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What does fetal monitoring tell us?
- Fetal oxygenation
- Acid-base status of the fetus
- Ability of the CNS to regulate FHR
Why monitor --> prevention of hypoxi/asphyxia
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What are the consequences of Inutero Hypoxia/Asphyxia?
- Cerebral Palsy
- Mental Retardation
- Epilepsy
- RDS
- Renal Damage --> lack of perfusion to kidney
- NEC (Necrotizing Enterocolitis)
- Chronic Brain Impairment
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Describe the device placement for External monitoring
Top device --> Toco tranducer (senses uterine activity NO GEL
Bottom device --> Ultrasound (senses fetal heart beat) GEL
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What are the 2 devices used for monitoring fetal heart rate?
External: Ultrasound
Internal: Fetal scalp electrode (FSE)
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What are the 2 devices used to monitor contractions?
External: Toco
- Internal: Interuterine pressure catheter (IUPC)
- only one that can measure intensity!
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What are two things that must happen before an IUPC can be placed?
BOW must be ruptured
Cervix must be dilated to 3 cm
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What is the only way to measure the intensity contractions objectively?
IUPC
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How can a nurse measure the strength of a contraction subjectively?
Palpate the fundus
- Tip of nose --> mild
- Chin --> Moderate
- Forehear --> strong
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On a FHR strip...
what is the top tracing?
What is the bottom tracing?
Top --> FHR
Bottom --> contractions
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How do you count contractions?
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What happens to uterine perfusion during contractions?
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What can happen if a mother is given too much petocin during labor?
Tetany --> uterus is almost vibrating from contractions!!
Decrease perfusion to the baby
RUPTURE!!
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What are the 3 important components of the fetal heart rate strip
Baseline heart rate
Variability
Periodic changes
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Why is tachycardia better than bradycardia in a fetus?
Tachycardia means there is still some fight left in him, bradycardia means he is giving up
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What is a normal heart rate for a fetus?
What constitutes bradycardia?
What constitutes tachycardia?
110-160 for 10 min
Brady = <110 for > 10 min
Tachy = >160 for > 10 min
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What are accelerations?
Transient increases above the FHR baseline
- Fetal movement
- Contractions
Always positive/reassuring!!!
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What are early decels?
- Gradual onset before peak of contraction
- Return to baseline before end of contraction
- Uniform in shape, similar to one another
Mirror!!
Head compression --> inc ICP, vagal nerve resp
May indicate CPD (head get stuck!)
Not associated with hypoxia or acidosis
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What are variable decels?
- U, V, or W in shape; varied shape
- Variable in duratio, timing, depth, not uniform
Cord Compression
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What are the interventions for Variable Decels?
- Position change
- Vag exam to rule out prolapsed cord
- Stop oxytocin
- Anticipate amnioinfusion
- Notify MD
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Describe how you would set up an amnioinfusion?
- Get 1000 cc NS from the warmer
- Use IUPC to administer
- Start with 500mL bolus
- ROA --> 125 cc/hr
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What is an amnioinfusion used for?
Replacing diminished amniotic fluid levels (helps prevent cord compression)
Helps to dilute/flush meconium-stained amniotic fluid
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What are Late decels?
- Decent of FHR begins after contraction
- Delayed onset. Also delayed return to baseline. Late recovery
Utero-placental insufficiency
Ominous
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What are the interventions for late decels?
- Lateral Positioning (Left side)
- Stop oxytocin
- oxygen
- IV fluid bolus --> volume for baby
- notify MD
- anticipate rapid delivery
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What is a placental abruption?
Placenta rips from uterine wall
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What is the #1 cause of tachycardia in a fetus?
Infection!!
Fight or flight response
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What is variability?
- Squiggliness of the FHR tracing
- Baseline variability is a measure of the interplay (push-pull effect) between the sympathetic and the parasympathetic nervous systems)
Lack of Variability is ominous
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Variability is _______________
the best indicator of fetal well-being!!!
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What type of periodic change would you expect to see:
True knot in the cord
Variable decels
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What are the 3 categories of Intrapartum fetal heart rate patterns?
- Category 1: Normal
- Category 2: Indeterminate
- Category 3: Abnormal
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Describe Category 1 (Normal) FHR pattern
- Tracing shows ALL of the following:
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- Baseline FHR 110-160 BPM, moderate FHR variability, accelerations may be present or
- absent, no late or variable decelerations, may have early decelerations
Strongly predictive of normal acid-base status at the time of observation. Routine care
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Describe Category 2 (Indeterminate) FHR pattern
- The fetal heart rate tracing shows ANY of the following:
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- Tachycardia, bradycardia without absent variability, minimal variability, absent variability
- without recurrent decelerations, marked variability, absence of accelerations after stimulation, recurrent variable decelerations with minimal or moderate variability, prolonged deceleration > 2minute but less than 10 minutes, recurrent late decelerations with moderate variability, variable decelerations with other characteristics such as slow return to baseline
- Not predictive of abnormal fetal acid-base status, but requires continued surveillance
- and re-evaluation
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Describe Category 3 (Abnormal) FHR tracing
The fetal heart rate tracing shows EITHER of the following:
Sinusoidal pattern OR absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia
Predictive of abnormal fetal-acid base status at the time of observation. Depending on the clinical situation, efforts to expeditiously resolve the underlying cause of the abnormal fetal heart rate pattern should be made
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Describe a Sinusoidal Fetal Heart Pattern
A sinusoidal fetal FHR pattern is defined as a pattern of fixed, uniform fluxuations of the FHR that creates a pattern resembling successive geometric sine waves. Characterized by the absence of variability. Associated with increased perinatal morbidity and mortality and poor perinatal outcome.
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Decelerations
A review!!!
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V C
E H
A O
L P
- V variable C cord
- E early H head
- A acceleration O ok
- L late P placental insufficiency
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