Labor and Delivery: Part Two

Flashcards covering fetal heart rate monitoring, decelerations, nursing interventions, and medical labor interventions based on the lecture material.

Normal Fetal Heart Rate (FHR)

$110-160\,bpm$.

Fetal Tachycardia

A fetal heart rate greater than $160\,bpm$, which may be caused by prematurity, maternal fever, fetal activity, or fetal hypoxia/infection.

Fetal Bradycardia

A fetal heart rate less than $110\,bpm$, which may indicate fetal hypoxia, maternal drugs/hypotension, or uterine hyperstimulation.

Tocodynamometer

An external sensor (often called a "toco") strapped to the abdomen used for monitoring uterine contractions.

Internal Fetal Monitoring Requirements

Requires cervical dilation, rupture of membranes, and carries a risk of infection; involves a spiral scalp electrode and intrauterine catheter.

Absent Variability

Fetal heart rate fluctuations that are undetectable.

Minimal Variability

Fetal heart rate fluctuations of <5\,bpm; can be caused by fetus sleeping, prematurity, or reaction to medications.

Moderate Variability

Fetal heart rate fluctuations ranging from >5\,bpm; it is normal and reflects the oxygenation of the central nervous system.

Marked Variability

Fetal heart rate fluctuations >25\,bpm.

Accelerations

A reassuring, normal elevation of fetal heart rate >15\,bpm over baseline, lasting more than $15\,seconds$ and less than $10\,minutes$.

Early Decelerations

A gradual decrease in FHR synchronized with a contraction (mirror image) caused by head compression (HC); no intervention is needed.

Late Decelerations

A smooth, symmetrical decrease in FHR where the lowest point occurs after the contraction peak, caused by uteroplacental insufficiency (UPI).

Variable Decelerations

Abrupt U/V/M shaped decreases in FHR caused by cord compression (CC); may be relieved by changing the mother's position.

VEAL CHOP MINE

A mnemonic for FHR patterns and interventions: Variable=Cord (Move mother), Early=Head (Intervention not needed), Accels=Ok (None needed), Late=Placental (Execute interventions like repositioning, stopping Pitocin, giving IV fluids/$O_2$).

Meconium Staining

A sign of fetal distress where the amniotic fluid appears pea-green, brown, or yellow instead of the normal pale, straw-colored fluid with white flecks.

Surfactant

A substance that permits the inflation of alveoli in the newborn's lungs.

Bishop Scoring

A system used to assess the readiness of the cervix for induction; a score of $5+$ is desired.

Amniotomy

Artificial rupture of membranes (AROM) performed to facilitate contractions.

Oxytocin (Pitocin) Stop Criteria

Stop infusion if contractions are $<2\,min$ apart or last $>90\,sec$, or if IUPC shows intensity >90\,mm\,HG or resting tone >20\,mm\,HG.

Forceps Delivery

An assisted vaginal birth using a spoon-like device on the fetus's head which may cause baby bruising, edema, or brachial plexus injury.

Vacuum Extraction

An assisted vaginal birth using a vacuum cup on the fetal head with negative pressure; may cause cephalohematoma or bruising in the baby.

TOLAC

Trial of labor after cesarean; allowing a woman to have normal spontaneous labor with close monitoring for uterine rupture.

VBAC

Vaginal birth after cesarean; the major complication is uterine rupture, signaled by acute abdominal pain, a "popping" sensation, or vaginal bleeding.