NM704 Exam 2: Questions With Proven Solutions (A+)
What are the ACNM recommendations IA monitoring during first and second
stage of labor? Right Ans - First Stage q15-30m
Second stage q15m and q5m for pushing
IA Relative to contractions Right Ans - In order to hear and appreciate
changes that are associate with contractions, especially decelerations, it is
recommended to listen
a. Through the end of the contraction
b. For at least 30 seconds after the end of the contraction to check the baseline
rate
Components of FHR assessment Right Ans - 1. Assess the baseline
2. Detecting changes from baseline
What factors cannot be assessed with IA? Right Ans - There are some FHR
attributes that can only be reliably assessed visually, and therefore require
CEFM. These include:
a. Baseline variability
b. Categorization of FHR deceleration as early, variable, or late
AWHONN advises:
a. Based on available research, IA is appropriate to assess FHR baseline rate,
rhythm, and increases or decreases from baseline
b. But NOT variability or types of declarations because they are based on
visual interpretation of FHR data
c. If auscultation of decreased FHR causes provider concern, a visual
assessment of FHR may be warranted and EFM may be initiated.
What categories are used in IA Right Ans - 1. Only Category I or Category II
designations are used for IA
2. Cannot use IA, for Category III because it requires visual assessment of
variability or a sinusoidal pattern
ALL of the following must be met Right Ans - 1. Normal FHR baseline 110-
160 bpm
,2. Regular rhythm
3. Presence OR absence of accelerations
4. Absence of decelerations
What is a category II in IA Right Ans - Any of the following:
1. Tachycardia (baseline >160 for >10 min)
2. Bradycardia (baseline <110 for >10 mins)
3. Irregular rhythm
4. Presence of decelerations
What 5 things must occur for optimal maternal-fetal gas exchange? Right
Ans - 1. Adequate flow of well-oxygenated maternal blood into the intervillous
space
2. Large enough placental area for exchange
3. Efficient diffusion of gases across the placental tissues that separate
maternal and fetal circulations
4. Unimpaired umbilical vein circulation into fetus
5. Adequate oxygen transport capacity in the fetus
Define asphyxia Right Ans - 1. Extreme deficiency of oxygen and carbon
dioxide excess
2. Caused by impaired gas exchange
3. Asphyxia is a continuum described by degrees of acidosis.
4. Clinically, the term is typically used only when tissue damage or death
occurs.
What are reasons fetuses usually becoming hypoxic (4 most common and 2
less common)? Right Ans - 1. A decrease in oxygen content in maternal
blood
2. Insufficient uterine/placental blood flow
3. Insufficient umbilical blood flow
4. Abnormal uterine contraction pattern -intrapartum
Less common
5. Fetal anemia -which decreases oxygen-carrying capacity
6. Pyrexia -which results in increased oxygen consumption
,Explain neonatal encephalopathy (NE) (3 points) Right Ans - 1. A complex
disease of the newborn associated with multi-organ dysfunction that occurs in
approximately 3 per 1000 live births in high-income nations
2. A clinically defined syndrome of disturbed neurologic functions in the
earliest days of life in the infant born at or beyond 35 weeks of gestation
3. S&S: subnormal level of consciousness or seizures, accompanied by
difficulty with initiating and maintaining respirations and depression of tone
and reflexes
What percentage of patients in US hospitals do EFM? Right Ans - 90%
What are the differences of outcomes between EFM and IA? (3 significant
differences) Right Ans - 1. EFM associated with approx. 50% increase in
C/S
2. EFM has slight increase in operative vaginal birth
3. EFM decrease in neonatal seizures (1.8% in EFM compared to 4.1% in IA
group)
No difference in APGAR scores, CP or perinatal mortality
How often is EFM monitored for "low risk" patients? First and second stage of
labor? Per ACOG Right Ans - First stage q30m
Second stage Q15min
How often is EFM monitored for "high risk" patients? First and second stage of
labor? Per ACOG Right Ans - First stage q15m
Second stage q5min
Define periodic changes Right Ans - Include early and late decelerations,
that occur in association with uterine contractions.
Define episodic changes Right Ans - Include variable and prolong
decelerations, are not clearly associated with uterine contractions.
Define normal uterine activity and tachysystole Right Ans - Normal = 5 cx
or less in 10 mins
Tachysystole = >5 cx in 10 mins
, Assessed based on the number of contractions in 10 min segment averaged
over 30 mins
How is baseline rate measured on EFM? (3 points) Right Ans - 1. The
approximate mean of FHR rounded to increments of 5 bpm during a 10-min
window
2. Excluding accels and decels and periods of marked variability (> 25bpm)
3. Duration must be 2 minutes
What is a normal baseline FHR? Right Ans - Normal =110-160
Tachycardia >160
Bradycardia <110
Physiology behind tachycardia Right Ans - 1. Short periods of tachycardia
are normal compensatory response to transient hypoxia
2. Mild tachycardia is common in fetus of less than 28 weeks
3. Admin of beta-mimetic drugs or ephedrine (for maternal hypotension)
4. Due to hypoxia caused by recurrent decelerations, decreasing variability
5. Maternal or fetal infection
6. Cardiac arrhythmias
7. Fetal anemia (Rh isoimmunization)
8. Acute fetal blood loss (placental abruption)
9. Poorly controlled maternal hyperthyroidism
Give possible causes of bradycardia Right Ans - 1. Fetal heart block
2. Maternal hypothermia
3. Can be idiopathic, especially in postmature fetus
4. Rapid descent of the fetal presenting part
5. End of second stage of labor when fetal head is compressed causing
intracranial pressure (vagal response) -okay oxygenation if FHR remains
>80bpm
6. Intrathecal opioids (maternal hypotension)
7. Local anesthetics for epidural (maternal hypotension)
When is a bradycardia NOT associated with fetal acidemia? Right Ans - 1.
When it is accompanied by moderate variability, when the FHR remains
What are the ACNM recommendations IA monitoring during first and second
stage of labor? Right Ans - First Stage q15-30m
Second stage q15m and q5m for pushing
IA Relative to contractions Right Ans - In order to hear and appreciate
changes that are associate with contractions, especially decelerations, it is
recommended to listen
a. Through the end of the contraction
b. For at least 30 seconds after the end of the contraction to check the baseline
rate
Components of FHR assessment Right Ans - 1. Assess the baseline
2. Detecting changes from baseline
What factors cannot be assessed with IA? Right Ans - There are some FHR
attributes that can only be reliably assessed visually, and therefore require
CEFM. These include:
a. Baseline variability
b. Categorization of FHR deceleration as early, variable, or late
AWHONN advises:
a. Based on available research, IA is appropriate to assess FHR baseline rate,
rhythm, and increases or decreases from baseline
b. But NOT variability or types of declarations because they are based on
visual interpretation of FHR data
c. If auscultation of decreased FHR causes provider concern, a visual
assessment of FHR may be warranted and EFM may be initiated.
What categories are used in IA Right Ans - 1. Only Category I or Category II
designations are used for IA
2. Cannot use IA, for Category III because it requires visual assessment of
variability or a sinusoidal pattern
ALL of the following must be met Right Ans - 1. Normal FHR baseline 110-
160 bpm
,2. Regular rhythm
3. Presence OR absence of accelerations
4. Absence of decelerations
What is a category II in IA Right Ans - Any of the following:
1. Tachycardia (baseline >160 for >10 min)
2. Bradycardia (baseline <110 for >10 mins)
3. Irregular rhythm
4. Presence of decelerations
What 5 things must occur for optimal maternal-fetal gas exchange? Right
Ans - 1. Adequate flow of well-oxygenated maternal blood into the intervillous
space
2. Large enough placental area for exchange
3. Efficient diffusion of gases across the placental tissues that separate
maternal and fetal circulations
4. Unimpaired umbilical vein circulation into fetus
5. Adequate oxygen transport capacity in the fetus
Define asphyxia Right Ans - 1. Extreme deficiency of oxygen and carbon
dioxide excess
2. Caused by impaired gas exchange
3. Asphyxia is a continuum described by degrees of acidosis.
4. Clinically, the term is typically used only when tissue damage or death
occurs.
What are reasons fetuses usually becoming hypoxic (4 most common and 2
less common)? Right Ans - 1. A decrease in oxygen content in maternal
blood
2. Insufficient uterine/placental blood flow
3. Insufficient umbilical blood flow
4. Abnormal uterine contraction pattern -intrapartum
Less common
5. Fetal anemia -which decreases oxygen-carrying capacity
6. Pyrexia -which results in increased oxygen consumption
,Explain neonatal encephalopathy (NE) (3 points) Right Ans - 1. A complex
disease of the newborn associated with multi-organ dysfunction that occurs in
approximately 3 per 1000 live births in high-income nations
2. A clinically defined syndrome of disturbed neurologic functions in the
earliest days of life in the infant born at or beyond 35 weeks of gestation
3. S&S: subnormal level of consciousness or seizures, accompanied by
difficulty with initiating and maintaining respirations and depression of tone
and reflexes
What percentage of patients in US hospitals do EFM? Right Ans - 90%
What are the differences of outcomes between EFM and IA? (3 significant
differences) Right Ans - 1. EFM associated with approx. 50% increase in
C/S
2. EFM has slight increase in operative vaginal birth
3. EFM decrease in neonatal seizures (1.8% in EFM compared to 4.1% in IA
group)
No difference in APGAR scores, CP or perinatal mortality
How often is EFM monitored for "low risk" patients? First and second stage of
labor? Per ACOG Right Ans - First stage q30m
Second stage Q15min
How often is EFM monitored for "high risk" patients? First and second stage of
labor? Per ACOG Right Ans - First stage q15m
Second stage q5min
Define periodic changes Right Ans - Include early and late decelerations,
that occur in association with uterine contractions.
Define episodic changes Right Ans - Include variable and prolong
decelerations, are not clearly associated with uterine contractions.
Define normal uterine activity and tachysystole Right Ans - Normal = 5 cx
or less in 10 mins
Tachysystole = >5 cx in 10 mins
, Assessed based on the number of contractions in 10 min segment averaged
over 30 mins
How is baseline rate measured on EFM? (3 points) Right Ans - 1. The
approximate mean of FHR rounded to increments of 5 bpm during a 10-min
window
2. Excluding accels and decels and periods of marked variability (> 25bpm)
3. Duration must be 2 minutes
What is a normal baseline FHR? Right Ans - Normal =110-160
Tachycardia >160
Bradycardia <110
Physiology behind tachycardia Right Ans - 1. Short periods of tachycardia
are normal compensatory response to transient hypoxia
2. Mild tachycardia is common in fetus of less than 28 weeks
3. Admin of beta-mimetic drugs or ephedrine (for maternal hypotension)
4. Due to hypoxia caused by recurrent decelerations, decreasing variability
5. Maternal or fetal infection
6. Cardiac arrhythmias
7. Fetal anemia (Rh isoimmunization)
8. Acute fetal blood loss (placental abruption)
9. Poorly controlled maternal hyperthyroidism
Give possible causes of bradycardia Right Ans - 1. Fetal heart block
2. Maternal hypothermia
3. Can be idiopathic, especially in postmature fetus
4. Rapid descent of the fetal presenting part
5. End of second stage of labor when fetal head is compressed causing
intracranial pressure (vagal response) -okay oxygenation if FHR remains
>80bpm
6. Intrathecal opioids (maternal hypotension)
7. Local anesthetics for epidural (maternal hypotension)
When is a bradycardia NOT associated with fetal acidemia? Right Ans - 1.
When it is accompanied by moderate variability, when the FHR remains
