Repro; Ortmann Electronic Fetal Monitoring, Kct;

Front 1

What is the most prevalent obstetric procedure in the US?

Back 1

electronic fetal monitoring

Front 2

What is the difference b/w measuring fetal heart rate directly & indirectly?

Back 2

directly: need bipolar electrode applied to scalp; records ELECTRICAL events;
indirectly: use US transducer to transmit fetal activity, it will detect heart motion, records MECHANICAL events

Front 3

With the direct technique of fetal heart rate measuring, how do you measure the voltage difference b/w the 2 poles?

Back 3

spiral portion enters scalp, 2nd pole is metal wing, vaginal saline completes the circuit;

Front 4

If you have a dead fetus, what will the EKG show?

Back 4

it'll read the maternal ECG b/c it'll go directly thru the fetus

Front 5

The scalp electrode on the fetus measures what types of waves?

Back 5

R waves

Front 6

How is heart rate measured? What units?

Back 6

measure in milliseconds, use distance b/w R waves;

Front 7

How much stronger is the mom's EKG than the fetus's?

Back 7

5x stronger but its diminished w/ the fetal scalp electrode

Front 8

What will you pick up on the EFM w/ placental abruption?

Back 8

Fetal heart rate will decrease then the maternal heart rate will take over;

Front 9

how would you define fetal bradycardia?

Back 9

baseline below 110bts/min. No beat to beat variability would indicate a compromised fetus.

Front 10

What happens to the signal b/w the time its detected and drawn on the graph? How many cm/min are recorded on the graph?

Back 10

signals are sent thru microprocessor & edited. Signal compared to previous signal (autocorrelation) is usually 3-4 beats is evaluated before rate is printed on graph; FHR recording at 3 cm/min

Front 11

What is the baseline FHR?

Back 11

rate apart from accels & decels w/ contractions. ex. if you place a ruler & eliminate all the ups & downs.

Front 12

When describing baseline FHR, what is included in the description?

Back 12

rate, beat to beat variability, arrhythmia, & certain patterns

Front 13

At what level of the baseline FHR is the baby considered to have tachycardia?

Back 13

>160

Front 14

What types of things inc the FHR?

Back 14

sympathetic

Front 15

What types of things DEC the FHR?

Back 15

parasympathetic,chemoreceptors, hypoxia, hypercapnia, rising blood lactate levels

Front 16

What is 't' on the FHM graph?

Back 16

beat to beat distance

Front 17

Fetal bradycardia can indicate what types of things?

Back 17

fetal compromise or heart block

Front 18

Fetal tachycardia can indicate what types of things?

Back 18

maternal fever rate >160 (ex. chorioamniotis or amniotis), mom will also show a moderate tachycardia.

Front 19

What is the difference b/w long and short term variability?

Back 19

short term variability: instantaneous change in heart rate;
long term variability: variation seen in 1 minute period (more wavy)

Front 20

What is the beat to beat variability?

Back 20

push pull of autonomic nervous system; nervous system is trying to regulate & is continuous

Front 21

What types of things can cause a flat line on the FHM (common cause of loss of beat to beat variability)?

Back 21

drugs given to mom like analgesics IV or conduction anaethetic.

Front 22

what is normal variability in a FHM?

Back 22

5-15 beats/min

Front 23

What is the single most reliable sign of fetal compromise? Should this be used as the only indicator of fetal well being.

Back 23

reduced baseline variability. No, it should not be the only sign for well being nor should good variability be the only indicator.

Front 24

A flat tracing w/in the normal range w/ decelerations may reflect what?

Back 24

previous insults that have resulting in neuro damage. (ex. something that happened 1 month ago that you didn't know about)

Front 25

Fetal arrhythmias are most commonly indicated by what?

Back 25

abrupt baseline spiking---you see baseline heart rate problem & then you see spikes.

Front 26

Conduction defects are frequently associated w/ what type of disease?

Back 26

connective tissue diseases like lupus

Front 27

Do arrhythmias continue during the lifetime if one is seen w/ FHM in pregancy?

Back 27

many disappear in neonatal period (birth-1 year old)

Front 28

what percent of fetuses have arrhythmias?

Back 28

3%

Front 29

In a patient w/ an arrhythmia, what type of treatment should be done in presence of clear amniotic fluid?

Back 29

conservative tx.

Front 30

When is a true sinusoidal heart rate seen?

Back 30

in fetal anemia from any source--ex. placental abruption involving fetal circulation where fetus is losing a lot of blood--can happen w/ twins since they have an interconnection & one twins can take blood & nutrition away from the other;

Front 31

Describe the true sinusoidal pattern.

Back 31

5-15 beat amplitude, flat beat to beat variability, long term cycles every 2-5/minute; no accelerations; oscillation above or below a baseline.

Front 32

What are accelerations? When do they occur? Are they ok?

Back 32

abrupt increases in rate; can occur @ any time, w/ fetal movement, stimulation of fetus, uterine contraction, cord compression; Yes, they're normal b/c they represent intact neurohormonal cardiovascular control mechanism.

Front 33

What are the 3 types of decelerations?

Back 33

early, late, variable;
early: at time of contraction
late: start at or past contraction peak; indicate poor uterine profusion or placental fxn.seen w/ any process causing maternal hypotension (ex. anaesthetic), placental dysfxn.
Variable: abrupt dec in rate & variable in profusion.

Front 34

What is a nadir?

Back 34

top of contraction

Front 35

What are the 2 most common causes of decelerations?

Back 35

epideral analgesia & oxytocin (maternal contraction dec blood supply to fetus)

Front 36

What are the causes of placental dysfxn?

Back 36

maternal dz, HTN, diabetes, collagen vascular dz,

Front 37

what are the causes of variable deceleration?

Back 37

umbilical cord occlusion (ex. if baby has cord wrapped around its neck)

Front 38

What is prolonged deceleration?

Back 38

lasts 2-10 minutes from onset to return to baseline. Very scary! uterus has become hyperstimulated & baby's heart doesn't beat at all

Front 39

During what part of the labor are decelerations almost universal? What are the causes?

Back 39

2nd part of labor (cervix has dilated to 10 cm & mom is trying to push baby out); head compression & cord compression.

Front 40

What are the complications of internal fetal monitoring?

Back 40

rare but electrode could be placed on eye or face--this is a blind procedure, so you just need to try to feel where you are; pressure cath can puncture placenta or uterus, scalp would can become infected

Front 41

When is internal FHR not indicated?

Back 41

if mom has HIV, herpes, hep B or C b/c you don't want to make a cut on baby by accidence since it'll be surrounded by maternal blood.

Front 42

what is 'fetal distress'?

Back 42

vague term that lacks clinical precision, based on interpretation of fetal heart rate patterns; often recorded in times of c-section.

Front 43

Describe a NORMAL fetal heart rate.

Back 43

baseline 110-160 bts/min. variability 6-25 bts/min. accelerations present. no decelerations

Front 44

Describe a severely abnormal heart rate.

Back 44

recurrent or late variable decelerations w/ 0 variability; substantial bradycardia w/ 0 variability.