Week 12 TUES Flashcards
maternal/ fetal assessment
- transducer emits high frequency sound waves, placed on mothers abdomen and moved to see the fetus
- standard component of prenatal care
ultrasonography
uses sound waves to examine the flow of blood in blood vessels
doppler ultrasonography
glycoprotein produced initally by the yolk sac and fetal gut, and later predominantly by the fetal liver
Alpha-fetoprotein analysis
what uses ultrasound in 1st trimester between 11-14 wks, allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities
Nuchal translucency screening
transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis and can determine chromosomal abnormalities and several hereditary metabolic defects in fetus before birth
Amniocentesis
indirect measurement of uteroplacental function
nonstress test
What does a nonstress test measure for the fetus
measures fetal heart rate patterns in response t fetal mov’t
NST procedure
- mother eats a meal or has a snack to stimulate fetal activity
- place in left lateral recumbent position to avoid supine hypotension syndrome
- external electronic fetal monitoring device applied to moms abdomen
- 2 belts w/ a sensor that records uterine activity and fetal heart rate
- procedure last 20-30 min
NST nursing management
- have mother empty bladder and eat a snack
- obtain baseline fetal monitor strip over 15-20 minutes
- during test observe signs of fetal activity w/ concurrent acceleration of the fetal HR
- reactive or nonreactive
Biophysical profile (BPP)
test used during pregnancy to check the health of the baby in the womb. It combines an ultrasound with a non stress test to measure the baby’s well-being. The BPP looks at five thing
- fetal breathing - fetal tone
- body mov’t - amniotic fluid level
- heart rate
What is the scoring system for BPP
Each area gets a score (usually 0 or 2), and the total helps doctors know if the baby is doing well or needs more monitoring. The maximum score is 10, with 8 to 10 generally being healthy.
What is primary powers
- The primary stimulus powering labor is contractions
- cause complete dilation and effacement of the cervix during first stage of labor
What is secondary powers
- use of intrabdominal pressure (voluntary muscle contracted) exerted by the woman as she pushes and bears down during 2nd stage of labor
uterine contractions
involuntary, rhythmic and intermittent w/ period of relaxation between contraction
thinning and shortening of the cervix as the body prepares for delivery
effacement
process of the cervical opening up to allow the baby to pass through the birth canal
dilation
Early labor dilation and contractions
0-3 cm dilation
- last 30 secs, occur every 5-7min
Active labor dilation
4-7 cm dilation
Transition stage
8-10cm dilation
3 phases of contraction
- increment
- acme
- decrement
increment
build-up of contraction
acme
peak
decrement
descent/ relaxation of uterine muscle fibers
Maternal Physiologic responses to labor
- Labor: the process by which the birth canal is prepared to allow the fetus to pass from the uterine cavity to the outside world
- Increased heart rate (increases by 10-20bpm)
- Cardiac output increases (12-31% 1st stage of labor and 50% in 2nd stage of labor)
- BP increases by up to 35mmHg during contractions
- WBC increase (? 2/2 to tissue trauma)
- RR increases (need more O2)
- Gastric motility/food absorption decreases
- Can increase likelihood of emesis and nausea
- Mild temperature elevation
- Increased basal metabolic rate and blood glucose levels decrease
- Muscle aches and cramps
Fetal physiologic responses to labor
- Periodic fetal heart rate changes (FHR)
- Decrease in circulation & perfusion secondary to uterine contractions
- Increase in arterial CO2 pressure
- Decrease in fetal breathing movements throughout labor
- Decrease in fetal oxygen pressure with decrease in partial pressure of oxygen (PO2)
What is the purpose of FHR monitoring
- determine rate and rhythm of fetal HR
- normal 11-160
What is the purpose of continuous electronic fetal monitoring
detect fetal FHR changes EARLY!
Indications for continuous electronic fetal monitoring
- women receiving oxytocin infusion
- epidural anesthesia
- variety of problems related to compromise in fetal/ maternal health
- moderate htn, delay in 1st/ 2nd stage of labor
- presence of meconium
Clinical goal with continuous electronic fetal monitoring
- identify fetuses w/ increased risk of hypoxia injury to that intervention can avoid adverse outcome
- early detection> early interventions> save lives
Category I FHR
- normal FHR
- baseline rate 110-160
- strongly predictive of normal
- no late decels/ variables
- early decels fine
Category II FHR
- tracing not assigned to cat I or cat III
- not predictive of abnormal fetus status
Category III FHR
- predictive of abnormal fetal acid base status at the time of observation
- sinusoidal pattern for at least 20 mins
- absent variability
- recurrent late decels, bradycardia, and variables
fetal bradycardia
FHR < 11bpm and lasts 10 mins
- caused by fetal hypoxia, fetal acidosis, hypoglycemia, cord compression
Fetal tachycardia
FHR >160bpm
- early compensatory response to asphyxia, hypoxia, maternal fever, fetal anemia & infection, maternal dehydration
4 categories of variability
absent, minimal, moderate, marked
irregular fluctuations in baseline FHR which is measured as the amplitude of the peak to trough in bpm
variability
transitory abrupt increases in FHR above the baseline that last less than 30 secs from onset to peak
Accelerations
tranisent fall in FHR caused by stimulation of the parasympathetic nervous system
deceleration
visually apparent, usually symmetrical, characterized by gradual decrease in FHR in which the nadir (lowest point) occurs at the peak of contraction
early decel
visually apparent, symetrical, transitory decrease in FHR that occurs after the peak of contraction
late decel
visually apparent abrupt decreases in FHR below baseline and have unpredictable shape on the FHR baseline, possible demonstrate no relationship with contractions
variable
visually apparent smooth, sinewave like undulating pattern in the FHR baseline with cycle frequency of 3-5bpm that persists for >20 minutes
Sinusoidal pattern
- super rare!
Nursing role in cat III FHR
- Notify the health care provider about the pattern and obtain further orders, document all interventions and their effects on FHR pattern
- Discontinue oxytocin or other uterotonic agent as dictated by the facilities protocol if being administered
- Turn client on L or R lateral, knee-chest or hands and knees to increase placental perfusion and relieve cord compression
- Administer O2 via nonrebreathing face mask to increase fetal oxygenation
- Increase IV fluid rate to improve intravascular volume and correct maternal hypotension
- Assess the client for any underlying contributing causes
- Provide reassurance that interventions are to effect pattern change
- Modify pushing in the 2nd stage of labor to improve fetal oxygenation
- Document any and all interventions and changes in FHR patterns
- Prepare for surgical birth if pattern not corrected in 30 minutes
