Fetal Monitorign

Question 1

Fetal Assessment

Answer 1

• primarily focuses on FHR pattern.
• characteristics of amniotic fluid
• Fetal cord blood sampling
• fetal scalp stimulation

Question 2

SROM

Answer 2

SPONTANEOUS RUPTURE OF MEMBRANES

Question 3

AROM

Answer 3

ARTIFICIAL RUPTURE OF MEMBRANES
(amnihook)

done by HCP

Question 4

Green fluid in amniotic fluid

Answer 4

Meconium staining
Normal if breeched

Question 5

• cause of respiratory failure in Term & post-term infants

Answer 5

MAS
(meconium aspiration syndrome)

Question 6

What causes MAS (meconium aspiration syndrome)?

Answer 6

• occurs when newborns inhale particulate MECONIUM mixd with amniotic fluid INTO THE LUNGS while still in utero or on the FIRST breath after birth.
• INTRAUTERINE DISTRESS CAUSES PASSAGE OF MECONIUM INTO AMNIOTIC FLUID
• CAUSES RESPIRATORY DISTRESS

Question 7

how to prevent MAS (meconium aspiration syndrome)

Answer 7

• Suctioning AFTER head is born BEFORE baby takes first breath
• direct tracheal suctioning AFTER birth

Question 8

When MODERATE-HEAVY meconium is present in placenta, what is done?

Answer 8

• Amnioinfusion: intro of warmed, sterile normal saline (NS) or RINGERS LACTATE solution in uterus
• Assists in preventing MAS

Question 9

What is used to monitor FETAL HEART RATE (FHR)?

Answer 9

1. electronic fetal monitor
2. fetoscope modified stethoscope
3. doppler US
4. Fetal Scalp electrode

Question 10

Intermittent FHR monitoring involves

Answer 10

• using doppler or fetoscope for periodic assessment of FHR.
• listen for short periods of time at REGULAR INTERVALS.
• does not provide a complete picture of fetal well being.
• 1 full min AFTER a contraction
• listen for 30 sec x 2

Question 11

does Intermittent FHR monitoring limit mobility?

Answer 11

no. MOM IS. MOBILE

Question 12

What type of pts are candidates for intermittent FHR monitoring?

Answer 12

• Acceptable option for LOW-RISK laboring women.

Question 13

When is the BEST time to listen FHR monitoring during ‘Intermittent FHR monitoring’

Answer 13

listen at the end of a contraction (NOT AFTER one) so late decelerations could be detected

Question 14

Where is FHR best heard?

Answer 14

fetals BACK

Question 15

What is CEPHALIC

Answer 15

cephalic means head in anatomy

Question 16

IF fetus is in cephalic position, FHR is in

Answer 16

mothers lower quadrants (R or L)

Question 17

IF fetus is in BREECH position, FHR is in

Answer 17

above level of maternal umbilicus

Question 18

To ensure that Maternal HR is not confused with Fetal HR

Answer 18

Palpate the maternal radial pulse simultaneously while auscultating FHR

Question 19

Guidelines for assessing FHR

Answer 19

• Initial 10 to 20 min continously. FHR upon entry in L&D
• Completion of a prenatal & labor risk assessment
• Intermittent auscultation during active labor

Question 20

Intermittent auscultation DURING LABOR for lOW-RISK moms is every

Answer 20

Q 30 min

Question 21

Intermittent auscultation DURING LABOR for HIGH-RISK moms is every

Answer 21

Q 15 min

Question 22

Intermittent auscultation DURING 2ND STAGE for lOW-RISK moms is every

Answer 22

Q 15 MIN

Question 23

Intermittent auscultation DURING 2ND STAGE for HIGH-RISK moms is every

Answer 23

Q 5 MIN AND DURING PUSHING STAGE

Question 24

• CONTINUOUS tracing of the FHR
  sound is produced with each heartbeat
• provides information about fetal oxygenation
• prevent fetal injury resulting from impaired fetal oxygenation during labor.

Answer 24

Continuous electronic fetal monitoring (EFM)

Question 25

Disadvantages of EFM (continuous electronic fetal monitoring)

Answer 25

* limits mobility * needs supine position

Question 26

Continuous EFM is used on MOMS that are

Answer 26

* Oxytocin infusion * Epidural analgesia * Compromised health – mom & baby * Moderate hypertension >150/100 * Confirmed delay in 1st or 2nd stage of labor * Prolonged ROM

Question 27

* ____________ is demonstrated in a heart rate pattern change and is by far the MOST common etiology of fetal injury & death * can be prevented WITH optimal fetal surveillance during labor & early intervention.

Answer 27

FETAL HYPOXIA (low levels of O2)

Question 28

continuous External monitoring is used when

Answer 28

* ROM intact or not. * no cervical dialation * dialated cervix

Question 29

* involves placement of a spiral electrode INTO fetal presenting part (usually parietal bone on head) to ASSESS FHR * Pressure transducer placed internally within the uterus to record uterine contractions

Answer 29

CONTINUOUS INTERNAL MONITORING

Question 30

Candidates for cont. internal monitoring

Answer 30

* high risk * decreased fetal mvmnt * abnormal FHR on auscultation * High HR, DM

Question 31

BAseline FHR is measured by

Answer 31

* occurs during 10-min segment * done when no contractions * fetus NOT experiencing episodic FHR changes.

Question 32

Baseline HR should be

Answer 32

**110-160 BPM** higher than an adult. (adult is 60-100)

Question 33

fetal bradycardia

Answer 33

* < 110 (lasting > 10 min)

Question 34

fetal tachycardia

Answer 34

* >160 (lasting > 10 min) ## Footnote `

Question 35

FHR falls into 3 categories.

Answer 35

* Category 1= normal (no intervention needed) * CAtegory 2= indeterminate * category 3 = abnormal **INTERVENTION NEEDED**

Question 36

type of category for FHR: * NOT predictive of abnormal fetal acid–base

Answer 36

CATEGORY II

Question 37

TYPE OF CATEGORY: * ABNORMAL FETAL ACID-BASE * REQ. PROMPT EVAL AND Rx * Requires action on mothers side

Answer 37

CATEGORY III

Question 38

* EARLY RESPONSE TO ASPHYXIA (suffocation) * Fetal infection * maternal fever CAUSES:

Answer 38

TACHYCHARDIA HIGH HR.

Question 39

* Prolonged maternal low BS * Maternal or fetal low Temp. * Fetal acidosis * MOM LOW BP CAUSES:

Answer 39

BRADYCARDIA LOW HR

Question 40

* **IRREGULAR fluctuations** in the baseline HR (110-160) * measured amplitude of PEAK TO TROUGH in **beats per min**. * push & play Nervous system

Answer 40

baseline variability

Question 41

VARIABILITY is ONE OF THE MOST IMPORTANT characteristics for

Answer 41

FHR

Question 42

Variability FHR has 4 categories. Name them:

Answer 42

4 * absent: undetectable * minimal: < 5 bpm * moderate: 6-25 bpm * marked: >25 bpm

Question 43

Absent (0 fluctuation= undetectable) **to** Minimal <5 bpm indicates:

Answer 43

* mom low bp * fetal problems **poor outcome**

Question 44

interventions for **Absent-minimal bpm**

Answer 44

* improve MATERNAL blood flow & perfusion * notify HCP * prepare for CS if no improvements

Question 45

Moderate category of 6-25 bpm indicates

Answer 45

* ANS & CNS developed and oxygenated * fetal well-being **continue to monitor**

Question 46

**Marked** category of >25 bpm interventions

Answer 46

* not good sign * determine cause * increase iv fluid rate * O2 admin * notify HCP

Question 47

Absent fluctuations is

Answer 47

0 fluctuations (undetectable)

Question 48

Minimal fluctuations is

Answer 48

fewer 5 bpm

Question 49

Moderate fluctuations is

Answer 49

6-25 bpm

Question 50

Marked fluctuations is

Answer 50

more thabn 25 bpm

Question 51

* transitory abrupt increases in the FHR above the baseline * associated with sympathetic nervous stimulation * considered reassuring and require no interventions

Answer 51

FETAL ACCELERATIONS

Question 52

What is fetal accelerations considered

Answer 52

reassuring This is good if in the 15x15 rule

Question 53

Associated with SYMPATHETIC nervous stimulation (fight-or-flight response)

Answer 53

Fetal Accelerations

Question 54

FETAL ACCELERATION last

Answer 54

Last < 30 sec from Onset to Peak

Question 55

Acceleration 15 x 15 rule What is this rule

Answer 55

Increase of 15 bpm every 15 seconds but less than 2 mins.

Question 56

What does fetal acceleration mean? Is this good or bad?

Answer 56

Fetal movement Fetal well-being **requires no interventions**

Question 57

A transient fall in FHR caused by stimulation of Parasympathetic NS

Answer 57

Fetal Decelerations

Question 58

Decelerations are described by

Answer 58

thier shape association to uterine contraction

Question 59

3 types of Fetal Decelerations

Answer 59

1. early deceleration 2. variable deceleration 3. late deceleration

Question 60

Mirror contractions Rarely below 100 bpm

Answer 60

Early deceleration

Question 61

* Nadir (lowest point) occurs AFTER contractions * gradual & shallow drops

Answer 61

late deceleration

Question 62

* Vary in shape, depth, & time * Abrupt decrease in FHR= QUICK DROPS * **15 bpm x 15 sec <2 Min.** * Accels. at onset & at end of cont. ( “shoulders”) * **U, V, W shapped - jagged lines** * **Not 1 looks like the other** * **No apparent association with contractions**

Answer 62

Variable decelerations

Question 63

causes for prolonged deceleration

Answer 63

* Prolonged cord compression * Supine maternal position * Fetal blood sampling * Maternal seizures * Regional anesthesia

Question 63

* Abrupt FHR declines * at least 15 bpm last >2 mins BUT <10 mins * drops to <90 bpm

Answer 63

Prolonged deceleration

Question 64

RX for prolonged deceleration

Answer 64

id underlying cause and correct it.

Question 65

* Visually apparent * Smooth, wavelike undulating pattern * Severe hypoxia R/T fetal anemia & hypovolemia

Answer 65

Sinusoidal Pattern

Question 66

Sinusoidal pattern is considered a category

Answer 66

always category III

Question 67

RX for sinusoidal pattern

Answer 67

fetal intrauterine infusion

Question 68

which categories require further analysis

Answer 68

Category II and Category III

Question 69

What are Other Fetal Assessment Methods

Answer 69

* umbilical cord blood analysis (done at birth- evaluates newborns condition) * Fetal scalp (vibroacoustic) stimulation (promotes fetal mvmnt to accelerate FHR)