WEEK 2 OB FALL 2019

• Elements of EFM (electronic fetal monitoring) o Baseline: Mean fetal heart rate (FHR) rounded to nearest 5 bpm during a 10 minute period excluding accelerations and decelerations. o Variability and causes for increased or decreased variability: Fluctuations in the baseline FHR that are irregular in amplitude and frequency. Measured from peak to trough (rise and fall) of the HR and given a range within a 1 min period. Classified as absent, mild, or moderate. Most important predictor of adequate fetal oxygenation and fetal reserve during labor  Absent: Undetectable (looks like a straight line)  Minimal: < 6 bpm  Average: 6-25 bpm (implies intact CNS, normal cardiac responsiveness, fetus is well-oxygenated and doing well)  Marked: > 25 bpm o Causes for decreased variability: Fetal sleep cycle, hypoglycemia, hypoxia, placental perfusion problems, narcotics, magnesium sulfate. o Causes for increased variability: Fetal or maternal catecholamine release, scalp stimulation, concerning if persistent. o Accelerations: Abrupt increase in FHR above baseline usually a reassuring sign. 15 bpm for at least 15 seconds. Indicate healthy, well-oxygenated fetus with intact CNS. Basis of reactive NST. o Decelerations- causes and **interventions** (Take this to the next level of detail and know VEAL-CHOP and POOF and other interventions): Transitory decrease in the FHR from baseline. Classified as early, late, variable or prolonged.  Early: Occur with contractions • Rounded in shape • Gradual > 30 secs from onset to bottom (nadir)