Intrapartum Fetal Surveillance:

Question 1

What is a fetoscope used for?

Answer 1

auscultation and palpation
- midwife uses in community

Question 2

What is a a Doppler ultrasound used for?

Answer 2

auscultate fetal heartbeat

Question 3

Benefits of auscultation and palpation

Answer 3

• Easy, inexpensive and less invasive
• Results comparable to EFM in low risk women
• Comfortable and allows freedom of movement
• Can be used with hydrotherapy (water birth)

Question 4

Limitations of auscultation and palpation

Answer 4

• Inability to perform in some situations
• No permanent record
• FHR counting is intermittent not continuous
• May not detect abnormal FHR at all, or in time for intervention- bc it’s intermittent
• Not recommended for high risk pregnancy

Question 5

What are the two monitors of a bedside electronic fetal monitor (EFM)?
Where do you place them for use?

Answer 5

• tocometer: measures uterine contractions
  — Placed at the fundus, top of uterus
• Ultrasound: placed on back of fetus, must know fetal positions
• External monitor cannot determine the intensity of contraction

Question 6

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LSA:

Answer 6

LUQ

Question 7

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LOP

Answer 7

LLQ

Question 8

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
RSA:

Answer 8

RUQ

Question 9

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
LOA

Answer 9

LLQ

Question 10

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
ROP:

Answer 10

RLQ

Question 11

FETAL POSITION; ABD QUAD FOR FHR PLACEMENT:
ROA:

Answer 11

RLQ

Question 12

Benefits of Doppler and EFM:

Answer 12

• Noninvasive
• Ease-of-use
• No risk to mother or fetus
• Provides continuous FHR and UA readings

Question 13

Limitation of Doppler and EFM

Answer 13

• Limits mobility of mother
• Does not assess strength or intensity of contractions
• Limited effectiveness in obese or multifetal women

Question 14

What needs to happen before using an:
Intrauterine pressure catheter (IUPC)

Answer 14

• Mom needs to be dilated at least 2 cm
• and her membranes need to be ruptured

Question 15

FHR MONITOR STRIP:
Each box = how many secs?

Answer 15

10 secs

6 boxes = 1 min
Assending boxes= FHR

Question 16

Normal baseline FHR:

Answer 16

110-160 bpm

Question 17

FHR Tachycardia:

Answer 17

> 160 bpm

Question 18

FHR Bradycardia:

Answer 18

<110 bpm

Question 19

What is Variability?

Answer 19

fluctuation in the FHR from the baseline FHR with irregular amplitude and frequency

• Variability: is considered normal (reassuring HR)

Question 20

Minimal Variability

Answer 20

5 bpm or less

Question 21

Moderate variability

Answer 21

6-25 bpm

Question 22

Marked variability

Answer 22

25 bpm or greater

Question 23

What are accelerations?

Answer 23

• 15 bpm above baseline for 15 seconds (normal)
• Indicates adequate fetal oxygenation and fetal pH. - Reassuring.

Question 24

What are periodic accelerations?

Answer 24

linked with uterine contractions

Question 25

What are episodic accelerations?

Answer 25

- fetal movement, vibroacoustic stimulation, scalp stimulation from vaginal exam - Are not directly linked to uterine activity - Caused by fetal or uterine stimulation

Question 26

Early decelerations:

Answer 26

Normal - early in the cycle of contractions the FHR starts to go down. - Cause: head compression - FHR goes back up after contractions - No intervention needed. Continue to monitor. This is a normal finding. This is a reassuring FHR

Question 27

Late deceleration:

Answer 27

- bad/ not reassuring - FHR goes down after the contractions

Question 28

Late deceleration causes:

Answer 28

- *Uteroplacental insufficiency - Maternal hypotension - Uterine hyperstimulation from Pitocin - Bleeding disorders

Question 29

Late deceleration nursing interventions

Answer 29

- IV fluids to correct hypotension - Stop/slow Pitocin - Address bleeding issue. Perhaps give PRBC - Reposition mother on side (especially left side) - Administer 02 - Prepare for C-section

Question 30

Variable decelerations: Causes:

Answer 30

- bad/not reassuring . - *Cord compression - Fetus on cord - Knot in cord - Nuchal cord

Question 31

Nuchal cord:

Answer 31

- cord around baby’s neck - Often occurs after membranes rupture

Question 32

Variable decelerations Nursing interventions:

Answer 32

- Change mothers position — Place mom in hands and knees, side lying, or Trendelenburg - Amnioinfusion - IVF - Oxygen

Question 33

Whartons Jelly

Answer 33

Gelatinous substance surrounding the umbilical cord that protects it from compression

Question 34

Variable deceleration=

Answer 34

Cord compression

Question 35

Early deceleration=

Answer 35

Head compression

Question 36

Acceleration=

Answer 36

Okay!

Question 37

Late deceleration=

Answer 37

Placental insufficiency