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Flashcards in 5. Fetal Assessment Deck (39):
1

Two tools for Hand Held FHR monitoring

• Fetoscope
• Doppler

2

Two tools for External Electronic Fetal Monitoring

o US transducer –High frequency sound waves

o Tocometer—Measures uterine activity via a pressure sensing device on the abdomen.

3

Two tools for Internal Electronic Fetal Monitoring

o Scalp elecrode (FSE / ISE)
o Intrauterine pressure catheter (IUPC)

4

How to assess the "baseline" FHR (2)

• Heartrate assessed between contractions
• Look at a 10 minute strip

5

Fetal tachycardia (def)

FHR baseline of more than 160 BPM for 10 minutes or longer

6

Maternal Causes of fetal tachycardia (5)

• Fever, Choriamnitis
• Maternal hyperthyroidism
• Drugs (Tocolytics, etc)
• Dehydration
• Anxiety

7

Fetal causes of fetal tachycardia (5)

• Early fetal hypoxia
• Asphyxia
• Fetal anemia (Decreased RBCs, Decreased Oxygen)
• Infection
• Prematurity

8

What is fetal bradycardia a sign of?

Can be a late sign of fetal hypoxia, fetal distress

9

Causes of fetal bradycardia (5)

• Placental transfer of drugs such as anesthetics
• Prolonged compression of the umbilical cord
• Maternal hypothermia and maternal hypotension
• Maternal supine hypotension syndrome
• These responses in the mother subsequently result in decrease of FHR and ultimately fetal bradycardia.

10

What causes maternal hypotension syndrome?

• Caused by the weight and pressure of the gravid uterus on the inferior vena cava

11

What is maternal hypotension syndrome?

• Decreases the return of blood flow which then reduces maternal cardiac output and blood pressure

12

Fetal Bradycardia (def)

A baseline FHR of less than 110 bpm for a duration of 10 minutes or longer.

13

Long term v Short Term variability

Long Term variability
• Irregularity of FHR over 10 minutes: Rhythmic waves or cycles from baseline

Short-Term variability
• Fluctuations from beat to beat

14

Four categories of variability. Which is optimal?

• Absent variability
• Minimal variability
• *** Moderate (avg) variability ***
• Marked variability

(Moderate variability is optimal)

15

Absent variability parameters

VARIABILITY UNDETECTABLE

16

Minimal variability parameters

Detectable, but less than or = to 5 bpm

17

Moderate variability parameters

6 to 25 bpm

18

Marked variability parameters

>25 bpm

19

Accelerations (def)

Increase in baseline of 15 bpm for 15 seconds. Indicates fetal well-being.

20

Decelerations (def)

Decrease in baseline of 15 bpm for 15 seconds.

21

What do accelerations indicate?

Fetal well-being

22

What do decelerations indicate?

May be benign or non-reassuring

23

Periodic changes and what they mean (pneumonic)

VEAL CHOP:

Variable Cord Compressions
Early Head Compressions
Accelerations OK
Late Placental Insufficiency

24

Characteristics of Early Decelerations
• Prognosis
• Severity
• Pattern, shape
• Correlation with contractions

• Prognosis: OK or benign
• Rarely goes more than 30 or 40 below baseline
• Shape is round (like head, the letter U).
• Mirror contractions.

25

Characteristics of Early Decelerations
• Related to...
• Secondary to...

• Related to vagal nerve stimulation
• Secondary to head compression

26

Characteristics of Late decelerations
• Shape / pattern
• Related to...

• Slow decrease, slow recovery (shape is rolling hills)
• Related to placental insufficiency

27

Characteristics of Variable Decelerations
• Related to...
• Correlation with contraction

• Related to Cord compressions
• Late in contraction

28

Characteristics of Variable Decelerations: Shape / Pattern (3)

• Shape: Looks like a V, U or W.
• Shoulders
• Abrupt decrease with an abrupt return to baseline.

29

What are shoulders?

Little overcompensations after deceleration. ONLY OCCUR WITH VARIABLE DECELERATIONS.

30

Early deceleration: Range

Within normal range: 120-160

31

Late deceleration: Range

Within normal range: 120-130

32

How often to document FHR assessment during each stage of labor?
• Latent phase
• Active phase
• 2nd stage

• Latent phase: Q1hour
• Active phase: Q15-30 minutes
• 2nd stage: Q5minutes or between contractions

33

Characteristics of a "reassuring" FHR pattern (4)

• Baseline between 110-116
• No decelerations or changes in baseline
• Accelerations with fetal movement
• Moderate variability

34

Characteristics of a "non-reassuring" FHR pattern (5)

• Tachycardia
• Bradycardia
• Decreased or absent variability
• Late decelerations
• Severe variable decelerations

35

What is the first thing you do if there are decelerations

TURN OFF THE PITOCIN

36

Nursing management of FHR changes (5 - in order)

o If pitocin is infusing, turn off pitocin with decelerations
o Position change (left lateral)
o Increase IV fluids
o O2 (8-10L via face mask)
o Notify Provider

37

Other interventions for FHR changes (4)

o Fetal stimulation
o Amnioinfusion
o Discourage valsalva maneuver
o Change maternal position

38

Scalp elecrode (FSE / ISE)
• What is it
• What does it do

• Tiny thing screwed in clockwise
• Takes a fetal ECG and turns it into a fetal HR

39

Intrauterine pressure catheter (IUPC)
• what does it do?

Measures the pressure inside the uterus