Chapter 18 - 2 Flashcards
(20 cards)
three basic FHR measurements
1) Baseline FETAL HEART RATE
2) Baseline VARIABILITY
3) Periodic RATE
baseline rate
Normal 120-160 bpm (some authors say 110 for normal term infant
tachycardia
> 160 persisting for 10 mins.
- Causes: fetal hypoxia (increase HR to pump more oxygen), maternal tachycardia (mom’s HR and temp are reflective of babies), infection, maternal anxiety
- Interventions: monitor closely, identify possible factors and intervene
bradycardia
<110 persisting for at least 10 mins.
- Causes: congenital heart disease, fetal distress with decreased variability, maternal hypothermia, postmaturity
- Interventions:change position, notify MD, give O2, prepare for immediate delivery
baseline variability
- The amount of baseline FHR variance from minute to minute
- The interplay of the symphatic/parasympathic central nervous system
- Usually 6-25 bpm variance
with hypoxic baby you
lose variability; should intervene if you loose variability
good variability =
good thing, adequate oxygen
-Short term variability-
beat to beat which is most accurate with scalp electrode
-Long term variability-
over a 10 minute period
-No variability:
fetal acidosis, immature CNS, analgesics to mom
-DO: check med times, assess if fetal problems are present, with decelerations intervene as recommended
-Decreased variability
<6 bpm causes include prematurity, infant sleep, medication, fetal acidosis, fetal cardiac arrhythmias
- DO: estimate fetal age, stimulate fetus(scalp or vibroacoustic stimulation, check med schedule
Increased Variability-
> 25 bpm
causes include maternal hypoxia and anxiety, tetanic contractions, immature CNS of fetus
-DO: check contractions, change positions, evaluate maternal status, notify MD if it persists
periodic rate -
Shows how the fetal heart rate is affected by uterine contractions
Either Accelerations or Decelerations
periodic rate accelerations -
-Above the FHR baseline, usually 15+bpm that lasts at least 15 seconds(10 w/<32 wks)
-Can occur at any time but often associated with fetal movement, vaginal exams, etc.
-Due to the stimulation of fetal autonomic nervous system – GOOD SIGN (baby trying to compensate for HR dropping)
-Seen with variable decelerations as a compensation mechanism
Do: Explain and watch
periodic rate declarations -
Three Types and causes
1) Early
2) Variable
3) Late
interventions for non reassuring patterns
- What’s the cause?
- Stop Pitocin
- Reposition
- Increase IV rate of nonadditive fluid
- Give oxygen
- Keep monitoring
- Notify MD/Midwife
- If continues or worsens prepare for c-section
- increase lactated ringers for hypotension
Ways to clarify fetal monitor data
- Fetal Scalp Stimulation - acceleration of FHR of 15bpm for at least 15 seconds
- Vibroacoustic Stimulation - used in place of scalp stimulation
- PH Fetal Blood sample - < 7.20 (normal 7.25-7.35 in fetus) For evaluation of fetal distress with persistent abnormal FHR patterns
- Cord Blood Samples Same as fetal blood samples- after delivery
early
- bc of head compression, pressure on the head, and stimulates the vagal nerve, so HR drops
- contaction occurring and correlation of HR dropping (contraction and drop minor each other)
- normal physiological occurance
- fetal HR decrease before peak of contraction (why called early)
- repetitive and usually doesn’t drop below 100 bpm
- does not mean fetal distress
- benign - don’t intervene
late
- drops after peak of contraction
- cause is uteroplacental insufficiency** - not adequate blood flow/oxygen to fetus
- doesn’t drop below 100 bpm
- maternal hypotension, excessive uterine activity, placental problem, or abdominal blood flow through placenta, IV to mom can cause
- give oxygen (non rebreather mask for 10 min), position change
- if loose variability with late then could be a CNS problem but with opioid variability pos O2
variable -
not varability!!
- can occur at anytime, don’t have relation to contraction
- caused by cool compression
- **change position of mother
- often drops below 100 bpm
- often W shaped
- can give O2 and increase IV fluids (hypoxia - lost of variability)
- see w/in an hour of delivery
- decrease in fetal HR of at least 15 beats/min at least 2 min