W 10 star: FHR & Uterine Activity

How is fetal heart rate measured?

1. external monitoring → intermittently auscultated → with doppler, fetoscope

2. external monitoring → done continuously → with EFM transducer (electronic fetal monitoring transducer)

3. internal monitoring → done continuously → with a fetal scale electrode (FSE)

How is uterine activity measured?

1. external monitoring → intermittently observing patient behavior or palpating uterine tone

2. external monitoring → done continuously → with a tocodynamometer (toco) pressure transducer applied to the maternal abdomen (on uterine fundus)

3. internal monitoring → done continuously → with an intrauterine pressure catheter (IUPC) placed inside the uterine cavity

What is baseline in FHR?

average resting FHR over a 10 min window

What is variability in FHR?

fluctuations in baseline FHR from beat to beat (peak to trough)

What is accelerations in FHR?

• increases in FHR (at least 15 bpm lasting 15sec - 2min)

• usually when something happens (ie; baby moves)

• usually reassuring

What is decelerations in FHR?

dip in FHR than normal baseline (4 different types)

What is onset in uterine activity?

start of a contraction5

What is increment in uterine activity?

contraction strength building/increasing/going up

What is peak in uterine activity?

highest point of contraction, max strength

What is decrement in uterine activity?

contraction strength decreasing

What is duration in uterine activity?

how long a contraction lasts (onset to end of contraction)

What is frequency in uterine activity?

time from onset of one contraction to onset of next contraction

What is normal baseline FHR?

Normal: 110 - 160 bpm

What is tachycardia in FHR?

+160 bpm (fetal distress)

What is bradycardia in FHR?

< 110 bpm (fetal hypoxia?)

What is absent variability in FHR?

• when the amplitude is undetectable

• abnormal, possibly concerning, hypoxia? acidemia? due to certain meds (opioid)

What is minimal variability?

• amplitude between 0-5 bpm

• abnormal, possibly concerning, hypoxia? acidemia? due to certain meds (opioid)

What is moderate amplitude?

• when amplitude is between 6 - 25 bpm

• this is reassuring, well oxygenated fetus with functioning autonomic nervous system

What is marked amplitude?

• when amplitude is > 25 bpm

• this is abnormal, acute hypoxia? mechanical compression of umbilical cord? often seen in second stage of labor

What FHR variability is this?

• moderate

• absent

• marked

• minimal

moderate

What FHR variability is this?

• moderate

• absent

• marked

• minimal

absent

What FHR variability is this?

• moderate

• absent

• marked

• minimal

marked

What FHR variability is this?

• moderate

• absent

• marked

• minimal

minimal

What are the 4 types of decelerations?

• Early

• Late

• Variable

• Prolonged

What are early decelerations?

• gradual decrease and return to baseline

• associated w/ contraction

• nadir (trough) of deceleration coincides with peak of contraction

Are early decelerations concerning?

generally not concerning, usually cause of head compression

Which deceleration characteristic is this?

• early

• late

• prolonged

• variable

early

What is late deceleration?

• a gradual decrease and return to baseline

• associated w/ contraction

• nadir (trough) of decelerations happens after peak of contraction (so peak of contraction, then dip in FHR)

Are late deceleration concerning?

may indicate uteroplacental insufficiency (close monitoring + interventions)

Which type of deceleration is this?

• early

• late

• prolonged

• variable

Late

What is variable deceleration?

• abrupt decrease in FHR below baseline

• nadir (trough) is more than 15 bpm below baseline

• lasts 15 secs - 2 mins from onset to return to baseline

Is variable decelerations concerning?

• attributed to umbilical cord compression (inadequate nutrients, oxygen)

• can pose significant disruption of fetal oxygenation and may require intervention

What type of deceleration is this?

• early

• late

• prolonged

• variable

variable

What is prolonged decelerations?

• decreased FHR below baseline by more than 15 bpm lasting 2 min - 10 min from onset to return to baseline

Is prolonged deceleration concerning?

• yes, usually requires intervention

• represents significant disruption of fetal oxygen

What type of deceleration is this?

• early

• late

• prolonged

• variable

prolonged

What does VEAL CHOP stand for

Variable Deceleration | Cord Compression

Early Deceleration | Head Compression

Acceleration | Ok

Late Deceleration | Placental Insufficiency

What is normal uterine activity?

Normal: ≤ 5 contractions in 10 mins over 30 min window

What is considered tachysystole?

> 5 contractions in 10 mins over 30 min window

What should you as a nurse do when someone is going through tachysystole (high contractions)?

• maternal repositioning

• IV fluid bolus

• stop oxytocin infusion

  • cause oxytocin stimulates contractions

What is considered normal Category I FHR and Uterine activity?

• baseline rate 110 - 160 bpm

• baseline variability FHR moderate

• NO late or variable decelerations FHR

• Early decelerations FHR absent or present

What is considered Category III abnormal FHR and uterine activity?

Either of these

• No (absent) variability and late decelerations

• No (absent) variability and variable decelerations

• No (absent) variability and bradycardia

• Sinusoidal pattern