Fetal Surveillance during labor

Question 1

is external monitoring useful for measure the frequency or strength of contractions? which one?

Answer 1

• frequency only

- the IUPC can sense strength real well

Question 2

What is the pH of the fetal scalp normally?

Answer 2

-7.25-7.3

Question 3

what is considered fetal acidosis?

Answer 3

-<7.2

Question 4

what does the upper tracing monitor?

Answer 4

-fetal heart rate

Question 5

What does the lower tracing monitor?

Answer 5

-uterine contractions

Question 6

What isthe normal uterine contraction rate?

Answer 6

5 contractions or less in 10 minutes averaged over a 30 minute window
-if greater, then it’s tachysystole

Question 7

What do we do with the montevideo units?

Answer 7

-add them up over a 10 minute period

Question 8

> 5 contractions in 10 min… what is it?

Answer 8

-tachysystole

Question 9

When is baseline FHR identified?

Answer 9

-between uterine contractions

Question 10

What is the normal baseline FHR?

Answer 10

-110 to 160 bpm

Question 11

is fetal tachycardia early or late sing of hypoxia?

Answer 11

• early

- late sign is bradycardia

Question 12

what are the landmark values for the FHR variability (peak to trough)?

Answer 12

• 6 and 25.

- minimal, moderate, and marked

Question 13

what does decreased variability mean?

Answer 13

-fetal stress

Question 14

What do we have to remember about abrupt accelerations?

Answer 14

-it’s a normal reassuring response

Question 15

What is prolonged acceleration?

Answer 15

• lasts >2 minutes

Question 16

What is change in baseline acceleration?

Answer 16

• lasts > 10 min

Question 17

What are the early decelerations looking like on the graph thing?

Answer 17

• mirror images!!!
• uterus contracts… decrease in FHR
• fetal head compression

Question 18

What is the key for Variable decelerations?

Answer 18

• they look like a big “V”…. they are just bigger
• secondary to umbilical cord compression
• the umbilical vein is what will get compressed, that is what returns oxygenated blood to the fetal heart

Question 19

What are late decelerations caused by?

Answer 19

• uterine placental insufficiency (UPI)

- the decelerations happen AFTER the uterine contraction

Question 20

when is prolonged deceleration commonly seen?

Answer 20

-with maternal pushing

Question 21

What do we think of if we see a sinusoidal pattern of uterine contraction?

Answer 21

-fetal anemia

Question 22

Describe the 3 FHR pattern categories?

Answer 22

• 1: normal
• 2: intermittent variable decelerations, if recurrent, think umbilical cord stuff
• 3: worst, recurrent late decels, sinusoidal pattern, increased risk of fetal acidemia

Question 23

what can alleviate cord compression?

Answer 23

-instillation of normal saline