AWHONN Fetal Heart Monitoring Basics: Questions and Answers 2024, Exams of Nursing

Download AWHONN Fetal Heart Monitoring Basics: Questions and Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 a) Frequency b) Duration - Correct Answers ✅Which contraction characteristics can be assessed with a tocodynamometer? a) Frequency b) Duration c) Intensity Uterus - Correct Answers ✅All Fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point? a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated - Correct Answers ✅The FHR can be monitored using doppler ultrasound? a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated b) Internally c) Only early in labor d) The FHR cannot be monitored by doppler ultrasound b) 110-160 bpm - Correct Answers ✅What is the normal range for FHR base line in a term infant? a) 80-120 bpm 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 b) 110-160 bpm c) 140-180bpm d) it depends on the sex of the fetus Mother's inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to bloodstream in uterus. Uterus to spiral arteries to placenta to intervillous space to travel via simple diffusion into the villi. The capillaries to the umb. vein to the fetus. The umb. artery sends waste (CO2) to the intervillous space to the mothers venous system. - Correct Answers ✅Trace the flow of oxygen from mother to fetus and back. 1. Mother (blood plasma, cardiac output, hemoglobin concentration & O2 saturation) 2. Placenta/intervillous space (uterine contractions & calcification's) 3. Fetus (vagal response aka decel or cord compression) - Correct Answers ✅What factors impact maternal oxygen delivery? 30-50% lateral recumbent or semi-Fowler's - Correct Answers ✅By what % does maternal cardiac output increase above the non-pregnant state and what position helps this uteroplacental blood flow? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 A decrease of blood flow and O2 delivery to fetus & increases CO2 level in fetus. Transient cord compression can be common in labor. Variable FHR decel's is frequently associated with cord compression. - Correct Answers ✅Define cord compression. May lead to hypoxemia and fetal acidemia. The depth of variable deceleration's is not enough to determine degree. Evaluate oxygenation through baseline heart rate characteristics through rate, variability and presence or absence of accelerations. - Correct Answers ✅Explain persistent or recurrent cord compression concerns and what to look at. A normal part of labor. As contractions build increased uterine pressure prevents blood from entering/leaving the intervillous space. During the peak the fetus relies completely on its oxygen reserve (an aerobic challenge that is not an issue for a health fetus. - Correct Answers ✅Explain transient interruptions in fetal oxygen supple during labor. Chronic deficiency of placenta function, usually from an interruption of oxygenation pathway due to abruption, mat. hypo or hypertension or other issues. Infant is not tolerant of contractions. Can result in fetal grow restrictions (FGR) - Correct Answers ✅Define Uteroplacental insufficiency (UPI) 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Assess baseline FHR Determine rhythms (regular vs irregular) ID accelerations and deceleration's but not the type of deceleration (early/late/variable) The fetal heartbeat is best heard over the fetal back. - Correct Answers ✅Auscultation of Fetal Heart Sounds tell you what information? Where is the best place to listen? Palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds. Head=hard, round, movable object Buttocks=soft and irregular shape Back=smooth, hard surface felt on one side of the abdomen Irregular knobs and lumps on opposite side of abdomen may be hands, feet, elbows, and knees - Correct Answers ✅Leopold's Maneuvers Uses sonar to track the fetal myocardium & converts movement into sound. If placed incorrectly may pick up maternal heart. Perform Leopold's maneuvers to find fetal back, locate heartbeat, count FHR, check mothers pulse and compare. - Correct Answers ✅Handheld Fetal Doppler 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 ID risk factors such as HTN (=vasoconstriction), Maternal smoking, abruption, post-term pregnancy, maternal diabetes and consider FHR characteristics - Correct Answers ✅How can you determine if the placenta is functioning optimally? 500-700ml to the uterus per minute, 80% is directed to the placenta - Correct Answers ✅How much blood normally flows to the placenta? This depends on oxygenation which is reflected in FHR variability and accelerations on the fetal monitor tracings. - Correct Answers ✅How many uterine contractions can be tolerated? Umb. cord -Proplapse Mat. inhalation -Asthma Placenta -Calcification Uterus -Tachysystole Fetus -Rh isoimmunization (fetal anemia) Mat. circulation -Hypertension - Correct Answers ✅What conditions impact the following pathways: Umbilical cord Maternal inhalation Placenta Uterus 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 70-80 in the second stage of labor. - Correct Answers ✅What is contraction intensity and what are the averages via IUPC during early 1st stage, late 1st stage, and the 2nd stage of labor? MVU's quantify uterine activity over 10 min period, requires the use of an IUPC. Minus the resting tone from the peak intensity of each contraction in a 10 min period and add the values together. At least 200 MVU's results in progressive cervical change. - Correct Answers ✅What is a Montevideo unit (MVU)? How do you calculate MVU's? Using your fingertips at the fundus you can assess duration and frequency. Intensity: nose= mild chin=moderate forehead=strong - Correct Answers ✅How do you palpate a contraction? Describe the intensities. Monitors changes in the contour of the maternal abdomen caused by uterine contractions, is placed over the fundus. Can measure relative changes in pressure, duration and frequency of contractions. Can NOT 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 measure intensity. Women with large amounts of abdominal adipose tissue can be difficult to monitor. - Correct Answers ✅Explain what a Tocodynamometer is, what it measures and its limitations. Most accurate method of assessing uterine contractions. Inserted through dilated cervix, its sensor tip monitors changes in pressure of the amniotic fluid. Measures resting tone, duration, frequency and intensity of contractions. Can NOT be used unless membranes are ruptured. - Correct Answers ✅Explain what an intrauterine pressure catheter is, what it measures and its limitations. Fetal heart rate patterns 5 characteristics 1 Baseline heart rate 2 Rhythm 3 FHR variability 4 Presence of accelerations 5 Periodic or episodic deceleration's - Correct Answers ✅How do you determine fetal oxygenation? Name the 5 characteristics Must be 2 min of segments. Range 110-160 BPM (represented in a multiple of 5) 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 <32 weeks is usually high normal >32 weeks gradual decrease due to increased vagal tone. Change in baseline is >10min. - Correct Answers ✅What are fetal baseline guidelines? Range? <32 weeks gest >32 weeks gest change in baseline It is the heart's internal pacemaker. It is specialized clump of cells at the top of the right atrium that gives electrical impulses to cause the heart to beat. The intrinsic rate is 110-160 in term fetus. Early in gestation (15-20 wks) can be much higher. In 26-28 weeks may be in the upper range of normal. - Correct Answers ✅What is the SA Node? Generated in the fetal brainstem carried via sympathetic fibers to the heart. Increases FHR, strength of myocardial contraction of the heart and fetal cardiac output. Sympathetic stimulation influences FHR variability. The sympathetic branch of the autonomic nervous system is present very early in fetal development. - Correct Answers ✅Explain the sympathetic impulses of the fetal central nervous system. Generated in the fetal brainstem carried via the vagus nerve to the fetal heart. Stimulates vagus nerve which increases fetal blood pressure, 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 undetectable amplitude range can be indicative of impending fetal hypoxia - Correct Answers ✅Explain absent FHR variability. amplitude >undetectable (visually detectable but less than or equal to 5 BPM) can be indicative of impending fetal hypoxia - Correct Answers ✅Explain minimal variability. amplitude range 6-25 BPM - Correct Answers ✅Explain moderate variability. amplitude range >25 BPM - Correct Answers ✅Explain marked variability. A compromised fetus. possible causes are severe fetal anemia from RH isoimmunization, massive feto-maternal hemorrhage, ruptured vasa previa, twin to twin transfusion, fetal intracranial hemorrhage. - Correct Answers ✅What does it mean to have an undulating FHR pattern? What are the causes of undulating patterns in FHR? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Defined as having a smooth, sine wave-like undulating pattern in the FHR baseline with a cycle frequency of 3-5/min. that persists for at least 20 minutes. It DOES NOT represent variability. You usually see amplitudes of 5-15 BPM. You will not see any accelerations with the sinusoidal pattern. Decelerations with a sinusoidal pattern are an even more ominous sign. - Correct Answers ✅Explain sinusoidal pattern FHR. Absent-fluctuations in the FHR are not detectable. - Correct Answers ✅What is the variability? Minimal- Small fluctuations in the FHR, detectable but not more than 5 BPM - Correct Answers ✅What is the variability? Moderate-note the span of the fluctuations in the baseline FHR. They are 10-20 BPM in height. The range of moderate variability is 6-20 BPM - Correct Answers ✅What is the variability? Marked- note the wide span of the fluctuations in the baseline FHR. In this case the fluctuations are >25BPM. - Correct Answers ✅What is the variability? Can be a sign of inadequate oxygenation, may indicate a fetal central nervous system or cardiovascular anomaly, or may indicate a pre- existing fetal brain injury. May also result from maternal medications 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 such as mag sulfate or narcotics. - Correct Answers ✅What does the absence of variability suggest? An increase in variability from moderate to marked may indicate early stages of fetal hypoxemia or can be normal. Therefore baseline is a key assessment. - Correct Answers ✅What does marked variability suggest? Moderate variability shows intact neurological modulation of the FHR, normal cardiac responsiveness, and fetal reserve. This predicts the absence of fetal metabolic acidemia at the time it is seen and indicates the fetus is well oxygenated. - Correct Answers ✅What does moderate variability suggest? Abnormal fetal acid-base status and possible hypoxemia or impending acidemia. This pattern requires prompt evaluation and intervention. - Correct Answers ✅What does persistent absent variability of the FHR in combination with recurrent late or variable decelerations or bradycardia suggest? Visually apparent abrupt increases from the onset of the acceleration to peak in <30 seconds in the FHR above baseline. They may be periodic (assoc. w/contractions) or episodic (not assoc. w/contractions) The peak must be >15 BPM and must last >15 seconds from onset to return to baseline. Before 32 wks gest. an acceleration is defined as >10 BPM 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 May be periodic or episodic, the most common pattern seen during labor. Their shape and depth are variable, not like early or late's, rarely smooth and regular. A visually apparent abrupt decrease in FHR from onset of decel to nadir of <30 seconds. The decrease is >15 BPM lasting >15 seconds and < 2 minutes in duration. Usually assoc. with cord compression, fetal baroreceptors increase the FHR to maintain cardiac output. - Correct Answers ✅What are variable decelerations? A decrease in FHR of > 15 BPM lasting > 2 min but < 10min from onset to return to baseline. Any decel longer than >10 min is a baseline change. Prolonged decels are due to a sudden significant change in the fetal environment rather than a repetitive stimulus. Immediate communication/ intervention is necessary. - Correct Answers ✅Define prolonged deceleration of the FHR. true - Correct Answers ✅True or False A preterm fetus my be more susceptible to hypoxemia true - Correct Answers ✅True or False 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 The nervous system is not fully developed in fetuses prior to 32 wks gest. 1. Higher baseline FHR i.e. a 23 wk gest may have a baseline of 155 BPM but at term, the same baby may have a baseline of 130 BPM. Any baseline above 160 BPM is still considered tachycardia. 2. Decreased variability bc the central nervous system is not fully developed, variability may be decreased. 3. lower amplitude accels in preterm (before 32 wks) accels of at least 10 BPM above baseline for at least 10 sec is acceptable. 4. more frequent occurrences of variable decels - Correct Answers ✅What are the different characteristics of a fetus prior to 32 wks gest. than a term fetus? When information can not be obtained by palpation or use of toco and if there are no contraindications to its use. i.e. increasing oxytocin w/ elevated BMI if contractions are not being detected using toco. - Correct Answers ✅When should an IUPC (intrauterine pressure catheter) be placed? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 The primary obstetric provider. - Correct Answers ✅Who may insert an IUPC? Ultrasound monitors externally FHR. Fetal Spiral Electrode (FSE) monitors internally FHR. Tocodynamometer (TOCO) monitors externally contractions. Intrauterine pressure catheter (IUPC) monitors internally contractions. - Correct Answers ✅Name several techniques/devices of fetal monitoring. External- Doppler ultrasound transducer (converts movement into sound to tracing on paper) Tocodynamometer (TOCO) monitors externally contractions. Internal- Fetal Spiral Electrode (FSE) monitors internally FHR. Intrauterine pressure catheter (IUPC) monitors internally contractions. - Correct Answers ✅Identify the 4 types of electronic instrumentation used to assess FHR and uterine activity. If the reflecting surface is moving the reflected signal has a frequency change known as a doppler shift. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 FSE is only direct method for monitoring the FHR & is less affected by outside interference. The tip if FSE is fine surgical grade wire in shape of corkscrew attached to the fetal presenting part. The electrode detects fetal heart electrical activity, sending and ECG signal to the monitor & produces PQRST waves. BPM are converted btwn R to R intervals. - Correct Answers ✅Explain how the FSE monitors FHR. The electrode is sterilely inserted through the dilated 2-3 cm cervix to the presenting part. Gently turning the electrode clockwise 1.5 turns allows the spiral tip to penetrate the top layer of skin (scalp or buttock) avoiding fontanels, suture lines, face or genitals enabling production of the the ECG. Once secure remove the introducer & attach the wires to the leg plate & secure to mothers thigh or abd near symphysis. To remove turn counter clockwise, do not pull as it can cause injury. Wires are non sterile so remove prior to C/S. - Correct Answers ✅Describe the procedures for application and removal of the FSE Advantage- FSE is only direct means of assessing the FHR. Limitations- *Most will not record R-R intervals (FHR) greater than 240 BPM *Maternal pacemaker may interfere. *Requires ROM and dilated cervix. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 *May measure maternal heart rate in case of fetal demise. *small possibility of electronic interference and artifact although less than with external ultrasound. - Correct Answers ✅List advantages and limitations of the FSE. Contraindications- Maternal infections like HIV, Hepatitis or GBS +, complete placenta previa, undiagnosed vaginal bleeding, do not place FSE on face, fontanels or genitalia. - Correct Answers ✅Discuss contraindications for use of the FSE. 1. Presentation (at the inlet of the pelvis)-palpate fundus if head is at fundus. 2. Position/lie (relationship of the presenting part to the pelvis anterior, posterior or transverse) and (long axis, fetal spine long smooth hard plane longitudinal, transverse or oblique.) 3. Descent (floating or engaged) grasp abd. above symphysis pubis note contour, size, consistency of presenting part. Head is firm, globular, mobile if unengaged and immoble if engaged. Breech is smaller, softer and irregular. 4. Prominence of the head over the pelvic brim. Press in direction of the pelvic inlet for cephalic prominence. If prominence is on opposite of fetal back is likely the forehead and is in vertex or well tucked position. - Correct Answers ✅Describe the the 4 maneuvers of Leopold's maneuvers. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Auscultate to confirm FHR. Turn off artifact elimination switch per manufacturers instructions. Check ECG cable and leg plate using self test per manufacturer. Check placement may be dislodged or attached to cervix instead of fetus. If none of the above works than apply new FSE or monitor by other means (US or auscultation) - Correct Answers ✅Explain how to trouble shoot an FSE that shows intermittent makings on the tracing rather than a continuous line. Maternal pulse detected Intermittent markings There is no problem Turn off logic switch, check circuitry by a self test, check electrode placement, confirm FHR by auscultation - Correct Answers ✅What the possible cause for the problem with this tracing? Maternal pulse detected There is no problem The FHR is abnormally low. Confirm maternal pulse by palpation and replace FSE. OR 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 g. Obscured or low baseline setting h. Inverted waveform r/t placement of toco - Correct Answers ✅Identify the uterine contraction variation: a. Uterine contraction wave form normal b. Maternal respiration c. Valsalva maneuver or pushing d. Maternal activity such as vomiting or seizure e. Fetal movement/activity f. Maternal position change or sudden baseline shift g. Obscured or low baseline setting h. Inverted waveform r/t placement of toco - Correct Answers ✅Identify the uterine contraction variation: a. Uterine contraction wave form normal b. Maternal respiration c. Valsalva maneuver or pushing d. Maternal activity such as vomiting or seizure e. Fetal movement/activity f. Maternal position change or sudden baseline shift g. Obscured or low baseline setting 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 h. Inverted waveform r/t placement of toco - Correct Answers ✅Identify the uterine contraction variation: a. Uterine contraction wave form normal b. Maternal respiration c. Valsalva maneuver or pushing d. Maternal activity such as vomiting or seizure e. Fetal movement/activity f. Maternal position change or sudden baseline shift g. Obscured or low baseline setting h. Inverted waveform r/t placement of toco - Correct Answers ✅Identify the uterine contraction variation: a. Uterine contraction wave form normal b. Maternal respiration c. Valsalva maneuver or pushing d. Maternal activity such as vomiting or seizure e. Fetal movement/activity f. Maternal position change or sudden baseline shift g. Obscured or low baseline setting h. Inverted waveform r/t placement of toco - Correct Answers ✅Identify the uterine contraction variation: 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 a. Uterine contraction wave form normal b. Maternal respiration c. Valsalva maneuver or pushing d. Maternal activity such as vomiting or seizure e. Fetal movement/activity f. Maternal position change or sudden baseline shift g. Obscured or low baseline setting h. Inverted waveform related to placement of toco - Correct Answers ✅Identify the uterine contraction variation: Advantages- it is external so it is non invasive and ROM is not necessary Limitations- it is location sensitive so improper placement or movement can cause uninterpretable tracing. It is not a means of assessing true resting tone or intensity so must use in conjunction with direct palpation. Toco only gives an approximate measure of duration and frequency. Reading can vary greatly based on mat. weight, mat. position, and position of belt. - Correct Answers ✅What are the advantages and limitation of Toco? top center is where you should receive the most accurate reading of uterine contractions as term. - Correct Answers ✅Select the best location for placement of Toco for a term pregnancy. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 *verify position (can be displaced or perforated uterus or uterine rupture) have pt cough/valsalva if place correctly tracing will spike with cough simultaneously palpate abd to verify presence/absence of contractions *a tracing with no visible resting tone may be improperly zeroed. *abnorm wave form can be due to IUPC lodging against uterine wall or body part *Notify MD if none of above helps and use another method to monitor such as toco or palpation - Correct Answers ✅Discuss troubleshooting of the IUPC *IUPC is assoc w/ increased risk of uterine, placental and cord perforation. *is an invasive method *limits maternal ambulation *catheter tips may be wedged against wall or body part preventing accurate data *higher pressure readings may occur *maternal position may affect the pressure readings - Correct Answers ✅Discuss the limitations of the IUPC Document what you see on the tracing. If baseline starts at 120 BPM and increases to 130BPM for 10 min or more this is a baseline change. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 If the FHR continues to show characteristics of a Category I tracing cont. routine assessment and doc. of variability, accels, uterine activity and other changes you observe. - Correct Answers ✅What should I do if the fetal heart rate baseline changes? ACOG says if no risk factors on admission Q30min in 1st stage then Q15min in 2nd stage active pushing of labor If on oxytocin or risk factors then Q15 in 1st stage then Q5 in 2nd stage active pushing of labor - Correct Answers ✅How often should I assess the FHR when using electronic monitoring? latent phase <4cm latent phase 4-5cm active phase >6cm second stage passive fetal descent second stage active pushing - Correct Answers ✅List the phases of (latent/active/2nd) labor and their associated descriptions. It is likely the tracing is showing the maternal heart rate not the FHR. Readjust the monitor, searching for fetal heart tones, using leopold's maneuvers also assess for for signs of fetal oxygenation with fetal movements. Oxygenation can not be assumed or confirmed without assessing the FHR. - Correct Answers ✅What should I do if the mothers palpated pulse matches what I hear coming from the monitor? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 When the US is not recording a consistent tracing. Cervix should be 1-2 cm dilated and there should be no contraindications to the procedure per the maternal history and labor status. - Correct Answers ✅When should the fetal spiral electrode (FSE) be applied? D. Intrauterine pressure catheter - Correct Answers ✅This instrument: -Is used to internally monitor contractions. -Provides absolute, rather than relative, measurements. -Carries with it a slightly increased chance of uterine infection. A. Doppler Ultrasound B. Fetal Spiral electrode C. Tocodynamometer D. Intrauterine pressure catheter A. Doppler Ultrasound - Correct Answers ✅This instrument: -Is used to externally monitor the fetal heart rate. -Is noninvasive and can be placed without rupture of membranes. -May be affected by maternal or fetal motion. A. Doppler Ultrasound B. Fetal Spiral electrode 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Intermittent if they occur in < 50% of contractions in any 20 min segment. - Correct Answers ✅What are the parameters for decelerations to be recurrent versus intermittent? Early Late Variable - Correct Answers ✅What are the 3 classifications of periodic decelerations? Late decels with normal FHR baseline, moderate variability and/or accelerations can be managed conservatively versus late decels with minimal or absent variability. Interventions are toward maximizing uteroplacental blood flow thereby improving oxygen delivery to the fetus. Turn mom on her side, increase IV fluids, decrease or d/c oxytocin, notify MD. Document assessment, interpretation, interventions and evaluate effects of actions. - Correct Answers ✅What does the presence of late decelerations tell us about the oxygen status of the fetus? Interventions may include administering a tocolytic to decrease uterine activity if tachysystole or elevated resting tone are present. Admin. Oxygen at 10 L/min by non rebreather and notify MD - Correct Answers ✅What actions would you take for late decels that are recurrent and occur with minimal or absent FHR variability? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Variable Decelerations, which are a visually abrupt decrease in the fetal heart rate (<30 seconds from onset to beginning of the nadir). The decrease is >15 BPM lasting >15 seconds and < 2 min in duration - Correct Answers ✅What is the most common decel pattern seen in labor? Prior to a contraction the umbilical arteries and vein are wide open; fetal BP is stable. With the beginning of the contraction of the vein, then the arteries are compressed & the fetal body detects decreased blood flow from the fetal heart. In response, the fetal baroreceptor increases the FHR to maintain cardiac output. As it continues to strengthen arteries are compressed increasing fetal BP. The vagus nerve slows down FHR. As the contraction eases the umbilical arteries are released and FHR returns to baseline, fetal HTN is resolved and carbon dioxide can be cleared from the fetal body. Lastly the umb. the vein is released, blood press stabilizes and oxygenation normalizes. - Correct Answers ✅What causes a variable deceleration? Change the mother's position to her side, sitting up, on hands and knees, or a combination of position to maximize umbilical circulation. - Correct Answers ✅How do you alleviate umbilical cord compression? vaginal exam - Correct Answers ✅How do you rule out cord prolapse? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 relieve cord compression, maximize umb. circulation and rule out cord prolapse and amnioinfusion. Admin oxygen by non-rebreather facemask, reduce or stop oxytocin to decrease uterine activity if needed. Inform the physician if recurrent variable decels with absent FHR baseline variability as a quick delivery may be necessary. - Correct Answers ✅What do you do if variable decelerations are associated with absent FHR variability or abnormal baseline rate and the absence of accelerations? Overshoots are exaggerated compensatory increases in FHR after a variable deceleration. Overshoots are usually at least 10-20 BPM above baseline range and at least 20 seconds in duration. Overshoots are usually accompanied by minimal or absent variability and a gradual return to baseline FHR. They resemble accelerations however unlike accels their significance to fetal acid-base status is unclear. - Correct Answers ✅What is an overshoot? Its an isolated event sometimes in conjunction with a procedure. May occur in response to transient cord compression, uterine tachysystole or excessive uterine activity, administration of anesthetics, maternal position change, or vaginal exam. By definition, they do not occur uniformly or repetitively. Ask 3 questions: 1. is there an obvious event that caused the decel? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Accelerations: present or absent Late or variable decelerations: absent Early decelerations: present or absent - Correct Answers ✅Define a category I (normal) fetal heart rate tracing. A method of assessing fetal acid-base status through vigorously rubbing the fetal head with a gloved hand to elicit an acceleration. This is dune when FHR is at baseline. Do not do during a deceleration to attempt to increase the FHR. A well-oxygenated fetus will respond with an acceleration of 15 BPM or more for > 15 seconds. This is a reliable prediction of the absence of fetal metabolic acidemia at that time. This does not predict fetal acidemia or fetal compromise. Stimulation is not needed if the tracing has category I characteristics. - Correct Answers ✅What is Scalp Stimulation? The response of the FHR to a vibroacoustic stimulus. An acceleration on NST (> 15 bpm for > 15 sec) is a positive result. An acceleration in response is an indicator of fetal oxygenation. Useful adjunct to decrease the time to achieve a "reactive" NST (R-NST) and to decrease the proportion of non-reactive NST at term, precluding the need for further testing. - Correct Answers ✅What is vibroacoustic stimulation? 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Category II (indeterminate) FHR tracings are indeterminate & not predictive of abnormal fetal acid-base status at that time. They do not reliably correlate with positive outcomes and require an evaluation and continued surveillance and reevaluation with review and consideration of all clinical factors. Interventions should be initiated appropriate to the situation, physician notified, and documentation. Baseline FHR rate: Bradycardia not accompanied by absent variability or tachycardia Baseline FHR variability: Minimal baseline variability, absent baseline variability not accompanied by recurrent decelerations, marked baseline variability Accelerations: the absence of induced accelerations after fetal stimulation Periodic or episodic decelerations: -recurrent variable decelerations accompanied by minimal or moderate baseline variability -Prolonged deceleration > 2 min but < 10 min -Recurrent late decelerations wi - Correct Answers ✅Define a category II (indeterminate) fetal heart rate tracing. Category III (abnormal) FHR tracings are predictive of abnormal fetal- acid base status at that time & may be indicative of current or impending fetal asphyxia so sever that the fetus is at risk for injury & include: 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Absent FHR baseline variability with recurrent late decels, with recurrent variable decels, with bradycardia or sinusoidal patterns. They require prompt evaluation and resolution. Interventions include oxygen via non-rebreather mask, changing position, d/c of oxytocin and treatment of maternal hypotension. - Correct Answers ✅Define a category III (abnormal) fetal heart rate tracings. Category II it shows tachycardia and minimum variability. - Correct Answers ✅Classify the tracing as I, II or III and explain. Category II shows recurrent variable decelerations and a prolonged deceleration. Although recurrent variable decelerations appear, moderate baseline variability is still present. Note the presence of a prolonged deceleration may indicate a decline in fetal acid-base status so it may be trending towards a category III. - Correct Answers ✅Explain and classify the tracing as I, II or III. Category III Shows tachycardia, recurrent late decelerations and absent variability. - Correct Answers ✅Classify and explain this tracings as I, II or III. 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 the jaggedness of this tracing indicates variability is present, and the amplitude of variability is between 6 and 25 BPM. - Correct Answers ✅The variability in this tracing is: Absent Minimal Moderate Marked A baseline with in normal range. The range is 110-160 BPM - Correct Answers ✅The tracing shows: Tachycardia A baseline within normal range Bradycardia Category I as it has accelerations, moderate FHR variability, normal FHR baseline and no interventions are needed at this time. - Correct Answers ✅The tracing is classified as: Category I Category II 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Category III Likely the cause of late decels is tachysystole. Tachysystole interrupts blood flow which can result in fetal hypoxemia. The lack of oxygen availability has led to slowing of the FHR. Contractions are so close in timing that Fetal heart is unable to recover as normally would. 3 Goals to achieve through assessment and interventions: reduce uterine activity max uterine blood flow max oxygenation SO: notify MD, DC oxytocin, change position, admin IV fluid bolus, admin oxygen by non-rebreather mask 10L/min - Correct Answers ✅Case study #1 First pregnancy. Contractions every 7 min lasting 40 seconds, moderate by palpation, pain rated 4/10. Vaginal exam shows 4cm dilated, 100% effaced and -1 station. However no change in the last 3 hours. Oxytocin was ordered to augment, an FSE & IUPC was placed. 2hrs after oxytocin started this is the tracing. Contractions q 1.5 min, lasting 60-70 seconds, 55-60 mmHg. Resting tone btwn contractions is 25 mmHg. Baseline FHR 155 BPM w minimal variability. A pattern of late decelerations is emerging. You should be able to see relationship btwn uterine activity pattern & FHR tracing characteristics. 140 BPM 1 AWHONN Fetal Heart monitoring basics Question & Answers 2024 Minimal variability Late decelerations Normal uterine activity Present accelerations - Correct Answers ✅Identify the tracing characteristics: FHR Baseline FHR variability FHR Decelerations Uterine Activity FHR Accelerations 140 BPM Moderate variability No decelerations Normal uterine activity Present accelerations - Correct Answers ✅Identify this tracing's characteristics: FHR Baseline FHR variability