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test 2- intrapartum > EFM > Flashcards

EFM Flashcards

1
Q

Why does EFM monitoring matter?

A

-Help detect changes in the normal fetal heart rate pattern during labor
-May prevent treatments that are unnecessary
-Monitor uterine contractions
-Allows for nursing judgement to make adjustments to the pt for better outcomes
-A normal fetal heart rate can reassure the healthcare team and the pt that it is safe to continue labor

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2
Q

Benefits of using external fetal monitoring

A

-pt can be on her side
-she can have her knees flexed
-she can use a birthing ball
-she can tilt her hips to avoid vena cava syndrome

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3
Q

Limitations of external fetal monitoring

A

decreased movement of the patient, obesity

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4
Q

what is external fetal monitoring

A

INDIRECT
uses an ultrasound transducer to listen to or record the fetal heart rate through the mothers abdomen

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5
Q

What is internal fetal monitoring

A

DIRECT
uses an electronic transducer connected directly to the fetal scalp

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6
Q

What are limitations to an internal fetal monitor

A

-requires rupture of membranes
-cervical dilation of 2+ cm
-presenting part much be reached

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7
Q

What do the horizontal lines represent?

A

*10 seconds
In the US the standard is to run at 3 cm per minute

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8
Q

How often do the darker horizontal lines occurs?

A

Every minute

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9
Q

What do the vertical lines represent?

A

every 10 bpm for FHR and every 10 mmHg for UC’s

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10
Q

What is a normal contraction pattern?

A

5 or less in a 10 minute timeframe

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11
Q

The intervals between the vertical red lines on an EFM strip represent what?

A

One minute

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12
Q

Is fetal heart rate displayed on the upper or lower pane?

A

Upper

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13
Q

Is uterine contractions displayed on the upper or lower pane?

A

Lower

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14
Q

What is time in minutes from the beginning of 1 ctx to the beginning of the next ctx?

A

Frequency

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15
Q

What is the time from beginning of a ctx to its completion?

A

Duration
**should be reported if it is >90 seconds

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16
Q

What is the strength of the contraction at acme phase?

A

Intensity

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17
Q

What is the acme phase?

A

The peak or highest point of the contraction

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18
Q

What is the expected cervical dilation, length of contractions, and time between contractions during the early or latent phase of labor?

A

Dilation: 0-3 cm
Length of contractions: 30-45 seconds
Time between: 5-10 minutes

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19
Q

What is the expected cervical dilation, length of contractions, and time between contractions during the active phase of labor?

A

Dilation: 3-8 cm
Length of contractions: 45-60 seconds
Time between: 3-5 minutes

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20
Q

What is the expected cervical dilation, length of contractions, and time between contractions during the transitional phase of labor?

A

Dilation: 8-10 cm
Length of contractions: 60-90 seconds
Time between: 2-3 minutes

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21
Q

What is the baseline fetal heart rate?

A

The average FHR over 10 minutes rounded to the nearest 5 BPM

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22
Q

What is the normal range for a baseline fetal heart rate?

A

110-160 BPM

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23
Q

A post-term fetus may have a FHR of what?

A

110-120 bpm
*parasympathetic tone becomes more dominant with advancing gestational age

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24
Q

What is heart rate set by?

A

Atrial pacemaker

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25
Q

What is tachycardia in a fetus associated with?
>160 bpm

A

prematurity, maternal fever, fetal activity, fetal hypoxia/infection, medications/drugs
**if this occurs for >10 minutes or accompanies by late decels= fetal distress

26
Q

What is bradycardia in a fetus associated with?
<110 bpm

A

fetal hypoxia, medications/drugs, hypotension, prolonged cord compression, congenital heart lesions

27
Q

What is variability?

A

single MOST important indicator of an adequately oxygenated fetus

28
Q

What can affect variability?

A

Conditions that alter the integrity of the neuro-cardiac axis, such as hypoxemia

29
Q

What is considered normal variability in a fetus?

A

Moderate
*this indicates a normally functioning central nervous system

30
Q

Normal variability is between ____ bpm from the baseline fetal heart rate.

A

5-25

31
Q

What is marked variability?

A

> 25 bpm from baseline fetal heart rate

32
Q

What does absent variability mean?

A

BAD
interruption of O2 transfer from the environment to the fetus can lead to progressive deterioration of fetal oxygenation

33
Q

What is non hypoxic causes of decreased variability?

A
  • fetal sleep (20 minutes)
    -medications
    -tachycardia (such as from maternal fever)
    -fetal anomaly
    -dysrhythmia
34
Q

What are hypoxic causes of decreased variability?

A

-uteroplacental insufficiency
-cord compression
-maternal hypotension
-tachysystole
-abruption
-tachycardia

35
Q

Can a pt walk in the door of L&D with a flat strip?

A

YES… can be fetal hypoxia, mom maybe just had a cigarette, or needs IV hydration, baby might be in sleep cycle

36
Q

What are accelerations?

A

transient increases in FHR above the baseline rate of at least 15 bpm lasting at least 15 seconds

37
Q

What causes accelerations?

A

sympathetic nervous system response to fetal movement to stimuli
NORMAL and reassuring
*rules out metabolic acidosis

38
Q

What are examples of stimuli that can create an acceleration?

A

-Touching mom’s abdomen
-Voices or music
-Scalp stimulation

39
Q

What are decelerations?

A

decrease in fetal heart rate during fetal monitoring

40
Q

What causes an early deceleration?

A

pressure on fetal head
*it is believed to precipitate a reflex vagal response which results in a slowing of the FHR

41
Q

What are interventions for an early deceleration?

A

**Requires NO intervention
evaluate fetal station, maternal dilation/effacement; usually no further intervention is required

42
Q

What type of deceleration is a gradual decrease and return to baseline that mirrors a uterine contraction?

A

Early

43
Q

What causes a variable deceleration?

A

cord compression

44
Q

What do variable decels look like?

A

ABRUPT decrease (<30 seconds to lowest point of decel) in FHR

45
Q

True or False: Variable decels do NOT mirror a contraction

A

True

46
Q

For a variable deceleration the decrease should be at least ___ bpm lasting at least ___ seconds.

A

15, 15

47
Q

Intrauterine variable deceleration causes?

A

-Nuchal cord or body entanglement
-Oligohydraminos
-ROM
-short cord or true knot
-prolapse of cord

48
Q

Maternal conditions the can cause variable deceleration?

A

-positioning
-2nd stage of labor with descent of fetus
-monoamniotic multiple gestation

49
Q

What do I do for a variable deceleration?

A

Vaginal exam to rule out prolapse (rare), position change, IV fluids, 10L O2 mask, turn Pit off or down, assess fetal response
***call MD AFTER treatments

50
Q

What causes late decelerations?

A

uteroplacental insufficiency
*maternal-fetal oxygen transfer becomes insufficient to meet fetal oxygen requirements

51
Q

What are characteristics of a late deceleration?

A

Gradual onset AFTER peak of ctx
**depth does NOT matter, shallow can be just as serious

52
Q

True or False: Late decelerations are always associated with a UC, with a delay in timing.

A

True

53
Q

Late decelerations are a gradual decrease from baseline to peak of contraction & they must last ___ seconds.

A

> 30

54
Q

What are causes of a late deceleration?

A

*Deficiency placental perfusion
-hypotension/hypertension
-diabetes mellitus
-uterine hyper stimulation from Pitocin
-hemorrhage
-placenta post maturity
-Illicit drug use
-Placenta abruption

55
Q

What are treatments for a late deceleration?

A

*needs urgent response
-left lateral position
-increase IV fluids
-10L O2 mask
-Stop Pit
-Call MD
-Prepare for c-section

56
Q

What is a sinusoidal pattern associated with?

A

severe fetal anemia

57
Q

Sinusoidal pattern causes?

A

Mild: maternal sedation
Moderate-Marked:
-Rh Isoimmunization
-Fetal hypoxia
-Chronic fetal bleeding
-Severe acidosis

58
Q

True or False: A category 1 tracing is non-reassuring.

A

False

59
Q

Category 1: Normal
Baseline FHR _____ (110-160)
_______ present
Accels: present or _____
Decels absent: late or variable
May see ____ decels *benign finding

A

Normal
Variability
absent
early

60
Q

Category 2: Compensating
Baseline FHR may be _____
Variability present or absent
Accels: _____
Decels present: ____ or variable
**Requires intervention

A

Abnormal
Absent
Late

61
Q

Category 3: Decompensating
____ variability
Abnormal ______
Late/Variable decels _____
**Requires intervention

A

Absent
baseline
present

test 2- intrapartum (2 decks)

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