Reduced blood flow from maternal vessels (HTN, HPN)
Reduced fetal circulation
Normal uterine activity is characterized by contractions occurring every ______ and lasting less than ______
Every 2-5 minutes
Less than 90 seconds
Uterine Activity
Normal vs Tachysystole
Normal - 5 or less contractions in 10 minutes averaged over a 30 minute window
Tachy - 5 or more contractions in 10 minutes averaged over a 30 minute window
When is an internal fetal scalp monitor contraindicated?
When the mom has HIV
When can a mom with beta strep use internal fetal scalp monitor?
After she is given antibiotics
What are reassuring fetal heart rate patterns?
Normal baseline heart rate between 110 and 160
Moderate variability
Presence of accelerations
Absence of decelerations
What are nonreassuring fetal heart rate patterns?
Baseline heart rate less than 110 or more than 160
Absent or minimal variability
Late or variable decelerations
Bradycardia
Nonreassuring fetal heart rate patterns are associated with _____?
Hypoxemia (or hypoxia in later stages)
What mm Hg are contractions and resting tone typically in an internal uterine pressure catheter?
Contractions - 50-85mm Hg
Resting tone - 20mm Hg
What is the one value that cannot be monitored on an external fetal monitor?
Uterine contraction intensity
What monitor is this: High frequency sound waves reflect mechanical action of the fetal heart. It is noninvasive, does not requir rupture of membranes or cervical dilation, and is used during both the antepartum and intrapartum periods
A) Ultrasound transducer
What monitor is this: this instrument monitors frequency and duration of contractions by means of a pressure-sensing device applied to the maternal abdomen. It is used during both the antepartum and intrapartum periods.
B) Tocotransducer
What monitor is this: this electrode converts fetal ECG to the FHR. This method can be used only when membranes rupture and the cervix is sufficiently dilated during intrapartum period.
C) Spiral electrode
What monitor is this: this instrument monitors frequency, duration and intensity of contractions. Can be used when membranes rupture and the cervix is sufficiently dilated during the intrapartum period.
C) Intrauterine pressure catheter
What is the definition of variability?
Fluctuations in the baseline FHR
What are the types of variabilty?
Absent
Minimal - less than 5bpm
Moderate - 6-25bpm
Marked - more than 25bpm
What is possibly going on with the fetus when the variability goes from moderate to minimal?
Most likely the fetus is sleeping. Wait about 30minutes to intervene.
What variability is ideal to have?
Moderate
Changes in fetal heart rate patterns
Periodic vs Episodic
P - fluctuations with contractions
E - fluctuations without contractions
An acceleration is classified as an increase of _____ bpm and last for at least _____
Pattern - abrupt decrease from baseline that is 15bpm or lasts more than 15 seconds. Tend to have a U, V or W shape. After deceleration, has an acceleration before going back to baseline.
Pattern - gradually decrease in association with contractions; start after contractions start, end after contractions end. The lowest point of deceleration is at the peak of contractions.
What are the 5 components of a FHR tracing that determines if the nurse needs to intervene?
Rate
Variability
Accelerations
Decelerations
Changes
What is the pattern of a prolonged deceleration?
Apparent decrease below the baseline 15bpm or more last more than 2 minutes but less than 10 minutes.
What are the 3 basic interventions for managing a nonreassuring FHR pattern?
Give O2 at 10L/min
Assist mom to side-laying position
Increase maternal blood volume by increasing the rate of IV infusion
What should the nurse do if the mom is experiencing hypotension?
Increase the IV infusion
Position to lateral or trendelenburg
*Give ephedrine or phenylephrine if other measures are unsuccessful
What should the nurse do if the mom is experiencing uterine tachysystole?
Stop the oxytocin or pitocin
Give a uterine relaxant (tocolytic or terbutaline)
What are the rank of priorities of intrauterine resuscitation?
1st - open maternal and fetal vascular systems
2nd - increase blood volume
3rd - continue circulation to have oxygenation
How should the nurse treat fetal tachycardia?
Give antipyretics for fever
Use cooling measures
Give O2
How should the nurse treat bradycardia?
Treat the underlying cause
Why should the Valsalva maneuver be discouraged?
Stimulate the parasympathetic nervous system and decreases the maternal heart rate and blood pressure
