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Utero-Placental Sufficiency
Placenta
During labor, there is an interruption of blood flow.
This is normally tolerated well.
Umbilical Cord
Changes in blood flow
Compression
Stretch
Physical
Psychological
Increase in norepinephrine and epinephrine
Blood flow to vital organs-less oxygen being delivered to uterus
Common causes
Rise in mothers temperature
Drugs: scopalomine, atropine,
phenothiazines, terbutaline,
ritodrine, or epinephrinein
Less common causes
fetal hyperthyroidism, fetal
anemia, fetal heart failure, and
fetal tachyarrhythmias, fetal
infection
Tachycardia with other signs of reassuring heart patterns-baby is most likely oxygenated.
Tachycardia with other signs of fetal distress-may have oxygen deprivation.
Normal variant-90-120
Make sure that it's not the mother's heart rate
Common Causes
Hypothermia
Drugs-magnesium may cause hypothermia
Complete heart block in infant(makes monitoring of fetal heart rate useless as the brain does not comunicate with the heart.
Hypoglycemia
Sever oxygen deprivation
difference in the heart rate from beat to beat
Sympathetic-increases heart rate
Parasympathetic-decreases heart rate
Moderate
6-25 bpm
Minimal
Causes
Severe oxygen deprivation
Baby's sleep cycles
CNS depression
fetal anomalies or previous damage to the fetal brain
lower gestational age
Marked
> 25 bpm
Absent
Undetectable from baseline
Accelerations
Presence
Absence
Other concerning patterns present-50% are hypoxic
Other reassuring patterns-rarely indicates hypoxia
Early Decelerations
Gradual decrease of the fetal heart rate. From the onset to the nadir, it is > or = 30 bpm.
The nadir of the deceleration occurs at the same time as the peak of the contraction.
It is thought that these are caused by the cervix overriding the front fontanel of the baby's head.
This causes an altered cerebral blood flow, with a subsequent slowing of the fhr due to the vagal reflex.
It usually occurs between 4-6cm dilation.
It is not an indication of hypoxia.
Late Decelerations
Tachycardia
Bradycardia
< or = 5 bpm
Variability
Moderate variability indicates the absence of severe hypoxia, but should be evaluated in context.
Diseases that cause poor perfusion
Hypertension
Pre-eclampsia
Collagen Vascular Disease
Diabetic Vasculopahty
Prolonged pregnancy
Hemorrage
Placenta previa
Placental abruption
Stress
Prolonged Decelerations
Decrease is > or = 15bpm and is between 2-10 min.
These look much like early decelerations, but they begin after the peak of the contraction.
Variable Decelerations
Sinusoidal Patterns
Abrupt increase(<30 sec) in the FHR above baseline. Acme is > or = 15bpm and lasts > or = to 15 sec. It lasts between 15 sec and 2 min. before returning to baseline. Almost all are in respone to fetal movement.
Almost always rules out hypoxia