5. Fetal Assessment

Question 1

Two tools for Hand Held FHR monitoring

Answer 1

• Fetoscope

* Doppler

Question 2

Two tools for External Electronic Fetal Monitoring

Answer 2

o US transducer –High frequency sound waves

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

Question 3

Two tools for Internal Electronic Fetal Monitoring

Answer 3

o Scalp elecrode (FSE / ISE)

o Intrauterine pressure catheter (IUPC)

Question 4

How to assess the “baseline” FHR (2)

Answer 4

• Heartrate assessed between contractions

* Look at a 10 minute strip

Question 5

Fetal tachycardia (def)

Answer 5

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

Question 6

Maternal Causes of fetal tachycardia (5)

Answer 6

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

Question 7

Fetal causes of fetal tachycardia (5)

Answer 7

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

Question 8

What is fetal bradycardia a sign of?

Answer 8

Can be a late sign of fetal hypoxia, fetal distress

Question 9

Causes of fetal bradycardia (5)

Answer 9

• 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.

Question 10

What causes maternal hypotension syndrome?

Answer 10

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

Question 11

What is maternal hypotension syndrome?

Answer 11

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

Question 12

Fetal Bradycardia (def)

Answer 12

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

Question 13

Long term v Short Term variability

Answer 13

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

Short-Term variability
• Fluctuations from beat to beat

Question 14

Four categories of variability. Which is optimal?

Answer 14

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

(Moderate variability is optimal)

Question 15

Absent variability parameters

Answer 15

VARIABILITY UNDETECTABLE

Question 16

Minimal variability parameters

Answer 16

Detectable, but less than or = to 5 bpm

Question 17

Moderate variability parameters

Answer 17

6 to 25 bpm

Question 18

Marked variability parameters

Answer 18

> 25 bpm

Question 19

Accelerations (def)

Answer 19

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

Question 20

Decelerations (def)

Answer 20

Decrease in baseline of 15 bpm for 15 seconds.

Question 21

What do accelerations indicate?

Answer 21

Fetal well-being

Question 22

What do decelerations indicate?

Answer 22

May be benign or non-reassuring

Question 23

Periodic changes and what they mean (pneumonic)

Answer 23

VEAL CHOP:

Variable Cord Compressions
Early Head Compressions
Accelerations OK
Late Placental Insufficiency

Question 24

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

Answer 24

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

Question 25

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

Answer 25

* Related to vagal nerve stimulation | * Secondary to head compression

Question 26

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

Answer 26

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

Question 27

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

Answer 27

* Related to Cord compressions | * Late in contraction

Question 28

Characteristics of Variable Decelerations: Shape / Pattern (3)

Answer 28

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

Question 29

What are shoulders?

Answer 29

Little overcompensations after deceleration. ONLY OCCUR WITH VARIABLE DECELERATIONS.

Question 30

Early deceleration: Range

Answer 30

Within normal range: 120-160

Question 31

Late deceleration: Range

Answer 31

Within normal range: 120-130

Question 32

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

Answer 32

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

Question 33

Characteristics of a "reassuring" FHR pattern (4)

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What is the first thing you do if there are decelerations

Answer 35

TURN OFF THE PITOCIN

Question 36

Nursing management of FHR changes (5 - in order)

Answer 36

``` 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 ```

Question 37

Other interventions for FHR changes (4)

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

Measures the pressure inside the uterus