NCC EFM Questions and Answers Already Graded A

NCC EFM Questions and Answers Already Graded A Causes of uteroplacental perfusion decrease: ✔✔• HTN • Pregnancy • DM • Hypotension • Excessive uterine contractions (hypertonus) • Decreased surface area, edema, deg ...

NCC EFM Questions and Answers Already Graded A 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 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 Baseline FHR: ✔✔• Approximate mean FHR excluding accelerations and decelerations 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 Baseline variability: ✔✔• Irregular fluctuation in baseline FHR in both amplitude and frequency • Absent- Undetectable • Minimal- 0-5 • Moderate- 6-25 • Marked >25 -> alpha-adrenergic response to decreased uteroplacental blood flow or ephedrine Causes of minimal variability: ✔✔• General anesthesia • Smoking • Quiet sleep • Mag • Acidemia Prolonged acceleration: ✔✔• >=2 min and < 10 min FHR accelerations: ✔✔• >=32- 15x15 • <32- 10x10 Scalp or vibroacoustic stimulation assures a fetal pH of: ✔✔• >=7.19 Recurrent: ✔✔• Occur with >=50% of contractions in any 20 min window Intermittent: ✔✔• Occur with <50% of contractions in any 20 min window Early decel definition: ✔✔• Usually symmetrical gradual decrease (onset to nadir >30 sec) and return to baseline FHR associated with uterine ctx • Nadir occurs at same time as peak of contraction Late decel definition: ✔✔• Usually symmetrical gradual decrease (onset of deceleration to nadir >30 sec) and return to baseline FHR associated with uterine ctx • Delay in timing- nadir after peak of contraction 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 Prolonged decel definition: ✔✔• Decrease in FHR >=15 BPM below BL • Lasting >= 2 min, but <10 min 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 Bradycardia definition: ✔✔• BL FHR <110 bpm for >=10 min • Make sure it is not mother's HR • BB and CCB may cause Tachycardia definition: ✔✔• BL FHR >160 bpm for >=10 min 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) Sinusoidal definition: ✔✔• Sinusoidal wave with frequency of 3-5/min persisting for >=20min True sinusoidal associations: ✔✔• Severe fetal anemia (massive FMH, ruptured vasa previa, Rh isoimmunization) • Severe hypoxia/acidosis/asphyxia Physiologic or drug induced sinusoidal associations: ✔✔• Rhythmic movements of fetal mouth or sucking • Fetal non-REM sleep • Narcotics How to alleviate umbilical cord compression (variable decles): ✔✔• Initiate maternal repositioning • Consider amniotransfusion (during 1st stage) • If prolapsed umbilical cord, elevate presenting part and go to operative delivery How to promote fetal oxygenation and improve uteroplacental blood flow (late decels): ✔✔• Initiate lateral position (R or L) • Administer oxygen at 10L/min with nonrebreather mask • IV fluid bolus • DC oxytocin or cervical ripening • Consider tocolytic (terbutaline) • If in second stage, consider stop pushing temporarily or alter pushing Normal uterine contractions definition: ✔✔• <=5 in 10 min averaged over 30 min Tachysystole definition: ✔✔• >5 in 10 min averaged over 30 min 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 Normal umbilical artery cord gas values: ✔✔• pH>7.1 • pCO2<60 • HCO3>22 • BE (base defecit) .-12 Respiratory acidemia: ✔✔• pCO2>60 Metabolic acidemia: ✔✔• HC03<22 • BE<-12 Mixed acidemia: ✔✔• pCO2>60 • HCO3<22 • BE<-12 Narcotics: ✔✔• Decrease variability • Decrease accelerations Butorphamon: ✔✔• Transient sinusoidal (pseudo-sinusoidal) Cocaine: ✔✔• Decrease variability Mag: ✔✔• Decrease variability Betamethasone: ✔✔• Decrease variability Terbutaline: ✔✔• Increased baseline FHR Zidovidine: ✔✔• No change B-Blockes: ✔✔• Decrease FHR CCBs: ✔✔• Decrease FHR