Which of the following is a characteristic of reassuring fetal heart rate pattern quizlet?

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Listening to fetal heart sounds at periodic intervals to assess FHR

Easy to use, inexpensive, less invasive than EFM

Difficult to perform on women who are obese

Does not provide a permanent record

can be performed with a Pinard fetoscope, Doppler ultrasound, an ultrasound stethoscope, or a DeLee-Hillis fetoscope

It is often more comfortable for the woman and gives her more freedom of movement.

Other care measures, such as ambulation and the use of baths or showers, are easier to carry out when IA is used.

Because IA is intermittent, significant events may occur during a time when the FHR is not being auscultated.

When using IA the nurse can assess the baseline FHR, rhythm, and increases and decreases from baseline.

Early deceleration of the FHR is a visually apparent gradual (onset to lowest point ≥30 seconds) decrease in and return to baseline FHR associated with UCs.

It is thought to be caused by transient fetal head compression and is considered a normal and benign finding
Generally the onset, nadir (lowest point), and recovery of the deceleration correspond to the beginning, peak, and end of the contraction

For this reason, an early deceleration is sometimes called the "mirror image" of a contraction.

Early decelerations may occur during UCs, during vaginal examinations, as a result of fundal pressure, and during placement of the internal mode of fetal monitoring.

When present, they usually occur during the first stage of labor when the cervix is dilated 4 to 7 cm.

Early decelerations are also sometimes seen during the second stage when the woman is pushing.

Because early decelerations are considered to be benign, interventions are not necessary.

The value of identifying early decelerations is so they can be distinguished from late or variable decelerations, which can be abnormal and for which interventions are appropriate.

Cause
Head compression resulting from the following:
• Uterine contractions
• Vaginal examination
• Fundal pressure
• Placement of internal mode of monitoring

Clinical Significance
Normal pattern; not associated with fetal hypoxemia, acidemia, or low Apgar scores

Nursing Interventions
None required

Late deceleration of the FHR is a visually apparent gradual decrease in and return to baseline FHR associated with UCs

The deceleration begins after the contraction has started, and the nadir of the deceleration occurs after the peak of the contraction.

The deceleration usually does not return to baseline until after the contraction is over

Traditionally late decelerations have been attributed to uteroplacental insufficiency.

However, in reality a number of factors can disrupt oxygen transfer to the fetus, even with mild UCs and a normally functioning placenta

These factors include maternal hypotension, uterine tachysystole (e.g., more than five contractions in 10 minutes averaged over a 30-minute window), preeclampsia, late term or postterm pregnancy, amnionitis, small for gestational age fetuses, maternal diabetes, placenta previa, placental abruption, conduction anesthetics, maternal cardiac disease, and maternal anemia.

Rarely fetal oxygenation can be interrupted sufficiently to result in metabolic acidemia.

For that reason late decelerations should be considered an ominous sign when they are associated with absent or minimal variability

The most common cause of late decelerations is uterine tachysystole, usually caused by oxytocin (Pitocin) administration

Cause
Disruption of oxygen transfer from environment to fetus caused by the following:
• Uterine tachysystole
• Maternal supine hypotension
• Epidural or spinal anesthesia
• Placenta previa
• Placental abruption
• Hypertensive disorders
• Postmaturity
• Intrauterine growth restriction
• Diabetes mellitus
• Intraamniotic infection

Clinical Significance
Abnormal pattern associated with fetal hypoxemia, acidemia, and low Apgar scores; considered ominous if persistent and uncorrected, especially when associated with absent or minimal baseline variability

Nursing Interventions
The usual priority is as follows:
1. Change maternal position (lateral).
2. Correct maternal hypotension by elevating legs.
3. Increase rate of maintenance IV solution.
4. Palpate uterus to assess for tachysystole.
5. Discontinue oxytocin if infusing.
6. Administer oxygen at 8 to 10 L/minute by nonrebreather face mask.
7. Notify physician or nurse-midwife.
8. Consider internal monitoring for a more accurate fetal and uterine assessment.
9. Assist with birth (cesarean or vaginal assisted) if the pattern cannot be corrected.
IV, Intravenous.

Variable deceleration of the FHR is defined as a visually abrupt (onset to nadir less than 30 seconds) decrease in FHR below the baseline.

The decrease is at least 15 beats/minute or more below the baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes from the time of onset

Variable decelerations occur any time during the UC phase and are caused by compression of the umbilical cord

The appearance of variable decelerations differs from those of early and late decelerations, which closely approximate the shape of the corresponding UC.

Instead, variable decelerations have a U, V, or W shape, characterized by a rapid descent and ascent to and from the nadir of the deceleration

Some variable decelerations are preceded and followed by brief accelerations of the FHR known as shoulders, which is an appropriate compensatory response to compression of the umbilical vein.

Occasional variables have little clinical significance.

Recurrent variable decelerations, however, indicate repetitive disruption in the fetus's oxygen supply.

This can result in hypoxemia and metabolic acidemia.

Variable decelerations are most commonly found during the transition phase of first stage labor or the second stage of labor as a result of umbilical cord compression and stretching during fetal descent

Cause
Umbilical cord compression caused by the following:
• Maternal position with cord between fetus and maternal pelvis
• Cord around fetal neck, arm, leg, or other body part
• Short cord
• Knot in cord
• Prolapsed cord

Clinical Significance
Variable decelerations occur in approximately 50% of all labors and usually are transient and correctable

Nursing Interventions
The usual priority is as follows:
1. Change maternal position (side to side, knee-chest).
2. Discontinue oxytocin if infusing.
3. Administer oxygen at 8 to 10 L/minute by nonrebreather face mask.
4. Notify physician or nurse-midwife.
5. Assist with vaginal or speculum examination to assess for cord prolapse.
6. Assist with amnioinfusion if ordered.
7. Assist with birth (vaginal assisted or cesarean) if the pattern cannot be corrected.

• Fetal well-being during labor is gauged by the response of the FHR to UCs.
• Standardized definitions for many common FHR patterns have been adopted for use in clinical practice by the ACNM, ACOG, and AWHONN.
• The five essential components of the FHR tracing are baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.
• The monitoring of fetal well-being includes FHR and UA assessment and assessment of maternal vital signs.
• The FHR can be monitored by either IA or EFM. The FHR and UA can be assessed by EFM using either the external or internal monitoring mode.
• Assessing FHR and UA patterns, implementing independent nursing interventions, and reporting abnormal patterns to the physician or nurse-midwife are the nurse's responsibilities.
• The AWHONN and ACOG have established and published health care provider standards and guidelines for FHR monitoring.
• The emotional, informational, and comfort needs of the woman and her family must be addressed when the mother and her fetus are being monitored.
• Documentation of fetal assessment is initiated and updated according to institutional protocol.

In assessing the immediate condition of the newborn after birth, a sample of cord blood is a useful adjunct to the Apgar score, especially if there has been an abnormal or confusing FHR tracing during labor or neonatal depression at birth.
Generally the procedure is performed by withdrawing blood from both the umbilical artery and the umbilical vein.
Both samples are then tested for pH, carbon dioxide pressure (PCO2), oxygen pressure (PO2), and base deficit or base excess
Umbilical arterial values reflect fetal condition, whereas umbilical vein values indicate placental function (Miller et al.).
The ACOG (2012) suggests obtaining cord blood values in the following clinical situations: cesarean birth for fetal compromise, low 5-minute Apgar score, severe intrauterine growth restriction, abnormal FHR tracing, maternal thyroid disease, intrapartum fever, and multifetal gestation.
Normal findings preclude the presence of acidemia at or immediately before birth.
If acidemia is present (e.g., pH less than 7.20), the type of acidemia is determined (respiratory, metabolic, or mixed) by analyzing the blood gas values

The five essential components of the FHR tracing that must be evaluated regularly are baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.
Whenever one of these five essential components is assessed as abnormal, corrective measures must be taken immediately.
The purpose of these actions is to improve fetal oxygenation
The term intrauterine resuscitation is sometimes used to refer to specific interventions initiated when an abnormal FHR pattern is noted.
Basic corrective measures include providing supplemental oxygen, instituting maternal position changes, and increasing intravenous fluid administration.
These interventions are implemented to improve uterine and intervillous space blood flow and increase maternal oxygenation and cardiac output (Miller et al.).
Depending on the underlying cause of the abnormal FHR pattern, other interventions, such as correcting maternal hypotension, reducing UA, and altering second-stage pushing techniques also may be instituted
Some of the items listed are not independent nursing interventions.
Any medications administered, for example, must be authorized either through inclusion in a specific unit protocol or by a written or verbal order.
Some interventions are specific to the FHR pattern.
Based on the FHR response to these interventions the primary health care provider decides whether additional interventions should be instituted or whether immediate assisted vaginal or cesarean birth should be performed.

Care of the woman receiving EFM in labor begins with evaluation of the EFM equipment.

If external monitoring is not adequate, changing to a fetal spiral electrode or IUPC may be necessary.

After ensuring that the monitor is recording properly, the FHR and UA tracings are evaluated regularly throughout labor.
the FHR tracing be evaluated at least every 30 minutes during the first stage of labor and every 15 minutes during the second stage of labor in low risk women.

If risk factors are present, the FHR tracing should be evaluated more frequently: every 15 minutes in the first stage of labor and every 5 minutes in the second stage of labor.

Assessing FHR and UA patterns, implementing independent nursing interventions, documenting observations and actions according to the established standard of care, and reporting abnormal patterns to the primary care provider (e.g., physician, nurse-midwife) are the responsibilities of the nurse providing care to women in labor.

Technology has made access to and communication regarding electronic FHR tracings much more convenient for health care providers.

Many hospitals use central monitor displays, which provide the opportunity to view the tracings of several women at the same time at the nurses' station.

Health care providers can also access the FHR tracings of one woman or several clients from remote locations, including office and home.

It is also possible to access FHR tracings and other client data using mobile phones

Electronic Fetal Monitoring Pattern Recognition and Interpretation
Categorizing Fetal Heart Rate Tracings
Nursing Management of Abnormal Patterns

the recommended frequency of IA in low risk women and found consistent recommendations for every 15 minutes in the active phase of the first stage of labor and every 5 minutes in the second stage of labor
performing IA every 30 minutes in the active phase of the first stage of labor and every 15 minutes in the second stage.
recommends auscultation of the FHR every 15 to 30 minutes in the active phase of the first stage labor, and every 5 to 15 minutes in the active phase of the second stage of labor
the optimal frequency for IA in low risk women during labor has not been determined
Every effort should be made to use the method of fetal assessment the woman desires, if possible.
However, auscultation of the FHR in accordance with the frequency guidelines suggested earlier may be difficult in today's busy labor and birth units.
When used as the primary method of fetal assessment, auscultation requires a one-to-one nurse-to-client staffing ratio.
If acuity and census change so that auscultation standards are no longer met, the nurse must inform the physician or nurse-midwife that continuous EFM will be used until staffing can be arranged to meet the standards.
The woman can become anxious if the examiner cannot readily count the fetal heartbeats.
It often takes time for the inexperienced listener to locate the heartbeat and find the area of maximal intensity.
To allay the mother's concerns, she can be told that the nurse is "finding the spot where the sounds are loudest." If it takes considerable time to locate the fetal heartbeat, the examiner can reassure the mother by offering her an opportunity to listen, too.
If the examiner cannot locate the fetal heartbeat, assistance should be requested.
In some cases ultrasound can be used to help locate the fetal heartbeat.
Seeing the FHR on the ultrasound screen will be reassuring to the mother if there was initial difficulty in locating the best area for auscultation.
When using IA, uterine activity is assessed by palpation.
The examiner should keep his or her fingertips placed over the fundus before, during, and after contractions.
The contraction intensity is usually described as mild, moderate, or strong.
Duration is measured in seconds, from the beginning to the end of the contraction.
The frequency of contractions is measured in minutes, from the beginning of one contraction to the beginning of the next.
The examiner should keep his or her hand on the fundus after the contraction is over to evaluate uterine resting tone or relaxation between contractions.
Resting tone between contractions is usually described as soft or hard
Accurate and complete documentation of fetal status and uterine activity is especially important when IA and palpation are being used because no paper tracing record or computer storage of these assessments is provided as is the case with continuous EFM.
Labor flow records or computer charting systems that prompt notations of all assessments are useful for ensuring such comprehensive documentation.

Variability of the FHR can be described as irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater
It is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FHR.
Variability is quantified in beats per minute and is measured from the peak to the trough of a single cycle.
Four possible categories of variability have been identified: absent, minimal, moderate, and marked
In the past, variability was described as either long term or short term (beat to beat).
The NICHD definitions do not distinguish between long- and short-term variability, however, because in actual practice they are visually determined as a unit
Depending on other characteristics of the FHR tracing, absent or minimal variability is classified as either abnormal or indeterminate
It can result from fetal hypoxemia and metabolic acidemia.
Other possible causes of absent or minimal variability include congenital anomalies and preexisting neurologic injury.
CNS depressant medications, including analgesics, narcotics (meperidine [Demerol]), barbiturates (secobarbital [Seconal], and pentobarbital [Nembutal]), tranquilizers (diazepam [Valium]), phenothiazines (promethazine [Phenergan]), and general anesthetics are other possible causes of minimal variability.
In addition, minimal variability can occur with tachycardia, prematurity, or when the fetus is temporarily in a sleep state
These sleep states do not usually last longer than 30 minutes.
Moderate variability is considered normal
Its presence is highly predictive of a normal fetal acid-base balance (absence of fetal metabolic acidemia).
Moderate variability indicates that FHR regulation is not significantly affected by fetal sleep cycles, tachycardia, prematurity, congenital anomalies, preexisting neurologic injury, or CNS depressant medications
The significance of marked variability ( is unknown due to limited scientific evidence
A sinusoidal pattern—a regular smooth, undulating wavelike pattern—is not included in the definition of FHR variability.
This uncommon pattern classically occurs with severe fetal anemia
Variations of the sinusoidal pattern have been described in association with chorioamnionitis, fetal sepsis, and administration of narcotic analgesics

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