Flashcards in Intrapartum Management Deck (14):
What kind of things do you monitor?
- Fetal movement (min 10 movements over 2 hr time). Decreased movement suggests baby is under stress
- Monitoring HR and fetal activity = Non Stress test. (Nonreactive = normal)
- Contraction stress test (older) - see how baby responds to induced contraction. If no stress with 3 contractions in 10 min.
- Biophysical profile: combined US with monitoring fetal HR tracing. Measure fetal HR, fluid, fetal movement, fetal tone, fetal breathing motion. Rated on a 1- pt scale, 2 pts per measurement. Good = 8-10/10
- S/D ratio
** False positives
What does fetal monitoring measure and name the 2 types
Assesses baseline, variability, accelerations, decelerations
External: Indirect, doppler ultrasound
Internal: directly applied scalp electrode; need to be dilated enough
ways to monitor contraction
External: Indirectly monitor via abdominal pressure electrode
Internal: Direct (IUPC)
- hollow tube next to baby's head in space around baby's body; measures intrauterine pressure. Membranes have to be ruptured and need to be dilated enough to fit tube in.
- assess how often and how intesnse
- increased risk of infection
How to assess fetal heart rate
Rate, variability, accelerations , deceleration
Normal baseline HR
- Determined based on 10 min window
What is considered normal, moderate variability in HR?
Do you want variability in HR
you want moderate variability. Don't really like No/minimal variability. Absent pretty bad.
What do variable decelerations look like
- like "V"---abrupt decrease in HR
- usually near contraction
- can be due to cord compression/interruption in blood flow
- healthy baby can tolerate this.
- see more often if low fluids
What is an amnioinfusion
hook up NS infusions into pressure catheter; may help with oligohydramnios and keep cord floating/not compressed
- too much will cause uterine rupture
- only indicated to help with variable decelerations
What are Early decelerations
gradual deceleration where lowest point of deceleration correlated with peak of contraction.
What are late decelerations
- gradual deceleration after contraction
- lowest HR after peak of contraction.
- fetal response to hypoxemia during contraction.
- Decreased maternal perfusion during contraction of intervillous space, so less blood to capillaries
- BP goes up due to vasoconstriction from hypoxemia, so HR goes down in resopnse
What can you do for fetal Supraventricular tachy
give beta blockers, they cross placenta
What does a sinusoidal pattern indicate on fetal HR tracings