#2    FHR variability, categories and decelerations THROUGH fetal position changes during labor, and cardinal movements

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson
Download our mobile app to listen on the go
Get App

Questions and Answers

What is the minimum duration of interpretable data required to determine baseline FHR?

  • 1 minute
  • 2 minutes (correct)
  • 5 minutes
  • 30 seconds

A baseline FHR of 170 bpm would be classified as which of the following?

  • Normal
  • Variable
  • Tachycardia (correct)
  • Bradycardia

Which FHR variability range is considered normal?

  • Minimal (1-5 bpm)
  • Marked (26+ bpm)
  • Moderate (6-25 bpm) (correct)
  • Absent (0 bpm)

According to the three-tier FHR categories, what does a Category I tracing indicate?

<p>Normal tracing with no specific action required (C)</p> Signup and view all the answers

Which of the following is a characteristic of Category III FHR tracings?

<p>Recurrent late decelerations (D)</p> Signup and view all the answers

Which type of FHR deceleration is often associated with umbilical cord compression?

<p>Variable decelerations (A)</p> Signup and view all the answers

What is the first intervention that should be implemented when observing late decelerations?

<p>Reposition the mother (B)</p> Signup and view all the answers

What is the priority nursing intervention for a prolonged deceleration?

<p>Prepare for an emergent cesarean section if no recovery to baseline (A)</p> Signup and view all the answers

What is the primary cause of early decelerations in fetal heart rate?

<p>Fetal head compression (C)</p> Signup and view all the answers

A sinusoidal FHR pattern is considered:

<p>An abnormal pattern requiring immediate intervention (D)</p> Signup and view all the answers

What does the term 'effacement' refer to in the context of cervical changes during labor?

<p>The thinning of the cervix (D)</p> Signup and view all the answers

Cervical dilation is measured in:

<p>Centimeters (D)</p> Signup and view all the answers

Ideally, what fetal attitude is preferred for vaginal delivery?

<p>General flexion (C)</p> Signup and view all the answers

Which cardinal movement involves the fetal head passing through the pelvic inlet?

<p>Engagement (B)</p> Signup and view all the answers

During which cardinal movement does the fetal occiput rotate anteriorly?

<p>Internal rotation (B)</p> Signup and view all the answers

What physiological process is indicated by the cardinal movement of flexion?

<p>Fetal chin moves closer to the chest. (D)</p> Signup and view all the answers

Which of the following interventions is LEAST appropriate for variable decelerations?

<p>Administering an analgesic (B)</p> Signup and view all the answers

What is the duration criterion that distinguishes a prolonged deceleration from other types of decelerations?

<p>Between 2 minutes and 10 minutes (B)</p> Signup and view all the answers

Which of the following findings would classify an FHR tracing as Category II?

<p>Minimal variability without recurrent decelerations (B)</p> Signup and view all the answers

A laboring patient's FHR tracing shows a pattern of accelerations lasting >15 seconds and peaking >15 bpm above the baseline. What is the MOST appropriate nursing action?

<p>Document the reassuring pattern. (B)</p> Signup and view all the answers

After internal rotation, what cardinal movement allows the fetal head to be born?

<p>Extension (A)</p> Signup and view all the answers

Following delivery of the fetal head, which cardinal movement occurs next?

<p>Restitution (C)</p> Signup and view all the answers

Which of the following FHR patterns definitively requires intrauterine resuscitation measures?

<p>Recurrent late decelerations with absent variability (C)</p> Signup and view all the answers

Dino, a medical student, is asked to describe Category II fetal heart rate tracings in detail. He notes that these tracings are 'Indeterminate'. Which of the following could be a characteristic of this tracing?

<p>Minimal baseline FHR variability not accompanied by recurrent decelerations. (C)</p> Signup and view all the answers

Which of the following decelerations typically requires no intervention?

<p>Early decelerations (A)</p> Signup and view all the answers

In fetal monitoring, which baseline variability pattern is defined as a fluctuation range of 1-5 bpm?

<p>Minimal (C)</p> Signup and view all the answers

During a complicated labor, a sinusoidal pattern is observed on the fetal heart rate monitor. This rare abnormal fetal heartbeat pattern is a sign of:

<p>Emergent status, often requires intrauterine resuscitation (A)</p> Signup and view all the answers

A woman is in labor, and the healthcare provider determines that the fetus is in the occiput posterior (OP) position. What cardinal movement is MOST likely to be affected or prolonged as a result of this malposition?

<p>Internal Rotation (B)</p> Signup and view all the answers

A seasoned nurse is teaching a group of new graduate nurses about fetal heart rate (FHR) monitoring and the importance of recognizing different patterns. She explains that certain FHR patterns require immediate intervention to prevent potential fetal compromise. According to the nurse, which of the following FHR patterns would necessitate the MOST urgent intervention?

<p>Recurrent late decelerations with absent variability (C)</p> Signup and view all the answers

In a rare obstetrical emergency, a previously healthy 28-year-old primigravida at term presents with sudden onset of prolonged fetal bradycardia and a sinusoidal FHR pattern after attempted external cephalic version (ECV). Despite immediate tocolysis and maternal repositioning, the abnormal FHR patterns persist. What is the MOST likely underlying cause of these findings, and what is the NEXT BEST step in management?

<p>Uterine rupture; perform immediate exploratory laparotomy and cesarean delivery. (D)</p> Signup and view all the answers

Flashcards

Baseline FHR

Average FHR over 10 minutes, excluding changes; must have 2 minutes of interpretable data.

Fetal Tachycardia

FHR greater than 160 bpm.

Fetal Bradycardia

FHR less than 110 bpm.

Periodic FHR Changes

Changes in FHR that occur with contractions.

Signup and view all the flashcards

Episodic FHR Changes

Changes in FHR not associated with contractions.

Signup and view all the flashcards

FHR Variability

Irregular fluctuations in the baseline FHR.

Signup and view all the flashcards

Absent FHR Variability

Absent variability (0 bpm fluctuation).

Signup and view all the flashcards

Minimal FHR Variability

Minimal variability (1-5 bpm fluctuation).

Signup and view all the flashcards

Moderate FHR Variability

Moderate variability (6-25 bpm fluctuation).

Signup and view all the flashcards

Marked FHR Variability

Marked variability (26+ bpm fluctuation).

Signup and view all the flashcards

Category I FHR

Normal FHR tracing with FHR 110-160 bpm, moderate variability, and no late or variable decels.

Signup and view all the flashcards

Category II FHR

FHR tracing that is not Category I or III; includes tachycardia, bradycardia without absent variability, minimal/absent variability without recurrent decels, or marked variability.

Signup and view all the flashcards

Category III FHR

Abnormal FHR tracing with absent variability and recurrent late decels, recurrent variable decels, bradycardia, or sinusoidal pattern.

Signup and view all the flashcards

Acceleration

Visually apparent abrupt decrease in FHR below the baseline. >=15 bpm x >=15 seconds.

Signup and view all the flashcards

Variable Decelerations

Variable decelerations indicate cord compression.

Signup and view all the flashcards

Early Decelerations

Early decelerations signify head compression.

Signup and view all the flashcards

Late Decelerations

Late decelerations indicate uteroplacental insufficiency.

Signup and view all the flashcards

Prolonged Deceleration

FHR decrease of at least 15 bpm lasting 2-10 minutes.

Signup and view all the flashcards

Sinusoidal Pattern

Smooth, undulating baseline; rare, abnormal pattern.

Signup and view all the flashcards

Cervical Dilation

Opening of the cervix (0-10 cm).

Signup and view all the flashcards

Cervical Effacement

Thinning of the cervix.

Signup and view all the flashcards

Engagement

Fetal head moving into the pelvic inlet.

Signup and view all the flashcards

Descent

Fetal head moving through the pelvis.

Signup and view all the flashcards

Flexion

Fetal chin touching chest.

Signup and view all the flashcards

Internal Rotation

Fetal occiput rotating anteriorly.

Signup and view all the flashcards

Extension

Fetal head extending upward.

Signup and view all the flashcards

Restitution

Realignment of fetal head with shoulders.

Signup and view all the flashcards

External Rotation

Shoulders rotate externally.

Signup and view all the flashcards

Expulsion

Delivery of the baby.

Signup and view all the flashcards

Study Notes

Fetal Heart Rate (FHR) Monitoring

  • Baseline FHR is the average heart rate over a 10-minute segment, excluding periodic or episodic changes, marked variability, or segments differing by more than 25 bpm; requires at least 2 minutes of interpretable data.
  • Tachycardia is a baseline FHR greater than 160 bpm.
  • Bradycardia is a baseline FHR less than 110 bpm.
  • Periodic FHR changes occur with contractions.
  • Episodic FHR changes do not occur with contractions.

FHR Variability

  • FHR variability refers to irregular fluctuations in the baseline FHR with a frequency of two cycles per minute or more.
  • Absent variability: 0 bpm fluctuation.
  • Minimal variability: 1-5 bpm fluctuation.
  • Moderate variability: 6-25 bpm fluctuation, considered normal.
  • Marked variability: 26+ bpm fluctuation.

FHR Categories

  • Category I (Normal): FHR 110-160 bpm, moderate variability (6-25 bpm), no late or variable decelerations; early decelerations or accelerations may be present or absent.
  • Category II (Indeterminate): Includes bradycardia without absent variability, tachycardia, minimal or absent variability without recurrent decelerations, marked variability (26+ bpm), absence of accelerations with fetal stimulation, and periodic or episodic decelerations.
  • Category III (Abnormal): Includes absent baseline FHR variability accompanied by recurrent late decelerations, recurrent variable decelerations, bradycardia, or a sinusoidal pattern.

Accelerations

  • Accelerations should last for 15 seconds and increase 15 bpm from baseline.

Decelerations

  • Variable decelerations are abrupt, appear as V/U/W shapes, and indicate cord compression; manage by changing position, administering O2 to the mother, and increasing IV fluids.
  • Early decelerations occur with head compression, with FHR decreasing before the peak of a contraction and recovering before it ends; no treatment needed, may perform a vaginal exam.
  • Late decelerations indicate uteroplacental insufficiency, with FHR decreasing AFTER the peak of a contraction and recovering after the contraction ends; treat by stopping Pitocin, administering oxygen (8-10 L), repositioning, increasing IV fluids, and considering amnioinfusion.
  • Prolonged decelerations involve a decrease of at least 15 bpm lasting more than 2 minutes but less than 10 minutes; manage by starting oxygen, having the mother lay on her left side, stopping Pitocin, increasing IV fluids, and considering an emergent cesarean if no recovery to baseline.
  • Sinusoidal pattern is a rare, abnormal fetal heartbeat with a rapid bounce pattern and requires emergency intrauterine resuscitation.

Cervical Changes During Labor

  • During labor, the cervix dilates (opens) from 0-10 cm and effaces (thins out).
  • Medications like misoprostol or dinoprostone may be given if the cervix is not effacing or dilating.

Fetal Position & Cardinal Movements During Labor

  • Ideal fetal position is head down with general flexion, tucking the chin to the chest to present the suboccipitobregmatic diameter.
  • Engagement: Fetal head reaches the pelvic inlet.
  • Descent: Fetal head moves through the pelvis.
  • Flexion: Infant's chin moves to chest.
  • Internal Rotation: Occiput rotates anteriorly.
  • Extension: Infant's chin lifts up.
  • Restitution and External Rotation: Realignment and rotation of the shoulders.
  • Expulsion: Baby is delivered.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

More Like This

Use Quizgecko on...
Browser
Browser