Fetal heart rate monitoring

Question 1

How are uterine contractions monitored?

Answer 1

of ctx in 10 minute window averaged 30 minutes

Question 2

Normal uterine activity

Answer 2

5 ctxs or less in 10 minutes averaged over 30 minutes

Question 3

Tachysystole uterine activity

Answer 3

more than 5 ctxs in 10 minutes averaged over 30 minutes

Question 4

Category 1 are strongly predictive of normal _______.

Answer 4

acid-base status

Question 5

Baseline FHR

Answer 5

mean FHR rounded to increments of 5 bpminute during a 10 minute segment excluding periodic/episodic changes, periods of marked variability, segments of baseline that differ by more than 25 bpm

Question 6

minimal baseline variability

Answer 6

range detectable but 5 bpm or fewer

Question 7

moderate baseline variability

Answer 7

amplitude range6-25 bpm

Question 8

Define acceleration

Answer 8

visually apparent increase in FHR w/ onset to peak less than 30 seconds. If it lasts 10 minutes or longer, then it is a baseline change

Question 9

Define acceleration at 32 wga and beyond

Answer 9

peak of 15 bpm or more above baseline w/ a duration of 15 seconds or more but less than 2 minutes

Question 10

Define acceleration before 32 wga

Answer 10

peak of 10 bpm above baseline w/ a duration of 10 seconds or more but less than 2 minutes

Question 11

Define prolonged acceleration

Answer 11

2min>FHT<10 min

Question 12

Define early decel

Answer 12

symmetrical gradual decrease and return of FHR w/ ctx/ Peak of nadir=peak of ctx.

Question 13

Late decel

Answer 13

nadir occurs after peak of ctx.

Question 14

Define variable decel

Answer 14

abrupt decrease is defined as from the onset of decel to beginning of FHR nadir of less than 30s. 15 bpm lasting 15 seconds to 2 minutes.

Question 15

prolonged decel

Answer 15

decrease from baseline that is 15 bpm or more lasting 2-10 minutes.

Question 16

Category 1 tracing

Answer 16

no late or variable decels

Question 17

Category 3 tracing

Answer 17

absent variability and any of the following: recurrent late decels, recurrent variable decels, bradycardia, sinusoidal.

Question 18

How often should pt w/o complications be monitored?

Answer 18

1st stage: 30 minutes. 2nd stage: 15 min

Question 19

The use of EFM decreases the risk of ____

Answer 19

neonatal seizures

Question 20

___% of encephalopathy occurs during IP period

Answer 20

4

Question 21

T or F moderate variability is strongly associated w/ arterial umbilical cord pH >7.15

Answer 21

true

Question 22

What is decreased variability associated with?

Answer 22

fetal hypoxia, acidemia, drugs, fetal tachycardia, CNS/cardiac anomalies, prolonged contractions, prematurity, fetal sleep, betamethasone

Question 23

Cause of early decel

Answer 23

pressure on fetal head. physiologic

Question 24

Cause of late decel

Answer 24

repititve (>50% in 20 minutes) are associated w/ uteroplacental insufficiency

Question 25

causes of variable decels

Answer 25

umbilical cord compression, oligohydramnios

Question 26

Absence of accelerations for ___ minutes correlates w/ increased neonatal morbidity

Answer 26

80

Question 27

Define reactivity

Answer 27

An increase of 15 BPM above baseline for 15 second duration (from baseline to baseline) twice in a 20 minute period.

Question 28

Decel etiology

Answer 28

Etiologies: Maternal hypotension [18] , uterine hyperactivity, cord prolapse, cord compression, abruption, artifact (maternal heart rate) , maternal seizure [19]

Question 29

How are late decels managed

Answer 29

Place patient on side [23,24]
Discontinue oxytocin.
Correct any hypotension
IV hydration.
If decelerations are associated with tachysystole consider terbutaline 0.25 mg SC [26,27]
Administer O2 by tight face mask [25, 40]
If late decelerations persist for more than 30 minutes despite the above maneuvers, fetal scalp pH is indicated.
Scalp pH > 7.25 is reassuring, pH 7.2-7.25 may be repeated in 30 minutes.
Deliver for pH < 7.2 or minimal baseline variability with late or prolonged decelerations and inability to obtain fetal scalp pH

Question 30

How are variable decels managed

Answer 30

Change position to where FHR pattern is most improved. Trendelenburg may be helpful.
Discontinue oxytocin.
Check for cord prolapse or imminent delivery by vaginal exam.
Consider amnioinfusion[35-37]
Administer 100% O2 by tight face mask [4].