Intrapartum Management Flashcards

1
Q

What kind of things do you monitor?

A
  • Fetal movement (min 10 movements over 2 hr time). Decreased movement suggests baby is under stress
  • Monitoring HR and fetal activity = Non Stress test. (Nonreactive = normal)
  • Contraction stress test (older) - see how baby responds to induced contraction. If no stress with 3 contractions in 10 min.
  • Biophysical profile: combined US with monitoring fetal HR tracing. Measure fetal HR, fluid, fetal movement, fetal tone, fetal breathing motion. Rated on a 1- pt scale, 2 pts per measurement. Good = 8-10/10
  • S/D ratio

** False positives

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2
Q

What does fetal monitoring measure and name the 2 types

A

Assesses baseline, variability, accelerations, decelerations

External: Indirect, doppler ultrasound
Internal: directly applied scalp electrode; need to be dilated enough

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3
Q

ways to monitor contraction

A

External: Indirectly monitor via abdominal pressure electrode

Internal: Direct (IUPC)

  • hollow tube next to baby’s head in space around baby’s body; measures intrauterine pressure. Membranes have to be ruptured and need to be dilated enough to fit tube in.
  • assess how often and how intesnse
  • increased risk of infection
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4
Q

How to assess fetal heart rate

A

Rate, variability, accelerations , deceleration

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5
Q

Normal baseline HR

A

110-160

- Determined based on 10 min window

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6
Q

What is considered normal, moderate variability in HR?

A

6-25 variability

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7
Q

Do you want variability in HR

A

you want moderate variability. Don’t really like No/minimal variability. Absent pretty bad.

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8
Q

What do variable decelerations look like

A
  • like “V”—abrupt decrease in HR
  • usually near contraction
  • can be due to cord compression/interruption in blood flow
  • healthy baby can tolerate this.
  • see more often if low fluids
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9
Q

What is an amnioinfusion

A

hook up NS infusions into pressure catheter; may help with oligohydramnios and keep cord floating/not compressed

  • too much will cause uterine rupture
  • only indicated to help with variable decelerations
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10
Q

What are Early decelerations

A

gradual deceleration where lowest point of deceleration correlated with peak of contraction.

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11
Q

What are late decelerations

A
  • gradual deceleration after contraction
  • lowest HR after peak of contraction.
  • fetal response to hypoxemia during contraction.
  • Decreased maternal perfusion during contraction of intervillous space, so less blood to capillaries
  • BP goes up due to vasoconstriction from hypoxemia, so HR goes down in resopnse
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12
Q

What can you do for fetal Supraventricular tachy

A

give beta blockers, they cross placenta

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13
Q

What does a sinusoidal pattern indicate on fetal HR tracings

A

anemia

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14
Q

What does terbutaline do

A

Stops contractions

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