EFM

Fetal heart tones

Millimeters mercury

Montevideo units

Uterine contraction

Gestational age

Fetal movement

Low point

High point

Rupture of membranes either spontaneous or artificial

Amnitotic fluid index

Ultrasound (FHR)

Tocodynamometer (UC)

Intrauterine pressure catheter (UC) (in your pussy computer)

Internal scalp lead (FHR)

Fetal heart rate

110-160 bpm

Over baby’s left shoulder is technically the best spot, so on the smooth side not the bumpy side.

X-is always time Y-is either FHR or mmHg which is uterine pressure

Average FHR rounded in increments of 5 bpm

Ignore increases and decreases, must have at least 2 mins of EFM (not consecutive) to determine baseline

Change in baseline over 10 minutes

Hypoxemia, drugs, maternal ⬇️ BP, hypothermia, maternal hypoglycemia, fetal arrhythmias, complete/congenital heart block, umbilical cord compresssion, amniotic fluid embolism or normal variation

Maternal fever (infection), chorioamnionitis, fetal sepsis, drugs, fetal hypoxemia, arrhythmias, fetal heart failure, severe fetal anemia, fetal hydrops or maternal hyperthyroid

Assess overall bpm fluctuations in FHR up or down, whole strip not one event (variability in baseline)

Absent- 0 bpm fluctuation (line will literally look. straight pretty much), Minimal- 1-5 bpm fluctuation, Moderate- 6-25 bpm fluctuation, Marked- Over 26 bpm fluctuation, Sinusoidal- visually apparent, smooth THIS IS AN EMERGENCY!

Refelects an intact nervous system with functioning parasympathetic (FHR decrease), and sympathetic (FHR increase) nerve pathways

Ignore increases and decreases Must have at least 2 mins of EFM to determine variability

Hypoxemia/acidosis, fetal sleep cycles, drugs, prematurity, arrhythmias, fetal tachycardia, preexisting neurobiological abnormality or congenital anomalies

Fetal stimulation, drugs, mild/transient Hypoxemia

Fetal oxygenation!!

Vissually apparent abrupt 15 bpm x 15 sec⬆️ in FHR above baseline (for over 32 weeks its 15x15 which is all we are worried about rn)

30 seconds or less= ABRUPT

15 seconds-2 mins

2mins-10mins

Last AT LEAST 10 mins or more!

Oxygen reserves present. Fetal movement or response to stimulus causes ⬆️in FHR

Fetal scalp stimulation, sounds, vibroacustic stimulation, drinking cold water, juice, eating a meal, maternal belly movement or repositioning

Variable ☹️, Early 😁, Late☹️☹️, Prolonged ☹️☹️☹️

Visually apparent abrupt ⬇️in FHR that may or may not be associated with UC

V,U, or W shaped

Abrupt- onset to nadir less than 30 seconds

With or without contractions, can happen anytime commonly seen with UC

⬇️ FHR 15 bpm lasting at least 15 seconds 15x15

*Cord compression* any cord compression, grasp reflex, oligohydroamnios, ROM, prolapsed or nuchal cord

Apparent gradual ⬇️FHR and return to baseline with UC

Spoon or saucer shaped

Gradual (onset to nadir: equal to or greater than 30 seconds)

Nadir of decel and peak of UC= same time (decel mirrors UC)

Head compression= vagal response

Continue to monitor, SVE PRN to evaluate imminence of delivery

Apparent gradual ⬇️FHR and return to baseline associated with UC

Spoon/saucer shaped

Graudal (insert to Nadir 30+ seconds)

Arrives late (does not mirror UC)= Nadir of decel is after peak of UC

Utero-placental insufficiency= Perfusion problems Uterine hyperactivity, maternal hypotension, maternal HTN, abruption, preiva, IUGR, DM, chorioamnionitis, post term gestation, maternal anemia, SS anemia, RH isoimmunization, cardiac disease or smoking, all bad basically

Increase perfusion and oxygenation through positioning, IVF blouse, O2, disease mgmt, evaluate oxytocin use, etc

Longer than 2mins but less than 10 mins (baseline change), Interventions are POISON IS AT CVS

Intermittent: occurring with less than 50% of contractions, Reccurrent: occurring with more than 50% of contractions

How often is mom having contractions?, And how long?, Unit: Range in MINUTES

From beginning to beginning of each UC

More than 5 contraction in 10 minutes (averaged over a 30 minute period)

Unit: Range in SECONDS (50-110), Measurement: From beginning of one UC to the end of the same UC, UC length: must be at least 40 seconds to be considered a UC, Uterine irritability: increase in uterine activity that lasts less time than 40 seconds

Category 1: Normal, Category 2: Intermediate, Category 3: Abnormal

Strongly predictive of normal acid-base status at the time of observation, Must have baseline FHR of 110-160 bpm with moderate variablility, May have (present or absent): Accelerations & earl decelerations, Can’t have: No late, variable or prolonged decelerations

Predicitve of fetal acid-base status at time of observation. Depending on the. clinical situation, efforts to expeditiously resolve the underlying cause of the abnormal heart rate should be made, Etiher: Sinusoidal pattern or absent variablity PLUS one of the following: Reccurrent late decals Recurrent variable decels Bradycardia, *Take a moment to read and understand*

Variable Deceleration ☹️, Early Deceleration 😁, Acceleration 😁, Late Deceleration ☹️, Cord compression, Head compression, O2 reserves (baby is active), Placental insufficiency

Cord compression

Head compression

O2 reserves

Placental insufficiency