Chapman ch 9. FHR Assessment Flashcards Preview

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Flashcards in Chapman ch 9. FHR Assessment Deck (47)
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1
Q

Three requirements for fetal heart rate interpretation

A

Baseline. Interpretation of episodic and periodic changes of fetal heart rate. Interpretation of uterine activity.

2
Q

IUPC

A

Intrauterine pressure catheter.

3
Q

Causes of decreased fetal oxygen supply

A

Reduction of blood flow through maternal vessels/hypertension, PIH

Reduction of oxygen via maternal blood such as the mom holding the breath, baby lying on vena cava.

Alterations in fetal circulation such as baby on cord, decreased blood flow to the placenta, hemorrhage, deterioration of the placenta

Reduction in blood flow to the placenta

4
Q

Reassuring FHR Pattern

A

Baseline should be 120 - 160. Accelerations with fetal movement. Should have moderate variability.

5
Q

Normal uterine activity in labor

A

Contractions every 2 to 5 minutes, lasting less than 90 seconds, intensity less than 80, relaxation 20 or less, the average pressure is 50 to 85

6
Q

Fetal compromise

A

Associated with fetal hypoxemia. Can lead to fetal hypoxia.

7
Q

Hypoxemia

A

Deficiency of oxygen

8
Q

Hypoxia

A

In adequate oxygen

Causes a release of epinephrine and norepinephrine to increase fetal heart rate and blood pressure

9
Q

Nonreassuring fetal heart rate patterns

A

Progressive increase or decrease in the baseline

Tachycardia/above 160

Decrease in variability

Severe variable deceleration’s equals less than 60, and lasting longer than 30 to 60 seconds

Late decelerations/not good with repetition or uncorrectable

Absence of variability/no movement

Prolonged deceleration/greater than 60 to 90 seconds

Severe bradycardia/less than 70

10
Q

Intermittent auscultation

A

Done with an ultrasound fetoscope, stethoscope, it DeLee/Hills fetoscope

11
Q

Leopold’s maneuvers

A

Know how to spell

Assesses fetal position to get the best PMI/point of maximum impulse

12
Q

Procedure for auscultation

A

Leopold’s maneuver’s
Place listening device over PMI
Palpate abdomen between contractions
Count maternal pulse while listening to fetal heart rate
Count fetal heart rate for 30 to 60 seconds
Auscultate fetal heart rate during contraction and 30 seconds afterwards to see how baby is responding

13
Q

Internal fetal monitoring

A

Membranes must be ruptured
Cervix sufficiently dilated about 2 cm
Presenting Part low enough to place electrodes

14
Q

Fetal tachycardia

A

Baseline above 160 that lasts for at least 10 minutes
Moderate =161-180
Marked 180+
Early sign of fetal hypoxemia
If heart rate persists from 200 to 220 fetal death may occur

Causes on the fetal side could be infection, drugs, chronic hypoxemia, Stimulation, compensation for hypoxemia, cardiac abnormalities, anemia.
Causes from the maternal side could be a anemia, hyperthyroidism, dehydration, fever, ChorioAmnionitis (infection uterus), anxiety, medications, drugs

15
Q

Bradycardia

A

Baseline below 110 that lasts at least 10 minutes
Less than 100 is a later sign of hypoxia
Occurs before fetal death
May be tolerated if it remains about 80 with variability
Moderate 110-119
Marked 100-

A decreased fetal heart rate leads to decreased cardiac output causes a decrease in umbilical bloodflow leads to decreased oxygen to the fetus causing hypoxia

Bradycardia with variability maybe benign. Bradycardia with a loss of variability or late decelerations is associated with impending hypoxia

16
Q

Maternal supine hypotensive syndrome

A

Caused by uterine pressure on the vena cava, decreases bloodflow return to heart, reduces cardiac output and blood pressure, decreases fetal heart rate causing bradycardia.

Treat by turning the mom on the right side, and rise slowly.

17
Q

Variability of fetal heart rate

A

One of the most reliable indicators of fetal health and oxygenation, confirms no metabolic acidosis. Shows irregular fluctuations in the baseline, short-term is Beat to beat. long-term is rhythmic waves or cycles from the baseline.

18
Q

Four ranges of variability

A

Absent or undetected: the amplitude range is undetectable, looks like a flatline

Minimal: not more than five bpm
Moderate: 6-25 from peak to trough
Marked: greater than 25bpm

If absent, turn mom to right side, Adjust the straps, give ice chips, no longer than 30 minutes. Fetus could be asleep or premature.

19
Q

Nervous system on fetal heart rate

A

Sympathetic increases it, responsible for long term variability, can be stimulated during hypoxemia.
Parasympathetic decreases it
Head compression stimulates the Vagus nerve causes a decrease.

20
Q

Accelerations

A

An abrupt increase above baseline
It’s a good thing predictive of good O2.
15 bpm or greater, last 15 seconds or more
Returns to baseline within two minutes from start
Periodic or episodic
Periodic are caused by the sympathetic nervous system or usually a breech presentation
Episodic occur during fetal movement and indicate fetal well-being

Require no interventions.

21
Q

Decelerations

A

Periodic changes that last from a few seconds to no longer than two minutes.
Caused by the parasympathetic and they are either benign or nonreassuring
Described by relation to onset and the end of contraction and shape
Early, late, or variable
Recurrent occur with at least 50% of the contractions over a 20 minute.
Intermittent are with less than 50% of the contractions over 20 minutes

22
Q

Early decelerations

A

Gradual decrease and return to baseline during contraction. Caused by head compression. Normal and usually benign. Uniform shape that mirrors contraction. Usually during the first stage while 4 to 7 cm dilated and also during the second stage during pushing
NADIR is the lowest point of deceleration
No intervention is needed

23
Q

Late decelerations

A

Sign on fetal intolerance to labor. Cause by uteroplacental insufficiency such as a smoker or cocaine user. Also caused if the placental cord is compressed. Gradual decrease and return to baseline usually after a contraction. Nadir is after peak of contraction. Returns after the contraction is over.

24
Q

Indications of late decelerations

A

Presence of fetal hypoxemia/insufficient placental perfusion. Fetal hypoxemia progressing to hypoxia. Acidemia progressing to acidosis.

*** Ominous when uncorrectable, especially with variability and tachycardia. Turn the mom to the right, place 02 at 10 L, if no change probably go for a Csection

25
Q

Causes of late deceleration

A

Oxytocin, pregnancy induced hypertension, postterm pregnancy, amnionitis/infection, small for gestational age from smoking, maternal diabetes, placenta previa, abruptio placenta, Anesthesia producing maternal hypotension in which she would need to get an IV bolus, maternal cardiac disease or anemia

26
Q

Variable late deceleration

A

Visual abrupt decrease below baseline. Most common decelerations. More than 15 bpm. Lasts at least 15 seconds, but less than two minutes. Occurs any time during contraction. Usually caused by cord compression. U, V, W pattern. They have a sudden drop in a rapid return, sometimes returning over baseline (shoulder).

Change positions, oxygen, give IV fluids, amnioinfusion, decrease oxytocin

First stage of labor is a partial, brief compression of the cord.
Second stage of labor is cord compression during fetal descent

27
Q

Prolonged decelerations

A

Decrease in the heart rate below baseline at least 15 bpm and lasting more than two minutes, but less than 10

Not associated with hypoxemia

28
Q

Benign changes

A

Pelvic exam, spiral electrode, rapid fetal descent, sustained maternal Valsalva maneuver which is pushing.

29
Q

Less benign causes we may need to worry about

A

Progressive severe variable deceleration. Sudden cord prolapse. Hypotension caused by spinal or epidural. Paracervical anesthesia. Tetanic contractions which are long. Maternal hypoxia during a seizure or from preeclampsia
Notify Dr. immediately of prolonged decelerations

30
Q

Amnioinfusion

A

Put in with the IUPC. Saline or LR. Supplements the amount of amniotic fluid or dilutes meconium stained fluid. Reduces severity of variable Decels caused by cord compression. Reduces the risk for meconium aspiration syndrome.
Oligohydramnios -Low amniotic fluid

Risks include uterine over distention, increased uterine tone, uterine rupture. Not recommended for previous C-section mothers

31
Q

Sinusoidal pattern

A

A deceleration. Having a visually apparent smooth sine-like wave like undulating pattern in fetal heart rate baseline with a cycle frequency of 3 to 5 minutes that last longer than 20 minutes.

32
Q

Palpation of contractions

A

Measured at the fundus.

Mild 1+ easily dented
Moderate 2+ slightly indent
Strong 3+ no indent

33
Q

Frequency of fetal heart rate assessment

A

INTERMITTENT
With no risk factors. Latent phase every one hour. Active phase every 5 to 15 minutes second stage every 5 to 15 minutes. Continuous monitoring if there are risk factors present
ELECTRONIC
No risk factors latent phase every hour, active phase every 30 minutes, second stage every 15 minutes. If there are risk factors latent phase every 30 minutes, active phase every 15 minutes, second stage every five minutes.

34
Q

Transfer of oxygen and CO2 between fetal and maternal bloodstream depends on

A

Adequate uterine bloodflow. Sufficient placental area. Unconstructed umbilical cord

35
Q

Adequate oxygenation to the fetus depends on

A

Adequate oxygenation of the mother. Adequate blood flow to the placenta. Adequate uteroplacental circulation. Adequate umbilical circulation. Fetuses ability to regulate the fetal heart rate.

36
Q

Other factors that influence fetal oxygenation

A

Uteroplacental function. Uterine activity. Umbilical cord issues. Maternal physiological function.

37
Q

Category one

A

Tracings are normal, looks well oxygenated, with normal acid-base balance.
Baseline normal, variability moderate, late or variable deceleration are absent, early decelerations absent or present. Accelerations absent or present

38
Q

Category two

A

Indeterminate, not predictive, require evaluation and surveillance.
They can include bradycardia, tachycardia, minimal variability, absent variability, Marked variability, absence of induced accelerations after stimulation, prolonged decelerations, Recurrent decelerations, variable deceleration with a slow return to baseline.

39
Q

Category three

A

Abnormal. Indicate an abnormal acid-base balance, requires prompt evaluation

Absent variability with recurrently decelerations, recurrent variable deceleration’s, or bradycardia
Or
Sinusoidal pattern

40
Q

Interpretation of fetal heart rate baseline

A

Rate, variability, acceleration, tachycardia, bradycardia, short and long-term variability

41
Q

Interpretation of periodic and episodic changes

A

Decelerations either early, variable, late, or prolonged

42
Q

Interpretation of uterine activity

A

Frequency, duration, intensity, resting tone, relaxation time between contractions

43
Q

Ominous patterns

A

Absent variability with tachycardia bradycardia under 80, recurrent late decelerations, recurrent variable deceleration’s increasing in depth and duration.

Minimal variability with tachycardia with late deceleration, bradycardia with late decelerations, recurrent late decelerations, recurrent variable deceleration’s increasing in depth and duration

44
Q

Treatment for tachycardia

A

Give antibiotics or antipyretics. Ice packs with a fever, assess hydration, reduce anxiety, position change or oxygen, decrease or discontinue oxytocin.

45
Q

Reasons for bradycardia

A

Maternal: supine position, dehydration, hypotension, rupture of uterus, placental abruption, anesthetic, maternal cardiopulmonary compromise

Fetal: response to hypoxia, umbilical cord occlusion, hypoxemia, hypothermia, fetal head compression, bradyarrhythmias

Treatment: confirm monitor is placed right, assess fetal movement, assess response to scalp stimulation, check for prolapsed cord, Change positions, discontinue oxytocin, oxygen, stop pushing,

46
Q

Periodic and episodic changes

A

Periodic is in relation to contractions and persists over time. Includes accelerations and early, variable, late, and prolonged deceleration.

Episodic are accelerations and decelerations not associated with contractions.

47
Q

Contractions

A

Frequency is The start of one contraction to the start of the next contraction

Duration is from the beginning to the end of a contraction is measured in seconds

Intensity is the strength of the contraction

Resting tone is the pressure between contractions.

Normal is five or fewer contractions a 10 minute.

Tachysystole is more than five in a 10 minute. It needs to be treated because it can result in decreased uteroplacental blood flow. Characteristics include contractions lasting two minutes or longer, contractions occurring within one minute of each other, increasing resting tone, increasing pressure greater than 80.

Hyperstimulation and tetanic