Be sure to ask any questions you might have beforehand. What Do Contractions Feel Like? A. Fetal Tracing Quiz Please answer each question. Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? 1. A way to assess your babys overall health, fetal heart tracing is performed before and during the process of labor. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? What are the two most important characteristics of the FHR? The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. You scored 6 out of 6 correct. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Assess fetal pH (fetal scalp stimulation, scalp pH, or acoustic stimulation), 8. Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. Since variable and inconsistent interpretation of fetal heart rate tracings may affect management, a systematic approach to interpreting the patterns is important. If one of the following is detected during structured intermittent auscultation for a low-risk patient, switch to continuous electronic fetal monitoring to assess the National Institute of Child Health and Human Development category and to determine necessary clinical management: Fetal tachycardia (> 160 beats per minute for > 10 minutes), Fetal bradycardia (< 110 beats per minute for > 10 minutes), Recurrent decelerations following contractions (> 50% of contractions) or prolonged deceleration (> 2 minutes but < 10 minutes). Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. Category I tracings reflect a lack of fetal acidosis and do not require intervention. This alone is not predictive of fetal acidosis unless accompanied by decreased variability and/or absent spontaneous or stimulated accelerations.2,5. 740-591-8118. Compared with EFM alone, the addition of fetal electrocardiography analysis results in a reduction in operative vaginal deliveries (NNT = 50) and fetal scalp sampling (NNT = 33). The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. Quizzes 6-10. Long-term variability is a somewhat slower oscillation in heart rate and has a frequency of three to 10 cycles per minute and an amplitude of 10 to 25 bpm. Fetal bradycardia (FHR less than 110 bpm for at least 10 minutes) is more concerning than fetal tachycardia, and interventions should focus on intrauterine resuscitation and treating reversible maternal or fetal causes (Table 62,5,7 and eFigure C). D. Determine the onset and end of each deceleration in relation to the onset and end of the contraction. The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. 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). What characteristic of this fetal heart rate tracing is indicative of fetal well-being? The nurse understands that the test will be read as which of the following? Yes. On a drawing of the body locate the major body regions containing lymph nodes. If the new rate is below 110 BPM, the pattern is considered a bradycardia. The FHR is controlled by the autonomic nervous system. 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. Initiate oxygen at 6 to 10 L per minute, 5. References. -Contraction Stress Test (CST), How? Structured intermittent auscultation is an underused form of fetal monitoring; when employed during low-risk labor, it can lower rates of operative and cesarean deliveries with neonatal outcomes similar to those of continuous electronic fetal monitoring. Additionally, an Apgar score of less than 7 at five minutes, low cord arterial pH (less than 7.20), and neonatal and maternal hospital stays greater than three days were reduced.22, Tocolytic agents such as terbutaline (formerly Brethine) may be used to transiently stop contractions, with the understanding that administration of these agents improved FHR tracings compared with untreated control groups, but there were no improvements in neonatal outcomes.23 A recent study showed a significant effect of maternal oxygen on increasing fetal oxygen in abnormal FHR patterns.24. To provide a systematic approach to interpreting the electronic fetal monitor tracing, the National Institute of Child Health and Human Development convened a workshop in 2008 to revise the accepted definitions for electronic fetal monitor tracing. Powered by. It takes that professionals understanding of what the continuous tracings show to properly assess the fetal condition. Prolonged decelerations (Online Figures K and L) last longer than two minutes, but less than 10 minutes.11 They may be caused by a number of factors, including head compression (rapid fetal descent), cord compression, or uteroplacental insufficiency. The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). NCC EFM Tracing Game. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. Health care professionals play the game to hone and test their EFM knowledge and skills. What is the baseline of the FHT for Twin A (Black)? 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. Determine Risk (DR). Gene amplification in cancer cells has been shown to lead to resistance to cancer-killing medications when the dose of medication is increased gradually. -Fetal breathing movements The patient is being monitored by external electronic monitoring. Describe the variability. Copyright 2009 by the American Academy of Family Physicians. Fetal heart tracing is also useful for eliminating unnecessary treatments. T(t)=50+50cos(6t). You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. (SELECT ALL THAT APPLY). The nurse will chart the variability as which of the following? -Monitor fetal heart rate response to The perception that structured intermittent auscultation increases medicolegal risk, the lack of hospital staff trained in structured intermittent auscultation, and the economic benefit of continuous EFM from decreased use of nursing staff may promote the use of continuous EFM.8 Online Table A lists considerations in developing an institutional strategy for fetal surveillance. Baseline of 140 - 150 with decelerations to 120 noted beginning with the contraction and returning to baseline by the end of the contraction. If you want to see how you are doing overall, try the comprehensive assessment: The monitor calculates and records the FHR on a continuous strip of paper. Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor. A. Predictive of abnormal fetal-acid base status at the time of observation. Uterine tachysystole is defined as more than five contractions in any 10-minute period, averaged over 30 minutes.2 Each normal uterine contraction causes a temporary decrease in uterine blood flow and fetal oxygenation, which is generally well tolerated.26,27 However, tachysystole increases the risk of acidosis.26,27 To correct tachysystole, physicians must reduce or stop uterine stimulants or add tocolytics.2,2729, Goals of intrapartum fetal monitoring include rapid identification and intervention for suspected fetal acidosis as well as reassurance and avoidance of unnecessary interventions in cases of adequate fetal oxygenation.4,26 Figure 1 provides an algorithm for suggested management.2,7,16,21,27,3033. The nurse is reviewing a non-stress test (NST) and notes the following: FHR baseline of 120-130 bpm with increase in FHR noted to 150 for 15 seconds and an increase of FHR noted to 135 for 10 seconds over a 20 minute time frame. -2 points for each normal, 0 for abnormal, -8-10: Normal result ,Repeat BPP weekly Sketch or describe how the To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles. Typically performed in the later stages of pregnancy and during labor, fetal heart tracing results can say a lot about the health of your baby. If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. None. The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. 3. The nurse understands that this is being done for which of the following reasons? Remember, the baseline is the average heart rate rounded to the nearest five bpm. The patient complains of breathlessness and becomes pale and diaphoretic. 2. is part of the free online EFM toolkit at. Compared with structured intermittent auscultation, continuous EFM showed no difference in overall neonatal death rate. The normal FHR range is between 120 and 160 beats per minute (bpm). b. Category III tracings have been associated with fetal hypoxia, acidosis, and encephalopathy.2,5,26,37, Fetal tachycardia (FHR of more than 160 bpm for at least 10 minutes) can be caused by maternal or fetal factors (Table 52,5,7 and eFigure B). b. apply a stressful stimulus to the fetus. Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. It is important to review the pressure tracing before assessing the fetal tracing to accurately interpret decelerations. Minimal variability during the hour preceding fetal bradycardic events has been shown to be most predictive of fetal acidosis and need for emergent delivery.23 During periods of minimal variability, accelerations produced by scalp stimulation offer reassurance.15,23,26,41 Management of minimal variability includes intrauterine resuscitation and identifying and treating reversible causes (Table 7).2,7,16, Marked variability is defined as more than 25 bpm fluctuations in FHR around the determined baseline for more than 10 minutes and may represent hypoxic stress5,33 (eFigure E). The decelerations show a symmetric gradual decrease in the FHR, which begins at the peak of each contraction and ends 10 to 15 seconds after the contraction has returned to resting baseline. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. What should the nurse do in this situation? This is followed by occlusion of the umbilical artery, which results in the sharp downslope. Contraction Stress Test (CST) Faculty, Students, State Boards & Volunteers. Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. -Fetal body movements Select the answer that doesn't belong with the others: Continuous electronic fetal monitoring, compared with structured intermittent auscultation, has been shown to increase the need for cesarean delivery (number needed to harm = 56; RR = 1.63; 95% CI, 1.29 to 2.07; n = 18,861) and operative vaginal delivery (number needed to harm = 41; RR = 1.15; 95% CI, 1.01 to 1.33; n = 18,615), with no statistical decrease in fetal death or cerebral palsy.1 Continuous electronic fetal monitoring has also led to a 50% reduction in the incidence of neonatal seizure vs. structured intermittent auscultation, but this has no effect on long-term outcomes.1, Several adjuncts have been studied to overcome the high false-positive rate of continuous electronic fetal monitoring. This system can be used in conjunction with the Advanced Life Support in Obstetrics course mnemonic, DR C BRAVADO, to assist in the systematic interpretation of fetal monitoring. Turn the patient to the left side, stop the oxytocin infusion, and assess maternal vital signs. Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. Fetal Tracing Index. Foremost, the entire fetal heart rate tracing requires evaluation, which includes assessing the uterine activity for tachysystole, presence or absence of variability, and accelerations. Nonreassuring patterns such as fetal tachycardia, bradycardia and late decelerations with good short-term variability require intervention to rule out fetal acidosis. Variable decelerations associated with a nonreassuring pattern, Late decelerations with preserved beat-to-beat variability, Persistent late decelerations with loss of beat-to-beat variability, Nonreassuring variable decelerations associated with loss of beat-to-beat variability, Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity, Administer oxygen through a tight-fitting face mask, Change maternal position (lateral or knee-chest), Administer fluid bolus (lactated Ringer's solution), Perform a vaginal examination and fetal scalp stimulation, When possible, determine and correct the cause of the pattern, Consider tocolysis (for uterine tetany or hyperstimulation), Consider amnioinfusion (for variable decelerations), Determine whether operative intervention is warranted and, if so, how urgently it is needed, A blunt acceleration or overshoot after severe deceleration, Late decelerations or late return to baseline (. A. (They start and reach maximum value in less than 30 seconds.) -Contractions started by: IV pitocin or Nipple stimulation Search dates: December 2018, July 2019, and March 2020. Shows all of the following: -Baseline FHR 110-160 BPM. the presence of moderate variability and/or accelerations offers reassurance in Category II tracings because the presence is predictive of a lack of fetal acidosis, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation, 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. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the.
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