Chapter 13- Fetal Assessment During Labor

What assessment determines fetal lie, presentation, and attitude through abdominal palpation?

Leopold maneuvers

What fetal presentation has heart tones heard below the umbilicus?

Vertex

What fetal presentation has heart tones heard above the umbilicus?

Breech

What should the client do before Leopold maneuvers are performed?

Empty bladder

What position should the client be placed in for Leopold maneuvers?

Supine with knees flexed

What device is placed under the hip during Leopold maneuvers to prevent hypotension?

Rolled towel

What fetal part feels round, firm, and movable during Leopold maneuvers?

Head

What fetal part feels soft and irregular during Leopold maneuvers?

Breech

Which Leopold maneuver identifies fetal lie and presenting part?

Fundal palpation

Which Leopold maneuver identifies the fetal back?

Side palpation

Which Leopold maneuver identifies fetal descent?

Lower uterine grasp

Which Leopold maneuver identifies fetal attitude?

Cephalic prominence

If the cephalic prominence is on the same side as the small parts, what presentation is present?

Vertex

If the cephalic prominence is on the same side as the back, what presentation is present?

Face presentation

What should be assessed after completing Leopold maneuvers?

FHR

What low-technology method assesses fetal heart rate during labor?

Intermittent auscultation

What device is commonly used for intermittent auscultation?

Doppler

What uterine contraction characteristics are assessed through palpation?

Frequency, duration, intensity, resting tone

During what period does fetal oxygenation improve the most?

Between contractions

During the active phase of labor, how often should FHR be assessed?

Every 15-30 minutes

During the second stage of labor, how often should FHR be assessed?

Every 5-15 minutes

What is the normal fetal heart rate baseline?

110-160 bpm

What fetal heart rate is considered tachycardia?

Greater than 160 bpm

What fetal heart rate is considered bradycardia?

Less than 110 bpm

What type of monitoring uses an ultrasound transducer and tocotransducer?

External fetal monitoring

What is a major advantage of external fetal monitoring?

Noninvasive

What is a major disadvantage of external fetal monitoring?

Cannot measure contraction intensity

Do membranes need to be ruptured for external fetal monitoring?

No

Does the cervix need to be dilated for external fetal monitoring?

No

What maternal condition is an indication for continuous external monitoring?

Gestational diabetes

What placental complication is an indication for continuous monitoring?

Placenta previa

What fetal growth complication is an indication for continuous monitoring?

IUGR

What type of variability is considered reassuring?

Moderate variability

What variability is considered nonreassuring?

Absent variability

What variability range defines minimal variability?

0-5 bpm

What variability range defines moderate variability?

6-25 bpm

What variability range defines marked variability?

Greater than 25 bpm

What are episodic changes in FHR?

Changes unrelated to contractions

What are periodic changes in FHR?

Changes related to contractions

What Category I finding indicates a reassuring tracing?

Moderate variability

What Category I baseline fetal heart rate is expected?

110-160 bpm

Are accelerations required for a Category I tracing?

No

Are late decelerations present in Category I tracings?

No

What baseline heart rate abnormality can be seen in Category II tracings?

Tachycardia

What variability abnormality can be seen in Category II tracings?

Minimal variability

What prolonged deceleration duration falls into Category II?

2-10 minutes

What tracing pattern automatically qualifies as Category III?

Sinusoidal pattern

What combination makes a tracing Category III besides sinusoidal pattern?

Absent variability plus abnormality

What are the three parts of a uterine contraction?

Increment, acme, decrement

What part of a contraction represents peak intensity?

Acme

What fetal heart rate pattern indicates a healthy fetus?

Accelerations

What fetal movement pattern commonly causes accelerations?

Spontaneous movement

What intervention is required for accelerations?

None

What fetal heart rate pattern is less than 110 bpm for at least 10 minutes?

Bradycardia

What cord complication can cause fetal bradycardia?

Cord prolapse

What maternal condition can cause fetal bradycardia?

Hypotension

What medication should be discontinued for fetal bradycardia?

Oxytocin

What position should be used for fetal bradycardia?

Side-lying

What fetal heart rate pattern is greater than 160 bpm for at least 10 minutes?

Tachycardia

What maternal condition commonly causes fetal tachycardia?

Fever

What substance use can cause fetal tachycardia?

Cocaine

What fluid intervention is used for fetal tachycardia?

IV fluid bolus

What medication is given if maternal fever is causing fetal tachycardia?

Antipyretic

What fetal heart rate finding indicates CNS depression or fetal hypoxemia?

Minimal variability

What position should be used for decreased variability?

Left lateral

What intervention may improve decreased variability?

Fetal scalp stimulation

What type of deceleration mirrors the contraction?

Early deceleration

What causes early decelerations?

Head compression

Are interventions required for early decelerations?

No

What type of deceleration begins after the contraction starts and ends after it ends?