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OB chapter 15
Terms in this set (28)
What are the normal Uterine Activity During Labor? (6)
Montevideo units (MVUs)
Contraction frequency overall generally ranges from how many for 10 minutes of labor?
How are the frequencies seen in first stage of labor? Second stage?
How long is contraction duration throughout first and second stages?
Uterine contractions generally range from peaking at ______ mm Hg in first stage of labor to over ______ mm Hg in second stage.
Contractions palpated as "mild" would likely peak at less than _____ mm Hg if measured internally, whereas contractions palpated as "moderate" or "strong" would likely peak at _____ mm Hg or greater if measured internally.
Average resting tone during labor is ____ mm Hg; if using palpation, should palpate as "_______" (i.e., easily indented, no palpable resistance).
is commonly ______ seconds or more in first stage and _____ seconds or more in second stage.
Montevideo units (MVUs)=
MVUs usually range from ______-______ in first stage; may rise to
______-______ in second stage.
Contraction intensities of ______ mm Hg or more and MVUs of
______-______ are generally sufficient to initiate spontaneous labor.
MVUs are used only with _________` monitoring of contractions.
higher (up to 5 in 10 mins)
-stable ranging from 45-80 seconds, not generally exceeding 90 seconds.
Although the 2008 National Institute of Child Health and Human Development workshop and ACOG both recommend use of the terms normal and abnormal to describe FHR tracings, the terms reassuring and nonreassuring are still frequently used clinically.
Abnormal FHR patterns are those associated with what? If uncorrected, what can happen?
severe fetal hypoxia (inadequate supply of oxygen at the cellular level that can cause metabolic acidosis, which can turn to acidemia.)
______________ involves listening to fetal heart sounds at periodic intervals to assess the FHR.
fetoscope is applied to the listener's ___________ because bone conduction amplifies the fetal heart sounds for counting.
Auscultate when? to identify FHR during the contraction or as a response to the contraction and to assess for absence or presence of increases or decreases in FHR.
-FHR before, during, and after contraction
AWHONN recommends the following IA frequencies for low-risk women who are not receiving oxytocin:
-latent phase (_____ cm) at least _______
-latent phase (_____-_____ cm) every _____-_____ minutes
-active phase (______ cm) every _____-_____ minutes
-second stage, passive fetal descent every _____ minutes
-second stage, active pushing every _____-_____ minutes
-less than 4, hourly
-4-5, 15-30 mins
-greater than or equal to 6, 15-30
auscultation of the FHR in accordance with the frequency guidelines suggested earlier may be difficult in today's busy labor and birth units. When used as the primary method of fetal assessment, auscultation requires a one-to-one nurse-to-patient staffing ratio. If acuity and census change so auscultation standards are no longer met, the nurse must inform the physician or nurse-midwife that continuous EFM will be used until staffing can be arranged to meet the standards.
When using IA, UA is assessed by palpation. The examiner should keep his or her fingertips placed over the fundus when?
The contraction intensity is usually described as what?
The contraction duration is measured in seconds, from when to when?
The frequency of contractions is measured in minutes, from when to when?
The examiner should keep his or her hand on the fundus after the contraction is over to evaluate what? between contractions.
Resting tone between contractions is usually described as what?
Accurate and complete documentation of fetal status and UA is especially important when IA and palpation are being used because no paper tracing record or computer storage of these assessments is provided as is the case with continuous EFM (external fetal monitoring)
-before, during, and after contractions
-mild, moderate, or strong
-beginning to the end of the contraction
-from the beginning of one contraction to the beginning of the next
-uterine resting tone or relaxation
-soft or hard
External Monitoring: whats its purpose?
-The ___________ works by reflecting high-frequency sound waves off a moving interface, in this case the fetal heart and valves.
-Once the area of maximal intensity of the FHR has been located, conductive gel is applied to the surface of the ultrasound transducer, and the transducer is then positioned over this area and held securely in place using an elastic belt.
-The tocotransducer (tocodynamometer) measures UA transabdominally.
-The device is placed where? and held with what?
-It can measure and record what? but NOT what?
-This method is especially valuable for measuring UA during?
-If the woman is obese, the tocotransducer may be unable to detect the exact frequency and duration of UA.
The external transducers are applied easily by the nurse but often must be readjusted as the woman or fetus changes position. The woman is asked to assume the semi-Fowler's or lateral position. Use of external transducers confines the woman to bed or chair.
-assess the adequacy of fetal oxygenation during labor.
-over the fundus above the umbilicus and held securely in place with an elastic belt
-frequency and approximate duration, intensity
-first stage of labor in women with intact membranes or for antepartum testing
-The technique of continuous internal FHR or UA monitoring provides a more accurate appraisal of fetal well-being during labor than external monitoring because it is not interrupted by fetal or maternal movement or affected by maternal size
-For this type of monitoring, how must things be with woman?
-Internal monitoring of the FHR is accomplished by attaching a small spiral electrode to what?
The FHR and UA are displayed on the monitor paper or computer screen. What is on the upper? Whats lower? with the FHR in the upper section and UA in the lower section.
-cervix sufficiently dilated (at least 2 to 3 cm)
-the presenting part low enough to allow placement of the spiral electrode or IUPC or both.
-the presenting part.
Baseline Fetal Heart Rate:
The intrinsic rhythmicity of the fetal heart, the central nervous system (CNS), and the fetal autonomic nervous system control the FHR.
An increase in __________ response results in acceleration of the FHR, whereas an increase in ________ response produces a slowing of the FHR.
Usually a balanced increase of sympathetic and parasympathetic response occurs during contractions, with no observable change in the baseline FHR.
Variability of the FHR can be described as what?
It is a characteristic of the baseline FHR and does NOT include what?
Variability is quantified in beats per minute and is measured from the peak to the trough of a single cycle.
Four possible categories of variability have been identified as?
- irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater
-accelerations or decelerations
-absent, minimal, moderate, and marked
-Absent variability = ?
-Minimal variability has an amplitude range that is detectable to the unaided eye, but is less than ____ beats/min
These 2 variabilities can result from what?
Other possible causes of absent or minimal variability include?
-fetal hypoxemia and metabolic acidemia
-fetal sleep cycles, fetal tachycardia, extreme prematurity, medications that cause central nervous system depression, congenital anomalies, and preexisting neurologic injury
Moderate variability is considered?
Its presence reliably predicts a normal fetal __________ (absence of fetal metabolic acidemia).
Moderate variability indicates that FHR regulation is not affected significantly by fetal sleep cycles, tachycardia, prematurity, congenital anomalies, preexisting neurologic injury, or CNS depressant medications
tachycardia= FHR =?
nursing interventions= Dependent on cause; reduce maternal fever with antipyretics as ordered and cooling measures; oxygen at 10 L/min by nonrebreather face mask may be of some value; carry out health care provider's orders based on alleviating cause.
bradycardia= HR <110 beats/min lasting >10 minutes
greater than 160 beats/min lasting longer than 10 mins
Changes in FHR from the baseline are categorized as periodic or episodic.
___________ changes are those that occur with contractions.
___________ changes are those that are not associated with contractions. These changes include both accelerations and decelerations
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