Comfort during labor fetal assessment during labor - OB exam 2

How does labor temporarily affect blood flow through the placenta?

Contractions compress blood vessels and reduce maternal blood flow; blood flow improves between contractions.

Define hypoxemia

Decreased oxygen in the blood.

Define hypoxia

Decreased oxygen reaching tissues.

Define acidemia

Increased acidity of the blood from persistent inadequate oxygenation.

What does intermittent auscultation assess?

Fetal heart rate at scheduled intervals using a Doppler or fetoscope.

What does an external ultrasound transducer assess?

Fetal heart rate.

What does an external tocotransducer ("toco") assess?

Contraction timing, frequency, and approximate duration.

What does a fetal scalp electrode (FSE) assess?

Fetal heart rate through direct detection of the fetal ECG.

What does an intrauterine pressure catheter (IUPC) assess?

Contraction pressure and resting tone in mm Hg.

What is the key distinction between an FSE and an IUPC?

An FSE measures fetal heart rate; an IUPC measures uterine pressure.

What does each small horizontal box represent on standard fetal monitoring paper?

10 seconds.

What does each bold vertical line represent on standard fetal monitoring paper?

1 minute.

What are the steps for interpreting a tracing in order?

1. Baseline FHR, 2. Variability, 3. Accelerations, 4. Decelerations, 5. Uterine activity, 6. Category/trend.

What is the definition of baseline fetal heart rate?

Average fetal heart rate during a 10-minute segment, excluding accelerations and decelerations.

What is the normal baseline fetal heart rate range?

110-160 beats/minute.

Define fetal bradycardia

Baseline fetal heart rate below 110 beats/minute.

Define fetal tachycardia

Baseline fetal heart rate above 160 beats/minute.

What is the amplitude of absent variability?

Undetectable.

What is the amplitude of minimal variability?

Detectable but 5 bpm or less.

What is the amplitude of moderate variability?

6-25 bpm.

What is the amplitude of marked variability?

More than 25 bpm.

Which variability finding is considered a reassuring indicator of fetal acid-base status?

Moderate variability.

What defines an acceleration at 32 weeks or later?

Increase of at least 15 bpm lasting at least 15 seconds and less than 2 minutes.

What defines an acceleration before 32 weeks?

Increase of at least 10 bpm lasting at least 10 seconds and less than 2 minutes.

What causes early decelerations?

Head compression triggering a vagal response.

What causes variable decelerations?

Cord compression.

What causes late decelerations?

Uteroplacental insufficiency.

What does the mnemonic VEAL CHOP stand for?

Variable-Cord, Early-Head, Accelerations-Okay, Late-Placental insufficiency.

What is a prolonged deceleration?

A decrease of at least 15 bpm lasting 2 minutes to less than 10 minutes.

What defines recurrent decelerations?

Decelerations occurring with at least 50% of contractions in a 20-minute segment.

What is the purpose of amnioinfusion?

To introduce isotonic fluid into the uterine cavity to reduce intermittent cord compression.

What are the features of a true sinusoidal pattern?

Smooth, regular, wave-like pattern persisting at least 20 minutes; Category III.

Define tachysystole

More than 5 contractions in 10 minutes, averaged over 30 minutes.

How do you palpate for mild contraction intensity?

Easily indented (feels like the tip of the nose).

How do you palpate for moderate contraction intensity?

Slightly indented (feels like the chin).

How do you palpate for strong contraction intensity?

Difficult to indent (feels like the forehead).

What is the usual internal resting pressure of the uterus?

Approximately 10 mm Hg (generally less than 20 mm Hg).

How are Montevideo Units (MVUs) calculated?

Subtract resting tone from each contraction's peak pressure and add the values for all contractions in 10 minutes.

What Montevideo Unit (MVU) value is commonly used as evidence of adequate uterine activity?

Approximately 200 MVUs.

What are the criteria for Category I fetal heart rate tracings?

Baseline 110-160, moderate variability, no late/variable decelerations; early decels and accelerations may be present or absent.

What do Category III fetal heart rate tracings include?

Absent variability plus recurrent late decelerations, recurrent variable decelerations, or bradycardia; OR a sinusoidal pattern.

What is visceral pain primarily associated with?

The first stage of labor (uterine contractions, reduced blood flow, and cervical dilation).

What is somatic pain primarily associated with?

Fetal descent and second-stage stretching of the vagina, pelvic floor, and perineum.

What are the water temperature guidelines for hydrotherapy during labor?

96.8-99.5°F (follow facility protocol).

What are potential maternal effects of systemic opioids like butorphanol and nalbuphine?

Sedation, respiratory depression, nausea, dizziness, and temporary decrease in fetal variability.

Who must hold and control the nitrous oxide mask?

The patient must hold and control the mask herself.

What is the most important early complication of an epidural?

Maternal hypotension due to sympathetic blockade.

What does a pudendal block anesthetize?

The lower vagina, vulva, and perineum.

What is a primary nursing response to maternal hypotension following an epidural?

Lateral positioning, assessing FHR, administering ordered fluids, and notifying anesthesia.