Fetal Assessments

Question 1

Intermittent Auscultation intervals for low risk pregos:

1) Latent
2) Active
3) Second Stage

Answer 1

1) Q 60 min
2) Q 30 min
3) Q 15 min

Question 2

Intermittent Auscultation intervals for high risk pregos:

1) Latent
2) Active
3) Second Stage

Answer 2

1) Q 30 min
2) Q 15 min
3) Q 5 min

Question 3

Indications for internal fetal monitoring?

Answer 3

ruptured, dilated ≥ 3cm, head of baby at 0 level of descent

Question 4

How to calculate the baseline fetal HR?

Answer 4

avg FHR over 10 mins, rounded to nearest 5 BPM

Question 5

Classifications of FHR variability?

Answer 5

absent, minimal, moderate &

marked

Question 6

Amplitude of FHR classifications?

Answer 6

1) absent = undetectable
2) minimal = ≤ 5 BPM
3) moderate = 6 - 25 BPM
4) marked = > 25 BPM

Question 7

What is the normal FHR?

Answer 7

110 - 160 BPM

Question 8

What is the desired FHR variability classification and amplitude?

Answer 8

moderate at 6-25 BPM

Question 9

Which variability classifications require interventsion?

Answer 9

absent and marked

Question 10

Which variability classification is indicative of fetal compromise?

Answer 10

marked

Question 11

Causes of decreased fetal heart rate variability?

Answer 11

• hypoxia and acidosis
  -fetal sleep cycles
• Drugs (narcs)
• general anesthesia
• fetal anomalies
• fetal sepsis
• tumors of the
  CNS
• fetal heart block
• tachycardia
• Extreme prematurity
• Previous neurologic insult

Question 12

What is the description of an early FHR deceleration?

Answer 12

uniform deceleration that mirrors contractions during labor

Question 13

What is a Nadir?

Answer 13

the lowest part of a FHR deceleration

Question 14

When does the nadir occur in an early FHR deceleration during labor?

Answer 14

at the peak of the contraction

Question 15

Description of a late FHR deceleration during labor?

Answer 15

• begins and ends after the contraction

- nadir occurs after the peak of a contraction

Question 16

Nursing interventions for a late FHR deceleration?

Answer 16

• stop pitocin
• turn mom on left side
• O2
• IV fluids
• notify provider immediately

Question 17

Description of a variable FHR deceleration?

Answer 17

• an abrupt deceleration below baseline with an acceleration or “shoulder” before returning to baseline
• can occur with or without a contraction

Question 18

Initial management of Variable Decelerations?

Answer 18

keep changing the mom’s position until improvement is noted

Question 19

Management if Variable Decelerations persist?

Answer 19

• IV fluids/bolus
• Vaginal exam to check for prolapsed cord
• Notify primary care provider
• may need amnioinfusion
• plan for immediate delivery

Question 20

Category 1 baseline FHR and variability?

Answer 20

• 110 -160 bpm

- moderate

Question 21

FHR Category 1 accelerations?

Answer 21

• Early deceleration: present or absent

- late or variable deceleration: absent

Question 22

Normal FHR Category?

Answer 22

Category 1

Question 23

FHR Category 3?

Answer 23

• Absent baseline FHR variability & any of the following:
  
  • Recurrent late decelerations
  • Recurrent variable decelerations
  • Bradycardia
  • Sinusoidal pattern

Question 24

Implications of an FHR Category 3?

Answer 24

• Predicts abnormal fetal acid-base status
• Requires prompt evaluation
• Expeditiously resolve the abnormal FHR pattern

Question 25

Interventions for an FHR Category 3?

Answer 25

``` INTRAUTERINE RESUSCITATION - Provide maternal oxygen - Change maternal position - Discontinue labor stimulation - Treat hypotension ```

Question 26

FHR Category 2 variability?

Answer 26

- minimal - absent variability not accompanied by recurrent decelerations - marked variabiliy

Question 27

FHR Category 2 accelerations?

Answer 27

absence of induced accelerations after fetal stimulation

Question 28

FHR Category 2 decelerations?

Answer 28

- Periodic or episodic decelerations - Recurrent variable decelerations with mod. BLV - Prolonged deceleration (≥ 2 min. but < 10 min.) - Recurrent late decelerations with mod. BLV - Variable decelerations with other features, ie. slow return to BL, overshoots or shoulders

Question 29

Implications of an FHR Category 2?

Answer 29

- Indeterminate - Not predictive of abnormal fetal acid-base status - Requires evaluation, continued surveillance, & reevaluation - Take into account the entire clinical circumstances

Question 30

What is the difference between external and internal uterine monitoring?

Answer 30

Internal monitoring shows intensity

Question 31

Definition of Tachysystole?

Answer 31

> 5 contractions in 10 mins