Fetal Evaluation 572

Front 1

Define hypoxemia

Back 1

decreased oxygen content in blood

Front 2

Define hypoxia

Back 2

Decreased level of oxygen in tissues

Front 3

Define acidemia

Back 3

Increased concentration of hydrogen ions in the blood

Front 4

Define acidosis

Back 4

Increased concentration of hydrogen ions in the tissue

Front 5

Define asphyxia

Back 5

Hypoxia with metabolic acidosis

Front 6

What is fetal distress directly related to?

Back 6

-Pre-existing status of the fetus
-Intensity and duration of stress
-Ability of team to assess fetal condition accurately
-Ability of team to react appropriately

Front 7

Why was fetal monitoring orginially introduced?

Back 7

Original rationale for FHR monitoring was that it would serve as a screening test for asphyxia
Despite poor interobserver and intraobserver reliability, uncertain efficacy, and high false-positive rates, the technology continues to be utilized.

Front 8

When was the NICHD guidelines introduced and what was the purpose?

Back 8

1997, National Institute of Child Health and Human Development Workshop
Purpose - to develop standardized and unambiguous definitions for FHR tracings
Inability to determine outcomes when there is no standard definition of terms with fetal monitoring
The prime focus of the workshop was for intrapartum patterns

Front 9

Describe the physiology of the placenta

Back 9

-Placenta is a ‘semipermeable membrane’
-Can store nutrients and oxygen, which allows for some reserve
-Oxygen is required to catabolize glucose the primary energy source
-When oxygen is inadequate glycolytic metabolism is replaced at the pyruvic acid step with by-product production of lactic acid – accumulates over time and bicarbonate is consumed.
-CO2 crosses placenta rapidly but lactic acid does not, therefore the decline in pH is progressive

Front 10

What is normal P02 in fetal oxygenation?

Back 10

25-30mmHg

Front 11

What is special about fetal hemoglobin?

Back 11

Favorable dissociation curve provides for sufficient oxygen delivery

Front 12

What happens to perfusion of the intervillous space during a contraction?

Back 12

Perfusion of the intervillous space essentially ceases during contractions of normal intensity

Front 13

What is fetal heart rate variability related to? What are the different types of variability?

Back 13

-Sympathetic and parasympathetic influences
-Short term/long term – absent, minimal, moderate, marked

Front 14

How is baseline FHR defined and what are the normal paremeters?

Back 14

Baseline – average over 10 minutes, rounded to increments of 5 bpm. 110-160 = WNL

Front 15

What are some causes of fetal tachycardia?

Back 15

– hyperthermia; atropine, terbutaline; hypoxemia

Front 16

What are some causes of fetal bradycardia?

Back 16

Sleeping, analgesic agents – should resolve after about 20-30 minutes

Front 17

What is the riteria for reactivity? What does it prove?

Back 17

-2 accelerations of 15 beats per minute, each accel lasting 15 seconds.
-Presence virtually ensures the absence of fetal acidosis

Front 18

What do scalp stim and vibro acoustic stimulation prove if positive? When and how often would you do these two techniques of assessment?

Back 18

Abcesnse of acidosis

Not sure look it up!

See below picture & review:

Front 19

Define a later deceleration

Back 19

Late – gradual, with the onset of the Deceleration to its nadir taking at least 30 seconds and the nadir occurring after the peak of the associated contraction - sinister

Front 20

Define an early deceleration

Back 20

Early – gradual, but coincident with associated contraction – benign

Front 21

Define an acceleration of the FHR

Back 21

-Increase above baseline in a periodic fashion
-Increase 15 bpm x 15 secs for the near term and term baby
-Increase 10 bpm x 10 secs for the <32 week fetus

Front 22

Define a variable deceleration, and state when it is concerning.

Back 22

-Variable – response to cord compression
-Abrupt fall with abrupt rise usually related to contraction
-Can be preceded and followed by brief accelerations (shoulders) – reassuring
-Reflects respiratory acidosis, transient
-Concerning when:
*Persistent to less than 70 bpm
lasting >60 seconds
*Slow return to baseline

Front 23

Define what a sinusoidal pattern is.

Back 23

Visually apparent, smooth, sine wave–like undulating pattern in FHR baseline with a cycle frequency of 3–5/min that persists for 20 minutes that persists for 20 minutes

Front 24

Describe criteria for a category one FHR tracing

Back 24

Cat I:
-Baseline rate: 110–160 beats per minute (bpm)
-Baseline FHR variability: moderate
-Late or variable decelerations: absent
-Early decelerations: present or absent
-Accelerations: present or absent

Front 25

Describe criteria for a category two FHR tracing

Back 25

-Category II FHR tracings include all FHR tracings not categorized as Category I or Category III. Category II tracings may represent an appreciable fraction of those encountered in clinical care.

Examples of Category II
FHR tracings include any of the following:
-Baseline rate
*Bradycardia not accompanied by
absent baseline variability
*Tachycardia
-Baseline FHR variability
*Minimal baseline variability
*Absent baseline variability not
accompanied by recurrent -Decelerations
*Marked baseline variability
-Accelerations
*Absence of induced accelerations
after fetal stimulation
-Periodic or episodic decelerations
*Recurrent variable decelerations
accompanied by minimal or
moderate baseline variability
*Prolonged deceleration 2 minutes
but 10 minutes
*Recurrent late decelerations with
moderate baseline variability
*Variable decelerations with other
characteristics, such as slow
return to baseline, “overshoots,”
or “shoulders”

Front 26

Describe criteria for a category three FHR tracing

Back 26

Category III FHR tracings include either:
-Absent baseline FHR variability and any of the following:
*Recurrent late decelerations
*Recurrent variable decelerations
*Bradycardia
*Sinusoidal pattern

Front 27

How is uterine contractions evaluated when looking at a strip, and what is considered a normal active pattern, and what is considered not normal?

Back 27

-Quantified as the number of contractions present in a 10-minute window, averaged over 30 minutes.
-Terminology
*Normal: 5 contractions in 10
minutes, averaged over a
30-minute window
*Tachysystole: 5 contractions in 10
minutes, averaged over a
30-minute window

Front 28

Define tachysystole in relation to contractions and what are charting aspects and prevention measures important to know when encountering this pattern?

Back 28

-Tachysystole: 5 contractions in 10 minutes, averaged over a 30-minute window
-Tachysystole should always be qualified as to the presence or absence of associated FHR decelerations.
-The term tachysystole applies to both spontaneous or stimulated labor.
-The clinical response to tachysystole may differ depending on whether contractions are spontaneous or stimulated.
-The terms hyperstimulation and hypercontractility are not defined and should be abandoned
Interventions:
*Maternal positioning
*Tachysystole – oxytocin with rising
resting tone
*Initiate tocolysis
*Increase IV fluids
*Initiate oxygen therapy, 10-12 L
preferably with rebreather mask
*Improper coaching
*Possibly amnioinfusion?

Front 29

List fetal heart rate patterns associated with adverse fetal outcomes

Back 29

-Minimal/absent variability for an hour or more as a single finding without known cause
-Recurrent late decelerations or repetitive moderate to severe variables and minimal or absent variability
-Persistent tachycardia or bradycardia and minimal/absent variability
-Persistent or progressive bradycardia below 80 beats per minute

Front 30

List common terminology when describing FHR patterns and their definitions: recurrent pattern, periodic changes, episodic changes prolonged deceleration, sinusoidal pattern

Back 30

-Reassuring/Non-reassuring
-Recurrent pattern – with >50% in any 20 minute window of time
-Periodic changes (w/ctx), episodic (w/out ctx)
-Prolonged deceleration: abrupt decrease to levels below baseline that lasts >2 min to <10 min
-Sinusoidal pattern – smooth, undulating pattern, lasting at least 10 minutes

Front 31

List basic steps in evaluation and management of a FHR pattern

Back 31

-Determine etiology
-Attempt to correct through measures aimed at improving fetal oxygenation and placental perfusion
-Consult with team
-Scalp pH or SaO2??
-Refer/transfer

Front 32

List the recommended documentation intervals according to AWHONN, ACOG, SOGC, & RCOG

Back 32

Front 33

What are the ACNM recommendations when doing intermittent FHR auscultation?

Back 33

-Determine baseline by listening between contractions, without fetal movement
-Subsequently count the FHR after UC for 30-60 seconds every 15-30 minutes in active labor and every 5 minutes in 2nd stage
-Note accelerations and decelerations using multiple-count strategy (count for 5-15 seconds during the total time segment)