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AWHONN Advanced Fetal Monitoring Exam 2025 |
Fetal Heart Rate Interpretation, Intrauterine
Resuscitation, Documentation, and Clinical
Decision-Making | Updated Questions and
Answers
Which contraction characteristics can be assessed with a tocodynamometer? a) Frequency b) Duration c) Intensity ---------CORRECT ANSWER-----------------a) Frequency b) Duration All Fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point? ---------CORRECT ANSWER-----------------Uterus The FHR can be monitored using doppler ultrasound? a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated b) Internally c) Only early in labor d) The FHR cannot be monitored by doppler ultrasound ---------CORRECT ANSWER- ----------------a) Throughout labor and delivery unless the use of a more accurate method is clearly indicated
What is the normal range for FHR base line in a term infant? a) 80-120 bpm b) 110-160 bpm c) 140-180bpm d) it depends on the sex of the fetus ---------CORRECT ANSWER-----------------b) 110- 160 bpm Trace the flow of oxygen from mother to fetus and back. ---------CORRECT ANSWER-----------------Mother's inhalation to lungs to mat. circulatory system to hemoglobin in RBC's to bloodstream in uterus. Uterus to spiral arteries to placenta to intervillous space to travel via simple diffusion into the villi. The capillaries to the umb. vein to the fetus. The umb. artery sends waste (CO2) to the intervillous space to the mothers venous system. What factors impact maternal oxygen delivery? ---------CORRECT ANSWER----------- ------1. Mother (blood plasma, cardiac output, hemoglobin concentration & O saturation)
- Placenta/intervillous space (uterine contractions & calcification's)
- Fetus (vagal response aka decel or cord compression)
Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply. A) Place the woman in a supine position. B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. D) Continuous Fetal Monitor E) Administer ephedrine per MD order ---------CORRECT ANSWER----------------- Place her in lateral position, & increase IV fluids. If no improvement may need to give epi to increase vascular tone. Define maternal hypertension (gestational). ---------CORRECT ANSWER----------------
- systolic BP >= 140mm hg, a diastolic BP>= 90 mm hg or MAP of >= What is the normal expected value for a term fetal HGB? ---------CORRECT ANSWER-----------------17g/dl, fetal hgb has a higher oxygen affinity than an adult to develop in an oxygen poor environment. The fetal circulatory pattern ensures blood with higher O2 and nutrition content is delivered to the vital organs (brain and heart) to tolerate the stress of labor. Detail the umbilical cord ---------CORRECT ANSWER-----------------1 vein, 2 arteries encased in wharton's jelly.
O2 (high content) travels via the vein CO2 travels via 2 arteries back to placenta Define cord compression. ---------CORRECT ANSWER-----------------A decrease of blood flow and O2 delivery to fetus & increases CO2 level in fetus. Transient cord compression can be common in labor. Variable FHR decel's is frequently associated with cord compression. Explain persistent or recurrent cord compression concerns and what to look at. --- ------CORRECT ANSWER-----------------May lead to hypoxemia and fetal acidemia. The depth of variable deceleration's is not enough to determine degree. Evaluate oxygenation through baseline heart rate characteristics through rate, variability and presence or absence of accelerations. Explain transient interruptions in fetal oxygen supple during labor. --------- CORRECT ANSWER-----------------A normal part of labor. As contractions build increased uterine pressure prevents blood from entering/leaving the intervillous space. During the peak the fetus relies completely on its oxygen reserve (an aerobic challenge that is not an issue for a health fetus. Define Uteroplacental insufficiency (UPI) ---------CORRECT ANSWER----------------- Chronic deficiency of placenta function, usually from an interruption of oxygenation pathway due to abruption, mat. hypo or hypertension or other issues. Infant is not tolerant of contractions. Can result in fetal grow restrictions (FGR)
How can you determine if the placenta is functioning optimally? ---------CORRECT ANSWER-----------------ID risk factors such as HTN (=vasoconstriction), Maternal smoking, abruption, post-term pregnancy, maternal diabetes and consider FHR characteristics How much blood normally flows to the placenta? ---------CORRECT ANSWER--------- -------- 500 - 700ml to the uterus per minute, 80% is directed to the placenta How many uterine contractions can be tolerated? ---------CORRECT ANSWER-------- ---------This depends on oxygenation which is reflected in FHR variability and accelerations on the fetal monitor tracings. What conditions impact the following pathways: Umbilical cord Maternal inhalation Placenta Uterus Fetus Maternal circulation ---------CORRECT ANSWER-----------------Umb. cord - Proplapse Mat. inhalation - Asthma Placenta - Calcification Uterus - Tachysystole
Fetus - Rh isoimmunization (fetal anemia) Mat. circulation - Hypertension Fetal Heart Rate Monitoring (two methods) ---------CORRECT ANSWER----------------
- Helps Assess Fetal Well-Being Can Use external Doppler US Device or Internal Fetal Scalp Electrode Should Be Monitored Every 30 Minutes in Stage I, Every 15 Minutes in Stage 2 When using toco what do you set the uterine resting tone or baseline to? What is toco measuring? ---------CORRECT ANSWER----------------- 10 - 20 mm Hg (this is an arbitrary #) Toco detects increases and decreases but can not quantify pressure. When using IUPC what is the resting tone or baseline? What is the IUPC measuring? ---------CORRECT ANSWER-----------------Between 5- 20 mm Hg IUPC gives a quantified measure of intrauterine pressure. What is the duration?
What is a Montevideo unit (MVU)? How do you calculate MVU's? ---------CORRECT ANSWER-----------------MVU's quantify uterine activity over 10 min period, requires the use of an IUPC. Minus the resting tone from the peak intensity of each contraction in a 10 min period and add the values together. At least 200 MVU's results in progressive cervical change. How do you palpate a contraction? Describe the intensities. ---------CORRECT ANSWER-----------------Using your fingertips at the fundus you can assess duration and frequency. Intensity: nose= mild chin=moderate forehead=strong Explain what a Tocodynamometer is, what it measures and its limitations. --------- CORRECT ANSWER-----------------Monitors changes in the contour of the maternal abdomen caused by uterine contractions, is placed over the fundus. Can measure relative changes in pressure, duration and frequency of contractions. Can NOT measure intensity. Women with large amounts of abdominal adipose tissue can be difficult to monitor.
Explain what an intrauterine pressure catheter is, what it measures and its limitations. ---------CORRECT ANSWER-----------------Most accurate method of assessing uterine contractions. Inserted through dilated cervix, its sensor tip monitors changes in pressure of the amniotic fluid. Measures resting tone, duration, frequency and intensity of contractions. Can NOT be used unless membranes are ruptured. How do you determine fetal oxygenation? Name the 5 characteristics ---------CORRECT ANSWER-----------------Fetal heart rate patterns 5 characteristics 1 Baseline heart rate 2 Rhythm 3 FHR variability 4 Presence of accelerations 5 Periodic or episodic deceleration's What are fetal baseline guidelines? Range? <32 weeks gest
32 weeks gest change in baseline ---------CORRECT ANSWER-----------------Must be 2 min of segments. Range 110-160 BPM (represented in a multiple of 5)
Is the baseline in this fetal tracing of a fetus at 40 weeks gestation normal or abnormal? ---------CORRECT ANSWER-----------------Baseline FHR is 130 BPM which falls within the range of normal baselines 110-160 BPM Is this baseline in this fetal tracing of a fetus at 26 weeks gestation normal or abnormal? ---------CORRECT ANSWER-----------------Baseline FHR is 135 BPM which falls within the range of normal baselines 110-160 BPM Is this baseline in this fetal tracing of a fetus at 24 weeks gestation normal or abnormal? ---------CORRECT ANSWER-----------------The baseline heart rate is 210 BPM which is outside the range of the normal baseline of 110-160 BPM. Define fetal tachycardia and factors that contribute to fetal tachycardia. --------- CORRECT ANSWER-----------------A baseline FHR of 160 BPM for at least 10 min. Contributing factors include hyperthermia, infections (maternal or fetal), maternal dehydration, hyperthyroidism, anxiety, drugs that stimulate the central nervous system, fetal immaturity, a cardiac conduction defect, or hypoxemia. Define fetal bradycardia and factors that contribute to fetal bradycardia. --------- CORRECT ANSWER-----------------A baseline FHR of <110 BPM for at least 10 min. Contributing factor include stimulation the fetal vagus nerve possibly due to prolonged head compression or application of the forceps or vacuum, fetal cardiac conduction defect such as heart block, maternal hypotension and drugs that timulate the parasympathetic branch or block the sympathetic branch of the autonomic nervous system such as anesthesia and regional analgesia or
hypoxemia. Hypoxic causes include maternal hypotension, placental abruption, cord prolapse or uterine rupture. Sympathetic impulses decrease or increase a fetal heart rate? ---------CORRECT ANSWER-----------------increase or speed up Parasympathetic impulses decrease or increase a fetal heart rate? --------- CORRECT ANSWER-----------------decrease or slow down Define fetal variability. ---------CORRECT ANSWER-----------------Fluctuations in the baseline FHR that are irregular in amplitude and frequency. Visually quantified as the amplitude of the peak to the trough in BPM within the baseline range. It is an indirect measure of fetal oxygenation. Explain absent FHR variability. ---------CORRECT ANSWER-----------------undetectable amplitude range can be indicative of impending fetal hypoxia Explain minimal variability. ---------CORRECT ANSWER-----------------amplitude
undetectable (visually detectable but less than or equal to 5 BPM) can be indicative of impending fetal hypoxia
What is the variability? ---------CORRECT ANSWER-----------------Minimal- Small fluctuations in the FHR, detectable but not more than 5 BPM What is the variability? ---------CORRECT ANSWER-----------------Moderate-note the span of the fluctuations in the baseline FHR. They are 10-20 BPM in height. The range of moderate variability is 6-20 BPM What is the variability? ---------CORRECT ANSWER-----------------Marked- note the wide span of the fluctuations in the baseline FHR. In this case the fluctuations are
25BPM. What does the absence of variability suggest? ---------CORRECT ANSWER------------- ----Can be a sign of inadequate oxygenation, may indicate a fetal central nervous system or cardiovascular anomaly, or may indicate a pre-existing fetal brain injury. May also result from maternal medications such as mag sulfate or narcotics. What does marked variability suggest? ---------CORRECT ANSWER-----------------An increase in variability from moderate to marked may indicate early stages of fetal hypoxemia or can be normal. Therefore baseline is a key assessment.
What does moderate variability suggest? ---------CORRECT ANSWER----------------- Moderate variability shows intact neurological modulation of the FHR, normal cardiac responsiveness, and fetal reserve. This predicts the absence of fetal metabolic acidemia at the time it is seen and indicates the fetus is well oxygenated. What does persistent absent variability of the FHR in combination with recurrent late or variable decelerations or bradycardia suggest? ---------CORRECT ANSWER--- --------------Abnormal fetal acid-base status and possible hypoxemia or impending acidemia. This pattern requires prompt evaluation and intervention. Define accelerations in FHR ---------CORRECT ANSWER-----------------Visually apparent abrupt increases from the onset of the acceleration to peak in < seconds in the FHR above baseline. They may be periodic (assoc. w/contractions) or episodic (not assoc. w/contractions) The peak must be >15 BPM and must last
15 seconds from onset to return to baseline. Before 32 wks gest. an acceleration is defined as >10 BPM and a duration of >10 seconds. Define decelerations of the FHR. ---------CORRECT ANSWER-----------------Changes in the FHR from baseline. Can be periodic or episodic and are defined depending on their timing in relation to contractions. Classification of a tracing w/ decelerations depends on the the type and context of the tracing. They are quantified by depth and nadir in BPM(except transient spikes or electronic artifact). The duration is quantified in minutes and seconds from beginning to end of the deceleration.
Define a late deceleration ---------CORRECT ANSWER-----------------Shaped like an early decel-visually apparent, usually symmetrical, gradual decrease and return of the FHR associated with a contraction
- the lowest point of the decel will occur after the peak of the contraction. They dip no more than 30-40 BPM below the baseline. This does not tell the degree of hypoxia. What are late decels with absent variability predictive of? ---------CORRECT ANSWER-----------------Abnormal fetal acid-base status and require an evaluation and prompt intervention. What are variable decelerations? ---------CORRECT ANSWER-----------------May be periodic or episodic, the most common pattern seen during labor. Their shape and depth are variable, not like early or late's, rarely smooth and regular. A visually apparent abrupt decrease in FHR from onset of decel to nadir of < seconds. The decrease is >15 BPM lasting >15 seconds and < 2 minutes in duration. Usually assoc. with cord compression, fetal baroreceptors increase the FHR to maintain cardiac output. Define prolonged deceleration of the FHR. ---------CORRECT ANSWER----------------- A decrease in FHR of > 15 BPM lasting > 2 min but < 10min from onset to return to baseline. Any decel longer than >10 min is a baseline change.
Prolonged decels are due to a sudden significant change in the fetal environment rather than a repetitive stimulus. Immediate communication/ intervention is necessary. True or False A preterm fetus my be more susceptible to hypoxemia ---------CORRECT ANSWER-- ---------------true True or False The nervous system is not fully developed in fetuses prior to 32 wks gest. --------- CORRECT ANSWER-----------------true What are the different characteristics of a fetus prior to 32 wks gest. than a term fetus? ---------CORRECT ANSWER-----------------1. Higher baseline FHR i.e. a 23 wk gest may have a baseline of 155 BPM but at term, the same baby may have a baseline of 130 BPM. Any baseline above 160 BPM is still considered tachycardia.
- Decreased variability bc the central nervous system is not fully developed, variability may be decreased.
- lower amplitude accels in preterm (before 32 wks) accels of at least 10 BPM above baseline for at least 10 sec is acceptable.
- more frequent occurrences of variable decels
