Fetal Distress and Fetal Monitoring

Question 1

Tocodynamometer

Answer 1

External contraction monitor

Measures frequency and duration, but not strength

Question 2

Intrauterine pressure catheter

Answer 2

Measures strength, frequency, and duration

Question 3

Doppler

Answer 3

Ultrasound through abdomen

Measures HR

Question 4

Fetal scalp electrode

Answer 4

Monitors R-R of QRS complex and extrapolates a HR

Question 5

Normal fetal HR

Answer 5

110-160 BPM

Question 6

Causes of fetal tachycardia

Answer 6

Maternal fever
Infection (maternal or fetal)
Hypoxemia
Prematurity
Dehydration
Thyrotoxicosis
Pharmacological agents

Question 7

Causes of fetal bradycardia

Answer 7

Hypoxemia
Pharmacological agents
Fetal arrhythmia’s (ex. heart block)
Maternal hypotension

Question 8

Baseline rate

Answer 8

Mean FHR rounded to increments of 5 BPM during a 10 min. segment

Question 9

Variability

Answer 9

Fluctuations in baseline FHR of two cycles per minute or greater
Irregular in amplitude and frequency
Visually quantitated as amplitude of the peak to trough

Question 10

What do you want to see in the fetal heart rate?

Answer 10

Variability

The more variability the better - baby is well

Question 11

Short term variability

Answer 11

Beat to beat changes in FHR with normal between 5 and 25 BPM

Question 12

Long term variability

Answer 12

Undulations of FHR around baseline
3-5 per min is normal
Good baby will increase over baseline 15 BPM lasting at least 15 seconds

Question 13

Long term variability ensures what?

Answer 13

Absence of fetal acidosis

Question 14

Acceleration

Answer 14

Visually apparent abrupt increase in FHR above baseline

Question 15

Early deceleration

Answer 15

Coincides with uterine contraction
Result from fetal head compression (vagal response)
“Mirror image”
Not associated with fetal distress

Question 16

Late deceleration

Answer 16

Shifted to the right in relation to contraction
Associated with uteroplacental insufficiency
Fetal hypoxia and acidosis are more pronounced with severe decelerations

Question 17

Variable decelerations

Answer 17

Most frequently encountered abnormal FHR pattern
Caused by umbilical cord compression
Visually apparent, abrupt decrease in FHR below baseline

Question 18

Management of variable decelerations

Answer 18

STOP PITOCIN

Change maternal position from left to right

Question 19

Management in late decelerations

Answer 19

STOP PITOCIN

Change in maternal position from left to right

Question 20

Meconium

Answer 20

Passage of fetal stool into amniotic fluid
Early - prior to rupture
Late - after rupture, usually heavy
Heavy associated with poorer outcome

Question 21

If pH is less than ? then fetus is distressed

Answer 21

7.25

Question 22

When is fetal scalp pH indicated?

Answer 22

When fetal distress is suggested