Fetal Monitoring

Question 1

What are the two types of fetal monitoring?

Answer 1

Intermittent Auscultation and Continuous Electronic Fetal Monitoring

Question 2

What does EFM assessment evaluate?

Answer 2

Uterine contractions (UC), Baseline FHR, FHR variability, Accelerations, Decelerations, Trends of FHR patterns over time

Question 3

What is considered a ‘normal’ uterine contraction rate?

Answer 3

< 5 contractions in 10 minutes (averaged over a 30-minute window)

Question 4

What defines tachysystole in uterine contractions?

Answer 4

> 5 contractions in 10 minutes (averaged over a 30-minute window)

Question 5

How is baseline FHR defined?

Answer 5

The approximate mean FHR rounded to increments of 5 bpm

Question 6

What is the normal range for baseline FHR?

Answer 6

110-160 bpm

Question 7

What is baseline tachycardia?

Answer 7

FHR >160 bpm for >10 minutes

Question 8

What can cause baseline tachycardia?

Answer 8

Excessive fetal movement, maternal fever, dehydration, chorio, drugs, hypoxia

Question 9

What is baseline bradycardia?

Answer 9

FHR <110 bpm for >10 minutes

Question 10

What are common causes of baseline bradycardia?

Answer 10

Maternal hypothermia, complete fetal heart block, post-term pregnancy, magnesium sulfate

Question 11

What is marked variability in FHR?

Answer 11

> 25 bpm

Question 12

What is moderate variability in FHR?

Answer 12

6-25 bpm

Question 13

What is minimal variability in FHR?

Answer 13

> Undetectable but <5 bpm

Question 14

What is absent variability in FHR?

Answer 14

Undetectable

Question 15

What characterizes a sinusoidal pattern in FHR?

Answer 15

Visually apparent, smooth, sine wave-like undulating pattern with a cycle frequency of 3-5/min that persists for > 20 minutes

Question 16

What are accelerations in FHR?

Answer 16

Abrupt increase in the FHR 15 beats above the baseline lasting a minimum of 15 seconds

Question 17

What causes early decelerations?

Answer 17

Head compression

Question 18

What interventions are needed for early decelerations?

Answer 18

Not a concerning pattern, sterile vaginal exam, prepare for birth

Question 19

What causes late decelerations?

Answer 19

Placental insufficiency

Question 20

What are the characteristics of chronic late decelerations?

Answer 20

Repetitive, associated with minimal variability, subtle, not correctable

Question 21

What are variable decelerations caused by?

Answer 21

Cord compression

Question 22

What shape do variable decelerations typically have?

Answer 22

V, U or W shaped

Question 23

What does the mnemonic VEAL CHOP stand for?

Answer 23

• V = variable decel
• E = Early decel
• A = accelerations
• L = Late decel
• C = Cord Compression
• H = head compression
• O = Okay!
• P = Placental perfusion

Question 24

What defines prolonged decelerations?

Answer 24

Deceleration 2-10 minutes long

Question 25

What are the three central concepts of intrapartum FHR interpretation?

Answer 25

* Periodic decelerations * Episodic decelerations * Recurrent decelerations

Question 26

What characterizes Category I FHR patterns?

Answer 26

BL FHR 110-160 bpm, moderate FHR variability, no late or variable decelerations, present or absent early decelerations, present or absent accelerations

Question 27

What defines Category II FHR patterns?

Answer 27

BL bradycardia without absent variability, BL tachycardia, minimal/marked variability, absent variability without recurrent decelerations

Question 28

What indicates Category III FHR patterns?

Answer 28

Absent variability and any of the following: recurrent late decelerations, recurrent variable decelerations, bradycardia, sinusoidal pattern