The EFM toolkit also offers EFM CE opportunities and C-EFM. The American College of Obstetricians and Gynecologists (ACOG), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Society for Maternal-Fetal Medicine developed a new three-tiered classification of fetal heart rate abnormalities and a system for interpreting these abnormalities (1). What is the baseline of the FHT for Twin A (Black)? Relevant ACOG Resources. 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). Fetal bradycardia is defined as a baseline heart rate less than 120 bpm. Practice Quizzes 1-5 - Electronic Fetal Monitoring B. Activate the organization's chain of command. However, the strength of contractions cannot always be accurately assessed from an external transducer and should be determined with an IUPC, if necessary. Faculty, Students, State Boards & Volunteers. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions. Remember, the baseline is the average heart rate rounded to the nearest five bpm. Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. The nurse's action after turning the patient to her left side should be:, The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning . On a drawing of the body locate the major body regions containing lymph nodes. The electronic fetal monitor uses an external pressure transducer or an intrauterine pressure catheter (IUPC) to measure amplitude and frequency of contractions. 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. Copyright 2023 American Academy of Family Physicians. You scored 6 out of 6 correct. The main goal is to identify fetuses who are prone to injuries stemming from hypoxia (or a lack of oxygen for fetal tissues). Structured intermittent auscultation detects changes in FHR during contractions but not overall FHR variability (moment-by-moment fluctuations in FHR)4,5; therefore, continuous electronic fetal monitoring remains the more appropriate option in high-risk labor (Table 214,16,17). 140 145 150 155 160 FHT Quiz 1 Fetal Tracing Quiz Perfect! 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. 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). Auscultation of the fetal heart rate (FHR) is performed by external or internal means. -Related to fetal movement 4. 740-591-8118. What is the baseline of the FHT? The Value of EFM Certification (One Team One Language), showcases the national PSA campaign Your Baby Communicates along with peer-to-peer video discussions on the value of EFM Board Certification. Are contractions present? -May have early decelerations. Continuous EFM reduced neonatal seizures (NNT = 661), but not the occurrence of cerebral palsy. A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. 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. This alone is not predictive of fetal acidosis unless accompanied by decreased variability and/or absent spontaneous or stimulated accelerations.2,5. A term, low-risk baby may have higher reserves than a fetus that is preterm, growth restricted, or exposed to uteroplacental insufficiency because of preeclampsia. Remember, the baseline is the average heart rate rounded to the nearest five bpm. e) lava dome. b. apply a stressful stimulus to the fetus. The descent and return are gradual and smooth. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. b. -Positive Contraction Stress Test: Hasten fetal delivery. A scalp pH of less than 7.20 is considered abnormal and generally is an indication for intervention, immediate delivery, or both.12 A pH less than 7.20 should also be assumed in the absence of an acceleration following fetal scalp stimulation when fetal scalp pH sampling is not available. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Practice Quizzes 6-10 - Electronic Fetal Monitoring 1. What should the nurse do in this situation? https://www.uptodate.com/contents/nonstress-test-and-contraction-stress-test?search=fetal%20heart%20rate%20assessment&source=search_result&selectedTitle=3~138&usage_type=default&display_rank=3 Am J Obstet . The organization's practice allows for IA if 1:1 nursing staff is available. Every 15 to 30 minutes in active phase of first stage of labor; every 5 minutes in second stage of labor with pushing, Assess FHR before: initiation of labor-enhancing procedure; ambulation of patient; administration of medications; or initiation of analgesia or anesthesia, Assess FHR after: admission of patient; artificial or spontaneous rupture of membranes; vaginal examination; abnormal uterine activity; or evaluation of analgesia or anesthesia, 1. -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 B. Internal vs external. No. Decelerations (D). fetal heart tracing quiz 12 - islamichouseofisrael.com EFM Tracing Game Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. Results in this range must also be interpreted in light of the FHR pattern and the progress of labor, and generally should be repeated after 15 to 30 minutes. On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. Category III tracings are highly concerning for fetal acidosis, and delivery should be expedited if immediate interventions do not improve the tracing. Late. Tracing patterns can and will change! Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. Maternal hypotension and uterine hyperstimulation may decrease uterine blood flow. Fetal heart rate decreases lasting 10 minutes are categorized as a new baseline heart rate. Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. The FHR baseline is 125 bpm. b. Although detection of fetal compromise is one benefit of fetal monitoring, there are also risks, including false-positive tests that may result in unnecessary surgical intervention. Fetal Tracing Quiz . Fetal heart rate monitoring can be done either externally or internally. Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. This content is owned by the AAFP. Recurrent variable decelerations can be treated with amnioinfusion, the placement of isotonic fluids into the intrauterine cavity, with the same requirement and risks as the intrauterine pressure catheter and fetal scalp electrode mentioned previously.7 Amnioinfusion has been shown to reduce cord compression, leading to resolution of FHR decelerations (RR = 0.53; 95% CI, 0.38 to 0.74; n = 1,000) and lowering the likelihood of cesarean delivery (RR = 0.62; 95% CI, 0.46 to 0.83; n = 1,400).26,42. A more recent article on intrapartum fetal monitoring is available. a streams response to precipitation. 10. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. -NST Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. . This pattern is most often seen during the second stage of labor. The figure in the next column shows a graph of TTT. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? comprehensive exam fetal tracing index references the maternal fetal triage index frequently asked questions web each of the ve levels has key questions with . One hour later, the nurse notices that the FHR baseline is 145 bpm with minimal variability. Issues such as hypoxia, however, might slow their heart rate. Increase mainline IV If decelerations are not reversed by intrauterine resuscitation measures, immediate delivery is recommended.2,43, This article updates previous articles on this topic by Bailey44 and by Sweha, et al.45. Questions and Answers 1. This pattern is sometimes called a saltatory pattern and is usually caused by acute hypoxia or mechanical compression of the umbilical cord. When you've finished these first five, here are five more. May 2, 2022 The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. Health care professionals play the game to hone and test their EFM knowledge and skills. Fetal Assessment Flashcards | Quizlet 150 155 160 The practitioner has ordered continuous electronic monitoring, but the patient requests IA for the early part of labor. An increase in risk status during labor, such as the diagnosis of chorioamnionitis, may necessitate a change in monitoring from structured intermittent auscultation to continuous EFM. Thus, it has the characteristic mirror image of the contraction (Figure 5). Membranes have to be rupture in order to establish direct contact. A. A pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal pH is indicated.16 Persistent late decelerations associated with decreased beat-to-beat variability is an ominous pattern19 (Figure 7). The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning after the contraction begins with return to baseline after the contraction ends. A way to assess your babys overall health, fetal heart tracing is performed before and during the process of labor. PDF Review of Category I, II, and III Fetal Heart Rate Classifications Fetal Heart Tracing Quiz 8 - Utilis https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.020 FHR baseline of 120-130 with V shaped decelerations to 100 noted before and after contractions. 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. Rate and decelerations B. Be sure to ask any questions you might have beforehand. -2 points for each normal, 0 for abnormal, -8-10: Normal result ,Repeat BPP weekly Your doctor uses special types of equipment to conduct electronic fetal monitoring. The patient received an epidural bolus approximately 10 minutes ago. JAMES J. ARNOLD, DO, AND BREANNA L. GAWRYS, DO. 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. Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG 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. Powered by. Other maternal conditions such as acidosis and hypovolemia associated with diabetic ketoacidosis may lead to a decrease in uterine blood flow, late decelerations and decreased baseline variability.23. What action by the nurse is most appropriate? The experienced nurse tells the new nurse that a Category III FHR tracing may include which characteristic? Your doctor will explain the steps of the procedure. What Do Contractions Feel Like? The true sinusoidal pattern is rare but ominous and is associated with high rates of fetal morbidity and mortality.24 It is a regular, smooth, undulating form typical of a sine wave that occurs with a frequency of two to five cycles per minute and an amplitude range of five to 15 bpm. Normal. These require attachment of fetal head electrodes; a recent randomized controlled trial and meta-analysis showed no improvement in neonatal outcomes or rates of operative or cesarean delivery.24,25, The National Institute of Child Health and Human Development terminology (revised in 2008) classifies continuous electronic fetal monitoring tracings using a three-tiered system and is the accepted national standard for continuous electronic fetal monitoring interpretation.5 Labor management depends on the continuous electronic fetal monitoring category and overall clinical scenario (Table 3).4,5,7, Interpretation of continuous electronic fetal monitoring tracings must include comments on uterine contractions, baseline FHR, variability (fluctuations in the FHR around the determined baseline during a 10-minute segment), presence of accelerations and/or decelerations, and trends of continuous electronic fetal monitoring patterns over time.2,5. D. Determine the onset and end of each deceleration in relation to the onset and end of the contraction. What should the nurse do before appropriate clinical interventions are initiated? -Reassuring for fetal well being A woman has just received pain medication in labor. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. Prolonged. The FHR baseline is 130 bpm with moderate variability. Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. Copyright 2023 American Academy of Family Physicians. The recommendations for the overall management of FHR tracings by NICHD, the International Federation of Gynecology and Obstetrics, and ACOG agree that interpretation is reproducible at the extreme ends of the fetal monitor strip spectrum.10 For example, the presence of a normal baseline rate with FHR accelerations or moderate variability predicts the absence of fetal acidemia.10,11 Bradycardia, absence of variability and accelerations, and presence of recurrent late or variable decelerations may predict current or impending fetal asphyxia.10,11 However, more than 50 percent of fetal strips fall between these two extremes, in which overall recommendations cannot be made reliably.10 In the 2008 revision of the NICHD tracing definitions, a three-category system was adopted: normal (category I), indeterminate (category II), and abnormal (category III).11 Category III tracings need intervention to resolve the abnormal tracing or to move toward expeditious delivery.11 In the ALSO course, using the DR C BRAVADO approach, the FHR tracing may be classified using the stoplight algorithm (Figure 19), which corresponds to the NICHD categories.9,11 Interventions are determined by placing the FHR tracing in the context of the specific clinical situation and corresponding NICHD category, fetal reserve, and imminence of delivery (Table 4).9,11, If the FHR tracing is normal, structured intermittent auscultation or continuous EFM techniques can be employed in a low-risk patient, although reconsideration may be necessary as labor progresses.2 If the FHR tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used.

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