Intrapartum fetal monitoring

Question 1

Definition of tachysystole

Answer 1

More than 5 ctx in 10 minutes averaged over 30 minutes

Question 2

How often does a cat I EFM need to be monitored?

Answer 2

q30 m in 1st stage, q15 m in 2nd stage of labor

Question 3

Differences between intermittent and recurrent variable decelerations?

Answer 3

intermittent is with < 50% ctx, recurrent is 50+%. recurrent especially with deep prolonged variables sign of worsened acid base status.

Question 4

Management of variable decels

Answer 4

reposition as first step reasonable; amnioinfusion (decreases variables, c/s rates, but not necessarily perinatal outcomes)

Question 5

What is ddx for fetal tachycardia?

Answer 5

over 160 bpm baseline for over 10 minutes. infection: IAI, pyelonephritis, medical comorbidities (hyperthyroidism), fetal tachycardia (usually > 200 bpm), obstetric issues

Question 6

What is your management with prolonged deceleration or bradycardia?

Answer 6

bradycardia: less than 110 for more than 10 minutes
prolonged decel: 15 bpm or more decrease for more than 2 but less than 10 minutes

ddx: hypotension (esp post epidural), umbilical cord compression, rapid fetal descent, tachysystole,

Question 7

What outcomes are associated with Cat III EFM?

Answer 7

neonatal encephalopathy, cerebral palsy, neonatal acidosis

Question 8

what is the most common FHR abnormalitiy?

Answer 8

intermittent variable decels (<50% ctx)

Question 9

definition of category III EFM

Answer 9

- absent variability
PLUS
- recurrent late decels
- recurrent variable decels
- bradycardia

SINUSOIDAL PATTERN ALONE is cat III