NUR 335 EXAM 2
According to the AWHONN, how often should you assess FHR?
Low risk without oxytocin fetal status assessment:
- stage 1= 15-30 minutes once 4-5 cm dilated
- stage 2= 5-15 minutes
Low risk without oxytocin electronic FHR monitoring:
- stage 1: every 30 minutes once 4-5 cm dilated
- stage 2: every 30 minutes up until active pushing then every 15 minutes
Low risk with oxytocin electronic FHR monitoring:
- stage 1: every 15 minutes
- stage 2: every 15 minutes up until active pushing then every 5 minutes
What is the difference between electronic fetal monitoring and internal fetal
monitoring?
- Electronic:
Use of the toco and FHR doppler to essentially perform an NST; external and non-
invasive devices that can be used any time after viability
- Internal fetal monitoring:
Use of an internal fetal scalp electrode which is attached directly to the fetus, and
can be paired with an intrauterine pressure catheter to get a more accurate
assessment of FHR and contraction strength; requires membranes to be ruptured
,What are some contraindications for internal fetal monitoring?
chorioamnionitis
active maternal genital herpes
HIV
positive GBS test
placental previa/undiagnosed vaginal bleeding
What qualifies an acceleration in FHR?
15 beat per minute increase for 15 or more seconds
What qualifies a deceleration in FHR?
15 beat per minute decrease for 15 seconds or more
What are the requirements of a category 1 fetal heart strip?
Baseline: 110-160 bpm
Variability: moderate (6-25 beat change within 1 box)
Decelerations: can be absent or early
Accelerations: absent or present
,What are the requirements for a category 3 fetal heart strip?
Variability:
absent variability (no change in heart rate) accompanied by any of the following
findings
Baseline:
less than 110 beats per minute (bradycardia) OR sinusoidal pattern
Decelerations:
recurrent late decelerations (nadir of deceleration occurs at end of 50% or more of
contractions seen) OR recurrent variable decelerations (nadir occurs within 15
seconds of start of deceleration)
What are the requirements of a category 2 fetal heart strip?
Baseline:
tachycardia, bradycardia without absent variability
Variability:
minimal (1-5 bpm change in one 10 second box), marked (>25 bpm change in one 10
second box), or absent (no bpm change) not accompanied by recurrent
decelerations
Decelerations:
, Recurrent variable decels with minimal or moderate variability, prolonged decels (2-
10 minutes), recurrent late decles with moderate variability, variable decels with
slow return to baseline, overshoots, or shoulders
Accelerations:
absent after fetal stimulation
How is uterine activity interpreted in FHR monitoring?
frequency
duration
intensity
resting tone
relaxation between contractions
What is indicated when a fetal heart strip has recurrent variable decelerations?
causes? treatment?
- indication: umbilical cord compression
- causes: cord prolapse, nuchal cord, baby laying on cord
- treatment: assess for cord prolapse (if found elevate presenting part and rush for
c/s), reposition mom, administer amnioinfusion (cushion the cord), stop oxytocin,
administer oxygen (10L/min face mask), have mom push every other contraction,
every third compression, or temporarily stop pushing
According to the AWHONN, how often should you assess FHR?
Low risk without oxytocin fetal status assessment:
- stage 1= 15-30 minutes once 4-5 cm dilated
- stage 2= 5-15 minutes
Low risk without oxytocin electronic FHR monitoring:
- stage 1: every 30 minutes once 4-5 cm dilated
- stage 2: every 30 minutes up until active pushing then every 15 minutes
Low risk with oxytocin electronic FHR monitoring:
- stage 1: every 15 minutes
- stage 2: every 15 minutes up until active pushing then every 5 minutes
What is the difference between electronic fetal monitoring and internal fetal
monitoring?
- Electronic:
Use of the toco and FHR doppler to essentially perform an NST; external and non-
invasive devices that can be used any time after viability
- Internal fetal monitoring:
Use of an internal fetal scalp electrode which is attached directly to the fetus, and
can be paired with an intrauterine pressure catheter to get a more accurate
assessment of FHR and contraction strength; requires membranes to be ruptured
,What are some contraindications for internal fetal monitoring?
chorioamnionitis
active maternal genital herpes
HIV
positive GBS test
placental previa/undiagnosed vaginal bleeding
What qualifies an acceleration in FHR?
15 beat per minute increase for 15 or more seconds
What qualifies a deceleration in FHR?
15 beat per minute decrease for 15 seconds or more
What are the requirements of a category 1 fetal heart strip?
Baseline: 110-160 bpm
Variability: moderate (6-25 beat change within 1 box)
Decelerations: can be absent or early
Accelerations: absent or present
,What are the requirements for a category 3 fetal heart strip?
Variability:
absent variability (no change in heart rate) accompanied by any of the following
findings
Baseline:
less than 110 beats per minute (bradycardia) OR sinusoidal pattern
Decelerations:
recurrent late decelerations (nadir of deceleration occurs at end of 50% or more of
contractions seen) OR recurrent variable decelerations (nadir occurs within 15
seconds of start of deceleration)
What are the requirements of a category 2 fetal heart strip?
Baseline:
tachycardia, bradycardia without absent variability
Variability:
minimal (1-5 bpm change in one 10 second box), marked (>25 bpm change in one 10
second box), or absent (no bpm change) not accompanied by recurrent
decelerations
Decelerations:
, Recurrent variable decels with minimal or moderate variability, prolonged decels (2-
10 minutes), recurrent late decles with moderate variability, variable decels with
slow return to baseline, overshoots, or shoulders
Accelerations:
absent after fetal stimulation
How is uterine activity interpreted in FHR monitoring?
frequency
duration
intensity
resting tone
relaxation between contractions
What is indicated when a fetal heart strip has recurrent variable decelerations?
causes? treatment?
- indication: umbilical cord compression
- causes: cord prolapse, nuchal cord, baby laying on cord
- treatment: assess for cord prolapse (if found elevate presenting part and rush for
c/s), reposition mom, administer amnioinfusion (cushion the cord), stop oxytocin,
administer oxygen (10L/min face mask), have mom push every other contraction,
every third compression, or temporarily stop pushing
