Intrapartum Fetal Surveillance

Chapter 14 Intrapartum Fetal Surveillance a. Amnioinfusion - infusion of a sterile solution into the amniotic cavity to reduce cord compression b. Baseline FHR - FHR when uterus is at rest c. Variable decels - caused by compression of the fetal umbilical cord d. Periodic FHR changes - temporary recurrent changes in the FHR e. Tocolytic - drug that reduces uterine muscle contractions f. Uterine resting tone - muscle tension when uterus is not contracting g. Variability - fluctuations in the baseline FHR 2. Explain how each of the following factors can reduce fetal oxygenation. How would you explain each to a laboring woman in simple terms? a. Maternal hypotension -Some meds, such as an epidural can cause mom’s blood pressure to drop significantly, this will decrease blood flow to baby as well as oxygen to baby to decrease. b. Severe range maternal BP c. Maternal hypoxia -If mom is hypoxic than she is not receiving enough oxygen, which then leads to baby not receiving enough oxygen as well. d. Tachysystole e. Umbilical cord blood flow compression -If the umbilical cord is compressed this is reducing blood flow and oxygen to baby. The umbilical cord is the baby’s lifeline. f. Fetal bradycardia/tachycardia -bradycardia can be due to hypoxia or mom not getting enough oxygen which reduces baby’s oxygen. Bradycardia in baby is less than 110 10min. -Tachycardia can be an early sign of hypoxia, if mom has an infection, or side effects from meds or drug use. This can affect moms breathing and reduce blood flow to baby. Tachycardia is greater than 160 10min 3. Define these terms, which describe the FHR a. Normal: 110 - 160bpm b. Bradycardia: less than 110 bpm that last for 10 mins; rate of 100-110bpm may be normal in the term fetus c. Tachycardia: greater than 160bpm that last for 10 mins 4. List factors that might decrease variability Maternal: narcotics or other sedatives, recent alcohol/drug ingestion; acidemia/hypoxemia Fetal: tachycardia, prematurity, decreased CNS oxygenation, abnormalities of CNS or heart; anomalies that may affect FHR, fetal sleep, magnesium 5. Why is variability an important component of fetal heart pattern evaluation? Under what circumstances might variability normally be minimal? Why? Variability is the most predicative info we have that baby is tolerating labor and oxygenating. Variability reflects normal fxn of the ANS, which helps the fetus adapt to the stress of labor. Minimal variability might be normal in prematurity or fetal sleep or after maternal narcotic or sedative administration because these conditions don’t reflect reduced nervous system oxygenation. Fetal sleep would be temporary, & variability should reappear when the fetus awakes. Narcotic effects would last longer but would still be temporary. 6. Periodic Change Appearance on Strip Possible Causes Reassuring or Nonreassuring (w/ Nursing Actions) Accelerations Early deceleration Consistently uniform; inversely mirrors the contraction When there is a contraction the HR of the baby goes down at the same time. This is caused by a vagal nerve stimulation & the head is getting compressed. After contraction, FHR goes back up. Reassuring Late decelerations FHR occurs after the contraction has started Due to placental insufficiency: from how old the placenta is or preeclampsia, HTN, DM, cardiac disease = anything Nonreassuring -Turn position: left lateral -stop pitocin/give tocolytic -put mom on cardiac monitor