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fetal assessment

fetal assessment during labor

baseline fhr the mean heart rate over 10 minutes, a single number rounded to the nearest 5bpm, is determined in the absence of accelerations and decelerations
Absent, minimal, moderate, marked amplitude range undetectable. amplitude greater than undetectable but less than or equal to 5bpm. amplitude 6bpm-25bpm. greater than 35bpm
Accelerations are abrupt increase in FHR, defined as an increase from onset of accel to peak in <30 seconds. The peak must be > or equal to 15bpm and accel must last longer than 15 seconds
Causes of decreased FHR maternal medications, fetal sleep cycle, fetal CNS anomalies, prolonged fetal hypoxia, fetal tachycardia
Fetal Bradycardia : less than 110at least 10 minutes. Bradycardia is a result in persistent increase in fetal parasympathetic tone. Caused by medications such as labetolol, umbilical cord prolapse, maternal supine position
Fetal Tachycardia : greater than 160 for 10minutes; Is a result of an increase in fetal sympathetic nervous system tone and a decrease in Parasympathetic nervous system. Caused by maternal fever or infection, chronic fetal hypoxemia, illicit drug use.
Uterine Contractions (UT) can cause changes by causing fetal head compression, umbilical cord compression, altering the exchange of nutrients from mother to fetus (placental)
Normal UT and Tachysystole <5 contractions in 10 minutes, averaged over 30 minutes. >5 contractions in 10 minutes, averaged over 30 minute
Contraction intensity, frequency, duration, is the strength of IUP above baseline of uterine tone. interval between the beginning of one contraction and the beginning of the next. length of time in seconds from the beginning of the contraction to its resolution
IUPD device used to measure strength of uterine contraction
Periodic patters and Episodic patters patterns of FHR associated with contractions. patterns of FHR not associated with contractions
Decelerations are recurrent if they occur at greater than or equal to 50% of UC in any 20 minute segment. Decelerations less than 50% of the UC in any 20 minute segment is intermittent
Late Decelerations Shallow, uniform decelerations characterized by a gradual decrease from baseline, beginning after the contraction has started, returning to baseline after the contraction ends. placental compression. Change position, elevating legs. Admin oxygen
Early Decelerations : A gradual decrease in the baseline FHR with a nadir in greater than or equal to 30 seconds that returns to baseline, occurring simultaneously with a uterine contraction. Head compression, are considered benign no interventions needed.
Category I : baseline 110-160, variability moderate (6-25bpm), late or variable are absent, early present or absent, accelerations are present or absent
Category II Bradycardia not accompanied by absent baseline variability (undetectable) and tachycardia
Category III Absent baseline FHR variability (amplitude range is undetectable) Recurrent late decelerations, Recurrent variable decelerations, bradycardia
5 components of FHR tracing baseline rate, baseline variability, accelerations, decelerations and changes or trends in the FHR patterns over time
Variable Deceleratiosn Caused by umbilical cord compression. Change maternal position, discontinue oxytocin, administer oxygen,
Tycolysis therapy relaxation of the uterus though admin of drugs to inhibit UC. improves blood flow through placenta by inhibiting UC, when position change, disc oxytocin don’t work. Terbutaline shown to improve Apgar score & cord pH value w/o apparent complications.
Tycolysis therarpy management Position on her side to enhance placental perfusion, monitor VS, determine fluid balance by weight and I&O, limit fluid to 1500-2500 especially if on magnesium sulfate. Magnesium sulfate is most commonly used
First stages of labor onset of regular UC and ends with complete cervical effacement and dilation
second stage of labor full cervical dilation and complete effacement and ends with the baby’s birth
Third stage of labor birth of baby until the placenta is expelled.
Fourth stage or labor first 1-2 hrs after labor
Preterm labor describes length of gestation, cervical changes and UC occurring between 20-37 weeks. Caused by infection, latrogenic pregnancy complications, sociodemographic factors.
life style risks of preterm labor riding long distances in a car or bus, carrying heavy loads, standing more than 50% of the time, heavy housework or climbing stairs, hard physical work
Low birth weight weight at birth, 2500 g or less.
bed rest commonly used for prevention of preterm birth. No evidence to support effictiveness in reducing preterm birth rates
management of inevitable preterm birth cervical dilation of 4cm likely to have premature birth. Tertiary care centers lead to better neonatal outcomes. First dose of antenatal glucocorticoids should be given before transfer.
Promoting lung maturity antenatal glucocorticoids, NIH recommends for all women at risk for preterm. Not indicated if cord prolapse, choriamnionitis and abruption placentae
Premature rupture of membranes rupture of amniotic sac & leakage of fluid beginning at least 1 hr before onset of labor at any gestational age. Occurs in 25% of premature cases. Often proceeded by infection. Diagnosed after woman complains of sudden gush or slow leak of vaginal fluid
Dystocia long, difficult, abnormal labor. From a big baby (check arms and clavicle for breaks). Caused by body build, uterine abnormalities, position of fetus, over stimulation with oxytocin. Precipitous labor: lasts <3 hrs from onset of contractions to birth.
oxytocin stimulates uterine contractions. Used to induce labor or augment a labor progressing slowly because of inadequate uterine contractions. Caution in multifetal, breech presentations, abnormal fetal heart rate, maternal cardiac disease.
Amnioinfusion isotonic fluid into the uterine cavity when amniotic fluid is low. Used to diminish cord compression. Also used to dilute moderate to thick meconium to prevent meconium aspiration, 1,000mL of fluid is needed.
uterine dysfunction abnormal uterine contractions that prevent normal progress of cervical dilation, effacement or descent. Risks include body build, uterine abnormalities, position of the fetus, maternal fatigue, dehydration and electrolyte imbalance and fear.
uterine dysfunction hypertonic Usually occur in latent stages, uterus may not relax completely between contractions. Therapeutic rest by a warm bath and administration of analgesics to inhibit uterine contractions, reduce pain and encourage sleep.
uterine dysfunction hyportonic more common type. Normal progression into labor; contractions become weak & inefficient or stop altogether. Intrauterine pressure during the contraction is insufficient for progress of cervical effacement & dilation. CPD & malposition most common causes.
treatment of uterine dysfunction ultrasound to determine fetal positioning & assess FHR, characteristic of amniotic fluid if membranes ruptures, findings normal such as ambulation, hydrotherapy, enema, stripping or rupture of membranes, & oxytocin infusion can be used to augment labor.
c/section transabdominal incision of uterus, consistent abnormal FHR, abnormalities, umbilical cord prolapse, dysfunctional labor patterns & multiple gestation are inc causes.
Complication of c/section maternal aspiration, wound infection, UTI, injuries to bladder, uterus or bowels, hemorrhage.
vaginal birth after cesarean indications for c/section such as dystocia, breech presentation or fetal distress often are nonrecurring. After a c/section she may not have any contraindications to labor and vaginal birth in that pregnancy and may attempt a vaginal birth after cesarean
prolapsed umbilical cord when cord lies below resenting part of fetus. Long cord (longer than 100cm), malpresentation (breech), transverse lie and unengaged presenting part
S/S preterm labor UC more frequent than q10min, persisting for 1 hr. UC become more painful/painless. Lower abdominal cramping, intermittent low back pain, suprapubic pain. Change usual discharge: thinker/ thinner, bloody, brown, increased amount, odor
Promotion of fetal lung maturity antenatal glucocorticoids given IM to mother accelerate fetal lung maturity. All women 24-34 weeks given this when preterm birth is a threat unless medically indication for immediate delivery; cord prolapse, chorioamnionitis or abrupto placentae.
Preterm premature rupture of membranes take temp & pulse q4h, report temp >38C, remain on modified bed rest, insert nothing in the vagina, assess for UC, do fetal movement counts daily, do not take tub baths, take antibiotics if prescribed.
forceps assisted birth compression of the cord between the fetal head and the forceps causes a drop in FHR, the FHR and pattern are checked, reported and recorded before and after forceps are applied. If a decrease n FHR occurs the physician can remove and reapply the forceps
Created by: smarti13
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