Questions and Answers
How long of a time period is baseline FHR measured for?
10 min
What is FHR rounded to?
5 bpm
Do you include accelerations and decelerations, marked variability, or baseline segments differing by more than 25 bpm in baseline?
False
What's a normal fetal baseline HR?
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What is the definition for minimal variability?
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What is the definition for moderate variability?
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What is the definition for marked variability?
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What is the definition of an acceleration?
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What is the definition of a late deceleration?
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What is the definition of an early deceleration?
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What is the definition of a variable deceleration?
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What is the definition of prolonged deceleration?
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How is a decel identified as intermittent?
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How is a decel identified as recurrent?
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What is normal uterine activity?
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What is tachysystole?
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What is the primary purpose for use of EFM?
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How often is EFM used for complications and no complications, and for 1st and 2nd stage of labor?
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How is fetal acid-base status categorized?
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What are two features of FHR that predict the absence of fetal metabolic acidemia?
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What are the characteristics of category I?
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What are the characteristics of category II?
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What are the characteristics of category III?
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What can be administered if fetal HR shows minimal or absent variability or recurrent late decels?
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What techniques can be done if baby shows minimal or absent variability, recurrent late decelerations, recurrent variable decelerations, prolonged decelerations, tachycardia, bradycardia?
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What techniques can be done if baby shows tachysystole?
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What techniques can be done if baby shows recurrent variable decelerations?
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What techniques can be done if there is maternal hypotension?
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What influence do most medications have on fetal HR?
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Study Notes
Fetal Heart Rate (FHR) Monitoring
- Baseline FHR is measured over a 10-minute period.
- FHR is rounded to the nearest 5 bpm.
- Accelerations, decelerations, marked variability, and baseline segments differing by more than 25 bpm are not included in baseline calculations.
Normal Values
- Normal fetal baseline heart rate ranges from 110-160 bpm.
- Minimal variability is defined as fluctuations of less than 5 bpm.
- Moderate variability encompasses fluctuations of 6-25 bpm.
- Marked variability indicates fluctuations of more than 25 bpm.
Definition of Decelerations
- Acceleration: An abrupt increase of at least 15 bpm lasting more than 15 seconds but less than 2 minutes.
- Late deceleration: Gradual decrease in FHR returning to baseline, occurring after peak of contraction; onset to nadir takes 30 seconds or more.
- Early deceleration: Similar to late deceleration but occurs simultaneously with the peak of contraction.
- Variable deceleration: Abrupt drop in FHR, occurring in less than 30 seconds, decreasing 15 bpm or more below baseline, can happen with or without contractions.
- Prolonged deceleration: Drop below baseline of 15 bpm or more, lasting 2-10 minutes.
Classification of Decelerations
- Intermittent decels occur with less than 50% of contractions in a 20-minute segment.
- Recurrent decels occur with 50% or more of contractions in a 20-minute segment.
Uterine Activity Classifications
- Normal uterine activity consists of 5 or fewer contractions in a 10-minute segment, averaged over 30 minutes.
- Tachysystole is defined as more than 5 contractions in a 10-minute segment, averaged over 30 minutes.
Purpose and Frequency of EFM
- The primary purpose of Electronic Fetal Monitoring (EFM) is to assess if the fetus is well-oxygenated.
- EFM monitoring frequency:
- No complications: every 30 minutes during the first stage, 15 minutes in the second stage.
- With complications: every 15 minutes in the first stage, 5 minutes in the second stage.
Fetal Acid-Base Status Classification
- Classified using a 3-tiered system.
Predictors of Fetal Metabolic Acidemia
- Absence of fetal metabolic acidemia is indicated by moderate variability and the presence of accelerations.
Category Characteristics
- Category I: Baseline 110-160 bpm, moderate variability, absent late/variable decels, early decels present or absent.
- Category II: Minimal/absent/marked variability, absent accelerations, prolonged decels, recurrent late decels with moderate variability.
- Category III: Absent variability with recurrent late/variable decels or bradycardia, or sinusoidal pattern.
Interventions Based on FHR Patterns
- For minimal or absent variability or recurrent late decels: Administer 10 L oxygen on a nonrebreather mask to the mother.
- Technique for promoting fetal oxygenation: lateral positioning, IV fluid bolus, oxygen therapy, modification of pushing efforts, decrease/discontinue oxytocin.
- For tachysystole: reduce uterine activity through IV fluid bolus, lateral positioning, and may consider terbutaline if no improvement.
- For recurrent variable decelerations: alleviate umbilical cord compression via repositioning or amnioinfusion.
- For maternal hypotension: correct through lateral positioning, IV fluid bolus, or ephedrine if no response.
- Most medications (narcotics, cocaine, betamethasone, magnesium sulfate) typically lead to decrease in FHR variability.
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Description
Test your knowledge on fetal heart rate (FHR) monitoring with this quiz. Covering topics such as baseline heart rates, variability, and definitions of accelerations and decelerations, this quiz is ideal for medical students and professionals. Understand the norms and deviations in FHR monitoring.
