-
If nipple stimulation is unsuccessful, uterine contractions can be stimulated with
oxytocin via IV until 3 uterine contractions in 10–20 minutes lasting 40 seconds
occur
-
Performed near the end of pregnancy to determine how well the fetus will cope with the
contractions of childbirth
o
Repetitive late deceleration = lack of oxygenation/acidotic/hypoxemia
-
The aim is to induce contraction and monitor the fetus to check for heart rate
abnormalities to see if the baby can deal with the stress of labor
-
If negative contraction stress test
baby’s heart rate isn’t slowed and good oxygen
o
Monitor vitals every 15 minutes during the test
Amniotic Fluid Index
– measures 4 quadrants of the belly
-
Twice a week non stress test and amniotic fluid index if patient is at high risk
-
An ultrasound procedure used to assess the amount of amniotic fluid
-
The amniotic fluid level is based on fetal urine production – renal perfusion
o
Normal levels are 5-25 cm of fluid
o
Less than 5 – oligohydramnios fluid
usually deliver patient no matter
gestational age
Placenta not functioning properly (normally)
Premature rupture membranes
o
Greater than 25 – polyhydramnios
the patient is still going to come in for
monitoring twice a week – we can still keep her pregnant unless SOB – tap
fluid off – too much fluid can cause contraction so if she’s increase risk of
preterm labor - SOB
Idiopathic (most common)
Fetal abnormalities
Diabetes
Fetal infection
Immune hydrops
Biophysical profile (BPP)
-
An ultrasound assessment of fetal status after a NON REACTIVE NST
-
After trying to wake up baby with (VAS)
if still not moving
do ultrasound BPP
(biophysical profile)
o
Score of 8 to 10 is excellent – she’s good to go, repeat NST twice a week
o
Score of 0 to 2 – deliver baby – emergent situation (inform provider)
-
0 or 2 for each category 10 max
Chapter 9
-
FHR reflects fetal oxygenation
-
EFM is used for virtually all women during labor
-
Nurses are expected to independently assess, interpret, and intervene related to
interpretations of EFM patterns
-
Intermittent fetal heart rate monitoring
o
Performed with fetoscope or hand-held Doppler
o
Low risk moms
– can’t have twins, bag of water broken
o
Home births and birthing centers (low-risk pregnancies, natural childbirth)
o
Allows for greater maternal freedom of movement
-
Continuous fetal heart rate monitoring
o
High risk pregnancy and/or delivery
o
Multiple gestation
o
Post dates
o
Meconium-stained amniotic fluid
o
Maternal bleeding
o
Oxytocin infusion
or
Abnormal uterine contractions
o
Fetal bradycardia/non-reassuring FHR or Fetal distress
o
Maternal Complications (Gestational Diabetes, Preeclampsia)
o
Intrauterine Growth Restriction (IUGR)
-
AWHONN Standards for Frequency for FHR Assessment
o
In the presence of risk factor, continuous EFM is recommended for
Every 15 minutes in the active phase
Every 5 minutes while pushing
o
In the absence of risk factor, FHR should be evaluated
Every 30 minutes in the active phase of labor
