9. Fetal Heart Monitoring

Question 1

63% of term pregnancies with fetal asphyxia have no known risk factors. Fetal heart rate FHR monitoring was developed to detect FHR patterns that may be assocaited with delivery of infants with?

Answer 1

Poor outcome

benefit: inc operative vaginal deliveries and Csections

Question 2

External electronic fetal monitoring has a doppler ultrasound transducer placed on the abdomen overlying the fetal heart- records reflected sound waves. There is also a pressure sensitive tocodynamometer transducer which detects and records contractions, used for frequency and NOT?

Answer 2

strength of contraction

Question 3

Internal electronic fetal monitoring includes a fetal scalp electrode FSE (avoid in HIV) rate is computed from R wave peaks of fetal echocardiogram, and also a intrauterine pressure catheter (IUPC) placed transcervically giving precise measurement of?

Answer 3

intensity of contractions in mmHg

**Provides most accurate infromation

Question 4

the pH of fetal scalp blood is normally between 7.25-7.3, if the pH is less than 7.20 it is considered?

Answer 4

Abnormal- fetal acidosis

Question 5

contractions cause compression of uterine myometrial vessels, umblical cord, and the fetal head which causes decreased blood flow, increasing/decrasing FHR….

Answer 5

MEOW YAS

Question 6

Normal uterine contractions is 5 or less in 10 minutes, tachysystole is when there are >5 contractions in 10 minutes with/without FHR decelerations, how often should they happen?

Answer 6

2-3 mins ish

Question 7

When someone is using montevideo units MVUs, normal is >200 units (sum of contractions in 10 min period) for at least two hours, MVU is measured by what device?

Answer 7

IUPC

Question 8

What is tachysystole?

Answer 8

> 5 uterine contractions in 10 minutes

each line is one minute, 10s per block

Question 9

Normal FHR is 110-160, tachycardia is >160, bradycardia is <110, FHR is assessed between contractions, not during the uterine contractions

Answer 9

MEOW

Question 10

Causes of bradycardia include fetal hypoxia (late sign), obstetric anethesia, pitocin, maternal hypotension, prolapsed or prolonged compression of the umbilical cord and?

Answer 10

Heart block

Question 11

Causes of tachycardia include fetal hypoxia (early sign), excessive oxytocin, arrhythmias, prematurity, maternal fever, and?

Answer 11

fetal infection such as chorioamnionitis ***MCC

Question 12

Baseline variability is visually quantified as the amplitude of peak to trough in BMP of change in baseline rate, absent= no range, minimal is amplitude <5, moderate is amplitude 6-25 (NORMAL) and marked is amplitude?

Answer 12

> 25bpm

Question 13

Decreased variability is an indicator of possible fetal stress, is ominous if associated with persistent late decelerations and is associated with? 2

Answer 13

hypoxia and acidemia

Question 14

Causes of decreased baseline variability is prematurity, sleep cycle, maternal fever, fetal tachycardia caffeine and?

Answer 14

nicotine

Question 15

Periodic FHR may vary with uterine contractions by slowing or accelerating, categorized as no change, accerleration, and deceleration… in which change of periodic does the FHR maintain the same characteristic as in preceding baseline FHR?

Answer 15

No Change

Question 16

An abrupt increase in FHR is an acceleration and is normal reassuring reponse**, at greater than 32 weeks: HR of >15 above baseline for 15s - 2 min, less than 32 weeks: Hr >10 bpm above baseline for ?

Answer 16

10s or more, less than 2 mins

Question 17

A prolonged accleration FHR lasts longer than 2 minutes and is considered a change in baseline if it lasts longer than 10 minutes, common causes include fetal movement, vaginal examination or scalp?

Answer 17

stimulation/vibroacoustic stimulation

Question 18

Decelerations occur as the FHR decreases in response to uterine contractions classified as early variable and late. Early decelerations are good, secondary to head compression, not associated with fetal distress and the nadir of deceleration occurs at what time compared to uterine peaks?

Answer 18

nadir of FHR occurs at same time as peak of uterine contractions

Question 19

What type of decelerations are secondary to UMBILICAL cord compression, abrupt decrease on FHR (looks like V), can occur before during or after contraction starts, decrease in FHR >15bmp lasting >15s and less than 2 mins, depth/duration vary?

Answer 19

Variable Decelerations

Question 20

Latedecelerations are caused by uterine placental insufficiency (UPI), most ominous deceleration (BAD), repetitive late decelerations usually indicate fetal metabolic acidosis and low arterial pH, nadir of deceleration is located where?

Answer 20

AFTER the peak for contraction

d/t excessive contraction/ maternal supine hypotension

Question 21

A prolonged deceleration is decreased FHR that is >15 and lasting >2 min but <10 mins, due to disruption of oxygen transfer from the environment to the fetus at one or more points, commonly seen during?

Answer 21

maternal pushing

Question 22

What is a very concerining pattern that is smooth, sine wave like undulating in FHR baseline with a cycle frequenc of 3-5 per minute… seen with fetal anemia*?

Answer 22

Sinusoidal Pattern

Question 23

Category II which is due to intermittnet variable decelerations//// and recurrent viaribale decelerations for >50% of contractions then the umblical cord compression with acidemia and to treat this, modify maternal pushing or do what procedure?

Answer 23

Amnioinfusion (1st stage labor)

Question 24

What is instillation of normal saline to alleviate cord pressure, initially 250-1000cc infused at a rate of 15cc/min, followed by continuous 100-200cc/hour, infused using IUPC?

Answer 24

Amnioinfusion

promote fetal oxygen with category 2

Question 25

If baby is category 3, there is increased risk of hypoxemia/acidemia (sinusoidal pattern) and the baby should be?

Answer 25

DELIVERED

Question 26

What is it called when the scalp is scratched and if there is an acceleration of 15bpm lasting 15 seconds the fetal pH value almost always is 7.22 or greater, used to differentiate fetal sleep from acidosis?

Answer 26

Fetal Scalp Stimulation

Question 27

emergent cesarian section takes how long?

Answer 27

30minutes

Question 28

A normal FHR pattern indicates >98% probability of fetal well being, electronic fetal monitoring does NOT result in reduction of?

Answer 28

Cerebral Palsy (false positive rate for detecting is >99%)

Question 29

Abnormal patterns or non reassuring FHR can occur in absence of fetal distress- false positive is as high as 80%, most patients with nonreassuring FHR patterns give birth to?

Answer 29

Health infants!

Question 30

The follow are associated with what situation…. VARIABLE and prolonged decelerations, along with fetal bradycardia?

Answer 30

Nuchal Cord