Electronic Fetal Monitoring

Question 1

5 essential components of electronic fetal monitoring

Answer 1

Baseline fetal heart rate, variability, accelerations, decelerations, and changes in fetal heart rate over time

Question 2

Main goal of fetal monitoring

Answer 2

Maximize oxygenation

Question 3

What does a continuous electronic fetal monitor measure?

Answer 3

Uterine contraction and fetal heart rate,intermittent or continuous monitoring, and can be used to monitor the fetal heart rate internally

Question 4

Noninvasive tool used to monitor the fetus externally

Answer 4

Tocotransducer for uterine contractions (is used transabdominally)

Question 5

how is an internal fetal monitor placed?

Answer 5

Membranes must be ruptured, cervix needs to be wide enough and presenting part of fetus must be low

Question 6

What are the two types of internal fetal monitors?

Answer 6

Spinal electrode for fetal heart rate,internal uterine pressure catheter for uterine contractions

Question 7

How can contractions be assessed?

Answer 7

Palpation

Question 8

How would you assess it a contraction is mild, moderate, or strong?

Answer 8

Mild: uterus is easily dented with palpation 1+
Moderate: uterus is slightly dented with palpation 2+
Strong: uterus cannot be dented with palpation 3+

Question 9

What is the downside of using a doppler/fetoscope?

Answer 9

Variability

Question 10

Can you tell contraction strength from the monitor strip?

Answer 10

No. an interuterine pressure catheter would have to be present

Question 11

What may be seen on a woman that receives an epidural? Why?

Answer 11

Pulse ox, because epidurals may cause respiratory depression

Question 12

When is the fetal heart rate considered variable?

Answer 12

When there are irregular fluctuations in the fetal heart rate of 2 cycles per minute or greater

Question 13

What can cause fetal tachycardia?

Answer 13

Maternal fever/dehydration, fetal hypoxia, certain drugs, , fetal anemia, fetal/maternal infection, maternal hyperthyroidism, fetal heart failure or dysrhythmia

Question 14

When is tachycardia non-reassuring?

Answer 14

When associated with late decelerations, severe variable decelerations or absence of variability

Question 15

When is bradycardia non-reassuring?

Answer 15

When associated with loss of variability or late decelerations

Question 16

What can cause fetal bradycardia?

Answer 16

Fetal hypoxia late sign), maternal supine position or hypotension, prolonged umbilical cord compression or cord prolapse

Question 17

Can variability predict the presence of hypoxemia or metabolic activity?

Answer 17

No

Question 18

What is moderate variability associated with?

Answer 18

Adequate cerebral oxygenation

Question 19

What is the variability in heart rate for fetuses with absent, minimal, average/ moderate or marked variability?

Answer 19

Absent: undetectable
Minimal: detectable, but ≤ 5bpm
Average/moderate: 6-25bpm
Marked: > 25bpm

Question 20

Is absent variability assuring or non-reassuring?

Answer 20

Nonreassuring

Question 21

If minimal variability is seen in a fetal monitor, what are the things that should be considered?

Answer 21

“Three ss”: sleep? sedation? sick?

Question 22

Is minimal variability reassuring or nonreassuring?

Answer 22

Non reassuring

Question 23

Is a sinusoidal pattern considered assuring or non reassuring?

Answer 23

Non reassuring

Question 24

Changes in the fetal heart rate associated with uterine contractions are classified into which categories?

Answer 24

Accelerations or decelerations

Question 25

What are early decelerations caused by?

Answer 25

Head compression resulting in vagal reflex

Question 26

What do early decelerations look like?

Answer 26

Uniform in shape, onset, and recovery
Inversely mirror contraction in the beginning, end, and nadir/peak

Question 27

What causes late decelerations?

Answer 27

Uteroplacental insufficiency

Question 28

What do late decelerations look like?

Answer 28

Fetal heart rate returns to baseline after contraction ends. Will have a uniform shape, gradual onset and recovery

Question 29

When are late decelerations considered non-reassuring?

Answer 29

Always!

Question 30

What does a nurse do when late decelerations begin?

Answer 30

Reposition, hydrate, give oxygen, discontinue oxytocin, notify provider

Question 31

What causes variable decelerations?

Answer 31

Umbilical cord compression

Question 32

Shape of variable decelerations

Answer 32

“V” or “u”

Question 33

When are variable decelerations non-reassuring?

Answer 33

If they are repetitive, prolonged, severe, or slow return to baseline

Question 34

What should a nurse do to counteract variable decelerations?

Answer 34

Reposition, hydrate, give oxygen, notify provider, do an amnioinfusion

Question 35

What is usually the cause of prolonged deceleration?

Answer 35

Prolonged cord compression

Question 36

When is prolonged deceleration considered non-reassuring?

Answer 36

Always!

Question 37

What does a prolonged deceleration look like?

Answer 37

Abrupt decrease in fetal heartrate of at least 15bpm below baseline, lasting 2-10 minutes

Question 38

What is uterine tachysystole?

Answer 38

More than 5 contractions in 10 minutes

Question 39

What is intrauterine resuscitation?

Answer 39

Interventions for none assuring FHR patterns

Question 40

What kind of drug is oxytocin?

Answer 40

Uterotonic

Question 41

When should pitocin be discontinued?

Answer 41

When there is uterine tachysystole