Electronic Fetal Monitoring

Question 1

what is the difference between an internal monitor and external monitor of contractions

Answer 1

• external monitor only tells frequency of contractions; internal monitor tells frequency and strength of contractions

Question 2

how are fetal bradycardia and tachycardia defined?

Answer 2

• bradycardia: Baseline rate < 110
• tachycardia: baseline rate > 160

Question 3

what are causes of fetal bradycardia?

Answer 3

• fetal hypoxia
• prolonged cord compression
• cord prolapse
• tetanic unterine contractions
• paracervical block
• epidural and spinal anesthesia
• maternal seizues
• rapid descent
• vigorus vaginal examination

Question 4

What are causes of fetal tachycardia?

Answer 4

• fetal hypoxia
• maternal fever
• hyperthyroidism
• maternal or fetal anemia
• parasympathetic drugs- atropine, hydoxyzine
• prematurity
• fetal tachyarrhythmia
• sympathomimetic- ritodrine

Question 5

What is a biophysical profile?

Answer 5

Used if non stress test is negative; or monitoring high risk pregnancies

• non stress test
• amniotic fluid
• fetal breathing (30sec within 30 minutes)
• gross movements (3)
• tone (1)

either 0 or 2 points are given for each category

Question 6

• Three or more contractions in 10 mintues
• negative (reassuring) if not late decel
• positive (non-reassuring) if late decel(s)
• contractions may be spontaneous or induced by oxytocin or nipple stimulation
• not used very often

Answer 6

contraction stress test

Question 7

what do early decelerations indicate?

Answer 7

• Head compression (Vagal response)

Question 8

what do late decelerations indicate?

Answer 8

• uteroplacental insufficiency
• causes for this include: epidural, pictocin, hypertensive disorders of pregnancy, diabetes
• tobacco, cocaine, SLE, IUGR

Question 9

What do variable decelerations indicate?

Answer 9

Cord Compression

Question 10

five non-assuring signs with variable decelerations?

Answer 10

1. lack of variablility (no shoulders)
2. severe variables (rule of 60s)
3. late component (return to baseline after contraction has ended)
4. large overshoot when returning to baseline
5. abnormal baseline (fetal tachycardia or bradycardia)

Question 11

what initial actions should be taken with fetal bradycardia or concerning decelerations?

Answer 11

• turn to left side (increases blood returning to heart by 30%)
• IV fluids
• oxygen
• vaginal check
• if on pitocin, stop or decrease dose
• if recent epidural > anesthesia, IVF, ephidrine

Question 12

• baseline rate: 110-160 bpm
• baseline FHR variability: moderate
• late or variable deceleration: absent
• early deceleration: present or absent
• accelerations: present or absent

Answer 12

category 1

Question 13

• absent baseline FHR variablity and any of the following
  1. recurrent late decelerations
  2. recurrent variable decelerations
  3. bradycardia
• sinusoidal pattern

Answer 13

Category 3

Question 14

how are category tracings managed?

Answer 14

• category 1: reassuring; no extra intervention
• category 2: boderline; observe closely; consider interventions
• category 3: concerning; move towards delivery if doesn’t respond quickly to interventions