fetal heart tracing quiz 10

Recurrent deep variable decelerations can be corrected with amnioinfusion. Fetal heart tracing is also useful for eliminating unnecessary treatments. 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. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. When continuous EFM tracing is indeterminate, fetal scalp pH sampling or fetal stimulation may be used to assess for the possible presence of fetal acidemia.5 Fetal scalp pH testing is no longer commonly performed in the United States and has been replaced with fetal stimulation or immediate delivery (by operative vaginal delivery or cesarean delivery). If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. FHR baseline of 120-130 with V shaped decelerations to 100 noted before and after contractions. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. Monochromatic light of wavelength \lambda is incident on a GP pair of slits separated by 2.40104m2.40 \times 10^{-4} \mathrm{~m}2.40104m and forms an interference pattern on a screen placed 1.80m1.80 \mathrm{~m}1.80m from the slits. Intrapartum category I, II, and III fetal heart rate tracings The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. The practitioner ruptures a laboring patient's membranes and inserts a fetal spiral electrode because the nurse is unable to obtain FHR data by the external method. 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. Membranes have to be rupture in order to establish direct contact. Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? 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). distribution of tributaries influences Electronic fetal heart rate monitoring (EFM) was first introduced at Yale University in 1958.1 Since then, continuous EFM has been widely used in the detection of fetal compromise and the assessment of the influence of the intrauterine environment on fetal welfare. The most important risk of EFM is its tendency to produce false-positive results. What should the nurse do in this situation? -Fetal breathing movements Interventions to increase fetal activity fail, Reactive NST: Copyright 2023 American Academy of Family Physicians. Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. The presence of moderate variability and/or accelerations is predictive of a lack of fetal acidosis. a) Recalculate the branch current in the 22 \Omega2 resistor, I2I _2I2. This pattern is most often seen during the second stage of labor. HESI - OB, Fetal Heart Rate: Interpretation Flashcards | Quizlet Continuous electronic fetal monitoring was developed to screen for signs of hypoxic-ischemic encephalopathy, cerebral palsy, and impending fetal death during labor. Table 1 lists examples of the criteria that have been used to categorize patients as high risk. (f) Comment on the agreement between the answers to parts (a) and (e). The patient is scheduled for an amniocentesis at 16 weeks gestation. y=4105xy=4 \times 10^{5 x}y=4105x, -Fetoscope: horn or stethoscope-like instrument, -Fetal movement decreases with low oxygen intake, -Test for fetal well-being after 28 weeks, -Any maternal or fetal condition that increases risk of "fetal demise", Reactive (Normal): The NCC EFM Tracing Game uses NICHD terminology. 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). a) lapilli Consider need for expedited delivery (operative vaginal delivery or cesarean delivery). c) On the basis of your answers, is it desirable to have the resistance of the two 120 V loads be equal? A woman has just received pain medication in labor. T(t)=50+50cos(6t).T(t)=50+50 \cos \left(\frac{\pi}{6} t\right) . Have you tested your EFM skills lately? 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). Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. -Biophysical Profile The nurse is caring for a low-risk primipara at 40 weeks' gestation and in active labor. 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. It indicates severe fetal anemia, as occurs in cases of Rh disease or severe hypoxia.24 It should be differentiated from the pseudosinusoidal pattern (Figure 11a), which is a benign, uniform long-term variability pattern. Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. 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. 9. A gradual decrease is defined as at least 30 seconds from the onset of the deceleration to the FHR nadir, whereas an abrupt decrease is defined as less than 30 seconds from the onset of the deceleration to the beginning of the FHR nadir.11, Early decelerations (Online Figure H) are transient, gradual decreases in FHR that are visually apparent and usually symmetric.11 They occur with and mirror the uterine contraction and seldom go below 100 bpm.11 The nadir of the deceleration occurs at the same time as the peak of the contraction. Variability (V; Online Table B). This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. -Contraction Stress Test (CST), How? You scored 6 out of 6 correct. Variable. The figure in the next column shows a graph of TTT. Variability and accelerations C. Variability and decelerations D. Rate and variability 3. Electronic fetal monitoring is performed in a hospital or doctors office. (SELECT ALL THAT APPLY), Baseline rate of 110-160 bpm Moderate variability. A more recent article on intrapartum fetal monitoring is available. Powered by. Continuous EFM reduced neonatal seizures (NNT = 661), but not the occurrence of cerebral palsy. is part of the free online EFM toolkit at. Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. Early decelerations (mirror contraction, with nadir at peak of contraction, likely fetal head compression) and accelerations (FHR increase of 15 bpm or more over at least 15 seconds) may be present.2,5,7,34 No intervention is required for Category I tracings. -Monitor fetal heart rate response to EFM Tracing Game The FHR baseline is 120-130 bpm. 140 145 150 155 160 2. Absent. : The patient's membranes ruptured 1 hour ago, and the fluid was clear. Your obstetrician reviews the fetal heart tracing at regular time intervals. FHR Quiz Flashcards | Quizlet The nurse is instructing a new staff nurse on reassuring FHR patterns. 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. Questions and Answers 1. Prolonged. Compared with structured intermittent auscultation, a period of EFM on maternity unit admission results in a lack of improved neonatal outcomes and increased interventions, including epidural analgesia (NNH = 19), continuous EFM (NNH = 7), and fetal blood scalp testing (NNH = 45). Management includes correction of identified reversible causes. Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5. Theyll wrap a pair of belts around your belly. 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.

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