Suppose the 4040 \Omega40 resistance in the distribution circuit is replaced by a 2020 \Omega20 resistance. While caring for a patient who is gravida 2 para 1 being induced for oligohydramnios, the nurse notices a pattern of recurrent abrupt decelerations down to 70 bpm with contractions lasting for 1 minute. The number of migratory animals (in hundreds) counted at a certain checkpoint is given by. A normal baseline rate ranges from 110 to 160 bpm. Correlate accelerations and decelerations with uterine contractions and identify the pattern. Management depends on the clinical picture and presence of other FHR characteristics.18, Overall Assessment (O). After discussion regarding the FHR tracing, the resident and attending practitioner on duty determine that the FHR tracing is a Category II. -How? On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. 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. a) lapilli Everything You Need to Know, 2023 Flo Health Inc., Flo Health UK Limited. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. 5 contractions in 10 minutes averaged over thirty minutes Count FHR between contractions for 60 seconds to determine average baseline rate, 6. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals ( Table 1). What would be an appropriate next action by the nurse? With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. Author disclosure: No relevant financial affiliations. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. Your doctor uses special types of equipment to conduct electronic fetal monitoring. Another area of interest is the use of computer analysis for key components of the fetal tracing,29 or decision analysis for the interpretation of the EFM tracing.30 These have not been demonstrated to improve clinical outcomes.29,30 Fetal pulse oximetry was developed to continuously monitor fetal oxygenation during labor by using an internal monitor, requiring rupture of membranes.31 Trials have not demonstrated a reduction in cesarean delivery rates or interventions with the use of fetal pulse oximetry.31. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions. If you want to see how you are doing overall, try the comprehensive assessment: -Contraction Stress Test (CST), How? All Rights Reserved. Try your hand at the following quizzes. 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. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.020 https://www.acog.org/~/media/For%20Patients/faq015.pdf, Current version ( May 2, 2022. The NCC EFM Tracing Game is just one of the valuable tools in this digital EFM toolkit. JAMES J. ARNOLD, DO, AND BREANNA L. GAWRYS, DO. Fetal Heart Tracing: All You'll Ever Need to Know - Flo Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG 9. 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. The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? Early decelerations (mirror contraction, with nadir at peak of contraction, likely fetal head compression) and accelerations (FHR increase of 15 bpm or more over at least 15 seconds) may be present.2,5,7,34 No intervention is required for Category I tracings. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. 1. None. 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 NICHD has stated that it is no longer useful to distinguish between short-term and long-term variability and has categorized variability into the following classifications, depending on the amplitude of the FHR tracing: absent (Online Figure C), minimal (Online Figure D), moderate (Online Figure E), and marked (Online Figure F).11, Sleep cycles of 20 to 40 minutes or longer may cause a normal decrease in FHR variability, as can certain medications, including analgesics, anesthetics, barbiturates, and magnesium sulfate.15 Loss of variability, accompanied by late or variable decelerations, increases the possibility of fetal acidosis if uncorrected.15, Sinusoidal pattern is a smooth, undulating sine wave pattern defined by an amplitude of 10 bpm with three to five cycles per minute, lasting at least 20 minutes.11 This uncommon pattern is associated with severe fetal anemia and hydrops, and it usually requires rapid intervention in these settings.15 Similar appearing benign tracings occasionally occur because of fetal thumb sucking or maternal narcotic administration, and generally these will persist for less than 10 minutes.15. Electronic fetal monitoring is performed in a hospital or doctors office. 4 It is. 2. Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. 1. It may also be performed using an external transducer, which is placed on the maternal abdomen and held in place by an elastic belt or girdle. The fetal membranes must be ruptured, and the cervix must be at least partially dilated before the electrode may be placed on the fetal scalp. Questions and Answers 1. What is the peak voltage across the 3.0F3.0 \mu \mathrm{F}3.0F capacitor? Prolonged decelerations (15 beats per minute drop below baseline for more than 2 and less than 10 minutes) Minimal variability. 100-170 bpm C. 110-160 bpm D. 120-140 bpm 2. Beat-to-beat or short-term variability is the oscillation of the FHR around the baseline in amplitude of 5 to 10 bpm. They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. 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). For the letters on this figure, choose the likely cause of melting for Site B. 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. Copyright 2023 American Academy of Family Physicians. ), What do Braxton Hicks contractions feel like? 3. The FHR baseline is 130 bpm with moderate variability. 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. (SELECT ALL THAT APPLY), Baseline rate of 110-160 bpm Moderate variability. 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. Is perinatal asphyxia predictable? - PMC - National Center for Yes, and the strip is reactive. 140 145 150 155 160 FHT Quiz 1 Fetal Tracing Quiz Perfect! 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). 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). The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. VEAL CHOP Nursing Mnemonic: Complete Guide - Nurseslabs Fetal scalp sampling for pH is recommended if there is no acceleration with scalp stimulation.11. Intrapartum Fetal Monitoring | AAFP Structured intermittent auscultation detects changes in FHR during contractions but not overall FHR variability (moment-by-moment fluctuations in FHR)4,5; therefore, continuous electronic fetal monitoring remains the more appropriate option in high-risk labor (Table 214,16,17). Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. The practitioner has ordered continuous electronic monitoring, but the patient requests IA for the early part of labor. Although these decelerations are not associated with fetal distress and thus are reassuring, they must be carefully differentiated from the other, nonreassuring decelerations. Gene amplification in cancer cells has been shown to lead to resistance to cancer-killing medications when the dose of medication is increased gradually. Which of the following heart rate patterns would the nurse interpret as normal during the transitional phase of stage one? -Neither period yields adequate accelerations If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at d4medstudrep@gmail.com. Issues such as hypoxia, however, might slow their heart rate. Intrapartum Fetal Monitoring | AAFP