As the myometrium contracts the flow of oxygenated blood through the uterne artery is __________. Therefore, casuing the fetus to have _______ oxygen available.
decrease
less
What is low tech monitoring?
auscultation and palpation
What is high tech monitoring?
electronic monitoring that monitors contractiosn and fetus
True or False: If a contraction lasts longer than 1 min you should be concenred.
True a contraction should not last longer than 1 min
Indications for fetal electronic monitoring:
previous hx of still birth
complications of pregnancy
induction of labor
preterm labor
nonreassuring fetal status (decreased movement)
meconium staining of amniotic fluid (sign baby is in distress)
Where is the tocodynamometer or "toco" placed on the womans abdomen?
placed over uterine fundus because it monitors uterine contractions
Where is the ultrasound monitor device placed?
over the area of the fetal back becuase it transmits info about FHR
Criteria for internal monitoring?
amniotic membranes ruptured
cervix dilated 2 cm
presenting part down against cervix
Where is the internal monitoring placed?
the sprial electrode is placed on the fetal occiput which allows for more accurate continous monitoring
With which type of monitoring is the mom limited to staying in bed with little movement?
External
Which type of electronic monitoring allows free movement by mom and fetus?
Internal
Baseline fetal HR?
110-160
Tachycardia fetal heart rate:
>160 bpm
Causes of fetal tachycardia:
maternal fever
fetal hypoxia
intrauterine infections
drugs
Bradycardia fetal HR:
< 110 bpm
Causes of fetal bradycardia:
profound hypoxia
anesthesia
beta adrenergic blocking drugs
Do you want variability of the fetal heart monitor or not?
YES abseence of variability (or a smooth flat baseline) indicates a sign of fetal compromise
Causes of decreased variability:
hypoxia and acidosis
medications
sleep cycle
preterm status
increase in fetal heart rate with a return to baseline = what?
accelerations
Acceleration of _______ indicates fetal well-being?
15 bpm for 15 seconds
Decerlerations can be ________, ______, or _______?
early
variable
late
Early, variable or late?
related to head compressions intervention not necessary
early
Early, variable or late?
realted to cord compression
interventions vary but focus on position changes or amnioinfusion
variable
Early, variable or late?
realated to uteroplacental insufficiency
most omnious need immediate attention
late
Early, variable or late?
The onest and return of the decceleration coincide with the start and end of the contraction.
early
Early, variable or late?
decelerations change with duration intensity and timing of contraction
variable
Early, variable or late?
the fetal heart tones return to the baseline after end of contraction
late
What should you do as the RN with FHR decelerations?
stop pitocin
reposition side lying or knee to chest position
adminster oxygen by mask at 10L/min
Give Terbutaline sub q
V C
E H
A O
L P
variable cord
early head
acceleration okay
late placenta
What are they testing for with fetal scalp blood sampling?
acidosis- present if pH <7.20
require rupturing of membranes
Cord blood analysis criteria:
significant abnoral FHR
meconium staining amniotic fluid
infant is depressed at birth
How do they perform a cord blood analysis?
Take a small amount of blood from umbilical cord and test for acidosis. normal pH >7.25 lower level indicates acidosis and hypoxia
What is the procedure when the MD "breaks the water"?
amniotomy
Risks of an Amniotomy?
umbilical cord prolapse
infection
abruption
Why would a MD perform an amniotomy?
induction/augmentation
allows for internal monitoring
Indication or contraindication for induction:
pregnancy inducted hypertension
indication
Indication or contraindication for induction:
placenta previa
contracindication
Indication or contraindication for induction:
premature rupture of membranes
indication
Indication or contraindication for induction:
post term pregnancy
indication
Indication or contraindication for induction:
chorioamnionitis
indication
Indication or contraindication for induction:
maternal medical conditions
indication
Indication or contraindication for induction:
hostile intraauterine conditons
indication
Indication or contraindication for induction:
fetal demise
indication
Indication or contraindication for induction:
abnormal fetal presentation
contraindication
Indication or contraindication for induction:
active genital herpes
contraindication
Indication or contraindication for induction:
previous classical uterone incision
contraindication
Indication or contraindication for induction:
overdistended uterus
contradindication
Indication or contraindication for induction:
severe maternal conditions
contraindication
Indication or contraindication for induction:
non reassuring fetal heart rate patterns
contraindication
What presentations are the greatest risk for cord prolapse?
-2, -3 presentation
What all does the bishop score evaluate?
dilation
effacement
fetal station
cervical consistency
cervical position
The higher the bishop score the ______ likely for a successful induction.
MORE
Risks associated with induction:
hyperstimulation
uterine rupture
maternal water intoxication
increaed risk for need for c-section
increased risk for operative vag delivery
What is the bishop score that indicates cervial rediness or cervical ripening?
>8
What type of drug causes cervical ripening?
prostaglandins
prepidil cervidil cytotec or
hydrophilic inserts (laminaria)
Most common drug given for induction/augmentation?
oxytocin (pitocin)
What is the doseage for pitocin?
30 U pitocin/ 500 ml of LR
always give as piggyback to closest prot to main iv bag... never mainline always use infusion pump and titration per hospital policy
Types of operative vaginal deliveries:
vacuum extraction
forceps extraction
Indication/Contraindication for use of forceps/vacuum:
maternal exhaustion fetal non reassuring FHR
indication
Indication/Contraindication for use of forceps/vacuum:
maternal ineffective pushing fetal failure of presenting part to rotate and descend
indication
Indication/Contraindication for use of forceps/vacuum:
maternal cardiac or pulmonary disease
indication
Indication/Contraindication for use of forceps/vacuum:
severe fetal compomise
contraindication
Indication/Contraindication for use of forceps/vacuum:
acute maternal conditions
contraindication
Indication/Contraindication for use of forceps/vacuum:
high fetal station
contraindication
Indication/Contraindication for use of forceps/vacuum:
cephalopelvic disproportion
contraindication
Risks of vacuume and foreps:
trauma to maternal and fetal tissues
vaginal lacerations and hematoma
fetal bruising facial laterations and cephalhematoma and intracranial hemorrhage
Two types of episiotomy incisions:
midline (more common)
mediolateral
Disadvantages of episiotomy:
infection risk
perineal pain may last longer
impairs resumption of sexual intercourse
Nursing intervention for episiotomy:
promote gradual stretching by perineal massage and warm compresses to perineum
C-section indications
dystocia
CPD
PIH
maternal diseases
active herpes
previous classical incision
presistent non reassurng FHR
prolapsed cord
fetal malpresentation
placental abnormalities
C-section prep:
shave prep
NPO or meds given to reduce acidity (reglan or bicitra)