EFM NCC Exam Study Guide

EFM NCC Exam Study Guide Why use fetal monitoring? - 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? - 3% of babies with poor tracing develop cerebral palsy What are most sentinel events due to? - Poor communication between providers. Most errors are traceable back to communication errors. Sentinel events - 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 - 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? - palpate and readjust IUPC resting tone - 20-25 IUPC resting tone with aminoinfusion - 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 - amnioinfusion Auscultation tools - intermittent monitoring, use fetoscope or hand help doppler to trace. Only true auscultation tool - 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 - 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 - normal FHR baseline, regular rhythm, presence of increases from FHR baseline, no decreases from baseline doppler category 2 - 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 - there is none! auscultation because there is no variabile determination with auscultation goal of external EFM - external monitoring: goal is to detect fetal heart movement (efm) Autocorrelation - 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? - Directly monitors R to R ratio (with scalp lead), definitively measures baby's heartbeat and when the heart is firing Narrow R-R interval - fetal tachycardia Prolonged R-R interval - fetal bradycardia FSE contraindications - communicable diseases: hepatitis and HIV Normal uterine activity - 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