Fetal Heart Rate Monitoring: Assessing Fetal Well-Being, Exams of Medicine

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AWHONN Fetal Heart monitoring basics Which contraction characteristics can be assessed with a tocodynamometer? a) Frequency b) Duration c) Intensity - ✔️✔️a) Frequency b) Duration All Fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point? - ✔️✔️Uterus The FHR can be monitored using doppler ultrasound? a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated b) Internally c) Only early in labor d) The FHR cannot be monitored by doppler ultrasound - ✔️✔️a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated What is the normal range for FHR base line in a term infant? a) 80-120 bpm b) 110-160 bpm c) 140-180bpm d) it depends on the sex of the fetus - ✔️✔️b) 110-160 bpm Trace the flow of oxygen from mother to fetus and back. - ✔️✔️Mother's inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to bloodstream in uterus. Uterus to spiral arteries to placenta to intervillous space to travel via simple diffusion into the villi. The capillaries to the umb. vein to the fetus. The umb. artery sends waste (CO2) to the intervillous space to the mothers venous system. What factors impact maternal oxygen delivery? - ✔️✔️1. Mother (blood plasma, cardiac output, hemoglobin concentration & O2 saturation) 2. Placenta/intervillous space (uterine contractions & calcification's) 3. Fetus (vagal response aka decel or cord compression) By what % does maternal cardiac output increase above the non-pregnant state and what position helps this uteroplacental blood flow? - ✔️✔️30-50% lateral recumbent or semi-Fowler's Define tachysystole contractions and the cause of. - ✔️✔️>5 contractions in 10 min (more frequently than Q 2 min) averaged over 30 min window. Caused by oxytocin, aminoinfusion or in rare cases spontaneously. List interventions for tachysystole contractions. - ✔️✔️Maintaining mat. volume, mat. positioning, intravenous hydration. Decreasing mat. pain/anxiety. 1. Reposition pt to side. 2. Admin IV fluid bolus. 3. Admin 0.25mg terbutaline SQ. 4. Admin O2 10L via non rebreather face mask. Describe passive diffusion as related to the maternal placental fetal system. - ✔️✔️higher conc. to lower concentration. 1.Oxygen from maternal (higher) to fetal compartment (lower) to fetal hgb then transported to fetal tissue. 2. CO2 returns to intervillous space by passive diffusion and is removed by the mat. venous system. Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply. A) Place the woman in a supine position. B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. D) Continuous Fetal Monitor E) Administer ephedrine per MD order - ✔️✔️Place her in lateral position, & increase IV fluids. If no improvement may need to give epi to increase vascular tone. Define maternal hypertension (gestational). - ✔️✔️systolic BP >= 140mm hg, a diastolic BP>= 90 mm hg or MAP of >=105 What is the normal expected value for a term fetal HGB? - ✔️✔️17g/dl, fetal hgb has a higher oxygen affinity than an adult to develop in an oxygen poor environment. The fetal circulatory pattern ensures blood with higher O2 and nutrition content is delivered to the vital organs (brain and heart) to tolerate the stress of labor. detail the umbilical cord - ✔️✔️1 vein, 2 arteries encased in wharton's jelly. O2 (high content) travels via the vein CO2 travels via 2 arteries back to placenta Define cord compression. - ✔️✔️A decrease of blood flow and O2 delivery to fetus & increases CO2 level in fetus. Transient cord compression can be common in labor. Variable FHR decel's is frequently associated with cord compression. Explain persistent or recurrent cord compression concerns and what to look at. - ✔️✔️May lead to hypoxemia and fetal acidemia. The depth of variable deceleration's is What is a Montevideo unit (MVU)? How do you calculate MVU's? - ✔️✔️MVU's quantify uterine activity over 10 min period, requires the use of an IUPC. Minus the resting tone from the peak intensity of each contraction in a 10 min period and add the values together. At least 200 MVU's results in progressive cervical change. How do you palpate a contraction? Describe the intensities. - ✔️✔️Using your fingertips at the fundus you can assess duration and frequency. Intensity: nose= mild chin=moderate forehead=strong Explain what a Tocodynamometer is, what it measures and its limitations. - ✔️✔️Monitors changes in the contour of the maternal abdomen caused by uterine contractions, is placed over the fundus. Can measure relative changes in pressure, duration and frequency of contractions. Can NOT measure intensity. Women with large amounts of abdominal adipose tissue can be difficult to monitor. Explain what an intrauterine pressure catheter is, what it measures and its limitations. - ✔️✔️Most accurate method of assessing uterine contractions. Inserted through dilated cervix, its sensor tip monitors changes in pressure of the amniotic fluid. Measures resting tone, duration, frequency and intensity of contractions. Can NOT be used unless membranes are ruptured. How do you determine fetal oxygenation? Name the 5 characteristics - ✔️✔️Fetal heart rate patterns 5 characteristics 1 Baseline heart rate 2 Rhythm 3 FHR variability 4 Presence of accelerations 5 Periodic or episodic deceleration's What are fetal baseline guidelines? Range? <32 weeks gest >32 weeks gest change in baseline - ✔️✔️Must be 2 min of segments. Range 110-160 BPM (represented in a multiple of 5) <32 weeks is usually high normal >32 weeks gradual decrease due to increased vagal tone. Change in baseline is >10min. What is the SA Node? - ✔️✔️It is the heart's internal pacemaker. It is specialized clump of cells at the top of the right atrium that gives electrical impulses to cause the heart to beat. The intrinsic rate is 110-160 in term fetus. Early in gestation (15-20 wks) can be much higher. In 26-28 weeks may be in the upper range of normal. Explain the sympathetic impulses of the fetal central nervous system. - ✔️✔️Generated in the fetal brainstem carried via sympathetic fibers to the heart. Increases FHR, strength of myocardial contraction of the heart and fetal cardiac output. Sympathetic stimulation influences FHR variability. The sympathetic branch of the autonomic nervous system is present very early in fetal development. Explain the parasympathetic impulses of the fetal central nervous system. - ✔️✔️Generated in the fetal brainstem carried via the vagus nerve to the fetal heart. Stimulates vagus nerve which increases fetal blood pressure, decreases firing rate at SA node and decreases FHR. Also influences the presence of fetal heart variability. The parasympathetic nervous system matures later in pregnancy. This balances out the sympathetic branch, the baseline heart rate gradually decreases toward the middle of the normal range. Is the baseline in this fetal tracing of a fetus at 40 weeks gestation normal or abnormal? - ✔️✔️Baseline FHR is 130 BPM which falls within the range of normal baselines 110- 160 BPM Is this baseline in this fetal tracing of a fetus at 26 weeks gestation normal or abnormal? - ✔️✔️Baseline FHR is 135 BPM which falls within the range of normal baselines 110- 160 BPM Is this baseline in this fetal tracing of a fetus at 24 weeks gestation normal or abnormal? - ✔️✔️The baseline heart rate is 210 BPM which is outside the range of the normal baseline of 110-160 BPM. Define fetal tachycardia and factors that contribute to fetal tachycardia. - ✔️✔️A baseline FHR of 160 BPM for at least 10 min. Contributing factors include hyperthermia, infections (maternal or fetal), maternal dehydration, hyperthyroidism, anxiety, drugs that stimulate the central nervous system, fetal immaturity, a cardiac conduction defect, or hypoxemia. Define fetal bradycardia and factors that contribute to fetal bradycardia. - ✔️✔️A baseline FHR of <110 BPM for at least 10 min. Contributing factor include stimulation the fetal vagus nerve possibly due to prolonged head compression or application of the forceps or vacuum, fetal cardiac conduction defect such as heart block, maternal hypotension and drugs that timulate the parasympathetic branch or block the sympathetic branch of the autonomic nervous system such as anesthesia and regional analgesia or hypoxemia. Hypoxic causes include maternal hypotension, placental abruption, cord prolapse or uterine rupture. Sympathetic impulses decrease or increase a fetal heart rate? - ✔️✔️increase or speed up Parasympathetic impulses decrease or increase a fetal heart rate? - ✔️✔️decrease or slow down Define fetal variability. - ✔️✔️Fluctuations in the baseline FHR that are irregular in amplitude and frequency. Visually quantified as the amplitude of the peak to the trough in BPM within the baseline range. It is an indirect measure of fetal oxygenation. Explain absent FHR variability. - ✔️✔️undetectable amplitude range can be indicative of impending fetal hypoxia Explain minimal variability. - ✔️✔️amplitude >undetectable (visually detectable but less than or equal to 5 BPM) can be indicative of impending fetal hypoxia Explain moderate variability. - ✔️✔️amplitude range 6-25 BPM Explain marked variability. - ✔️✔️amplitude range >25 BPM What does it mean to have an undulating FHR pattern? What are the causes of undulating patterns in FHR? - ✔️✔️A compromised fetus. possible causes are severe fetal anemia from RH isoimmunization, massive feto- maternal hemorrhage, ruptured vasa previa, twin to twin transfusion, fetal intracranial hemorrhage. Explain sinusoidal pattern FHR. - ✔️✔️Defined as having a smooth, sine wave-like undulating pattern in the FHR baseline with a cycle frequency of 3-5/min. that persists for at least 20 minutes. It DOES NOT represent variability. You usually see amplitudes of 5-15 BPM. You will not see any accelerations with the sinusoidal pattern. Decelerations with a sinusoidal pattern are an even more ominous sign. What is the variability? - ✔️✔️Absent-fluctuations in the FHR are not detectable. What is the variability? - ✔️✔️Minimal- Small fluctuations in the FHR, detectable but not more than 5 BPM What is the variability? - ✔️✔️Moderate-note the span of the fluctuations in the baseline FHR. They are 10-20 BPM in height. The range of moderate variability is 6-20 BPM 2. Decreased variability bc the central nervous system is not fully developed, variability may be decreased. 3. lower amplitude accels in preterm (before 32 wks) accels of at least 10 BPM above baseline for at least 10 sec is acceptable. 4. more frequent occurrences of variable decels When should an IUPC (intrauterine pressure catheter) be placed? - ✔️✔️When information can not be obtained by palpation or use of toco and if there are no contraindications to its use. i.e. increasing oxytocin w/ elevated BMI if contractions are not being detected using toco. Who may insert an IUPC? - ✔️✔️The primary obstetric provider. Name several techniques/devices of fetal monitoring. - ✔️✔️Ultrasound monitors externally FHR. Fetal Spiral Electrode (FSE) monitors internally FHR. Tocodynamometer (TOCO) monitors externally contractions. Intrauterine pressure catheter (IUPC) monitors internally contractions. Identify the 4 types of electronic instrumentation used to assess FHR and uterine activity. - ✔️✔️External- Doppler ultrasound transducer (converts movement into sound to tracing on paper) Tocodynamometer (TOCO) monitors externally contractions. Internal- Fetal Spiral Electrode (FSE) monitors internally FHR. Intrauterine pressure catheter (IUPC) monitors internally contractions. Explain the principles of the Doppler shift as related to FHR monitoring. - ✔️✔️If the reflecting surface is moving the reflected signal has a frequency change known as a doppler shift. If the reflecting surface is moving toward the signal source the frequency of the signal increases; if the frequency decreases the surface is moving away. The back and forth movement of the fetal myocardium will produce an alternately higher and lower frequency. Stationary surfaces undergo no frequency change. The US ignores all reflected signals that have the same frequency as the transmitted signal. Those signals that have undergone a frequency change - a Doppler shift- are converted into electronic signals. List the 4 steps in using the external ultrasound device. - ✔️✔️1. Performing Leopold's maneuvers. 2. Applying the conduction gel. 3. Securing the ultrasound. 4. Reading the FHR tracing. What are Leopold maneuvers are used to determine? - ✔️✔️Assess fetal lie, presentation, position and descent by abdominal palpation. This includes 4 maneuvers to assess the fetal part in the upper uterus, location of fetal back, presenting part and descent of the presenting part. List advantages and limitations of the ultrasound transducer. - ✔️✔️Advantages- detects FHR baseline, variability, accels, decels, & rhythm. Provides permanent recording of tracing. Non-invasive, can be used prior to ROM and w/o cervical dilation. Limitations-Movement may result in weak or absent tracing. Elevated BMI, fetal position, presentation & anterior placental location my affect signal quality. May double FHR if below 30 BPM and 1/2 FHR if > 240BPM. US indirectly measures Fetal heart movement. External US monitoring may restrict ambulation. Identify clinical measures for troubleshooting the ultrasound transducer. - ✔️✔️too high or low FHR pattern- *maternal pulse interference, palpate mothers pulse compare to assure differentiation. *dysrhythmia can cause unusual pattern, auscultate FHR to confirm *May double FHR if below 30 BPM and 1/2 FHR if > 240BPM, establish rate by auscultation *test button to reset *check connections *reposition the US transducer *reposition the mother *monitor by other means (auscultation or fetal spiral electrode FSE) Explain how the FSE monitors FHR. - ✔️✔️FSE is only direct method for monitoring the FHR & is less affected by outside interference. The tip if FSE is fine surgical grade wire in shape of corkscrew attached to the fetal presenting part. The electrode detects fetal heart electrical activity, sending and ECG signal to the monitor & produces PQRST waves. BPM are converted btwn R to R intervals. Describe the procedures for application and removal of the FSE - ✔️✔️The electrode is sterilely inserted through the dilated 2-3 cm cervix to the presenting part. Gently turning the electrode clockwise 1.5 turns allows the spiral tip to penetrate the top layer of skin (scalp or buttock) avoiding fontanels, suture lines, face or genitals enabling production of the the ECG. Once secure remove the introducer & attach the wires to the leg plate & secure to mothers thigh or abd near symphysis. To remove turn counter clockwise, do not pull as it can cause injury. Wires are non sterile so remove prior to C/S. List advantages and limitations of the FSE. - ✔️✔️Advantage- FSE is only direct means of assessing the FHR. Limitations- *Most will not record R-R intervals (FHR) greater than 240 BPM *Maternal pacemaker may interfere. *Requires ROM and dilated cervix. *May measure maternal heart rate in case of fetal demise. *small possibility of electronic interference and artifact although less than with external ultrasound. Discuss contraindications for use of the FSE. - ✔️✔️Contraindications- Maternal infections like HIV, Hepatitis or GBS +, complete placenta previa, undiagnosed vaginal bleeding, do not place FSE on face, fontanels or genitalia. Describe the the 4 maneuvers of Leopold's maneuvers. - ✔️✔️1. Presentation (at the inlet of the pelvis)-palpate fundus if head is at fundus. 2. Position/lie (relationship of the presenting part to the pelvis anterior, posterior or transverse) and (long axis, fetal spine long smooth hard plane longitudinal, transverse or oblique.) 3. Descent (floating or engaged) grasp abd. above symphysis pubis note contour, size, consistency of presenting part. Head is firm, globular, mobile if unengaged and immoble if engaged. Breech is smaller, softer and irregular. 4. Prominence of the head over the pelvic brim. Press in direction of the pelvic inlet for cephalic prominence. If prominence is on opposite of fetal back is likely the forehead and is in vertex or well tucked position. Explain how to trouble shoot an FSE that shows intermittent makings on the tracing rather than a continuous line. - ✔️✔️Auscultate to confirm FHR. Turn off artifact elimination switch per manufacturers instructions. Check ECG cable and leg plate using self test per manufacturer. Check placement may be dislodged or attached to cervix instead of fetus. If none of the above works than apply new FSE or monitor by other means (US or auscultation) What the possible cause for the problem with this tracing? - ✔️✔️Maternal pulse detected Intermittent markings There is no problem Turn off logic switch, check circuitry by a self test, check electrode placement, confirm FHR by auscultation What the possible cause for the problem with this tracing ? - ✔️✔️Maternal pulse detected There is no problem The FHR is abnormally low. Confirm maternal pulse by palpation and replace FSE. OR It is possible the fetus is bradycardic. What the possible cause for the problem with this tracing ? - ✔️✔️Maternal pulse detected What are the advantages and limitation of Toco? - ✔️✔️Advantages- it is external so it is non invasive and ROM is not necessary Limitations- it is location sensitive so improper placement or movement can cause uninterpretable tracing. It is not a means of assessing true resting tone or intensity so must use in conjunction with direct palpation. Toco only gives an approximate measure of duration and frequency. Reading can vary greatly based on mat. weight, mat. position, and position of belt. Select the best location for placement of Toco for a term pregnancy. - ✔️✔️top center is where you should receive the most accurate reading of uterine contractions as term. What is an Intrauterine pressure catheter (IUPC) and what does it measure? - ✔️✔️It is the only method that directly measures the uterine resting tone, contraction intensity, frequency and duration. It is an invasive procedure that requires ROM and cervical dilation. IUPC is used when there is a need for more detailed information than palpation or toco can provide. The IUPC measures hydrostatic pressure in the uterus, measuring intrauterine pressure during and between contractions. What are indications for IUPC monitoring? - ✔️✔️1. When labor and not progressing & assessment of the adequacy of the contraction is needed. 2. When the nature or event of previous uterine scarring necessitates internal monitoring 3. Amnioinfusion is required 4. Differentiation of FHR patterns relative to contractions is needed How are IUPC tracings displayed, what are normal values? - ✔️✔️Similar to toco tracings, contractions are in (mm HG) and appear as elevations from the baseline resting tone and are quantified measures of contractions intensity and resting tone. Normal baseline tone is 5-20 mmHg Mild contractions w/ peak of <40 mm Hg Moderate contractions w/ peak of 40-70 mm Hg Strong contractions w/ peak of >70 mm Hg Does this IUPC tracing show normal resting tone or elevated tone? - ✔️✔️Normal resting tone 15 mm Hg is with in normal range of 5-20 mm Hg Does this IUPC tracing show normal resting tone or elevated tone ? - ✔️✔️Elevated tone 30 mmHg is above the normal resting tone of 20-25 Does this IUPC tracing show normal resting tone or elevated tone ? - ✔️✔️Normal resting tone 15 mm Hg is with in the normal range of 5-20 mm Hg How is an IUPC intrauterine pressure catheter placed? - ✔️✔️Used to measure uterine contractions it is inserted via sterile introducer tube placed within the cervix next to the presenting part. The catheter itself is flexible is inserted into the uterus. Insertion is complete when the mark on the catheter is just visible at the introitus. Discuss troubleshooting of the IUPC - ✔️✔️*check all attachment points *verify position (can be displaced or perforated uterus or uterine rupture) have pt cough/valsalva if place correctly tracing will spike with cough simultaneously palpate abd to verify presence/absence of contractions *a tracing with no visible resting tone may be improperly zeroed. *abnorm wave form can be due to IUPC lodging against uterine wall or body part *Notify MD if none of above helps and use another method to monitor such as toco or palpation Discuss the limitations of the IUPC - ✔️✔️*IUPC is assoc w/ increased risk of uterine, placental and cord perforation. *is an invasive method *limits maternal ambulation *catheter tips may be wedged against wall or body part preventing accurate data *higher pressure readings may occur *maternal position may affect the pressure readings What should I do if the fetal heart rate baseline changes? - ✔️✔️Document what you see on the tracing. If baseline starts at 120 BPM and increases to 130BPM for 10 min or more this is a baseline change. If the FHR continues to show characteristics of a Category I tracing cont. routine assessment and doc. of variability, accels, uterine activity and other changes you observe. How often should I assess the FHR when using electronic monitoring? - ✔️✔️ACOG says if no risk factors on admission Q30min in 1st stage then Q15min in 2nd stage active pushing of labor If on oxytocin or risk factors then Q15 in 1st stage then Q5 in 2nd stage active pushing of labor List the phases of (latent/active/2nd) labor and their associated descriptions. - ✔️✔️latent phase <4cm latent phase 4-5cm active phase >6cm second stage passive fetal descent second stage active pushing What should I do if the mothers palpated pulse matches what I hear coming from the monitor? - ✔️✔️It is likely the tracing is showing the maternal heart rate not the FHR. Readjust the monitor, searching for fetal heart tones, using leopold's maneuvers also assess for for signs of fetal oxygenation with fetal movements. Oxygenation can not be assumed or confirmed without assessing the FHR. When should the fetal spiral electrode (FSE) be applied? - ✔️✔️When the US is not recording a consistent tracing. Cervix should be 1-2 cm dilated and there should be no contraindications to the procedure per the maternal history and labor status. This instrument: -Is used to internally monitor contractions. -Provides absolute, rather than relative, measurements. -Carries with it a slightly increased chance of uterine infection. A. Doppler Ultrasound B. Fetal Spiral electrode C. Tocodynamometer D. Intrauterine pressure catheter - ✔️✔️D. Intrauterine pressure catheter This instrument: -Is used to externally monitor the fetal heart rate. -Is noninvasive and can be placed without rupture of membranes. -May be affected by maternal or fetal motion. A. Doppler Ultrasound B. Fetal Spiral electrode C. Tocodynamometer D. Intrauterine pressure catheter - ✔️✔️A. Doppler Ultrasound This instrument: -Is used to eternally monitor uterine contractions. - Is noninvasive and can be placed without rupture of membranes. -Cannot detect uterine resting tone or exact intensity of contractions. A. Doppler Ultrasound B. Fetal Spiral electrode C. Tocodynamometer D. Intrauterine pressure catheter - ✔️✔️C. Tocodynamometer This instrument: -is used internally to monitor fetal heart rate. -detects fetal heart rates up to 240 bpm -requires rupture of membranes and cervical dilation for placement. A. Doppler Ultrasound B. Fetal Spiral electrode C. Tocodynamometer D. Intrauterine pressure catheter - ✔️✔️B. Fetal Spiral electrode What is a prolonged deceleration? - ✔️✔️a visually apparent decrease in FHR below the baseline rate of 15 bpm or more and lasting > 2 minutes but < 10 minutes, prolonged decels are usually isolated events that end spontaneously. Prolonged decel's typically have an abrupt onset, reach the nadir in <30 sec, and are in response to a sudden significant change in the fetal environment. IF > 10 min it is a baseline change. With prolonged decelerations, further maternal and fetal assessment is needed to determine if immediate intervention is needed. Describe this tracing: A. Accelerations B. Early Decelerations C. Variable decelerations D. Late decelerations E. Episodic deceleration - ✔️✔️D. Late decelerations notice the gradual decrease in baseline that follows the peak of each contraction. Describe the variability in this tracing: A. Absent B. Minimal C. Moderate D. Marked - ✔️✔️A. Absent notice the smoothness of the tracing indicating absent variability. This tracing shows: A. Tachycardia B. A baseline within normal range C. Bradycardia - ✔️✔️B. A baseline within normal range The baseline is 150 BPM which is within the range for normal fetal baseline heart rate. Define a category I (normal) fetal heart rate tracing. - ✔️✔️Category I (normal) FHR tracings are normal & predictive of normal fetal acid-base status at that time. No action is required. Baseline FHR rate: 110-160BPM Baseline FHR variability: moderate Accelerations: present or absent Late or variable decelerations: absent Early decelerations: present or absent What is Scalp Stimulation? - ✔️✔️A method of assessing fetal acid-base status through vigorously rubbing the fetal head with a gloved hand to elicit an acceleration. This is dune when FHR is at baseline. Do not do during a deceleration to attempt to increase the FHR. A well-oxygenated fetus will respond with an acceleration of 15 BPM or more for > 15 seconds. This is a reliable prediction of the absence of fetal metabolic acidemia at that time. This does not predict fetal acidemia or fetal compromise. Stimulation is not needed if the tracing has category I characteristics. What is vibroacoustic stimulation? - ✔️✔️The response of the FHR to a vibroacoustic stimulus. An acceleration on NST (> 15 bpm for > 15 sec) is a positive result. An acceleration in response is an indicator of fetal oxygenation. Useful adjunct to decrease the time to achieve a "reactive" NST (R-NST) and to decrease the proportion of non-reactive NST at term, precluding the need for further testing. Define a category II (indeterminate) fetal heart rate tracing. - ✔️✔️Category II (indeterminate) FHR tracings are indeterminate & not predictive of abnormal fetal acid- base status at that time. They do not reliably correlate with positive outcomes and require an evaluation and continued surveillance and reevaluation with review and consideration of all clinical factors. Interventions should be initiated appropriate to the situation, physician notified, and documentation. Baseline FHR rate: Bradycardia not accompanied by absent variability or tachycardia Baseline FHR variability: Minimal baseline variability, absent baseline variability not accompanied by recurrent decelerations, marked baseline variability Accelerations: the absence of induced accelerations after fetal stimulation Periodic or episodic decelerations: -recurrent variable decelerations accompanied by minimal or moderate baseline variability -Prolonged deceleration > 2 min but < 10 min -Recurrent late decelerations wi Define a category III (abnormal) fetal heart rate tracings. - ✔️✔️Category III (abnormal) FHR tracings are predictive of abnormal fetal-acid base status at that time & may be indicative of current or impending fetal asphyxia so sever that the fetus is at risk for injury & include: Absent FHR baseline variability with recurrent late decels, with recurrent variable decels, with bradycardia or sinusoidal patterns. They require prompt evaluation and resolution. Interventions include oxygen via non- rebreather mask, changing position, d/c of oxytocin and treatment of maternal hypotension. Classify the tracing as I, II or III and explain. - ✔️✔️Category II it shows tachycardia and minimum variability. Explain and classify the tracing as I, II or III. - ✔️✔️Category II shows recurrent variable decelerations and a prolonged deceleration. Although recurrent variable decelerations appear, moderate baseline variability is still present. Note the presence of a prolonged deceleration may indicate a decline in fetal acid-base status so it may be trending towards a category III. Classify and explain this tracings as I, II or III. - ✔️✔️Category III Shows tachycardia, recurrent late decelerations and absent variability. Classify and explain the tracing as I, II or III. - ✔️✔️Category I Shows normal FHR baseline, moderate variability, and accelerations. Normal baseline, moderate variability, accelerations, and decelerations absent meet criteria for Category I tracing. What are the interventions for category I, II and III? - ✔️✔️Generally, the goal of all 3 categories is fetal oxygenation. You are determining the impact of contractions on fetal oxygenation. Category I- (normal) no intervention fetus is sufficiently oxygenated. Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. Category III- (abnormal) fetal oxygenation is severely compromised resulting in hypoxemia and possible acidemia. What is intrauterine resuscitation? - ✔️✔️Intrauterine resuscitation's refer to interventions done to correct Category II (indeterminate) and category III (abnormal) FHR characteristics : shifting maternal position, maternal IV hydration, administering oxygen and reducing pain and anxiety and modification of maternal pushing efforts during the 2nd stage of labor. Also you could stop oxytocin for recurrent late decels or diminishing FHR variability. You can add tocolytic's to reduce uterine activity. Terbutaline can be given to reduce excessive uterine activity (tachysystole) Explain the pharmacologic interventions used for intrauterine resuscitation. - ✔️✔️You could stop oxytocin for recurrent late decels or diminishing FHR variability. You can add tocolytic's to reduce uterine activity. Terbutaline can be given to reduce excessive uterine activity (tachysystole). Anesthesia may = vasodilation/ mat hypotension to prevent normally prehydrate IV 500/1000ml crystalloid. Mat. hypotension can cause FHR tracing w late declel's, prolonged decels or bradycardia. Treat w epinephrine /norepinephrine = vasoconstrictions & improves utereoplacental blood flow. Amnioinfusion (NS or LR) can resolve cord compression in cases of oligohydramnios and variable decelerations. Which of the following fetal heart rate characteristics does the tracing show: Acceleration Early decelerations Variable decelerations Late decelerations Episodic decelerations - ✔️✔️Accelerations The variability in this tracing is: Absent Minimal