Intrapartum Fetal Monitoring: FHR Tracing

Question 1

On a FHR strip, each box indicates…

Answer 1

10sec of time

Question 2

Each section between bold vertical lines indicates…

Answer 2

1min of time

Question 3

What do the upper and lower sections of the strip represent?

Answer 3

Upper = FHR

Lower = Contractions/uterine activity

Question 4

Define the baseline FHR on the strip

Answer 4

FHR average over 10mins

Question 5

What do accelerations indicate and is it bad?

Answer 5

• Normal HR increases with fetal movement.
• This is a reassuring pattern

Question 6

What are decelerations?

Answer 6

Drops in fetal heart rate

Question 7

What are the three types of decelerations?

Answer 7

• Early
• Late
• Variable

Question 8

What are the nursing interventions for late decels?

Answer 8

Reposition mother, monitor and document

Question 9

What are the nursing interventions for variable decels?

Answer 9

Reposition, O2 administration @ 8-10L/min w/ non-rebreather mask

Question 10

A FHR reading is either _____ or _____.

Answer 10

Reassuring or non-reassuring

Question 11

During the second stage of labor, fetal heart tones are documented…

Answer 11

every 5 to 15 minutes.

Question 12

During the early phase of labor, fetal heart tones only need to be documented every

Answer 12

30 minutes

Question 13

During the latent phase of labor, fetal heart tones only need to be documented every

Answer 13

30 minutes

Question 14

Regarding Cesareans, The guidelines for decision to incision are

Answer 14

30 minutes.

Question 15

What causes early decelerations?

Answer 15

Head compressions caused by uterine contractions.

Question 16

What are the characteristics of early decelerations on a FHR tracing?

Answer 16

• Mirror contraction
  
  • The FHR dips when the contraction peaks
  • The peaks align
• Consistent in appearance

Question 17

What interventions are needed for early decels?

Answer 17

They require no intervention

Question 18

What causes late decelerations and what do they indicate?

Answer 18

• They are caused by uteroplacental insufficency
• It indicates lack of O2 reserve and may be acute or chronic

Question 19

What are the characteristics of late decelerations on a FHR tracing?

Answer 19

• FHR may remain in normal range
• Deceleration shifts to the right in relation to the peak of the contraction
• NOTE A LATE RETURN TO BASELINE HEART RATE

Question 20

What interventions are needed for late decels?

Answer 20

• Reposition mother,
• Monitor and document
  
  • NOTE A LATE RETURN TO BASELINE HEART RATE

Question 21

What causes variable decelerations?

Answer 21

• Caused by umbilical cord compression
• May be unrelated to contraction

Question 22

What are the characteristics of variable decelerations on a FHR tracing?

Answer 22

• No uniformity
• Shape and duration may vary

Question 23

What interventions are needed for early decels?

Answer 23

• Reposition mother
• O2 administration @ 8-10L/min w/ non-rebreather mask
• Monitor and document

Question 24

What are the 3 categories of FHR patterns?

Answer 24

1. Reassuring
2. Indeterminate
3. Non-reassuring

Question 25

Reassuring or Non-reassuring? Early Decelerations

Answer 25

* Reassuring * These are expected, but do need to be monitored for any shifts or changes

Question 26

Reassuring or Non-reassuring? Late Decelerations

Answer 26

* non-reassuring * An intervention is necessary

Question 27

Reassuring or Non-reassuring? Variable Decelerations

Answer 27

* Non-reassuring * An intervention is necessary

Question 28

What is a deceleration called that occurs over a period of several contractions?

Answer 28

Prolonged deceleration

Question 29

What is the formula for interventions of Category III patterns?

Answer 29

* Clarification of data * Identify cause * Improve oxygenation * increase maternal blood oxygen saturation

Question 30

What do Category I patterns indicate re: acid base status?

Answer 30

They are strongly associated with a normal acid base status

Question 31

What do Category II patterns indicate re: acid base status?

Answer 31

Not predictive of abnormal fetal acid base status but inadequate evidence to classify as normal or abnormal

Question 32

What do Category III patterns indicate re: acid base status?

Answer 32

Predictive of abnormal fetal acid base status

Question 33

What are the five essential components of the FHR tracing that must be evaluated regularly?

Answer 33

* Baseline rate * Baseline variability * Accelerations * Decelerations * Changes or trends over time

Question 34

If any of the essential components of FHR tracing are abnormal what corrective actions must be taken?

Answer 34

* Immediately improve fetal oxygenation * (aka intrauterine resuscitation) * Reposition can improve on its own * Provide O2 if reposition not enough

Question 35

If not receiving accurate data via external FHR monitoring, what action may be indicated?

Answer 35

The need for internal monitoring via IUPC and spiral electrode

Question 36

Define FHR variability

Answer 36

The variation of FHR tracing line from baseline

Question 37

Is low FHR reassuring or non-reasurring? What is it indicative of?

Answer 37

* non-reassuring * lack of activity or response to labor * indicative of CNS issue * emergent and doc needs to be notified

Question 38

FHR \>160 indicate

Answer 38

Tachycardia

Question 39

FHR \<110 indicates

Answer 39

Bradycardia

Question 40

To practice reading FHR tracings, go to: https://ncc-efm.org/game/efmgame.cfm Unit II exam may include FHR equipment used. To review that, visit the Intrapartum Fetal Monitoring deck in Unit I

Answer 40

To practice reading FHR tracings, go to: https://ncc-efm.org/game/efmgame.cfm Unit II exam may include FHR equipment used. To review that, visit the Intrapartum Fetal Monitoring deck in Unit I