External pressuresensitive monitoring of uterine fundus external monitor ing of

External pressuresensitive monitoring of uterine

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c. External pressure—sensitive monitoring of uterine fundus external monitor- ing of contractions (1) Internal monitoring with fetal scalp electrode and intrauterine pressure monitor may be done in high risk situations 2. Monitoring Fetal Heart Rate (FHR) a. Normal rate is 120–160 bpm. Baseline FHR is rate between contractions. b. Variability (desirable) (1) Irregularity of fetal heart rate over 10 minutes long term variability (2) Fluctuations of FHR from beat to beat short term variability (3) Variability greater than 6–10 bpm is good; 3–5 is minimal; 0–2 is absent. (Classification may vary by institution and by new terminology instituted over time.) Chapter 5: Maternal Newborn Nursing 71 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(4) Early deceleration: 10–20 beat deceleration that mirrors a contraction; caused by head compression (5) Late deceleration: 10–0 beat deceleration that begins after a contraction has started and ends after it is finished; usually indicates uteroplacental insufficiency—fetal distress (6) Variable deceleration: Non-uniform in shape and irregular timing—usually indicates cord compression (7) Bradycardia: a persistent (greater than 10 minute) drop of 20 bpm or under 110 bpm may indicate fetal distress (8) Tachycardia: a FHR of greater than 160 bpm for 10 minutes or more; may indicate fetal distress or maternal or fetal infection (9) Acceleration: a FHR increase of 15 bpm for at least 15 seconds; considered a “reassuring” sign indicating fetal well-being D. Complications of Labor and Delivery 1. Dystocia/Dysfunctional Labor— can be caused by large baby; cephalopelvic disproportion—head is too large for the pelvis; an unusual presentation—breech; abnormalities of the pelvis, uterus or cervix; or ineffective contractions a. If the signs of abnormal labor persist, or if fetal distress occurs, a cesarean section is usually performed b. This is the most common reason given for an unplanned C/S 2. Premature Labor and Delivery— when infant is delivered after the age of viability but before 37 weeks. Incidence between 5–10 percent of pregnancies. a. Causes may be cervical incompetence, infection, multiple births, preeclampsia, or placental disorders. Many are for unknown reasons. b. Medical management (1) Attempt to arrest labor by Ritodrine, Brethine, or MgSO4. Often put patient on bed rest. (2) Administration of betamethasone, if labor progresses, to help accelerate fetal lung maturation c. Nursing interventions (1) Monitor patient with electronic fetal monitor, as ordered (2) Help patient maintain bed rest on left side, if possible (3) Monitor patient for signs and symptoms of labor and fetal movement (4) Administer medications, as ordered, and inform patient of expected side effects (5) Help patient with diversional activities and other means of tolerating prolonged bed rest, if indicated 3. Prolapsed Umbilical Cord a. Cord displacement near or in front of presenting part; may occur when membranes rupture or after b. More common in premature labor, unengaged fetus, breech presentation c. Emergency—cord compression leads to fetal hypoxia, CNS damage, and death
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