Fetal Monitoring and Assessment Flashcards
(26 cards)
Fetal Assessment Before/During Labor
intermittent auscultation (IA): listening to heart sounds at periodic intervals to assess FHR
electronic fetal monitoring: visualize FHR patterns on screen; more sensitive than auscultation in predicting fetal compromise
Factors Affecting Oxygenation and Perfusion
maternal HTN/hypotension
hypovolemia
umbilical cord compression
External Fetal Monitoring
FHR (US transducer)
UCS (tocotransducer)
NOVII
Internal Fetal Monitoring (Continuous and Invasive)
fetal spiral electrode (FSE)
intrauterine pressure catheter (IUPC)
Baseline
where the tracing lies (on or between two lines)
average FHR over 10 min. (rounded to nearest 5 BPM)
Tachycardia
baseline more than 160 BPM for duration of 10 min+
Bradycardia
baseline less than 110 BPM for duration of 10 min+
check maternal HR
Baseline FHR Variability
absent amplitude range undetectable (amplitude change from beat to beat) MOST CONCERNING!
minimal is 2-5 BPM
moderate is 6-25 BPM
marked is greater than 25 BPM
Accelerations
greater than 15 BPM rise for at least 15 seconds, less than 10 min with fetal movement!
mature autonomic system
with ctx, a drop in O2 signals sympathetic stimulation (increase in HR)
sign of fetal reserves to cope with stress of ctx’s (OXYGENATION!)
FHR Patterns for Decelerations
early “normal”
late
variable
prolonged
Early Decelerations
head compression
vagal response
sign of progress
no need to intervene!
decal less than 2 min
more than 30 s from start to finish
gradual decrease with onset of contraction
symmetrical with contraction
resolves before contraction has ended
Variable Decelerations
cord can be compressed in a variety of ways
first intervention is to REPOSITION PT!
can be persistent after membrane rupture
less than 30 s from start to finish
abrupt decrease in FHR below baseline is 15 BPM+
lasts at least 15 s
returns to baseline in less than 2 min from time of onset
Late Decelerations
uterus, placenta, maternal circulation causes; insufficient delivery of O2 to fetus (hypoxia!!)
goal is to improve oxygenation and perfusion
decel less than 2 min
more than 30 s from start to finish
gradual decrease with LATE onset and begins after peak of contraction
doesn’t resolve until after contraction has ended
Prolonged Deceleration
decel more than 2 min. but less than 10 min
Late/Prolonged Deceleration Interventions
reposition (flip)
IV fluids (float)
O2 (high flow)
Variable Deceleration Interventions
reposition
amnio infusion
Early Deceleration Interventions
document
check progress and monitor
Normal FHR Interpretation (Cat 1)
baseline FHR 110-160 BPM
moderate variability
accelerations (may be present or absent)
NO late or variable decelerations (may have early)
strongly predictive of normal acid-base balance at time of observation
Indeterminate FHR Interpretation (Cat 2)
FHR tracing may have…
tachy
brady
minimal or marked variability
absent variability without recurring decelerations
absence of accelerations after stimulation
recurrent variable decelerations with minimal/mod variability
prolonged deceleration less than or equal to 2 min but less than 10
recurrent late decelerations with mod variability
variable detections with other characteristics such as slow return to baseline
requires continued surveillance and reeval
Abnormal FHR Interpretation (Cat 3)
sinusoidal pattern OR absent variability with 1+ of…
recurrent late decelerations
recurrent variable decelerations
brady
resolve underlying cause; predictive of abnormal acid-base balance at time of observation
Reassuring FHR Patterns
FHR baseline of 110-160 BPM
no periodic decels (or early)
moderate variability
present/absent accelerations
cat 1 (baby is well oxygenated!)
Contractions
frequency, duration and intensity can affect FHR
Duration
count boxes underneath each “hill”
box # x 10= ___ s of duration
Intensity
TOCO is an external monitor part and isn’t calibrated to measure strength
when TOCO is used, the size of hill doesn’t = intensity
strength utilizing a TOCO MUST BE PALPATED!
