Wh Session 8 Fetal Surveillance

Front 1

types of variability from absent to marked?

Back 1

Absent variability = flat and does not vary around the baseline
Minimal (< 5 bpm) = little variation around the baseline
Moderate (5-25 bpm)
Marked (>25 bpm) = substantial variation in relation to the baseline

Front 2

what are acceleration and what do they indicate?

Back 2

heart rate above baseline
reassure baby is safe

Front 3

what is normal FR, and normal fetal monitoring strip

Back 3

110-160 bpm
moderat variability with occasional accelerations and small or absent decelerations

Front 4

what are indications for antepartum testing in patients at high risk for placental insufficiency?

Back 4

prolonged preg
DM
HTN
previous stillbirth
suspected intrauterine growth restriction (IUGR)
advanced maternal age
multiple gestation with discordant growth

Front 5

what are indications from other tests to do antepartum testing?

Back 5

suspected IUGR
decreased fetal movement
oligohydramnios (low amniotic fluid)

Front 6

how to determine if a fetus is well oxygenated?

Back 6

a baby who moves is well oxygenated and fetal movements correlate with fetal HR accelerations on the strip

Front 7

fetal movement

Back 7

mvoes about 30/hr in third trimester
periods of movement last about 40 mins
periods of quiet last about 20 mins
the mother can feel 75% of fetal movement

Front 8

how to do kick counts?

Back 8

used during the 3rd trimester
pts count fetal movements up to 10 within 2 hours- that is good.
performed every 24 hours
if pt reports decreased fetal movement then perform further testing

Front 9

what is the NST?

Back 9

The goal is to determine if FHR accelerations are present because accelerations require an intact neurological coupling between the CNS and the fetal heart so if there is hypoxia this will not occur. Only done in late gestation.

Front 10

how many accelerations per hour does the fetus exhibit in late gestation

Back 10

34/hr

Front 11

what is required for a reactive NST?

Back 11

2 FHR accels of 15 gpb amplitude and 15 seconds in duration in 20 minutes of monitoring
this would be considered normal

Front 12

what is the most common cause for a nonreactive tracing?

Back 12

fetal quiet or sleep

Front 13

how often are NST performed?

Back 13

2x week

Front 14

what should be done if there is a nonreactive NST?

Back 14

proceed to further testing?

Front 15

what is a biophysical profile?

Back 15

uses real time US to assess anterpartum fetal condition plus a NST. It evaluates for normal levels of amniotic fluid and watches for appropriate fetal movement

Front 16

how often if the biophysical profile performed?

Back 16

1-2x a week especially in high risk pts

Front 17

what are the components of the biophysical profile?

Back 17

fetal breathing movements
gross (full) body movements
fetal tone
reactive FHR
qualitative amniotic fluid volume

Front 18

how to score a NST and what does it mean?

Back 18

each category gets 2 points and scores 8-10 are normal
less than 8 and bad
and less or equal to 4 the baby needs to be delivered

Front 19

what are the two intrapartum ways to measure FHR?

Back 19

external- dopplar placed on mothers abdomen
internal- uses fetal scalp electrode once fetal membranes are ruptures (more direct measurement)

Front 20

what type of decel mirrors a contraction in timing from onset to nadir to resolution

Back 20

early decel

Front 21

what does early decel represent?

Back 21

cardiac reflexes response to head compression (fetal descent)
they do not represent fetal O2 status

Front 22

which decel is an abrupt decline and return of FHR that can occur at any time with regard to contraction?

Back 22

variable decel

Front 23

what does variable decel indicate?

Back 23

umbililcal cord compression
if briefly then its mild and if for a longer period it is more severe and that is worrisome for insufficient O2 to the fetus and corrective measures should be taken

Front 24

what type of decel has a gradual onset and return but the onset begins after the contraction already started and nadir of decel occurs after peak of contraction has ended?

Back 24

late decel

Front 25

what does lat decel indicate?

Back 25

uteroplacental insufficiency- it is the fetal cardiac response to O2 insufficiency

Front 26

what is indicated when fetal HR drops and stays below 90 bpm?

Back 26

bradycardia and baby cant get enough O2

Front 27

what should be done in early decel?

Back 27

not concerning
occurs around 4-10 cm
check pt, be ready for delivery

Front 28

what should be done in mild variable decel?

Back 28

not concerning especially with good variabiltiy

Front 29

what should be done in severe variable decel?

Back 29

give O2, Iv fluids, stop oxytocin
check cervix to r/o cord prolapse
lateral positioning of mother
amniofusion
consider delivery if not resolved

Front 30

what should be done in late decel?

Back 30

fetus cant tolerate contractions and that may lead to hypoxia so maternal postition change,
give O2, stop any oxytocin infusion
consider delivery if not resolved

Front 31

what should be don ein bradycardia?

Back 31

this is an emergency
check pt to evaluate for cord prolapse
stop any oxytocin infusion
move for immediate delivery if no resolution (c- section)

Front 32

look at FHR pics!

Back 32

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