None. What should the nurse do before appropriate clinical interventions are initiated? They are characteristically variable in duration, intensity and timing. Auscultation of the fetal heart rate (FHR) is performed by external or internal means. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. 04 November 2020 Category II tracings are defined as indeterminate, are common, and represent all tracings that do not fall into the Category I or III groups.2,5 They vary widely in level of concern for acidosis, so the family physician must determine the severity of the Category II tracing and take the appropriate action.2,5,7,35, There is a direct association between fetal acidosis, recurrent decelerations, and depth of decelerations2,5,34,36; however, the presence of moderate variability and/or accelerations offers reassurance in Category II tracings because the presence is predictive of a lack of fetal acidosis.2,4,26,27,34,3638 For Category II tracings without spontaneous or provoked accelerations, minimal/absent variability, or deep decelerations (i.e., FHR drops to 70 bpm or less), immediate action is needed.3,4, A management algorithm30 (eFigure A) has been developed that is based on the suspected degree of fetal acidosis and ideally minimizes unnecessary interventions.7, A five-tiered classification/management scheme for management of Category II tracings has been developed (http://www.obapps.org).7,37,39 Each continuous electronic fetal monitoring tracing is color coded to represent the threat of acidosis based on the National Institute of Child Health and Human Development definitions, and Category II is broken into three separate severity and intervention subcategories based on the presence of accelerations and/or moderate variability.7,37 This classification has been shown to improve identification of fetal acidosis and newborns requiring immediate intervention after delivery.37, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation(Figure 1).2,7,16,21,27,3033 Lateral recumbent maternal positioning reduces compression of the maternal vena cava and aorta and the fetal umbilical cord.2,32,33 Intravenous fluid boluses up to 1 L have been shown to improve fetal oxygenation up to 30 minutes after administration.32,33 Maternal oxygen may be administered after other maneuvers, but it can be discontinued after tracing improvement because there is no evidence to support its routine use.2,32,33 Modification in maternal pushing efforts, such as initiating only with the urge to push and allowing for fetal recovery by pushing with every second or third contraction, can improve maternal and fetal oxygenation.40, Category III tracings, defined by a sinusoidal FHR pattern (Figure 37) or absent FHR variability (Figure 47) with recurrent late and/or variable decelerations or fetal bradycardia (see the Fetal Bradycardia section), require immediate intrauterine resuscitation and intervention.2,5,8,14,27,30,32,33,38,39 If the Category III tracing does not rapidly improve, expedited delivery is recommended. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. An increase in risk status during labor, such as the diagnosis of chorioamnionitis, may necessitate a change in monitoring from structured intermittent auscultation to continuous EFM. Assessments - Electronic Fetal Monitoring Appendix A: Amnioinfusion Appendix B: Selected FHR Tracings and Cases: Interpretation and . A meta-analysis showed that if there is absent or minimal variability without spontaneous accelerations, the presence of an acceleration after scalp stimulation or fetal acoustic stimulation indicates that the fetal pH is at least 7.20.19, If the FHR tracing remains abnormal, these tests may need to be performed periodically, and consideration of emergent cesarean or operative vaginal delivery is usually recommended.15 Measurements of cord blood gases are generally recommended after any delivery for abnormal FHR tracing because evidence of metabolic acidosis (cord pH less than 7.00 or base deficit greater than 12 mmol per L) is one of the four essential criteria for determining an acute intrapartum hypoxic event sufficient to cause cerebral palsy.20, When using continuous EFM, tracings should be reviewed by physicians and labor and delivery nurses on a regular basis during labor. Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. The nurse's action after turning the patient to her left side should be: Applying oxygen per face mask at 8-10 L/min. No. 740-591-8118. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. The patient is having contractions every 4 minutes, each lasting 50 seconds. Countdown to Intern Year, Week 4: Fetal Heart Tracings | ACOG Accelerations (A). Quizzes 6-10. Fetal Assessment quiz Flashcards | Quizlet 3. This content is owned by the AAFP. If you have any feedback on our "Countdown to Intern Year" series, please reach out to Samhita Nelamangala at [email protected]. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Chemoreceptors located in the aortic and carotid bodies respond to hypoxia, excess carbon dioxide and acidosis, producing tachycardia and hypertension.15 The FHR is under constant and minute adjustment in response to the constant changes in the fetal environment and external stimuli. Data Sources: PubMed searches were completed using the key terms intrapartum fetal heart monitoring, cardiotocography, structured fetal heart monitoring, National Institute of Child Health and Human Development classifications, amnioinfusion, and advanced life support in obstetrics. What would be an appropriate next action by the nurse? a streams response to precipitation. Category I tracings reflect a lack of fetal acidosis and do not require intervention. 1. The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. All Rights Reserved. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. d) volcanic neck Mosby's Pocket Guide to Fetal Monitoring: A Multidisciplinary - eBay They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. 1. Additionally, an Apgar score of less than 7 at five minutes, low cord arterial pH (less than 7.20), and neonatal and maternal hospital stays greater than three days were reduced.22, Tocolytic agents such as terbutaline (formerly Brethine) may be used to transiently stop contractions, with the understanding that administration of these agents improved FHR tracings compared with untreated control groups, but there were no improvements in neonatal outcomes.23 A recent study showed a significant effect of maternal oxygen on increasing fetal oxygen in abnormal FHR patterns.24. What is an appropriate initial intervention in this case? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. VEAL CHOP Nursing Mnemonic: Complete Guide - Nurseslabs The nurse understands that this NST will be read as: A woman in active labor has just received an epidural. 3/10/2017 Fetal Heart Tracing Quiz 1 Correct. -6:Suspect lack of adequate oxygen, Repeat BPP in 24 hours & deliver if <= 6 Mucus plug: What is it and how do you know you've lost it during pregnancy? The use of amnioinfusion for recurrent deep variable decelerations demonstrated reductions in decelerations and cesarean delivery overall.

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