Week 2 Flashcards
What is chorionic villus sampling (CVS)?
Aspiration of a small amount of placental tissue (chorion) for chromosomal, metabolic, or DNA testing for fetal abnormalities caused by genetic disorders
when is chorionic villus sampling done?
Around 10-12 weeks gestation
how is chorionic villus sampling done?
Using a catheter either transvaginally through the cervix using an ultrasound guide or abdominally through a needle and ultrasonography
what are some advantages of chorionic villus sampling versus amniocentesis?
Can be performed earlier than amniocentesis but is not recommended before 10 weeks
examination of fetal chromosomes
what position would a woman be to do a chorionic villus sampling?
Lithotomy for transvaginal aspiration
supine for trans abdominal aspiration
how many times would you assess the fetal heart rate after a chorionic villus procedure?
Twice in 30 minutes post procedure
what is amniocentesis?
A needle is inserted through the maternal abdominal wall to gather amniotic fluid
when is amniocentesis commonly performed during pregnancy?
14 to 20 weeks gestation
what are some risk factors for fatal genetic disorders that might warrant amniocentesis?
Older than 35 years
history of genetic disorders
positive screening test such as alpha fetal protein
known or suspected hemolytic disease
what does amniocentesis test for?
Genetics, assessment of fetal lung maturity, and assessment of hemolytic disease, or interuterine infection
what are the advantages of amniocentesis?
Examines fetal chromosomes for genetic disorders
direct examination of biochemical specialists
accuracy rate of 99%
what might elevated bilirubin levels indicate on a amniocentesis?
Fetal hemolytic disease
positive PG indicates what on an amniocentesis?
Fetal lung maturity
L:S ratio >2:1 indicates what?
Fetal lung maturity
what are the risks of amniocentesis?
1% fetal loss rate after 15 weeks which increases to 2% to 5% earlier in gestation
Trauma to the fetus
Bleeding
Preterm labor
Maternal infection
RH sensitization from fetal blood to maternal circulation
what is delta OD 450?
Diagnostic evaluation of amniotic fluid obtained via amniocentesis product life threatening anemia in the fetus during the second or third trimester
what is an indication of delta OD 450?
When alloimmunzation exists from the increase risk for fetal anemia from RBC hemolysis
what is a safer alternative to delta OD 450for Rh alloimunized pregnancies?
Umbilical artery Doppler flow to measure the peak velocity of systolic blood flow in the middle cerebral artery of a fetus
what are some risks to Delta OD 450?
Membrane rupture
Infection
Worsening sensation
Fetal loss
what is alpha - fetoprotein?
Glycogen produced in the fetal liver, GI tract, and yolk sac in early gestation
what does AFP screen for?
Maternal blood screening for developmental defects in the fetus such as NTD and ventral abdominal wall defects
when is AFP screening done?
15-20 weeks
Increased levels of AFP are associated with what defects?
NTD, ventral abdominal wall defects
Decreased levels of AFP are associated with what defects?
Trisomy 21 also known as Down syndrome
what are some advantages of AFP testing?
Many types of neural tube defects and open abdominal wall defects can be detected early in pregnancy
what is a big risk of AFP results?
There is a high false positive rate that kind of curve with low birth weight, oligohydramnios, multifetal gestation, decreased maternal weight, and underestimated fetal gestational age
what are two types of multiple marker screens?
Triple marker and quad screen
what is the difference between triple marker and quad screen?
The triple marker has all three chemical markers– AFP, human chorionic gonadotropin, and estriol levels, but quad screen adds inhibin-A
when might the multiple marker screen be done?
15-16 weeks gestation
low levels of MSAFP mean what?
Maternal serum alpha fetoprotein and unconjugated estriol levels suggest an abnormality
Elevated gCG and inhibin-A levels mean what?
twice as high in pregnancies with trisomy 21
decreased estriol levels are an indicator of what defect?
Neural tube defects
What do multiple marker tests screen for?
Down syndrome and neural tube defects
What is chorioamnionitis?
Ascending infection from the lower GI tract and migrating to the amniotic cavity when amniotic sac is broken for a long time before birth
Risk factors for chorioamnionitis
amniotic SAC breaks long before you deliver
Long labor
Frequent vaginal exams during labor
First pregnancy
STI
Alcohol or tobacco use
Internal fetal monitoring
Epidural anesthesia during labor
GBS positive
what are the symptoms of chorioamnionitis?
Fever
Fetal and maternal tachycardia
Sore or painful uterus
Bad smell from amniotic fluid
Many women start feeling fetal movements?
Around 16 to 20 weeks
how many times a day for how long should a woman track fetal movements?
One to two hours once a day
how many fetal movements in two hours is normal?
10 fetal movements
how many fetal movements in one hour is normal?
4 fetal movements
when should fetal movements be reported to the provider?
Fewer than four in two hours
How should a woman be positioned while counting Fetal movements?
By lying on her side
why are fetal movements important to evaluate?
It is an important evaluation of fetal well-being
What should a woman do if fetal movement is decreased?
Eat, rest, and focus on fetal movement for one hour
what is the most widely accepted method of evaluating fetal status especially for high risk pregnancies with hypertension?
Non stress test
what might a provider do if a woman comes in reporting decreased fetal movements daily?
Use a non stress test
what is a non stress test for fetal monitoring?
Assesses the heart rate of physiologically normal fetus with adequate oxygenation and intact autonomic nervous system which accelerates in response to movement
when is the NST considered reactive in fetuses more than 32 weeks gestation?
When the FHR increases 15 beats above baseline for 15 seconds twice or more in 20 minutes
how long will a fetal heart rate monitor take?
Up to 20 to 40 minutes
when is the NST considered reactive in fetuses less than 32 weeks gestation?
Two accelerations peaking at least 10 beats per minute above baseline and lasting 10 seconds and 20 minutes.
What is a non reactive NST?
Insufficient fetal heart rate accelerations in 40 minutes
what might repetitive variable decelerations that are less than 30 seconds on a NST indicate?
possible abnormalities of amniotic fluid
what might a non-reactive NST be followed up with?
BPP
what might you do after no 15 by 15 within 20 minutes of a non stress test?
Use a vibroacoustic stimulator and then repeat the test for 20 more minutes
what are the advantages of a non stress test?
It is non invasive
Easily performed
Reliable indicator of fetal well-being
how would you prep the patient for a non stress test?
Explain the procedure
Have the patient void before
Light and semi Fowler or lateral position
What is a biophysical profile?
Ultrasound assessment of fetal status along with an NST.
What does a biophysical profile evaluate?
Fetal status through ultrasound observation of various fetal reflex activities that are controlled by the central nervous system and sensitive to fetal hypoxia
For what complications is the biophysical profile assessment indicated?
Pregnancies involving increased risk of fetal hypoxia and placental insufficiency such as maternal diabetes and hypertension
what does the biophysical profile Assessment assess for (5)?
breathing movement
body movement,
fetal tone
fluid volume (amniotic), and
heart rate activity
4 indicators of ultrasound observation are what?
Fetal breathing movements, fetal movements, fetal tone, and measurement of amniotic fluid
What assessments does the BPP consist of?
NST with additional 30 minutes of ultrasound observation
what is normal fetal movement?
Three or more discrete body or limb movements in 30 minutes
what is normal fetel breathing movement rate?
One or more episodes of rhythmic breathing movements of 30 seconds or movement within 30 minutes is expected
what is normal fetal tone?
One or more fetal extremity extension with return to fetal flexion or opening and closing of the hand is expected
what is normal amniotic fluid volume?
A pocket of amniotic fluid that measures at least 2cm in two planes perpendicular to each other
How would you interpret a BPP?
A score of two which means present or 0 which means absent is assigned to each of the five components
what do the numbers of a BPP scoring mean?
Eight is reassuring
6 out of 10 is equivocal and may indicate delivery depending on gestational age
4 out of 10 means delivery is recommended
two out of 10 or less means immediate delivery
activity decrease or sensation warrants reversal order of normal development
___ is the activity that appears earliest in pregnancy and last to cease
fetal activities
Activities that are the ____ to develop are usually the ___ to diminish
last, first
What are the five factors that affect labor?
Powers, passage, passenger, psyche, position
what are some signs of impending labor?
Lightning
Braxton Hicks contractions
cervical changes
Surge in energy sometimes referred to nesting
GI changes like weight loss
Backache due to relaxation of pelvic joints
Bloody show or discharge
during the first stage of Labor the uterus becomes ___?
Shorter
when does lightening usually occur?
Two weeks before term and first time pregnancies
what does powers include?
Uterine contractions and bearing down
what are responsible for the dilation and effacement of the cervix in the first stage of Labor?
Uterine contractions
the resting phase allows what to happen in the uterus and placenta?
Blood flow to return back to the uterus and placenta so that the fetal exchange of oxygen, nutrients, and waste products occurs in the placenta
which segment of the uterus contracts to push the fetus down?
The upper 2/3 of the uterus
How are uterine contractions described? (3)
frequency, duration, intensity
with every contraction___ mL of blood leaves the utero-placental unit and moves back into maternal circulation.
500 mL
how would you describe frequency in uterine contractions?
Timing from the beginning of 1 contraction to the beginning of other in minutes
how would you evaluate the intensity of a uterine contraction ?
The strength of a contraction evaluated with the palpation using fingertips on the maternal abdomen
what are the three levels of intensity of a uterine contraction?
Mild, moderate, and strong where the uterine wall cannot be indented during a contraction
how would you describe the duration of a uterine contraction?
starts from the beginning of a contraction to the end of a contraction recorded in seconds
in which level of uterine contraction intensity does the uterine wall easily indent during a contraction?
Mild intensity
how much indentation would a moderate intensity contraction have?
Uterine wall is resistant to indentation Contraction
what are the three phases of a contraction?
Increment, Acme, decrement phases
in which phase of a contraction is the peak of intensity the shortest part of contraction?
Acme
the increment phase is characterized by what?
Ascending or buildup of the contraction that begins in the fundus and spreads throughout the uterus also the longest part of the contraction
____ facilitates cervical changes
Contractions
which is the longest part of the contraction?
Increment phase
____ and ____ occurs during the _____ stage of Labor when the uterine contractions pushed the presenting part of the fetus towards the cervix causing it to open and then out
dilation, effacement, and 1st
in which phase is a descending or relaxation of the uterine muscle?
Decrement phase
at what diameter is the cervix considered fully dilated and no longer palpable on examination?
10 cm
____ Is the shortening and thinning of the cervix
effacement
the degree of effacement is measured in ____ and goes from _____ to _____
percentage and it goes from 0% to 100%
effacement often_____ dilation in a ____- times pregnancy, but occurs_____ in ____ pregnancies
Precedes, first
Simultaneously, subsequent
the urge to push is triggered by the _____ reflex, activated when the_____ part stretches the pelvic floor muscles
Ferguson, presenting
What receptors are activated to release what hormone?
Stretch, oxytocin
what is the most common type of pelvis shapes ?
Gynecoid
what is referred to as the relationship of the ischial spines to the presenting part of the fetus and assist in assessing for fetal descent during labor?
Station
what station is the narrowest diameter the fetus must pass through during a vaginal birth?
0
At station zero, where is the baby’s head?
In line with the ischial spine
how is the relationship between the fetus and the passageway described?
Fetal skull, fetal attitude, fetal life, fetal presentation, fetal position and fetal size
what would you call a head first delivery?
cephalic
what are some factors that might influence a woman’s psyche?
Coping mechanisms including culture, expectations, a strong support system and type of support during labor , expectations such as past experience and current pregnancy experience, fear and anxiety
what does position refer to in the five factors that affect labor?
The maternal position during labor and birth
what kind of position is encouraged in the first stage of Labor?
Upright such as walking, sitting, kneeling, or squatting
why is an upright position encouraged in the first stage of Labor?
Decrease compression of the maternal descending aorta and ascending vena cava to prevent supine hypotension
also good for heating the scent of infant and more effective contractions for a shorter labor
why might it be good to frequently change positions during the first stage of Labor
to reduce fatigue, increase comfort, and improve circulation
What are the passage portions that affects labor?
The pelvis and vaginal canal
What is the most common kind of pelvis?
Gynecoid
What axes are important in fetal lie?
The long access the spine of the fetus in relationship to the long axis or spine of the woman
Which fetal position are the long axis of the fetus and mother are parallel?
longitudinal lie
a fetus cannot be delivered functionally in the____ lie
transverse
what would you call the relationship of fetal parts to one another?
Fetal attitude or posture
what determines fetal presentation?
The part or pull of the fetus that first enters the pelvic inlet
what would you call presentation that has partial extension of the neck with a brow as the presenting part?
Frontal or brow presentation
how would you describe a complete breach?
Complete flexion of the thighs and legs extending over the anterior surfaces of the body like they are cross legged
what would you call a frank breach?
When the babies bottom is facing the mouth of the pelvis and its feet are near its head so complete flexion of the thighs and legs
any compound presentation which part is presenting usually
arm or hand presenting alongside the presenting part
When the babies bottom is facing the mouth of the pelvis and its feet are near its head so complete flexion of the thighs and legs
Extension of one or both thighs and legs so that one or both feet are presenting
In a transverse presentation which part is presenting usually?
Shoulder
what is the relation of the denominator or reference point to the maternal pelvis?
Fetal position
what is the specific fetal structure for a cephalic presentation?
Occiput
what is the specific fetal structure for a shoulder presentation?
Acromion
Which position occiput position is bad for birth?
Occiput posterior because it can press on the mom’s sacrum and cause prolonged labor
position is designated by a ___ letter abbreviation
three
what does the 2nd letter of fetal position designate?
Specific fetal part presenting such as O for occipital S for sacrum M for mentum and a for shoulder
what does the 1st letter of fetal position designate?
Designate which side are presenting part the left or the right L or R
what does the 3rd letter of fetal position designate
relationship of presenting fetal heart to the woman’s pelvis such as A for anterior P for posterior or T for transverse
What are some signs of false labor?
Contractions but no change in cervix
Activities or position changes does not change pattern of contraction
hydration or sedation slows or stops contractions
what is in the second stage of Labor?
10 centimeters to birth of baby
what are some signs of true labor?
Regular contractions increase in frequency and intensity
Change in cervix
Causing effacement and dilation
What is in the first stage of Labor?
Latent phase up to 5 centimeters
active phase up to 6 centimeters and transition phase from 8 to 10 centimeters
what is in the fourth stage of Labor?
Postpartum
what would you assess in the first stage of Labor?
Maternal vital signs
Women’s response to labor and pain
Fetal heart rate and uterine contractions
Cervical changes
Fetal position and descent in the pelvis
which stage of Labor is the longest?
Stage 1
what is in the third stage of Labor?
The delivery of the placenta
What should a laboring women eat and drink?
Once a minute typically clear liquids and women can dictate their oral intake of carbs to decrease maternal ketosis
what is the latent phase of labor?
Right before active labor
what will you do during latent labor stage?
Assess fetal heart rate every 30 minutes or per protocol
Leopold’s maneuver for fetal position
Sterile Vaginal Exam of Patient
take the patient off her back
Another term for completely dilated
Another term for completely dilated
100% effaced
In what stage of labor would you perform Leopold’s maneuver and SVE?
latent
What would you look for with an SVE?
Cervical dilation, position, and effacement, station, presentation, and fetal position
What are different techniques to confirm rupture of the membranes?
Speculum exam
nitrazine paper
ferning
lab tests not test for proteins in the amniotic fluid
What color will nitrazine paper turn it touches amniotic fluid?
Blue
What shape will amniotic fluid become if is placed on a slide?
Ferning pattern
What is amnisure?
Tests for proteins and the amniotic fluid and 99.9% accurate
what would you do if a woman’s water broke?
Assess the fetal heart rate, amniotic fluid for color, amount, and odor, and document the date and time
Why would you assess the fetal heart rate when a woman’s water breaks?
There’s an increased risk of umbilical cord prolapse
Higher risk of umbilical cord prolapse when the presenting part is not engaged
how should normal amniotic fluid be?
Clear or cloudy with normal odor similar to ocean water
what might meconium indicate?
Indication of fetal compromise in utero
what are the four maneuvers of Leopold’s maneuvers?
1st- determine what part of the fetus is located in the fundus of the uterus
2nd- determine location of fetal back
3rd- determine presenting part
4th- determine the location of cephalic prominence
what are some characteristics of the transition phase?
Cervical dilation from 8 to 10 centimeters with complete effacement
intense contractions every one to two minutes lasting 60 to 90 seconds
Exhaustion and increased difficulty concentrating
Increase of bloody show
Nausea and vomiting
Backache and back pressure
Trembling
Diaphoresis
Strong urge to bear down or push
What is the number one uterotonic?
Oxytocin/pitocin, which helps contract the uterus
When is methergine contraindicated?
hypertension
What happens in the third stage?
Placental delivery
Quantification of blood loss
Uterotonic medications
What will be given if the mother is still bleeding after placental delivery?
Methylergonovine
Hemabate
Oxytocin
Tranexamic acid
misoprostol
When is hemabate contraindicated?
Asthmatic
What is misoprostol used for?
To stop bleeding and induction of labor
What is tranexamic acid?
Control bleeding
How often should FHR be assessed in active labor?
Every 15-30 minutes
How often should FHR be assessed in the second stage of labor?
Every 5-15 minutes
How often should UC be assessed in active labor?
Every 15-30 minutes
How often should UC be assessed in the second stage of labor?
Every 5-15 minutes
what are some goals in the fourth stage 2 facilitate newborn family attachment?
Early contact with newborn
Encouragement of eye contact and touch
Allowing time to hold newborn
Talking to the baby, smiling, and cuddling
Initiate breastfeeding
what are 6 care practices that support and promote normal physiologic birth?
Labor begins on its own
Freedom of movement throughout labor
Continuous labor support
No routine interventions
Spontaneous pushing and non supine positions
No separation of mother and baby
____ Is an incision in the perineum to provide more space for the presenting part at delivery
episiotomy
what are two types of episiotomies?
Median or midline versus medilateral
what does a first-degree laceration involve?
Perennial skin and vaginal mucous membranes
what does a second-degree laceration involve
skin, mucousmembrane, and fascia of the perineal body
what does a third-degree laceration involve?
skin, and muscle of the perineal body extending to the rectal sphincter
what does a fourth-degree laceration involve?
Extends into the rectal mucosa and exposes the lumen of the rectum
what are signs that signify impending delivery of the placenta?
Upward rising of the uterus into a ball shape
lengthening of the umbilical cord at the introitus
sudden gush of blood from the vagina
active management of placental delivery consists of urogenital, control or traction, and uterine massage
what is normal blood loss for a vaginal birth?
About 500 milliliters
What are indications of oxytocin?
Labor induction and augmentation. Control of postpartum bleeding after placental expulsion
how does oxytocin work?
Stimulates uterine smooth muscle that produces intermittent contractions
Also has vasopressor and antidiuretic properties
what is the indication of methylergonovine?
Prevent or treat postpartum hemorrhage, uterine atony, sub involution
what is the action of methylergonovine?
Directly stimulates smooth and vascular smooth muscles causing sustaining uterine contractions
how does carboprost work?
Contracts uterine muscle
What is the indication of carboprost?
Uterine atony
how does misoprostol work?
Acts as a prostaglandin analog causes uterine contractions
what is the indication of misoprostol?
Control postpartum hemorrhage
what are analgesic medications during labor?
meperidine or Demerol
butorphanol (stadol)
sublimaze (fentanyl)
morphine
remifentanil
all opiates
what type of block is an epidural?
Reginal
When can an epidural be administered?
1st and/or second stage of Labor
what would you administer before an epidural? Why?
IV fluid bolus with normal saline or lactated ringers to prevent hypertension
how often would you monitor maternal vital signs and fetal heart rate after an epidural?
Every 5 minutes initially and every 15 minutes thereafter
What are the five physiological signs of an apgar score?
Heart rate based on auscultation
Respiratory rate based on observed movement of the chest
muscle tone based on degree of flexion and movement of the extremities
Reflex irritability based on response to tactile stimulation
Color based on observation
what does a score of 0 to 3 on the apgar scale indicate?
Severe distress
what does a score of four to six indicate on the apgar scale?
Moderate difficulty with transition to extrauterine life
what does an apgar scale of seven to 10 indicate?
Stable status
when would you give a score of one for muscle tone?
If there is only some flexion of extremities
when would you give a score of 1 for reflex activity?
grimacing
when would you give a score of one for color?
If the baby has a pink body but blue extremities
when would you give a 2 for heart rate?
If the heart rate is above 100 beats per minute
when would you give a 2 for respiratory effort?
Good cry
how often would you assess apgar scores?
At 1:00 and 5:00 minutes
if a baby had a score of 6, what would you do?
Assess every 5 minutes up to 20 minutes until the baby has a score above 6
if a baby had zero to three apgar score then what would you do?
Indicates severe distress, so may need extra help
what does a score of four to six mean you have to do for a baby?
Give them supplemental oxygen, maybe a warm blanket, extra stimulation.
What type of monitoring is more accurate for urine contractions?
Intrauterine
what is a consideration for intra uterine monitoring devices?
infection
when is the best part on a strip to assess fetal heart rate?
Place where there is resting tone in the contraction and no accelerations or decelerations
What is a baseline fetal heart rate?
The mean or average fetal heart rate rounded to increments of five beats per minute during a 10 minute window excluding accelerations and decelerations
what is baseline variability?
Fluctuations in the baseline fetal heart rate that are irregular in amplitude and frequency which are visually quantified as the amplitude of the peak to trough in beats per minute. Determined by a 10 minute window excluding accelerations and decelerations
What are the four types of baseline variability?
Absent
Minimal
Moderate
Marked
Baseline variability is the interaction between what and what?
Fetal sympathetic and parasympathetic nervous systems
what would an absent baseline variability look like?
Amplitude range is undetectable
what would a minimal baseline variability look like?
Amplitude range is visually undetectable and less than 5 beats per minute
what would a moderate baseline variability look like?
Amplitude from peak to trough is 6 to 25 beats per minute
what would a marked baseline variability be?
Amplitude range is greater than 25 beats per minute
What do accelerations in FHR look like?
Visually apparent with an abrupt increase in FHR above baseline where the peak of the acceleration is greater than 15 beats per minute over the baseline fetal heart rate 4 greater than 15 seconds and greater than two minutes
what do decelerations look like in an FHR?
Transitory decrease in the FHR from baseline
what are the four types of decelerations?
Early deceleration
Variable
Late
Prolonged
Sinusoidal
what does an early deceleration look like and is it good or bad?
visually apparent gradual decrease in FHR below baseline where the lowest point of deceleration occurs simultaneously with peak of uterine contraction. This is good
What does a variable deceleration look like?
Visually abrupt decrease in the FHR below baseline where the FHR is greater than 15 beats per minute lasting more than 15 seconds and less than two minutes in direction
what is late deceleration?
A visually apparent gradual decrease of FHR below baseline where nadir is after the peak of uterine contraction
what is prolonged deceleration?
Are you visually apparent abrupt decrease in FHR below baseline that is greater than 15 and two BPM but less than 10 min
what is considered fetal tachycardia?
10 or more minutes of greater than 160 BPM
what is considered fetal bradycardia?
10 or more minutes of less than 110 BPM
Normal fetal heart rate is hey FHR pattern that reflects a _________ to the_______.
Physiological response, maternal fetal environment
The FHR is measured via a(n)________.
Ultrasound transducer.
External EFM detects what four things?
Fetal heart rate baseline, variability, accelerations, and decelerations
what are some reasons for erratic FHR recordings or gaps?
Inadequate conduction of the ultrasound signal displacement of the transducer, fetal or maternal movement, inadequate ultrasound gel, or fetal arrhythmia
what is the device that measures contractions?
Tocodynamometer
the _______ and ____ of uterine contractions, ____, which is the tone of the uterus between contractions can be measured by a tocodynamometer
relative frequency, duration of uterine contractions, relative resting tone
how must the pressure or intensity of the contractions be measured?
By palpation
Where toco transducer be positioned?
On the area of uterus palpated to be the strongest area of contraction where the resting tone is not dialed to 15 to 20mm of mercury when the uterus is relaxed, basically where the contraction feels strongest to palpation
what does an internal electric fetal monitoring system do?
Apply directly to the fetus to detect fetal heart rate
where is the intrauterine pressure catheter placed?
In the uterine cavity
who can attach the IETF or ISE?
A nurse or care provider certified to attach it
what are some contraindications to direct methods of monitoring?
Chorioamnionitis, active maternal genital herpes and HIV
what are some indications for internal monitoring?
Lack of progress in labor
Obesity When external monitoring is inadequate
Treat worsening category 2 tracing
how are uterine contractions measured with an intrauterine pressure catheter?
In millimeters of mercury; peak pressure minus the baseline pressure in MMHg
contraction intensity varies during labor, from ____in early spontaneous labor to ____ and transition to ____ in the second stage
30, 70, 70-90
what is resting tone also known as?
baseline pressure of contractions
what should the baseline pressure be?
5-25 mm Hg
contraction intensity varies during labor, from ¬¬¬-____in early spontaneous labor to ____ and transition to ____ in the second stage
contraction intensity varies
which category of FHR interpretation is normal?
Category one
which category of FHR interpretation is abnormal?
Category 3
what are the components of category one FHR interpretation?
Include all of the following
Baseline rate 110 to 160 beats per minute
Baseline variability is moderate
Late or variable deceleration absent
Early decelerations are absent or present
Accelerations absent or present
Components of category 3 FHR interpretation
either absent variability with any of the following
Recurrently late decelerations
Recurrent variable decelerations
Bradycardia
or sinusoidal pattern
what are the maternal causes of minimal or absent variability?
Supine hypotension
Cord compression
Uterine tachysystole
Drugs such as prescription, illicit or alcohol
what are the fetal-related causes of minimal or absent variability?
Fetal sleep or prematurity
the presence of FHR accelerations is predictive of_____ and reflects____
adequate central fetal oxygenation, absence of fetal acidemia
what would you do for an FHR acceleration?
nothing
when are decelerations recurrent versus intermittent
recurrent when occurring at least 50% of uterine contractions over 20 minutes and intermittent when fewer than 50% of contractions
what is the most common deceleration seen in labor?
Variable decelerations
what type of deceleration is a compensatory response to hypoxemia?
An acceleration that precedes or follows a deceleration
what is the relationship between the FHR and uterine contraction In variable decelerations?
May vary in duration, depth and timing in relation to uterine contraction
Variable decelerations can take the shape of what?
U, W, or V
what are three characteristics of a normal variable deceleration?
Duration of less than 60 seconds
Rapid return to baseline
Accompanied by normal baseline and variability
what are some causes of variable decelerations
umbilical cord occlusion
Compression that triggers A vagal response
Sudden descent of vertex late in active phase of Labor such as head compression
what are some management techniques for variable deceleration?
Consider amnio infusion, tocolytics, delivery
what is amnioinfusion?
When as a result of decreased amniotic fluid room temperature saline is infused into the uterus through the cervix to increase intra amniotic fluid to cushion the umbilical cord and reduce compression
late deceleration can be a sign of______ to labor
fetal intolerance
when does the nadir of a late deceleration occur?
After the peak of the contraction and mostly after the end of the contraction occurs
what are some causes of late decelerations?
Fetal response to transient or chronic uteroplacental insufficiency
suppression of the federal myocardium
decreased availability of O2 because you’re a placental insufficiency
what kinds of decelerations are not re occurrent and preceded and followed by normal baseline and moderate variability not associated with fetal hypoxemia?
Prolonged deceleration
how long might a prolonged deceleration last four?
Greater than two minutes but less than 10
what are some causes of prolong deceleration?
Any mechanism that causes a profound change in the fetal O2 level
vagal stimulation
interruption of umbilical blood flow
what are the medical managements for prolonged decelerations?
Treat the cause
Consider Amy on fusion
Consider tocolytics
Consider delivery
in what kind of deceleration would you do nothing?
Early decelerations
What is reglan used for?
Antiemetic
What antibiotic would you give for GBS+?
Penicillin
According to veal chop what is the physiological reason for variable deceleration?
Cord compression; move mother
According to veal chop what is the reason for early deceleration?
Head compression; no intervention necessary
According to veal chop what is the reason for acceleration?
Oxygenation- lack of; no intervention needed
According to veal chop what is the reason for late deceleration
placental insufficiency evaluate reason,
what are the POOF interventions?
Position or reposition
Oxygenate
Oxytocin (stop oxytocin or Pitocin)
Fluid administration
How would you determine uterine activity?
Assessing the contractions frequency, duration, and intensity, and uterine resting tone
how would you count the frequency of contractions?
Count the number of contractions in a 10 minute., counting from the start of 1 contraction to the start of the next contraction in minutes
What is a normal amount of contractions?
Five or fewer contractions in 10 minutes average over a 30 minute window
what would you call more than five contractions in 10 minutes over 830 minute window?
Tachysystole
Characteristics of tachysystole?
More than five contractions in 10 minutes
Contractions lasting 2 minutes or longer
Contractions occurring within one minute of each other
Increasing resting tone greater than 20 to 25mm Hg with peak pressure greater than 80
what are some causes of tachysystole?
Spontaneous or simulated labor
Medications used for cervical ripening, induction, and augmentation of Labor
what are some actions to take for tachysystole?
Changing positions, providing hydration, IV fluid bolus, reducing anxiety or pain, administering tocolytics such as terbutaline, supporting woman and family
___ and ___ are considered the up and down of a contraction
Increment, decrement
which is shorter a duration or frequency of a contraction
duration because it only counts the increment peak and decrement of a contraction
how is a external versus internal uterine monitoring device different?
The intrauterine device can measure the intensity of a contraction
what drug can cause fetal tachycardia?
terbutaline
what can cause fetal tachycardia?
Early fetal hypoxemia
Maternal fever
Terbutaline
what can fetal bradycardia lead to?
100 decreased cardiac output
Decrease in umbilical blood flow
Decrease oxygen to the fetus leading to fetal hypoxia
what does terbutaline do?
It stops the contractions
what is considered a fever?
Body temperature of above 100.4°F
what are some tocolytics?
Nifedipine, nicardipine, terbutaline
what is an indication of beta methadone?
Women at 24 to 34 weeks gestation with signs of preterm labor or at risk to deliver preterm
what is an adverse reaction to betamethasone?
Adverse reactions include and may require temporary insulin coverage to maintain euglycemia
what is the action of betamethasone?
Stimulates the production of more mature surfactant in the fetal lungs to prevent respiratory distress syndrome and premature infants
what is the difference between a variable deceleration and early deceleration?
Variable decelerations have sudden drops with or without contractions such as the letters U, V, or W
Amniotic fluid index
measures the volume of amniotic fluid with ultrasound to assess fetal well-being and placental function
contraction stress test
Assess fetal well-being and utero placental function with external fetalmonitor and women with non reactive NST at term gestation to identify a compromised fetus
multiple marker screening
triple marker and quad screen
alpha fetoprotein screening
glycoprotein produced in the fetal liver GI tract and yolk sack to assess for developmental defects in the fetus such as neural tube defects
when would you conduct an umbilical artery Doppler flow?
to assess fetal status and intrauterine growth restricted fetuses
which test is both a screening and diagnostic?
Ultrasound
nuchal translucency
looks at the space at the back of your baby’s neck called the nuchal fold to help assess risk for down syndrome and other genetic problems in the baby.
umbilical artery Doppler flow
uses advanced ultrasound technology to assess resistance to blood flow in the placenta to evaluate rate and volume of blood flow through the placenta and umbilical cord vessels
vibroacoustic stimulation
screening tool that uses Tory simulation to assess fetal well-being with EFM when non stress test is reactive to startle the fetus
what kind of information can you get with an ultrasonography? (8)
Gestational age
Fetal anatomy, growth, and activity
Placental abnormalities and location
Amount of amniotic fluid
Visual assistance for invasive procedures
What trimester would you detect placenta previa or abruption from an ultrasound?
3rd trimester
when is the best time to check for fetal anomalies on an ultrasound?
Best after 18 weeks or intrauterine growth restriction
when is umbilical artery Doppler considered abnormal?
If the systolic diastolic ratio is above the 95th percentile for gestational age
Or ratio above 3.0, or the end diastolic flow is absent or reversed
when should you not use vibroacoustic stimulation?
When there is a deceleration or bradycardia
Components of a biophysical profile
MRI
US
Doppler (umbilical artery)
What are some maternal triggers of labor?
Stretching of uterine muscle
oxytocin release
release of prostoglandins
estrogen/progesterone changes
Fetal factors to trigger labor
Prostaglandin Increase to cause contractions
Cortisol changes of fetus
Aging placenta
