fetal heart tracing quiz 10

structured intermittent auscultation should be considered for low-risk labor because it statistically decreases cesarean and operative vaginal delivery rates without an increase in unfavorable outcomes associated with continuous monitor use and a high false-positive rate. Whenever possible, they will implement measures to prevent an unfavorable outcome. All Rights Reserved. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. -Stress = uterine contractions A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Test your EFM skills using NCC's FREE tracing game! This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. Do not automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first. Turn off oxytocin (Pitocin) Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. Other rare risks associated with EFM include fetal scalp infection and uterine perforation with the intra-uterine tocometer or catheter. All Rights Reserved. Describe a hypothesis that explains these results. What are the two most important characteristics of the FHR? A scalp pH less than 7.25 but greater than 7.20 is considered suspicious or borderline. Auscultation of the fetal heart rate (FHR) is performed by external or internal means. Although these decelerations are not associated with fetal distress and thus are reassuring, they must be carefully differentiated from the other, nonreassuring decelerations. Differentiate maternal pulse from fetal pulse, 4. Category II tracings are defined as indeterminate, are common, and represent all tracings that do not fall into the Category I or III groups.2,5 They vary widely in level of concern for acidosis, so the family physician must determine the severity of the Category II tracing and take the appropriate action.2,5,7,35, There is a direct association between fetal acidosis, recurrent decelerations, and depth of decelerations2,5,34,36; however, the presence of moderate variability and/or accelerations offers reassurance in Category II tracings because the presence is predictive of a lack of fetal acidosis.2,4,26,27,34,3638 For Category II tracings without spontaneous or provoked accelerations, minimal/absent variability, or deep decelerations (i.e., FHR drops to 70 bpm or less), immediate action is needed.3,4, A management algorithm30 (eFigure A) has been developed that is based on the suspected degree of fetal acidosis and ideally minimizes unnecessary interventions.7, A five-tiered classification/management scheme for management of Category II tracings has been developed (http://www.obapps.org).7,37,39 Each continuous electronic fetal monitoring tracing is color coded to represent the threat of acidosis based on the National Institute of Child Health and Human Development definitions, and Category II is broken into three separate severity and intervention subcategories based on the presence of accelerations and/or moderate variability.7,37 This classification has been shown to improve identification of fetal acidosis and newborns requiring immediate intervention after delivery.37, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation(Figure 1).2,7,16,21,27,3033 Lateral recumbent maternal positioning reduces compression of the maternal vena cava and aorta and the fetal umbilical cord.2,32,33 Intravenous fluid boluses up to 1 L have been shown to improve fetal oxygenation up to 30 minutes after administration.32,33 Maternal oxygen may be administered after other maneuvers, but it can be discontinued after tracing improvement because there is no evidence to support its routine use.2,32,33 Modification in maternal pushing efforts, such as initiating only with the urge to push and allowing for fetal recovery by pushing with every second or third contraction, can improve maternal and fetal oxygenation.40, Category III tracings, defined by a sinusoidal FHR pattern (Figure 37) or absent FHR variability (Figure 47) with recurrent late and/or variable decelerations or fetal bradycardia (see the Fetal Bradycardia section), require immediate intrauterine resuscitation and intervention.2,5,8,14,27,30,32,33,38,39 If the Category III tracing does not rapidly improve, expedited delivery is recommended.

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