OB-GYN: Electronic fetal monitoring and Fetal distress management

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Which type of electronic monitoring instrument for fetal heart monitoring?

-external contraction monitor. Measures frequency and duration. Does not measure strength

Tocodynamometer

Which type of electronic monitoring instrument for fetal heart monitoring?
- measures strength, frequency and duration

Intrauterine pressure catheter

Which type of electronic monitoring instrument for fetal heart monitoring?
- ultrasound through abdomen measures heart rate

Doppler

Which type of electronic monitoring instrument for fetal heart monitoring?
- Monitors R-R of QRS complex and extrapolates a heart rate

Fetal scalp electrode

Where should a fetal scalp electrode NOT be placed?

Don't put it in the fontanelle!!! Find a hard piece of scalp to put it in

1. Which nervous system develops first in the fetus?
2. Which develops second?

1. Sympathetic nervous system develops first. This gives a base rate of 150-160 bpm.
2. Parasympathetic system develops next which lowers the rate and gives variability. This is mediated through the vagus nerve.

What is normal baseline fetal heart rate?

110-160 beats per minute.

Define fetal tachycardia and fetal bradycardia

TACHYCARDIA > 160 beats per minute.
BRADYCARDIA < 110 beats per minute.

•MATERNAL FEVER
•INFECTION- maternal or fetal
•Hypoxemia
•Prematurity
•Dehydration
•Thyrotoxicosis
•Pharmacological Agents

These are all causes of what abnormality with fetal heart rate?

tachycardia

•HYPOXEMIA
•Pharmacological Agents
•Fetal Arrhythmia's (heart block)
•Maternal Hypotension
These are all causes of what abnormality with fetal heart rate?

bradycardia

Definition: The changes over time of the fetal heart rate.

variability

Is variability in the fetal heart rate good or bad?

•The more variability the better. Baby is well

the beat to beat changes in FHR. Normal is between 5 and 25 bpm.

which type of FHR variability?

short-term

Undulations of fetal HR around the baseline. 3-5 undulations per minute is normal. A good baby will have an increase over baseline of 15bpm lasting at least 15 seconds. (this ensures the absence of fetal acidosis).

which type of FHR variability?

Long Term

Long term variability of fetal heart rate

Undulations of fetal HR around the baseline. __-__ undulations per minute is normal. A good baby will have an increase over baseline of 15bpm lasting at least 15 seconds. (this ensures the absence of fetal ________).

Undulations of fetal HR around the baseline. 3-5 undulations per minute is normal. A good baby will have an increase over baseline of 15bpm lasting at least 15 seconds. (this ensures the absence of fetal acidosis).

Which periodic fetal heart rate change?
- FHR increase in response to uterine contractions

Accelerations

Which periodic fetal heart rate change?
-FHR decreases in response to uterine contractions. May be early, late, variable or mixed.

Decelerations

Which periodic fetal heart rate change?
•Has an onset, maximum fall and recovery that coincides with the onset, peak and end of the uterine contraction.
• Usually result from fetal head compression. (Vagal response).
•These are gradual (onset to nadir > Or = to 30 sec) decrease in with return to baseline. Coincides with the peak of the contraction. "Mirror Image".
•Are not associated with fetal distress.

Early decelerations

Which periodic fetal heart rate change?
•Onset, maximal decrease and recovery that is shifted to the right in relation to the contraction.
•Associated with Uteroplacental Insufficiency.
•Fetal hypoxia and acidosis are more pronounced with severe decelerations.
•Associated with low scalp pH values and high base deficits (indicating metabolic acidosis).
•Severity is graded by the magnitude of the decrease in FHR at the nadir.

Late decelerations

•"U" shaped

1. Early decelerations are usually a result of what?
2. Late deceleration are usually a result of what?
3. What type of deceleration is not associated with fetal distress?

1. Usually result from fetal head compression. (Vagal response)
2. Associated with Uteroplacental Insufficiency
3. Early decelerations

Early decelerations
1. Has an onset, maximum fall and recovery that coincides with the onset, peak and end of the uterine __________.
2. Usually result from fetal head __________. (Vagal response).
3. These are gradual (onset to nadir > Or = to 30 sec) decrease in with return to baseline. Coincides with the peak of the _________. "Mirror Image".
4. Are not associated with fetal ________.

1. Has an onset, maximum fall and recovery that coincides with the onset, peak and end of the uterine contraction.
2. Usually result from fetal head compression. (Vagal response).
3. These are gradual (onset to nadir > Or = to 30 sec) decrease in with return to baseline. Coincides with the peak of the contraction. "Mirror Image".
4. Are not associated with fetal distress.

Late decelerations
1.Onset, maximal decrease and recovery that is shifted to the _____ in relation to the contraction.
2. Associated with __________ Insufficiency.
3. Fetal hypoxia and _______ are more pronounced with severe decelerations.
4. Associated with low scalp pH values and high base deficits (indicating metabolic _______).
5. Severity is graded by the magnitude of the decrease in _____ at the nadir.

1.Onset, maximal decrease and recovery that is shifted to the right in relation to the contraction.
2. Associated with Uteroplacental Insufficiency.
3. Fetal hypoxia and acidosis are more pronounced with severe decelerations.
4. Associated with low scalp pH values and high base deficits (indicating metabolic acidosis).
5. Severity is graded by the magnitude of the decrease in FHR at the nadir.

Which periodic fetal heart rate change?
•Most frequently encountered abnormal FHR pattern.
•Caused by umbilical cord compression.
•Has a variable time of onset, variable form and may be nonrepetitive.
•If cord compression is prolonged, hypoxia can be present and show a combined respiratory and metabolic acidosis.
•Severity is graded by their duration.
•Visually Apparent, abrupt (onset to nadir <30 sec) decrease in FHR below the baseline. The decrease in FHR is > or = to 5bpm below the baseline and lasts > or = 15 sec but < 2 minutes.
•Prolonged Deceleration- > or = to 15bpm below baseline lasting > or = to 2min but < 10 min

Variable decelerations

•Quick down and quick up, looks like a "V"

What is the cause of variable decelerations in FHR?

umbilical cord compression

Variable decelerations
•Most frequently encountered abnormal FHR pattern.
•Caused by __________ compression.
•Has a variable time of onset, variable form and may be nonrepetitive.
•If _____ compression is prolonged, hypoxia can be present and show a combined respiratory and metabolic _______.
•Severity is graded by their ________.

•Most frequently encountered abnormal FHR pattern.
•Caused by umbilical cord compression.
•Has a variable time of onset, variable form and may be nonrepetitive.
•If cord compression is prolonged, hypoxia can be present and show a combined respiratory and metabolic acidosis.
•Severity is graded by their duration.

What is the intervention for variable decelerations?

•STOP PITOCIN!!!!!
•Change in maternal position left to right.
•100% O2.
•Amnioinfusion
•Delivery

Intervention for variable decelerations
•STOP _______!!!!!
•Change in maternal _______left to right.
•100% O2.
•Amnioinfusion
•Delivery

•STOP PITOCIN!!!!!
•Change in maternal position left to right.
•100% O2.
•Amnioinfusion
•Delivery

What is the intervention for late decelerations?

•STOP PITOCIN!!!!!!
•Change in maternal position left to right. Supine Hypotension (Poseiro Effect)
•100% O2.
•Scalp Stimulation: rub the baby's head and see if they have any accelerations in heart rate; if the heart rate doesn't elevate that could be a sign that the baby is becoming hypoxic
•Tocolytics
•Delivery- if fetus is in distress and vaginal delivery is remote, Cesarean Section is indicated.

Intervention for late decelerations
•STOP ______!!!!!!
•Change in maternal ______left to right. Supine Hypotension (Poseiro Effect)
•100% O2.
•Scalp ______
•Tocolytics
•Delivery- if fetus is in distress and vaginal delivery is remote, ___________ is indicated.

•STOP PITOCIN!!!!!!
•Change in maternal position left to right. Supine Hypotension (Poseiro Effect)
•100% O2.
•Scalp Stimulation: rub the baby's head and see if they have any accelerations in heart rate; if the heart rate doesn't elevate that could be a sign that the baby is becoming hypoxic
•Tocolytics
•Delivery- if fetus is in distress and vaginal delivery is remote, Cesarean Section is indicated.

Definition: The passage of fetal stool into the amniotic fluid

meconium

If pH is less than ____ the fetus is distressed.

7.25

CONCLUSIONS
•Cerebral dysfunction does not seem to occur unless the 5 minute Apgar score is less than ___, umbilical artery blood pH is less than ___ and __________is necessary at birth.

•Cerebral dysfunction does not seem to occur unless the 5 minute Apgar score is less than 3, umbilical artery blood pH is less than 7 and resuscitation is necessary at birth.

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