Chapter 9 OB Fetal heart rate assessment PDF

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This document is a summary very well organized and with the most important information of chapter 9....

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Chapter 9 Fetal heart rate assessment Normal FHR 110-160 bpm UCs → 160 bpm lasting >10 min) ● Stress anxiety ● Premature ● Arrhythmia ● Infection ● Illicit drugs Variability ● ●

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Fluctuation of the baseline of >2 cycles/min Absent ○ Not goof ○ Causes: metabolic acidosis Low ○ 25 bpm ○ Causes: possible fetal hypoxia

Acceleration ● ● ● ● ● ●

It is good to see them Increases FHR by 15 bpm for at least 15 sec BUT not more than 2 min 15x15 Periodic acceleration → coincides with contractions Episodic acceleration → independent from contractions Prolonged accelerations → last>2-10 seconds 10x10

Deceleration Early

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Coincide with contractions Mirror imagine vagal nerve stimulation Associated with → HEAD COMPRESSIONS Gradual decrease of the FHR and return to baseline in 30 sec

Variable ● ABRUPT change in the FHR ● Tend to be V or W shaped ● Associated with → CORD COMPRESSIONS ● Each variable is different ● It takes 10-15 seconds to return to baseline ● Decrease of >15 bpm for > 15 sec but 60 bpm ○ fetal acidosis Late ● ● ● ● ●

BAD Gradual decrease of the FHR and return to baseline Occurs AFTER the peak of the contraction Delayed Associated with → PLACENTA INSUFFICIENCY

Contractions The intensity of contractions → PALPATION ● Mild 1+ nose ● Moderate 2+ chin ● Strong 3+ forehead External electronic fetal and uterine monitoring ● ● ●

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Detects baseline, variability, accelerations, and decelerations Also to assess uterine contractions FHR ○ Use Leopold's maneuver to locate fetal back ○ Apply ultrasound gel to the FHR ultrasound transducer and place it on the woman's stomach at the FETUS BACK ○ Move transducer until a clear signal is heard ○ Secure it with a belt UCs ○ Place uterine sensor (tocodynameter) in the fundal area when it feels strongest to palpation ○ Secure monitor with a belt

Internal electronic fetal and uterine monitoring

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Uses fetal scalp Placed during a vaginal exam Contraindications ○ Chorioamnionitis (infection in the amniotic fluid) ○ Active maternal genital herpes ○ HIV ○ Positive group B ○ Placenta previa/undiagnosed vaginal bleeding FHR ○ A vaginal exam is performed and the guide tube attaches to the fetus ○ Membranes must be ruptured for placenta and cervix dilated to 2 cm UCs ○ Review manufacturer directions ○ The guide tube is inserted through a vaginal exam through the cervix into the amniotic cavity ○ Membranes must be ruptured for placement and cervix dilated 2 cm

FHR 3 tier categories Category I ● Well-oxygenated and normal acid-base balance ● No interventions needed ● Baseline 110-160 ● late/variable deceleration absent ● Moderate variability ● Early decels absent/present ● accelerations absent/present Category III ● Abnormal ● EMERGENCY ● Absent variability ○ Recurrent late decels ○ Recurrent variable decels ○ Bradycardia ○ Sinosund pattern Category II ● Everything else Interventions ●

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Promote fetal O2 ○ Move mother to a lateral position ○ Stop oxytocin ○ Administer O2 10L/min Reduce uterine activity ○ Stop oxytocin ○ Tocolytics ■ Indomethacin

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■ Magnesium sulfate ■ Nifedipine Alleviate umbilical cord compression ○ Repositioning ○ Altering pushing Correct maternal hypotension ○ IV bolus ○ Repositioning...