Questions and Answers
Which of the following is an extrinsic influence on the FHR?
The most highly oxygenated blood in fetal circulation is carried by:
If fetal arterial pressure begins to fall below normal levels:
Baroreceptors cause vasoconstriction and increase the FHR
Fetal heart rate variability is defined as fluctuations in the baseline that are irregular in _____ and _____.
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An increase in the fetal heart rate immediately preceding a variable deceleration is caused by:
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When assessing a FHR tracing, the first step is to:
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Which deceleration in the FHR is considered benign and does not require an intervention to correct?
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If the umbilical vein is the only vessel occluded during cord compression,
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During a fetal sleep cycle, FHR variability is usually ____.
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Uterine tachysystole is defined as:
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Maternal-fetal oxygen and nutrient transfer takes place in the:
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During a contraction, the tocodynamometer detects:
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Normal fetal heart rate baseline is:
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Following birth, a fetal cord blood sample is taken. The results are: pH: 6.95, pCO2: 86 mmHg, pO2: 4mmHg, BE: -18.6 mEq/L. These results are best interpreted as:
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A characteristic of variable decelerations is:
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Stimulation of the vagus nerve in a healthy fetus will cause:
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What is the baseline rate?
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What is the correct interpretation?
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What is the primary physiologic goal?
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Based on the tracing, the most appropriate interventions are:
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Which of the following is a correct interpretation of the tracing?
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The nurse supports maternal coping to appropriately assist Robin because:
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Describe the type of variability seen in the majority of the tracing.
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Identify appropriate interventions to implement based on this tracing.
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What does the EFM tracing above and the observed patient assessment raise your suspicion of?
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What is the physiologic goal of top priority for Robin?
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What bedside interventions are important at this time?
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If the nurse does not get the appropriate response from the provider, the next step is
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What is the correct interpretation of the tracing?
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The tracing in question 29 is which category?
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Robin has a cesarean birth. Umbilical arterial cord blood gas results are as follows: pH: 6.86, pCO2: 48, pO2: 4.2, BE: -23.7. These results meet the criteria for:
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What is the baseline rate?
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What type of variability is observed?
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What do you observe in the tracing that rules out metabolic acidemia at this time?
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Study Notes
Fetal Heart Rate (FHR) Monitoring
- Extrinsic influence on FHR is from fetal-placental circulation.
- Ductus venosus carries the most oxygenated blood in fetal circulation.
- Falling fetal arterial pressure triggers baroreceptors to vasoconstrict, increasing FHR.
- FHR variability is fluctuations in baseline that vary in amplitude and frequency.
Types of Decelerations
- Early deceleration is benign and does not require intervention.
- Variable decelerations have an abrupt onset.
Umbilical Cord Compression
- Occlusion of the umbilical vein restricts oxygenated blood delivery to the fetus.
- Increased FHR before variable deceleration is due to umbilical vein occlusion.
FHR Baseline and Variability
- Normal FHR baseline ranges from 110 to 160 bpm.
- Minimal variability occurs during a fetal sleep cycle; absent variability indicates no fluctuations.
Uterine Activity Measurement
- Tocodynamometer measures pressure from tensing of the uterine muscle.
Maternal-Fetal Interaction
- Maternal-fetal oxygen and nutrient transfer occurs in the intervillous space.
- Uterine tachysystole is defined as more than five contractions in a ten-minute period.
Clinical Interpretation
- Fetal cord blood results with pH of 6.95 indicate mixed acidemia.
- Fetal heart rate baseline for given scenarios may vary; examples include 145 bpm or 160 bpm with recurrent late decelerations.
Interventions and Communication
- Priority interventions may include decreasing oxytocin infusion and starting IV fluid bolus.
- Proper assessment of uterine activity requires palpation.
- Enhancing maternal coping reduces catecholamine production, improving uterine blood flow.
Complications and Responses
- Observations raising suspicion for placental abruption include vaginal bleeding and abnormal EFM tracing.
- Sinusoidal patterns in EFM tracings suggest more severe issues, categorized as Category III.
Cord Blood Gas Interpretation
- Umbilical arterial blood gas results with a pH of 6.86 and BE of -23.7 indicate metabolic acidemia.
Variability Assessment
- FHR variability can be categorized as absent, moderate, or severe, affecting clinical decisions.
Communication Protocols
- In case of inadequate response from healthcare providers, activating a chain of command is essential for patient safety.
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Description
Test your knowledge with these flashcards focused on intermediate fetal monitoring concepts from AWHONN. Each flashcard covers key aspects of fetal heart rate (FHR) influences and fetal circulation. Perfect for students and professionals in obstetrics and midwifery.
