Term
| What are the 5 factors for adequate fetal oxygenation? |
|
Definition
Placental blood flow
Maternal 02 saturation
Exchange of O2 and CO2 in placenta
Vessels in umbilical cord
Fetal circulatory & O2 carrying functions |
|
|
Term
| How does O2 get to the fetus? |
|
Definition
| O2 & nutrients in maternal blood pass into the fetal blood via the intervillous spaces of the placenta via the spinal arteries. |
|
|
Term
| How are waste products removed from the fetus? |
|
Definition
| Maternal blood carrying fetal waste products drains from the intervillous spaces through endometrial veins and returns to the mom’s circulation for elimination from her body |
|
|
Term
| What happens to the uteroplacental arteries during labor when contractions are occurring? |
|
Definition
Contractions gradually compress the uteroplacental arteries, temporarily stopping maternal blood flow into the intervillous spaces.
During UCs, the fetus depends on oxygen supply already present in body cells, fetal RBCs, and intervillous spaces. |
|
|
Term
| What happens when contractions stop? |
|
Definition
As the contraction relaxes, freshly oxygenated maternal blood re-enters the intervillous spaces and waste-laden blood drains out.
1-2 minutes |
|
|
Term
| What is fetal circulation? |
|
Definition
The umbilical vein carries oxygenated blood to the fetus.
Two umbilical ateries carry deoxygenated blood from the fetus to the placenta
opposite of adult!!! |
|
|
Term
| What are the 3 shunts in fetuses? |
|
Definition
| the ductus venosus, the ductus arteriosus, and the foramen ovale—allow most blood from the placenta to bypass the fetal lungs and liver. |
|
|
Term
| What regulates fetal heart rate? |
|
Definition
Autonomic nervous system:
Parasympathetic: decreases heart rate
Sympathetic: increases heart rate
Baroreceptors
Chemoreceptors
Adrenal Glands
CNS
Causes HR to increase with fetal movement
Causes HR to decrease when fetus sleeps |
|
|
Term
| How do barorecptors affect FHR? |
|
Definition
| cells in the carotid arch and major arteries respond to stretching when the fetal BP increases. The baroreceptors stimulate the vagus nerve to slow the FHR and decrease BP. As fetal BP falls, the HR accelerates to maintain normal CO2. |
|
|
Term
| How do chemoreceptors affect FHR? |
|
Definition
| Cells that respond to changes in oxygen, CO2, and pH are found in the medulla oblongta and in the aortic and carotid bodies. Decreased O2 content, increased CO2 or lower pH in the blood triggers an increase in HR. Prolonged hypoxia, hypercapnia, and acidosis depress the FHR. |
|
|
Term
| How do adrenal glands affect FHR? |
|
Definition
| secrete epinephrine and norepinephrine in response to stress, causing the sympathetic NS to accelerate the FHR. |
|
|
Term
| How does the CNS effect FHR? |
|
Definition
The fetal cerebral cortex causes the HR to increase during fetal movement and to decrease when the fetus sleeps.
Cerebral cortex (↑HR w/fetal movement & ↓HR w/fetal sleep)
Hypothalamus (coordinates ANS)
Medulla (maintains balance between stimuli that speed and stimuli that slow the HR) |
|
|
Term
| What are the maternal pathologic influences on fetal oxygenation? |
|
Definition
Cardiopulmonary alterations
Uterine Activity
Placental
Cord |
|
|
Term
| What does maternal HTN cause? |
|
Definition
Maternal HTN→vasospasm and narrowing of the spiral arteries causes decreased blood flow to the placenta
i.e. the patient w/HTN who might need to be delivered early…placenta may start to infarct d/t ↓flow |
|
|
Term
| What does maternal blood volume loss cause? |
|
Definition
Blood volume=Hemorrhage or Altered distribution of blood volume without loss…
For example, epidural causes generalized maternal vasodilation which causes hypotension which causes decreased blood flow to the placenta
CHANGES IN BP, OXYGENATION, ACID BASE, ASTHMA, SMOKING |
|
|
Term
| How does uterine activity effect the fetus? |
|
Definition
| HYPERTONIC ACTIVITY: over 90-120 sec or too frequent (closer than q 2 min) or too short of an interval (less than 30 sec relaxation) remember what happens to the intervillous spaces during UCs and the amount of o2 reserve (1-2 min) |
|
|
Term
| How does placental activity affect the fetus? |
|
Definition
Open circulation paths…abruptio placentae (DESCRIBE WHAT IT IS-JESSICA STORY)
INFARCTS: Amount and location of disruption relates to the degree of impairment of uteroplacental exch |
|
|
Term
| How does the cord effect the fetus? |
|
Definition
| Interruptions in umbilical flow or OLIOGHYDRAMNIOS: may not be enough fluid to cushion the cord. |
|
|
Term
| What are the fetal pathologic influences on fetal oxygenation? |
|
Definition
Low fetal blood volume
Fetal anemia
Fetal hypotension
Prolonged bradycardia
Prolonged tachycardia |
|
|
Term
| How does low fetal blood volume effect oxygenation? |
|
Definition
May be hypoxic despite adequate oxygen supply from Mom and adequate exchange in the placenta
LOW FETAL BLOOD VOLUME, FETAL HYPOTENSION, FETAL ANEMIA |
|
|
Term
| How does fetal CNS abnormalities effect? |
|
Definition
| CNS or Cardiac abnormalities: may cause abnormal rate and rhythm |
|
|
Term
| How does prolonged bradiacardia effect the fetus? |
|
Definition
| both a response to hypoxia and causes hypoxia/OXYGENATION IS RATE-DEPEND |
|
|
Term
| How does prolonged tachy effect the fetus? |
|
Definition
| decreases CO-ventricles have less time to fill with oxygenated blood |
|
|
Term
| What is electronic fetal monitoring? |
|
Definition
Method of assessing fetal status both before and during labor.
Indicator of uteroplacental physiology and fetal oxygenation. |
|
|
Term
| What are the 2 modes of fetal monitoring? |
|
Definition
be external or internal
2 modes for external monitoring
Intermittent/Continuous |
|
|
Term
| What other data should fetal monitoring be used with? |
|
Definition
Maternal/fetal risk factors
Stage of labor/etc. |
|
|
Term
| What is the nurses responsibility? |
|
Definition
| assess FHR patterns, implement nursing interventions, and report non-reassuring patterns to primary care provider |
|
|
Term
| What is intermittent monitoring? |
|
Definition
Perform Leopold’s maneuvers
Auscultate using Doppler
Palpate abdomen at fundus to assess uterine contractions
Count FHR 30-60 sec for baseline
Auscultate FHT during contraction and for 30 sec after end of ctx
Identify any non-reassuring patterns and notify provider |
|
|
Term
| What are the advantages of external fetal monitoring? |
|
Definition
Noninvasive/reduces infection
Membranes may be intact
Cervix does not have to be dilated
Placement can be performed by nurse
Records permanent record of FHR tracing |
|
|
Term
| What are the disadvantages of external fetal monitoring? |
|
Definition
Contraction intensity is NOT measurable
Patient movement requires repositioning of transducers
Obesity and fetal position affect quality of tracing |
|
|
Term
| What are the advantages to auscultation monitoring? |
|
Definition
| mobility, water-based methods of pain mgmt (whirlpool, tub), more NATURAL |
|
|
Term
| What are the disadvantages of auscultation monitoring? |
|
Definition
FHR & UCs assessed for only portions of labor,
no continuous printed record is available to show fetal response throughout labor or to identify subtle trends in the response.
Some women don’t like the interruptions of auscultation: distracting
More staff-intensive than EFM |
|
|
Term
| What are the advantages of continuous monitoring? |
|
Definition
Supplies more data about the fetus: early, late, variable decels; variability;
Permanent record
Gradual trends in FHR and uterine activity are more apparent
Women may find constant sound of FHR soothing and comforting
The coach can use the tracing to anticipate UCs
Allows one nurse to monitor 2 laboring women; allows time for other interventions like teaching. |
|
|
Term
| What are the disadvantages of continuous monitoring? |
|
Definition
Reduced mobility
Frequent adjustment of equipment
Belts, monitors may be uncomfortable
Woman may concentrate on making a good tracing vs. comfort
Technical rather than natural |
|
|
Term
| When do you externally monitoring a low risk woman in the latent phase? |
|
Definition
|
|
Term
| When do you externally monitor a high risk woman in the latent phase? |
|
Definition
|
|
Term
| When do you externally monitor a low risk woman in the active phase? |
|
Definition
|
|
Term
| When do you externally monitor a high risk woman in the active phase? |
|
Definition
|
|
Term
| When do you monitor a low risk woman in the second stage of labor? |
|
Definition
|
|
Term
| When do you monitor a high risk woman in the 2nd stage of labor? |
|
Definition
|
|
Term
| WHen is routine monitoring done? |
|
Definition
Rupture of membranes
Before and after ambulation
Before and after medication administration
Peak action of anesthesia
Following vaginal exam
Following expulsion of enema
After urinary catheterization
Following period of abnormal/excessive ctx’s |
|
|
Term
| What are the 2 external monitoring systems? |
|
Definition
|
|
Term
| What are the 2 internal monitoring systems? |
|
Definition
|
|
Term
|
Definition
| Fetal scalp electrode and intrauterine pressure catheter. A, Parts of the fetal scalp electrode before it is applied. B, Fetal scalp electrode and intrauterine pressure catheter in place and connected to the bedside monitor unit. |
|
|
Term
| How do you assess tracings for fetal heart tones? |
|
Definition
Baseline (#1)
Variability (#2)
Periodic changes (#3) |
|
|
Term
| How do you assess for contraction pattern? |
|
Definition
Frequency, duration, strength
MUST PALPATE FOR STRENGTH |
|
|
Term
| What is the upper grid for? |
|
Definition
|
|
Term
| What is the lower grid for? |
|
Definition
|
|
Term
| What are the indications of continuous fetal monitoring? |
|
Definition
Multiple gestations
Placenta previa
Oxytocin (Pitocin) infusion
Fetal bradycardia/tachycardia
Maternal complications: Diabetes, Pregnancy HTN
Intrauterine growth restriction (IUGR)
Post dates
Meconium-stained fluid
Abruption placenta (suspected or actual)
Abnormal nonstress test
Abnormal uterine contractions
Fetal distress
Facility/provider preference |
|
|
Term
| What maternal history calls for continuous monitoring? |
|
Definition
| Prior stillbirth, Prior C/S, Poor nutrition, Chronic diseases, Acute infections, Hematologic problems |
|
|
Term
| What antepartum conditions calls for continuous monitoring? |
|
Definition
HTN, PIH, DM, CV disease, Sickle cell, preterm, Post-term >42 weeks, Multiples, IUGR, Maternal age
↓fetal movement, Placental abnormalities, Severe anemia, Maternal trauma, Maternal infection |
|
|
Term
| What intrapartum conditions call for contunous monitoring? |
|
Definition
Maternal Problems: PROM, Prolong ROM, Hypotension or hypertension, Hypertonic Ucs, Failure To Progress (FTP), Chorioamnionitis, Fever, Bleeding ,Pitocin, PTL, CPD, VBAC
Fetal or Placental Problems: Fetal anemia, Abnormal FHR or pattern, Meconium-stained amniotic fluid
Abnormal presentation or position, Prolapsed cord, Abruptio placentae |
|
|
Term
| What factors effect the apparent intensity of the strip? |
|
Definition
1.Fetal size: small fetus doesn’t allow the uterus to push firmly against the abdominal wall w/each UC, making contractions appear less intense.
2. Abdominal fat thickness: thicker layer absorbs energy from UCs while thin woman may appear to have intense contractions
that are actually mild.
3. Maternal position: different maternal positions may increase or decrease pressure against the toco
4. Location of the transducer: uterine activity is best detected where it’s strongest and where the fetus lies close to the uterine wall= upper uterus=fundus
Internal IUPC- must be 2-3 cm dilated |
|
|
Term
| What does the internal uterine monitoring system show? |
|
Definition
Frequency
Duration
Intensity
Resting Tone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Less than 120 bpm for 10 mins or longer |
|
|
Term
|
Definition
| More than 160 bpm for 10 mins or longer |
|
|
Term
| How is variability scored? |
|
Definition
Absent
Minimal
Moderate
Marked |
|
|
Term
| When is baseline FHR assessed? |
|
Definition
| between contractions with no fetal movement noted |
|
|
Term
| Over how many minutes is the FHR taken? |
|
Definition
Over 2 mins
Rounded up to 5 bpm
Example: 125, 140, 135
Excludes temporary increases or decreases |
|
|
Term
| What causes fetal bradycardia? |
|
Definition
Uteroplacental insufficiency
Umbilical cord prolapse
Maternal hypotension
Prolonged cord compression
Fetal congenital heart block
Anesthetic medications |
|
|
Term
|
Definition
Maternal infection
Maternal dehydration
Maternal cocaine or meth use
Fetal anemia
Fetal heart failure
Fetal cardiac dysrhythmia |
|
|
Term
| What are the nursing interventions for fetal brady? |
|
Definition
Notify provider
Stop oxytocin
Left side
Administer O2
Start IV
Administer tocolytic
Terbutaline
Scalp stimulate |
|
|
Term
| What are the nursing interventions for fetal tacky? |
|
Definition
If fever, antipyretics
Administer O2
Bolus IV fluids |
|
|
Term
|
Definition
| Fluctuations in baseline FHR: the normal irregularity of the FHR |
|
|
Term
| What does variability result from? |
|
Definition
| Results from a continuous balancing of the sympathetic (cardioacceleration) and the parasympathetic (cardiodeceleration) branches of the ANS. |
|
|
Term
| What is variability an indicator of? |
|
Definition
|
|
Term
| What does variability reflect? |
|
Definition
| Reflects neurological modulation of the FHR |
|
|
Term
| What is the amplitude range of absent variability? |
|
Definition
|
|
Term
| What is the amptitude range of minimal variability? |
|
Definition
|
|
Term
| What is the amplitude of moderate variability? |
|
Definition
|
|
Term
| What is the amplitude of marked variability? |
|
Definition
|
|
Term
| What is long term variability? |
|
Definition
Rhythmical and cyclical fluctuations
Interpretation of LTV is made by visual examination of the rise and fall and frequency of changes in FHR within the baseline range.
Assessed w/either external or internal monitors
It’s the zigzag you see in the FHR line |
|
|
Term
| What is short term variability? |
|
Definition
Changes in FHR from one beat to the next (beat-to-beat)
Internal scalp electrode is only method to accurately measure STV
Presence of STV indicates the fetus is appropriately responding to nerve impulses and has an intact ANS
Indicator of fetal oxygenation and oxygen reserve in the tissue |
|
|
Term
| What are the causes of decreased variability? |
|
Definition
Medications that depress the CNS
Narcotics, barbiturates, tranquilizers, general anesthetics
Fetal hypoxemia with resulting acidosis
Fetal sleep cycle
Congenital anomalies |
|
|
Term
| What are the nursing interventions r/t decreased variability? |
|
Definition
Position patient to left lateral position
Stimulate the fetal scalp
Assist provider with scalp electrode or fetal blood PH sampling |
|
|
Term
T or F?
VARIABILITY YOU SEE EXTERNALLY WILL OFTEN BE LESS INTERNALLY |
|
Definition
|
|
Term
| What causes increased variability? |
|
Definition
Mild hypoxia
Fetal stimulation |
|
|
Term
| What causes decreased variability/ |
|
Definition
Extreme prematurity
Arrhythmias
Hypoxia
Acidosis
Drugs
Fetal sleep |
|
|
Term
| What are periodic changes? |
|
Definition
| Temporary, recurrent changes from baseline that are associated with uterine contractions |
|
|
Term
| What are the types of decels? |
|
Definition
|
|
Term
| What is the most common periodic change in the fhr? |
|
Definition
|
|
Term
|
Definition
| Increase in FHR of > 15 BPM above baseline lasting 15 seconds-2minutes |
|
|
Term
| What is an acceleration a sign of? |
|
Definition
Not a sign of distress
Reassuring symptom of fetal well being.
Indicates intact CNS system
Normal response
Indicates REACTIVE NON-STRESS TEST |
|
|
Term
| When do early decels occur? |
|
Definition
| only during contractions as the fetal head is compressed |
|
|
Term
| When do early decels end? |
|
Definition
| Return to the baseline fetal heart rate by the end of the contraction |
|
|
Term
| What are early decels mirror images of? |
|
Definition
|
|
Term
| Are early decels associated with fetal compromise? |
|
Definition
NO
HEAD COMPRESSION-vagal stimulation
Requires no additional interventions |
|
|
Term
|
Definition
Reflect impaired placental exchange or uteroplacental insufficiency
Another cause: maternal hypertension |
|
|
Term
| What are the characteristics of late decesl? |
|
Definition
Look similar to early decels
Begin well after the contraction begins
(often near the peak of contraction)
FHR returns to baseline after the contraction ends
THEY ARE “LATE” TO RETURN TO BASELINE! |
|
|
Term
| What nursing intervention is there r/t late decelerations? |
|
Definition
Require nursing intervention to improve placental blood flow and fetal oxygen supply
Position on left side!
Discontinue Oxytocin if infusing
Administer O2 at 8-10L/min via face mask
Start an IV if not in place or IV rate
Notify provider of care
Prepare for assisted vaginal birth or C/S |
|
|
Term
| What causes a variable deceleration? |
|
Definition
Umbilical cord compression
Also: Short cord, Prolapsed cord, Nuchal cord (cord around neck), Oligohydramnios |
|
|
Term
| What are the characteristics of a variable deceleration? |
|
Definition
The shape, duration, and degree of fall below baseline rate are variable: V, U, W shaped
The fall and rise in rate is abrupt
May be nonperiodic =not associated with UCs |
|
|
Term
| When do variable decelerations occur? |
|
Definition
| After rupture of membranes |
|
|
Term
| What is the nursing intervention r/t variable decelerations? |
|
Definition
#1-Change position (any position!)
Discontinue Oxytocin if infused
Administer 8-10 L/min per mask
Perform or assist with vaginal exam
Assist with amnioinfusion if ordered |
|
|
Term
| What causes variable decels? |
|
Definition
|
|
Term
| What causes early dccels? |
|
Definition
|
|
Term
| What causes accelerations? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are non reassuring patterns? |
|
Definition
Tachycardia
Bradycardia
Decreased or absent variability
Late decelerations
Variable decelerations
Below 70 bpm for longer than 60 sec. indicates a nonreassuring pattern
Prolonged decelerations
Hypertonic uterine activity |
|
|
Term
| What are the main things to remember with fetal monitoring? |
|
Definition
Identify the cause of the pattern
Evaluate for probable cause
Evaluate maternal vital signs
Identify prolapsed umbilical cord
Stop oxytocin (Pitocin) infusion
Reposition woman – R or L side |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What interventions should you do with nonreassurring fetal heart rate? |
|
Definition
Increase rate of infusion of a nonadditive intravenous fluid
Administer oxygen by face mask at 8 to 10 L/min
Initiate continuous electronic fetal monitoring (if not already in place)
Notify physician or nurse-midwife
Prepare for immediate delivery, if necessary |
|
|
Term
| What is fetal scalp stimulation? |
|
Definition
| Fetal scalp stimulation identifies fetal response to gentle massage. An acceleration in the fetal heart rate of 15 beats per minute for 15 seconds suggests that the fetus is in normal oxygen and acid-base balance. Accelerations often occur with vaginal examination unrelated to nonreassuring fetal heart rate patterns. |
|
|
Term
| What is vibroacoustic stimulation? |
|
Definition
| the application of a vibratory sound stimulus to the abdomen of a pregnant woman to induce FHR accelerations. |
|
|
Term
| Where does the fetal o2 monitor work? |
|
Definition
special sensor places near fetal cheek or temple
O2 sat of 30-70% normal because of high HCT/HGB
Critical for use: single fetus/36 wks/vertex/nonreassuring FHR/ruptured/2cm/-2 station
Critical Threshold=less than 30%
Technical issues (faint/debris) |
|
|
Term
| What is fetal scalp blood sampling? |
|
Definition
Ph < 7.2= acidosis
Requirements
ROM
Cervix 3cm
Used to verify FHR pattern |
|
|
Term
| When is cord blood gases and pH done? |
|
Definition
| After birth not during labor |
|
|
Term
| What is the nursing interventions r/t mother's during non reassuring patterns |
|
Definition
| Identify potential candidates/Assist/Provide comfort and reassurance/communicate and document findings and interventions |
|
|
Term
| What is a cord blood gas test? |
|
Definition
| Obtaining a blood sample to determine umbilical cord blood gas values and pH. Samples are drawn from the umbilical artery and vein. Arterial samples most closely reflect fetal oxygen and acid-base status. The samples in capped syringes may be kept for up to 60 minutes at room temperature. |
|
|
Term
| When should you document? |
|
Definition
Every 15 min during 1st Stage
Every 5 min during 2nd Stage
Before and after procedures
With changes in activity |
|
|
