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Obstetrics Junior > Fetal Monitoring > Flashcards

Fetal Monitoring Flashcards

1
Q

What is the purpose of electronic fetal monitoring (EFM)?

A

EFM measures the response of fetal heart rate (FHR) to uterine contractions during labor.

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2
Q

What are the two main types of EFM?

A
  1. External fetal monitoring (EFM)
  2. Internal fetal monitoring (IFM)
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3
Q

What are the components of internal fetal monitoring (IFM)?

A
  1. Fetal scalp electrode: Monitors FHR.
  2. Intrauterine pressure catheter: Measures uterine contractions.
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4
Q

When is internal fetal monitoring typically used?

A
  1. After membrane rupture.
  2. Very morbid obesity.
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5
Q

What is external fetal monitoring (EFM)?

A

A non-invasive method using external detectors to monitor:

FHR: Via an ultrasound transducer.

Uterine activity: Via a tocotransducer.

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6
Q

What are the advantages of external fetal monitoring (EFM)?

A

It avoids the need for membrane rupture and uterine invasion.

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7
Q

Where are the transducers placed in external fetal monitoring?

A

On the mother’s abdomen

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8
Q

What is the normal baseline fetal heart rate (FHR)?

A

The normal baseline FHR ranges between 110-160 beats/minute.

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9
Q

What is fetal bradycardia?

A

Fetal bradycardia is an FHR of <110 beats/minute.

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10
Q

What is fetal tachycardia?

A

Fetal tachycardia is an FHR of >160 beats/minute.

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11
Q

Definition of wandering baseline in FHR?

A

An unsteady baseline rate that wanders between 110 and 160 beats/minute.

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12
Q

Significance of a wandering baseline in FHR?

A

Rare finding suggestive of a neurologically abnormal fetus, possibly a preterminal event.

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13
Q

What is beat-to-beat variability?

A

Baseline FHR fluctuations of two cycles per minute or greater.

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14
Q

Interpretation of beat-to-beat variaility?

A

Normal variability: 6 to 25 beats/minute.

Diminished variability: May indicate a seriously compromised fetus.

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15
Q

What are cardiac arrhythmias in FHR?

A

Baseline bradycardia, tachycardia, or abrupt baseline spiking.

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16
Q

What does intermittent bradycardia indicates?

A

Often due to congenital heart block.

17
Q

Types of sinusoidal heart rate pattern, and what causes it?

A

True sinusoidal pattern: Severe fetal anemia, caused by:

  1. D-isoimmunization.
  2. Ruptured vasa previa.
  3. Twin-to-twin transfusion.

Insignificant sinusoidal pattern: May follow narcotic administration, with beat-to-beat variability still >6 cycles per minute.

18
Q

What are periodic fetal heart rate (FHR) changes?

A

Deviations from baseline FHR that are related to uterine contractions.

19
Q

Definition of FHR accelerations?

A

Increase in FHR >15 beats/minute >15 seconds above baseline.

20
Q

Causes of FHR accelerations?

A
  1. Fetal movements
  2. Uterine contractions
  3. Pelvic examination
  4. Fetal scalp blood sampling
21
Q

Significance of FHR accelerations?

A

Almost always reassuring, confirming the fetus is not acidemic at that time.

22
Q

Definition of FHR decelerations?

A

Decrease in FHR < 15 beats/minute for > 15 seconds below baseline.

23
Q

Classification of FHR decelerations?

A

Based on timing relative to uterine contractions:

a) Early decelerations (Type I).

b) Late decelerations (Type II).

c) Variable decelerations (Type III).

24
Q

What causes early decelerations (Type I), and what is their clinical significance?

A

Cause: Fetal head compression.

Significance: Usually benign and not associated with fetal distress, lowest point at same time with peak of contractions.

25
Q

What causes late decelerations (Type II), and what is their clinical significance?

A

Cause: Utero-placental insufficiency.

Significance: Indicates fetal hypoxia or acidemia, requiring immediate intervention, lowestoft after peak of uterine contractions.

26
Q

What causes variable decelerations (Type III), and what is their clinical significance?

A

Cause: Umbilical cord compression.

Significance: May be concerning if prolonged or severe.

27
Q

What is an admission CTG?

A

A short-term cardiotocography (CTG) performed on admission to monitor fetal heart rate in low-risk pregnancies.

28
Q

When is continuous EFM indicated in low-risk pregnancies?

A

When abnormalities in the fetal heart rate are identified during admission CTG.

29
Q

What are potential complications of internal EFM electrodes?

A
  1. Fetal injuries: Scalp or eye injuries.
  2. Placental blood vessel injury: Leading to hemorrhage.
  3. Uterine perforation: From catheter placement.
  4. Infection risk: Increased for both mother and baby.
30
Q

Why is the risk of infection higher with internal EFM?

A

The invasive nature of internal electrodes increases the likelihood of infection in both mother and fetus.

31
Q

What is fetal scalp blood sampling.

A
  • Fetal scalp blood is obtained with
  • an illuminated fetoscope
  • through the dilated cervix,
  • and pH of the capillary blood is measured.
32
Q

pH interpretation of fetal scalp blood sampling?

A

pH interpretation:

> 7.25: Reassuring; continue labor observation.

7.20-7.25: Borderline; repeat in 30 minutes.

<7.20: Repeat immediately; if acidemia is confirmed, consider immediate delivery.

33
Q

What is fetal scalp stimulation, and what does it assess?

A

Definition: Stimulation of the fetal scalp (e.g., using Allis forceps) to observe FHR acceleration.

Significance:

  1. Acceleration present: Normal pH (>7.20).
  2. No acceleration: May indicate fetal acidemia (pH <7.20).
34
Q

What is fetal pulse oximetry, and is it widely used?

A

Definition: Measures fetal oxygen saturation using technology similar to adult pulse oximetry.

Status: Still under evaluation before clinical adoption.

35
Q

What is vibro-acoustic stimulation?

A

Definition: An electronic artificial larynx stimulates the fetus via the maternal abdomen to assess FHR response.

36
Q

How is vibro-acoustic stimulation interpreted?

A

Normal: FHR acceleration >15 bpm lasting 15 seconds, occurring within 15 seconds after stimulation, with prolonged fetal movements.

Abnormal: Only 50% correlate with acidotic pH.

37
Q

What is fetal electrocardiography, and what does it monitor?

A

Analyzes fetal ECG changes (S-T segment and P-R interval) to detect fetal hypoxia.

Obstetrics Junior (7 decks)

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