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44 Cards in this Set

  • Front
  • Back
What is the most prevalent obstetric procedure in the US?
electronic fetal monitoring
What is the difference b/w measuring fetal heart rate directly & indirectly?
directly: need bipolar electrode applied to scalp; records ELECTRICAL events;
indirectly: use US transducer to transmit fetal activity, it will detect heart motion, records MECHANICAL events
With the direct technique of fetal heart rate measuring, how do you measure the voltage difference b/w the 2 poles?
spiral portion enters scalp, 2nd pole is metal wing, vaginal saline completes the circuit;
If you have a dead fetus, what will the EKG show?
it'll read the maternal ECG b/c it'll go directly thru the fetus
The scalp electrode on the fetus measures what types of waves?
R waves
How is heart rate measured? What units?
measure in milliseconds, use distance b/w R waves;
How much stronger is the mom's EKG than the fetus's?
5x stronger but its diminished w/ the fetal scalp electrode
What will you pick up on the EFM w/ placental abruption?
Fetal heart rate will decrease then the maternal heart rate will take over;
how would you define fetal bradycardia?
baseline below 110bts/min. No beat to beat variability would indicate a compromised fetus.
What happens to the signal b/w the time its detected and drawn on the graph? How many cm/min are recorded on the graph?
signals are sent thru microprocessor & edited. Signal compared to previous signal (autocorrelation) is usually 3-4 beats is evaluated before rate is printed on graph; FHR recording at 3 cm/min
What is the baseline FHR?
rate apart from accels & decels w/ contractions. ex. if you place a ruler & eliminate all the ups & downs.
When describing baseline FHR, what is included in the description?
rate, beat to beat variability, arrhythmia, & certain patterns
At what level of the baseline FHR is the baby considered to have tachycardia?
What types of things inc the FHR?
What types of things DEC the FHR?
parasympathetic,chemoreceptors, hypoxia, hypercapnia, rising blood lactate levels
What is 't' on the FHM graph?
beat to beat distance
Fetal bradycardia can indicate what types of things?
fetal compromise or heart block
Fetal tachycardia can indicate what types of things?
maternal fever rate >160 (ex. chorioamniotis or amniotis), mom will also show a moderate tachycardia.
What is the difference b/w long and short term variability?
short term variability: instantaneous change in heart rate;
long term variability: variation seen in 1 minute period (more wavy)
What is the beat to beat variability?
push pull of autonomic nervous system; nervous system is trying to regulate & is continuous
What types of things can cause a flat line on the FHM (common cause of loss of beat to beat variability)?
drugs given to mom like analgesics IV or conduction anaethetic.
what is normal variability in a FHM?
5-15 beats/min
What is the single most reliable sign of fetal compromise? Should this be used as the only indicator of fetal well being.
reduced baseline variability. No, it should not be the only sign for well being nor should good variability be the only indicator.
A flat tracing w/in the normal range w/ decelerations may reflect what?
previous insults that have resulting in neuro damage. (ex. something that happened 1 month ago that you didn't know about)
Fetal arrhythmias are most commonly indicated by what?
abrupt baseline spiking---you see baseline heart rate problem & then you see spikes.
Conduction defects are frequently associated w/ what type of disease?
connective tissue diseases like lupus
Do arrhythmias continue during the lifetime if one is seen w/ FHM in pregancy?
many disappear in neonatal period (birth-1 year old)
what percent of fetuses have arrhythmias?
In a patient w/ an arrhythmia, what type of treatment should be done in presence of clear amniotic fluid?
conservative tx.
When is a true sinusoidal heart rate seen?
in fetal anemia from any source--ex. placental abruption involving fetal circulation where fetus is losing a lot of blood--can happen w/ twins since they have an interconnection & one twins can take blood & nutrition away from the other;
Describe the true sinusoidal pattern.
5-15 beat amplitude, flat beat to beat variability, long term cycles every 2-5/minute; no accelerations; oscillation above or below a baseline.
What are accelerations? When do they occur? Are they ok?
abrupt increases in rate; can occur @ any time, w/ fetal movement, stimulation of fetus, uterine contraction, cord compression; Yes, they're normal b/c they represent intact neurohormonal cardiovascular control mechanism.
What are the 3 types of decelerations?
early, late, variable;
early: at time of contraction
late: start at or past contraction peak; indicate poor uterine profusion or placental fxn.seen w/ any process causing maternal hypotension (ex. anaesthetic), placental dysfxn.
Variable: abrupt dec in rate & variable in profusion.
What is a nadir?
top of contraction
What are the 2 most common causes of decelerations?
epideral analgesia & oxytocin (maternal contraction dec blood supply to fetus)
What are the causes of placental dysfxn?
maternal dz, HTN, diabetes, collagen vascular dz,
what are the causes of variable deceleration?
umbilical cord occlusion (ex. if baby has cord wrapped around its neck)
What is prolonged deceleration?
lasts 2-10 minutes from onset to return to baseline. Very scary! uterus has become hyperstimulated & baby's heart doesn't beat at all
During what part of the labor are decelerations almost universal? What are the causes?
2nd part of labor (cervix has dilated to 10 cm & mom is trying to push baby out); head compression & cord compression.
What are the complications of internal fetal monitoring?
rare but electrode could be placed on eye or face--this is a blind procedure, so you just need to try to feel where you are; pressure cath can puncture placenta or uterus, scalp would can become infected
When is internal FHR not indicated?
if mom has HIV, herpes, hep B or C b/c you don't want to make a cut on baby by accidence since it'll be surrounded by maternal blood.
what is 'fetal distress'?
vague term that lacks clinical precision, based on interpretation of fetal heart rate patterns; often recorded in times of c-section.
Describe a NORMAL fetal heart rate.
baseline 110-160 bts/min. variability 6-25 bts/min. accelerations present. no decelerations
Describe a severely abnormal heart rate.
recurrent or late variable decelerations w/ 0 variability; substantial bradycardia w/ 0 variability.