Terms in this set (22)
Fetal Monitoring Categories
EFM Category 1
(This would be a "Reactive" non stress test)
EFM Category 2
Will have patterns of reassuring AND nonreassuring characteristics
(Example: Tachycardia and bradycardia, absent variability but no decelerations, etc)
What is the best indicator of FHR?
Variability; means baby is moving and well-oxygenated
Types of variability
Minimal- undetectable to change in FHR that is less than 5 bpm
Moderate- 6 to 25 bmp
Marked- more than 25 bpm
Causes of Absent or decreased variability?
- Fetus sleeping
- Fetal hypoxia
- CNS depressants
- Local anesthetic agents
Interventions for decreased/absent variability?
- Cold juice or water for mom
- Vibroacoustic stimulation
- Fetal scalp stimulation (physician will gently stroke fetal head through cervix)
Rules for a true acceleration
Must last 15 seconds
And FHR must go up by 15 beats or more
What do accelerations indicate?
Fetal heart rate increases with fetal movement
Variable decelerations indicate?
Which can be caused by:
- Oligohydramnios (amount of amniotic fluid inadequate to cushion the cord)
- Ruptured membranes
- Nuchal cord (wrapped around fetal neck)
- Fetal parts occluding cord (Reposition mother)
- Prolapsed cord (OB emergency! will need C section)
Variable decelerations are shaped like a "V", "W" or"U" because the cord will be kinked, then unkinked with the contraction. Will fall and rise abruptly with the onset and relief of cord compression.
Will have "shoulders"- spikes in baseline before and after deceleration as fetus tries to compensate.
Early decelerations indicate?
Happen with contractions
No interventions needed; FHR returns to baseline after the end of contraction
Fetal head compression briefly increases intracranial pressure, causing vagus nerve to slow the heart rate. Occurs during contractions as the fetal head is pressed against pelvis/cervix.
Late decelerations indicate?
- Placental insufficiency (Decreased blood supply from placenta)
- Happen after contractions
Causes of placental insufficiency:
Maternal hypo or hypertension
Excess uterine activity
Placental interruption: abruptio placenta or placenta previa
Maternal diabetes, anemia, cardiac disease
FHR drops for 2 minutes
Will need to POISN
Occur WITH contractions
(Contractions are also periodic)
Interventions for Prolonged decelerations or nonreassuring FHR, or drop from baseline
Oxygen (Face mask, 8-10 L/min to increase oxygen saturation to fetus)
Occurs without a contraction
"Had an episode of decelerations"
Why are IV fluids needed if there is a nonreassuring FHR?
Will increase mother's blood volume and improve placental perfusion
How will you reposition the mother if there is a nonreassuring FHR? Why?
- Avoid supine position (causes hypotension)
- Left side is best
- Will reposition because cord may be compressed
When would we use internal monitoring devices? (Fetal scalp electrode and IUPC)
1. Decreased variability (an FSE would give a clearer picture of variability)
2. Obese mother
External devices preferred because less invasive, but would have to use them in these circumstances.
What are montevideo units?
Used to describe contraction intensity when an IUPC is used, measures in mmHg
In nonreassuring readings, what do we use for clarification of data?
Clarification of data: Clarifying the fetal condition to determine the best course of action.
- Vibrouacoustic stimulation
- Fetal scalp stimulation
- Fetal scalp blood sample (to evaluate the pH, which should be 7.25 to 7.35)
- Cord blood gases and pH: used to assess fetal oxygenation and acid-base balance immediately after birth
- Fetal O2 sat monitor