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37 Cards in this Set
- Front
- Back
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What are the different ways you can assess fetal heart rate?
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hand hel fetal monitoring (fetoscope, doppler)
Electronic Fetal Monitoring External US Transducer Tocometer Internal Scalp Electrode Intrauterine pressure catheter |
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What does a us transducer measure?
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fetal heart rate using high frequency sound waves
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What does a tocometer measure?
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uterine pressure
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IUPC measures
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intraamniotic pressure
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Internal fetal monitoring requires
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ruptured membranes
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Internal fetal monitor must be placed
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between the fetus and uterine wall
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Internal fetal measures
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long term variability in HR
beat to beat variability continuous monitoring |
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Methods/ Modes of Monitoring
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Intermittent
Continuous |
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What are the characteristics of FHR?
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Baseline heart rate, assessed between contractions
Periodic changes- during and after contraction Variability - only seen with EFM - heart rate variation from baseline |
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Intensity of a contraction can only be measured with
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an internal monitor
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Duration of a contraction is
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the time from the beginning to the end of a contraction
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Frequency of a contraction is
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the time from the beginning of one contraction to the beginning of the next
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Fetal Tachycardia
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baseline more than 160 beats per min for a duration of 10 minutes or longer
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Causes of fetal tachycardia
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Mother has:
-fever, chorioamnonitis -maternal hyperthyroidism drugs dehydration anxiety Fetus has: early fetal hypoxia asphyxia fetal anemia infection prematurity |
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Fetal Bradycardia
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baseline FHR less than 110 beats per min for a duration of 10 minutes or longer
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Fetal Bradycardia can result from
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placental transfer of drugs such as anesthetics
prolonged cord compression maternal hypothermia and hypotension maternal supine hypotension syndrom |
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What is maternal supine hypotension syndrome
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caused by the weight and pressure of the gravid uterus on the inferior vena cava
decreased blood return to the maternal heart and thus reduced maternal cardiac output and blood pressure Results in decreased fetal heart rate |
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Long term variability is defined as
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irregular FHR over 10 minutes
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Short term variability is defined as
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fluctuations from beat to beat
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Decreased variability is not
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reassuring and is considered a sign of fetal stress
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Accelerations in heart rate are defined as
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increase in baseline of 15 bpm for 15 seconds
indicates fetal well being |
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Deceleration in heart rate is defined as
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decrease in baseline of 15 bpm for 15 sec
may be benign or non-reassuring |
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VEAL CHOP
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V- Variable C- umbilical cord compression
E- early H- head compression A- acceleration O- OK L- late P- placental insufficiency |
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Early decelerations are
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decelerations of no more then 30BPM
Indication of head compression |
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Variable Decelerations
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occur independent of contractions
Visually abrupt, variable, shaped like U,V, or W Sudden drop and sudden return of heart rate Heart rate may also jump before and after Results from umbilical cord compression |
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Late decelerations
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gradual decrease with a slower return
results rom placental insufficiency |
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Accelerations are
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normal
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When documenting FHR include
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baseline
periodic changes variability |
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Assess FHR
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Q 1 hr during latent phase
Q 15-30 min during active phase Q5 min or between ctx during 2nd stage |
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A Reassuring pattern is when the FHR pattern is
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baseline 110-160
No decelerations or changes in baseline Accelerations with fetal movement moderate variablity |
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a non reassuring patter is when the FHR pattern is
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tachycardia
bradycardia decreased or absent variablity late decelerations severe variable decelerations |
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Nursing management of changes in FHR
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turn of pit
position increase IV fluids O2 Notify provider |
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Other interventions with change in FHR
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fetal stim
amnioinfusion discourage valsalva maneuver change maternal position |
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When assessing fetal strip decide the following
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FHR
Variable Accelerations Decelerations Reassuring |
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minimal variability
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less then 5 bpm change
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moderate variability
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6-25 bpm
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marked variability
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more then 25 bpm change
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