Intrapartum Fetal Monitoring

Question 1

a full description of an EFM tracing requires both qualitative and quantitative assessment of

Answer 1

1. uterine contractions
2. baseline fetal heart rate
3. baseline FHR variability
4. presence of accelerations
5. periodic or episodic decelerations
6. changes / trends of FHR over time.

Question 2

category 1

Answer 2

normal

Question 3

category 2

Answer 3

indeterminate and require reevaluation, surveillance, and reevaluation

Question 4

category 3

Answer 4

abnormal, require prompt evaluation and treatment, and mandate delivery if they do not resolve.

Question 5

fetal heart rate acceleration in response to fetal scalp stimulation in presence of NRFH suggests

Answer 5

fetus may not be acidotic, but close surveillance should be continued.

Question 6

FHR monitoring used to indirectly assess

Answer 6

fetal oxygenation

Question 7

EFM has poor inter and intraobserver reliability and a high false-positive rate for detection of fetal compromise

Answer 7

true

Question 8

uterine activity is a key component in the interpretation of EFM.

Answer 8

true

Question 9

hyperstimulation and hypercontractility should be

Answer 9

ABANDONED

Question 10

BASELINE must be for a minimum of 2 minutes in any 10 minute segment; if baseline for a segment cannot be determined, the PRIOR 10 minute segment should be used.

Answer 10

baseline must be for a min of 2 mins in any 10 min segment.

Question 11

normal FH

Answer 11

110-160bpm

Question 12

tachycardia

Answer 12

> 160bpm

Question 13

bradycardia

Answer 13

<110bpm

Question 14

baseline variability: absent

Answer 14

amplitude range undetectable.

Question 15

minimal variability:

Answer 15

amplitude range detectable but <=5bpm

Question 16

moderate (normal):

Answer 16

amplitude range 6-25bpm

Question 17

marked;

Answer 17

amplitude range >25bpm

Question 18

normal uterine activity

Answer 18

<= 5 contractions every 10 minutes averaged over 30 mins

Question 19

tachysystole

Answer 19

> =5 contractions every 10 minutes . tachysystole applies to both spontaneous and induced labor. tachysystole should always be defined by presence or absence of fhr decelerations.

Question 20

pattern: baseline

Answer 20

mean FHR to nearest 5bpm over 10 minute segment excluding periodic or episodic changes, periods of marked fhr variability, and segments of baseline that differ by >25bpm.

Question 21

pattern: baseline variability

Answer 21

fluctuations in the baseline FHR that are irregular in implitude and frequency, quantitated as the amplitude of the peak to trough in bpm.

Question 22

acceleration:

Answer 22

abrupt increase in FHR must reach peak in =32 weeks, accelerations must be >= 15bpm above baseline for >=15 seconds and =10bpm above baseline for >=10 seconds and <2 minutes from onset to return to baseline.

Question 23

sinusoidal pattern

Answer 23

smooth sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3-5/min that persists for >=20 mins.

Question 24

late deceleration

Answer 24

symmetrical graduate decrease and return of FHR associated with a uterine contraction. a gradual FHR decrease is defined as fron onset to the FHR nadir of >= 30 seconds. the decrease in FHR calculated from onset to nadir of the deceleration. the deceleration is delayed in timing, with nadir of the deceleration occuring after the peak, and ending of the contraction, respectively.

Question 25

FHR accelerations reliably predict

Answer 25

absence of fetal metabolic acidemia

Question 26

absence of accelerations

Answer 26

does NOT reliably predict fetal acidemia

Question 27

Moderate FHR variability reliably predicts absence of

Answer 27

fetal metabolic acidemia

Question 28

Minimal or absent FHR variability

Answer 28

ALONE, does NOT reliably predict fetal metabolic acidemia or hypoxemia.

Question 29

Category 1

Answer 29

1. baseline rate 110-160bpm.
2. baseline FHR variability: moderate
3. Late/ variable decelerations: absent
4. Early decelerations: present OR absent
5. Accelerations: present or absent.

Question 30

Cateogry II

Answer 30

all fHR tracings not categorized as Category I or CAtegory II. Examples: Bradycardia not accompanied by absent baseline varability; tachycardia. minimal baseline variability; absent baseline variability with no recurrent decelerations; marked baseline variability. Absence of induced accelerations after fetal stimulation. Recurrent variable decelerations accompanied by minimal / moderate baseline variability. prolonged deceleration >2 mins but

Question 31

Cateogory III

Answer 31

either of the following:
ABSENT baseline FHR variability AND any of the following:
1. recurrent late decelerations
2. recurrent variable decelerations
3. bradycardia. 
OR
sinusoidal fhr pattern.