Maternal-Midterm PDF

Discomfort of Pregnancy 6. Round Ligament Pain - tickle or snap in the chest, vaginal 1. Nausea and Vomiting Interventions: - caused by HCG...

Discomfort of Pregnancy 6. Round Ligament Pain - tickle or snap in the chest, vaginal 1. Nausea and Vomiting Interventions: - caused by HCG - when getting out of bed: turn to side first Interventions: and then get up slowly - crackers or dry toast in morning before - bend toward pain, squat, or bring knees up getting up to chest - drink fluids separate from meals - place heating pad Avoid: - use good body mechanics and avoid very - odors that increase nausea strenuous exercise - fried, high fat, greasy, and spicy food (food Avoid: that can increase HCL) - stretching and twisting at the same time 2. Ptyalism 7. Urinary Frequency and Loss of Urine - excessive salivation caused by elevated - caused by pressure of enlarged uterus on estrogen bladder Intervention: Interventions: - use mouthwash - do Kegel’s exercise to maintain bladder control 3. Heartburn (pyrosis) - contract muscles hold for 10 seconds, relax - reflux of stomach content into esophagus, at least 10 seconds, repeat 30 times each caused by delayed emptying time of day stomach Interventions: 8. Varicosities - remain upright at least an hour - prevent pooling of the blood in the large - small, frequent meals veins of the legs - use antacids Interventions: high sodium (alka-seltzer) - apply support hose or elastic stockings high calcium (alka-mints, tums) (compression stockings) Avoid: Avoid: - eating or drinking at bedtime - constricting clothing or crossing the legs at - caffeine is bad for pregnant (can cause the knees that impede blood vessels vomiting) 9. Hemorrhoids 4. Hyperemesis Gravidarum - caused by hypoperistalsis, lack of fluid, low - excessive nausea and vomiting fiber intake, and progesterone-induced - result in metabolic alkalosis and fluid & effects on muscle electrolyte imbalances Interventions: Intervention: - establish a regular pattern of bowel - replace fluid and monitor intake and output elimination - complete bed rest - gently push any external hemorrhoid back - TPN (total parenteral nutrition) - cabiven, into the rectum transfuse within 24hrs - if pain or bleeding persists, call health care provider 5. Backache - hot sitz bath for control Interventions: - maintain correct posture with head up and 10. Constipation shoulder back Interventions: - when sitting, use: foot support, arm rest, - drink plenty of water (not include coffee, tea pillow behind the back and carbonated drinks) diuretic effect - exercise: tailor sitting, shoulder circling, - eat fiber: papaya, suha, pineapple squatting, pelvic rocking, and maternity Avoid: back binder - restrict cheese Avoid: - curtail the intake of sweets which increase - high-heeled shoes flatulence - bending  11. Leg Cramps ○ 70mg/day of Vit. C to enhance iron - caused by prolonged standing, overfatigue, absorption Ca and P imbalance, oversexed, and Iron sacral nerve plexus Nutritional Instruction: Interventions: ○ eat kangkong, alugbati, saluyot, - elevate the legs to improve circulation horseradish, ampalaya - extend legs, keep knee straight ○ Parenteral (Imferon) Avoid: - severe anemia - excessive foods rich in P such as soft - not proper administration result in drinks hematoma - give IM Z-track method (3-5cc) 12. Thrombophlebitis ○ Oral - presence of thrombus at inflamed blood - ferrous sulfate (0.3gm, TID) vessels - give 1hr before or 2hrs after - Outstanding sign - (+) Homan’s Sign = pain meals on calf during dorsiflexion - side effects: black stool and - Thrombus - stays constipation - Embolus - a thrombus that moves through Nursing Alert: the blood vessels (embolism) - iron from red meat is better absorbed iron Intervention: from other sources - bed rest, never massage (might dislodge - better absorbed when taken with Vit C thrombus) - circulate blood volume is increased and - give anticoagulants to prevent clotting heme is required (thrombolytics) - Heparin IV (Antidote: Protamine Sulfate), 2. Calcium-Phosphorous Warfarin PO (Antidote: Vitamin K) - essential for growth development of fetal - avoid Aspirin (might aggravate bleeding) skeletons and tooth buds - maintenance of mineralization of maternal 13. Musculoskeletal bones and teeth - Lordosis - pride of pregnancy - some babies are born with teeth due to - Waddling Gait - awkward walking due to over intake of Ca hormone relaxin - cause osteoporosis to a pregnant mother when it is not provided enough Nursing Diagnoses: Requirement: ★ Impaired Urinary Elimination related to Pressure of ○ 1200mg/day (R: 50% above daily req) Gravid Uterus ○ 1600mg/day for adolescent (12-20 yrs old) ★ Risk for Fluid Imbalance related to Increased Fluid still developing Needs and Hormonal Changes secondary to ○ 10mcg/day of Vit D (this enhances Ca and Pregnancy P absorption) Food Sources: Nutritional Deficiencies ○ Dairy Products: milk (1pint/day or 3-4 servings) 1. Iron ○ Vit D: fortified milk, margarine, egg yolk, - expansion of blood volume and RBC and butter formation; important for physiologic anemia - establish fetal iron stores for few months of 3. Calories life - essential to supply energy for increase - decreased iron, decreased oxygen metabolic rate - iron-deficiency anemia - most common - development of structures such as nutritional disorder in pregnancy placenta, amniotic fluid, and tissue growth - fetal effects: decreased availability of Requirement: oxygen, affecting fetal growth ○ 300kcal/day (begin increased in second Requirements: trimester) ○ 30mg/day in second trimester ○ severe caloric restriction is contraindicated ○ 60mg/day along with copper and zinc (low because is potentially hazardous especially hemoglobin, iron deficiency anemia) on organogenesis ○ use weight-gain pattern  ○ average weight: 14.4kg - 16kg (25 - 35 lbs) Sexual Activity during Pregnancy ○ failure to meet, lead to ketosis (epileptic) as fat and protein are used for energy, 1. Coitus associated with fetal damage - promotes birth Food Sources: - should be: moderation, private place, ○ complex carbohydrates, proteins, no more comfy position: side-lying or mom on top than 30% fats - avoid 6 weeks prior to EDD - avoid blowing of air during cunnilingus (oral 4. Protein sex of vulva or clitoris) - essential for fetal tissue growth - maternal growth: uterus and breast ★ 1st Trimester - formation of RBC and plasma proteins ○ decrease desire due to bodily - inadequate association with pregnancy- changes induced hypertension ★ 2nd Trimester Requirement: ○ increase desire due to increase ○ 60mg/day (R: 10% above daily req) estrogen that enhances lubrication ○ mature breast 25 yr age and above ★ 3rd Trimester Food Source: ○ decrease desire ○ lean meat, whole grains, poultry, fish, eggs, Contraindications: nuts ➔ Vaginal Spotting ◆ 1st Tri - threatened abortion 5. Zinc ◆ 2nd Tri - placenta previa - essential for formation of enzymes ➔ Incompetent Cervix - prevention of congenital malformation of fetus ➔ Preterm Labor Requirement: ➔ Premature Rupture of Membrane ○ 15mcg/day (R: increased 3mg/day over pregnant daily req) 2. Exercise Food Sources: - strengthen muscles use during delivery ○ liver, legumes, whole grain, shellfish, nuts, process milk - principles: done in moderation; must be individualized 6. Folic Acid, Folacin, Folate a. Walking - best exercise - essential for formation of RBC and prevent b. Squatting - increase circulation; back pain relieved of anemia (feet flat on floor) - DNA synthesis and cell c. Tailor Sitting - one leg in front of other leg (Indian - prevention of neural tube defects (spina sit); raise buttocks first to prevent postural bifida), abortion, abruptio placenta hypotension Requirements: d. Shoulder Circling Exercise ○ 400mcg/day (R: 2x more than daily req) e. Pelvic Rocking/Pelvic Tilt Exercise - relieves pain ○ 300mcg/day - low folate level or dietary f. Kegel’s Exercise - strengthen pubococcygeal deficiency muscles Food Sources: g. Abdominal Exercise - strengthen muscles of ○ liver, lean beef, broccoli, kidney, dark green abdomen leafy vegetables Childbirth Preparation 7. Other Vitamins and Minerals: ★ Minerals: Different Methods of Childbirth ○ Iodine - 175mcg/day ○ Magnesium - 320mg/day 1. Birthing Chair ○ Selenium - 65mcg/day - mostly at Lying In Clinics (midwife with no nurse or doctor) not allowed: first time, ★ Vitamins: breech, and has abnormalities ○ Thiamine - 10mg/day ○ Riboflavin - 1.5mg/day 2. Birthing Bed ○ Pyridoxine - 1.6mg/day - mostly at hospitals ○ B12 - 2.2mg/day - has stirrups for feet in lithotomy position ○ Niacin - 17mg/day  3. Squatting (with holder) -expecting multiples - not utilized in Ph, instead birthing bed -have placenta previa - pelvis makes open wide -have a breech baby -have a baby with macrosomia or 4. Leboyer’s Method large baby - warm, quiet, dark, comfy room (this is to not - have a uterine fibroid or other stimulate the environment of the baby) obstruction - after delivery, baby gets warm bath ★ unplanned CS: - fetal distress 5. Water Birth - labor isn’t progressing - bathtub during labor and delivery - umbilical cord prolapses - warm water and soft music - placental abruption - hemorrhage or excessive bleeding Types of Delivery Types of CS: 1. Vaginal Delivery - Low Transverse (bikini cut, high a. Spontaneous Vaginal Delivery risk of infection) - happen on its own without labor- - Low Vertical (faster healing) inducing drugs - High Vertical - naturally at 40 weeks of pregnancy is ideal 4. Vaginal Birth After Cesarean Section (VBAC) b. Induced Vaginal Delivery - surgical cut results in scar on uterus, the - drugs or other techniques start concern is the pressure of labor is in the labor and soften or open your vagina cervix for delivery - induced with Pitocin, a synthetic ★ Criteria: form of oxytocin ○ low transverse incision during CS ○ no uterine scars or abnormalities Pros: faster recovery, safest for the ○ had a prior vaginal delivery pregnant person and the baby, ○ no previous uterine rupture lower rates of infection, lower risk for respiratory problems, & lactation and breastfeeding are Tetanus Immunization usually easier. TT1 - during pregnancy, first contact with health worker 2. Assisted Vaginal Delivery protection: none ★ happens when: - you’ve been labor a long time TT2 - 4 weeks after 1st dose - your labor isn’t progressing protection: 1-3 years - you become fatigued to continue optimum dosing interval: 6-8 weeks pushing - you or your baby show signs of TT3 - 6 months after 2nd dose distress protection: 5 years a. Vacuum Delivery (vacuum extractor) optimum dosing interval: 6-12 weeks b. Forceps Delivery (forceps) ★ side effects: TT4 - 1 year after 3rd dose - longer head protection: 10 years - forceps marks optimum dosing interval: 5 years 3. Cesarean Section TT5 - 1 year after 4th dose - surgical incisions in abdomen and uterus protection: all childbearing age years; possibly - might be planned in advanced if a medical longer-lifetime reason calls for it or it might be unplanned optimum dosing interval: 10 years (emergency CS) ★ planned CS: - had a previous C-Section delivery Sleep and Rest Embryonic Development - to build new body cells during pregnancy 14 days ★ Nursing Intervention ○ heart begins to beat ○ 1st Trimester ○ development of brain a glass of warm milk ○ early spinal cord relaxation exercise ○ muscle segment ○ 2nd Trimester 26 days sleep on two pillows or in a chair ○ buds for arms appear with armrest 28 days Sim’s Position (left lateral) - best ○ buds for legs appear sleeping position 30 days frequent walking may lead to loss ○ embryo is ¼ to ½ inches in length of: ○ in definite form REM (not-well rested) ○ has umbilical cord dyspnea ○ becomes visible 31 days Important Terms: ○ arms buds develop into hands, arms, and Doula - non-medical companion to support during shoulders childbirth 33 days Tocolytic - opposite of Pitocin, slower uterine ○ development of fingers contractions 46 to 48 days ○ first bone cells ○ development of amniotic fluid Adolescent Pregnancy Organogenesis Assessment: - first 8 weeks 1. personal and family health, menstrual hx - irreparable damage (teratogens) 2. developmental level 3. support system, financial status Fetal Membranes 4. potential role of infant’s father - surround the developing fetus 5. understanding the responsibility of pregnancy ★ Amnion Nursing Diagnosis: ○ inner membrane that give rise to umbilical ★ Disturbed Body Image related to altered cord and amniotic fluid appearance ○ occur 12 days after fertilization ★ Decisional Conflict related to immature problem- ★ Chorion solving abilities ○ outer membrane that give rise to the ★ Ineffective Health Maintenance related to lack of placenta knowledge about the changes of pregnancy ★ Chorionic Villi ★ Imbalanced Nutrition (less/more) than body ○ finger-like projections requirement related to food preferences ★ Risk for Impaired Parenting related to age, lack of Placenta knowledge, and lack of support system - comes from the Latin word “paragra” which means pancake Care of the Fetus Mechanisms: 1. Diffusion - higher concentration to area of Zygote - fertilization until the 14th day lower concentration Embryo - 15th day to 2 months 2. Facilitated Diffusion - carry more substance Fetus - 2 months until birth into and through the membrane 3. Active Transport - requires energy and Normal Pregnancy: action of an enzymes to facilitate - Days: 266-280 days 4. Pinocytosis - absorption of cellular - Weeks: 37-42 weeks membranes - Months: 10 lunar months; 9 calendar months  Placental Circulation disturbance of kidney function ➔ Maternal Blood Flow blocked urinary excretion ◆ gas exchange occurs in placenta through the uterine arteries Rupture Nursing Intervention: ◆ specifically, in villous tree or 1. assess for pH chorionic villi a. amniotic fluid is slightly alkaline (7.2) ➔ Fetal Blood Flow 2. ferning test ◆ nutrients and oxygen are transported through umbilical cord, Fetal Development (by Month) which has: Vein - collects nutrient and First Trimester (focus: organogenesis) oxygen flow of development: cardiovascular - digestive - Arteries - release waste urinary Uterine Perfusion: most efficient in left side-lying position 1st Month Weight of the Placenta: 400 to 600 gm brain and heart development Schultz Placenta: shiny side which faces the baby (amnion) GIT and Respiratory Tract remains as Duncan Placenta: dirty side attached to the uterine wall single tube (chorion) fetal heart tone begins CNS develops - dizziness of mom due to Umbilical Cord hypoglycemic effect - formed from the fetal membranes - connects embryo to placenta Heart - oldest part of the body - 20-22 inches Glucose - food of brain - pumps blood at around 400ml/min Complex CHO - pregnant woman foods (potato) Wharton’s Jelly Prenatal Development protective covering which surrounds the entire cord ★ fertilization occurs, zygote implant and to not cut off in uterine lining, embryonic state lasts from 2 to 8 weeks Problems: ★ cell layers: ectoderm, mesoderm, ★ Nuchal Cord endoderm ○ cord coil in the fetal neck ★ Embryo: 1/2 inch long ○ has long cord ★ Inverted Uterus Changes in Mother ○ uterus is tipped down due to pressure of the ★ morning sickness and other umbilical cord symptoms of pregnancy occurs ○ has short cord ★ Weight Gain: none Amniotic Fluid ` 2nd Month - diffusion from maternal blood all vital organs formed; placenta developed - average: 500m-1000ml sex organ formed Function: meconium is formed cushions the fetus ○ first poop maintains temperature keeps the umbilical cord getting entangled Corpus Luteum - source of estrogen and progesterone of infant – life span – end of 2nd ★ Hydramnios or Polyhydramnios month ○ 800-1200ml ○ resulting from: Prenatal Development esophageal atresia ★ gender can be distinguished anencephaly (no brain) ★ Embryo: 1 inch long; weighs 1/10 ★ Oligohydramnios ounce ○ reduction in the amount of fluid ○ less than 300ml Changes in Mother ○ resulting from: ★ increased frequency urination  ★ Weight Gain: none ○ cheese-like cover 3rd Month Prenatal Development kidneys functional ★ Embryo: 14 inches long; weighs 2 buds of milk teeth appear pounds fetal heart tone heard in Doppler (10-12 weeks) Changes in Mother sex is distinguishable ★ Weight Gain: 3-4 lbs Prenatal Development Third Trimester (focus: weight of focus) ★ bone formation begins period of most rapid growth ★ Embryo: 3 inches long; weighs 1 ounce 7th Month development of surfactant Changes in Mother ○ ripening of alveoli to become viable ★ increased perspiration ○ gas exchange happens ★ Weight Gain: 2-3 lbs Prenatal Development Second Trimester (focus: length of focus) ★ cerebral cortex of brain develops ★ Embryo: 16 inches long; weighs 3 4th Month pounds lanugo begins to appear fetal heart tone heard in Fetoscope (18-20 Changes in Mother weeks) ★ Weight Gain: 3-4 lbs buds of permanent teeth appear 8th Month 5th Month lanugo begin to disappear lanugo covers body subcutaneous fats deposits (in skin) actively swallowing and excreting amniotic nails extend to finger fluid 19 - 25 cm fetus Prenatal Development Quickening - 1st fetal movement ★ Embryo: 17 inches long; weighs 5 ○ Primiparous - 18-20 weeks pounds ○ Multiparous - 16-18 weeks fetal heart tone heard with or without Changes in Mother instrument ★ Weight Gain: 3-5 lbs Prenatal Development 9th Month ★ fine, downy fuzz covers the entire lanugo and vernix caseosa completely body disappear ★ fetus may suck thumb and hiccup amniotic fluid decreases ★ Embryo: 12 inches long; weighs 14 ounces Prenatal Development ★ organ systems function actively Changes in Mother ★ Neonate: 21 inches long; weighs 7 ★ shortness of breath pounds ★ foods craving ★ pelvic relaxes Changes in Mother ★ Weight Gain: 3-4 lbs ★ uterus has now moved a few inches lower 6th Month ★ Weight Gain: 3-5 lbs eyelids open wrinkled skin (lack of sebaceous fats) vernix caseosa present ○ a waxy coating collects over the body Fetal System ○ HPN ○ acute or non-acute infections Cardiovascular System ○ STD one of the first systems to become functional in ○ severe anemia intrauterine life ○ parents carry genetic disorder forms at 16th day of life, and starts to beat as early ★ Demographic Factors as the 24th day ○ maternal age less than 16 or more than 35 ○ poverty Heart Chambers (atrium & ventricle) ○ nonwhite (greater risk for prematurity or Heart Valves (tricuspid, mitral, pulmonary, & aortic) infant death) ○ develop during 6th or 7th week ○ inadequate prenatal care ★ Obstetric Factors heartbeat heard on: ○ history of low birth weight or preterm infant ○ Doppler: 10th to 12th week ○ multifetal pregnancy ○ ECG: 20th week ○ malpresentation (breech, shoulder) ○ previous fetal loss Fetal Circulation Bypass ○ hydramnios ○ oligohydramnios 1. Foramen Ovale - is an opening between the right ○ decrease or absence in fetal movements and left atria during fetal life, bypassing fetal lung ○ uncertainty about the age of gestations ➔ closed foramen ovale becomes the fossa ○ post mature/preterm ovalis Diagnostic Procedures 2. Ductus Arteriosus - is a connection between pulmonary trunk and aorta, also bypassing fetal 1. Ultrasound lung - identify gestational sac in early pregnancy ➔ once closed, the ductus arteriosus is - locate placenta replaced by connective tissue and is known - diagnose multiple pregnancy as the ligamentum arteriosum - identify some congenital anomalies - determine gestational age; assessment of 3. Ductus Venosus - is a connection between the fetal viability umbilical vein and ascending vena cava, bypassing - safe for fetus because no ionizing radiation the fetal liver involved ➔ umbilical vein's remnant becomes the a. Transvaginal Ultrasonography liver's round ligament and the ductus a probe is inserted through the venosum becomes the ligamentum vagina venosum confirm pregnancy verify the location of the pregnancy Assessing Fetal Growth and Development (uterine or ectopic) detect multifetal gestations Nursing Responsibilities determine gestational age a. obtain consent form confirm number and viability of b. scheduling of the procedure fetus c. explaining the procedure to the woman and her determine locations of the uterus, support persons cervix and placenta for procedure d. preparing the woman physically and such as chorionic villi sampling psychologically e. providing support during the procedure Nursing Intervention f. assessing both fetal and maternal responses to the i. place woman in a lithotomy procedure position g. providing necessary follow up care ii. coat the disposable cover of the h. managing equipment and specimens probe with a gel to provide lubrication and promote Indications for Fetal Diagnostic Procedures conductivity iii. the procedure takes about 10-15 ★ Medical Conditions minutes ○ pre existing DM  Nursing Management b. Transabdominal Ultrasonography iii. place folded towel under her right confirm fetal viability buttock to tip her body to the left evaluate fetal anatomy, including iv. take maternal BP and fetal heart the umbilical cord, its vessels and rate for baseline levels the insertion site v. ask the mother to rest quietly for 30 determine the gestational age minutes assess serial fetal growth vi. advise the patient to report fetal locate placenta when placenta hyperactivity or hypoactivity, previa is suspected vaginal bleeding, chills, fever, fluid determine fetal presentation leakage and vaginal discharge 2. Amniocentesis 4. Chorionic Villi Sampling (CVS) - sampling of amniotic fluid (15ml is taken) - done in 8-12 weeks AOG - can be done as early as 14-17 weeks - determines genetic make-up of the fetus a. 2nd Trimester (general objective) Nursing Interventions detect inborn errors of metabolism vii. obtain a signed consent form chromosomal abnormalities viii. instruct the patient to drink water to level of Alpha-fetoprotein fill the bladder to aid in the maternal diagnosis of X-linked attainment of the desired position condition of the uterus. assess fetal lung maturity ix. explain to the patient that risks detect fetal hemolytic disease involved include: estimates fetal renal maturity and spontaneous abortion function (creatinine level) infection hematoma and b. 3rd Trimester (reasons) intrauterine death test to determine fetal lung maturity test for fetal hemolytic disease a. Transcervical (erythroblastosis fetalis): anemic, position – Lithotomy jaundiced and edematous as the ask mother to wash cervix and heart fails vagina with an antiseptic agent Color of Amniotic Fluid b. Transabdominal ★ Normal: clear, may include bits of vernix position – Supine ★ Abnormal: ultrasound is done first to ○ cloudy, yellow, and foul-smelling - determine the best entry position suggests infection an area of the abdomen is ○ yellow - suggests a blood cleansed with antiseptic solution incompatibility (presence of bilirubin) Post Procedure ○ green – meconium staining, x. document the fetal heart activity associated with fetal distress xi. check the maternal vital signs xii. allow woman to void xiii. Rhogam is given to woman who 3. Lecithin-Spingomyelin Ratio are Rh-negative xiv. report any vaginal spotting, ➔ Matured Lung: bubbles appear after the shake test passage of amniotic fluid, clots or tissue ➔ ratio is 2:1 xv. sexual intercourse may be limited for a few days Nursing Care (before procedure) i. instruct patient to void if gestation is greater than 20 weeks ii. position the patient on supine 5. Fetal Movement Count 7. Nonstress Testing kick counts measures the response of the fetal heart rate to felt by the mother (quickening) at approximately 18 fetal movement to 20 weeks of pregnancy mother should be in left recumbent position Method count 2-3 times daily, preferably after a meal the woman is positioned and the fetal heart 30-60 minutes each time rate and uterine contraction monitors are should feel 10 times movements a day attached as for obtaining a rhythm strip instruct mother to notify care provider immediately the woman pushes a button attached to the if with abrupt change or no movement monitor whenever she feels the fetus move Result Reactive 6. Fetal Heart Rate Monitoring o when the fetus moves, the heart heard on the 10th and 11th week of pregnancy by rate should increase 15 bpm and the use of ultrasonic doppler technique remain elevated for 15 seconds nurse assesses FHR patterns, implements Non-reactive interventions, and reports suspicious patterns o poor oxygen perfusion of the fetus is suggested Methods o the baby may be sleeping intermittent auscultation: HR 120 - 160 o oral carbohydrate snack (orange beats per minute juice) to increase blood glucose electronic fetal monitoring: can be external level or internal monitor a. Rhythm Strip Testing 8. Contraction Stress Testing for fetal heart rate assessment of whether contraction initiated by oxytocin may lead to variability is present preterm labor, thus, it should only be achieved by recorded for 20 minutes nipple stimulation (to release oxytocin same in breastfeeding) b. Electronic Fetal Monitoring Negative (normal) if no fetal heart rate it shows how the fetus responds before, deceleration is present during contraction during and after each contraction (oxytocin stress test) best identifies the well oxygenated fetus 9. Leopold’s Maneuver Nursing Interventions to determine presentation and position of the fetus place mother in semi-fowler’s position to and aid in the location of fetal heart sounds prevent the uterus from compressing the vena cava a. Fundal Grip require the mother to remain in fairly fixed b. Umbilical Grip position for 20 minutes c. Pawlick’s Grip d. Pelvic Grip Alterations in FHR Tachycardia (more than 160 bpm) Bradycardia (less than 120 bpm) Variability o beat to beat fluctuation in the baseline FHR that causes the printed line to have an irregular appearance (Normal 6-25 bpm); indicates sympathetic and parasympathetic nervous system status o Absent or Decreased Variability associated with: ▪ fetal sleep ▪ hypoxia ▪ narcotics/sedative drugs such as MgSO4