The normal FHR range is between 120 and 160 beats per minute (bpm). They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. The practitioner has ordered continuous electronic monitoring, but the patient requests IA for the early part of labor. Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. 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. Prematurity decreases variability16; therefore, there is little rate fluctuation before 28 weeks. One benefit of EFM is to detect early fetal distress resulting from fetal hypoxia and metabolic acidosis. 1. ), What do Braxton Hicks contractions feel like? Category I is defined by an FHR baseline of 110 to 160 beats per minute (bpm), moderate variability (six- to 25-bpm fluctuation in FHR from baseline), with no late decelerations (onset and nadir after peak of contraction, decrease of more than 15 bpm from baseline, likely uteroplacental insufficiency) and no variable decelerations (onset variable to contraction and slow [i.e., more than 15 seconds and less than two minutes] return to baseline, likely from cord compression) present5 (Figure 27). Continuous electronic fetal monitoring was developed in the 1960s to assist in the diagnosis of fetal hypoxia during labor. Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary - eBay Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of labor. Clinically, loss of beat-to-beat variability is more significant than loss of long-term variability and may be ominous.18 Decreased or absent variability should generally be confirmed by fetal scalp electrode monitoring when possible. "The test results are within normal limits.". Rate and decelerations B. The National Institute of Child Health and Human Development terminology is used when reviewing continuous electronic fetal monitoring and delineates fetal risk by three categories. What should be the nurse's next action? Intrapartum Fetal Monitoring | AAFP The use of amnioinfusion for recurrent deep variable decelerations demonstrated reductions in decelerations and cesarean delivery overall. 5. What Do Contractions Feel Like? -Fetal body movements b. apply a stressful stimulus to the fetus. Remember, the baseline is the average heart rate rounded to the nearest five bpm. 7. Assessments. Fetal Heart Tracing Quiz 2 - 3/10/2017 - Course Hero What characteristic of this fetal heart rate tracing is indicative of fetal well-being? Shows FHR as well as uterine contractions. to access the EFM tracing game and to take full advantage of all the resources available. This system can be used in conjunction with the Advanced Life Support in Obstetrics course mnemonic, DR C BRAVADO, to assist in the systematic interpretation of fetal monitoring. While assessing the FHR, the nurse notices a pattern of uniform decelerations that have an abrupt onset with a nadir down to 90 bpm for 30 seconds. 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). Moderate. Fetal Assessment in Non-Obstetric Settings 9. Late. The nurse understands that this is being done for which of the following reasons? Additionally, an Apgar score of less than 7 at five minutes, low cord arterial pH (less than 7.20), and neonatal and maternal hospital stays greater than three days were reduced.22, Tocolytic agents such as terbutaline (formerly Brethine) may be used to transiently stop contractions, with the understanding that administration of these agents improved FHR tracings compared with untreated control groups, but there were no improvements in neonatal outcomes.23 A recent study showed a significant effect of maternal oxygen on increasing fetal oxygen in abnormal FHR patterns.24. d) volcanic neck A. 3. 4. These segments help establish an estimated baseline (for a duration of 10 minutes) which is expressed in beats per minute. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. e) lava dome. The nurse is administering a contraction stress test and notes the presence of late decelerations corresponding to three contractions in a ten-minute period of time. 3/10/2017 Fetal Heart Tracing Quiz 10 Correct. Increased variability in the baseline FHR is present when the oscillations exceed 25 bpm (Figure 2). Compared with EFM alone, the addition of fetal electrocardiography analysis results in a reduction in operative vaginal deliveries (NNT = 50) and fetal scalp sampling (NNT = 33). Fetal hypoxemia results in biphasic changes in the ST segment of the fetal electrocardiography (FECG) waveform and an increase in the T:QRS ratio.15 The ST-segment automated analysis (STAN) software from Noventa Medical can record the frequency of ST events and, combined with changes in continuous EFM, can be used to determine if intervention during the labor process is indicated.15 Several studies have evaluated FECG analysis, documenting its effectiveness at reducing operative vaginal deliveries, fetal scalp sampling, neonatal encephalopathy, and fetal acidosis (pH < 7.05).2528 One drawback to this technology is that it requires rupture of the membranes and internal fetal scalp monitoring. Fetal tachycardia may be a sign of increased fetal stress when it persists for 10 minutes or longer, but it is usually not associated with severe fetal distress unless decreased variability or another abnormality is present.4,11,17. Non-reactive: The reporting nurse states that the FHR baseline is 150 bpm with moderate variability, no decelerations are present, and episodic accelerations are occurring. (They start and reach maximum value in less than 30 seconds.) Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). Fetal heart rate monitoring is a process of monitoring the fetal heart rate during labor and delivery to assess the fetus's well-being. JAMES J. ARNOLD, DO, AND BREANNA L. GAWRYS, DO. Fetal Heart tracings (FHR) Flashcards | Quizlet Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. Gene amplification in cancer cells has been shown to lead to resistance to cancer-killing medications when the dose of medication is increased gradually. If you want to see how you are doing overall, try the comprehensive assessment: Early decelerations (mirror contraction, with nadir at peak of contraction, likely fetal head compression) and accelerations (FHR increase of 15 bpm or more over at least 15 seconds) may be present.2,5,7,34 No intervention is required for Category I tracings. The effect of continuous EFM monitoring on malpractice liability has not been well established. The nurse still interprets the FHR tracing as a Category III. Test your EFM skills using NCC's FREE tracing game! Do not automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first. -2+Fetal Heart Rate increases in 20 minutes b. Sketch or describe how the Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. See permissionsforcopyrightquestions and/or permission requests. Electronic Fetal Heart Monitoring Trivia Quiz Questions! C. Evaluate the patient's understanding of the monitoring methods and notify the practitioner. The onset, nadir, and recovery of the deceleration usually coincide with the beginning, peak, and ending of the contraction, respectively.11 Early decelerations are nearly always benign and probably indicate head compression, which is a normal part of labor.15, Variable decelerations (Online Figure I), as the name implies, vary in terms of shape, depth, and timing in relationship to uterine contractions, but they are visually apparent, abrupt decreases in FHR.11 The decrease in FHR is at least 15 bpm and has a duration of at least 15 seconds to less than two minutes.11 Characteristics of variable decelerations include rapid descent and recovery, good baseline variability, and accelerations at the onset and at the end of the contraction (i.e., shoulders).11 When they are associated with uterine contractions, their onset, depth, and duration commonly vary with successive uterine contractions.11 Overall, variable decelerations are usually benign, and their physiologic basis is usually related to cord compression, with subsequent changes in peripheral vascular resistance or oxygenation.15 They occur especially in the second stage of labor, when cord compression is most common.15 Atypical variable decelerations may indicate fetal hypoxemia, with characteristic features that include late onset (in relation to contractions), loss of shoulders, and slow recovery.15. May 2, 2022. For the letters on this figure, choose the likely cause of melting for Site B. 2. Interpretation of the FHR variability from an external tracing appears to be more reliable when a second-generation fetal monitor is used than when a first-generation monitor is used.3 Loss of variability may be uncomplicated and may be the result of fetal quiescence (rest-activity cycle or behavior state), in which case the variability usually increases spontaneously within 30 to 40 minutes.19 Uncomplicated loss of variability may also be caused by central nervous system depressants such as morphine, diazepam (Valium) and magnesium sulfate; parasympatholytic agents such as atropine and hydroxyzine (Atarax); and centrally acting adrenergic agents such as methyldopa (Aldomet), in clinical dosages.19. An acceleration pattern preceding or following a variable deceleration (the shoulders of the deceleration) is seen only when the fetus is not hypoxic.15 Accelerations are the basis for the nonstress test (NST). A nurse is teaching a woman how to do "kick counts." ACOG Guidelines on Antepartum Fetal Surveillance | AAFP -Fetal Doppler: transmits small, high frequency sound waves that are reflected off of the fetal heart - measures heart rate -Normal fetal heart rate = 110-160 BPM Electronic Fetal Monitoring What is the baseline of the FHT? Antepartum Fetal Assessment 10. Yes. Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. This alone is not predictive of fetal acidosis unless accompanied by decreased variability and/or absent spontaneous or stimulated accelerations.2,5. Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. During auscultation, the nurse hears an abrupt deceleration of the FHR down to 60 bpm that lasts for 1 minute before returning to baseline. Intrapartum Fetal Monitoring | AAFP Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). The NCC EFM Tracing Game uses NICHD terminology. Count FHR after uterine contraction for 60 seconds (at 5-second intervals) to identify fetal response to active labor (this may be subject to local protocols), Abnormal umbilical artery Doppler velocimetry, Maternal motor vehicle collision or trauma, Abnormal fetal heart rate on auscultation or admission, Intrauterine infection or chorioamnionitis, Post-term pregnancy (> 42 weeks' gestation), Prolonged membrane rupture > 24 hours at term, Regional analgesia, particularly after initial bolus and after top-ups (continuous electronic fetal monitoring is not required with mobile or continuous-infusion epidurals), High, medium, or low risk (i.e., risk in terms of the clinical situation), Rate, rhythm, frequency, duration, intensity, and resting tone, Bradycardia (< 110 bpm), normal (110 to 160 bpm), or tachycardia (> 160 bpm); rising baseline, Reflects central nervous system activity: absent, minimal, moderate, or marked, Rises from the baseline of 15 bpm, lasting 15 seconds, Absent, early, variable, late, or prolonged, Assessment includes implementing an appropriate management plan, Visually apparent, abrupt (onset to peak < 30 seconds) increase in FHR from the most recently calculated baseline, Peak 15 bpm above baseline, duration 15 seconds, but < 2 minutes from onset to return to baseline; before 32 weeks gestation: peak 10 bpm above baseline, duration 10 seconds, Approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding periodic or episodic changes, periods of marked variability, and segments of baseline that differ by > 25 bpm, In any 10-minute window, the minimum baseline duration must be 2 minutes, or the baseline for that period is indeterminate (refer to the previous 10-minute segment for determination of baseline), The nadir of the deceleration occurs at the same time as the peak of the contraction, The nadir of the deceleration occurs after the peak of the contraction, Abrupt decrease in FHR; if the nadir of the deceleration is 30 seconds, it cannot be considered a variable deceleration, Moderate baseline FHR variability, late or variable decelerations absent, accelerations present or absent, and normal baseline FHR (110 to 160 bpm), Continue current monitoring method (SIA or continuous EFM), Baseline FHR changes (bradycardia [< 110 bpm] not accompanied by absent baseline variability, or tachycardia [> 160 bpm]), Tachycardia: medication, maternal anxiety, infection, fever, Bradycardia: rupture of membranes, occipitoposterior position, post-term pregnancy, congenital anomalies, Consider expedited delivery if abnormalities persist, Change in FHR variability (absent and not accompanied by decelerations; minimal; or marked), Medications; sleep cycle; change in monitoring technique; possible fetal hypoxia or acidemia, Change monitoring method (internal monitoring if doing continuous EFM, or EFM if doing SIA), No FHR accelerations after fetal stimulation, FHR decelerations without absent variability, Late: possible uteroplacental insufficiency; epidural hypotension; tachysystole, Absent baseline FHR variability with recurrent decelerations (variable or late) and/or bradycardia, Uteroplacental insufficiency; fetal hypoxia or acidemia, 2.
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