If nipple stimulation is unsuccessful uterine contractions can be stimulated

If nipple stimulation is unsuccessful uterine

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- 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
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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
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