432 Exam 1

Topic 1 - 24% of exam

● Perry chapters 1, 2, 7, 8, 9

Topic 2 - 68% of exam

● Perry chapters 13, 14, 15, 16

Topic 1

Intro to Childbearing Family

● Family Centered care

○ Maternity nursing
■ All stages of pregnancy - 6 weeks after birth

○ Health Disparities
■ By 2060 population %:
● White 46%
● Black 14%
● Hispanic 26%
● Asian 11%
● Native 2%
● Pacific Islander 0.7%
● Due to biologic, environmental, and health behavior factors
● Higher morbidity and mortality rates in every group when
compared with asians and whites
○ Cause = Education and income disparities
■ Efforts to reduce disparities
● HRSA
● NIH
● CDC
● USDHHS
○ Community Health Promotion
■ Levels of preventative care:
● Primary - promote healthy lifestyles w/ vax, exercise, nutrition
● Secondary - targeting populations at risk for diseases
● Tertiary - rehabilitation focus in presence of disease or illness
○ Primary & Secondary relevant in pregnancy
■ Home Care
● La Leche League
○ Postpartum support for nursing mothers
● AWHONN
○ Defines home care
● Perinatal services
○ Can be hospital-based, independent, or nonprofit
agencies
■ Assessment of the Community
● Data collection
● Access to Healthcare
○ Related to availability and accessibility of care

○ US Healthcare
■ Problems
● Reduction of medical errors, high cost, limited access, reform
■ Trends
● Maternal mortality (death)
○ 3 major causes today:
■ Gestational HTN
■ PE
■ Hemorrhage
○ Related to:
■ <20, >35 years of age
■ Lack of PNC
■ Non-white, low-education, or unmarried
● Maternal Morbidity (illness, disease)
○ No surveillance methods to measure incidence
● Obesity
● Regionalization of perinatal healthcare services
○ Different levels of care (1, 2, 3)
● High technology care, Social media, Community based care
■ Vulnerable Populations
● Women
 ● Adolescent girls
○ Concern for being pregnant, STDs, unprotected sex
○ Education is key
● Older women
○ Longer life expectancy, chronic illness
○ Less likely to use preventative services
○ More likely to spend more on health care
● Racial/Ethnic minorities
● Incarcerated women
○ High-risk for STDs, HIV, AIDS due to IVDA
○ Generally report physical/sexual abuse
○ High # non-hispanic black women
● Immigrants/refugees
○ Often do not seek medical care in fear of deportation
○ Challenged w/ healthcare access bc not citizens
○ Refugees more likely to be poorer than immigrants
● Homeless
● Rural vs Urban

○ HP 2020 Goals
■ Attain high-quality longer lives free of preventable diseases, disability,
injury, or death
■ Achieve health equity, eliminate disparities & improve health for all
groups
■ Creating social & physical environments that promote good health for
all
■ Promote quality of life, healthy development, and healthy behaviors
across all life stages

○ Legal Issues
■ Standards described by several organizations:
● ANA - publishes standards for maternal-child nursing
● AWHONN - standards, practice/education for perinatal nursing
○ Defines nurses responsibility to patient
○ Standards of professional performance that delineate
roles & behaviors for which nurse is accountable
● ACNM - publishes standards of practice for midwives
● NANN - standards of practice for neonatal nurses
 ○ Risk Management
■ Sentinel event
● unexpected occurrence involving death or serious physical or
psychological injury or the risk thereof
○ Signals need for an immediate investigation & response
■ Perinatal Nursing:
● Careful surveillance and ID of complications
● Quick action to initiate appropriate interventions &
activate a team response to minimize patient harm
■ Maternal complications: (appropriate for process measurement)
○ Placental abruption
○ PP hemorrhage
○ Uterine rupture
○ Eclampsia
○ Amniotic fluid embolism
■ Fetal Complications:
○ Non-reassuring FHR and pattern
○ Prolapsed cord
○ Shoulder dystocia
○ Uterine hyperstimulation
■ Failure to rescue = failure to recognize or act on early signs of distress

Pregnancy Adaptation

● Gravidity & Parity

○ Definitions
■ Gravidity:
● Gravida - woman who is pregnant
● Gravidity - pregnancy
● Nulligravida - woman who has never been pregnant
● Primigravida - woman pregnant for 1st time
● Multigravida - woman who has had 2+ pregnancies
■ Parity:
● Parity - # of pregnancies in which fetus(es) have reached
viability, not # of fetuses born
○ Whether fetus is born alive or stillborn after viability
reached does not affect parity
● Nullipara - woman who has not completed a pregnancy w/
fetus who have reached stage of fetal viability
 ● Primipara - woman who has completed one pregnancy w/
fetus who have reached stage of viability
● Multipara - woman who has completed 2+ to fetal viability
■ Term:
● Preterm - pregnancy that has reached 20 weeks of gestation
but before completion of 37 weeks of gestation
● Late Preterm - pregnancy reached between 34 weeks 0 days
and 36 weeks 6 days gestation
● Early Term - pregnancy btwn 37 weeks 0 days & 38 wks 6 days
● Full Term - between 39 wks 0 days & 40wks 6 days
● Late Term - 41 wks 0 days & 41 wks 6 days
● Post Term - 42 wks 0 days & beyond gestation
■ Viability - capacity to live outside the uterus
● About 22-25 weeks gestation are on threshold of viability
○ Very premature infants vulnerable to brain injury

○ OB History
■ Summarizing
● Two digits
○ G - gravida
○ P - para
● Five digits
○ GTPAL
■ Gravidity, term, preterm, abortions, living
children
■ Abortions/micarriage = loss of fetus < 20 weeks
● Signs of Pregnancy
○ Testing
■ hCG
● Human chorionic gonadotropin
● Earliest biochemical marker of pregnancy
● Recognizes hCG or β-subunit of hCG
● Can detect in serum/urine early as 7-8 days after ovulation
○ hCG normally doubles every 2 days for 1st 4 weeks
○ Testing too early = false negative
○ Signs
■ Presumptive - subjective changes felt by woman
● Breast changes
● Amenorrhea
● Nausea/vomiting
● Urinary frequency
● Fatigue
● Quickening - starts to feel movements in the fetus
● Can be due to conditions other than pregnancy
■ Probable - objective changes assessed by an examiner
● Goodell Sign - cervix softens, appears velvety; friability ↑
● Chadwick Sign - deepened violet-bluish color of vaginal mucosa
● Hegar Sign - softening/compressibility of cervical isthmus
● Positive pregnancy test (serum/urine)
● Braxton Hicks Contractions - uterus contractions
○ Not felt until 2nd or 3rd trimester
○ Painless, irregular, relieved by walking
● Ballottement - rebound of unengaged fetus
■ Positive - objective signs assessed by examiner that can be attributed
only to the presence of a fetus
● Visualization of fetus by ultrasound (US)
● Fetal heart tones by US
● Visualization of fetus by radiographic study
● Fetal heart tones by Doppler US stethoscope
● Fetal heart tones by fetal stethoscope
● Fetal movements palpated by examiner
● Fetal movements visible to examiner
● Adaptations to Pregnancy
○ Uterus
■ Uteroplacental Blood Flow
● Diagnostics
○ Rate: 450-650 mL/min at term
○ Uterine Souffle: bruit from uterine arteries to placenta
■ Synchronous w/ maternal pulse
○ Funic Souffle: fetal blood coursing thru umbilical cord
■ Synchronous w/ fetal HR
○ Auscultated with US or fetal stethoscope
● Main Factors that ↓ uteroplacental blood flow:
○ Low maternal arterial pressure
○ Uterine contractions
○ Maternal supine position
○ Vagina
■ ↓ pH of secretions, anaerobic bacteria
■ ↑ vascularity of vagina & other pelvic viscera, risk of candidiasis
■ Risk for edema and varicosities
■ External structures enlarged
○ Breasts
■ ↑ sensitivity, tingling, heaviness
■ Nipples and areolae pigmented
■ Montgomery’s tubercles
■ Blood vessels noticeable
■ Colostrum as early as 16 weeks
■ Striae gravidarum - stretch marks
○ Cardiovascular
■ Hypertrophy possible
■ Heart pushed to the left and upward
■ PMI shifted upward
■ Blood volume ↑ 40-45%
● WBCs ↑
● ↑ risk for DVT
■ CO ↑ 30-50%
■ HR ↑ 15-20 bpm
■ Blood pressure
● Bp lowest on left lateral side
● Compression of vena cava when lying flat
● Supine hypotension syndrome occurs = feeling faint
■ ↓ SVR
 ■ ↑ risk of thromboembolic disease
● Pregnancy = hypercoagulative state
○ Respiratory
■ O2 needs ↑
■ Ligaments of rib cage relax
■ Elevated diaphragm (about 4 cm)
■ ↑ RR
■ ↓ total lung capacity
○ Renal
■ Physiological
● Renal pelvis & ureters - dilate
● Ureters - elongate, become tortuous, form single/double curves
● Stagnated urine
● Lag time between urine formation & reaching the bladder
● Dilated more on right than the left
■ Fxn Changes
● GFR & RPF - ↑
● Irritability, nocturia, frequency, & urgency common
● Glycosuria can occur
● Proteinuria doesn’t naturally occur
○ Integumentary
■ Stretching, altered hormonal balance
■ Hyperpigmentation (especially nipples)
■ Melasma - blotchy, brownish hyperpig. on cheeks, nose, forehead
● Especially if pregnant w/ dark complexions
■ Linea Nigra - pigmented line from symphysis pubis → top of fundus
■ Angiomatas - vascular spiders on neck, thorax, face, and arms
■ Palmar Erythema - pinkish red, diffusely mottled, or well-defined
blotches on palmar surfaces of hands
● 70% caucasian
● 30% african american
■ Pruritus Gravidarum - mild itching over abdomen
■ Polymorphic Eruption of Pregnancy (PEP) - common dermatosis
● Aka PUPPP
○ Musculoskeletal
■ Posture alteration, Waddling, Center of gravity shift
■ Abdominal muscles stretch/lose tone
■ Slight relaxation & ↑ mobility of pelvic joints
■ Overall muscle tone ↓
 ○ Neuro
■ Carpal Tunnel Syndrome - may be caused by peripheral nerve edema
■ Sensory changes in legs
■ Dorsolumbar lordosis
■ Acroesthesia - numbness & tingling of hands
● Caused by stoop-shouldered stance
■ Tension headache, lightheadedness, corneal thickening, hypocalcemia
○ GI
■ Appetite, PICA, Gums hyperemic, N&V
■ Epulis - red, raised nodule on gums that bleeds easily
■ Ptyalism - excessive salivation
■ Heartburn - delayed stomach emptying
■ Hiatal Hernia - may occur due to displaced stomach
■ ↑ water absorption due to ↑ transit time
■ ↓ hydrochloric acid
■ Flare-ups of existing peptic ulcers uncommon
■ ↑ risk of cholithiasis & cholecystitis
○ Endocrine
■ Pituitary/placental hormones → progesterone → estrogen → serum
prolactin → oxytocin → human chorionic somatomammotropin

● Nursing Care During Pregnancy

○ Normal Pregnancy
■ Spans 9 months
■ HCP uses lunar months
■ 10 months / 40 weeks / 280 days
■ 1st trimester - week 1-13
■ 2nd trimester - week 14-26
■ 3rd trimester - week 27-term

○ Naegele’s Rule - Calculates EDB

■ Determine 1st day of last menstrual period (LMP)
■ Subtract 3 months
■ Add 7 days and 1 year
○ Alternate:
■ Add 7 days to LMP and count forward 9 months
○ Prenatal Care
■ Initial Visit:
● Prenatal interview
● Hx of physical abuse
● Education

○ Nutrition Needs in Pregnancy

■ Benefits
● Feelings of well-being
● Increases energy
● Improves chances of healthy baby
● Decreases risk of complications
● Shortens labor
● Helps alleviate some discomforts
■ Components
● Protein
● Fluid - 8-10 glasses
● Increase blood volume, digestion, constipation prevention,
amniotic fluid volume
● Caffeine - 200mg/day
■ Nutrition for Lactation
● Caloric needs similar to those during pregnancy
● Fluid to maintain milk production, ↑ maternal weight loss
● Smoking, alcohol, excessive caffeine = no
■ Physical Activity
● Moderate exercise yields many benefits including improving
muscle tone, shortening cause of labor, and sense of well-being
○ Liberal amounts of fluid should be consumed before,
during, and after exercise
○ Calorie intake sufficient to meet increased needs to
pregnancy & exercise
■ Nutrition-Related Discomforts of Pregnancy
● N/V
● Constipation
● Pyrosis
 Topic 2

The Laboring Woman & her Family During Labor & Birth

● Nursing Care During Labor & Birth

○ Labor
■ Timeline
○ Begins w/ 1st uterine contraction
○ Continues w/ hard work during cervical dilation & birth
○ Ends as woman and family begin attachment process w/ infant

■ True vs False Labor

True False

Contractions regular Contractions irregular

Pain in back radiating → front Lying/moving may stop labor

Cervical change No change in cervical dilation

Fetus engages Not engaged, often posterior

Position change doesn’t matter No change in effecement

Bloody Show No bloody show

○ Psychosocial
■ Hx of abuse, stress in labor, culture, body language, etc.

○ Physical Examination
■ General
○ Vitals
○ FHR assessment
○ Contraction assessment
○ Vaginal examination
 ■ Cervical Examination
○ Sterile Vaginal Examination
○ Assessment of:
● Dilation (diagram to Right)
● Effacement
■ Shortening & thickening of cervix
■ 1st stage
● Station (diagram to Left)
■ Relation of the presenting part of fetus in an
imaginary line drawn between maternal ischial
spines
■ Measured in degree of descent of the presenting
part of fetus through birth canal
■ -2, -1, 0, +1, +2
● Position
■ Relationship of a reference point on the
presenting part to the 4 quadrants of the
mother’s pelvis
● Engagement
■ Term used to indicate that largest transverse
diameter of presenting part has passed thru
maternal pelvic brim or inlet into the true pelvis

■ Diagnostics
○ Urine
○ Blood
○ Membranes
○ Leopold’s
● Series of 4 maneuvers by a provider to determine
position of fetus
■ Round, hard mass = head
■ Soft, round = booty
■ Convex shape = fetal spine

○ Stages of Labor
■ 1st stage
● Length:
○ Onset of regular uterine contractions → full dilation of
cervix
 ● 3 phases
○ Latent (early) Phase = EXCITEMENT
■ Dilation: 0-5 cm
■ Effacement: 100%
■ Station: 0 (nullip) to -2 (multip)
■ Contraction: q5-30 min
■ Duration: 6-8 hours
■ Distraction
■ Rest-Relax
■ Ambulation
■ Slow-paced breathing
○ Active Phase = SERIOUS
■ Dilation: 6-10 cm
■ Contraction: q2-3 min
■ Duration: 3-6 hours
■ Change positions frequently
■ Empty bladder frequently
■ Use hydrotherapy
■ Use encouragement, don’t distract
■ “Feel like you’re losing it” (in ppt.)
■ Transition Phase = IRRITABLE
■ Dilation: 8-10 cm
■ Contraction: q2-3 min
■ Duration: 20-40 min
■ Trembling, nausea, perspiration, patterned
breathing, snap at coach
■ Don’t leave alone
● For labor with epidural anesthesia:
■ Transition phase may not always be identified based on
maternal physical sensations and behavior
■ Epidural = Latent & Active phases ONLY
● Nursing Care:
■ Hygiene, nutrition, elimination, ambulation, positioning,
supportive care, siblings
■ Doulas

■ 2nd stage - Delivery

● Length: from time cervix is fully dilated → birth of fetus
● Dilation: 10 cm
● 2 Phases:
 ■ Latent Phase - Resting
■ “Laboring down”
■ Active Phase - Pushing
■ Spontaneous & “directed”
■ Lasts a few minutes - several hours

● Bearing Down
■ Urge
■ Spontaneous pushing
■ Directed pushing
■ Valsalva maneuver
● Delivery positions
● Fetal HR
■ Check regularly
■ Decelerations
■ Interventions
■ Support of father, continuous support, encourage
presence at delivery
● Supplies
● Newborn Care & Assessment
■ Skin to Skin / warmth
■ Quick assessment
■ APGAR scoring
■ Activity Pulse Grimace Appearance Respirations

Score Activity Pulse Grimace Appearance Respirations

Muscle tone Heart beat Reflex irritability Skin color

0 Limp Absent No response Blue-gray, pale Absent

all over

1 Arms and < 100 Grimace Normal skin Slow, irregular

legs flexed BPM color w/
acrocyanosis

2 Active > 100 Sneeze, cough, Normal skin Good, crying

movement BPM pulls away color all over

○ Episiotomies
■ Gooch slice or goochie coochie
 ○ Lacerations
■ 1st degree
● Extends thru: skin & structures superficial to
muscles
■ 2nd degree
● Extends thru: muscles → perineal body
■ 3rd degree
● Extends thru: anal sphincter muscle
■ 4th degree
● Laceration that also involves anterior rectal wall

■ 3rd stage - Placenta

○ Length: birth of fetus → placenta is delivered
○ Duration: 10-15 min (usually)
○ Separation & Expulsion
○ Manual extraction
○ Oxytocin
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■ 4th stage
○ Length: placenta delivery → at least first 2 hr after birth
○ Post Delivery Care
○ Recovery
○ Care of the family
○ Family newborn relationships

● Factors Affecting the Process of Labor

○ Passenger:
■ Fetal Head Size
○ Parietal, temporal, frontal, occipital overlap
○ Fontanels - anterior & posterior
○ Molding
○ Engagement: occurs when largest transverse diameter of the
presenting part has passed thru the maternal pelvis brim or
inlet into the true pelvis
■ Fetal Presentation
○ 3 Types:
● Vertex (96%)
 ■ Head first (AKA cephalic)
● Breech (3%)
■ Buttocks, feet, or both first
● Shoulder (1%)

■ Lie
○ Relation of long axis of fetus to long axis of mother
○ 2 types
● Longitudinal (or vertical)
● Transverse (or horizontal)
■ Cannot give vaginal birth
■ Attitude
○ Relation of fetal body parts to each other
○ General flexion = normal position of chin flexion, thighs on
abdomen, arms over thorax, umbilical cord b/w legs and arms
■ Fetal Position
○ Position denoted by 3 letter abbreviation
● 1) (R) Right or (L) Left in relation to mother’s pelvis
● 2) Presenting part:
■ O - occiput
■ S - sacrum
■ M - mentum or chin
■ SC - scapula or shoulder
● 3) Location of presenting part in relation to portion of
pelvis:
■ A - anterior
■ P - posterior
■ T - transverse
○ Station
○ Engagement
 ○ Passageway:
■ Bony Pelvis
■ 4 basic types of pelvis:
● Gynecoid (female - classic type)
● Android (resembles male pelvis)
● Anthropoid (oval)
● Platypelloid (flat)
■ Soft Tissues
○ Powers:
■ Primary - involuntary contractions
■ Secondary - voluntary contractions to augment involuntary
○ Psychological Response
○ Process of Labor
○ Position of mother

● Fetal Adaptations to Labor

○ FHR
○ Fetal circulation
○ Fetal respiration

● Maternal Adaptations to Labor

○ CV
■ CO ↑
■ BP ↑ during UCs
■ Supine hypotension
■ Valsalva
■ WBC ↑
● Peripheral vasculature changes
○ Respiratory
■ RR ↑
○ Renal
■ Proteinuria up to 1+ may occur
○ Integumentary
 ■ Stretching of vaginal introitus
○ MS
■ Diaphoresis, fatigue, ↑Temp., joint aches / leg cramps
○ Neuro
■ Euphoria then seriousness, then amnesia, elation/fatigue
○ GI
■ Digestive changes occur
○ Endocrine
■ Blood glucose ↓ w/ workload of labor

● Labor Inductions
○ Methods:
■ Prostaglandins - cytotec, cervidil
■ Balloon catheters
■ Laminaria
■ Amniotomy - artificial ROM w/ an amnihook
■ Pitocin
● Synthetic form of oxytocin
● Given IV mu/min per IV pump, slowly
■ Cervical Ripening
● Prostaglandin E2: Dinoprostone (cervidil)

● Augmentation of Labor
○ Labor started spontaneously but has unsatisfactory progression
○ Methods:
■ Oxytocin
■ Amniotomy
■ Nipple stimulation;)
■ Emptying bladder
■ Ambulation
■ Position changes
■ Hydrotherapy
■ Relaxation techniques
■ Nourishment
Obstetrical Pain Management
● Factors that Influence Pain
○ Physiologic
○ Culture
○ Anxiety/emotional state
○ Past experiences
○ Gate control theory

● Non-pharmacological Management
○ Prenatal period
■ Music, meditation, massage, warm baths
○ Practice activities
■ Hypnosis?, patterned breathing, controlled relax techniques,
biofeedback

● Childbirth Prep Methods

○ Grantly-ready-psychoprophylaxis
○ Lamaze-psychoprophylaxis
○ Bradley-husband-coached
○ Birthing from within
○ Birthworks
○ Hypnobirthing

● Pharm Management
○ Sedatives
○ Analgesia
○ Anesthesia
■ Regional
● Contraindications
○ Active or anticipated serious maternal hemorrhage
○ Maternal hypotension
○ Coagulopathy
○ Allergy
○ Abnormal (non-reassuring) FHR & pattern requiring
immediate birth
○ Maternal refusal or inability to cooperate
○ Infection at injections site
○ Some types of maternal cardiac conditions
○ ↑ ICP
 ● Types:
○ Epidural
■ Nursing Considerations:
● Baseline maternal VS & FHR
● Have patient void
● Hydrate w/ 500:1000 mL LR or NS
● O2 ready
● Position patient either side lying or sitting
up on edge of bed
● VS after procedure per protocol
■ Side Effects:
● Bladder distention, elevated temp,
short/long term backache, disruption of
labor, ↑ oxytocin use, ↑ use of
instrumentation, ↑ C-section incidence
■ Complications:
● Hypotension leading to fetal bradycardia
or late decelerations
● IV injection
● “Total spinal”
● Spinal headache, infection, epidural
hematoma
● Impotent block or “spotty” block
○ Spinal
■ MOA/Admin.
● Local anesthetic or combined w/ opioid
● 3rd, 4th, or 5th lumbar → subarachnoid
● Marked hypotension
● Positioning
○ Pudendal
■ General
● May be necessary for emergency childbirth
● Keep anesthesia time to a minimum to ↓ side effects
● NPO status
● IV infusion
● Pre-oxygenation w/ 100% O2
● Cricoid pressure during intubation
● Delivery fetus ASAP
○ Nitrous Oxide
■ Mixed w/ O2
 ■ Reduces pain
■ 1st & 2nd stage
■ Remains awake
■ Used in combo w/ non-pharm measures
■ Self administered
■ Observe for N/V, drowsiness, dizziness, hazy memory, LOC

Fetal Assessment
● Basics for Monitoring
○ Uterine activity
○ Fetal well-being measured by response of FHR to contractions
○ Fetal compromise
○ Goal of FHR monitoring is to ID non-reassuring patterns that indicate
potential compromise

● Monitoring Techniques
○ Electronic Fetal Monitoring (EFM)
○ External Monitoring
■ FHR: Ultrasound transducer
■ UC: Tocotransducer
● Can only be external
● Placed at fundus (top of uterus)
● Can’t measure intensity of contractions
○ Internal Monitoring (invasive)
■ Spiral Electrode - monitor FHR, screw on baby’s head
■ Intrauterine pressure catheter (IUPC) - Montevideo units
● Membrane has to be ruptured to be inserted

● Fetal HR Patterns
○ Baseline FHR: 110-160 bpm
■ Baseline rate is average during 10 min segment, excluding:
● Periodic or episodic changes
● Periods of marked variability
● Segments of the baseline that differ by more than 25 bpm
■ Tachycardia
● Baseline more than 160 bpm for > 10 min
● Often seen with maternal fever
 ■ Bradycardia
● Baseline < 110 bpm for > 10 min
○ Duration = count from beginning of one contraction to the end of the same
contraction
○ Frequency = beginning of one contraction to the next
○ Tachysystole (AKA uterine hyperstimulation)
■ More than 5 UCs in 10 minutes or 2 UCs > 120 s in duration
■ Requires intervention

○ FHR Variability
■ Variability = amplitude change from beat to beat (how squiggly the
line is))
■ Absent (1)
● Flat ass line
■ Minimal (2)
● minimal : amplitude range < 5 bpm
● Abnormal or indeterminate
○ Can indicate fetal hypoxemia or metabolic acidemia
■ Moderate (3)
● Normal
● Amplitude range: 6-25 bpm
■ Marked (4)
● Unclear significance
● Amplitude range: >25 bpm
■ Sinusoidal pattern = undulating wave

○ Periodic & Episodic Changes

■ Accelerations
● Change of 15 bpm for 15 seconds or longer
■ Decelerations
● Early
 ○ Start early, end early
○ Mirror reverse of U/C
○ Caused by head compression
● Variable
○ Vary in everything
● Late
○ FHR starts late, recovers late w/ respect to UCs
● Prolonged
○ Can be gradual or abrupt in onset
○ Lasts more than 2 min & less than 10 min

■ Mnemonic - VEAL CHOP

● V - variable deceleration = C - cord compression
● E - early deceleration = H - head compression
● A - accelerations = O - OK
● L - late decelerations = P - placenta
○ Do POISON interventions
○ Interventions
■ POISON
● P - position change
● O - oxygen
● I - increase IV rate
● S - sterile vaginal exam
● O - oxytocin off
● N - notify provider
■ Amnioinfusion
● Injects water through IUPC into uterus
● Relieves
○ Oligohydramnios (insufficient amniotic fluid)
○ Umbilical cord compression
○ Recurrent variable decelerations
■ Tocolytics
■ Fetal pulse ox
■ Patient & family education
■ Documentation

○ 3 Tier FHR Classification

■ Category 1
● Baseline: 110-160
● Variability: moderate
 ● Decelerations: absent late & variable
● May have: early decelerations or accelerations
■ Category 2
● Baseline: brady or tachy
● Variability: minimal baseline variation, absent baseline
variability w/out recurrent decelerations; marked variability
● Accelerations: none produced in response to fetal stimulation
● Decelerations:
○ Periodic or episodic
○ Recurrent variable w/ minimal or moderate variability
○ Prolonged
○ Recurrent late w/ moderate variability
○ Variable w/ other characteristics such as slow return to
baseline, overshoots or shoulders
■ Category 3
● Absent variability and any of the following:
○ Recurrent late deceleration
○ Recurrent variable deceleration
○ Bradycardia
● Sinusoidal pattern

○ Antepartum Assessment using EFM

■ Determine if intrauterine environment is supportive to fetus
■ Non-stress test (fetal activity determination)
■ Vibroacoustic stimulation