
Rh isoimmunization
Cardiac disease
Smoking

Nursing interventions

Late decelerations Dangerous

Nursing interventions: Increase perfusion and oxygenation through positioning.

IVF Bolus

Chemoteceptors that detect Ox and CO² are used to detect this problem

Late decelerations

Uterine hyperactivity, tachysystole, Doesn’t allow for perfusion between contractions.

Low maternal BP

Late decelerations

Difference between

Intermittent & Recurrent

Intermittent: Occurs <50% of contractions

Recurrent: Occurs >50% of contractions

UC frequency

Range in minutes

Measure….

Measured from beginning of contraction to the beginning of next contraction

To get range for contractions calculate which contractions…

Closest together and farthest apart

Always measure contractions with this time frame

Minutes

Never seconds

More than 5 contractions in a 10 minute period. Averaged over 30 minutes

Tachysystole

Step 6 is duration

Measure from beginning of one UC to the end of same

UC length: must be atleast ___ seconds to be considered an UC

Uterine “Irritability “…..

Duration is always measured in…

UC is atleast 40 seconds

Uterine Irritability is Uterine activy that last <40 seconds

Duration is always measured in seconds

UC duration is measured and seconds and given in this format

UC is minimal 40 sec

Range

50 - 110 sec

How to assess UC intensity with toco monitor

How to assess UC Intensity with IUPC

Palpation: Firmer the stronger the Intensity. Mild, Moderate, Strong

In addition, ask mother her subjective perception of UC Intensity

IUPC strips will be smoother lines. Read the mmHg in increment of 5

Step 8 resting tone of the uterus

Is the uterus resting between contractions.

Toco vs IUPC

Toco: Palpate the uterus (Soft & relaxed between contractions)

IUPC( Select average lowest number in between contractions) to determine Uterine Resting Tone

Step 9 Montevideo Units

Are the contractions strong enough for labor to progress?

Represents total intensity of each UC added together for 10 minute period

MVU >____ are considered adequate for 90% of labors to progress

200

How to calculate MVU ?

Which number indicates they are strong enough for labor to progress?

10 minute time span

Add all peaks of contractions and Minus from each peak the Resting Tone located to its right.

Add together all and if # is > than 200 it is 90% likely ready for labor

Step 10 FHR Category

Strong predictive of normal acid-base balance at time of observation.
Routine Care

Fetal heart rate tracing shows ALL of the following

Must have Baseline 110 - 160 BPM & Moderate Variability

May Have (Present or Absent) Accelerations & Early Decelerations

Can’t have: Late, variable or prolonged Decelerations

Which category

Category 1 NORMAL

Must have Baseline ____ BPM & _____ Variability

May Have (Present or Absent) ______&_________

Can’t have: _____, ______ or ______
Which category

Fetal heart rate tracing shows ALL of the following

Must have Baseline 110 - 160 BPM & Moderate Variability

May Have (Present or Absent) Accelerations & Early Decelerations

Can’t have: Late, variable or prolonged Decelerations

Strong predictive of normal acid-base balance at time of observation.
Routine Care

Category ____ ABNORMAL

Predictive of abnormal fetal-acid base status at time of observation. Efforts to quickly resolve the underlying cause of abnormal fetal heart rate pattern should be made.

Fetal heart rate shows EITHER of the following

Sinusoidal pattern

Absent variability Plus One of the following

Recurrent late decelerations
Recurrent variable Decelerations
Bradycardia

Category III

Category III ABNORMAL

Predictive of abnormal fetal-acid base status at time of observation. Efforts to quickly resolve the underlying cause of abnormal fetal heart rate pattern should be made.

Fetal heart rate shows EITHER of the following

_______ pattern

______ variability Plus One of the following

________ late decelerations
________ variable Decelerations
Bradycardia

Fetal heart rate shows EITHER of the following

Sinusoidal pattern

Absent variability Plus One of the following

Recurrent late decelerations
Recurrent variable Decelerations
Bradycardia

A C/S is called in the FHR Category

Category II Intermediate

FHR Interventions

When seeing diffent types of decelerations

POISON IS AT CVS

P posistion change (Increases perfusion & Lowers Oxytocin Effects. Left/Right Lateral then hands and knees NEVER SUPINE)

O oxytocin off (Lowers fetal stess from contractions & Increases fetal Perfusion

I ivf Bolus: 300 - 500 mL (Increase Fluid volume, Perfusion to baby, Lowers Oxytocin effects)

S sve (Assess imminence of delivery, rapid vaginal change and cord Prolapse.

O o² 10 L face mask for material Ox Sat <95

N notify provider

I internal monitors Consider ISL/UPC placement for more accurate data

S support maternal coping (Fight or Flight = Catecholamine = Lower uterine perfusion

A aminoinfusion (Variable Decelerations ONLY Provides fluid cushion back around cord

T terbutaline Stops UC with unresolved tachysystole + fetal distress. Cardiac /PPH SE

C c/s or svd Deliver baby. Push, Forceps, Vaccumm. Remote from delivery = C/S

V vital signs

S staff help: Altert the team

Only decelerations caused by cord compression

Variable Decelerations

Terbutaline is used for this problem

Tachysystole (5 contractions in 10 min)

Terbutaline stops UC

SE = Cardiac/ PPH

26 y.o. G2P1 41.2 IOL for oligohydramnios (AFI 2cm)

26 years old

Pregant twice Give birth once

41 weeks 2 days GA

Induction of labor due to oligohydramnios (Amniotic fluid index 2) low AFI normal = 5 - 25

AROM (mec) and IUP/ISL placed at 1700.

Artificial rupture of membranes due to meconium in fluid. Internal monitors placed at 1700

Late decelerations = Utero-placental insufficiency which is a problem with…

Perfusion

When to use an Amnionfusion

Recurrent variable Decelerations

Describe

Category 1 Nomral FHR pattern (3)

Category 3 Abnormal

(A) Must have Baseline 110 - 160 BPM & Moderate Variability

(B) May have (Present or Absent) Accelerations & Early Decelerations

Category III Either of the following

(A) Sinusoidal pattern
(B) Absent variability PLUS One of the following
Recurrent late decelerations
Recurrent variable Decelerations
Bradycardia

Mom gets epidural which type of Bad decelerations is expected…

Give interventions

Late Decelerations

Turn left side
Give O²
If HPTN give fluids
If oligohydramnios, call md, prepare for Amnionfusion

UPI uterine-placental insufficiency can happen from….

Interventions . ..

HTN/ Preeclampsia
Post Term

Turn left side
10L ox via face mask
Monitor BP
D/C IV oxytocin aka Pitocin
Call Dr

Which is bigger concern Variable or Late decelerations

Late Call Dr.

Variable you can monitor

Average fetal HR is rounded in increments of….

5 BPM

Onset to peak of Accelerations Time?

Duration of Accelerations?

Prolonged Accelerations

Onset to peak <30 ABRUPT

Duration 15 sec - 2 minutes

Prolonged 2 - 10 min

Variable Decelerations

V,U,W shaped

With or without contractions (Commonly occurs with UC)

Onset: Abrupt Onset to Nadir _____

BMP & TIME considerations to be considered Variable Decelerations….

Onset = Onset to Nadir < 30 secs

Variable Decelerations = 15 secs & 15 BMP lower

Early Decelerations / Late Decelerations

Shape: Spoon/ Saucer

Onset _____

Timing_____

Etiology ____

Onset Both Early Onset to Nadir + 30 sec

Time: Early: Decel mirrors UC ; Late Nadir of decelerations arrives after UC

Etiology: Early = Head Compression/ Vagal response

Late = Utero-placental insufficiency = Perfusion problems

Prolonged Decelerations are DANGEROUS.

Nursing interventions….

POISON IS AT CVS

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Test 2 EFM Video Flashcards

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