Fetal Heartrate Monitoring (Moulton)

Question 1

Between external and internal monitoring, which will provide the most accurate tracings?

Answer 1

Internal

Question 2

With an uncomplicated pregnancy, continuous external monitor should be done every ____ minutes in the active phase of first stage of labor.

Monitor every ____ minutes in second stage of labor.

Answer 2

1) 30

2) 15

Question 3

With a complicated pregnancy, continuous external monitor should be done every ____ minutes in the active phase of first stage of labor.

Monitor every ____ minutes in second stage of labor.

Answer 3

1) 15

2) 5

Question 4

With external electronic fetal monitoring, ____ is placed on maternal abdomen overlying the fetal heart and it records reflected sound waves from the fetal
heart back to the transducer.

Answer 4

Doppler ultrasound transducer

Question 5

With external electronic fetal monitoring, a pressure sensitive tocodynamometer transducer detects and records frequency of __1__.

It does NOT measure the __2__.

Answer 5

1) Contractions

2) Strength of contraction

Question 6

Rate is computed from the R wave peaks of

the fetal echocardiogram with what internal electronic fetal monitoring device?

Answer 6

Fetal scalp electrode

Question 7

Fetal scalp electrode should be avoided in patients with?

Answer 7

HIV

Question 8

What internal electronic fetal monitoring device gives precise measurement of the intensity of the uterine contractions in millimeters of mercury?

Answer 8

Intrauterine pressure catheter

Question 9

Fetal Heart rate is determined by the?

Answer 9

Atrial pacemaker

Question 10

Modulation of the rate occurs physiologically through innervation of the heart by the __1__ (decelerator) and __2__ (accelerator) nerves.

Answer 10

1) Vagus

2) Sympathetic

Question 11

A fetus whose oxygen supply is marginal cannot tolerate the stress of ____ and will become hypoxic.

Answer 11

Contractions

Question 12

Hypoxia, when severe, will result in anaerobic metabolism, resulting in the accumulation of pyruvic and lactic acid resulting in fetal __1__.

pH of fetal scalp blood normally is between __2__.

pH < __3__ is considered abnormal.

Answer 12

1) Acidosis
2) 7.25-7.30
3) 7.20 (fetal acidosis)

Question 13

With each contraction, blood flow from the mother to the baby initially ceases as the ____ are compressed.

Answer 13

Uterine myometrial vessels (arteries and veins)

Question 14

With a fetal monitoring strip, the upper tracing monitors?

The lower tracing measures?

Each small box equals how many seconds?

Dark line to dark line equals?

Answer 14

1) FHR
2) Uterine contractions
3) 10 seconds
4) 1 minute

Question 15

Normal uterine activity is characterized by __1__ contractions or less in __2__ minutes, averaged over a 30 minute window.

If there are more contractions than this in the same time period it is termed __3__?

Answer 15

1) 5
2) 10
3) Tachysystole

Question 16

With a fetal monitoring strip contractions can be measured from?

Answer 16

Peak to peak

Question 17

What are Montevideo units?

What should they be at for a 2 hour period?

Answer 17

1) Sum of the contractions in a 10 minute period

2) Greater than 200

Question 18

__1__ are calculated from readings of intrauterine pressure catheter by subtracting baseline from peak contraction for each contraction during a 10-minute window and adding the pressures.

The uterine contraction pattern should exceed __2__ units for at least 2 hours.

Answer 18

1) Montevideo units

2) 200 Montevideo

Question 19

What is the range for a normal FHR?

Tachycardia is defined as?

Bradycardia is defined as?

Answer 19

1) 110-160 bpm
2) > 160 bpm
3) < 110 bpm

Question 20

What is a late sign of hypoxia?

What is an early sign of hypoxia?

Answer 20

1) Bradycardia

2) Tachycardia

Question 21

Maternal hypotension will result in?

Maternal fever will result in?

Answer 21

1) Bradycardia

2) Tachycardia

Question 22

What is the most common cause of fetal tachycardia?

Answer 22

Chorioamnionitis

Question 23

__1__ produce tachycardia in response to hypoxia.

__2__ influence FHR via the vagus n. in response to changes in fetal blood pressure.

Answer 23

1) Chemoreceptors

2) Baroreceptors

Question 24

Baseline variability is due to fluctuations in the baseline FHR that are irregular in amplitude and frequency. Variability is visually quantified as the amplitude of __1__ in bpm of change in baseline rate.

Absent variability is when the amplitude range is __2__.

Minimal variability is when the amplitude range is __3__.

Moderate (normal) variability is when the amplitude range is __4__.

• Marked variability is when the amplitude range is __5__.

Answer 24

1) Peak-to-trough
2) Undetected
3) <5 bpm
4) 6-25 bpm
5) > 25 bpm

Question 25

1) Decreased variability is an indicator of? It is associated with __2__ and __3__.

Answer 25

1) Possible fetal stress | 2) Hypoxia and acidemia

Question 26

Prematurity, maternal fever, fetal tachycardia, maternal hyperthyroidism, and maternal substance abuse are all potential causes of ____ baseline variability.

Answer 26

Decreased

Question 27

FHR may vary with uterine contractions by slowing or | accelerating. These responses are categorized as?

Answer 27

No change, acceleration, and deceleration

Question 28

What type of FHR change is characterized by the FHR maintains the same characteristics as in the preceding baseline FHR?

Answer 28

No change

Question 29

What type of FHR change is characterized by an abrupt increase in the FHR and is a normal reassuring response?

Answer 29

Acceleration

Question 30

Acceleration at 32 weeks or greater is defined as heart rate of greater than or equal to __1__ bpm above baseline for __1__ sec or more (but less than 2 minutes). Acceleration at less than 32 weeks is defined as heart rate of greater than or equal to __1__ bpm above baseline for __1__ sec or more (but less than 2 minutes).

Answer 30

1) 15 bpm 2) 15 seconds 3) 10 bpm 4) 10 seconds

Question 31

Prolonged acceleration of FHR is defined by these changes lasting greater than? There is a change in baseline if the acceleration how many minutes or more?

Answer 31

1) 2 minutes | 2) 10 minutes

Question 32

Spontaneous fetal movement, scalp stimulation or vibroacoustic stimulation, and vaginal examination are all causes of?

Answer 32

Acceleration

Question 33

What type of FHR change is characterized by the FHR decreasing in response to uterine contractions? These changes may be subclassified as?

Answer 33

1) Decelerations | 2) Early, variable, late

Question 34

Early decelerations are secondary to __1__? This causes an increase in __2__? Which then leads to a decrease in __3__. Causing the activation of the central __4__ nerve. This activation produces a decrease in __5__. Recovery occurs as __6__ is relieved.

Answer 34

1) Head compression 2) Increased intracranial pressure 3) Cerebral blood flow 4) Vagus 5) Heart rate 6) Pressure

Question 35

The __1__ of the deceleration occurs at the same time as the __2__ of the contraction and thus is a “mirror image”.

Answer 35

1) Lowest point | 2) Peak

Question 36

Variable decelerations are secondary to __1__? The abrupt decrease in FHR can occur before, during, or after __2__ starts.

Answer 36

1) Umbilical cord compressions | 2) Contraction

Question 37

Variable decelerations is characterized by a decrease in FHR of > __1__ bpm lasting >15 sec and lasting < 2 minutes in duration.

Answer 37

1) 15 bpm | 2) 15 seconds

Question 38

If the umbilical cord is only slightly compressed, this will obstruct the __1__ which returns re-oxygenated blood to the fetal heart. The initial normal fetal response to this is a slight __2__ in fetal heart rate to compensate for the lack of blood return and the slowly diminishing oxygen supplies. If this slight __2__ in FHR is followed by a major drop in FHR, this phenomenon is called a "__3__."

Answer 38

1) Umbilical vein (low pressure system) 2) Increase 3) Shoulder

Question 39

Which deceleration is the most ominous deceleration?

Answer 39

Late decelerations

Question 40

Late decelerations are caused by?

Answer 40

Uterine placental insufficiency

Question 41

Repetitive late decelerations usually indicate fetal __1__ and __1__. The low point of the deceleration occurs __2__ the peak of the contraction.

Answer 41

1) Metabolic acidosis and low arterial pH | 2) After

Question 42

Prolonged decelerations is defined as a decrease in FHR from baseline that is greater than or equal to __1__ bpm lasting more than __2__ minutes but less than 10 min.

Answer 42

1) 15 bpm | 2) 2 minutes

Question 43

Prolonged decelerations is commonly seen during?

Answer 43

Maternal pushing

Question 44

Smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3-5 per minute is characteristic of? It is seen with?

Answer 44

1) Sinusoidal pattern | 2) Fetal anemia

Question 45

Amnioinfusion is the process of instillation of normal saline to alleviate? This can eliminate what problem?

Answer 45

1) Cord compression | 2) Variable decelerations

Question 46

1) When the scalp is stimulated, if an acceleration of 15 bpm lasting 15 seconds occurs the fetal pH value almost always is? This is especially useful to differentiate fetal sleep from __2__, when the fetal tracing shows reduced variability but no decelerations.

Answer 46

1) 7.22 or greater | 2) Acidosis

Question 47

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend how long from decision‐to‐incision for emergency caesarean delivery?

Answer 47

30 minutes

Question 48

Electronic Fetal monitoring does NOT result in reduction of?

Answer 48

Cerebral palsy