Fetal Movement and Health Indicators

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Questions and Answers

What is an indication for using a cardiotocograph (CTG) for fetal monitoring?

Cervix dilated 1 cm

Amniotic membranes intact

Cervix dilated 2 cm (correct)

Fetal presentation not cephalic

During a non-stress test (NST), how long should the fetal heart rate (FHR) be monitored at minimum?

20 minutes (correct)

60 minutes

10 minutes

30 minutes

Which of the following statements is true regarding fetal heart baseline rates?

Baseline FHR can only be assessed using an internal transducer.

Fetal bradycardia is identified when the baseline FHR exceeds 160 bpm.

The normal baseline fetal heart rate typically falls between 110 and 160 bpm. (correct)

Fetal tachycardia is defined as a baseline FHR below 110 bpm.

What is a common cause of fetal tachycardia?

Severe fetal anemia Signup and view all the answers

Which of the following characteristics indicates decreased fetal heart rate variability?

Fetal sleep cycles Signup and view all the answers

What defines an acceleration in fetal heart rate during monitoring?

An increase of at least 15 bpm for 15 seconds Signup and view all the answers

Which condition could lead to decreased fetal heart rate variability?

Maternal fever Signup and view all the answers

Which method is used for acoustic stimulation during fetal monitoring?

An artificial larynx Signup and view all the answers

What is the significance of fetal movement counting during pregnancy?

It helps gauge fetal health and detect potential stress. Signup and view all the answers

When should a mother start counting fetal movements?

Around 28 weeks of pregnancy. Signup and view all the answers

What is the expected duration for a mother to feel 10 fetal movements?

Should feel 10 movements in no more than 2 hours. Signup and view all the answers

What is quickening and when does it typically occur?

The first time a mother feels fetal movements, occurring at 16-25 weeks. Signup and view all the answers

Which of the following factors can influence a mother's perception of fetal movement?

Placental location and maternal obesity. Signup and view all the answers

What does the HC/AC ratio indicate during second and third-trimester ultrasounds?

Growth abnormalities and possible IUGR. Signup and view all the answers

What is the primary purpose of a basic first-trimester ultrasound?

To evaluate fetal viability and detect anomalies. Signup and view all the answers

What indicates a normal sleeping pattern for the fetus?

Periods of no movement lasting more than 90 minutes. Signup and view all the answers

What does a digital fetal scalp stimulation leading to an acceleration in fetal heart rate indicate?

The baby is healthy. Signup and view all the answers

How are early decelerations characterized in relation to uterine contractions?

They mirror the contraction with no significant timing difference. Signup and view all the answers

What type of fetal heart rate deceleration is associated with cord compression?

Variable decelerations. Signup and view all the answers

What does a late deceleration indicate regarding placental function?

Decreased uteroplacental perfusion. Signup and view all the answers

What is the main significance of using electronic fetal monitoring (EFM) during labor?

To identify intrapartum hypoxia. Signup and view all the answers

What is the recommended timing for intermittent auscultation in the first stage of labor for low-risk women?

Immediately after each contraction for at least 1 minute every 15 minutes. Signup and view all the answers

What duration and intensity characterizes variable decelerations?

Variable in duration and intensity. Signup and view all the answers

What potential outcome should EFM be cautious to avoid when used on low-risk women?

Higher rates of cesarean section. Signup and view all the answers

Study Notes

Fetal Movement

Fetal movement is a key indicator of fetal health
A change in the normal number of fetal movements may indicate the fetus is under stress
The simplest way to chart movements is to record the amount of time it takes to feel 10 movements. It should take no more than 2 hours.
Most fetuses have circadian rhythms and are more active in the evening hours.
A fetus will often be more active an hour after the mother eats.
The mother will likely begin feeling fetal movements (quickening) around 16-25 weeks of pregnancy. The average is 20-22 weeks, but can be earlier for those who have had multiple pregnancies.

Fetal Movement Count

A fetus spends 10% of its time making gross fetal body movements
It makes approximately 30 movements each hour
Active periods for fetal body movement typically last about 40 minutes
Quiet periods generally last about 20 minutes
The longest period without fetal movement should not be more than 75 minutes

Factors Affecting Perception of Fetal Movement

Fetal and Placental factors:
- Placental location
- Length and type of fetal movements
- Amniotic fluid volume (AFV)
Maternal factors:
- Parity
- Obesity

Ultrasound for Fetal Parameters

Basic Ultrasound - Done at 10-14 weeks.
- Number of fetuses
- Fetal heart and viability
- Gestational age - CRL
- Any gross anomaly - anencephaly, limb reduction defects
- Nuchal translucency
- Placental localization
- Cervical length
- Maternal pelvic masses

2nd & 3rd Trimester Ultrasound

Serial Measurements - Done at 10-14 weeks.
- BPD, AC, HC, FL (Growth US Scan)
- HC/AC Ratio: Exceeds 1 before 32 weeks. After 34 weeks, it falls below 1. In symmetric IUGR, it remains normal. This ratio can identify 85% of IUGR fetuses.

Internal Cardiotocograph

Uses an electronic transducer connected directly to the fetal scalp through the cervical opening.
Connected to a monitor
Requires ruptured amniotic membranes
Requires a dilated cervix (2 cm)
Cephalic presentation with the presenting part down against the cervix

Non-Stress Test (NST) Method

Patient positioned in a lateral tilt position
FHR and uterine activity monitored with an external transducer
FHR monitored for 20 minutes
Monitoring extended for 40 minutes in cases to compensate for sleep cycles - Extended NST
Acoustic stimulation used if the fetus is not reactive.

Intrapartum CTG Interpretation

Baseline Fetal Heart Rate (FHR)
Baseline FHR Variability
Presence of Accelerations
Decelerations
Uterine Activity (contractions)

Fetal Heart Baseline

Differentiate between fetal and maternal heartbeats.
Baseline FHR usually ranges between 110 and 160 beats/minute.
Fetal Tachycardia - Baseline FHR greater than 160 beats per minute
Fetal Bradycardia - Sustained fetal heart rate less than 110 beats per minute

Causes of Fetal Tachycardia

Maternal fever
Chorioamnionitis
Fetal sepsis
Drugs (Atropine, Phenothiazines, Beta-sympathomimetics)
Tachyarrhythmias
Fetal heart failure
Severe fetal anemia, fetal hydrops
Maternal hyperthyroidism

Variability

Variability normally ranges between 5 and 25 beats/minute.
Intermittent periods of reduced baseline variability are normal, especially during sleep.

Causes of Decreased Variability

Hypoxemia/acidosis
Fetal sleep cycles
Drugs (Analgesics, barbiturates, phenothiazines, anesthetics)
Prematurity
Arrhythmias
Pre-existing neurological abnormality
Congenital anomalies

Accelerations

Increase in FHR greater than or equal to 15 bpm for greater than or equal to 15 seconds from the onset to return to baseline.
The presence of accelerations, even with reduced baseline variability, is generally a sign that the baby is healthy.
The absence of accelerations on an otherwise normal cardiotocograph does not indicate fetal acidosis.
Digital fetal scalp stimulation (during vaginal examination) that leads to an acceleration in fetal heart rate is a sign that the baby is healthy.

Decelerations

Decreases in fetal heart rate from the baseline by at least 15 bpm, lasting for at least 15 seconds.

Types of Decelerations

Early Decelerations:
- Begin at the start of uterine contraction and end with conclusion of contraction.
- The onset, nadir, and recovery of the deceleration are with the beginning, peak, and ending of the contraction, respectively (mirror like).
- Related to head compression.
- Early decelerations are a benign finding caused by a vasovagal response as a result of fetal head compression by the contraction.
- No intervention necessary. Just continue to watch for any changes.
Variable Decelerations:
- Variable in duration, intensity, and timing.
- Abrupt(sudden) decrease in FHR of > 15 beats per minute measured from the most recently determined baseline rate.
- The onset of deceleration to nadir is less than 30 seconds. The deceleration lasts > 15 seconds and less than 2 minutes.
- Related to cord compression.
Late Decelerations:
- Gradual decrease in FHR with onset of deceleration to nadir > 30 seconds.
- Onset of the deceleration occurs after the beginning of the contraction, and the nadir of the deceleration occurs after the peak of the contraction.
- Related to decreased uteroplacental perfusion.

EFM Learning Points

It is used to identify intrapartum hypoxia, a significant cause of fetal death and disability. Fetal hypoxia can lead to fetal asphyxia and death.
It should not be used unless indicated as it increases the rates of cesarean section and instrumental delivery in low-risk women.
It has become an integral component of labor management in high-risk women.

Intermittent Auscultation of Fetal Heart Rate

Intermittent auscultation of the fetal heart rate can be used for women at a low risk of complications in the established first stage of labor.
Auscultate immediately after a contraction for at least 1 minute, at least every 15 minutes in the first stage of labor, and at least every 5 minutes in the second stage. Record as a single rate.

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Description

Explore the significance of fetal movements as a key indicator of fetal health. This quiz covers the normal range of movements, their timing, and what deviations may signal potential stress. Learn how to monitor fetal activity effectively during pregnancy.