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Test 2- Intrapartum > EFM > Flashcards

EFM Flashcards

(61 cards)

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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
What is tachycardia in a fetus associated with? >160 bpm
prematurity, maternal fever, fetal activity, fetal hypoxia/infection, medications/drugs **if this occurs for >10 minutes or accompanies by late decels= fetal distress
26
What is bradycardia in a fetus associated with? <110 bpm
fetal hypoxia, medications/drugs, hypotension, prolonged cord compression, congenital heart lesions
27
What is variability?
single MOST important indicator of an adequately oxygenated fetus
28
What can affect variability?
Conditions that alter the integrity of the neuro-cardiac axis, such as hypoxemia
29
What is considered normal variability in a fetus?
Moderate *this indicates a normally functioning central nervous system
30
Normal variability is between ____ bpm from the baseline fetal heart rate.
5-25
31
What is marked variability?
>25 bpm from baseline fetal heart rate
32
What does absent variability mean?
BAD interruption of O2 transfer from the environment to the fetus can lead to progressive deterioration of fetal oxygenation
33
What is non hypoxic causes of decreased variability?
- fetal sleep (20 minutes) -medications -tachycardia (such as from maternal fever) -fetal anomaly -dysrhythmia
34
What are hypoxic causes of decreased variability?
-uteroplacental insufficiency -cord compression -maternal hypotension -tachysystole -abruption -tachycardia
35
Can a pt walk in the door of L&D with a flat strip?
YES... can be fetal hypoxia, mom maybe just had a cigarette, or needs IV hydration, baby might be in sleep cycle
36
What are accelerations?
transient increases in FHR above the baseline rate of at least 15 bpm lasting at least 15 seconds
37
What causes accelerations?
sympathetic nervous system response to fetal movement to stimuli NORMAL and reassuring *rules out metabolic acidosis
38
What are examples of stimuli that can create an acceleration?
-Touching mom's abdomen -Voices or music -Scalp stimulation
39
What are decelerations?
decrease in fetal heart rate during fetal monitoring
40
What causes an early deceleration?
pressure on fetal head *it is believed to precipitate a reflex vagal response which results in a slowing of the FHR
41
What are interventions for an early deceleration?
**Requires NO intervention evaluate fetal station, maternal dilation/effacement; usually no further intervention is required
42
What type of deceleration is a gradual decrease and return to baseline that mirrors a uterine contraction?
Early
43
What causes a variable deceleration?
cord compression
44
What do variable decels look like?
ABRUPT decrease (<30 seconds to lowest point of decel) in FHR
45
True or False: Variable decels do NOT mirror a contraction
True
46
For a variable deceleration the decrease should be at least ___ bpm lasting at least ___ seconds.
15, 15
47
Intrauterine variable deceleration causes?
-Nuchal cord or body entanglement -Oligohydraminos -ROM -short cord or true knot -prolapse of cord
48
Maternal conditions the can cause variable deceleration?
-positioning -2nd stage of labor with descent of fetus -monoamniotic multiple gestation
49
What do I do for a variable deceleration?
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
What causes late decelerations?
uteroplacental insufficiency *maternal-fetal oxygen transfer becomes insufficient to meet fetal oxygen requirements
51
What are characteristics of a late deceleration?
Gradual onset AFTER peak of ctx **depth does NOT matter, shallow can be just as serious
52
True or False: Late decelerations are always associated with a UC, with a delay in timing.
True
53
Late decelerations are a gradual decrease from baseline to peak of contraction & they must last ___ seconds.
>30
54
What are causes of a late deceleration?
*Deficiency placental perfusion -hypotension/hypertension -diabetes mellitus -uterine hyper stimulation from Pitocin -hemorrhage -placenta post maturity -Illicit drug use -Placenta abruption
55
What are treatments for a late deceleration?
*needs urgent response -left lateral position -increase IV fluids -10L O2 mask -Stop Pit -Call MD -Prepare for c-section
56
What is a sinusoidal pattern associated with?
severe fetal anemia
57
Sinusoidal pattern causes?
Mild: maternal sedation Moderate-Marked: -Rh Isoimmunization -Fetal hypoxia -Chronic fetal bleeding -Severe acidosis
58
True or False: A category 1 tracing is non-reassuring.
False
59
Category 1: Normal Baseline FHR _____ (110-160) _______ present Accels: present or _____ Decels absent: late or variable May see ____ decels *benign finding
Normal Variability absent early
60
Category 2: Compensating Baseline FHR may be _____ Variability present or absent Accels: _____ Decels present: ____ or variable **Requires intervention
Abnormal Absent Late
61
Category 3: Decompensating ____ variability Abnormal ______ Late/Variable decels _____ **Requires intervention
Absent baseline present

Test 2- Intrapartum (2 decks)

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