Are there decelerations present? Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. 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. Copyright 2023 American Academy of Family Physicians. Continuous electronic fetal monitoring (EFM), using external or internal transducers, became a part of routine maternity care during the 1970s; by 2002, about 85 percent of live births (3.4 million out of 4 million) were monitored by it.1 Continuous EFM has led to an increase in cesarean delivery and instrumental vaginal births; however, the incidences of neonatal mortality and cerebral palsy have not fallen, and a decrease in neonatal seizures is the only demonstrable benefit.2 The potential benefits and risks of continuous EFM and structured intermittent auscultation should be discussed during prenatal care and labor, and a decision reached by the pregnant woman and her physician, with the understanding that if intrapartum clinical situations warrant, continuous EFM may be recommended.3, There are several considerations when choosing a method of intrapartum fetal monitoring. Collections are larger groups of tracings, 5 tracings are randomly. The baseline FHR is 135 bpm with moderate variability. Other rare risks associated with EFM include fetal scalp infection and uterine perforation with the intra-uterine tocometer or catheter. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. For more information on the use, interpretation and management of patients based on Fetal Heart Tracings check out the resources below. 9. 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. It involves using an electronic fetal monitor that records the fetal heart rate and the frequency and duration of uterine contractions. Describe the variability. Palpate for uterine contraction during period of FHR auscultation to determine relationship, 5. Contractions (C). A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. The FHR tracing should be interpreted only in the context of the clinical scenario, and any therapeutic intervention should consider the maternal condition as well as that of the fetus. -No late or variable decelerations. a streams response to precipitation. A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. d) volcanic neck The effect of continuous EFM monitoring on malpractice liability has not been well established. Persistent tachycardia greater than 180 bpm, especially when it occurs in conjunction with maternal fever, suggests chorioamnionitis. This is followed by occlusion of the umbilical artery, which results in the sharp downslope. 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. A woman has just received pain medication in labor. 3/10/2017 Fetal Heart Tracing Quiz 1 Correct. Prolonged. This content is owned by the AAFP. Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. 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. Place the Doppler over the area of maximal intensity of fetal heart tones, 3. 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. -2+Fetal Heart Rate increases in 20 minutes b. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. Most patients who undergo internal fetal monitoring during labor accept monitoring as a positive experience.6. 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. Which of the following information should be included? Patient Safety, Risk Management, and Documentation 11. Which nursing intervention is necessary before a second trimester transabdominal ultrasound? Fetal heart tracing is also useful for eliminating unnecessary treatments. A more recent article on intrapartum fetal monitoring is available. PDF Awhonn Fetal Monitoring Test Questions And Answers Pdf Copy A normal fetal heart tracing would reassure both you and your obstetrician that it's safe to proceed with labor and delivery. Category III tracings are highly concerning for fetal acidosis, and delivery should be expedited if immediate interventions do not improve the tracing. The nurse's first action should be which of the following? Try your hand at the following quizzes. Powered by. 740-591-8118. What should the nurse do before appropriate clinical interventions are initiated? Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. The Value of EFM Certification (One Team One Language), showcases the national PSA campaign Your Baby Communicates along with peer-to-peer video discussions on the value of EFM Board Certification. Fetal Assessment Flashcards | Quizlet This content is owned by the AAFP. Incorrect. 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. a) lapilli d. Places the tocotransducer over the uterine fundus, An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed. https://www.ncbi.nlm.nih.gov/pubmed/19546798 FHR Quiz Flashcards | Quizlet Statistical analysis included univariate analyses with Student T-test, one-way ANOVA, chi-square and Fisher exact test. What is the most appropriate nursing response? HESI - OB, Fetal Heart Rate: Interpretation 5.0 (1 review) A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. to access the EFM tracing game and to take full advantage of all the resources available. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Air Force, Uniformed Services University of the Health Sciences, Department of Defense, or the U.S. government. The nurse understands that that if the woman has hypotension the fetal monitor tracing would indicate which of the following? Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG Differentiate maternal pulse from fetal pulse, 4. 140 145 Correct . Yes. Assess fetal pH (fetal scalp stimulation, scalp pH, or acoustic stimulation), 8. See permissionsforcopyrightquestions and/or permission requests. Which of the following heart rate patterns would the nurse interpret as normal during the transitional phase of stage one? 150 155 160 Electronic Fetal Heart Monitoring Trivia Quiz Questions! Which of the following steps are included in this intervention? The National Institute of Child Health and Human Development terminology is used when reviewing continuous electronic fetal monitoring and delineates fetal risk by three categories. Am J Obstet . B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern. Variable and inconsistent interpretation of tracings by clinicians may affect management of patients. 7. Fetal Heart Tracing Quiz 10 - 3/10/2017 - Course Hero 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. Fetal hypoxemia results in biphasic changes in the ST segment of the fetal electrocardiography (FECG) waveform and an increase in the T:QRS ratio.15 The ST-segment automated analysis (STAN) software from Noventa Medical can record the frequency of ST events and, combined with changes in continuous EFM, can be used to determine if intervention during the labor process is indicated.15 Several studies have evaluated FECG analysis, documenting its effectiveness at reducing operative vaginal deliveries, fetal scalp sampling, neonatal encephalopathy, and fetal acidosis (pH < 7.05).2528 One drawback to this technology is that it requires rupture of the membranes and internal fetal scalp monitoring. 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.
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