Podcast
Questions and Answers
What is the appropriate color of normal amniotic fluid?
What is the appropriate color of normal amniotic fluid?
What does dark yellow or green amniotic fluid indicate?
What does dark yellow or green amniotic fluid indicate?
What should be noted when performing a sterile speculum examination?
What should be noted when performing a sterile speculum examination?
How can one encourage fluid to leak from the os if no visible fluid is present?
How can one encourage fluid to leak from the os if no visible fluid is present?
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A pH of 6.5 or higher when using a nitrazine swab suggests what?
A pH of 6.5 or higher when using a nitrazine swab suggests what?
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What indicates the need for continuous electronic fetal heart rate monitoring?
What indicates the need for continuous electronic fetal heart rate monitoring?
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What should be avoided when collecting a sample of fluid with a sterile swab?
What should be avoided when collecting a sample of fluid with a sterile swab?
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What is a potential risk associated with meconium-stained amniotic fluid?
What is a potential risk associated with meconium-stained amniotic fluid?
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What is the significance of the time from rupture of membranes to delivery?
What is the significance of the time from rupture of membranes to delivery?
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Which method can help differentiate premature rupture of membranes (PROM) from urinary incontinence?
Which method can help differentiate premature rupture of membranes (PROM) from urinary incontinence?
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Which symptom is most commonly associated with ruptured membranes?
Which symptom is most commonly associated with ruptured membranes?
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What should be evaluated during the history taking for suspected ruptured membranes?
What should be evaluated during the history taking for suspected ruptured membranes?
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What is the role of Leopold's maneuvers in the evaluation for ruptured membranes?
What is the role of Leopold's maneuvers in the evaluation for ruptured membranes?
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What should be done after more than 6 to 12 hours have passed since membranes ruptured?
What should be done after more than 6 to 12 hours have passed since membranes ruptured?
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What characteristic of the amniotic fluid can provide clues to fetal well-being?
What characteristic of the amniotic fluid can provide clues to fetal well-being?
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Which of the following is NOT typically included in the physical examination when evaluating ruptured membranes?
Which of the following is NOT typically included in the physical examination when evaluating ruptured membranes?
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What is the minimum frequency of contractions necessary to achieve progressive cervical change in active labor?
What is the minimum frequency of contractions necessary to achieve progressive cervical change in active labor?
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Which method is NOT used for external fetal heart rate monitoring?
Which method is NOT used for external fetal heart rate monitoring?
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Which factor is an indication for continuous fetal heart rate monitoring?
Which factor is an indication for continuous fetal heart rate monitoring?
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What is monitored using an intrauterine pressure catheter?
What is monitored using an intrauterine pressure catheter?
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During labor, what parameters should be assessed in a digital cervical examination?
During labor, what parameters should be assessed in a digital cervical examination?
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When can internal fetal heart rate monitoring be utilized?
When can internal fetal heart rate monitoring be utilized?
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What is the purpose of correlating the woman's perceptions of contractions with abdominal palpation?
What is the purpose of correlating the woman's perceptions of contractions with abdominal palpation?
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Which of the following is NOT a method of fetal assessment during labor?
Which of the following is NOT a method of fetal assessment during labor?
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What is the purpose of conducting a cervical examination during first-stage labor?
What is the purpose of conducting a cervical examination during first-stage labor?
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Which of the following is NOT a reason for performing a cervical examination in normal labor?
Which of the following is NOT a reason for performing a cervical examination in normal labor?
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Which test is considered diagnostic when the classic pattern of ferning is clearly seen?
Which test is considered diagnostic when the classic pattern of ferning is clearly seen?
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What is the pH range indicating the presence of amniotic fluid when using a nitrazine test?
What is the pH range indicating the presence of amniotic fluid when using a nitrazine test?
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Which of the following findings indicates a potential risk for a prolapsed cord during labor?
Which of the following findings indicates a potential risk for a prolapsed cord during labor?
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During a sterile speculum examination for the fern test, which area should be avoided to prevent contamination?
During a sterile speculum examination for the fern test, which area should be avoided to prevent contamination?
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What does a pooling of fluid in the posterior fornix of the vagina indicate?
What does a pooling of fluid in the posterior fornix of the vagina indicate?
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What does cervical examination help determine regarding the fetus in labor?
What does cervical examination help determine regarding the fetus in labor?
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Study Notes
Uterine Contraction Monitoring
- Uterine activity can be assessed by correlating a woman's perception of contractions with observation and abdominal palpation.
- Electronic monitoring uses an external tocodynamometer or an intrauterine pressure catheter.
- Three contractions within 10 minutes are considered the minimum frequency for progressive cervical change during active labor.
Fetal Well-being
- Ongoing, standardized fetal heart rate assessment is crucial for evaluating fetal well-being throughout labor, regardless of the chosen monitoring method.
Fetal Heart Rate Monitoring
- Methods for fetal assessment during labor include intermittent auscultation and both continuous external and internal fetal heart rate assessment.
- Indications for continuous fetal heart rate monitoring include high-risk pregnancies (e.g., diabetes, high blood pressure) and high-risk fetuses (e.g., IUGR, LBW). Monitoring can also be used to assess the impact of tocolytics or induction agents on the fetus.
External Fetal Heart Rate Monitoring
- External monitoring involves wrapping a pair of belts around the abdomen.
- One belt uses Doppler technology to detect the fetal heart rate.
- The other belt measures the length of contractions and the time intervals between them.
Internal Fetal Heart Rate Monitoring
- Internal monitoring involves placing an electrode on the fetus's scalp, usually the part closest to the cervix.
- Monitoring uterine contractions also involves inserting an intrauterine pressure catheter through the vagina into the uterus.
- Internal monitoring is only used after the amniotic membranes rupture.
Fetal Assessment During Labor - Terminology
- Baseline: Mean fetal heart rate (FHR) over a 10-minute segment, excluding periodic changes, marked variability, and baseline segments differing by more than 25 bpm. Duration must be at least 2 minutes.
- Bradycardia: Baseline FHR < 110 bpm.
- Tachycardia: Baseline FHR > 160 bpm.
- Variability: Fluctuations in the baseline FHR; ≥ 2 cycles per minute.
- Absent Variability: Amplitude from peak to trough is undetectable.
- Minimal Variability: Amplitude from peak to trough is > undetectable and ≤ 5 bpm.
- Moderate Variability: Amplitude from peak to trough is 6–25 bpm.
- Marked Variability: Amplitude from peak to trough is > 25 bpm.
Acceleration
- A visually apparent, abrupt increase in FHR above baseline (onset to peak < 30 secs).
- Peak ≥ 15 bpm, duration ≥ 15 bpm and < 2 mins, ≥ 10 bpm for gestations < 32 weeks.
Prolonged Acceleration
- Duration ≥ 2 minutes and < 10 minutes. An acceleration lasting ≥ 10 minutes is considered a baseline acceleration change.
Early Deceleration
- Visually apparent, gradual decrease (onset to nadir ≥ 30 seconds) in FHR below the baseline.
- Recovery to baseline is associated with a uterine contraction.
- The nadir occurs at the same time as the peak of the contraction.
Late Deceleration
- Visually apparent, gradual decrease (onset to nadir ≥ 30 seconds) in FHR below baseline.
- The nadir of the deceleration occurs after the peak of the contraction.
Variable Deceleration
- Visually apparent, abrupt decrease (onset to nadir < 30 seconds) in FHR below the baseline.
- Decrease ≥ 15 bpm below baseline.
- Duration ≥ 15 seconds and < 2 minutes from onset to return to baseline.
Prolonged Deceleration
- Visually apparent decrease in FHR below baseline.
- Decrease ≥ 15 bpm below baseline.
- Duration ≥ 2 minutes but < 10 minutes from onset to return to baseline.
Fetal Heart Rate Interpretive Categories
- Category I (Normal): Baseline rate 110–160 bpm, moderate variability, and absence of late or variable decelerations.
- Category II (Indeterminate): All FHR tracings not categorized as Category I or Category III.
- Category III (Abnormal): Includes either absent baseline FHR variability and any of the following (recurrent late decelerations, recurrent variable decelerations, bradycardia, sinusoidal pattern), or variable decelerations with other characteristics, like slow return to baseline, "overshoots", or "shoulders".
Labor Progress
- Digital Cervical Examinations: Assess dilation, effacement, position, consistency, and fetal station/position.
- Recommendations include performing the examination by the same professional whenever possible. Avoid frequent exams (every one to two hours).
- Indications for cervical exams: baseline; labor status (prelabor, latent, active); progress evaluation; managing labor pain; dilated cervix verification; prolapsed cord assessment.
Evaluation and Diagnosis of Ruptured Membranes
- History (timing, quantity, color, consistency/texture, associated symptoms, odor [normal amniotic fluid can be clear, straw or cloudy], presence of meconium)
- Physical Examination (assessing for fluid, presence of membranes rupture and signs as well as signs of infection) – Note the color, consistency, and amount of fluid; note for signs of prolapsed cord, bulging forebag, or fetal parts; check the cervical os and pooling of fluid.
Fern Test
- A sterile cotton swab is used to collect fluid.
- Care should be taken not to touch cervical mucus.
- The specimen is placed on a slide and allowed to dry.
- Inspect for a fern-like pattern.
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Description
Test your knowledge on uterine contraction monitoring, fetal heart rate assessment, and the evaluation of fetal well-being during labor. This quiz covers various monitoring methods and their indications, including the techniques utilized in high-risk pregnancies. Challenge yourself with key concepts and practices in maternal-fetal medicine.
