Fetal Monitoring

Question 1

three principles of fetal heart tracings

Answer 1

1) heart tones (top of strip)
2) uterine contractions (bottom of strip)
3) fetal heart tones in relationship to uterine contractions

Question 2

normal heart tones of fetus

Answer 2

110-160 bpm lasting >10 min

Question 3

what is bradycardia defined as in fetus

Answer 3

<110 bpm

Question 4

causes of bradycardia

Answer 4

anything that decreases pressure to placenta (decrease O2 to fetus)
hypoxia, maternal hypotension, r/t epideral

Question 5

what do you give if fetus is bradycardic

Answer 5

give mom oxygen (10 L of O2 on nonbreather mask)
give mom bolus of fluid (500 cc saline to increase BP)
change mother position, TURN PT (fetus cord may be compressed)

Question 6

what is tachycardia defined as in fetus

Answer 6

> 160 bpm

Question 7

cause of tachycardia in fetus

Answer 7

maternal/fetal INFECTION, fetal hypoxia, street drugs (meth, cocaine)

Question 8

what is chorioamnionitis

Answer 8

infection of chorion and amnion of placenta
fetus and mom are infected- need to give them antibiotics
causes increase in HR and fever

Question 9

measure of changes in fetal heart rate/ waviness

controlled by fetal brain (sympathetic and parasympathetic system)

Answer 9

variability

Question 10

NO changes in fetal heart rate

ie/ consistently 140 bpm

Answer 10

Undetected

Question 11

what does undetected variability mean

Answer 11

SEVERE brain damage

Question 12

undetected or less than or equal to 5 bpm
little bit wavy, some activity
okay for 20 min/ hr

Answer 12

minimal variability

Question 13

what is usually the cause of minimal variability and intervention

Answer 13

sleeping fetus (if > 20 min be concerned)
intervention: give mother caffeine and sugar to wake baby up

Question 14

what is moderate variability indicative of

Answer 14

Good parasympathetic and sympathetic nervous system

heart and brain are reacting together

Question 15

describe what moderate variability looks like

Answer 15

squiggly line

6-25 bpm

Question 16

describe marked variability

Answer 16

OMINOUS
early hypoxia or fetal seizures
>25 bpm
thick, wavy lines

Question 17

form of long term variability
6-25 beats above baseline
periodic “hills” in EKG

Answer 17

accelerations

Question 18

describe what type of accelerations you want

Answer 18

2 accelerations every 10 min
GOOD
up 15 beats, lasts 15 sec

Question 19

why are accelerations good

Answer 19

indicates that baby gets enough Oz to supply muscles/body to move

Question 20

what do no accelerations indicate

Answer 20

damage to cord

fetus not getting enough O2

Question 21

during uterine contractions…

Answer 21

blood flow is REDUCED to placenta

Question 22

what is the normal cycle of uterine contractions

Answer 22

normal flow, reduced flow, no blood flow, reduced flow, normal flow

Question 23

contractions that last 5 min…

Answer 23

hypoxic baby

Question 24

contractions=______

Answer 24

stress

Question 25

done on high risk pts who may not supply fetus with enough Oz

Answer 25

non stress test

Question 26

2 or more accelerations in 10-20 min

Answer 26

reactive NST

Question 27

fetus did not meet acceleration requirement

Answer 27

nonreactive NST

Question 28

causes of nonreactive NST

Answer 28

sleep: monitor for 2 hrs and give glucose hypoxia: further testing necessary with stress test or biophysical profile

Question 29

ideally, what contraction frequency do we want

Answer 29

contracts every 3-5 min lasting 45-90 seconds

Question 30

each box is how many seconds

Answer 30

10

Question 31

need relaxation period for what

Answer 31

normal arterial transfusion to gap | O2 pushed to gap

Question 32

contractions...

Answer 32

pushes baby out and dilates cervix

Question 33

resting...

Answer 33

gives baby O2

Question 34

from the beginning of one contraction to the beginning of the next contraction

Answer 34

frequency

Question 35

what frequency do you want

Answer 35

every 3-5 min

Question 36

delivered to help women go into labor | starts to increase the amount of uterine contractions

Answer 36

Pitocin

Question 37

how is Pitocin given

Answer 37

IV if contractions are <3 min | nurse triates med to optimal dose

Question 38

if contractions are closer than 3-5 min apart lasting 45-90 sec this occurs

Answer 38

hyperstimulation

Question 39

as resting period is decreased...

Answer 39

O2 to fetus is decreased | causes prolonged constriction of endometrial arteries

Question 40

interventions for hyperstimulation

Answer 40

1) turn down or off the Pitocin | 2) give a tocolytic to relax uterus

Question 41

do not want contractions ______ if giving pitocin

Answer 41

>3 minutes apart

Question 42

types of tocolytic

Answer 42

brethine | terbutaline

Question 43

decelerations have _______ to contractions

Answer 43

NO relationship

Question 44

these are variable decreases in beats lasting 15 sec

Answer 44

decelerations

Question 45

what do decelerations look like

Answer 45

all look different | U, V, or W shaped

Question 46

what are decelerations caused by

Answer 46

manual cord compression

Question 47

interventions for decelerations

Answer 47

change position to remove force on cord | O2 per 10 L non rebreather

Question 48

if severe decelerations then do this

Answer 48

amniofusion- float away from force | discontinue Pitocin to allow fetus to rest

Question 49

this is a good sign, fetal head compression | moving down for delivery

Answer 49

early decelerations

Question 50

starts before the peak of the contractions smooth, not shaped no nursing interventions

Answer 50

early decelerations

Question 51

OMNIOUS | occurs after the peak of the contraction

Answer 51

late decelerations

Question 52

what do late decelerations indicate

Answer 52

uteroplacental insufficiency | presence of fetal hypoxia from the inability of the placenta to perfuse to the fetus

Question 53

intervention for late decelerations

Answer 53

``` change maternal position turn of Pitocin (stop closing arterioles) O2 per 10L non rebreather LR bolus to increase pressure notify physician ```

Question 54

pneumonic to remember for fetal monitoring

Answer 54

VEAL CHOP

Question 55

what does the fetal monitor pneumonic stand for

Answer 55

``` Variables Cord compression(change position) Early decelerations Head compressions (no intervention) Accelerations Okay (placenta is good shape/able to give O2 to aby and take CO2 from gap) Late decelerations P-uteroplacental insufficiency (fetus is hypoxic, change position, shut off Pitocin, give O2, fluid bolus, and call provider) ```