Snapshot A 35-year-old woman at 42 weeks of gestation presents for an induction of labor due to postterm pregnancy. She reports positive fetal movement, and denies vaginal bleeding. After amniotomy is performed, a change in the fetal heart rate is noted, as seen in the tracing in the image. Maternal repositioning is performed. (Variable decelerations) Introduction Overview intrapartum fetal assessments are performed to assess fetal well-being during labor and delivery biophysical profile (BPP) fetal heart rate (FHR) monitoring electronic fetal monitoring (EFM) is the most common method to assess the fetus during labor Biophysical Profile (BPP) Five measurements of fetal well being, each rated on scale of 0 or 2 measurements fetal breathing gross body movements fetal tone extremity extension and flexion amniotic fluid volume nonstress test (NST) Scoring 8-10 is reassuring 6 is equivocal delivery if > 36 weeks repeat BPP in 24 hours if < 36 weeks ≤ 4 is abnormal requires immediate intervention, prompt delivery Fetal Heart Rate (FHR) Normal FHR 120-160/min Tachycardia is FHR > 160/min causes include maternal fever fetal hypoxia prematurity anemia (maternal or fetal) chorioamnionitis hyperthyroidism Bradycardia is FHR < 110/min for > 10 minutes causes include congenital heart block maternal β-blockers FHR variability reliable indicator of fetal well being causes of decreased variability include fetal hypoxia congenital heart anomalies Electronic Fetal Heart Rate Monitoring (EFM) Tracing Interpretation Accelerations ↑ FHR at least 15/min above baseline for ≥ 15 seconds and < 2 minutes in a 20 minute period when gestational age is > 32 weeks or 10/min for ≥ 10 seconds when gestational age is < 32 weeks considered a reactive NST (needs the presence of at least 2 accelerations) suggests fetal well being if this was a NST during pregnancy (not intrapartum), management would be routine-follow-up Early decelerations ↓ FHR (not below 100/min) that coincide with uterine contraction nadir of the deceleration meets the apex of the uterine contraction results from pressure on fetal head (fetal head compression) resulting in vagus nerve stimulation and reflex bradycardia physiologic and not harmful to fetus Variable decelerations may not coincide with uterine contractions rapid ↓ in FHR (often < 100/min) with variable recovery reflex mechanism due to umbilical cord compression rupture of membrane can lead to umbilical artery compression correct by shifting maternal position or amnioinfusion if membranes ruptured considered first-line if maternal repositioning does not improve FHR tracing, amnioinfusion can be considered Late decelerations begins after uterine contraction has started associated with uteroplacental insufficiency and viewed as potentially dangerous potential causes placental abruption maternal diabetes maternal anemia maternal sepsis postterm pregnancy hyperstimulated uterus repetitive late develerations require intervention Sinusoidal tracing sine-wave like pattern associated with increased morbidity and mortality indicative of severe fetal anemia e.g., severe hypoxia and Rh disease
QUESTIONS 1 of 9 1 2 3 4 5 6 7 8 9 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.OB.17.4867) A 28-year-old G1P0 woman at 42 weeks gestation is admitted to the maternity ward for induction of labor. She states that her prenatal care has been notable for gestational hypertension. She has been taking her multivitamin daily. She feels fetal movement and denies any vaginal bleeding. Her temperature is 98.6°F (37°C), blood pressure is 107/54 mmHg, pulse is 72/min, and respirations are 20/min. Her cervix is 0 cm dilated, and the fetus is in cephalic position. The fetal heart monitor shows a heart rate of 130/min. She agrees to have an epidural catheter placed for analgesia. Shortly thereafter, amniotomy is performed. No vaginal bleeding is observed. While attending to documentation of the procedure, the nurse calls your attention to a change in the fetal heart monitor, shown in Figure A. What is the most likely cause for this finding? QID: 109557 FIGURES: A Type & Select Correct Answer 1 Epidural analgesia 17% (10/59) 2 Cord compression 42% (25/59) 3 Vasa previa 2% (1/59) 4 Fetal head compression 10% (6/59) 5 Uteroplacental insufficiency 29% (17/59) M 6 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M2.OB.17.4867) A 28-year-old G1P0 woman who is 30 weeks pregnant presents to the women's health center for a prenatal checkup. She is concerned that her baby is not moving as much as usual over the past five days. She thinks she only felt the baby move eight times over an hour long period. Her prenatal history was notable for morning sickness requiring pyridoxine. Her second trimester ultrasound revealed no abnormal placental attachment. She takes a multivitamin daily. Her temperature is 98.6°F (37°C), blood pressure is 120/70 mmHg, pulse is 80/min, and respirations are 16/min. The patient's physical exam is unremarkable. Her fundal height is 28 cm, compared to 26 cm two weeks ago. The fetal pulse is 140/min with no accelerations. The patient undergoes external fetal monitoring. With vibroacoustic stimulation, the patient feels eight movements over two hours with no fetal heart rate accelerations. What is the best next step in management? QID: 109560 Type & Select Correct Answer 1 Reassurance 28% (5/18) 2 Induction of labor 0% (0/18) 3 Oxytocin challenge 17% (3/18) 4 Biophysical profile 44% (8/18) 5 Inpatient monitoring 6% (1/18) M 6 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.OB.15.95) You are the intern on the labor and delivery floor. Your resident asks you to check on the patient in Bed 1. She is a 27-year-old prima gravida with no significant past medical history. She has had an uncomplicated pregnancy and has received regular prenatal care. You go to her bedside and glance at the fetal heart rate tracing (Image A). What is the most likely cause of this finding? QID: 105265 FIGURES: A Type & Select Correct Answer 1 Fetal head compression 77% (24/31) 2 Utero-placental insufficiency 0% (0/31) 3 Cord compression 16% (5/31) 4 Fetal distress 3% (1/31) 5 Congenital heart block 0% (0/31) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (M2.OB.13.195) A 29-year-old G2P1001 woman at 39 weeks gestation presents to labor and delivery triage with intermittent lower abdominal pain. Her pregnancy has been followed and she is currently taking folate and a multivitamin. Her temperature is 98.0°F (36.7°C), blood pressure is 129/82 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. The fetal heart rate monitoring strip depicted in Figure A is obtained. Which of the following best explains this fetal heart rate tracing? QID: 105365 FIGURES: A Type & Select Correct Answer 1 Compression of the fetal head 21% (3/14) 2 Compression of the umbilical cord 21% (3/14) 3 Normal fetal heart rate tracing 7% (1/14) 4 Sleeping fetus 14% (2/14) 5 Uteroplacental insufficiency 36% (5/14) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
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