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Fetal Monitoring Certification: Heart Rate Patterns & Interventions, Exams of United States Philosophy

West Chester University of Pennsylvania (WCUPA)United States Philosophy

This study guide provides a comprehensive overview of fetal heart rate (fhr) monitoring during labor and delivery. It covers the causes of uteroplacental perfusion decrease, the factors influencing fhr, fetal shunts, and the oxygen depletion cascade. The guide also explains the different categories of fhr tracings, including normal, indeterminate, and abnormal patterns. It further delves into in-utero resuscitation techniques and the interpretation of umbilical cord blood gas values. This resource is valuable for students and professionals in the field of obstetrics and maternal-fetal medicine.

Typology: Exams

2024/2025

Available from 02/26/2025

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NCC Electronic Fetal Monitoring Certification
Study Guide
1. Causes of uteroplacental perfusion decrease:: • HTN
• Pregnancy
• DM
• Hypotension
• Excessive uterine contractions (hypertonus)
• Decreased surface area, edema, degenerative calcifications, infarcts,
infection
2. FHR reflects fetal oxygenation from which extrinsic factors:: •
Maternal oxygenation
• Uterine blood flow
• Placental change
• Umbilical blood flow
3. FHR reflects oxygenation from which intrinsic factors:: • Fetal circulation
• Oxygenation of tissues
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NCC Electronic Fetal Monitoring Certification

Study Guide

  1. Causes of uteroplacental perfusion decrease:: • HTN
  • Pregnancy
  • DM
  • Hypotension
  • Excessive uterine contractions (hypertonus)
  • Decreased surface area, edema, degenerative calcifications, infarcts, infection
  1. FHR reflects fetal oxygenation from which extrinsic factors:: • Maternal oxygenation
  • Uterine blood flow
  • Placental change
  • Umbilical blood flow
  1. FHR reflects oxygenation from which intrinsic factors:: • Fetal circulation
  • Oxygenation of tissues
  • FHR regulation
  1. Fetal shunts:: • Ductus venosus- liver
  • PFO- Right to left atria
  • Ductus arteriosis- pulmonary a. to aorta
  1. Oxygen depletion cascade:: • Aerobic metabolism
  • Hypoxemia
  • Tissue hypoxia
  • Anaerobic metabolism
  • Lactic acid build up
  • Metabolic acidosis
  1. Sympathetic innervation:: • Releases Eip/norepi
  • Increases FHR
  1. Parasympathetic/Vagal innervation:: • Releases ach
  • Decreases FHR and transmits variability

PO2, and decreased pH

  • ->Fetal bradycardia and hypertension
  1. Category I:: • Normal fetal acid base status
  • All the following are required:
  • Moderate variability
  • Baseline rate 110-
  • Late or variable decels are absent
  • Early decels present or absent
  • Accels present or absent
  1. Category II:: • Indeterminate compensatory response
  • Not category I or II
  1. 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
  1. In-Utero resuscitation:: • Change maternal position
  • Decrease uterine activity
  • IV fluid bolus
  • Correct maternal hypotension
  • Oxygen administration
  • Amnioinfusion
  • Alteration in 2nd stage maternal pushing efforts
  • If prolapsed cord, then elevate fetal presenting part while moving toward operative birth
  1. Baseline FHR:: • Approximate mean FHR excluding accelerations and decel- erations or periods of marked variability (>25 bpm)
  • Minimum of 2 minutes of identifiable BL segments in any 10 min window
  • May need to refer to previous 10 min window
  1. Baseline variability:: • Irregular fluctuation in baseline FHR in both amplitude and frequency
  • Absent- Undetectable
  • Minimal- 0-
  • Moderate- 6-
  • Delay in timing- nadir after peak of contraction
  1. Variable decel definition:: • Abrupt (variable) decrease in FHR (onset of decel to beginning of nadir <30 sec)
  • Decrease in FHR >=15 bpm below BL for >=15 sec and < 2 min
  1. Prolonged decel definition:: • Decrease in FHR >=15 BPM below BL
  • Lasting >= 2 min, but <10 min
  1. Causes of prolonged deceleration:: • Uterine hyperstimulation or hypertonus
  • Abruptio placenta
  • Acute maternal hypotension
  • Uterine rupture
  • Maternal hypoxia (seizure or respiratory depression)
  • Umbilical cord accidents
  • Terminal fetal conditions
  • Ruptured vasa previa
  • Rapid fetal decent
  • Vagal stimulation or maternal valsalva
  1. Bradycardia definition:: • BL FHR <110 bpm for >=10 min
  • Make sure it is not mother's HR
  • BB and CCB may cause
  1. Tachycardia definition:: • BL FHR >160 bpm for >=10 min
  2. Causes of tachycardia:: • Maternal or fetal infection (chorio or pyelo)
  • Progressive disruption of fetal oxygenation (hypoxia, metabolic acidosis)
  • Fetal anemia
  • Maternal hyperthyroidism
  • Fetal tachyarrhythmias (sinus tach or SVT)
  • Smpathomimetics (terbutaline, ritodine, albuterol)
  • Parasympatholytic (atropine, phenothiazines)
  • Other (caffeine, theophylline, cocaine, methamphetamine)
  1. Sinusoidal definition:: • Sinusoidal wave with frequency of 3-5/min persisting for >=20min
  2. True sinusoidal associations:: • Severe fetal anemia (massive FMH, rup- tured vasa previa, Rh isoimmunization)
  • Severe hypoxia/acidosis/asphyxia
  1. Physiologic or drug induced sinusoidal associations:: • Rhythmic move- ments of fetal mouth or sucking
  • Fetal non-REM sleep
  1. Indications to attempt cord blood samples: • Abnormal FHR tracing
  • CS for fetal compromise
  • Thyroid dz
  • Severe growth restriction
  • Low 5 min Apgar
  • Intrapartum fever
  • Multifetal gestations
  1. Normal umbilical artery cord gas values:: • pH>7.
  • pCO2<
  • HCO3>
  • BE (base defecit) .-
  1. Respiratory acidemia:: • pCO2>
  2. Metabolic acidemia:: • HC03<
  • BE<-
  1. Mixed acidemia:: • pCO2>
  • HCO3<
  • BE<-
  1. Narcotics:: • Decrease variability
  • Decrease accelerations
  1. Butorphamon:: • Transient sinusoidal (pseudo-sinusoidal)
  1. Cocaine:: • Decrease variability
  2. Mag:: • Decrease variability
  3. Betamethasone:: • Decrease variability
  4. Terbutaline:: • Increased baseline FHR
  5. Zidovidine:: • No change
  6. B-Blockes:: • Decrease FHR
  7. CCBs:: • Decrease FHR