INtrapartum Fetal Monitoring

Question 1

The false-positive rate for electronic FHR monitoring for predicting CP is_____

Answer 1

> 99%.

Question 2

The mean FHR rounded to increments of 5 beats/min during a 10-minute segment. Normal FHR baseline: ______

Answer 2

110–160 beats/minute

Question 3

Non-hypoxic explanations include of tachycardia (maternal factors)

Answer 3

medications (β-adrenergic agonists [terbutaline], atropine, scopolamine), fever, thyrotoxicosis

Question 4

Non-hypoxic explanations include of tachycardia (fetal factors)

Answer 4

repetitive accelerations (from fetal movements), fetal tachyarrythmias, prematurity

Question 5

Bradycardia: FHR baseline is <110 beats/min

Non-hypoxic explanations include(maternal factors)

Answer 5

β-adrenergic blockers, local anesthetics

Question 6

Bradycardia: FHR baseline is <110 beats/min

Non-hypoxic explanations include(fetal factors)

Answer 6

congenital heart block (associated with maternal lupus)

Question 7

Fluctuations in the baseline FHR that are irregular in amplitude and frequency. It is a reflection of the autonomic interplay between the sympathetic and parasympathetic
nervous system.

Answer 7

Baseline variability:

Question 8

Baseline variability:

• Absent amplitude range undetectable
• Minimal amplitude range detectable but ____
• Moderate (normal): amplitude range ____
• Marked: amplitude range_____

Answer 8

<5 beats/min

6-25 beats/min

> 25 beats/min

Question 9

A visually apparent abrupt increase (onset to peak in <30 seconds) in the FHR.

These are mediated by the sympathetic nervous system in response to fetal movements or scalp stimulation

Answer 9

Acceleration

Question 10

Normal acceleration

At ≥32 weeks gestation, an acceleration has

Answer 10

a peak of >15 beats/min above baseline,

with a duration of >15 seconds but < 2 min from onset to return

Question 11

Normal acceleration

At <32 weeks gestation,

Answer 11

an acceleration has a peak of >10 beats/min above baseline,

with a duration of >10 sec but <2 min from onset to return

Question 12

A visually apparent usually symmetrical gradual decrease and return of
the FHR associated with a uterine contraction

Answer 12

Early deceleration:

Question 13

Significance of Early deceleration:

Answer 13

These are mediated by parasympathetic stimulation and occur in response to head compression.

Question 14

Importance of late decel

Answer 14

These are mediated by either vagal stimulation or myocardial depression and occur in response to placental insufficiency

Question 15

What deceleration?

The nadir of the deceleration occurs at the same time as the peak of the contraction

Answer 15

Early deceleration

Question 16

What deceleration?

The deceleration is delayed in timing, with the nadir of the deceleration occurring
after the peak of the contraction.

Answer 16

Late deceleration

Question 17

A visually apparent abrupt decrease in FHR. These are mediated by umbilical cord compression

Answer 17

Variable deceleration

Question 18

It is important to recognize that FHR tracing patterns provide information only on the current acid–base status
of the fetus.

Answer 18

FHR tracing

Question 19

Cat 1 tracing for FHR

Answer 19

• Baseline rate: 110-160 beats/min
• Baseline FHR variability: moderate
• Late or variable decelerations: absent
• Early decelerations: present or absent
• Accelerations: present or absent

Question 20

These include all FHR tracings not categorized as category I or III, and may represent an appreciable fraction of those encountered in clinical care

Answer 20

Cat II

Question 21

Mx of Cat II

Answer 21

evaluation and continued surveillance and reevaluation, taking into account the
entire associated clinical circumstances

Question 22

What category?

• Recurrent late decelerations
• Recurrent variable decelerations
• Bradycardia
• Sinusoidal pattern

Answer 22

Category III: FHR tracings are abnormal

Question 23

Mx of Cat III

Answer 23

expeditious intrauterine resuscitation to resolve the abnormal FHR pattern; if
tracing does not resolve with these measures, prompt delivery should take place

Question 24

Variable Decelerations significance

Answer 24

umbilical cord compression

Question 25

IU resuscitation

Answer 25

Decrease uterine contractions
Augment IV fluid volume
Administer high-flow oxygen
Amniofusion
Change position
Vaginal examination
Scalp stimulation

Question 26

How to augment IV fluid volume

Answer 26

Infuse the parturient with a 500 mL bolus of intravenous normal saline rapidly to enhance uteroplacental infusion

Question 27

How to give O2

Answer 27

Give the parturient 8–10 L of oxygen by facemask to increase

delivery of maternal oxygen to the placenta

Question 28

_____ is useful for eliminating or reducing the severity of variable decelerations

Answer 28

Amniofusion

Question 29

______ may be used in labor if the EFM strip is equivocal

Answer 29

fetal scalp blood pH

Question 30

Prerequisites of fetal scalp pH include

Answer 30

cervical dilation, ruptured membranes, and adequate descent of the fetal head

Question 31

Contraindications of fetal scalp pH monitoring

Answer 31

Contraindications are suspected fetal blood dyscrasia

Question 32

_____is used to confirm fetal status at delivery.

involves obtaining both umbilical cord venous and arterial samples.

Answer 32

umbilical artery blood pH

Question 33

Arterial Pco2 and base deficit values

are higher than venous, but pH and Po2 are _____. Normal fetal pH is ____

Answer 33

lower

> 7.20

Question 34

Specific Interventions If Immediate Delivery Is Indicatedin Cat III tracing

• In stage 1 of labor, _____
• In stage 2 of labor, _____

Answer 34

the only option is emergency cesarean section.

an operative vaginal delivery (e.g., vacuum extractor assisted or
obstetrical forceps) may be appropriate, or an emergency cesarean section must be
performed.