Birth Process: Fetal Heart Monitoring

Front 1

What is the purpose of fetal heart monitoring?

Back 1

- Continually assessing the FHR and obtaining info on contractions to identify and abnormalities that could impact fetal wellbeing

Front 2

What are the two types of fetal heart monitoring?

Back 2

- External
- Internal

Front 3

What are the two components of the external fetal monitor? and what do they monitor?

Back 3

- ultrasonic transducer (FHR)
- Toco (uterine ctx)

Front 4

Is intensity or resting tone of ctx measured using an external fetal monitor?

Back 4

No

Front 5

Where is the toco placed?

Back 5

Placed over the fundus above the umbilicus

Front 6

What are the two components of the internal fetal monitor? and what do they monitor?

Back 6

- Fetal scalp electrode (FHR)
- Intrauterine Pressure Catheter (ctx)

Front 7

What is the most accurate way of recording FHR?

Back 7

Using a fetal scalp electrode

Front 8

True or False
When using a IUPC, intensity, duration, frequency, and resting tone are assessed.

Back 8

True

Front 9

Cervix must be dilated 2 cm, membranes must be ruptured, and presenting part needs to be engaged to use which device?

Back 9

IUPC

Front 10

A person must have ____ min between each contraction.

Back 10

1

Front 11

Define baseline fetal heart rate

Back 11

- Mean fetal heart rate rounded to increments of 5 bpm during a 10 min span
- Must be 2 mins of identifiable baseline segments

Front 12

True or False
The baseline excludes accelerations, decelerations, marked variability or any segments differing by greater than 25 bpm.

Back 12

True

Front 13

For a term fetus, what are the upper and lower limits for baseline?

Back 13

Upper- 150-160 bpm
Lower- 110-120 bpm

Front 14

Does the baseline fluctuate when fetus moves or sleeps? If so by how much?

Back 14

Yes, by 5-15 bpm

Front 15

For an actual change in baseline how long must the change happen for?

Back 15

10 minutes

Front 16

Tachycardia is defined as?

Back 16

greater than 160 bpm

Front 17

What are the causes for baseline tachycardia?

Back 17

- Hypoxia
- Meds
- Maternal Infections

Front 18

What is one thing to check on the mom if there was fetal tachycardia?

Back 18

Check mom's temp

Front 19

Bradycardia is defined as?

Back 19

less than 110 bpm

Front 20

What are the causes for baseline bradycardia?

Back 20

- Fetal hypoxia
- CNS depressants
- Regional anesthesia
- Maternal hypotension
- Cord compression

Front 21

What are variabilities?

Back 21

Fluctuations in the baseline that are irregular in amplitude and frequency

Front 22

What are variabilities indicative of?

Back 22

Mature fetal neurological system that is capable of controlling FHR during a ctx

Front 23

What are the 4 types of variability?

Back 23

- Absent or undetected
- Minimal
- Moderate
- Marked

Front 24

What classifies a minimal variability?

Back 24

less than or equal to 5 bpm

Front 25

What classifies a moderate variability?

Back 25

6-25 bpm

Front 26

What classifies a marked variability?

Back 26

greater than 25 bpm

Front 27

Which variability to you normally want?

Back 27

Moderate

Front 28

When are absent and minimal variability ok?

Back 28

If you can state a reason for it, ex. fetus is sleeping

Front 29

Are marked variability anything to be worried about?

Back 29

No, but long term is a bad sign

Front 30

What are some causes of decreased variability?

Back 30

- Hypoxia/acidosis
- Drugs
- Fetal sleep
- Congenital anomalies
- Extreme prematurity

Front 31

What are some causes of marked variability?

Back 31

- increased fetal movement
- hypoxia
- vaginal exams
- second stage pushing

Front 32

Define accelerations

Back 32

The increase is 15 bpm or more and lasts 15 seconds or more, with a return to baseline less than 2 mins from the beginning

Front 33

True or False
Accelerations are the normal cardiac response of the fetus to increased O2 needs.

Back 33

True

Front 34

When should one start seeing accelerations?

Back 34

32 weeks or more

Front 35

If you start having accelerations should you then always have them?

Back 35

Yes

Front 36

What is the difference between episodic and periodic?

Back 36

-Episodic changes are not associated with a ctx, they occur in response to fetal movement
- Periodic changes begins with onset of ctx and returns to baseline at the end of the ctx

Front 37

What nursing interventions are done for accelerations?

Back 37

none

Front 38

Define an early deceleration

Back 38

- gradual decrease in FHR, from onset of the deceleration to the FHR nadir of greater than or equal to 30 sec

Front 39

In an early deceleration, the nadir occurs at the _____ time as the peak of the ctx.

Back 39

Same

Front 40

True or False
An early deceleration is back to baseline by the end of the contraction.

Back 40

True

Front 41

Early delcelerations occur in response to?

Back 41

Fetal head compression

Front 42

Define late decelerations

Back 42

- from onset to nadir is greater than or equal to 30 secs
- nadir occurs after the peak of the ctx

Front 43

Do late decelerations come back to baseline before or after the ctx ends?

Back 43

After

Front 44

Late delcelerations occur in response to?

Back 44

uteroplacental insufficiency

Front 45

Does a nurse want to see late deceleration?

Back 45

NO

Front 46

What are the nursing interventions for late decelerations?

Back 46

- Change maternal position
- Correct maternal hypotension
- D/C Pitocin
- Admin O2 by face mask
- Delivery of fetus

Front 47

Define variable decelerations

Back 47

Abrupt decrease in FHR is 15 bpm or greater, lasting 15 secs or more and less than 2 mins in duration.

Front 48

Variable decelerations are caused by?

Back 48

Umbilical cord compression

Front 49

What does a variable deceleration look like?

Back 49

V

Front 50

Does a variable deceleration have any relationship with a contraction?

Back 50

No

Front 51

What are the nursing interventions for a variable deceleration?

Back 51

- Change position
- D/C Pitocin
- Admin O2 per face mask
- Perform sterile vaginal exam
- Amnioinfusion
- Delivery of fetus

Front 52

What is a deceleration lasting longer than 10 mins?

Back 52

Change in baseline

Front 53

What is a deceleration lasting longer than 2 mins?

Back 53

Prolonged deceleration