OB Exam 1

The top of the fetal monitor shows the…

FHR

The bottom of the fetal monitor shows the…

uterine activity

FHR is assessed by….(4)

baseline, variability, accelerations, decelerations

What is the FHR Baseline?

average FHR over 10 mins

Normal FHR Baseline? (round to nearest ___bpm)

100-160bpm, 5

Bradycardia FHR Baseline is…

<110 for >/= 10 mins

Bradycardic FHR Baseline is caused by…(5)

low O2, cord problems, meternal hypotension, hemorrhage, meds

Tachycardia FHR Baseline is…

>/= 160bpm for >/= 10 mins

Tachycardic FHR Baseline is caused by…(4)

maternal fever, prematurity, abnormal fetal rhytmn, terbutaline

Variabilities are little FHR ___________ that reflect _______ _____________ and _________ _______________.

fluctuations, CNS function, fetal oxygenation

What are the 4 types of FHR Variability?

absent, minimal, moderate, marked

Absent Variability

• concerning

• ________________ variability

undetectable

Minimal Variability

• ___-____ bpm

• caused by ________, sedation, and ____________

1,5, sleep, hypoxemia

Moderate Variability

• ____-____ bpm

• ___________!

6, 25, normal

Marked Variability

• > ____bpm

• unclear significance

25

What is it called FHR goes up?

acceleration

For a qualifying FHR acceleration…

• it must be ____ bpm above the baseline

• for at least ______ seconds

15,15

FHR Accelerations indicate

• good fetal _____________

• intact _______

• fetal well-being

oxygenation, CNS

What are the 4 kinds of FHR Decelerations?

early, late, variable, prolonged

Early Deceleration = ________ ____________

• gradual

• mirrors the ____________

• benign

head compression, contractions

Late Deceleration = _______________ _______________

• gradual

• starts _________ contraction ________

• _______ occurs after _________ of contraction

• CONCERNING because fetus may not be getting enough _____.

uteroplacental insufficiency, after, begins, nadir, peak, O2

Variable Deceleration = __________ _____________

• ____________ drop and ____________return to baseline

• can look like a ____, ____ or _____.

• 
  

cord compression, abrupt, abrupt, v, u, w

Prolonged Deceleration = ______________ _______________

• lasts ____-_____ mins

• related to interrupted ___________ supply

oxygen problem, 3, 10, oxygen

Which 2 kinds of FHR deceleration are cause for concern?

late and prolonged

When checking Uterine Activity, Assess…(4)

frequency, duration, intensity, and resting tone

How often contractions happen

frequency

Measure Frequency from _______ of one contration to _______ of the next

start, start

How long each contraction lasts

duration

Duration is measured from _______ to ________ of same contraction

start, end

How strong the contraction is

intensity

Intensity is measured by ___________ or with _______.

palpation, IUPC

Intensity measured with palpation from ________, ____________, to _______________

mild, moderate, strong

Intensity measured with IUPC in ________ and can calculate _______.

mmHg, MVU

What the uterus is like between contractions

resting tone

Resting tone can be measured by…(2)

palpation and IUPC

Resting tone can be _______ or ________.

soft, rigid

too many contractions

tachysystole

Tachysystole is when > ____ contractions happen in ______ mins.

5, 10

Tachysystole can decrease _______ ______________ because uterus doesn’t have time to rest

fetal oxygenation

Tachysystole is extra concerning if __________ in running.

oxytocin

What are 2 main Fetal Monitoring Methods?

external and internal

What are 2 kinds of External FHR monitors?

ultrasound transducer, toco

Ultrasound Transducer is placed over ________ _________ (where FHR is best heard) via ________________’s ________________.

fetal back, Leopald maneuver

Ultrasound Transducer measures ______

FHR

Toco measures __________ _______________

uterine contractions

Toco is placed near the _______ (top of the uterus)

fundus

Fetal Scalp Electrode (FSE)

• measures______ ___________ through _______

• Invasive

• electrodes attached to _______ _________

FHR directly, ECG, fetal scalp

Intrauterine Pressure Catheter (IUPC)

• measures _________ ___________

• provides a __________ measurement

• mmHg

• can measure _________ and _____’s

uterine pressure, direct, intensity, MVU

Both Internal FSE and Internal IUPC both require ________________ ______________ and ______________ _________.

ruptured membranes, dilated cervix

Intrauterine Resusitation includes…(4)

position, fluids, O2, and stop oxytocin

Intrauterine Resuscitation

• turn pt to _______ to increase uterine _______ _______ and relieve ___________ ____________.

side, blood flow, cord compression

Repositioning the mom on her side (during intrauterine resuscitation) is used for…(4)

variables, lates, prolonged decelerations, and maternal hypotension

IV Fluid Bolus (during intrauterine resuscitation) should be _______-________ mL of ______________ _____________.

300, 500 lactated ringers

300-500mL LR’s Fluid Bolus (during intrauterine resuscitation)

• increases maternal ______________ ___________ and ______________ ___________ _________

circulating volume, uterine blood flow,

300-500mL LR’s Fluid Bolus (during intrauterine resuscitation) is used for…(2)

decelerations and maternal hypotension

Oxygen (during intrauterine resuscitation) should be delivered via ______________ _________ at ____-____L/min

rebreather mask, 8,10

Oxygen given (during intrauterine resuscitation) improves maternal and fetal _____________.

oxygenation

Oxygen given (during intrauterine resuscitation) is used for…(2)

decelerations, and dec maternal SpO2

Decreasing Uterine Stimulation (during intrauterine resuscitation) can be done by…

stopping oxytocin

Decreasing Uterine Stimulation (during intrauterine resuscitation)

• if the uterus is still TOO FIRM, or contractions are EXCESSIVE, give _____________ ______ mg ________.

terbutaline, 0.25, SubQ

Uterine stimulation is decreased by stopping oxytocin, leading to…

• decreased ________________

• increased _______________ _________ and _____________ __________ _______.

contractions, resting time, placental blood flow

Amnioinfusion is used for…

recurrent variable decelerations

rupture of membranes decreases ______________ fluid and can cause _________ ____________.

amniotic, cord compression

Amnioinfusion works by adding fluid around the ________, providing a cushion to reduce cord compression.

cord

Fluid is infused during amnioinfusion via ________.

IUPC

What 2 fluids can be used for amnioinfusion?

LR or NS

Two things to do after giving Amnioinfusion

• check pad for _________ __________

• avoid _________ ______________

fluid return, uterine overdistension

FHR Strip Cheat Sheet

• Baseline: is it _____-______?

• Variability: is it moderate ______-______?

• Acceleration: do I see _____x______?

• Deceleration: What kind?

• Contractions: How __________, __________, _________, is uterus ____________?

110, 160, 6, 25, 15, 15, long, strong, often, relaxing

Category 1

• _____-_____ bpm

• ___________ variability

• _____ late or variable decels

110, 160, moderate, no

Category 2

• doesn’t qualify for ____ or _____.

1,3

Category 3

• __________variability

• PLUS ______________ ________ or _____________ decels, _____________, or _____________ pattern

absent, recurrent late, variable, bradycardia, sinusodial

Fundus should decend ____-____ cm/day postpartum

1,2

Uterus should be nonpalpable about _____ _______ post partum

2 weeks

Uterus should be fully involuted around _____ ________ postpartum

6 weeks

Afterpains are expected ____-_____ days postpartum

2,3

Lochia should go from ________, _________, to ________.

rubra, serosa, alba

Rubra

• ______ color

• expected ____-____ days postpartum

red, 3,4

Serosa

• _______/_______ color

pink, brown

Alba

• _________/________ color

• can last ____-____ ________ postpartum

yellow, white, 4,8

Bowel Movement postpartum should take ____-_____ ______

2,3, days

Baby blues is expected to occur during first _____ ________ postpartum.

2 weeks

Mature Milk should come in _____-______hrs postpartum

72, 96

The Cervix is _______ immediately after birth then becomes _______ over _____-_____hrs

soft, firm, 12, 18

Lochia should NOT be _______ ___________

foul smelling

What healthcare professional should the nurse involve for…

• breastfeeding difficulty?

• Postpartum mood/anxiety disorder? (2)

• community/family needs?

lactation specialist, psych, PMAD specialist, community agencies/resources

What is uterine atony?

uterus isn’t contracting/firming properly

What does Uterine atony cause?

postpartum hemorrhage

What is the leading cause of PPH in the first hour?

uterine atony

If the uterus is boggy (not firm), what is the priority intervention?

fundal massage

Excessive bleeding post-partum may occur from… (2) if the fundus is FIRM

unrepaired laceration or hematoma

For a patient with heavy Bleeding postpartum and a firm uterus what 2 things are most likely the cause?

laceration/hematoma

What are 5 symptoms of Endometritis?

chills, tachycardia, fever, tender uterus, foul smelling lochia

What is the treatment for Endometritis?

broad spectrum IV antibiotics

Endometritis is a post-partum infection associated with…

• _____- ___________

• prolonged ______ or ________

• ____________ placenta

• __________

• __________

• hemorrhage

C, section, labor, ROM, retained, diabetes, anemia

Why are postpartum patients at risk of DVT/VTE? (2 main reasons)

hypercoaguability, venous stasis

Risk factors that contribute to DVT/VTE

• ____-_________

• ___________ or HTN disorders

• __________/ decreased mobility

• smoking

• ____________ veins

c section, preeclampsia, bedrest, varicose

What is the main way to prevent postpartum DVT/VTE?

early ambulation

Engorgement happens ____-_____ hrs postpartum

72, 96

Engorgement 72-96 hrs postpartum is ______ and _________-.

hard, painful

What are some interventions for Engorgement?

• frequent _________

• _________ ____________ or shower before feeds

• ________ between feedings

• __________

• ____________ specialist

feeding, warm compress, ice, analgesics, lactation