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22 Cards in this Set

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Define abnormal fetal heart rate
changes in the fetal heart rate pattern detected by either IA or EFM that suggest that there may be a physiologic response to the normal stresses of labour
Define normal fetal heart rate
baseline 110-160
variablity 6-25 bpm
no late decels
occasional uncomplicated variables or early decels
spontaneous accelerations
Define Atypical fetal heart rate
baseline 100-110 bpm or tachycardia short term
<5 bpm variability for 40-80 mins
occasional late decels or single decel >2mins but <3
repetitive (>3) uncmplicated variable decels
no accels
Define Abnormal fetal heart rate
<100 bpm
tachycardia for long term
erratic baseline
minimal variability >80 mins
Associated Maternal Risk Factors (4)
dehydration
intrauterine infection
unterine rupture
epidural
Associated fetal risk factors(4)
congenital anomaly
significant anemia (isoimmunization)
fetal hemorrhage (vasa previa)
meconium
Risk factors associated with the umbilical cord (6)
oligohydramnios
cord prolapse
nuchal cord
true knot
short cord cord entanglement
Risk factors associated with the placenta
gestatinal hypertention
placental abruption
iugr
chorioamnionitis
Indications for EFM
meconium
maternal fever
VBAC
oxytocin
IUGR
gestational hypertension with proteinuria
Management of Abnormal Fetal Heart Rate
Inform family of concern
change position
maternal oxygen
VE to assess change
communicate
coach tomodify breathing
IV bolous
stop oxytocin
palpate contrations
call for help monitor vitals
draw blood
document
management if birth is imminent
facilitate birth
prep for nrp
clamp and cut cord leaving several inches in order to facilitate umbilical catheter
consider active management
define asphyxia
pathological changes caused by lack of oxygen in respired air, resulting in a deficiency of oxygen in the blood (hypoxia) and an increase in carbon dioxide in the blood and tissues (hypercapnia)
Rspiratory acidosis
Respiratory acidosis is a condition in which a build-up of carbon dioxide in the blood produces a shift in the body's pH balance and causes the body's system to become more acidic.

uncommon to have secondary postnatal complications
Metabolic acidosis
a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid

happens in 2% of deliveries
long term sequelae more likely
Hypoxia
reduction of oxygen supply to a tissue below physiological levels despite adequate perfusion of the tissue by blood
hypoxic acidemia
can occur anytime
includes various cerebral injuries mostly in the cerebral cortex at term
cerebral palsy
chronic motor disorder of cerebral origin
incidence of cerebral palsy
2-3/1000
cord ph <7 & base deficit >12
early onset of severe encephalopathy
CP of quadriplegia or dyskinetic type
exclusion of other causes
what do cord gases do
provide evidence of fetal oxygenation at birth
Early decelerations
a drop in FHR at the start of contraction and returns to baseline by the end
usually due to head compression
late decelerations
drop in fhr that starts midway through contration and returns to baseline after the contraction has ended.
this is caused by reduced utero/placental blood flow and fetal hypoxia
variable deceleration
non uniform in shape with sudden drops and accelerations anytime between/during contractions