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RGU Exam 2 > EFM > Flashcards

EFM Flashcards

1
Q

What is Cardiotocography

A
  • Electric Fetal Monitoring
  • Measures fetal heart rate via external doppler or internal scalp electrode
  • Also measures uterine activity
  • Uses 2 around the mothers abdomen; 1 for fetal heart rate monitoring and 1 for uterine contractions
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2
Q

Montevideo units

A
  • Calculation derived from subtracting the baseline uterine pressure from the peak contraction pressure for each contraction in a 10-min. window and adding the pressures generated by each contraction. In the example shown, there were 5 contractions, producing pressure changes of 52, 50, 47, 44 and 49 mm HG, respectively. The sum of these 5 contractions is 242 Montevideo units
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3
Q

Why do we use EFM

A
  • To determine if a fetus is well oxygenated

*fetal brain regulates heart rate thru parasympathetic and sympathetic nervous system

*hypoxia changes activity of nervous system which affects heart rate

*results in changes on EFM

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4
Q

Important sings to look for in EFM

A
  • Baseline heart rate

*fetus normal HR is ~160bpm

  • Variability

*refers to how squiggly the line is on the monitor

  • Presence or absence of accelerations and decelerations

*accelerations are good; HR going up then going back down

*decelerations are bad; HR going down then coming back up

  • Frequency of contractions
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5
Q

FHR ranges

A

Fetal hear rate ranges

  • Normal baseline: 110-160bpm
  • Bradycardia: <110bpm for >10min
  • Tachycardia: >160bpm for >10min
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6
Q

Causes of abnormal fetal baseline HR chart

A
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7
Q

EFM variability ranges

A
  • Fluctuation in beat to beat rate
  • Amplitude of peak-to-trough in bpm
  • Absent: amplitude range undetectable

*never want; baby needs to be delivered ASAP

  • Minimal: amplitude rang <5bpm
  • Moderate: amplitude range 6-25bpm
  • Marked: amplitude range >25bpm
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8
Q

EFM Variability Chart examples

A
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9
Q

Variability significance

A
  • Variability is sensitive to fetal biochemical (acid-base) status
  • Moderate variability suggests adequate oxygenation
  • Decreased variability is assoc. w/:

*medications (opiods, magnesium sulfate)

*fetal sleep cycle

*prematurity

*CNS or cardiac abnormalities

*fetal hypoxia

*fetal acidemia

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10
Q

EFM Sinusoidal pattern

A
  • Smooth sine wave-like undulating pattern in FHR baseline
  • Cycle freq. of 3-5per min
  • Persists for 20min or more
  • Assoc. w/ severe fetal anemia
  • Transient pattern can be assoc. w/ maternal administration of butophanol (Stadol)
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11
Q

EFM Accelerations

A
  • Abrupt increase in FHR w/ peak of >15 beats above baseline
  • Duration of at least 15sec, up to 2min

*if duration is >2min, it is a prolonged acceleration

*if duration is >10min, it is a change in baseline

  • Assoc. w/ fetal mvmt
  • Demonstrates a mature neurocardiac tract
  • Usually indicates the fetus is not acidemic
  • Reassuring of fetal well-being
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12
Q

EFM Decelerations

A
  • Decrease in FHR from baseline
  • Descriptions

*recurrent: decel occurs w/ >50% of contractions

*intermittent: occurs w/ <50% of contractions

  • Types:

*early: assoc. w/ head compression (not so bad)

*variable: assoc. w/ cord compression (okay)

*late: assoc. w/ uteroplacental insufficiency (bad)

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13
Q

Early Decelerations

A
  • Mirrors contraction—>starts at onset of contraction, nadirs at peak of contraction, returns to baseline at end of contraction
  • Onset of nadir >30sec
  • Due to head compression that stimulates the vagal nerve
  • No treatment necessary, consider checking pt as head is probably descending
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14
Q

Variable Decelerations

A
  • Babies HR decelerates to compensate for something going wrong
  • Abrupt decrease in FHR wher onset to nadir is <30sec
  • Decrease in FHR is >15bpm w/ total duration >15sec
  • “V” config
  • Due to vagal response from cord compression
  • Not necessarily assoc. w/ contraction, can occur at any time
  • Can cause fetal hypoxia if persistent
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15
Q

Decelerations Interventions

A
  • Maternal repositioning

*decelerations could be compensating for cord compression and by moving mother you can shift things relieving the pressure on cord

  • Amnioinfusion

*places intrauterine fluid via IVF/IUPC

  • Check patient

*if prolapsed cord is palpated, elevate presenting fetal part while preparations are made for operative delivery

  • GOAL IS TO ALLEVIATE CORD COMPRESSION
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16
Q

Late Decelerations

A
  • Symmetrical gradual decrease in FHR
  • Begins at or after peak of contraction and returns to baseline after contraction is over
  • Assoc. w/ uteroplacental insufficiency from decreased uterine perfusion or decreased placental function

*post-term pregnancy, placental abruption, maternal hypertension/hypotension, maternal DM, maternal anemia, maternal sepsis, uterine tachysystole

17
Q

Late Decelerations Interventions

A
  • Maternal repositioning—> left or right lateral
  • Maternal oxygen admin
  • Administer IV fluid bolus
  • Reduce contraction freq.

*discontinue oxytocin or cervical ripening age

*administer tocolytic medication

  • GOAT IS TO IMPROVE UTEROPLACENTAL BLOOD FLOW
18
Q

“A-B-C-D” Approach to decelerations

A
  • Assess oxygen pathway
  • Begin conservative corrective measures
  • Clear obstacles to rapid delivery
  • Determine decision-to-delivery time
19
Q

When do we need to expedite delivery?

A
  • At FHR category 3
20
Q

Decelerations Chart

A
21
Q

Category 1 FHR tracings

A

Category 1 FHR tracings include all of the following:

  • Baseline rate: 110-160bpm
  • Baseline FHR variability: moderate
  • Late or variable decelerations: absent
  • Early decelerations: present or absent
  • Accelerations: present or absent
  • Assoc. w/ normal acid-base status
22
Q

Category 3 FHR tracings

A

Category III FHR tracings include either:

  • Absent baseline FHR variability and any of the following:

*recurrent late decelerations

*recurrent variable decelerations

*bradycardia

  • Sinusoidal pattern
  • Assoc. w/ abnormal acid-base status
23
Q

Category 2 FHR tracings

A
  • Everything else not in category 1 or 3
  • Assoc. w/ indeterminate acid-base status; i.e. not predictive of either normal or abnormal
24
Q

3 Tier FHR Classification Chart

A
25
Q

Normal FHR Strip

A
26
Q

Management of Category 1

A
  • No interventions necessary
  • This is reassuring that fetus is not acidemic
27
Q

Management of Category 2

A
  • Requires eval, continues monitoring, and possibly intrauterine resuscitation
  • Interventions include:

*maternal repositioning

*maternal oxygen admin

*IVF

*reduce contraction freq

*possible amnioinfusion (if variable decels)

  • Presence of moderate variability and accelerations are reassuring that fetus is not acidemic
28
Q

Management of Category 3

A
  • Requires intrauterine resuscitation
  • If unresolved, deliver pt
29
Q

Uterine Activity

A
  • Contractions are quantified as number of contractions present in 10min window averaged over 30min
  • Duration, intensity, and relaxation time b/w contractions are also important
  • Normal: <5 contractions in 10min averaged over a 30min window
  • Tachysystole: >5 contractions in 10min averaged over a 30min window
30
Q

Normal contraction pattern

A
  • <5 contractions in 10min averaged over a 30min window
31
Q

Tachysystole contractions pattern

A
  • >5 contractions in 10min averaged over a 30min window

RGU Exam 2 (21 decks)

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