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RGU 2 > Electronic Fetal Monitoring > Flashcards

Electronic Fetal Monitoring Flashcards

1
Q

What 2 things will you look at on the fetal monitoring strip?

A
  1. fetal HEART RATE (baby)

2. UTERINE contractions (mom)

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2
Q

What are the 2 types of fetal monitors?

A
  1. EXTERNAL= little doppler transducers with stretchy straps.
  2. INTERNAL= fetal scalp electrode (FSE) placed on the baby’s scalp by going in through the mother’s cervix.
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3
Q

When do you use internal fetal heart monitors?

A
  • if pt is very obese, or you can’t pick up the fetal heart beat using the external monitor.
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4
Q

What is a potential risk of placing an internal fetal monitor?

A
  • infection
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5
Q

What is electronic fetal monitoring (EFM)?

A
  • cardiotocography (aka cardiography + uterine contractions (tocodynamometer)
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6
Q

Is the top line or bottom line the fetal heart rate?

A

TOP LINE

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7
Q

What tells us the variability of the baby’s heart rate on the fetal heart strip?

A
  • the “squiggliness” of the line, indicating sympathetic and parasympathetic nervous system activities working together.
  • aka you want VARIABILITY
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8
Q

*** What is the normal range or fetal heart rate?

A

110-160 BPM

  • less than 110= bradycardia.
  • greater than 160=tachycardia.
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9
Q

Where is the contraction pattern on the fetal monitor strip?

A
  • bottom line that looks like mountain peaks.
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10
Q

What are the units for contractions?

A
  • MONTEVIDEO UNITS= calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10-min window and adding the pressures generated by each contraction.
    Ex. 5 pressure changes of 52, 50, 47, 44, and 49 mm Hg are added together= 242 Montevideo units.
    *greater than 200 indicates adequate contractions!
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11
Q

Why do we care if the contractions are high enough?

A
  • to get her fully dilated so she can start to push.
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12
Q

Why do we use electronic fetal heart monitors?

A
  • to determine if a fetus is well oxygenated. Hypoxia changes activity of the nervous system, which affects HR and will result in changes on EFM.
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13
Q

How is EFM described?

A
  • baseline HR
  • variability
  • presence or absence of accelerations and decelerations.
  • frequency of contractions.
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14
Q

What actually makes up the irregular horizontal line of the fetal heart rate monitor?

A
  • it’s just a series of closely-spaced R to R waves in the fetal EKG.
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15
Q

How do you get the mean fetal HR?

A
  • round to nearest 5 BPM during a 10 min segment.
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16
Q

** What are some causes of fetal BRADYcardia (less than 110 BPM)?

A
  • maternal HYPOtension
  • umbilical cord prolapse
  • rapid fetal descent
  • uterine tachysystole
  • placental abruption
  • uterine rupture
  • myocardial conduction defect
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17
Q

** What are some causes of fetal TACHYcardia (greater than 160 BPM)?

A
  • infection (chorioamnionitis)
  • medications (terbutaline, cocaine)
  • fetal anemia
  • placental abruption
  • maternal disorders (HYPERthyroidism)
  • fetal tacharrhythmia
18
Q

*** What is variability?

A
  • the fluctuation in beat to beat rate (amplitude of peak-to-trough in BPM).
19
Q

*** What is ABSENT variability?

A
  • amplitude range undetectable
20
Q

*** What is MINIMAL variability?

A
  • amplitude range less than 5 BPM
21
Q

** What is MODERATE variability? (TEST QUESTION)

A
  • amplitude range 6-25 BPM
22
Q

*** What is MARKED variability?

A
  • amplitude rang greater than 25 BPM
23
Q

Is variability sensitive to fetal acid-base status?

A

YES

24
Q

What does MODERATE variability suggest?

A

adequate oxygenation :)

25
Q

What could cause decreased variability?

A
  • medications (opioids, magnesium sulfate)
  • fetal sleep cycle (only 30-40 mins max).
  • prematurity
  • CNS or cardiac abnormalities
  • fetal hypoxia
  • fetal acidemia
26
Q

*** What is an ACCELERATION?

A
  • abrupt increase in fetal HR (FHR) with peak of greater than 15 beats above baseline. This is associated with fetal movement, a mature neurocardiac tract, and indicates that the fetus is not acidemic.
  • duration of at least 15 sec, up to 2 min.
  • aka this reassures fetal well-being
27
Q

** What happens if an acceleration is greater than 2 min?

A
  • this is a prolonged acceleration

* if over 10 min, it is a CHANGE IN BASELINE.

28
Q

*** What is a DECELERATION?

A
  • decrease in FHR from baseline:
  • recurrent= occurs for more than 50% of contractions.
  • intermittent= occurs with less than 50% of contractions.
29
Q

** What are the 3 types of DECELERATIONS? (she said she wants us to know these)

A
  1. EARLY= associated with HEAD COMPRESSION.
  2. VARIABLE= associated with CORD COMPRESSION.
  3. LATE= associated with UTEROPLACENTAL INSUFFICIENCY; BAD.
    * all about timing.
30
Q

What type of deceleration is TIMED WITH THE CONTRACTIONS?

A
  • EARLY (mirror image of the contraction; as the contraction goes up, the HR goes down).
31
Q

What should you do in an EARLY deceleration?

A
  • no treatment necessary, but check pt as head is probably descending.
32
Q

*** What does a VARIABLE deceleration look like?

A
  • ABRUPT decrease in FHR (goes down faster; less than 30 sec).
  • decrease in FHR is greater than 15 BPM with a total duration greater than 15 sec.
  • V configuration!
33
Q

When do VARIABLE decelerations occur?

A
  • can occur at ANY time; not necessarily associated with contraction.
34
Q

What do we do for VARIABLE decelerations?

A
  • ALLEVIATE CORD COMPRESSION by maternal repositioning, amnioinfusion, or check for prolapsed cord.
35
Q

*** What are LATE decelerations?

A
  • symmetrical gradual decrease in FHR.
  • begins at or after peak of contraction and returns to baseline after contraction is over.
  • associated with uteroplacental insufficiency from decreased uterine perfusion or decreased placental function.
36
Q

** What do we do for LATE decelerations? (she wants us to know this)

A
  • maternal repositioning (left or right lateral).
  • maternal oxygen administration
  • administer IV fluid bolus
  • reduce contraction frequency (discontinue oxytocin (pitocin) or cervical ripening agents)
  • administer TOCOLYTIC medication.
  • goal is to IMPROVE UTEROPLACENTAL BLOOD FLOW
37
Q

What is the ABCD approach?

A
  • Assess oxygen pathway.
  • Begin conservative corrective measures.
  • Clear obstacles to rapid delivery.
  • Determine decision-to-delivery time
38
Q

** What are the 3 categories of strips and what do they mean?

A
  1. Category I= normal HR, moderate variability, no lates or variables, early decelerations don’t matter, accelerations may be present or absent, normal acid-base status (aka everything is GOOD).
  2. Category II= everything else.
  3. Category III= absent baseline FHR variability, late decelerations, recurrent variable decelerations, bradycardia, sinusoidal pattern, abnormal acid-base status (aka all the BAD stuff).
39
Q

What do we do for category II management?

A
  • continued monitoring and possibly intrauterine resuscitation (maternal repositioning, O2 administration, IVF, reduce contraction frequency, possible amnioinfusion).
40
Q

What is normal uterine activity?

A
  • less than 5 contractions in 10 min averaged over 30 min window.
41
Q

What is tachysystole of uterine activity?

A
  • greater than 5 contractions in 10 min averaged over a 30 min window.

RGU 2 (24 decks)

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