Chapter 9 - FHR Assessment

Question 1

EFM

electronic fetal monitoring

Answer 1

• Small box = 10 seconds
• Horizontal line = 10 bpm
• Intervals between red vertical lines = 1 min

Question 2

Baseline

Answer 2

Where the bb is most comfortable

-Norm FHR: 110-160 bpm

Question 3

Variability

Answer 3

Fluctuation in BB’s baseline

3 types: absent, minimal, mod

Question 4

absent variability

Answer 4

0 bmp fluctuation or absent

Question 5

minimal variability

Answer 5

<5 bpm fluctuation fr baseline

• Can occur due to admin of pain meds like fentanyl or nubain
• Minimal that occurs in less than 20 min may be bc BB is sleeping

Question 6

moderate variability

Answer 6

6-25 bpm fluctuation fr baseline

-BB is oxygenated

Question 7

Acceleration (before + after 32 wk gestation)

Answer 7

> 32 wk: Increase in FHR by 15 bmp, lasting 15 seconds
-Up 1.5 box, across 1.5 box

<32 wk: Increase in FHR by 10 bmp, lasting 10 seconds

• What is being assessed in NON-STRESS TEST [NST]
• Indicates SUPER-OXYGENATION

Question 8

Early Deceleration

Answer 8

-dips matches the contraction peaks
-Starts + Ends at the same time
gradual
-Indicates head is coming down birth canal: when UC occurs, fetal head is subjected to pressure that stim vagal nerve> incr ICP> decr cerebral BF
-At least 5 cm dilation

Question 9

Late Deceleration

Answer 9

Caused by placental insufficiency

• Starts at the peak of uterine contraction
• U-shaped
• gradual
• Occurs in late onset of contraction
• Indicates that the BB is NOT getting oxygenated
• may be due to transient or chronic placental insufficiency

Question 10

Variable Deceleration

Answer 10

Abrupt drop from baseline

• Decrease in FHR by 15 bpm, lasting 15 seconds
• Down 1.5 box, across 1.5 box
• Most commonly caused by amniotic fluid loss
• may be caused by fetal acidemia too
• Less fluid leads to more compression of the cord

Question 11

FHR baseline tracing is based on…

Answer 11

variability + accelerationor deceleration

Question 12

normal baseline

Answer 12

• 110-160
• moderate variability
• NO LATE OR VAR DECEL
• ABSENT/PRESENT ACELL or EARLY DECEL

Question 13

FSE

Answer 13

fetal scalp electrode

• applied to presenting part of fetus
• directly detects FHR

Question 14

FSE can only be used if…

Answer 14

membrane is ruptured

Question 15

External Monitors

Answer 15

• ultrasound for FHR

- tocodynamometry= contractions

Question 16

Internal Monitors

Answer 16

FSE- more invasive but direct FHR

IUPC- contractions, or to infuse saline into uterus

Question 17

main causes of variable decel

Answer 17

-amniotic fluid loss
>bc fluid cushions cords
>w/o fluid, cord comprssion

Question 18

Goal of contractions

Answer 18

Q 2-3min

Question 19

Uterine Activity is described by

Answer 19

• frequency
• duration
• contraction (mild, mod, strong)

Question 20

frequency

Answer 20

start of one to the start of another

expressed in minutes

Question 21

duration

Answer 21

start to end of a contraction

written in seconds

Question 22

contraction strength

Answer 22

mild -tip of nose
mod - chin
strong -forehead

Question 23

bradycardia

Answer 23

FHR less than 110

Question 24

Category 1

Answer 24

• norm baseline
• moderate variability
• can have EARLY decel or accel
• cannot have late or var decel

Question 25

Category 3

Answer 25

• absent variability

- can have recurrent decel, bradycardia, recurrent late decel, sinusoidal pattern

Question 26

Category 2 cannot have…

Answer 26

absent variability