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ENRP > Fetal Surveillance During Labor > Flashcards

Fetal Surveillance During Labor Flashcards

1
Q

How does FHR monitoring effect fetal neurologic damage/death?

A

It does NOT decrease it!

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2
Q

Even though FHR monitoring does not decrease fetal neurologic damage or death, what is good about it?

A

Good outcomes are associated with normal FHR data and it can provide a warning of potential problems

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3
Q

What does a Doppler US Transducer measure?

A

External on abdomen

= Records sound waves from the fetal heart

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4
Q

What does a Tocodynamometer measure?

A

External

= Detects and records contraction frequency only

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5
Q

Internal Fetal Monitoring is the most accurate. What are 2 options and which can measure the intensity of contractions?

A
  1. Fetal Scalp Electrode

2. Intrauterine Pressure Catheter - measures intensity

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6
Q

Blood flow from maternal circulation crosses the placenta and supplies the fetus with oxygen. During a contraction, what occurs?

A

Blood flow is temporarily stopped

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7
Q

A fetus who cannot tolerate the stress of contractions may become ___ and show ____ changes

A

Hypoxic with FHR changes

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8
Q

What does the upper tracing show?

A

FHR (Fetal Heart Rate)

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9
Q

What does the lower tracing show?

A

Uterine Contractions

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10
Q

For the FHR tracing, what do the horizontal lines measure?

A

FHR in bpm

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11
Q

For the Uterine Contractions, what does the horizontal lines measure?

A

Pressure of contractions

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12
Q

For the upper and lower tracings, describe the vertical lines

A

Each small box = 10 seconds

Each think line = 1 minute

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13
Q

What is a normal value for Uterine Contractions?

A

Less than 5 contractions in a 10 minute period

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14
Q

What defines Uterine Tachysystole?

A

> 5 contractions in a 10 minute period

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15
Q

More than 5 uterine contractions in a 10 minute period

A

Uterine Tachysystole

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16
Q

What are Montevideo Units (MVU)?

A

The sum of the pressures with each peak contraction in a 10 minute period for 2+ hours

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17
Q

What is normal value for MVU?

A

> 200

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18
Q

When do you assess Baseline FHR?

A

Between contractions

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19
Q

Normal Baseline

A

110 - 160 bpm

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20
Q

Tachycardia Baseline

A

> 160 bpm

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21
Q

What can cause Tachycardia Baseline?

A

Early fetal hypoxia

*fetal infection (chorioamnionitis)

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22
Q

Bradycardia Baseline

A

< 110 bpm

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23
Q

What can cause Bradycardia Baseline?

A

Late fetal hypoxia

Meds

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24
Q

Baseline Variability is fluctuations in the baseline FHR. How is it measured?

A

Amplitude of peak to trough in bpm

25
Q

Amplitude of peak to trough in bpm of change in baseline rate

A

Baseline variability

26
Q

Absent Baseline Variability

A

Amplitude range is undetected

27
Q

Minimal Baseline Variability

A

Amplitude range is < 5 bpm

28
Q

Moderate Baseline Variability

A

Amplitude range is between 6 - 25 bpm

29
Q

Marked Baseline Variability

A

Amplitude range > 25 bpm

30
Q

What type of Baseline Variability is normal?

A

Moderate – range between 6 - 25 bpm

31
Q

What type of Baseline Variability is associated with possible fetal stress?

A

Decreased Variability

32
Q

Decreased Baseline Variability is associated with what 2 things?

A 
Hypoxia
Acidosis (pH < 7.2)
33
Q

What should you do if you see Decreased Variability to differentiate fetal sleep from acidosis? What should you see?

A

Fetal Scalp Stimulation

– should see an associated Acceleration

34
Q

What are 2 categories of Periodic FHR changes and when are they seen?

A

Accelerations
Decelerations
– seen with uterine contractions

35
Q

If the FHR during a uterine contraction is the same as the preceding baseline FHR, what is that called?

A

No change

36
Q

If the baby is > 32 weeks, what is a normal Acceleration?

A

FHR > 15 bpm above baseline for > 15 seconds but not more than 2 minutes

37
Q

If the baby is < 32 weeks, what is a normal Acceleration?

A

FHR > 10 bpm above baseline for > 10 seconds but not more than 2 mins

38
Q

What defines a Prolonged Acceleration?

A

If the Acceleration lasts more than 2 minutes

39
Q

When is a Change in Baseline noted?

A

If the Acceleration or Deceleration lasts more than 10 minutes

40
Q

Are Accelerations normal?

A

YES - reassuring response

41
Q

What are 3 causes of Accelerations?

A

Fetal movement
Fetal Scalp Stimulation
Vaginal Exam

42
Q

What is a Deceleration?

A

FHR decreases with a uterine contraction

43
Q

What are 3 types of Decelerations?

A

Early
Variable
Late

44
Q

What causes Early Decelerations?

A

Head Compression

45
Q

With fetal head compression, what change in FHR should you see?

A

Early Deceleration

46
Q

What do Early Decelerations look like?

A

Mirror image

= Occur at the same time as the uterine contraction peak

47
Q

What causes Variable Decelerations?

A

Umbilical Cord Compression

48
Q

With umbilical cord compression, what FHR change should you see?

A

Variable Deceleration

49
Q

When do Variable Decelerations occur on the FHR strip?

A

Can occur before, during or after the beginning of a uterine contraction

50
Q

What causes Late Decelerations?

A

Uterine placental insufficiency

– excess uterine activity or maternal supine hypotension

51
Q

With excessive uterine activity or maternal supine hypotension (uterine placental insufficiency), what FHR change will be seen?

A

Late Deceleration

52
Q

How do Late Decelerations look?

A

Occur AFTER peak of contraction

53
Q

What is the most ominous Deceleration type and why?

A

Late Decelerations

– may indicate fetal acidosis

54
Q

What defines a Prolonged Deceleration?

A

Decreased FHR > 15 bpm below baseline lasting more than 2 minutes

55
Q

When are Prolonged Decelerations commonly seen?

A

Maternal pushing

56
Q

If you see a sinusoidal pattern of FHR, what does that mean?

A

Fetal anemia

57
Q

What pattern of FHR will be seen with fetal anemia?

A

Sinusoidal pattern

58
Q

If there is umbilical cord compression, what is a possible treatment?

A

Amnioinfusion

- saline though the IUPC

59
Q

With Variable Decelerations, what is a possible treatment?

A

Amnioinfusion

- saline through the IUPC

ENRP (45 decks)

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