Fetal Assessment During Labor

Questions and Answers

Which statement regarding electronic fetal monitoring is correct?

Both can measure the frequency, duration, and intensity of uterine contractions.

Both may need to rely on the woman to indicate when uterine activity is occurring. (correct)

Both internal and external can be used when membranes are intact.

Both can be used during the antepartum and intrapartum periods. (correct)

What is the normal baseline heart rate for a fetus?

110 to 160 beats/min

Which condition may cause increased variability of the fetal heart rate?

Narcotics

Barbiturates

Tranquilizers

Methamphetamines (correct)

Which type of deceleration does not require a change in maternal position?

Early decelerations Signup and view all the answers

Match the type of deceleration with its likely cause:

Early deceleration = Head compression Late deceleration = Uteroplacental inefficiency Variable deceleration = Umbilical cord compression Prolonged deceleration = Cause unknown Signup and view all the answers

What is the purpose of stimulating the fetal scalp?

To elicit an acceleration in the fetal heart rate. Signup and view all the answers

Which factor should nurses encourage to assist with fetal status?

Avoiding the supine position. Signup and view all the answers

What is a contraindication for the application of internal monitoring devices?

Unruptured membranes Signup and view all the answers

Where should the tocotransducer for electronic fetal monitoring be placed?

Over the uterine fundus. Signup and view all the answers

Which categories are included in the tiered system of categorizing fetal heart rate?

Category III Signup and view all the answers

What physiological alterations could likely cause a late deceleration?

Maternal supine hypotension Signup and view all the answers

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction. What should the nurse's first priority be?

Change the woman's position Signup and view all the answers

What causes early decelerations in the fetal heart rate?

Altered fetal cerebral blood flow Signup and view all the answers

Accelerations with fetal movement are regarded as:

Reassuring Signup and view all the answers

Variable fetal heart rate (FHR) decelerations are caused by:

Umbilical cord compression Signup and view all the answers

Late fetal heart rate (FHR) decelerations are the result of:

Uteroplacental insufficiency Signup and view all the answers

Amnioinfusion is used to treat:

Variable decelerations Signup and view all the answers

Maternal hypotension can result in:

Uteroplacental insufficiency Signup and view all the answers

Maternal cardiac output can be increased by:

Change in position Signup and view all the answers

What should the nurse do when the fetal heart rate (FHR) begins to decelerate at the onset of contractions but returns to baseline before each contraction ends?

Document the finding in the patient's record Signup and view all the answers

Which fetal heart rate (FHR) finding would concern the nurse during labor?

Late decelerations Signup and view all the answers

The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is:

Fetal sleep cycles Signup and view all the answers

Fetal well-being during labor is assessed by:

The response of FHR to uterine contractions (UCs) Signup and view all the answers

What additional nursing measures should be taken if fetal heart rate remains at 80 beats/min after repositioning and other interventions?

Notify the care provider immediately Signup and view all the answers

What three measures should the nurse implement for intrauterine resuscitation, in order of priority?

Reposition the mother, increase IV fluid, and provide oxygen via face mask Signup and view all the answers

Perinatal nurses are legally responsible for:

Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes Signup and view all the answers

A fetal heart rate that is tachycardic, bradycardic, or has late decelerations or loss of variability is associated with:

Hypoxemia Signup and view all the answers

When explaining the electronic fetal monitor (EFM) graph to the partner of a laboring woman, what is the best response?

The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor. Signup and view all the answers

A normal uterine activity pattern in labor is characterized by:

Contractions every 2 to 5 minutes Signup and view all the answers

According to standard professional practices, when should nurses auscultate the fetal heart rate (FHR)?

Before and after ambulation and rupture of membranes Signup and view all the answers

When using intermittent auscultation (IA) for fetal heart rate, what should nurses be aware of?

Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor Signup and view all the answers

When using intermittent auscultation (IA) to assess uterine activity, nurses should be cognizant that:

The examiner's hand should be placed over the fundus before, during, and after contractions Signup and view all the answers

What is an advantage of external electronic fetal monitoring?

The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs) Signup and view all the answers

Study Notes

Fetal Heart Rate Assessment

Late Decelerations: Indicate potential uteroplacental insufficiency, often resolved by maternal repositioning to relieve vena cava pressure.
Early Decelerations: Reflect fetal head compression, not ominous; they respond to the fetal descent during labor.
Accelerations: Signify fetal well-being and do not require intensive monitoring; occur with fetal movement.
Variable Decelerations: Caused primarily by umbilical cord compression; can happen intermittently during contractions.
Nursing Priorities for Decelerations: If late decelerations occur, priorities include repositioning the mother, increasing IV fluids, and providing oxygen. If unresolved, a care provider should be notified.

Maternal Factors Influencing Fetal Heart Rate

Maternal Hypotension: Reduces placental blood flow, leading to fetal hypoxemia; does not cause early decelerations.
Position Changes: Encouraged to improve maternal cardiac output and alleviate venous pressure during labor.
Amnioinfusion: Utilized for variable decelerations due to cord compression; not effective for late decelerations or bradycardia.

Fetal Heart Rate Variability and Monitoring

Normal FHR Range: 110-160 beats/min; averages of 135 beats/min are considered within normal limits.
Decreased Variability: Often linked to fetal sleep cycles; temporary decreases persist for less than 30 minutes.
Non-reassuring FHR Patterns: Tachycardia, bradycardia, late decelerations, or reduced variability can indicate fetal hypoxemia.

Monitoring Techniques and Guidelines

Electronic Fetal Monitoring (EFM): Provides continuous assessment during labor; necessary to clarify with patients about FHR readings.
Intermittent Auscultation (IA): Utilized with a nurse-to-patient ratio of one to one; requires documentation in clearly defined terms, not subjective.
Assessing Uterine Activity: Done through palpation to monitor frequency, duration, and intensity.

Legal and Clinical Responsibilities

Nursing Accountability: Includes interpretation of FHR patterns, initiating interventions, and proper documentation.

Key Interventions during Labor

Intrauterine Resuscitation Protocol: Should begin with maternal repositioning, followed by IV fluid increase and oxygen administration.
Documentation: Vital for ongoing assessment of labor progress and fetal well-being.

Additional Considerations

Common Medications Impacting FHR: Methamphetamines increase FHR variability, while narcotics and tranquilizers may decrease it.
Fetal Condition Assessment: Regular monitoring of FHR and uterine contractions is essential to detect any distress or abnormal patterns.

Summary of FHR Findings

Early Decelerations: Non-threatening, associated with head compression.
Late Decelerations: Concerning, linked with uteroplacental insufficiency.
Variable Decelerations: Caused by umbilical cord issues.
Bradycardia and Tachycardia: Indicative of potential complications, requiring immediate attention.### Fetal Heart Rate Decelerations
Types of Decelerations:
- Early Decelerations: Typically associated with head compression; do not require maternal position change.
- Late Decelerations: Indicative of uteroplacental inefficiency; necessitate a lateral position change.
- Variable Decelerations: Caused by umbilical cord compression; require maternal position change to side-to-side.
- Prolonged Decelerations: Have various causes, may be benign or critical.

Maternal Positioning

Recommended Positions: Side-lying positions are preferred; semi-Fowler with a lateral tilt is optimal.
Avoiding Supine Position: Encouraged to prevent pressure on major blood vessels and improve fetal oxygenation.
Pushing Technique: Should avoid the Valsalva maneuver; encourage open mouth and glottis to allow air escape.

Internal Monitoring

Contraindications: Internal monitoring devices require ruptured membranes; unruptured membranes are a contraindication.
Cervical Dilation: 4 cm dilation permits the use of fetal scalp electrodes and intrauterine catheters.
External Monitor Use: Can be discontinued once internal monitors are applied.

Fetal Monitoring

Tocotransducer Placement: Should be positioned over the uterine fundus to accurately monitor uterine contractions.
Categories of Fetal Heart Rate (FHR) Tracings:
- Category I: Normal FHR pattern, no intervention needed.
- Category II: Indeterminate patterns requiring further evaluation.
- Category III: Abnormal tracings necessitating immediate intervention.

Physiological Alterations and Late Decelerations

Causes of Late Decelerations: Primarily linked to uteroplacental insufficiency, which can result from:
- Maternal hypotension (e.g., supine hypotension).
- Uterine tachysystole.
- Conditions like placental abruption.
Effects of Other Factors:
- Spontaneous fetal movement and head compression typically result in accelerations or early decelerations.
- Variable decelerations often occur due to umbilical cord entanglement or compression.

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Description

This quiz focuses on key nursing interventions and assessments for fetal well-being during labor, particularly the interpretation of fetal heart rate patterns. It is essential for healthcare professionals to be equipped with this knowledge to ensure safe delivery outcomes.