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. 5 contractions in 10 minutes averaged over thirty minutes Any type of abnormality spotted in a fetal heart tracing could indicate an inadequate supply of oxygen or other medical issues. -Positive Contraction Stress Test: Hasten fetal delivery. Fetal Heart Tracing Quiz 1 - utilis.net Decelerations represent a decrease in FHR of more than 15 bpm in bandwidth amplitude. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Fetal Heart Tracing Quiz 8 - Utilis Management of intrapartum fetal heart rate tracings - UpToDate What action by the nurse is most appropriate? Practice Quizzes 6-10 - Electronic Fetal Monitoring What Do Contractions Feel Like? Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. 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. 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). The patient in labor is having multiple deep variable decelerations down to 60-70 bpm. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. -NST Non-reactive: Assess maternal vital signs (temperature, blood pressure, pulse), 3. a. Questions and Answers 1. 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. The practitioner has ordered continuous electronic monitoring, but the patient requests IA for the early part of labor. Variability (V; Online Table B). The nurse's action after turning the patient to her left side should be: Applying oxygen per face mask at 8-10 L/min. 2. The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. Remember , the baseline is the average heart rate rounded to the nearest five bpm . The patient is having contractions every 4 minutes, each lasting 50 seconds. Conclude whether the FHR recording is reassuring, nonreassuring or ominous. Detection is most accurate with a direct fetal scalp electrode, although newer external transducers have improved the ability to detect variability. Initiate scalp stimulation to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. References. Bradycardia in the range of 100 to 120 bpm with normal variability is not associated with fetal acidosis. Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. a) lapilli Persistent tachycardia greater than 180 bpm, especially when it occurs in conjunction with maternal fever, suggests chorioamnionitis. Your obstetrician reviews the fetal heart tracing at regular time intervals. What characteristic of this fetal heart rate tracing is indicative of fetal well-being? Fetal Tracing Quiz Please answer each question. -Related to fetal movement D. Determine the onset and end of each deceleration in relation to the onset and end of the contraction. 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. The term hyperstimulation is no longer accepted, and this terminology should be abandoned.11. 2. Which of the following information should be included? 5. Abrupt increases in the FHR are associated with fetal movement or stimulation and are indicative of fetal well-being11 (Online Table B, Online Figure G). Count FHR after uterine contraction for 60 seconds (at 5-second intervals) to identify fetal response to active labor (this may be subject to local protocols), Abnormal umbilical artery Doppler velocimetry, Maternal motor vehicle collision or trauma, Abnormal fetal heart rate on auscultation or admission, Intrauterine infection or chorioamnionitis, Post-term pregnancy (> 42 weeks' gestation), Prolonged membrane rupture > 24 hours at term, Regional analgesia, particularly after initial bolus and after top-ups (continuous electronic fetal monitoring is not required with mobile or continuous-infusion epidurals), High, medium, or low risk (i.e., risk in terms of the clinical situation), Rate, rhythm, frequency, duration, intensity, and resting tone, Bradycardia (< 110 bpm), normal (110 to 160 bpm), or tachycardia (> 160 bpm); rising baseline, Reflects central nervous system activity: absent, minimal, moderate, or marked, Rises from the baseline of 15 bpm, lasting 15 seconds, Absent, early, variable, late, or prolonged, Assessment includes implementing an appropriate management plan, Visually apparent, abrupt (onset to peak < 30 seconds) increase in FHR from the most recently calculated baseline, Peak 15 bpm above baseline, duration 15 seconds, but < 2 minutes from onset to return to baseline; before 32 weeks gestation: peak 10 bpm above baseline, duration 10 seconds, Approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding periodic or episodic changes, periods of marked variability, and segments of baseline that differ by > 25 bpm, In any 10-minute window, the minimum baseline duration must be 2 minutes, or the baseline for that period is indeterminate (refer to the previous 10-minute segment for determination of baseline), The nadir of the deceleration occurs at the same time as the peak of the contraction, The nadir of the deceleration occurs after the peak of the contraction, Abrupt decrease in FHR; if the nadir of the deceleration is 30 seconds, it cannot be considered a variable deceleration, Moderate baseline FHR variability, late or variable decelerations absent, accelerations present or absent, and normal baseline FHR (110 to 160 bpm), Continue current monitoring method (SIA or continuous EFM), Baseline FHR changes (bradycardia [< 110 bpm] not accompanied by absent baseline variability, or tachycardia [> 160 bpm]), Tachycardia: medication, maternal anxiety, infection, fever, Bradycardia: rupture of membranes, occipitoposterior position, post-term pregnancy, congenital anomalies, Consider expedited delivery if abnormalities persist, Change in FHR variability (absent and not accompanied by decelerations; minimal; or marked), Medications; sleep cycle; change in monitoring technique; possible fetal hypoxia or acidemia, Change monitoring method (internal monitoring if doing continuous EFM, or EFM if doing SIA), No FHR accelerations after fetal stimulation, FHR decelerations without absent variability, Late: possible uteroplacental insufficiency; epidural hypotension; tachysystole, Absent baseline FHR variability with recurrent decelerations (variable or late) and/or bradycardia, Uteroplacental insufficiency; fetal hypoxia or acidemia, 2.
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