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348 OB exam 2 > Chapter 18 > Flashcards

Chapter 18 Flashcards

1
Q

We’ve been able to assess the fetal heart initially described more than how many years?

A

300

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2
Q

Electronic fetal monitoring debuted in ?

A

1970s

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3
Q

Research has not shown that intrapartum FHR monitoring leads to ?

A

Significant decrease in neonatal neurologic morbidity

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4
Q

What is the fetal response?

A

The oxygen supply must be maintained to prevent fetal compromise

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5
Q

What are 4 things that can decrease fetal response?

A

Reduction of blood flow through maternal vessels

Reduction in oxygen content in maternal blood

Alterations in fetal circulation

Reduction in blood flow to intervillous space in placenta

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6
Q

What are two monitors we want to have?

A

Uterine activity

Fetal monitor

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7
Q

What is uterine activity?

A

Monitoring provides information on uterine contractions

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8
Q

Why do we want to watch the contractions?

A

To see how the baby is reacting to it

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9
Q

What are some normal findings of a fetal heart rate?

Rate?

A

110-160

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10
Q

What are accelerations??

A

So when the babies heart rate will increase 15 beats per minute and stay there for 15 seconds

These are good!! Good oxygen flow

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11
Q

What are early decelerations?

Is this normal?

A

When the contraction goes up
And then the heart rate goes down

Yes normal

( they like mirror images of each other )

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12
Q

What is a late deceleration?

A

When the contraction goes up
But then the heart rate goes up
Then goes down

Like the baby is late to the party

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13
Q

What is the cause of early deceleration?

( mirroring !!)

A

Because of head compression

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14
Q

What does variability mean?

What’s the normal fluctuations of the fetal heart rate?

A

How the heart changes second to second

6-25beats per minute around the baseline

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15
Q

What does the variability of the heart rate indicate?

A

A healthy nervous system

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16
Q

Why do we want to see fluctuations of the heart rate between 6-25 ? Instead of like a steady 120?

A

Because it means we have a healthy nervous system

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17
Q

What’s a normal variability ?

A

Moderate!

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18
Q

What is fetal bradycardia?

A

Anything below 110

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19
Q

How do we determine fetal bradycardia or anything abnormal ?

A

When that heart rate is sustained for 10mins !!

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20
Q

Why does fetal bradycardia happen?(4)

A

Prolong cord compression
( no oxygen!! )

Umbilical cord prolapse

Anesthetic medications
( morphine ! )

Fetal heart abnormalities

21
Q

So when we have fetal bradycardia, we have to think that the baby isn’t receiving enough oxygen, so what are some ways we can help baby?

A

Side lying position
Repositioning the uterus
Iv fluids
Oxygen
Notify the provider

22
Q

Before you notify a provider, you need to what?

A

See if you can intervene in your scope of practice

23
Q

What is fetal tachycardia?

A

Anything above 160 beats per min

24
Q

What can cause fetal tachycardia?

A

Maternal fever /infection !!!
Fetal hypoxia
Maternal hypothyroidism
Stimulants ( cocaine )

25
Q

Fetal tachycardia accompanied by decreased variability is indicative of?

A

Severe fetal distress!!!

Heart rate goes up but variability go down

26
Q

Again
A late deceleration is what? Think of the stripe

A

Like the baby is slightly off from the mirror contraction of a acceleration

The peak of the contraction is gonna come first
Then the base of the heart rate is later

27
Q

What’s the biggest cause of late declarations?

A

Uteroplacenta insufficiency !!!

( decrease blood flow which leads to fetal hypoxia )

28
Q

How can you treat late declarations ??
Following the anagram ? (6)

A

L - left lying positions
I - IV fluids
O - oxygen & discontinue oxytocin
N - notify the provider
S - surgery

29
Q

What is variable decelerations?

A

They kinda look like a V

Sharp dramatic drop!!
Then comes back
Then goes alone

30
Q

What’s the cause of variable declarations?

A

Umbilical cord compression

Increase fetal blood pressure & decreased fetal heart rate

31
Q

How can we treat variable decelerations? (3)

A

Put mom in trendelenburg position
( head down and feet up )
( gravity shift the uterus & baby off the cord )

Knee chest position

Amnioifnusion

32
Q

Why might we give aminoinfusion to patients with fetal variable decelerations?

A

This is for patients who have oligohydraminios
( meaning too little amniotic fluid )

( amniotic fluid is like a cushion of the baby and the cord and if we don’t have enough, we can get stuck with the cord so, we add to make a cushion )

33
Q

What’s
V
E
A
L

C
H
O
p

They line up and you can see the cause for each reason !!

A

Variable
Early decelerations
Accelerations
Late declarations

Cord compression
Head compression
Okay!!
Placental insufficiency

34
Q

What are some monitoring techniques?

A

Intermittent auscultation
( listening to fetal heart sounds )
15-30mins in early labor
15mins later labor
5mins when in labor

35
Q

What is the downside of intermittent ausculstion?

A

Just like not constant record
Just the documentation is the record

Better if you have it tied to a machine and have constant record

36
Q

When do we want to listen during intermittent ausculstion?

We want to see how the baby is during a contraction

Hearing for early and lates

A

Before or as the contraction is starting and all the way through the contraction until the uterus is at rest

37
Q

Notes
Electronic fetal monitoring
External
- ultrasound transducer
- toco transducer ( contractions )
- wireless external monitoring

Internal monitoring
- spiral electrode
- intrauterine pressure catheter
- Montevideo units

Display
- FHR in upper section
- UA in lower section
- each small square represents 10 sec

A
38
Q

There is a 3 stage system of FHR monitoring what are they?

A

Category 1 - normal
Category 2 - intermediate
Category 3 - abnormal

39
Q

Average rate during a ___minutue segments

Segments may differ by more than ?

A

10!!!!!
To have establish baseline

25beats/mins

40
Q

What does variability mean?

A

Described as irregular waves or fluctuations in the baseline FHR of two cycles per minutes or greater

41
Q

We don’t want a straight baseline why?

A

Because the baby is not having good reserve and hard time

42
Q

What are the 4 possible categories of variability?

A

Absent
Minimal
Moderate
Marked

43
Q

Absent : low/ even line
Minimal : mom may be medicated / baby sleep
Moderate : normal
Marked : high

A
44
Q

Accelerations can be considered an indication of what?
( always a what!! )

A

Fetal well being

Good thing

45
Q

Accelerations : good
Decelerations : benign or abnormal

Early d : fetal head compression
Late D : uteroplacenfal insuifficency
Variable D : umbilical cord compression

Prolonged d : lashing more than 2 mins but less than 10mins

A
46
Q

What’s a category 1
Base line?
Variability ?
Are there late or variable declarations?
Are there early declarations?

There are accelerations?

A

110-160
Moderate
Nope
Nope

Either present or absent

47
Q

What is an acceleration again?

A

15 beats above the baseline for 15 seconds!

48
Q

What’s category 2
Baseline?
Minimal or marked ?
Accelerations?

Periodic or episode what?

Is this an ominous sign?

A

Could be Brady or tachy
Can be both
Nope

Decelesrions

Ehh
( mom can be medication or sleep baby )

49
Q

What’s category 3?
Baseline?
Recurrent or late decelerations ?

Notes
Nonreassuring FHR patterns associated with fetal hypoxemia

Hypoxemia can deteriorate to severe fetal hypoxia

Absence of baseline variability

Recurrent or late delectations

Bradycardia

Sinusoidal patterns

A

Bradycardia ( absence )
Yes

348 OB exam 2 (4 decks)

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