National Certification Corporation (NCC) Electronic Fetal Monitoring Certification Test 1, Answered

National Certification Corporation (NCC) Electronic Fetal Monitoring Certification Test 1, Answered-Causes of uteroplacental perfusion decrease: - • HTN • Pregnancy • DM • Hypotension • Excessive uterine contractions (hypertonus) • Decreased surface area, edema, degenerative calcifications, infarcts, infection FHR reflects fetal oxygenation from which extrinsic factors: - • Maternal oxygenation • Uterine blood flow • Placental change • Umbilical blood flow FHR reflects oxygenation from which intrinsic factors: - • Fetal circulation • Oxygenation of tissues • FHR regulation Fetal shunts: - • Ductus venosus- liver • PFO- Right to left atria • Ductus arteriosis- pulmonary a. to aorta Oxygen depletion cascade: - • Aerobic metabolism • Hypoxemia • Tissue hypoxia • Anaerobic metabolism • Lactic acid build up • Metabolic acidosis Sympathetic innervation: - • Releases Eip/norepi • Increases FHR Parasympathetic/Vagal innervation: - • Releases ach • Decreases FHR and transmits variability Early decel: - • Fetal head compression • ->vasovagal response Variable decel: - • Cord compression • ->increase BP/HTN • ->activation of baroreceptor • ->decrease FHR, BP, and CO Late decel: - • Inadequate uteroplacental blood flow->decreased maternal fetal O2 transfer • ->activation of chemoreceptors to respond due to increased PCO2, decreased PO2, and decreased pH • ->Fetal bradycardia and hypertension Category I: - • Normal fetal acid base status • All the following are required: • Moderate variability • Baseline rate 110-160 • Late or variable decels are absent • Early decels present or absent • Accels present or absent Category II: - • Indeterminate compensatory response • Not category I or II Category III: - • Abnormal fetal acid-base status • Either required • Absent variability with: o Recurrent late decels, or o Recurrent variable decels, or o Bradycardia • Sinusoidal pattern