FHR Evaluation
Uterine Evaluation
Periodic Changes in FHR
Interpretation of FHR
Labor Review
100
What are the 3 things we evaluate FHR for?
Baseline Variability Periodic Changes
100
What are the 4 things we evaluate uterine activity for?
Ctx frequency Ctx intensity Ctx duration resting tone
100
Define acceleration
Abrupt, temporary increase in FHR 15 beats above the baseline for 15 seconds. Reassuring Prolonged acceleration = >2 min <10 min > 10 min = change in FHR baseline
100
Name the 3 categories for interpretation of FHR
Category I - reassuring Category II - Indeterminate (equivocal / ambiguous ) Category III - Abnormal ( Non-reassuring )
100
Hallmark of true labor
Cervical change
200
What is the normal FHR baseline?
110-160 bpm
200
What is ctx frequency
How often From beginning of one to the beginning of the next
200
Define early deceleration and what causes them
Gradual decrease from baseline Mirrors contraction Cause: Fetal head compression No treatment necessary
200
Give 3 examples of a non-reassuring FHR
Late decels, prolonged decels, persistent variables, brady, tachy, lack of variability.
200
Describe the first stage of labor
1-10cm latent to 3-4cm active 4-7 cm transition 8-10cm
300
What are periodic changes - give 2 examples:
Accelerations and decelerations
300
What is ctx intensity
How strong Only measurable through palpation and IUPC
300
Define late deceleration and what causes them
FHR slows AFTER uterine ctx has ended. May not dip below normal FHR norms. NON REASSURING Uteroplacental Insufficiency Tx: Change moms position, oxygen, increase IV fluids, discontinue Pitocin, notify provider
300
What is the priority intervention for a non-reassuring FHR pattern. Hint: What do have to do before we can fix it?
Identify the cause
300
Define the second stage of labor
10cm - birth Pushing
400
What does variability tell us and name the 4 classifications
"best indicator of fetal-well-being" shows fetus is oxygenated cardiac-neural pathways are intact Undetectable, minimal ( < 5 bpm), moderate (6-25 bpm), marked (> 25 bpm) Effected by anesthesia, fetal sleep, alcohol, fetal sepsis, prematurity, fetal hypoxia, acidosis
400
What is ctx duration and uterine resting tone?
How long it lasts Relaxation between ctx
400
Define variable deceleration and the cause of them
May or may not be connected to a ctx "V" shape Umbilical cord compression Tx: Think of things to relieve cord compression Become worrisome if they persist or also have decreased variability with FHR < 70bpm
400
Other interventions for non-reassuring FHR patterns include:
Position Turn off Pitocin O2 Increase IV fluids Internal fetal monitoring if not contraindicated
400
Define the third stage of labor
Placenta delivery
500
Define fetal bradycardia AND fetal tachycardia
Brady <110 bpm for 10 minutes pushing, anesthesia, hypotension, hypoxia/acidosis, head compression, heart block Tachy >160 bpm for 10 min. mat. temp, infection, dehydration, hypoxia, anemia, hypothyroid, fetal anemia, hypoxia, acidosis, cardiac arrhythmias
500
Examples of uterine ctx intesity by palpation are:
Mild = nose Moderate = chin Strong = forehead
500
How long must a periodic change in FHR be present before it is considered a change in baseline?
> 10 minutes
500
All else fails - what next????
C/S Urgent Emergent 30 minute from decision to incision
500
What is the cause of the onset of labor?
Unknown
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