Ob Exam 1 Module 1 – Efm Exam With Correct Answers

OB Exam 1 Module 1 – EFM EXAM |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




WITH CORRECT ANSWERS |||\\\ |||\\\




What is EFM? - correct answer✔✔EFM provides a continuous tracing of the fetal heart rate
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allowing characteristics of the fetal heart rate (FHR) to be observed and evaluated
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What is the primary objective of fetal heart rate monitoring? - correct answer✔✔-The primary
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objective of FHR monitoring is to prevent fetal injury that might result from disruption of
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normal fetal oxygenation during labor |||\\\ |||\\\ |||\\\ |||\\\




-To identify FHR changes potentially associated with inadequate fetal oxygenation which will
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enable timely intervention to decrease the likelihood of hypoxic injury
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EFM Today - correct answer✔✔-Used in virtually all labors in U.S. hospitals.
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-Nurses are expected to assess, interpret and intervene in interpretations of EFM patterns.
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-Clear and accurate communication with providers is essential.
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-Informed consent? |||\\\




--Do we get the patient's consent or do we just put the monitors on?
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Benefits of EFM - correct answer✔✔-Evaluate fetal well-being |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-Helps identify fetal stress |||\\\ |||\\\ |||\\\




-Useful in diagnostic testing |||\\\ |||\\\ |||\\\




-Helps evaluate labor progress(?) |||\\\ |||\\\ |||\\\




Risks of EFM - correct answer✔✔-Supine postural hypotension
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--Can cause decelerations in the fetal because of decreased blood flow to fetus
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-Intrauterine perforation (with internal monitoring) |||\\\ |||\\\ |||\\\ |||\\\

,-Infection (internal monitoring) |||\\\ |||\\\




-Decreased personal interaction (attention paid to machine, not the patient) |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-Mother unable to ambulate or change position |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




--Affects mobility |||\\\




EFM Systematic Review showed no decrease in: - correct answer✔✔-Acidemia (cord blood)
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-5 min. Apgar scores <4
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-NICU admission |||\\\




-Perinatal mortality |||\\\




-Hypoxic ischemic encephalopathy (HIE) |||\\\ |||\\\ |||\\\




-Cerebral Palsy |||\\\




EFM Study results - correct answer✔✔-A decrease in neonatal seizures
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-An increase in operative vaginal deliveries and C-sections
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-Conclusion: routine use of EFM has no measurable impact on morbidity and mortality |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




EFM Evidence - correct answer✔✔-The use of FHR patterns to predict subsequent neurologic
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damage, such as cerebral palsy, results in a 99% false-positive rate.
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-Permanent neurologic damage is a rare event, and variant fetal heart rate patterns are |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




extremely common. |||\\\




-Interpretation → subjective process. |||\\\ |||\\\ |||\\\




-Experts will agree on approximately 60% of normal patterns but only 25% of pathologic
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patterns.



Factors that influence use of EFM have changed - correct answer✔✔-Subspecialty of
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neonatology

-Attempt to save very premature infants |||\\\ |||\\\ |||\\\ |||\\\ |||\\\

, -Use of surfactant /mechanical ventilation
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-Cesarean rates / cesarean on demand |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




-Induction

-Societal effects (age of women having children) |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




--People who previously would not have been able to have a baby are doing so now
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So why do we use EFM? - correct answer✔✔-It's very reassuring to parents
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-It provides a legal record when we have poor outcomes.
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--We can go back and identify what we missed, what we can do better
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-"Clearly, the most positive effect of EFM is that the fetus is now accepted as a patient 'to
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whom the perinatal team has a definitive duty.'"
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Why are we concerned about the EFM evidence? - correct answer✔✔-22,680,000 births that
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EFM was used for during a 6-month period in early 2000s (even higher now)
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-About 27% of C-sections are done because of variant FHR patterns seen on fetal monitoring
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--This is second most common indication
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--We may be intervening too early
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--Creates higher infection / anesthesia risks |||\\\ |||\\\ |||\\\ |||\\\ |||\\\




--Longer hospital stay |||\\\ |||\\\




-EFM is used by >80% of our patients in labor
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EFM Conclusion - correct answer✔✔-The routine use of EFM has no measurable impact on
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morbidity and mortality. |||\\\ |||\\\




-The goal of Electronic fetal monitoring is to recognize specific features of the FHR that suggest
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a normal acid-base balance, AND identify patterns that are indicative of impending or existing
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fetal acidemia so that appropriate interventions may be initiated
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--This is the goal of EFM |||\\\ |||\\\ |||\\\ |||\\\ |||\\\