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OB Exam 2 > Fetal Assessment > Flashcards

Fetal Assessment Flashcards

(48 cards)

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1
Q

Measuring Contractions

A
  • Small boxes on strip represent
    > 10 seconds
  • Bigger boxes on strip represent
    > 1 minure interval
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2
Q

What Type of Fetal Response are we Worried about that will be Monitored

A
  • Reduction of blood flow through maternal vessels
  • Reduction of O2 content in maternal term
  • Alterations in fetal circulation
  • Reduction in blood flow to placenta
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3
Q

Uterine Activity

A
  • Hypertonicity
    > a steady contraction
    > no resting tone
  • Tachysystole
    > too many contractions
    > 5 contractions in less than 10 mins
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4
Q

Fetal Compromise

A
  • Abnormal FHR patterns are associated with:
    > hypoxemia
    > hypoxia
    > metabolic acidosis
    > acidemia: incrd hydrogen ion content in blood dcr pH
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5
Q

Reduction of Blood Flow Through Maternal Vessels

A
  • At risk for:
    > HTN
    > hypotension
    > hypovolemia
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6
Q

Reduction of O2 Content in Maternal Blood

A
  • At risk for
    > hemorrhage
    > anemia
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7
Q

Alterations in Fetal Circulation

A
  • Umbilical cord compression
  • Partial placental separation
  • Complete abruption
  • Head compression
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8
Q

Reduction in Blood Flow to Placenta

A
  • Hypertonus
    > too much contraction
  • Damage to placenta vascular
    > due to diabetes or HTN
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9
Q

Intermittent Auscultation

A
  • Listening to FH sounds at periodic intervals to assess FHR
  • Disadvantage
    > can miss major events since its in intervals
  • Intruments Used
    > doppler/fetoscope
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10
Q

Palpation

A
  • Monitors contractions
  • Examiner should keep fingertips placed over fundus before, during, and after contractions
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11
Q

Contraction Monitoring

A
  • Intensity
    > usually described as mild, moderate, or strong
  • Duration
    > contraction duration is measured in seconds, from beginning to end of contraction
  • Frequency
    > measured in minutes, from beginning of one contraction ot beginning of next
  • Resting Tone
    > evaluates relaxation btwn contractions, described as soft or hard
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12
Q

Electronic Fetal Monitoring Purpose

A

Assess the adequacy of fetal oxygenation during labor

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13
Q

Ultrasound Transducer

external monitoring

A
  • Works by reflecting high-frequency sound waves off moving interface; the fetal heart & valves
  • measure FHR
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14
Q

Tocotransducer

external monitoring

A
  • Measures uterine activity transabdominally
  • Placed over fundus
  • Measure frequency & duration but not intensity
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15
Q

Internal Monitoring Purpose

A
  • Membranes must be ruptured
  • Cervix dilated 2-3cm
  • Presenting part low enough for placement of spiral electrode or IUPC or both
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16
Q

Spiral Electrode

internal monitoring

A

Monitors FHR

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17
Q

Intrauterine Pressure Catheter (IUPC)

internal monitoring

A

Measure frequency, intensity, and duration

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18
Q

Location of HR Based on Position

A
  • Vertex HR below umbilicus
  • Breech HR above umbilicus
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19
Q

What is Variability

A

Irregular waves or fluctuations in the baseline FHR of 2 cycles per minute or greater

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20
Q

Normal Variability

21
Q

Absent Variability

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A

Scariest
Range not detected to naked eye

22
Q

Minimal Variability

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A

Detectable but less than 5bpm

23
Q

Absent/Minimal Classification

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A

Abnormal/indeterminate

24
Q

Causes of Absent/Minimal Variability

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A
  • Fetal hypoxia/metabolic acidemia
  • Fetal sleep cycles
  • Fetal tachycardia
  • Extreme prematurity
  • Meds tht cause CNS depression
  • Congenital anomalies
  • Preexisting neurologic injury
25
Moderate Variability
- **Its presence reliably predicts a normal fetal acid-base balance** - **Well O2/neuro intact** - **Intervention**: > continue to observe
26
Marked Variability
- **Unclear likely normal** - **Fluctuation of greater than 25bpm**
27
Sinusoidal Patterns
- **Sinusoidal patterns are regular, smooth, undulating wavelike pattern tht persists for at least 20 mins** - Can be caused from opioid or anemia
28
FHR - Tachycardia
- **Causes**: > Premature prolonged rupture of membranes (PPROM) > drugs > FH abnormalities > fetal/maternal infection; incrd maternal temp - **Early sign of fetal hypoxemia** > associated w/ late deceleration or minimal or absent variability
29
FHR - Bradycardia
- **Causes**: > low maternal BO > prolonged umbilical cord compression > structural defects > fetal heart failure > maternal hypoglycemia > maternal hypothermia > viral infection - **Late sign of fetal hypoxia** > terminal
30
Periodic vs Episodic
- **Periodic**: refer to events tht occur at regular intervals, with contractions - **Episodic**: refer to irregular events that are independent of uterine contractions
31
Accelerations
- **Visually apparent abrupt incr in FHR above baseline rate** - **Associated w/ fetal movement** - **Scalp stim/ vibroacoustic stim**
32
Accelerations Criteria
**15 beats x 15 seconds**
33
Accelerations Predictive of
**Highly predictive of normal fetal acid-base balance**
34
Accelerations Nursing Interventions
**Nothing, continue to monitor**
35
Early Decelerations
- **Visually apparent, gradual dcr in & return to baseline FHR** - **Associated w/ uterine contractions** - **Cause deatl head compression** - No known relationshipd btwn fetal O2
36
Early Decelerations Nursing Interventions
**Check dilation**
37
Late Decelerations
- **Visually apparent, gradual dcr in & return to baseline FHR** - **Associated w/ uterine contractions** - **Common after epidural** - **Begins after the contraction has started and lowest point is after peak of contraction** - **Caused by reflex fetal response to transiet hypoxemia due to dcr in mom's BP, hypertonicity** > uteroplacental insufficiency = abruption of O2 transfer
38
Late Decelerations Nursing Interventions
- **DC oxytocin** - **Incr IV fluids** - **Side lying position** - **Admin 10L of O2 non rebreather** - **Elevate legs to correct hypotension**
39
Variable Decelerations
- **Visually abrupt & apparent dcr in FHR below baseline** - **Dcr is at least 15 bpm x 15 seconds** - **Returns to baseline in less than 2 mins** - **Indication of cord compression** - **Shaped like U, V, or W** - **Reoccuring is worse**
40
Variable Late Decelerations Nursing Interventions
- **1st Priority**: > reposition > then amnioinfusion
41
Prolonged Decelerations
- **Visually apparent dcr of at least 15 bpm below baseline** > lasting > 2mins but less than 10 mins - **Caused by cord compression or fetal hypoxemia last for an extended period**
42
Prolonged Decelerations
- **Must be corrected** - **If it can not be fixed then c-section**
43
Category I FHR Tracings
**Normal & strongly predictive of normal fetal acid-base status at time of observation**
44
Category II FHR Tracings
- **Indeterminate** - **Continue to observe/evaluate**
45
Category III FHR Tracings
- **Abnormal** - **Immediate interventions are required** - **Need to improve fetal O2**
46
Pattern Recognition Interpretation - Nursing Management ## Footnote these are assessments!
- **Purpose/Goal**: > improve fetal oxygenation - **Interventions** > for hypotension: O2 (non-rebreather), side-lying, IV fluid bolus (incr fluid vol), cardiac meds > too many contractions: reduce oxytocin/pitocin; uterine stimulant > abnormal FHR during 2nd stage of labor: open glottis pushing, fewer pushing efforts during each contraction, push w/ every other or every third, make pushing efforts shorter
47
Pattern Recognition Interpretation - Interventions
- **Way to elicit an incr in FHR**: > scalp stimulation > vibroacoustic: strong vibration for baby; like ab alarm clock - **Labs** > to access fetal well being > umbilical cord acid-base - **Amnioinfusion** > it can help w/ cord compression > monitor I&Os , don't want FVE - **Tocolytic Therapy** > relaxation of uterus > pharm: Brethine (terbutaline)
48
VEAL CHOP
- **V**ariable decel - **E**arly decel - **A**ccelerations - **L**ate decels - **C**ord compression - **H**ead compressions - **O**xygenation - **P**lacental insufficiency

OB Exam 2 (11 decks)

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