fetal heart tracing quiz 10

Clinically, loss of beat-to-beat variability is more significant than loss of long-term variability and may be ominous.18 Decreased or absent variability should generally be confirmed by fetal scalp electrode monitoring when possible. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the FHR during a uterine contraction and for 30 seconds thereafter to identify fetal response. Health care professionals play the game to hone and test their EFM knowledge and skills. Mucus plug: What is it and how do you know you've lost it during pregnancy? Use a logarithmic transformation to find a linear relationship between the given quantities and graph the resulting linear relationship on a log-linear plot. Treat placental fetal perfusion through intrauterine resuscitation before proceeding to immediate delivery for all Category II or III tracings with concern for fetal acidosis. Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of labor. -Fetal breathing movements Variable decelerations may be classified according to their depth and duration as mild, when the depth is above 80 bpm and the duration is less than 30 seconds; moderate, when the depth is between 70 and 80 bpm and the duration is between 30 and 60 seconds; and severe, when the depth is below 70 bpm and the duration is longer than 60 seconds.4,11,24 Variable decelerations are generally associated with a favorable outcome.25 However, a persistent variable deceleration pattern, if not corrected, may lead to acidosis and fetal distress24 and therefore is nonreassuring. Absent. They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. Amnioinfusion for umbilical cord compression in the presence of decelerations reduced: fetal heart rate decelerations (NNT = 3); cesarean delivery overall (NNT = 8); Apgar score < 7 at five minutes (NNT = 33); low cord arterial pH (< 7.20; NNT = 8); neonatal hospital stay > three days (NNT = 5); and maternal hospital stay > three days (NNT = 7). If the cause cannot be identified and corrected, immediate delivery is recommended. Postdate gestation, preeclampsia, chronic hypertension and diabetes mellitus are among the causes of placental dysfunction. 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): Any decrease in uterine blood flow or placental dysfunction can cause late decelerations. -Daily Fetal Kick Counts Copyright 2009 by the American Academy of Family Physicians. 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. Theyll wrap a pair of belts around your belly. Electronic fetal monitoring is performed in a hospital or doctors office. The baseline FHR is 135 bpm with moderate variability. Variable decelerations are shown by an acute fall in the FHR with a rapid downslope and a variable recovery phase. However, the strength of contractions cannot always be accurately assessed from an external transducer and should be determined with an IUPC, if necessary. The use of amnioinfusion for recurrent deep variable decelerations demonstrated reductions in decelerations and cesarean delivery overall. Continuous electronic fetal monitoring has been shown to reduce the incidence of neonatal seizures, but there has been no beneficial effect in decreasing cerebral palsy or neonatal mortality. The patient's membranes ruptured 1 hour ago, and the fluid was clear. 1. Select the answer that doesn't belong with the others: NCC EFM Tracing Game. -Neither period yields adequate accelerations Hypoxia, uterine contractions, fetal head compression and perhaps fetal grunting or defecation result in a similar response. The FHR baseline is 130 bpm with moderate variability. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. Variability describes fluctuations in the baseline FHR, whether in terms of frequency, amplitude, or magnitude. Tracing patterns can and will change! The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. 90-150 bpm B. Challenge yourself every tracing collection is FREE! They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. The probe sends your babys heart sounds to a computer and shows FHR patterns. Fetal heart rate monitoring is a process of monitoring the fetal heart rate during labor and delivery to assess the fetus's well-being. Management of late decelerations includes intrauterine resuscitation and identifying and treating reversible causes, with immediate delivery recommended if they do not resolve2,5,7 (Figure 67). Fetal Tracing Index. -Positive: Repetitive; persistent late decelerations, Decelerations with more than half of contractions, Not due to uterine hyperstimulation, -Negative Contraction Stress Test: Reassuring for fetal well being, Follow daily Fetal Kick Counts Identify type of monitor usedexternal versus internal, first-generation versus second-generation. Which nursing intervention is necessary before a second trimester transabdominal ultrasound? Other maternal conditions such as acidosis and hypovolemia associated with diabetic ketoacidosis may lead to a decrease in uterine blood flow, late decelerations and decreased baseline variability.23. A nurse is teaching a woman how to do "kick counts." View questions only 3/10/2017 Fetal Heart Tracing Quiz 2 Correct. https://www.acog.org/~/media/For%20Patients/faq015.pdf, Current version ( You scored 6 out of 6 correct. 1. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. The nurse's first action should be which of the following? structured intermittent auscultation should be considered for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without an increase in unfavorable outcomes associated with continuous monitor use and a high false-positive rate. The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST. This content is owned by the AAFP. 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). T(t)=50+50cos(6t). RN 45 Nonstress Test (Maternal Newborn) Quiz, Evolve Fetal Heart Rate: Assessment via Inter, Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh, Modulo 21: Impacto De La Ciencia Y La Tecnolo. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. A key causal event in the release of neurotransmitter molecules from vesicles into the synaptic cleft is the________. Be sure to ask any questions you might have beforehand. The health care provider has ordered an amnioinfusion. The purpose of initiating contractions in a CST is to. What should the nurse do before appropriate clinical interventions are initiated? Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. -Related to fetal movement Bradycardia of this degree is common in post-date gestations and in fetuses with occiput posterior or transverse presentations.16 Bradycardia less than 100 bpm occurs in fetuses with congenital heart abnormalities or myocardial conduction defects, such as those occurring in conjunction with maternal collagen vascular disease.16 Moderate bradycardia of 80 to 100 bpm is a nonreassuring pattern. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Fetal tachycardia is defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern (Figure 3). Evaluate recordingis it continuous and adequate for interpretation? -Monitor fetal heart rate response to Antepartum Fetal Assessment 10. Baseline Rate (BRA; Online Table B). On a drawing of the body locate the major body regions containing lymph nodes. c. Reassure the family the finding is normal. In 1991, the National Center for Health Statistics reported that EFM was used in 755 cases per 1,000 live births in the United States.2 In many hospitals, it is routinely used during labor, especially in high-risk patients. Structured intermittent auscultation can be used for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without increasing cerebral palsy or fetal death. The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. The normal FHR range is between 120 and 160 beats per minute (bpm). Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. b) basalt plateau a streams response to precipitation. 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. We also searched the Cochrane Library, Essential Evidence Plus, and Clinical Evidence. Everything You Need to Know, 2023 Flo Health Inc., Flo Health UK Limited. Accelerations represent a sudden increase in FHR of more than 15 bpm in bandwidth amplitude. About. Practice Quizzes 1-5. 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. 4. Since variable and inconsistent interpretation of fetal heart rate tracings may affect management, a systematic approach to interpreting the patterns is important. If the new rate is below 110 BPM, the pattern is considered a bradycardia. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions. 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). Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. See permissionsforcopyrightquestions and/or permission requests. Unfortunately, precise information about the frequency of false-positive results is lacking, and this lack is due in large part to the absence of accepted definitions of fetal distress.7 Meta-analysis of all published randomized trials has shown that EFM is associated with increased rates of surgical intervention resulting in increased costs.8 These results show that 38 extra cesarean deliveries and 30 extra forceps operations are performed per 1,000 births with continuous EFM versus intermittent auscultation. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. A change in baseline FHR is said to occur when the change persists for 10 minutes or longer. Internal monitoring involves intravaginal placement of monitors within the uterine cavity.7 A fetal scalp electrode is recommended for fetal heart monitoring when fetal position and/or maternal habitus make external monitoring suboptimal.4 External monitors measure only contraction frequency, but an intrauterine pressure catheter can also determine the strength of contractions.13 Placement of an intrauterine pressure catheter or fetal scalp electrode requires cervical dilation and amniotomy, which can increase the risk of intrauterine infection, fetal injury, and the transmission of herpes simplex virus and hepatitis B or C.4,13, Structured intermittent auscultation is a fetal monitoring option for detecting fetal acidosis in low-risk pregnancies.7,14,15 Typically, the labor nurse auscultates the fetal heartbeat with a handheld Doppler device (Table 1).7,1417 Structured intermittent auscultation is not standard practice in the United States because of 1:1 nursing staff requirements and physician oversight concerns, whereas continuous electronic fetal monitoring can be monitored centrally with continuous recording capabilities.7,1418, Despite these challenges, structured intermittent auscultation should be considered for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without an increase in unfavorable outcomes associated with continuous monitor use and a high false-positive rate.1,7,14,16,17 Compared with women who receive structured intermittent auscultation, those who receive continuous electronic fetal monitoring for an initial 20-minute period at admission are at increased risk of continuing use for the duration of their labor (relative risk [RR] = 1.30; 95% CI, 1.14 to 1.48; n = 10,753) and a possible 20% increased rate of cesarean delivery.19. The nurse will chart the variability as which of the following? Turn mother to her left side, Family Health (BSN2) Exam Three Sherpath/Quiz, ANTEPARTUM AND POSTPARTUM COMPLICATIONS QUIZ-, Julie S Snyder, Linda Lilley, Shelly Collins, Volume 1, Chapter 11 Human Lifespan Develop. is part of the free online EFM toolkit at. c) caldera An acceleration pattern preceding or following a variable deceleration (the shoulders of the deceleration) is seen only when the fetus is not hypoxic.15 Accelerations are the basis for the nonstress test (NST). The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. A pseudosinusoidal pattern shows less regularity in the shape and amplitude of the variability waves and the presence of beat-to-beat variability, compared with the true sinusoidal pattern (Figure 11b). 3. These segments help establish an estimated baseline (for a duration of 10 minutes) which is expressed in beats per minute. Faculty, Students, State Boards & Volunteers. Accelerations (A). Table 1 lists examples of the criteria that have been used to categorize patients as high risk. Decreased variability is defined as a variation of one to five bpm from baseline for at least 10 minutes5 (eFigure D). 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. See permissionsforcopyrightquestions and/or permission requests. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended (Figure 6). 3/10/2017 Fetal Heart Tracing Quiz 10 Correct. Ominous patterns require emergency intrauterine fetal resuscitation and immediate delivery. Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. 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). -Positive Contraction Stress Test: Hasten fetal delivery. A woman has just received pain medication in labor. https://www.acog.org/Patients/FAQs/Fetal-Heart-Rate-Monitoring-During-Labor?IsMobileSet=false -Relative: Multiple Gestation, History of classic cesarean section, -Negative (Normal): Adequate contractions, No concerning rate changes with contractions (no late decelerations) Assess fetal pH (fetal scalp stimulation, scalp pH, or acoustic stimulation), 8. While admitting a patient who is at 40 weeks' gestation, the nurse observes an FHR of 165 bpm with recurrent decelerations. Table 3 lists examples of nonreassuring and ominous patterns. 2. The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. This is associated with certain maternal and fetal conditions, such as chorioamnionitis, fever, dehydration, and tachyarrhythmias. Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. A normal baseline rate ranges from 110 to 160 bpm. 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. The nurse's best response is, b. 7. The nurse still interprets the FHR tracing as a Category III. Relevant ACOG Resources. To assess 5 areas of fetal health: Usually done after 32 weeks, Assesses 5 areas of fetal well-being: B. Activate the organization's chain of command. The nurse notes a prolonged deceleration of the FHR to 80 bpm and begins intrauterine resuscitation. The FHR is under constant variation from the baseline (Figure 1). The recommendations for the overall management of FHR tracings by NICHD, the International Federation of Gynecology and Obstetrics, and ACOG agree that interpretation is reproducible at the extreme ends of the fetal monitor strip spectrum.10 For example, the presence of a normal baseline rate with FHR accelerations or moderate variability predicts the absence of fetal acidemia.10,11 Bradycardia, absence of variability and accelerations, and presence of recurrent late or variable decelerations may predict current or impending fetal asphyxia.10,11 However, more than 50 percent of fetal strips fall between these two extremes, in which overall recommendations cannot be made reliably.10 In the 2008 revision of the NICHD tracing definitions, a three-category system was adopted: normal (category I), indeterminate (category II), and abnormal (category III).11 Category III tracings need intervention to resolve the abnormal tracing or to move toward expeditious delivery.11 In the ALSO course, using the DR C BRAVADO approach, the FHR tracing may be classified using the stoplight algorithm (Figure 19), which corresponds to the NICHD categories.9,11 Interventions are determined by placing the FHR tracing in the context of the specific clinical situation and corresponding NICHD category, fetal reserve, and imminence of delivery (Table 4).9,11, If the FHR tracing is normal, structured intermittent auscultation or continuous EFM techniques can be employed in a low-risk patient, although reconsideration may be necessary as labor progresses.2 If the FHR tracing is abnormal, interventions such as position changes, maternal oxygenation, and intravenous fluid administration may be used.

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