EFM (decelerations)

Question 1

define FHR decelerations

Answer 1

• symmetrical & gradual decrease & return of FHR

Question 2

what are the 4 different types of decelerations?

Answer 2

1. early
2. late
3. variable
4. prolonged

Question 3

what are the two ways to read decelerations?

Answer 3

1. shape
2. timing

Question 4

describe the shape of a early deceleration?

Answer 4

• gradual decelerations mirror the contractions

Question 5

when is the timing of an early deceleration?

Answer 5

• decel starts & ends with the contraction

Question 6

what is the cause of an early deceleration?

Answer 6

• fetal head compression during second stage of labor (normal finding, means baby will be here soon!)

Question 7

what is the nursing intervention for early declerations?

Answer 7

• none needed, document & continue to observe FHR
• no narcotics at this time

Question 8

describe the shape of LATE decelerations

Answer 8

• gradual deceleration, mirrors the contraction
• (same shape as early)

Question 9

describe the timing of when a LATE deceleration takes place

Answer 9

• deceleration starts and ends after the contraction (!!!!!)
• if at the end of the contraction the baseline FHR is NOT back to normal = late decel
• peal of the contraction there is no o2

Question 10

what is the cause of late declarations?

Answer 10

• multiple causes
• uteroplacental insufficiency & perfusion
• vena cava syndrome
• hypotension after epidural (give bolus)
• vascular damage to placenta (HTN, DM)
• chromosomal abnormality

Question 11

what are the nursing interventions for late decelerations?

Answer 11

• Increase perfusion !!!!
• reposition to other side or do hands or knees
• IV fluid bolus
• discontinue Pitocin to give fetus break from labor stress)
• give 02 (10 ml via non rebreather)
• notify provider
• do all these things at the same time

Question 12

what is the shape of a variable deceleration?

Answer 12

• ABRUPT deceleration from baseline
• V, U, W shaped typically

Question 13

describe the timing for a variable deceleration

Answer 13

• not at all dependent on cord compression

Question 14

what is the cause of variable decelerations?

Answer 14

• umbilical cord compression
• not always by uc’s, baby could be squeezing their own cord

Question 15

what is the nursing intervention to variable decelerations?

Answer 15

• relieve cord compression
• reposition to lateral side or hands & knee
• decrease or discontinue Pitocin
• IV fluid bolus
• amnioinfusion if amino fluids are low

Question 16

what are prolonged decelerations?

Answer 16

• decelerations that last longer than 2 minutes but less than 10 mins
• NEW BASELINE

Question 17

what is the cause of prolonged decelerations

Answer 17

• cord prolapse, uterine tachysystole, severe hypo of brither, rapid cervical change

Question 18

what are the nursing interventions for prolonged decels

Answer 18

• reposition (side to side, then hand to knee)
• fluids iv bolus
• discontinue pitocin
• tocolytic meds
• o2 mask
• emergency c/s delivery

Question 19

what does veal chop stand for?

Answer 19

• V (variable)
• E (early)
• A (acceleration)
• L (late)
• C (cord compress)
• H (head compress)
• O (okay, fetus has enough 02)
• P (placental hypoperfusion)

Question 20

what does a non reassuring fetal status mean? or indicate?

Answer 20

• lack of variability or decelerations
• imbalance between o2 supply and fetal demands
• hypoxia = metabolic acidosis

Question 21

what are contributing factors of hypoxia (non reassuring fetal status)

Answer 21

• cord compression
• uteroplacental insufficiency
• pre existing birther or fetal disease (tacycardia)

Question 22

what is the clinical presentation of hypoxia in utero?

Answer 22

• changes in FHR
• baseline changes
• decrease in or lack variability
• late severe or recurrent variable decelerations

Question 23

what is the tx for non reassuring fetal status?

Answer 23

• intrauterine resuscitation measures
• reposition pt
• give IV bolus
• discontinue Pitocin
• give 02 10L/min by mask