Advantages of external monitoring:

• not invasive
• no internal change has to occur
• membranes not ruptured
• can be used anytime during pregnancy
• mobile monitors available
• reassuring to mom

Disadvantages of external monitoring:

• baby shifts, could lose FHR
• premies are difficult to get a continuous strip (due to extra room in mom)
• could be uncomfortable (must be snug to mom)
• FHR and CTX intensity could be innaccurate on obese clients

Advantages of internal monitoring:

• can tell neurologic status of fetus
• shows patterns of change, FHR and variability
• provides most accurate FHR monitoring
• shows minute to minute/second to second changes

Disadvantages of internal monitoring:

• requires ROM
• Invasive
• increased risk of infection
• baby shifts = poss fetal injury during monitor placement
• decreased mom mobility
• neurological status must be developed to display variability

Baseline FHR

110 - 160 BPM

Changes in the periodic patterns of the FHR

•  Acceleration - when baby moves FHR increases (15 BPM increase for >15 sec)  GOOD
• Deceleration - 3
1. Early - mirror image of CTX.  r/t fetal head compression.  Nadir of FHR is at same time as peak of CTX.  RN = think delivery
2. Late - directly r/t uteroplacental insufficiency.  FHR decreases late and ends late in relation to mom's CTX.  Fetal distress.  RN = stop oxytocin, left side, O2 mask 8-10L/min, IV bolus  250mL LR, call Dr.  Unresolved = emergency C/S
3. Variable - directly r/t cord compression.  Rapid decrease FHR w/ rapid return to baseline.  Baby playing w/ cord.  RN = change position, low flow O2, and continue to monitor.

HELLP syndrome

• Hemolysis -
• Elevated Liver enzymes -
• Low Platelets - thrombocytopenia

Management - RUQ pain, neck or shoulder pain, MgSO4, poss birth if severe.

Complications - DIC, placental abruption, adult RDS, hepatorenal failure, pulmonary edema, subcapsular hematoma, and hepatic rupture.

DIC - Dissimiated Intravascular Coagulation

• Defect in coagulation, anti and pro activated simultaneously.
• Plt count, pt&ptt all decreased.  Fibrin degradation increased.
• Treatment - delivery of fetus and place

Colostrum is present by

12-16 weeks

Ptyalism

excessive salivation