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What is the purpose of EFM? ✔Correct Answer-monitor how baby is doing and how he/she
will tolerate labor
Electronic Fetal Monitoring ✔Correct Answer-- fetal HR monitored w/ultrasound
- maternal ctx monitored w/pressure sensor
- sensors connected to recording machine --> print-out or view FHR and maternal CTX together
- 89% of mothers have EFM at some point
- provides: minute-by-minute information on fetus, insight into stresses on fetus
Oxygen pathway ✔Correct Answer-oxygen pathway (environment, lungs, heart, vasculature,
uterus, placenta, cord) --> fetal response (hypoxemia, hypoxia, metabolic acidosis, metabolic
academia)
Limitation of electric fetal monitoring ✔Correct Answer-- monitoring is adjunct tool --> not
diagnostic
- overly optimistic --> most of the problems have already occurred by L&D
- provides information only on current acid-base status of the fetus
- one point in time --> tracings can and will change
- Outcomes --> EFM leads to increase overall C/S rate compared to intermittent auscultation,
increased risk vacuum and forceps delivery, reduced rate of neonatal seizures, does not reduce
risk of CP (cerebral palsy)
Types of fetal monitoring ✔Correct Answer-1. intermittent auscultation
2. Continuous fetal monitoring
- external --> ultrasound doppler
- internal --> fetal scalp electrode (reserved for concerns about baby)
External monitoring ✔Correct Answer-- consists of tocotransducer and ultrasound transducer
- measures uterine ctx and FHR
- Tototransducer provides info about --> frequency, duration, relative strength of contractions
- DOES NOT give actual intrauterine pressure or anything about quality or intensity of
contractions
- indentability of uterine wall
1. nose --> mild
2. chin --> moderate
3. forehead --> strong
, Internal monitoring (when something bad happens) ✔Correct Answer-- consists of: spiral
electrode for FHR, IUPC (intrauterine pressure catheter)
- most precise method to monitoring FHR (beat to beat)
- placed during vaginal exam (cervix must be dilated at least 2cm, must have ROM, accessible
presenting part)
- contraindications: mom declines, moms with hepatitis, HIV, preterm babies (risk of ventricular
hemorrhage)
- electrode removed prior to birth
____________________ is the time between the beginning of one contraction and the
beginning of the next contraction ✔Correct Answer-frequency
______________ is the number of contractions in a 10 minutes period ✔Correct Answer-
number
______________ is measured from the beginning of the contraction to the completion of the
contraction ✔Correct Answer-duration
____________ is the strength. Peak of the contraction minus the resting tone ✔Correct
Answer-intensity
_____________ _____ is the intrauterine pressure when uterus is not contracting (relaxation)
✔Correct Answer-resting tone
__________________ ______ is the time from the end of one contraction to the beginning of
the next ✔Correct Answer-relaxation time
What happens to the uterus during contractions? ✔Correct Answer-CTX --> reduces blow flow
to placenta; temporary pause on blood flow during peak of ctx
- If there's already issues with utter-placental blood flow then --> blood flow is reduced for
longer period of time, predisposes fetus to hypoxia, takes less pressure to decrease blood flow
to uterus
Reassuring FHR ✔Correct Answer-- 100-160 BPM --> parasympathetic nervous system begins
to mature with gestational age
Tachycardia rate ✔Correct Answer-160+ --> early sign of hypoxemia
Bradycardia rate ✔Correct Answer-<110 --> later sign of hypoxia (prolonged bradycardia can
lead to progressive tissue oxygen debt
Sinusoidal rate ✔Correct Answer-- smooth, wavelike, undulating sine pattern in FHR baseline
Tachycardia ✔Correct Answer-- FHR above 160 BPM for at least 10 minutes