The onset, nadir, and recovery of the deceleration usually coincide with the beginning, peak, and ending of the contraction, respectively.11 Early decelerations are nearly always benign and probably indicate head compression, which is a normal part of labor.15, Variable decelerations (Online Figure I), as the name implies, vary in terms of shape, depth, and timing in relationship to uterine contractions, but they are visually apparent, abrupt decreases in FHR.11 The decrease in FHR is at least 15 bpm and has a duration of at least 15 seconds to less than two minutes.11 Characteristics of variable decelerations include rapid descent and recovery, good baseline variability, and accelerations at the onset and at the end of the contraction (i.e., shoulders).11 When they are associated with uterine contractions, their onset, depth, and duration commonly vary with successive uterine contractions.11 Overall, variable decelerations are usually benign, and their physiologic basis is usually related to cord compression, with subsequent changes in peripheral vascular resistance or oxygenation.15 They occur especially in the second stage of labor, when cord compression is most common.15 Atypical variable decelerations may indicate fetal hypoxemia, with characteristic features that include late onset (in relation to contractions), loss of shoulders, and slow recovery.15. Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. FHR Quiz Flashcards | Quizlet -NST Turn the patient to the left side, stop the oxytocin infusion, and assess maternal vital signs. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. Prematurity decreases variability16; therefore, there is little rate fluctuation before 28 weeks. Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice. The experienced nurse tells the new nurse that a Category III FHR tracing may include which characteristic? 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. Fetal tachycardia may be a sign of increased fetal stress when it persists for 10 minutes or longer, but it is usually not associated with severe fetal distress unless decreased variability or another abnormality is present.4,11,17. -Try to get 3 uterine contractions within 10-minute period, -Absolute: Placenta Previa, Cerclage, Incompetent cervix While assessing the FHR, the nurse notices a pattern of uniform decelerations that have an abrupt onset with a nadir down to 90 bpm for 30 seconds. Intrapartum Fetal Monitoring | AAFP EFM In-Depth. Interpretation of the Electronic Fetal Heart Rate During Labor 740-591-8118. Describe a hypothesis that explains these results. Early. 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). Copyright 2023 American Academy of Family Physicians. Identify type of monitor usedexternal versus internal, first-generation versus second-generation. The resulting printout is known as a fetal heart tracing, which will be read and analyzed. For the letters on this figure, choose the likely cause of melting for Site B. Theyll wrap a pair of belts around your belly. Variability should be normal after 32 weeks.17 Fetal hypoxia, congenital heart anomalies and fetal tachycardia also cause decreased variability. Remember, the baseline is the average heart rate rounded to the nearest five bpm.140 145 150 155 160 FHT Quiz 10 Fetal Tracing Quiz 1A. 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. Initiate oxygen at 6 to 10 L per minute, 5. If the cause cannot be identified and corrected, immediate delivery is recommended. 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. Evaluate recordingis it continuous and adequate for interpretation? comprehensive exam fetal tracing index references the maternal fetal triage index frequently asked questions web each of the ve levels has key questions with . Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. None. The nurse notes a prolonged deceleration of the FHR to 80 bpm and begins intrauterine resuscitation. Place the Doppler over the area of maximal intensity of fetal heart tones, 3. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate. 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). Management includes further investigation into and correction of possible stressors.14,33, Variable decelerations are recurrent when they occur with greater than 50% of contractions in any 20-minute period2,5 (Figure 57). Fetal Heart Tracing: All You'll Ever Need to Know - Flo The nurse's best response is, b. What should the nurse do before appropriate clinical interventions are initiated? Most patients who undergo internal fetal monitoring during labor accept monitoring as a positive experience.6. -Stress = uterine contractions A key causal event in the release of neurotransmitter molecules from vesicles into the synaptic cleft is the________. Category II tracings are defined as indeterminate, are common, and represent all tracings that do not fall into the Category I or III groups.2,5 They vary widely in level of concern for acidosis, so the family physician must determine the severity of the Category II tracing and take the appropriate action.2,5,7,35, There is a direct association between fetal acidosis, recurrent decelerations, and depth of decelerations2,5,34,36; however, 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.2,4,26,27,34,3638 For Category II tracings without spontaneous or provoked accelerations, minimal/absent variability, or deep decelerations (i.e., FHR drops to 70 bpm or less), immediate action is needed.3,4, A management algorithm30 (eFigure A) has been developed that is based on the suspected degree of fetal acidosis and ideally minimizes unnecessary interventions.7, A five-tiered classification/management scheme for management of Category II tracings has been developed (http://www.obapps.org).7,37,39 Each continuous electronic fetal monitoring tracing is color coded to represent the threat of acidosis based on the National Institute of Child Health and Human Development definitions, and Category II is broken into three separate severity and intervention subcategories based on the presence of accelerations and/or moderate variability.7,37 This classification has been shown to improve identification of fetal acidosis and newborns requiring immediate intervention after delivery.37, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation(Figure 1).2,7,16,21,27,3033 Lateral recumbent maternal positioning reduces compression of the maternal vena cava and aorta and the fetal umbilical cord.2,32,33 Intravenous fluid boluses up to 1 L have been shown to improve fetal oxygenation up to 30 minutes after administration.32,33 Maternal oxygen may be administered after other maneuvers, but it can be discontinued after tracing improvement because there is no evidence to support its routine use.2,32,33 Modification in maternal pushing efforts, such as initiating only with the urge to push and allowing for fetal recovery by pushing with every second or third contraction, can improve maternal and fetal oxygenation.40, Category III tracings, defined by a sinusoidal FHR pattern (Figure 37) or absent FHR variability (Figure 47) with recurrent late and/or variable decelerations or fetal bradycardia (see the Fetal Bradycardia section), require immediate intrauterine resuscitation and intervention.2,5,8,14,27,30,32,33,38,39 If the Category III tracing does not rapidly improve, expedited delivery is recommended. Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. 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. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. What characteristic of this fetal heart rate tracing is indicative of fetal well-being? Yes, and the strip is reactive. Fetal Heart Tracing Quiz 2 - 3/10/2017 - Course Hero Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns.11,12 Evaluation for immediate delivery is recommended for patients with ominous patterns. All Rights Reserved. Health care professionals play the game to hone and test their EFM knowledge and skills. -Daily Fetal Kick Counts What is the baseline of the FHT for Twin A (Black)? 100-170 bpm C. 110-160 bpm D. 120-140 bpm 2. Any written information on the tracing (e.g., emergent situations during labor) should coincide with these automated processes to minimize litigation risk.21, Table 5 lists intrauterine resuscitation interventions for abnormal EFM tracings.9 Management will depend on assessment of the risk of hypoxia and the ability to effect a rapid delivery, when necessary. 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 transducer uses Doppler ultrasound to detect fetal heart motion and is connected to an FHR monitor. 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. Internal is more accurate, measuring the beat to beat time since it has direct contact with the fetus. Strongly Predictive of normal acid-base status at the time of observation. It is important to review the pressure tracing before assessing the fetal tracing to accurately interpret decelerations. -Fetal breathing movements Fetal Tracing Quiz . External monitoring (unless noted differently), paper speed is 3cm/min. Determine whether accelerations or decelerations from the baseline occur. 1. b. Table 3 lists examples of nonreassuring and ominous patterns. -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 Copyright 1999 by the American Academy of Family Physicians. What is the peak current supplied by the emf Variability describes fluctuations in the baseline FHR, whether in terms of frequency, amplitude, or magnitude. 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. Are contractions present? The FHR baseline is 120-130 bpm. Although detection of fetal compromise is one benefit of fetal monitoring, there are also risks, including false-positive tests that may result in unnecessary surgical intervention. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. 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. Palpate for uterine contraction during period of FHR auscultation to determine relationship, 5. to access the EFM tracing game and to take full advantage of all the resources available. The incoming nurse is receiving a report regarding a laboring patient whose cervix is 7 cm dilated, who has a fetal spiral electrode in place, and who is receiving IV oxytocin for augmentation of labor. -Rate increase by 15 beats for 15 seconds (SELECT ALL THAT APPLY). Practice Quizzes 1-5. Normal. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. Copyright 2009 by the American Academy of Family Physicians. Non-reactive: The reporting nurse states that the FHR baseline is 150 bpm with moderate variability, no decelerations are present, and episodic accelerations are occurring. What should the incoming nurse do FIRST? Fetal Heart Tracing Quiz 8 - Utilis 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 Doppler: transmits small, high frequency sound waves that are reflected off of the fetal heart - measures heart rate -Normal fetal heart rate = 110-160 BPM Electronic Fetal Monitoring DR C BRAVADO incorporates maternal and fetal risk factors (DR = determine risk), contractions (C), the fetal monitor strip (BRA = baseline rate, V = variability, A = accelerations, and D = decelerations), and interpretation (O = overall assessment). A more recent article on intrapartum fetal monitoring is available. Questions and Answers 1. Decelerations (D). A systematic approach is recommended when reading FHR recordings to avoid misinterpretation (Table 2). The nurse is assessing the fetal monitor tracings of a patient in labor. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.15. A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. Author disclosure: No relevant financial affiliations. About. See permissionsforcopyrightquestions and/or permission requests. [7] The fetal heart rate tracing categorizes into I, II, or III depending upon the criteria as mentioned above. Fetal tachycardia is defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern (Figure 3). Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions. NCC EFM Tracing Game. Electronic fetal monitoring is performed in a hospital or doctors office. The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. 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. A concern with continuous EFM is the lack of standardization in the FHR tracing interpretation.5,811 Studies demonstrate poor inter-rater reliability of experts, even in controlled research settings.12,13 A National Institute of Child Health and Human Development (NICHD) research planning workshop was convened in 1997 to standardize definitions for interpretation of EFM tracing.14 These definitions were adopted by the American College of Obstetricians and Gynecologists (ACOG) in 2002,5 and revisions were made in a 2008 workshop sponsored by NICHD, ACOG, and the Society for Maternal-Fetal Medicine.11 The Advanced Life Support in Obstetrics (ALSO) curriculum developed the mnemonic DR C BRAVADO (Table 3) to teach a systematic, structured approach to continuous EFM interpretation that incorporates the NICHD definitions.9,11. "The test results are within normal limits.". -Accelerations my be present or absent. INTRODUCTION. 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). Perform a vaginal examination (check for cord prolapse, rapid descent of the head, or vaginal bleeding suggestive of placental abruption), 6. 2023 National Certification Corporation. 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). Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. Treat placental fetal perfusion through intrauterine resuscitation before proceeding to immediate delivery for all Category II or III tracings with concern for fetal acidosis. Heres how to tell if youre experiencing them. The incoming nurse enters the patient's room to complete an initial assessment and sees that the FHR has been 80 bpm for the last 3 minutes and that variability is minimal to absent. What action by the student indicates to the registered nurse that the student understands the procedure? What would be an appropriate next action by the nurse? What information about this assessment is most appropriate? 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. Interpretation of the FHR variability from an external tracing appears to be more reliable when a second-generation fetal monitor is used than when a first-generation monitor is used.3 Loss of variability may be uncomplicated and may be the result of fetal quiescence (rest-activity cycle or behavior state), in which case the variability usually increases spontaneously within 30 to 40 minutes.19 Uncomplicated loss of variability may also be caused by central nervous system depressants such as morphine, diazepam (Valium) and magnesium sulfate; parasympatholytic agents such as atropine and hydroxyzine (Atarax); and centrally acting adrenergic agents such as methyldopa (Aldomet), in clinical dosages.19. Assess maternal vital signs (temperature, blood pressure, pulse), 3. While admitting a patient who is at 40 weeks' gestation, the nurse observes an FHR of 165 bpm with recurrent decelerations. These segments help establish an estimated baseline (for a duration of 10 minutes) which is expressed in beats per minute. Health care professionals play the game to hone and test their EFM knowledge and skills. The patient is scheduled for an amniocentesis at 16 weeks gestation. Instruct the woman to drink 1 to 2 quarts of water. A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? The EFM toolkit also offers EFM CE opportunities and C-EFM(R) certification information. Intraobserver variability may play a major role in its interpretation. Fetal Tracing Index. Relevant ACOG Resources. -Related to fetal movement Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. efm.com/fhm/files/quiz2.php?QiD=DCABCC 1/2Correct. The health care provider has ordered an amnioinfusion. Try your hand at the following quizzes. Fetal Heart Tracing Quiz 10 - 3/10/2017 - Course Hero Professionals using Electronic Fetal Monitoring in their practice should also take advantage of: The EFM Resources page with linked papers and articles including the NCC monograph Fetal Assessment and Safe Labor Management authored by Kathleen Rice Simpson, PhD, RNC-OB, CNS-BC, FAAN. The NCC EFM Tracing Game is just one of the valuable tools in this digital EFM toolkit. It means your fetus is neurologically responsive and doesnt have an oxygen deficiency. . When you've finished these first five, here are five more. You scored 6 out of 6 correct. Results in this range must also be interpreted in light of the FHR pattern and the progress of labor, and generally should be repeated after 15 to 30 minutes. To assess 5 areas of fetal health: Usually done after 32 weeks, Assesses 5 areas of fetal well-being: 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. Decompression melting as the mantle rises, C. Melting of continental crust caused by an influx of mantle-derived magmas. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. 4 It is. -Reassuring for fetal well being The nurse observes smooth, gradual decelerations to 135 bpm occurring with more than 50% of the contractions. A way to assess your babys overall health, fetal heart tracing is performed before and during the process of labor. The FHR is controlled by the autonomic nervous system. -Neither period yields adequate accelerations The first-order bright fringe is at a position ybright=4.52mmy_{\text {bright }}=4.52 \mathrm{~mm}ybright=4.52mm measured from the center of the central maximum. Contractions (C). Compared with structured intermittent auscultation, continuous EFM showed no difference in overall neonatal death rate. For example, fetuses with intrauterine growth restriction are unusually susceptible to the effect of hypoxemia, which tends to progress rapidly.4, A growing body of evidence suggests that, when properly interpreted, FHR assessment may be equal or superior to measurement of fetal blood pH in the prediction of both good and bad fetal outcomes.13 Fetuses with a normal pH, i.e., greater than 7.25, respond with an acceleration of the fetal heart rate following fetal scalp stimulation. What is the peak voltage across the 3.0F3.0 \mu \mathrm{F}3.0F capacitor? They last for longer than 15 seconds. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. 1. The clinician and the patient with a low-risk pregnancy discuss the benefits of structured intermittent auscultation vs. continuous electronic fetal monitoring; patient agreement to structured intermittent auscultation is documented in medical record; labor team ensures appropriate nurse staffing (1:1), Labor nurse determines current fetal position and best location to place Doppler handheld probe (usually over the fetal back) with Leopold maneuvers; transabdominal ultrasonography (passive mode) can be used to identify the location of the fetal heart if manual palpation proves difficult, With one hand holding the probe in place, the other hand palpates the uterine fundus to detect maternal contractions, Following contractions, baseline fetal heart rate is assessed by counting the number of beats during a 30- to 60-second interval, For a minimum of 1 minute following contraction onset, fetal heart rate is reassessed at 6- to 10-second intervals to detect accelerations or decelerations in heart rate, American College of Obstetricians and Gynecologists, Association of Women's Health, Obstetric and Neonatal Nurses, At least hourly (< 4 cm cervical dilation), 15 to 30 minutes (4- to 5-cm cervical dilation), Any condition in which placental insufficiency is suspected, Maternal preeclampsia/gestational hypertension, Use of oxytocin (Pitocin) or other uterine stimulants for labor induction or augmentation.
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- fetal heart tracing quiz 10