18 Questions
What is the basis for monitoring fetal response during labour?
Fetal health surveillance
In fetal health surveillance during labour, why should FHR and uterine activity be assessed together?
To assess the total clinical picture
What is a normal uterine activity pattern during labour?
5 or less contractions in a 10-minute window
What is the goal of intrapartum FHR monitoring during labour?
To identify non-reassuring patterns indicative of fetal compromise
Why are atypical fetal heart rate patterns during labour characterized by vigilance and ongoing monitoring?
To ensure timely interventions if needed
How is uterine activity assessed during labour?
By palpation or IUPC
Which monitoring technique is recommended for healthy patients in spontaneous labor between 37 and 41 weeks gestation?
Intermittent auscultation
What is the normal range for baseline fetal heart rate at term?
110 to 160 beats/min
Which device can be used for performing intermittent auscultation?
DeLee-Hillis fetoscope
What is the purpose of assessing fetal heart rate patterns systematically?
To include baseline FHR, variability, accelerations, and decelerations
Which mode of monitoring involves the use of a spiral electrode and intrauterine catheter as signal sources?
Internal mode
What device is used for external monitoring of FHR?
Doptone
What is considered fetal tachycardia?
FHR > 160 bpm
What can cause a sinusoidal pattern on an electronic fetal monitor tracing?
Fetal sleep
When are accelerations likely to occur during labor based on the information provided?
At any time during labor, with or without a contraction
What is the significance of marked fetal heart rate variability?
Fetal hypoxemia or metabolic acidemia
What does the term 'prolonged decelerations' refer to in fetal monitoring?
A decrease in FHR lasting an extended period
What does the acronym 'VEAL CHOP' stand for in the context of fetal monitoring?
'Variable Early Accelerations Linked to Cord Compression'
Study Notes
Fetal Health Surveillance During Labour
- Fetal heart rate (FHR) and uterine activity (UA) must be assessed together to interpret the total clinical picture.
Basis for Monitoring Fetal Response
- Labour is a period of physiological stress for the fetus, making frequent monitoring of fetal status crucial.
Fetal Heart Rate Patterns
- Normal FHR patterns require no intervention.
- Atypical FHR patterns require vigilance and ongoing monitoring.
- Abnormal FHR patterns require various interventions, potentially including expediting birth.
Uterine Activity (UA)
- Assessed by palpation or internal uterine pressure catheter (IUPC).
- Components of UA:
- Frequency of contractions.
- Duration of contractions.
- Intensity of contractions.
- Resting tone.
- Normal UA pattern: 5 or less contractions in a 10-minute window.
Fetal Assessment
- Identifies possible fetal decompensation, allowing timely and effective interventions.
Monitoring Techniques
External Fetal Monitoring (EFM)
- Screening tool for identifying non-reassuring FHR patterns indicative of fetal compromise.
- Associated with fetal hypoxemia, deficiency of oxygen in arterial blood.
- Uses ultrasound transducer for FHR and tocotransducer for UA.
Intermittent Auscultation (IA)
- Recommended for healthy patients in spontaneous labour between 37-41 weeks gestation.
- Listening to fetal heart sounds at periodic intervals to assess FHR and using palpation to assess UA.
- Can be performed with DeLee-Hillis fetoscope, Pinard stethoscope, or Doppler ultrasound.
- IA frequency is dependent on UA assessment.
Internal Monitoring
- Uses spiral electrode and intrauterine pressure transducer.
- Diagrammatic representation shows internal invasive fetal monitoring with intrauterine pressure catheter and spiral electrode in place.
Fetal Heart Rate Patterns
- Must be assessed systematically, including:
- Baseline FHR (normal range: 110-160 beats/min at term).
- Variability, accelerations, and decelerations.
- Interpretation of uterine activity.
Fetal Heart Rate Variability
- Absent and minimal variability: associated with fetal hypoxemia or metabolic acidemia.
- Moderate variability: normal.
- Marked variability: unclear significance.
- Sinusoidal pattern: associated with fetal anemia or cardiac arrhythmias.
Fetal Heart Rate Tracing Patterns
- Early decelerations: head compression, umbilical cord compression, or maternal pushing efforts.
- Late decelerations: fetal hypoxemia, placental insufficiency, or umbilical cord compression.
- Variable decelerations: umbilical cord compression, fetal movement, or maternal position changes.
- Prolonged decelerations: fetal distress, umbilical cord prolapse, or placental abruption.
Learn about the importance of monitoring fetal health during labour, including assessing fetal heart rate (FHR) and uterine activity (UA) together. Understand the basis for monitoring fetal response and different heart rate patterns.
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