Correct. The FHR baseline is 125 bpm. -Fetal body movements The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Copyright 2020 by the American Academy of Family Physicians. -Accelerations my be present or absent. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. Tachycardia is certainly not always indicative of fetal distress or hypoxia, but this fetal tracing is ominous. Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice during active labor.13 Continuous electronic fetal monitoring was developed for widespread use in the 1970s as a screening test for fetal hypoxia/acidosis during labor, specifically to reduce hypoxic-ischemic encephalopathy, cerebral palsy, and fetal death.13, Fetal acidemia (pH < 7.15) is most accurately diagnosed via umbilical cord arterial sampling immediately after delivery.46 Because fetal acidosis can affect autonomic control and therefore variability of FHR, continuous electronic fetal monitoring is considered a surrogate marker for measurement.2,7 However, the very low prevalence of cerebral palsy (antepartum events are most likely causative agents), hypoxic-ischemic encephalopathy, and fetal death has led to a false-positive rate of 99%3 for continuous electronic fetal monitoring and a low predictive value.810 Additionally, continuous electronic fetal monitoring is falsely positive for fetal acidosis two-thirds of the time, with low sensitivity (57%) and specificity (69%).1,3 Furthermore, user variability in interpretation is high, with agreement between experts only half the time.11,12, Continuous electronic fetal monitoring includes external and internal monitoring.7 External monitoring involves placement of two monitors (one for FHR and the other for contractions) against the maternal abdomen. Powered by. c) On the basis of your answers, is it desirable to have the resistance of the two 120 V loads be equal? Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? It is also characterized by a stable baseline heart rate of 120 to 160 bpm and absent beat-to-beat variability. Tachycardia is considered mild when the heart rate is 160 to 180 bpm and severe when greater than 180 bpm. A systematic approach is recommended when reading FHR recordings to avoid misinterpretation (Table 2). Category II tracings are defined as indeterminate, are common, and represent all tracings that do not fall into the Category I or III groups.2,5 They vary widely in level of concern for acidosis, so the family physician must determine the severity of the Category II tracing and take the appropriate action.2,5,7,35, There is a direct association between fetal acidosis, recurrent decelerations, and depth of decelerations2,5,34,36; however, the presence of moderate variability and/or accelerations offers reassurance in Category II tracings because the presence is predictive of a lack of fetal acidosis.2,4,26,27,34,3638 For Category II tracings without spontaneous or provoked accelerations, minimal/absent variability, or deep decelerations (i.e., FHR drops to 70 bpm or less), immediate action is needed.3,4, A management algorithm30 (eFigure A) has been developed that is based on the suspected degree of fetal acidosis and ideally minimizes unnecessary interventions.7, A five-tiered classification/management scheme for management of Category II tracings has been developed (http://www.obapps.org).7,37,39 Each continuous electronic fetal monitoring tracing is color coded to represent the threat of acidosis based on the National Institute of Child Health and Human Development definitions, and Category II is broken into three separate severity and intervention subcategories based on the presence of accelerations and/or moderate variability.7,37 This classification has been shown to improve identification of fetal acidosis and newborns requiring immediate intervention after delivery.37, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation(Figure 1).2,7,16,21,27,3033 Lateral recumbent maternal positioning reduces compression of the maternal vena cava and aorta and the fetal umbilical cord.2,32,33 Intravenous fluid boluses up to 1 L have been shown to improve fetal oxygenation up to 30 minutes after administration.32,33 Maternal oxygen may be administered after other maneuvers, but it can be discontinued after tracing improvement because there is no evidence to support its routine use.2,32,33 Modification in maternal pushing efforts, such as initiating only with the urge to push and allowing for fetal recovery by pushing with every second or third contraction, can improve maternal and fetal oxygenation.40, Category III tracings, defined by a sinusoidal FHR pattern (Figure 37) or absent FHR variability (Figure 47) with recurrent late and/or variable decelerations or fetal bradycardia (see the Fetal Bradycardia section), require immediate intrauterine resuscitation and intervention.2,5,8,14,27,30,32,33,38,39 If the Category III tracing does not rapidly improve, expedited delivery is recommended. Notify your provider if the baby's movement slows down, The nurse explains to the student that increasing the infusion rate of non-additive intravenous fluids can increase fetal oxygenation primarily by, A pregnant woman's biophysical profile score is 8. PDF Awhonn Fetal Monitoring Test Questions And Answers Pdf Copy All Rights Reserved. Continuous electronic fetal monitoring has been shown to reduce the incidence of neonatal seizures, but there has been no beneficial effect in decreasing cerebral palsy or neonatal mortality. -Amount of amniotic fluid The use of amnioinfusion for recurrent deep variable decelerations demonstrated reductions in decelerations and cesarean delivery overall. -Contraction Stress Test (CST), How? The effect of continuous EFM monitoring on malpractice liability has not been well established. (They start and reach maximum value in less than 30 seconds.) After discussion regarding the FHR tracing, the resident and attending practitioner on duty determine that the FHR tracing is a Category II. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.15. -How? Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG Interventions to increase fetal activity fail, Reactive NST: Fetal heart rate monitoring can be done either externally or internally. Adequate documentation is necessary, and many institutions are now employing flow sheets (e.g., partograms), clinical pathways, or FHR tracing archival processes (in electronic records). The fetal membranes must be ruptured, and the cervix must be at least partially dilated before the electrode may be placed on the fetal scalp. Delivery is indicated if tracing does not improve and acidemia suspected. It is important to review the pressure tracing before assessing the fetal tracing to accurately interpret decelerations. The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? External monitoring (unless noted differently), paper speed is 3cm/min. This pattern is sometimes called a saltatory pattern and is usually caused by acute hypoxia or mechanical compression of the umbilical cord. The nurse observes smooth, gradual decelerations to 135 bpm occurring with more than 50% of the contractions. B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern. A nurse is teaching a woman how to do "kick counts." Correlate accelerations and decelerations with uterine contractions and identify the pattern. Prematurity decreases variability16; therefore, there is little rate fluctuation before 28 weeks. Late. Absent. Palpate the abdomen to determine the position of the fetus (Leopold maneuvers), 2. Turn mother to her left side, Family Health (BSN2) Exam Three Sherpath/Quiz, ANTEPARTUM AND POSTPARTUM COMPLICATIONS QUIZ-, Julie S Snyder, Linda Lilley, Shelly Collins, Volume 1, Chapter 11 Human Lifespan Develop. Document in detail interpretation of FHR, clinical conclusion and plan of management. When you've finished these first five, here are five more. Are there decelerations present? Accelerations last from 15 seconds to 10 minutes, and the majority occur in conjunction with fetal movements. Obstetric Models and Intrapartum Fetal Monitoring in Europe NEW! External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended (Figure 6). Is perinatal asphyxia predictable? - PMC - National Center for This variability reflects a healthy nervous system, chemoreceptors, baroreceptors and cardiac responsiveness. Non-stress test PLUS 140 145 Correct . Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. Category I tracings reflect a lack of fetal acidosis and do not require intervention. What is the baseline of the FHT? Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. Category II tracing abnormalities can be addressed by treating reversible causes and providing intrauterine resuscitation, which includes stopping uterine-stimulating agents, fetal scalp stimulation and/or maternal repositioning, intravenous fluids, or oxygen. It means your fetus is neurologically responsive and doesnt have an oxygen deficiency. The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine if the fetus has. Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. It indicates severe fetal anemia, as occurs in cases of Rh disease or severe hypoxia.24 It should be differentiated from the pseudosinusoidal pattern (Figure 11a), which is a benign, uniform long-term variability pattern. [7] The fetal heart rate tracing categorizes into I, II, or III depending upon the criteria as mentioned above. What are the two most important characteristics of the FHR? However, the strength of contractions cannot always be accurately assessed from an external transducer and should be determined with an IUPC, if necessary. Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of labor.
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