Fetal Monitoring

Question 1

What is the purpose of monitoring?

Answer 1

• To detect and treat hypoxia asap to prevent acidosis

- See how fetus handles stress

Question 2

What can decreases O2 to fetus be caused by?

Answer 2

• Contractions
• HTN
• Hypotension
• Hypovolemia
• Anemia
• Alteration in fetal circulation (pinched cord)
• Head compression of fetus

Question 3

Auscultation

Answer 3

• Done with fetoscope/doppler
  
  • immediately p ROM
  • listen during and beyond contraction
• Increase/decrease of 30 bpm indicate distress
• Delay in return to baseline is sign of distress

Question 4

What are some modes of monitoring?

Answer 4

• External (indirect)
• Internal (direct)
• Intrauterine Pressure Catheter (IUPC)

Question 5

FM paper

Answer 5

-Each square=10 sec

• Paper speed set at 3 cm/min
  
  • can be set lower for certain circumstances

Question 6

Parts of EFM

Answer 6

Fetal-Ultrasound

 - detects movement of heart not sound 
 - use gel on transducer 
 - Apply to baby’s back 

Uterine-Tocotransducer (Toco)

 - monitors via pressure button
 - no gel 
 - apply to fundus (top) of uterus

Question 7

Benefits of EFM

Answer 7

• continuous and complete
• noninvasive
• can show contraction before pt feels it
• shows fetal movement
• records FHR in relation to contraction

Question 8

Limits of EFM

Answer 8

• slippage
• keeps pt in bed
• limited (maternal size, position, movement)
• may half or double heart tone
• artifact may show as variability

Question 9

Types of IFM?

Answer 9

Fetal - spiral electrode

Uterine -IUPC

Question 10

Spiral Electrode Benefits

Answer 10

• continuous recorded FHR in any position
• accurate STV
• 0 artifact

Question 11

Spiral Electrode Limits

Answer 11

Can cause infection
-keep clean, s/s: baby tachy

Cord prolapse

Question 12

IUPC Benefits

Answer 12

Accurate freq, duration, and intensity

Resting tone of uterus

Port for fluid withdrawal or infusion

Question 13

TOLAC

Answer 13

Trial of labor after c section

Question 14

VBAC

Answer 14

Vaginal birth after c section

Question 15

IUPC Limits

Answer 15

invasive

Can cause infection

Catheter obstruction

Placental injury

Question 16

Frequency

Answer 16

Beginning of contraction to beginning

Question 17

Duration

Answer 17

Beginning of contraction to end

Question 18

Hyperstimulation

Answer 18

Interval <60 sec

Question 19

Peak intrauterine pressure

Answer 19

Peak of contraction

Question 20

Intensity

Answer 20

Difference between peak and resting tone

Question 21

Strength

Answer 21

Measure by touching

Mild, medium, or strong

Question 22

Hypertonus

Answer 22

Resting tone >25 (can rupture uterus if too high)

Question 23

Interval

Answer 23

End to beginning of contraction (60 sec)

Question 24

Monte vedeo units (MVU)

Answer 24

Add up intensity of contractions within 10 min period

Tells you if its adequate labor (150-300)

> 300 too strong; potential to rupture

Question 25

Dystocia

Answer 25

Difficult labor (slow, not doing anything)

Question 26

NADIR

Answer 26

Peak of depression of FHR

Question 27

Irritability

Answer 27

squiggly line d/t dehydration, infection

Question 28

*Variability

Answer 28

Are short term and long term Can only be seen on monitor (Cant listen) Indicates well-being

Question 29

Long term variability

Answer 29

``` Absent: 1-3 bmp Minimal: 3-5 bmp Average:6-10 bpm Moderate: 11-25 bpm Marked: >25 ``` Now called - decreased, average, increased

Question 30

Absent or exaggerated variability

Answer 30

Find out why: acidosis, CNS depression (fentanyl given?), trauma, meds, infection? If on EFM switch to IFM d/c pitocin (don't just turn down), bolus of fluids (makes contraction slower)

Question 31

What are drugs that can slow contractions?

Answer 31

Terbutaline | Mag, sulfate

Question 32

What can a early deceleration be due to?

Answer 32

Fetal head compression

Question 33

What can a late deceleration be due to?

Answer 33

uteroplacental insufficiency

Question 34

What can a variable deceleration be due to?

Answer 34

Cord compression

Question 35

Decelerations

Answer 35

At least 15 bpm decrease from baseline lasting 15 sec

Question 36

Late decelerations

Answer 36

Interventions: lay pt on L side, fluid bolus, O2 by mask (8-10 1/min), check BP, call provider Risk factors: diabetes, vasoconstriction (ciggs) Always document decels, interventions, and who you called and what they said Orders: ephedrine 5-10 mg SLOW for bp; terbutaline 0.25 mg SLOW to slow contractions (can make pt nervous, have beta blocked handy in case of chest pain)