Chapter 18

Question 1

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

Answer 1

300

Question 2

Electronic fetal monitoring debuted in ?

Answer 2

1970s

Question 3

Research has not shown that intrapartum FHR monitoring leads to ?

Answer 3

Significant decrease in neonatal neurologic morbidity

Question 4

What is the fetal response?

Answer 4

The oxygen supply must be maintained to prevent fetal compromise

Question 5

What are 4 things that can decrease fetal response?

Answer 5

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

Question 6

What are two monitors we want to have?

Answer 6

Uterine activity

Fetal monitor

Question 7

What is uterine activity?

Answer 7

Monitoring provides information on uterine contractions

Question 8

Why do we want to watch the contractions?

Answer 8

To see how the baby is reacting to it

Question 9

What are some normal findings of a fetal heart rate?

Rate?

Answer 9

110-160

Question 10

What are accelerations??

Answer 10

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

These are good!! Good oxygen flow

Question 11

What are early decelerations?

Is this normal?

Answer 11

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

Yes normal

( they like mirror images of each other )

Question 12

What is a late deceleration?

Answer 12

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

Like the baby is late to the party

Question 13

What is the cause of early deceleration?

( mirroring !!)

Answer 13

Because of head compression

Question 14

What does variability mean?

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

Answer 14

How the heart changes second to second

6-25beats per minute around the baseline

Question 15

What does the variability of the heart rate indicate?

Answer 15

A healthy nervous system

Question 16

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

Answer 16

Because it means we have a healthy nervous system

Question 17

What’s a normal variability ?

Answer 17

Moderate!

Question 18

What is fetal bradycardia?

Answer 18

Anything below 110

Question 19

How do we determine fetal bradycardia or anything abnormal ?

Answer 19

When that heart rate is sustained for 10mins !!

Question 20

Why does fetal bradycardia happen?(4)

Answer 20

Prolong cord compression
( no oxygen!! )

Umbilical cord prolapse

Anesthetic medications
( morphine ! )

Fetal heart abnormalities

Question 21

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?

Answer 21

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

Question 22

Before you notify a provider, you need to what?

Answer 22

See if you can intervene in your scope of practice

Question 23

What is fetal tachycardia?

Answer 23

Anything above 160 beats per min

Question 24

What can cause fetal tachycardia?

Answer 24

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

Question 25

Fetal tachycardia accompanied by decreased variability is indicative of?

Answer 25

Severe fetal distress!!! Heart rate goes up but variability go down

Question 26

Again A late deceleration is what? Think of the stripe

Answer 26

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

Question 27

What’s the biggest cause of late declarations?

Answer 27

Uteroplacenta insufficiency !!! ( decrease blood flow which leads to fetal hypoxia )

Question 28

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

Answer 28

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

Question 29

What is variable decelerations?

Answer 29

They kinda look like a V Sharp dramatic drop!! Then comes back Then goes alone

Question 30

What’s the cause of variable declarations?

Answer 30

Umbilical cord compression Increase fetal blood pressure & decreased fetal heart rate

Question 31

How can we treat variable decelerations? (3)

Answer 31

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

Question 32

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

Answer 32

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 )

Question 33

What’s V E A L C H O p They line up and you can see the cause for each reason !!

Answer 33

Variable Early decelerations Accelerations Late declarations Cord compression Head compression Okay!! Placental insufficiency

Question 34

What are some monitoring techniques?

Answer 34

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

Question 35

What is the downside of intermittent ausculstion?

Answer 35

Just like not constant record Just the documentation is the record Better if you have it tied to a machine and have constant record

Question 36

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

Answer 36

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

Question 37

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

Question 38

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

Answer 38

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

Question 39

Average rate during a ___minutue segments Segments may differ by more than ?

Answer 39

10!!!!! To have establish baseline 25beats/mins

Question 40

What does variability mean?

Answer 40

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

Question 41

We don’t want a straight baseline why?

Answer 41

Because the baby is not having good reserve and hard time

Question 42

What are the 4 possible categories of variability?

Answer 42

Absent Minimal Moderate Marked

Question 43

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

Question 44

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

Answer 44

Fetal well being Good thing

Question 45

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

Question 46

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

Answer 46

110-160 Moderate Nope Nope Either present or absent

Question 47

What is an acceleration again?

Answer 47

15 beats above the baseline for 15 seconds!

Question 48

What’s category 2 Baseline? Minimal or marked ? Accelerations? Periodic or episode what? Is this an ominous sign?

Answer 48

Could be Brady or tachy Can be both Nope Decelesrions Ehh ( mom can be medication or sleep baby )

Question 49

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

Answer 49

Bradycardia ( absence ) Yes