Fetal Heart Rate Monitoring Flashcards

What is the purpose of fetal heart rate (FHR) monitoring during labor?

• To assess fetal well-being and oxygenation during labor

• Detect early signs of hypoxia or distress

• Guide interventions to protect the baby

What two parameters are assessed together during labor?

• Uterine contractions (maternal activity)

• Fetal heart rate (fetal response)

What are the two types of devices used for external fetal monitoring?

• Sono/Ultrasound transducer: measures fetal heart rate

• Toco/Tocodynamometer: measures uterine contractions

Where is the ultrasound transducer placed?

At the point of maximal impulse (PMI) — the spot where the fetal heart rate is heard loudest, usually between the baby’s shoulder blades

Where is the PMI located for different fetal positions?

• Cephalic (head-down) → Lower abdomen

• Breech (buttocks/feet first) → Upper abdomen

🧠 Memory trick: “Head down, monitor down; feet first, monitor first (up high).”

Where is the Toco monitor placed?

High on the mother’s abdomen — over the uterine fundus to measure contraction frequency and duration

What is the invasive method of fetal monitoring called?

• Internal fetal monitor or Fetal Scalp Electrode (FSE / FSSE)

When can an internal fetal scalp electrode be used?

Only when:

• Amniotic membranes are ruptured

• Cervix is dilated ≥2 cm

• Head is engaged and accessible

What are the risks of internal fetal monitoring?

• Infection (maternal or fetal)

• Injury to fetal scalp

• Contraindicated in cases of maternal HIV, hepatitis, or active herpes

What is the correct answer to the ATI-style question: “Which must be present before initiating internal monitoring?”

Cervical dilation of at least 2 cm

What is displayed on the fetal monitor strip?

• Top line: Fetal heart rate (FHR)

• Bottom line: Uterine contractions

🧠 Tip: Always assess the top line (FHR) first!

What is the normal baseline fetal heart rate?

110–160 bpm

What is variability?

• The “wiggliness” or fluctuation in the FHR line

• Shows how well the baby is tolerating labor and that the CNS and oxygenation are intact

🧠 Memory trick: “The more jiggly, the more happy the baby.”

What does absent variability mean?

• Red light — emergency!

• No fluctuations in FHR → fetal distress, hypoxia, or acidosis

• Requires immediate C-section or emergency intervention

What does minimal variability mean?

• Yellow light — warning!

• Flat, small fluctuations (<5 bpm) → baby may be sleeping or in trouble

• Requires close monitoring and stimulation

What does moderate variability mean?\

• Green light — good!

• Normal, desired pattern (6–25 bpm fluctuations) → well-oxygenated, happy baby

What does marked variability mean?

• Jagged, erratic “roller coaster” pattern

• Indicates temporary stress during labor, but baby can usually recover

What are accelerations?

• Temporary increases in FHR above baseline

• Indicate fetal well-being and adequate oxygenation

• “A is for Awesome — baby is doing great!”

What are decelerations?

• Drops in FHR below baseline

• Categorized into Early, Variable, and Late decelerations

Describe Early Decelerations.

• Mirror contractions (start and end with the contraction)

• Caused by head compression — normal finding

• 🧠 Memory trick: “It’s good to be early — early = expected.”

Describe Variable Decelerations.

• Sharp, deep ‘V’ or ‘U’ shaped dips

• Caused by umbilical cord compression

• Concerning — reposition mother or perform amnioinfusion if needed

• 🧠 Memory trick: “V for Variable = V for cord ‘V’ compression.”

Describe Late Decelerations.

• Begin after the contraction starts and recover after it ends

• Caused by uteroplacental insufficiency (↓ O₂ to baby)

• Most dangerous type — requires immediate intervention!

Interventions:

• Turn mother to left side

• Stop oxytocin

• Apply O₂ (8–10 L/min by mask)

• Increase IV fluids

• Notify provider

🧠 Memory trick: “Late to the party = bad — baby’s losing O₂.”

What is the order of priority for fetal decelerations?

1⃣ Reposition (side-lying)
2⃣ Oxygen
3⃣ IV fluids
4⃣ Stop Pitocin (oxytocin)
5⃣ Notify provider

Which fetal heart rate pattern indicates adequate oxygenation and an intact nervous system?

A. Minimal variability with no accelerations
B. Moderate variability with accelerations
C. Absent variability with late decelerations
D. Sinusoidal pattern

B. Moderate variability with accelerations
Rationale:

• Moderate variability (6–25 bpm) and accelerations are reassuring signs.

• They indicate adequate fetal oxygenation and an intact CNS.

• Minimal or absent variability and sinusoidal patterns are nonreassuring.

Which fetal heart rate pattern is most concerning and requires immediate intervention?

A. Early decelerations with contractions
B. Variable decelerations with quick return to baseline
C. Absent variability with recurrent late decelerations
D. Moderate variability with accelerations

C. Absent variability with recurrent late decelerations
Rationale:

• Indicates fetal hypoxia and acidosis.

• Priority interventions: reposition, O₂, IV fluids, stop oxytocin, and notify provider.

A “V”-shaped deceleration is noted on the fetal heart monitor. What is the likely cause?

A. Head compression
B. Cord compression
C. Placental insufficiency
D. Maternal hypotension

Answer: B. Cord compression
Rationale:

• Variable decelerations are abrupt, “V”-shaped drops caused by umbilical cord compression.

• Relieved by repositioning or amnioinfusion.

Which condition must be present before applying an internal fetal scalp electrode?

A. Intact membranes and cervical dilation of 1 cm
B. Intact membranes and full dilation
C. Ruptured membranes and cervical dilation ≥2 cm
D. Ruptured membranes and complete effacement

C. Ruptured membranes and cervical dilation ≥2 cm
Rationale:

• Internal FHR monitoring requires ROM and ≥2 cm dilation to access the presenting fetal part safely.

What is the most accurate method for assessing fetal well-being during labor?

A. External fetal monitoring
B. Intermittent auscultation with Doppler
C. Internal fetal scalp electrode
D. Leopold maneuvers

C. Internal fetal scalp electrode
Rationale:

• Provides a continuous, direct measurement of fetal heart electrical activity.

• Most accurate, but invasive and carries infection risk.

A nurse observes late decelerations on the monitor. Which nursing intervention is priority?

A. Increase oxytocin infusion
B. Reposition client to left lateral position
C. Encourage frequent pushing
D. Document and continue monitoring

B. Reposition client to left lateral position
Rationale:

• Late decelerations = uteroplacental insufficiency.

• Interventions: side-lying position, O₂ 8–10 L/min, stop oxytocin, increase IV fluids, notify provider.

The nurse is monitoring a laboring client with FHR baseline 90 bpm and absent variability. What action should the nurse take first?

A. Document as normal
B. Continue to observe
C. Apply oxygen and reposition
D. Encourage bearing down

C. Apply oxygen and reposition
Rationale:

• Bradycardia (<110 bpm) with absent variability = fetal distress.

• Oxygen + repositioning improve perfusion; notify provider if unresolved.

The nurse notes moderate variability (6–25 bpm) on the fetal heart monitor. What does this indicate?

A. Fetal hypoxia
B. Normal finding
C. Sleep pattern
D. Cord compression

B. Normal finding
Rationale:

• Moderate variability indicates normal oxygenation and intact neurologic function.

Which fetal heart rate pattern would cause the nurse to prepare for emergency delivery?

A. Moderate variability with accelerations
B. Early decelerations
C. Absent variability with persistent bradycardia (<80 bpm)
D. Variable decelerations with recovery

C. Absent variability with persistent bradycardia (<80 bpm)
Rationale:

• Indicates severe fetal hypoxia or acidosis.

• Immediate intervention or emergency C-section is warranted.

Which finding on the fetal monitor represents a reassuring pattern?

A. Baseline 155 bpm with moderate variability and accelerations
B. Baseline 170 bpm with minimal variability and late decelerations
C. Baseline 100 bpm with absent variability and variable decelerations
D. Baseline 165 bpm with marked variability and no accelerations

A. Baseline 155 bpm with moderate variability and accelerations
Rationale:

• This pattern is reassuring and shows a healthy, well-oxygenated fetus.

• Other options reflect non-reassuring patterns that require interventions.