Why use fetal monitoring? - correct Primary goal is to prevent fetal and maternal
morbidity and mortality (prevent injury and death to mother and/ or
... [Show More] baby), to prevent
bad patient outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored,
develop cerebral palsy? - correct 3% of babies with poor tracing develop cerebral
palsy
What are most sentinel events due to? - correct Poor communication between
providers. Most errors are traceable back to communication errors.
Sentinel events - correct bad things that happen to patients due to a human or
equipment error, and not due to the reason that they came into the hospital (disease
process)
Equipment - correct your hands (palpation) use fingertips, ultrasound transducer,
FSE, tocodynamometer, Intrauterine Pressure Catheter, Auscultation (fetoscope, hand
held doppler device).
What if you can not get contractions? - correct palpate and readjust
IUPC resting tone - correct 20-25
IUPC resting tone with aminoinfusion - correct should not be above 40, troubleshoot if
this is higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or recurrent variables
- correct amnioinfusion
Auscultation tools - correct intermittent monitoring, use fetoscope or hand help
doppler to trace.
Only true auscultation tool - correct fetoscope, the reason is it is the only tool that
listens to the open and close of the fetal heart valve
Using the doppler or fetoscope - correct count the FHR before, during, and after a
contraction. Document the baseline rate (range), regular vs irregular, increases or
decreases. Do NOT document variability, accels, or decels
doppler category 1 - correct normal FHR baseline, regular rhythm, presence of
increases from FHR baseline, no decreases from baseline
doppler category 2 - correct includes ANY of the following: irregular rhythm, presence
of FHR decreases, tachycardia, bradycardia (i feel the need to intervene, I feel like I
can't walk out of the room)
doppler category 3 - correct there is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM - correct external monitoring: goal is to detect fetal heart
movement (efm)
Autocorrelation - correct how the monitor adjusts with every third beat using a
mathematical formula, that it is still monitoring this baby. Detected what is normal for
this baby and is making the appropriate adjustments.
What does the FSE measure? - correct Directly monitors R to R ratio (with scalp
lead), definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval - correct fetal tachycardia
Prolonged R-R interval - correct fetal bradycardia
FSE contraindications - correct communicable diseases: hepatitis and HIV
Normal uterine activity - correct Normal activity: less than 5 ctx in a 10 minute period
averaged over a 30 minutes period (5,5,6 OK but 6,5,6 NOT OK)
Excessive uterine activity - correct Tachysystole (not hyperstim), hypertonus (with
IUPC resting tone does not go below 20 mmHG-IUPC, 20-25mmhg shouldn't be
higher..if higher usually due to inadequate relation time), inadequate relaxation time,
tetanic contractions(cxn greater than 2 minutes)
What do you do with tachysystole? - correct turn down pitocin (reposition etc)
Reduce blood flow through the intervillous space - correct Mild Contractions (30
mmHG)
No blood flow through the intervillous space - correct Moderate Contractions (50
mmHG)
Adequate MVUS - correct 200-300...greater than 200, spontaneous labor less than
280 for the first stage but up to 400 for the second stage. Typically less than 300 (so
200-300).
Importance of doing multiple interventions sooner than later - correct you see
tachysystole or deceleration, turn pitocin off & IV bolus & resposition. Multiple
interventions are important. [Show Less]