Week 9 pt 1

Question 1

Give a bunch of examples of fetal surveillance

Answer 1

Fundal height measurement
Kick counts
Fetal heart rate auscultation (doppler/stethoscope)
Electronic Fetal Monitoring
Non-stress Test
Biophysical Profile
Oxytocin Challenge Test (Contraction Stress Test)
Fetal Scalp Sampling (not used as often)
Amniocentesis

Question 2

What does fundal height measurement assess? When?

Answer 2

1) Assesses (grossly) the growth of the fetus
2) Fundal height = gestation age between 16-36 weeks gestation

Question 3

Larger than expected [fundal height] is worrisome for what?

Answer 3

Molar pregnancy
Large for gestational age baby/gestational diabetes
Polyhydramnios
Multiples

Question 4

Smaller than expected [fundal height] is worrisome for what?

Answer 4

Small for gestational age baby or IUGR
Fetal Death
Oligohydramnios

Question 5

What is the primary fetal response to stress?

Answer 5

Decreased fetal growth rate

Question 6

Around how many weeks should fundal height be at its peak?

Answer 6

~36wks

Question 7

What are 2 different methods of external fetal monitoring?

Answer 7

Continuous vs intermittent

Question 8

Give examples of continuous vs intermittent external fetal monitoring

Answer 8

1) Transducer fastened to abdomen during labor (external fetal monitor)
2) Doppler ultrasound device
3) Fetoscope

Question 9

Fetal Heart Rate Auscultation: When is FHR heart?

Answer 9

After 5-6 wks gestation

Question 10

Fetal Heart Rate Auscultation: What are some questions to ask?

Answer 10

Is the heart rate within normal range? (110-160)
Do you hear any abnormalities?

Question 11

Describe External Fetal Heart Rate (FHR) Monitors

Answer 11

1) The most common means of assessing the health and viability of the fetus throughout labor
2) Tracks the variability in the fetal heart rate
3) Used to perform Non-Stress and Contraction Stress testing

Question 12

Intrapartum Fetal Surveillance is important bc it’s an indirect measurement of indicators of fetal status (oxygenation) during labor; give examples of these indicators

Answer 12

1) FHR
2) Blood gases
3) Pulse rate
4) Amniotic fluid volume
5) Fetal stimulation responses

Question 13

What is the Fetal heart rate lead? Is it accurate?

Answer 13

Scalp electrode; more accurately assesses FHR

Question 14

Intrapartum Fetal Surveillance: Why may intermittent be appropriate for low-risk labors?

Answer 14

Enables maternal movement and ambulation.
Requires more nursing time/intervention.
Requires skill to determine FHR associated with contractions
Can lower rates of operative and cesarean deliveries

Question 15

What are the advantages and disadvantages to Continuous Intrapartum Fetal Surveillance?

Answer 15

1) Gives constant feedback about fetal status
2) Restrictive, limits maternal movement, discourages maternal ambulation

Question 16

Contraindications to Intermittent Fetal Monitoring: List some maternal medical illness contraindications

Answer 16

Gestational diabetes
Hypertension
Asthma
HIV, TB, syphilis, acute hepatitis

Question 17

Contraindications to Intermittent Fetal Monitoring: List some maternal obstetric contraindications

Answer 17

Multiple gestation
Post-date gestation
Previous cesarean section
Intrauterine growth restriction
Premature rupture of the membrane
Congenital malformation
Third-trimester bleeding
Oxytocin induction/augmentation of labor
Preeclampsia

Question 18

What are some other contraindications to intermittent fetal monitoring?

Answer 18

No prenatal care
Tobacco use and/or drug abuse

Question 19

Intermittent Fetal Monitoring:
1) What are the 2 ways to do it?
2) When is it done?

Answer 19

1) doppler or the fetal heart monitor
2) During labor, listen from the beginning of one contraction to the beginning of the next contraction
Assess fetal well-being

Question 20

Do NOT Interpret FHR in Isolation; what are some important factors

Answer 20

1) TIMING IS IMPORTANT
2) Pelvis & Baby size & OB history + any OB Complications
3) Clinical factors:
Gestational age
4) Maternal Medical Complications
Previous Fetal Status
Fetal Complications (IUGR, Oligohydramnios, Anomalies, etc)
Medications (Narcotics, B sympathomimetics, Ephedrine, B blockers)
5) Misc. factors: Fever, Meconium, Magnesium Sulfate, etc.

Question 21

Non-Stress Test (NST):
1) Define this
2) What does it not require?
3) What does it measure? Why?

Answer 21

1) Evaluation of the fetal heart rate tracing while the fetus is not placed under any stress
2) Does not require an IV, oxytocin, or contractions
3) Measures the fetal heart rate, patterns, and accelerations for at least 20min to see how the baby is tolerating the pregnancy

Question 22

Non-Stress Test (NST): Explain how to interpret this test

Answer 22

1) Reactive = reassuring
Accelerations of FHR with fetal movement
>2 accelerations of >15bpm lasting >15seconds in 20min = healthy
2) Non-reactive = non-reassuring
Fetal heart rate does not accelerate with movement
3) Equivocal = concerning
Baby not moving OR accelerations of heart rate that do not meet criteria for reactivity

Question 23

Biophysical Profile (BPP): What does it measure?

Answer 23

Fetal heart rate variability (from NST)
Fetal tone
Fetal movement
Fetal breathing movements
Amniotic fluid volume (AFV)

Question 24

Monitoring during Labor: Electronic Fetal Monitoring
FHR is described in terms of what?

Answer 24

Contraction pattern
Baseline rate
Variability
Presence of accelerations
Periodic or episodic deceleration
Changes in these characteristics over time

Question 25

Baseline FHR: 1) What is normal? 2) What is tachy? 3) What is brady?

Answer 25

1) Normal FHR baseline: 110–160 bpm 2) Tachycardia FHR baseline: > 160 beats per minute 3) Bradycardia: FHR baseline: < 110 beats per minute

Question 26

Baseline FHR: 1) What is it? 2) When is it best done?

Answer 26

1) Heart rate observed for >2 and <10 minutes 2) During a “quiet” time so not confused by accelerations or decelerations

Question 27

Variability in FHR: 1) Define absent variability 2) Define minimal variability 3) Define moderate variability 4) Define marked variability

Answer 27

1) Amplitude range undetectable (0) 2) Amplitude range detectable but <5 bpm 3) Amplitude range 6–25 bpm $) Amplitude range > 25 bpm

Question 28

Accelerations: 1) Define prolonged acceleration 2) Define baseline change

Answer 28

1) > 2 minutes but < 10 minutes in duration 2) If an acceleration lasts > 10 minutes

Question 29

Explain Variable Decelerations of FHR

Answer 29

1) Reflects a fetal autonomic reflex response to compression of umbilical cord 2) Onset, depth, and duration often vary with successive uterine contractions

Question 30

Late Decelerations: 1) Define these 2) These mean hypoxia is happening; what are 3 causes?

Answer 30

1) Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction 2) -Placental abruption -Maternal seizure -Pneumonia/PE/severe asthma

Question 31

Define prolonged deceleration and differentiate from baseline change

Answer 31

1) Decrease from baseline is ≥15 beats/min, lasting ≥2 minutes but <10 minutes from onset to return to baseline. 2) If a >15 BPM “deceleration” lasts ≥ 10 minutes, it is a BASELINE change.

Question 32

List and give examples of the 4 main causes of prolonged deceleration

Answer 32

1) Cord compression: no fluid; cord prolapse 2) Uteroplacental insufficiency: anesthesia, hypotension, tachysystole, abruptio, uterine rupture 3) Maternal hypoxia: asthma, seizures 4) Fetal: hemorrhage, rapid descent, FSE

Question 33

FHR tracing patterns reflect what?

Answer 33

Current fetal acid-base status: -Category 1 (normal) -Category 2 (concerning) -Category 3 (abnormal)

Question 34

Category I FHR tracings include what? Describe each

Answer 34

1) Baseline rate: 110–160 bpm 2) Baseline FHR variability: Moderate 3) Late, Variable, or Prolonged Decelerations: Absent 4) Early decelerations: May or may not be present 5) Accelerations: May or may not be present

Question 35

Category 2 Tracings (concerning): 1) Describe rate 2) Describe Accelerations

Answer 35

1) Fetal bradycardia without loss of variability Tachycardia 2) Unable to elicit an acceleration

Question 36

Category 2 Tracings (concerning): Describe Baseline FHR variability

Answer 36

Minimal baseline variability Absent baseline variability with no recurrent decelerations Marked baseline variability

Question 37

Category 2 Tracings (concerning): Describe Periodic or episodic decelerations

Answer 37

Recurrent variable decelerations accompanied by minimal or moderate baseline variability Prolonged deceleration > 2 min but < 10 minutes Recurrent late decelerations with moderate baseline variability