10.7 Fetal Monitoring

Front 1

top line of fetal cardiotocography strip

Back 1

babies heart rate

Front 2

bottom line of fetal cardiotocography strip

Back 2

uterine activity

Front 3

what is the main reason for using EFM

Back 3

to determine if the fetus is well oxygenated

Front 4

what results for the changes on EFM

Back 4

The fetal brain regulates heart rate through the parasympathetic and sympathetic nervous system. Hypoxia changes the activity of the nervous system which affects heart rate and results in changes on EFM.

Front 5

what is the FHR described by

Back 5

baseline heart rate

variability

presence or absence of accelerations or decelerations

frequency of contractions

Front 6

how do you determine the baseline heart rate

Back 6

round it to the nearest 5 bpm during a 10 min segment

Need at least 2 min of mean FHR in 10 mins to determine the baseline

Front 7

normal baseline heart rate

Back 7

110-160 bpm

Front 8

fetal bradycardia

Back 8

anything < 110 bpm for 10 mins or more

Front 9

fetal tachycardia

Back 9

anything > 160 bpm for 10 mins or more

Front 10

causes of fetal tachy

Back 10

maternal HTN

umbilical cord prolapse

rapid fetal descent

uterine tachysystole

placental abruption

Front 11

causes of fetal bradycardia

Back 11

infection

medications

fetal anemia

placental abruption

Front 12

minimal variability

Back 12

amplitude range changes less than 5 bpm

Front 13

moderate variability

Back 13

amplitude range changes 6-25 bpm

Front 14

marked variability

Back 14

amplitude range greater than 25 bpm

Front 15

what is variability sensitive to

Back 15

fetal biochemical status

Front 16

what does moderate variability suggest

Back 16

adequate oxygenation

Front 17

what is a sinusoidal pattern associated with

Back 17

severe fetal anemia

Front 18

what is a fetal acceleration

Back 18

an abrupt increase in FHR with a peak of greater than 15 beats above the baseline

Front 19

how long do accelerations have to last

Back 19

at least 15 seconds for up to 2 mins

if the duration is greater than 2 mins it's a prolonged accel

if duration is greater than 10 mins it's a change in baseline

Front 20

what are accelerations associated with

Back 20

fetal movement

mature and intact neurocardiac tract

non acidemic fetus

well being of the fetus

Front 21

what is a deceleration

Back 21

a dec. in FHR from the baseline

Front 22

recurrent deceleration

Back 22

occurs with greater than 50% of contractions

Front 23

intermittent deceleration

Back 23

occurs with less than 50% of contractions

Front 24

what are early decelerations associated with and when do they occur as compared to a contraction

Back 24

head compression that stimulates the vagal nerve

these mirror contractions (start at onset of contraction, returns to baseline at end of contraction)

Front 25

what are variable decelerations associated with

Back 25

cord compression

Front 26

what are late decelerations associated with

Back 26

uteroplacental insufficiency from dec. uterine perfusion or dec placental function

Front 27

early contractions onset of nadir

Back 27

onset to nadir is greater than 30 sec.

Front 28

timing of variable decelerations

Back 28

-Decrease in FHR is greater than or equal to 15 beats per minute with total duration greater than or equal to15 sec

Front 29

what is the goal for a variable decompression

Back 29

alleviate cord compression

Front 30

late deceleration timing

Back 30

Begins at or after peak of contraction and returns to baseline after contraction is over

Front 31

interventions for variable deceleration

Back 31

maternal repositioning

amnioinfusion

check pt. for prolapsed cord, elevate presenting fetal part and prep for c section

Front 32

interventions for late decelerations

Back 32

maternal reposition

maternal oxygen administration

IV fluid bolus

reduce contraction freq (stop oxytocin, administer tocolytic)

Front 33

goal in treating a late deceleration

Back 33

improve uteroplacental blood flow

Front 34

ABCD approach

Back 34

Assess oxygen pathway

Begin conservative corrective measures

Clear obstacles to rapid delivery

Determine decision-to-delivery time

Front 35

category 1 FHR tracings

Back 35

baseline rate= 110-160 bpm

baseline FHR variability is moderate

late/moderate decelerations are absent

early decelerations are present or absent

accelerations are present or absent

Front 36

category 3 FHR tracings

Back 36

absent baseline FHR variability along with any of the following:

recurrent late decelerations

recurrent variable decelerations

bradycardia

sinusoidal pattern

Front 37

what are category 3 FHR tracings associated with

Back 37

abnormal acid base status

Front 38

management of cat. 1 tracing

Back 38

no interventions needed

Front 39

management of category 2 tracing

Back 39

req. evaluation, continued monitoring, possible intrauterine resuscitation

Front 40

what reassures you that a fetus is not acidemic

Back 40

presence of moderate availability and accelerations

Front 41

management of category 3 FHR tracing

Back 41

requires intrauterine resuscitation

if unresolved deliver the pt.

Front 42

how are contractions quantified

Back 42

as number of contractions present in 10 min window averaged over 30 min

Front 43

normal contraction timing

Back 43

less than or equal to 5 contractions in 10 minaveraged over a 30 min window

Front 44

tachysystole contractions

Back 44

greater than 5 contractions in 10min averaged over a 30 min window

Front 45

what is the only way to measure the strength of a contraction

Back 45

IUPC

Front 46

onset of nadir in variable decelerations

Back 46

-Abrupt decrease in FHR where onset to nadir is less than 30 sec