OB: FHR monitoring Flashcards by Linsley Lloyd

Q

Historically labor puts the fetus at increased risk of ____ and _____

A

morbidity and mortality

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Q

Neonatal outcomes have drastically improved in the last ___ ____ in developing countries

A

40 years

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Q

In developing countries intrapartum stillbirths account for as many as ____ % of stillbirths

A

50

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Q

Developed countries ____ ____ are rare, less than 10% of stillbirths

A

intrapartum stillbirths

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Q

The WHO reports that ___ of all deaths in children under 5 are due to intrapartum stillbirth. (Livingston, 2014)

A

10%

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Q

High risk mothers constitute ____% of the pregnant population

A

20%

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Q

(high risk mothers) Their babies represent 50% of the cases of perinatal _____ and _____

A

morbidity and mortality

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Q

High risk pregnancies:

_____ complications
_____ complications
_____ complications

A

Medical complications (HTN, pre-E, diabetes, autoimmune, hemoglobinopathy)
Fetal complications (IUGR, nonlethal anomalies, prematurity, multiple gestation, post-datism, hydrops)
Intrapartum complications (bleeding, maternal fever, meconium-stained amniotic fluid, oxytocin augmented labor)

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Q

Intrapartum Fetal Assessment -

____ ____ ____ ____ Monitoring
Not a specific predictor of fetal wellbeing
No optimal while still practical method has been developed

A

Electronic Fetal Heart Rate

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Q

Intrapartum Fetal Assessment -

Neuronal and humoral factors affect the intrinsic FHR
Fetal parasympathetic outflow → ___________FHR
Fetal sympathetic activity → _________ FHR

A

decreases
increases

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Q

Intrapartum Fetal Assessment -

______ respond to increased BP

A

Baroreceptors

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Q

Intrapartum Fetal Assessment -

Chemoreceptors respond to decreased ____ and increased ____

A

PaO2
PaCO2

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Q

External vs Internal Monitoring -

FHT and uterine contractions are monitored _____

A

simultaneously

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Q

External vs Internal Monitoring -

This allows for a determination of a baseline rate and patterns of FHR compared to _______

A

contractions

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Q

External vs Internal Monitoring -

The external FHR transducer uses ____ _____ to detect changes in ventricular wall motion and blood flow through major vessels

A

doppler ultrasonography

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Q

External vs Internal Monitoring -

Alternatively, a scalp ECG lead measures the ____ interval

A

R to R

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Q

External vs Internal Monitoring -

Both allow for ___ ___ monitoring

A

continuous FHR

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Q

External vs Internal Monitoring -

The external tocodynamometer measures contractions while ____ ____ on the fundus

A

sitting externally

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Q

External vs Internal Monitoring -

An ____ ____ ____ (___) measures exact pressures in the uterus

A

intrauterine pressure catheter (IUPC)

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Q

External vs Internal Monitoring -

IUPC is more accurate regarding the ____ of contractions

A

strength

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Q

Methods to Improve FHR Monitoring -

Continuous FHR monitoring – requires patient to be ____ a ____ ____ of the base

A

within a few feet

Q

Methods to Improve FHR Monitoring -

_____ – Allows for more movement and ambulation

A

Telemetry

Q

Methods to Improve FHR Monitoring -

Electronic recording – eliminating the need for ____ ____ (medicolegal implications)

A

paper record

Q

Uterine Contraction Pattern -

A normal pattern of contractions is ___ ___ ___ in a __-____ period averaged over 30 minutes

A

5 or less
10-minute

Uterine Contraction Pattern - _____ is more than 5 contractions in a 10-minute period

Tachysystole

Uterine Contraction Pattern - The Toco ___________ the onset, duration, and offset of contractions

approximates

Uterine Contraction Pattern - An IUPC can measure the ____________ of contractions and __________ onset and offset of each contraction

strength precise

FHR assessment: (4)

- baseline measurements - variability (long term and beat-to-beat) - accelerations - decelerations (and their association with uterine contractions)

Baseline Fetal Heart Rate - Normal baseline FHR is ___-____ Term fetuses have a ____ baseline FHR than preterm

110-160 bpm lower

Baseline Fetal Heart Rate - _____cardia is the initial fetal response to hypoxia

brady

Baseline Fetal Heart Rate - Prolonged hypoxia may result in fetal _____cardia Due to catecholamine _____ and SNS ____

tachy secretion activity

Baseline Fetal Heart Rate - Changes in baseline FHR may also be caused by fetal anatomic or functional heart pathology, maternal fever, intrauterine infections, maternally administered medications (____ ____ – terbutaline, or _______ - atropine)

beta agonists anticholinergic

Fetal heart Rate Variability - fluctuations in FHR is ______

GOOD

FHR variability - _____ variability indicates presence of intact fetal cerebral cortex, midbrain, vagus nerve, and cardiac conduction system

Normal

FHR variability - Variability greatly influenced by _____ tone

parasympathetic

FHR variability - Hypoxemia fetal myocardial and cerebral blood flow ____ to maintain O2 delivery and a loss of FHR _____ is observed

increase variability

Accelerations - ____ changes in FHR above baseline

Abrupt

Accelerations - Defined as at least ____ beats above baseline for at least ____ seconds

15 15

Accelerations - Prolonged acceleration is >__ ____, but if it persists >__ _____ it is a change in baseline

2 minutes 10 minutes

Accelerations - ______ accelerations correspond with fetal movement, _____ the significance is unclear.

Antepartum intrapartum

Accelerations - Accelerations preclude the existence of fetal ___ ____

metabolic acidosis

Decelerations - Early

Occur simultaneously with uterine contractions Usually less than 20 bpm below baseline Onset and offset mirrors contraction Uniform in appearance Head compression

Decelerations - variable

Vary in depth, shape, duration Abrupt onset and offset Vagal activity Umbilical cord occlusion (partial or complete)

Decelerations - Late

Occur with each uterine contraction Uniform appearance Begin 10-30 seconds after contraction begins End 10-30 seconds after contraction ends Vary in depth according to the strength of contraction Placental issues Ominous when accompanied by lack of variability Severe if decrease more than 45 bpm

VEAL CHOP

variable = cord compression early = head compression acceleration = okay late = placental insufficiency

Abnormal FHR patterns - Saltatory pattern: _____ alterations in variability Acute fetal ____ Weak association to ___ Apgar scores

Excessive hypoxia low

Abnormal FHR patterns - _____ pattern: Fetal anemia Occasional maternal opioid consumption

Sinusoidal

Anesthesia Implications - Rule out _____ intervention as the cause If it is related to anesthetic – correct _____ If epidural level is higher than necessary, let it ____

anesthetic hypotension recede

Anesthesia Implications - If there are ___ _____ FHR tracing during preanesthetic assessment, consider whether anesthetic intervention could worsen fetal status. Discuss with OB

non reassuring

Anesthesia Implications - When an ____ ____ ____ is called, be prepared (already ready) to move quickly

emergent cesarean delivery

Anesthesia Implications - If a labor epidural is already in place determine if it can be adequately dosed and utilized for cesarean.... ask yourself what

Is it patchy? Will the patient/fetus tolerate additional local anesthetic to achieve an adequate level? How quickly can adequate level be achieved? What is the probability of block failure? Would a SAB behoove the situation? Would it make things worse?

KEY POINTS A _____ FHR accurately predicts fetal well being A _____ FHR is not specific in the prediction of fetal compromise (false positive) _____ prolonged bradycardia or late decelerations with absence of variability

normal abnormal Except