EFM

Reasons for maternal tachycardia that lead to fetal tachycardia

fever/infection

thyroid disorders

anxiety

dehydration

medications

reasons for fetal tachycardia

hypoxia

acidosis

chorioamnionitis

tachydysrhythmias

reasons for sustained fetal tachycardia

maternal fever

infection

dehydration

medications (terbutaline, atropine, cocaine, and stimulants)

hypothyroidism

placental abruption

fetal bleeding

fetal anemia

fetal heart failure

fetal cardiac arrhythmias

fetal hypoxia

metabolic acidemia

FHR baseline of 50-70 may indicate

complete heart block

hypoxic events related to fetal bradycardia

umbilical cord prolapse

maternal hypotension

excessive uterine stimulation

placental abruption

uterine rupture

reasons for sudden-onset fetal bradycardia

acute change in maternal oxygenation

acute uteroplacental insufficiency

prolonged umbilical cord compression/occlusion

tachysystole

uterine rupture

placental abruption

significant vagal stimulation

How do you recognize the difference between hypoxic and nonhypoxic fetal bradycardia?

Hypoxic bradycardia = minimal to absent variability

Nonhypoxic bradycardia = moderate variability

32+ week accelerations

onset to peak lasts <30 seconds; 15 beats above baseline lasting 15+ seconds but less than 2 minutes

10 beats above baseline lasting 10+ seconds but less than 2 minutes

early deceleration

apparent gradual decrease below the baseline with onset to nadir greater than or equal to 30 seconds with the nadir associated with the peak of a contraction

late deceleration

apparent gradual decrease below the baseline with onset to nadir greater than or equal to thirty seconds with the nadir occurring after the peak of the contraction

sinusoidal pattern

smooth, sine wavelike pattern occurring every 3-5 minutes lasting >20 minutes

moderate variability

fluctuation in the baseline rate that is 6-25 bpm

variable deceleration

abrupt decrease >15 seconds, with onset to nadir <30 seconds

reasons for minimal variability

maternal CNS depressants

sleeping

congenital abnormalities

fetal tachycardia

preexisting neurologic abnormalities

prematurity

bethamethasone

reasons for absent variability

cord prolapse/compression

maternal hypotension

tachysystole

placental abruption

fetal tachycardia

fetal dysrhythmia

reasons for marked variability

hemodynamic compromise

mild hypoxia

umbilical cord prolapse/significant compression

maternal hypotension

tachysystole

placental abruption

category I tracing

Baseline FHR = 110-160 bpm

Moderate variability

Accelerations may be present or absent

Early decelerations may be present

No late or variable decelerations

category II tracing

fetal tachycardia

fetal bradycardia with variability

minimal/marked variability

absent variability without recurrent decels

absence of accelerations after stimulation

recurrent variables with any abnormal characteristics (slow to return to baseline, minimal/moderate variability, etc)

prolonged decel >2 minutes but <10

recurrent lates with moderate variability

category III tracing

sinusoidal pattern

absent variability

interventions for category II or III tracings

position changes (side lying or knee to chest)

IV fluids

oxygen for maternal hypoxia

amnioinfusion (for variables)

ephedrine or phenylephrine for maternal supine hypotension

interventions for fetal SVT

digoxin

Flecainide

interventions for fetal atrial flutter

digoxin

sotalol

interventions for fetal heart block

betamethasone and dexamethasone

reasons for sinusoidal tracing

fetal anemia

maternal-fetal hemorrhage

twin to twin transfusion syndrome

fetal-maternal Rh incompatibility

tetanic contraction

lasts longer than two minutes

treatment for consistent fetal tachycardia without hydrops

administer digoxin

extended fetal monitoring

admit to hospital

Kleinhauer-Betke test

determines volume of maternal-fetal hemorrhage

monitoring needed for fetal premature atrial contractions

routine monitoring

Which of the following is not a common cause for late decels?

A. Collagen vascular disease

B. Maternal diabetes mellitus

C. Multifetal gestation

C. Multifetal gestation

What typical uterine activity characteristics may be present in preterm labor?

low-amplitude, high-frequency contractions

Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via

Active transport

A wandering fetal heart rate baseline may be indicative of

impending fetal death

A modified biophysical profile shows the following: Reactive nonstress test with moderate variability and maximum vertical pocket of 2.6cm. This test would be interpreted as:

Normal

Abnormal results of a BPP

Nonreactive NST or MVP less than 2 cm

In a fetal heart rate tracing with marked variability, which of the following is likely the cause?

Fetal acidemia

After applying an external monitor to a patient with premature rupture of membranes at 38 weeks gestation, the clinician notes that the FHR monitor is recording half the rate heard audibly. The clinician should:

apply a fetal scalp electrode

As fetal lactic acid increases, what is the impact on the fetal blood gas?

Base deficit increases

Fetal blood is most oxygenated in the

ductus venosus

Signal ambiguity occurs most frequently:

during pushing when maternal HR rises more closely to fetal baseline

Which of the following describes the sequential progression of decompensation in the fetus when the oxygen pathway is interrupted?

hypoxemia, hypoxia, metabolic acidosis, metabolic acidemia

When fetal chemoreceptors are activated, what happens to the FHR?

It decreases

A patient presents for a term induction of labor with oligohydramnios. Based on this, FHR change that can be expected is:

Variable decels

EFM paper speed

3cm/min

During a time of fetal stress with catecholamine release, blood flow is:

shunted toward the adrenal glands

At 26 weeks, the FHR baseline begins to decline. This is a normal physiologic response to the development of the:

vagus nerve

The fetus has an intrinsic response to oxygen deprivation. Catecholamine levels increase, reducing peripheral blood flow while increasing blood flow to vital organs. How do these changes affect fetal BP and FHR?

They increase BP and decrease FHR

Significant neonatal morbidity occurs when more than how many minutes elapses between the onset of significant FHR decelerations and delivery?

18

A pregnant patient in labor is currently being monitored externally but has a suspected fetal arrhythmia. The next best action is to

insert a fetal spiral electrode and turn off the logic

Which of the following actions would be best to stimulate an acceleration in a patient with ruptured membranes?

Performing a cervical exam

A nurse wants to document a conversation with the attending physician that occurs during an emergent c-section. The best approach to documenting the event would be to:

Continue providing care to the patient and write a late entry after the c-section is complete

Which of the following fetal systems has the greatest influence on fetal pH? Heart, kidneys, or nervous system?

Kidneys

Mono-mono twins are prone to what type of decels during labor?

Variable

Normal umbilical cord pH

7.2-7.29 (SD 7.02-7.43)

Normal umbilical cord pO2

15.1-23.7 (SD 2.0-37.8)

Normal umbilical cord pCO2

49.2-56.3 (SD 21.5-78.3)

Normal umbilical cord base deficit

2.7-8.3 (SD 2.0-16.3)

Normal umbilical cord HCO3

22.0-24.1 (SD 14.8-29.2)

Respiratory acidosis cord blood values

low pH

variable pO2

high pCO2

normal HCO3

normal base deficit

Metabolic acidosis cord blood values

low pO2

normal pCO2

low HCO3

high base deficit

Mixed acidosis cord blood values

low pH

low pO2

high pCO2

low HCO3

high base deficit

Chorioamnionitis increases the risk of

postpartum hemorrhage

What do you do when observing irregular lines of various lengths on the FHR tracing of a FSE?

Perform a vaginal exam to ensure proper placement

What do you do when a FHR has a baseline of 180 with absent variability and recurrent late decels?

Expedite delivery

Misoprostol should not be administered if

contractions are more frequent than every 4 minutes

Characteristics of sinusoidal pattern

baseline is indeterminate

amplitude is consistent and usually within 5-15 bpm with oscillations in FHR that occur from 2-5 cycles/min for at least 20 minutes

accelerations are absent

What is the most common fetal arrhythmia?

Premature atrial contractions

Conversion pattern

rapid and significant change in rate, variability, and deceleration pattern associated with fetal neurologic injury

Accelerations are caused by the

sympathetic response

A common time to note marked variability on a FHR tracing is

during the intrapartum period

Reactive NST for fetus at 36 weeks+

2+ 15x15 accelerations within 20 minutes

A cord gas with an elevated partial pressure of carbon dioxide indicates the fetus has

lack of oxygen

The primary focus of the contraction stress test is looking for the presence of

decelerations

When fetal O2 drops below a critical level, peripheral blood vessels constrict and raise MAP. As a result, the heart rate

decreases

The cell type of the placenta that is responsible for filtering nutrients and waste products between the maternal and fetal systems is the

fetal trophoblast

Anticipated normal contraction pattern

3-5 contractions in 10 minutes

Each should not exceed 60-90 seconds

Minimum of 1 minute relaxation between contractions

MVU 95-395

The five components of a BPP are

1. FHR reactivity

2. fetal movement (3+ discrete body or limb movements within 30 minutes)

3. tone (1+ episodes of extension of a fetal extremity with return to flexion, or opening or closing of a hand)

4. breathing (1+ episodes of rhythmic fetal breathing movements of 30 seconds or more within 30 minutes)

5. amniotic fluid volume (deepest vertical pocket >2cm)

BPP scoring

8-10 = reassuring
6 = equivocal

0-4 = abnormal with potential for chronic fetal asphyxia

*score of 6 or below requires further evaluation