Indications for Fetal monitoring
- ↓ fetal movement
- previous stillbirth
- Routine surveillance
- Rh disease
What can be measured with external monitoring (Tocotransducer)?
Frequency of uterine contractions only. Not intensity
What needs to happen for the placement of an internal fetal heart monitor (Spiral electrode)?
Dilation and rupture of membranes
What uterine measurements are seen in active labor?
- Resting tone 5-15 mm HgFrequency 3-5 mins
- Duration 30-60 secs
- INTeNSITY 50-75 mm Hg
Define and give causes for fetal tachycardia
- Sustained FHR >160 for >10 minutesLoss of PSM activity
- Fetal anemia or hypoxia
- Maternal Fever
When is fetal tachycardia an ominous sign
- Late Decels
- Severe variables
- No variability
Define and give causes for fetal bradycardia -
Decreased from baseline X10 minutes (<120 or 30 drop from baseline)
- Fetal hypoxia from cord compression
- Maternal hypotension or hypothermia
- Anesthetic agents
What is variability indicative of?
- Normal neurological control of HR
- Fetal reserve
(Balance between SYM and PSM systems balance)
Begins prior to contraction peak
Recovers with contraction
Vag exam or fundal pressure
Begins late - at or after peak
recovers after contraction ends
Indicates hypoxic stress, metabolic acidosis
Seen c strong contraction
Causes of Late Decels
- Uteroplacental insufficiencyMaternal DM
- supine hypotension
- Abruptio placenta
How long is a prolonged decel
>90 seconds - fetal survival poor if not managed
What is the criteria for a reactive NST
(Best time is late in evening: baby more active)
2 - 15bpm accelerations
within 15 minutes
Oxytocin Challenge Test or
Contraction Stress Test criterion
3 moderate contractions in 10 minutes, lasting 40-60 seconds
Oxytocin IV or nipple stim until contractions begin
When is CST ordered and what constitutes healthy/compromised?
CST is ordered when there is a non-reactive NST
Healthy CST is with a stable FHR and No late decels
Compromised with late decels
What are the indications for fetal Ultrasound?
- gestational age
- well being
- amniotic fluid level
- confirm demise/presentation
What are indications for Ultrasound for mom?
- evaluate vaginal bleeding
- R/O molar pregnancy
- evaluate mass
- cervical length
What are AFI measurements for:
NL, Oligo, and Poly
What problems are associated with Polyhydramnios?
- GI tract obstruction
- Multiple gestation
- Fetal hydrops
What are consequences of oligohydramnios?
- Restricted fetal movement
- Impaired lung development, compression
- orthopedic abnormalities
Cord compression (inadequate circulation)
What is late amniocentesis used to detect?
- Fetal Lung Maturity
- (inadequate surfactant = RDS)
What is scoring for the L/S ratio?
2 or > = mature lungs
at 1.5 = 50% incidence of RDS
<1.5 = 73% incidence of RDS
When does fetal breathing become regular and what does it demonstrate?
Fetal breathing becomes regular at 20-21 wks and this demonstrate intact neurologic control
BIOPHYSICAL PROFILE (to test CNS functioning) is composed of what
- Fetal tone
- Fetal movement
Scoring is 2 or 0 for each category. Max 10
What must happen for a score of 2 in each category of BPP?
- FBM: 1 episode (>30sec) in 30 min
- Movement: 3 discrete body/limb movement in 30 mins
- Tone: 1 episode limb or trunk extension and back to flexion
- NST: Reactive
- AFI: at least 1 pocket = 2x1 cm
BPP Scoring management
8 or 10: 10 NL low risk. 8 NL. Deliver if Oligo
6: Suspect chronic asphyxia >36 wks - deliver. < 36wks repeat
4: Suspect chronic asphyxia >32 wks deliver, <32 wks repeat
0-2: Strongly suspect chronic asphyxia - Extend test to 120 minutes. If persistently <4, deliver