Chapter 18 - 2

Question 1

three basic FHR measurements

Answer 1

1) Baseline FETAL HEART RATE
2) Baseline VARIABILITY
3) Periodic RATE

Question 2

baseline rate

Answer 2

Normal 120-160 bpm (some authors say 110 for normal term infant

Question 3

tachycardia

Answer 3

> 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

Question 4

bradycardia

Answer 4

<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

Question 5

baseline variability

Answer 5

• The amount of baseline FHR variance from minute to minute
• The interplay of the symphatic/parasympathic central nervous system
• Usually 6-25 bpm variance

Question 6

with hypoxic baby you

Answer 6

lose variability; should intervene if you loose variability

Question 7

good variability =

Answer 7

good thing, adequate oxygen

Question 8

-Short term variability-

Answer 8

beat to beat which is most accurate with scalp electrode

Question 9

-Long term variability-

Answer 9

over a 10 minute period

Question 10

-No variability:

Answer 10

fetal acidosis, immature CNS, analgesics to mom

-DO: check med times, assess if fetal problems are present, with decelerations intervene as recommended

Question 11

-Decreased variability

Answer 11

<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

Question 12

Increased Variability-

Answer 12

> 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

Question 13

periodic rate -

Answer 13

Shows how the fetal heart rate is affected by uterine contractions
Either Accelerations or Decelerations

Question 14

periodic rate accelerations -

Answer 14

-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

Question 15

periodic rate declarations -

Answer 15

Three Types and causes

1) Early
2) Variable
3) Late

Question 16

interventions for non reassuring patterns

Answer 16

• 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

Question 17

Ways to clarify fetal monitor data

Answer 17

• 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

Question 18

early

Answer 18

• 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

Question 19

late

Answer 19

• 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

Question 20

variable -

Answer 20

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