EFM NCC
Why use fetal monitoring? - ANS-Primary goal is to prevent fetal and maternal morbidity
and mortality (prevent injury and death to mother and/ or baby), to prevent bad patient
outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored,
develop cerebral palsy? - ANS-3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? - ANS-Poor communication between providers.
Most errors are traceable back to communication errors.
Sentinel events - ANS-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 - ANS-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? - ANS-palpate and readjust
IUPC resting tone - ANS-20-25
IUPC resting tone with aminoinfusion - ANS-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
- ANS-amnioinfusion
Auscultation tools - ANS-intermittent monitoring, use fetoscope or hand help doppler to
trace.
Only true auscultation tool - ANS-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 - ANS-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 - ANS-normal FHR baseline, regular rhythm, presence of increases
from FHR baseline, no decreases from baseline
doppler category 2 - ANS-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 - ANS-there is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM - ANS-external monitoring: goal is to detect fetal heart movement
(efm)
Autocorrelation - ANS-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? - ANS-Directly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval - ANS-fetal tachycardia
Prolonged R-R interval - ANS-fetal bradycardia
FSE contraindications - ANS-communicable diseases: hepatitis and HIV
Normal uterine activity - ANS-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 - ANS-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? - ANS-turn down pitocin (reposition etc)
Reduce blood flow through the intervillous space - ANS-Mild Contractions (30 mmHG)
No blood flow through the intervillous space - ANS-Moderate Contractions (50 mmHG)
Why use fetal monitoring? - ANS-Primary goal is to prevent fetal and maternal morbidity
and mortality (prevent injury and death to mother and/ or baby), to prevent bad patient
outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored,
develop cerebral palsy? - ANS-3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? - ANS-Poor communication between providers.
Most errors are traceable back to communication errors.
Sentinel events - ANS-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 - ANS-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? - ANS-palpate and readjust
IUPC resting tone - ANS-20-25
IUPC resting tone with aminoinfusion - ANS-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
- ANS-amnioinfusion
Auscultation tools - ANS-intermittent monitoring, use fetoscope or hand help doppler to
trace.
Only true auscultation tool - ANS-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 - ANS-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 - ANS-normal FHR baseline, regular rhythm, presence of increases
from FHR baseline, no decreases from baseline
doppler category 2 - ANS-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 - ANS-there is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM - ANS-external monitoring: goal is to detect fetal heart movement
(efm)
Autocorrelation - ANS-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? - ANS-Directly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval - ANS-fetal tachycardia
Prolonged R-R interval - ANS-fetal bradycardia
FSE contraindications - ANS-communicable diseases: hepatitis and HIV
Normal uterine activity - ANS-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 - ANS-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? - ANS-turn down pitocin (reposition etc)
Reduce blood flow through the intervillous space - ANS-Mild Contractions (30 mmHG)
No blood flow through the intervillous space - ANS-Moderate Contractions (50 mmHG)
