Copyright 2009 by the American Academy of Family Physicians. c) caldera The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Air Force, Uniformed Services University of the Health Sciences, Department of Defense, or the U.S. government. The workshop introduced a new classification scheme for decision making with regard to tracings. The American College of Obstetricians and Gynecologists (ACOG) states that with specific intervals, intermittent auscultation of the FHR is equivalent to continuous EFM in detecting fetal compromise.4 ACOG has recommended a 1:1 nurse-patient ratio if intermittent auscultation is used as the primary technique of FHR surveillance.4 The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor.4 Continuous EFM is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients. -Related to fetal movement selected each time a collection is played. She asks the nurse to explain the results. Moderate. 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. Accelerations (A). -Accelerations my be present or absent. The electronic fetal monitor uses an external pressure transducer or an intrauterine pressure catheter (IUPC) to measure amplitude and frequency of contractions. Increase mainline IV Table 3 lists examples of nonreassuring and ominous patterns. Continuous EFM increased cesarean delivery rates overall (NNH = 20) and instrumental vaginal births (NNH = 33). You scored 6 out of 6 correct. Develop a plan, in the context of the clinical scenario, according to interpretation of the FHR. The nurse understands that the test will be read as which of the following? The nurse observes smooth, gradual decelerations to 135 bpm occurring with more than 50% of the contractions. 140 145 150 155 160 2. Finally, the recovery phase is due to the relief of the compression and the sharp return to the baseline, which may be followed by another healthy brief acceleration or shoulder (Figure 8). Table 1 lists examples of the criteria that have been used to categorize patients as high risk. May 2, 2022 The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. -2 points for each normal, 0 for abnormal, -8-10: Normal result ,Repeat BPP weekly Yes, and the strip is reactive. Consider need for expedited delivery (operative vaginal delivery or cesarean delivery). Statistical analysis included univariate analyses with Student T-test, one-way ANOVA, chi-square and Fisher exact test. A scalp pH of less than 7.20 is considered abnormal and generally is an indication for intervention, immediate delivery, or both.12 A pH less than 7.20 should also be assumed in the absence of an acceleration following fetal scalp stimulation when fetal scalp pH sampling is not available. Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. b. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Fetal hypoxemia results in biphasic changes in the ST segment of the fetal electrocardiography (FECG) waveform and an increase in the T:QRS ratio.15 The ST-segment automated analysis (STAN) software from Noventa Medical can record the frequency of ST events and, combined with changes in continuous EFM, can be used to determine if intervention during the labor process is indicated.15 Several studies have evaluated FECG analysis, documenting its effectiveness at reducing operative vaginal deliveries, fetal scalp sampling, neonatal encephalopathy, and fetal acidosis (pH < 7.05).2528 One drawback to this technology is that it requires rupture of the membranes and internal fetal scalp monitoring. 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. Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. NCC EFM Tracing Game. The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). Remember, the baseline is the average heart rate rounded to the nearest five bpm. What are the two most important characteristics of the FHR? If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. Gene amplification in cancer cells has been shown to lead to resistance to cancer-killing medications when the dose of medication is increased gradually. Variable and inconsistent interpretation of tracings by clinicians may affect management of patients. The nurse is assessing the fetal monitor tracings of a patient in labor. Fetal heart rate decreases lasting 10 minutes are categorized as a new baseline heart rate. Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. Persistent tachycardia greater than 180 bpm, especially when it occurs in conjunction with maternal fever, suggests chorioamnionitis. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the. Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. Pressure on the cord initially occludes the umbilical vein, which results in an acceleration (the shoulder of the deceleration) and indicates a healthy response. ), What do Braxton Hicks contractions feel like? Management includes further investigation into and correction of possible stressors.14,33, Variable decelerations are recurrent when they occur with greater than 50% of contractions in any 20-minute period2,5 (Figure 57). Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. The clinician and the patient with a low-risk pregnancy discuss the benefits of structured intermittent auscultation vs. continuous electronic fetal monitoring; patient agreement to structured intermittent auscultation is documented in medical record; labor team ensures appropriate nurse staffing (1:1), Labor nurse determines current fetal position and best location to place Doppler handheld probe (usually over the fetal back) with Leopold maneuvers; transabdominal ultrasonography (passive mode) can be used to identify the location of the fetal heart if manual palpation proves difficult, With one hand holding the probe in place, the other hand palpates the uterine fundus to detect maternal contractions, Following contractions, baseline fetal heart rate is assessed by counting the number of beats during a 30- to 60-second interval, For a minimum of 1 minute following contraction onset, fetal heart rate is reassessed at 6- to 10-second intervals to detect accelerations or decelerations in heart rate, American College of Obstetricians and Gynecologists, Association of Women's Health, Obstetric and Neonatal Nurses, At least hourly (< 4 cm cervical dilation), 15 to 30 minutes (4- to 5-cm cervical dilation), Any condition in which placental insufficiency is suspected, Maternal preeclampsia/gestational hypertension, Use of oxytocin (Pitocin) or other uterine stimulants for labor induction or augmentation. Fetal heart tracing is also useful for eliminating unnecessary treatments. 2. a streams response to precipitation. Periodic changes in FHR, as they relate to uterine contractions, are decelerations that are classified as recurrent if they occur with 50 percent or more of contractions in a 20-minute period, and intermittent if they occur with less than 50 percent of contractions.11 The decrease in FHR is calculated from the onset to the nadir of the deceleration. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Recurrent variable decelerations can be treated with amnioinfusion, the placement of isotonic fluids into the intrauterine cavity, with the same requirement and risks as the intrauterine pressure catheter and fetal scalp electrode mentioned previously.7 Amnioinfusion has been shown to reduce cord compression, leading to resolution of FHR decelerations (RR = 0.53; 95% CI, 0.38 to 0.74; n = 1,000) and lowering the likelihood of cesarean delivery (RR = 0.62; 95% CI, 0.46 to 0.83; n = 1,400).26,42. What is the peak current supplied by the emf A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. It means your fetus is neurologically responsive and doesnt have an oxygen deficiency. 3/10/2017 Fetal Heart Tracing Quiz 10 Correct. Identify type of monitor usedexternal versus internal, first-generation versus second-generation. A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? A.>6 contractions in 10 minutes averaged over twenty minutes B. The patient is being monitored by external electronic monitoring. Whenever possible, they will implement measures to prevent an unfavorable outcome. Compared with EFM alone, the addition of fetal electrocardiography analysis results in a reduction in operative vaginal deliveries (NNT = 50) and fetal scalp sampling (NNT = 33). Conclude whether the FHR recording is reassuring, nonreassuring or ominous. Any tracing not meeting the criteria of Category I or III, with any of the following findings: 5 contractions in 10-minute period averaged over 30 minutes, Tachysystole: > 5 contractions in 10-minute period averaged over 30 minutes, No response to intrauterine resuscitative measures; stopping/reducing uterotonic agents or tocolytics with persistent Category II/III tracing, 110 to 160 bpm; determine by 2-minute segment in 10-minute period, Fluctuations from baseline over 10-minute period, with 6 to 25 bpm: moderate, 15 bpm above baseline rate, onset to peak < 30 seconds, lasts for at least 15 seconds, Early: onset to nadir 30 seconds, nadir occurs with peak of contraction, Variable: onset to nadir < 30 seconds, decrease in fetal heart rate 15 bpm with duration 15 seconds to < 2 minutes, Recurrent late or prolonged decelerations for > 30 minutes or for > 20 minutes if reduced variability, No hypoxia/acidosis; no intervention necessary, Low probability of hypoxia/acidosis; take action to correct reversible causes and monitor closely, High probability of hypoxia/acidosis; take immediate action to correct reversible causes and expedite delivery. Category III tracings have been associated with fetal hypoxia, acidosis, and encephalopathy.2,5,26,37, Fetal tachycardia (FHR of more than 160 bpm for at least 10 minutes) can be caused by maternal or fetal factors (Table 52,5,7 and eFigure B). The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. 3. A key causal event in the release of neurotransmitter molecules from vesicles into the synaptic cleft is the________. The nurse understands that the primary intervention is to: The nurse notes that the fetal heart rate baseline is 120-130 with an increase in FHR to 145 bpm lasting 15 seconds. Typically performed in the later stages of pregnancy and during labor, fetal heart tracing results can say a lot about the health of your baby. Category I is defined by an FHR baseline of 110 to 160 beats per minute (bpm), moderate variability (six- to 25-bpm fluctuation in FHR from baseline), with no late decelerations (onset and nadir after peak of contraction, decrease of more than 15 bpm from baseline, likely uteroplacental insufficiency) and no variable decelerations (onset variable to contraction and slow [i.e., more than 15 seconds and less than two minutes] return to baseline, likely from cord compression) present5 (Figure 27). Influence of Gestational Age on Fetal Heart Rate 8. Are contractions present? Fetal Tracing Quiz . On entering the room, the nurse sees the patient lying supine and notices that there has been abrupt slowing in the FHR to 90 bpm during the last two contractions, each episode lasting 30 seconds or less. Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. Remember, the baseline is the average heart rate rounded to the nearest five bpm.120 125 130 135 140 FHT Quiz 2 Fetal Tracing Quiz Perfect! Place the Doppler over the area of maximal intensity of fetal heart tones, 3. What should the nurse do in this situation? Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. The FHR baseline is 125 bpm. . c. Reassure the family the finding is normal. Uterine tachysystole is defined as more than five contractions in any 10-minute period, averaged over 30 minutes.2 Each normal uterine contraction causes a temporary decrease in uterine blood flow and fetal oxygenation, which is generally well tolerated.26,27 However, tachysystole increases the risk of acidosis.26,27 To correct tachysystole, physicians must reduce or stop uterine stimulants or add tocolytics.2,2729, Goals of intrapartum fetal monitoring include rapid identification and intervention for suspected fetal acidosis as well as reassurance and avoidance of unnecessary interventions in cases of adequate fetal oxygenation.4,26 Figure 1 provides an algorithm for suggested management.2,7,16,21,27,3033. Category 1. This content is owned by the AAFP. Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns.11,12 Evaluation for immediate delivery is recommended for patients with ominous patterns. What action by the student indicates to the registered nurse that the student understands the procedure? 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, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation, Amnioinfusion has been shown to reduce cord compression, leading to resolution of FHR decelerations (RR = 0.53; 95% CI, 0.38 to 0.74; n = 1,000) and lowering the likelihood of cesarean delivery. A. See permissionsforcopyrightquestions and/or permission requests. A nurse notes the following fetal heart rate pattern on the external fetal monitor. -Fetal breathing movements This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. The five components of the biophysical profile are as follows: (1) nonstress test; (2) fetal breathing movements (one or more episodes of rhythmic fetal breathing movements of 30 seconds or. While caring for a patient in active labor at 39 weeks' gestation, the nurse interprets the FHR tracing as a Category III. The nurse's action after turning the patient to her left side should be:, The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning . Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. A pattern of persistent late decelerations is nonreassuring, and further evaluation of the fetal pH is indicated.16 Persistent late decelerations associated with decreased beat-to-beat variability is an ominous pattern19 (Figure 7). Electronic fetal monitoring is performed in a hospital or doctors office. Late decelerations (Online Figure J) are visually apparent, usually symmetric, and have the characteristic feature of onset of the deceleration after the onset of the uterine contraction.11 The timing of the deceleration is delayed, with the nadir of the deceleration occurring after the peak of the contraction.11 The onset, nadir, and recovery of the deceleration usually occur after the beginning, peak, and ending of the contraction, respectively. comprehensive exam fetal tracing index references the maternal fetal triage index frequently asked questions web each of the ve levels has key questions with . a) lapilli B. Reposition the patient, check blood pressure, and continue to monitor the FHR pattern. While caring for a patient who is gravida 2 para 1 being induced for oligohydramnios, the nurse notices a pattern of recurrent abrupt decelerations down to 70 bpm with contractions lasting for 1 minute. A scalp pH less than 7.25 but greater than 7.20 is considered suspicious or borderline. See permissionsforcopyrightquestions and/or permission requests. Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice. Minimal variability during the hour preceding fetal bradycardic events has been shown to be most predictive of fetal acidosis and need for emergent delivery.23 During periods of minimal variability, accelerations produced by scalp stimulation offer reassurance.15,23,26,41 Management of minimal variability includes intrauterine resuscitation and identifying and treating reversible causes (Table 7).2,7,16, Marked variability is defined as more than 25 bpm fluctuations in FHR around the determined baseline for more than 10 minutes and may represent hypoxic stress5,33 (eFigure E). Severe prolonged bradycardia of less than 80 bpm that lasts for three minutes or longer is an ominous finding indicating severe hypoxia and is often a terminal event.4,11,16 Causes of prolonged severe bradycardia are listed in Table 6. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. If you want to see how you are doing overall, try the comprehensive assessment: The nurse's action after turning the patient to her left side should be: Applying oxygen per face mask at 8-10 L/min. Initiate scalp stimulation to provoke fetal heart rate acceleration, which is a sign that the fetus is not acidotic. One benefit of EFM is to detect early fetal distress resulting from fetal hypoxia and metabolic acidosis. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. Health care professionals play the game to hone and test their EFM knowledge and skills. Internal vs external. https://www.ncbi.nlm.nih.gov/pubmed/19546798 Regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. Baseline of 140 - 150 with decelerations to 120 noted beginning with the contraction and returning to baseline by the end of the contraction. The FHR tracing should be interpreted only in the context of the clinical scenario, and any therapeutic intervention should consider the maternal condition as well as that of the fetus. Perform a vaginal examination (check for cord prolapse, rapid descent of the head, or vaginal bleeding suggestive of placental abruption), 6. e) lava dome. Internal is more accurate, measuring the beat to beat time since it has direct contact with the fetus. Copyright 2020 by the American Academy of Family Physicians. B. Activate the organization's chain of command. c) On the basis of your answers, is it desirable to have the resistance of the two 120 V loads be equal? Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Thus, it has the characteristic mirror image of the contraction (Figure 5). Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. The nurse understands that this is being done for which of the following reasons? The resulting printout is known as a fetal heart tracing, which will be read and analyzed. Self Guided Tutorial. What should the incoming nurse do FIRST? AMIR SWEHA, M.D., TREVOR W. HACKER, M.D., AND JIM NUOVO, M.D. 90-150 bpm B. b) Recalculate the primary current, IpI _{ p }Ip. Category I tracings reflect a lack of fetal acidosis and do not require intervention. The patient complains of breathlessness and becomes pale and diaphoretic. Most patients who undergo internal fetal monitoring during labor accept monitoring as a positive experience.6. The physiology behind late deceleration is uteroplacental insufficiency.16,17 Transient late deceleration patterns may be seen with maternal hypotension or uterine hyperstimulation. RN 45 Nonstress Test (Maternal Newborn) Quiz, Evolve Fetal Heart Rate: Assessment via Inter, Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh, Modulo 21: Impacto De La Ciencia Y La Tecnolo. Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. Electronic fetal monitoring is performed in a hospital or doctors office. Variable. A baseline of less than 110 bpm is defined as bradycardia.11 Mild bradycardia (100 to 110 bpm) is associated with post-term infants and occipitoposterior position.15 Rates of less than 100 bpm may be seen in fetuses with congenital heart disease or myocardial conduction defects.15 A baseline greater than 160 bpm is defined as tachycardia11 (Online Figure B). - When considering the effectiveness of Electronic Fetal Monitoring, it comes down to the experience and knowledge of the person identifying the tracings. This pattern is sometimes called a saltatory pattern and is usually caused by acute hypoxia or mechanical compression of the umbilical cord. They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. The patient's labor has been normal to this point. The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. Some clinicians have argued that this unproven technology has become the standard for all patients designated high risk and has been widely applied to low-risk patients as well.9 The worldwide acceptance of EFM reflects a confidence in the importance of electronic monitoring and concerns about the applicability of auscultation.10 However, in a 1996 report, the U.S. Preventive Services Task Force7 did not recommend the use of routine EFM in low-risk women in labor. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. Variability describes fluctuations in the baseline FHR, whether in terms of frequency, amplitude, or magnitude. No. In the United States, an estimated 700 infant deaths per year are associated with intrauterine hypoxia and birth asphyxia.5 Another benefit of EFM includes closer assessment of high-risk mothers. The experienced nurse tells the new nurse that a Category III FHR tracing may include which characteristic? Early decelerations are caused by fetal head compression during uterine contraction, resulting in vagal stimulation and slowing of the heart rate. The practitioner ruptures a laboring patient's membranes and inserts a fetal spiral electrode because the nurse is unable to obtain FHR data by the external method. Every 15 to 30 minutes in active phase of first stage of labor; every 5 minutes in second stage of labor with pushing, Assess FHR before: initiation of labor-enhancing procedure; ambulation of patient; administration of medications; or initiation of analgesia or anesthesia, Assess FHR after: admission of patient; artificial or spontaneous rupture of membranes; vaginal examination; abnormal uterine activity; or evaluation of analgesia or anesthesia, 1. A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. A normal fetal heart tracing would reassure both you and your obstetrician that it's safe to proceed with labor and delivery. Copyright 2023 American Academy of Family Physicians. Do not automatically initiate continuous electronic fetal heart rate monitoring during labor for women without risk factors; consider intermittent auscultation first. The presence of moderate variability and/or accelerations is predictive of a lack of fetal acidosis. -Contractions started by: IV pitocin or Nipple stimulation The American College of Obstetricians and Gynecologists (ACOG), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Society for Maternal-Fetal Medicine developed a new three-tiered classification of fetal heart rate abnormalities and a system for interpreting these abnormalities (1). 5 contractions in 10 minutes averaged over thirty minutes Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5. EFM In-Depth. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. 1. 1. The presence of a saltatory pattern, especially when paired with decelerations, should warn the physician to look for and try to correct possible causes of acute hypoxia and to be alert for signs that the hypoxia is progressing to acidosis.21 Although it is a nonreassuring pattern, the saltatory pattern is usually not an indication for immediate delivery.19. All Rights Reserved. Practice Quizzes 1-5. The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. 140 145 Correct . Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. Decelerations represent a decrease in FHR of more than 15 bpm in bandwidth amplitude. (They start and reach maximum value in less than 30 seconds.) Interpretation of intrapartum electronic fetal heart rate (FHR) tracings has been hampered by interobserver and intraobserver variability, which historically has been high [].In 2008, the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the United States National Institute of Child Health and Human Development (NICHD . Fetal Tracing Index. Obstetric Models and Intrapartum Fetal Monitoring in Europe NEW! 1. Your doctor analyzes FHR by examining a fetal heart tracing according to baseline, variability, accelerations, and decelerations. The nurse's best response is, b. : -Amount of amniotic fluid 10. Long-term variability is a somewhat slower oscillation in heart rate and has a frequency of three to 10 cycles per minute and an amplitude of 10 to 25 bpm. Which of the following information should be included? Fetal monitoring. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? Use a definite integral to find the number of animals passing the checkpoint in a year. Prolonged. Count FHR after uterine contraction for 60 seconds (at 5-second intervals) to identify fetal response to active labor (this may be subject to local protocols), Abnormal umbilical artery Doppler velocimetry, Maternal motor vehicle collision or trauma, Abnormal fetal heart rate on auscultation or admission, Intrauterine infection or chorioamnionitis, Post-term pregnancy (> 42 weeks' gestation), Prolonged membrane rupture > 24 hours at term, Regional analgesia, particularly after initial bolus and after top-ups (continuous electronic fetal monitoring is not required with mobile or continuous-infusion epidurals), High, medium, or low risk (i.e., risk in terms of the clinical situation), Rate, rhythm, frequency, duration, intensity, and resting tone, Bradycardia (< 110 bpm), normal (110 to 160 bpm), or tachycardia (> 160 bpm); rising baseline, Reflects central nervous system activity: absent, minimal, moderate, or marked, Rises from the baseline of 15 bpm, lasting 15 seconds, Absent, early, variable, late, or prolonged, Assessment includes implementing an appropriate management plan, Visually apparent, abrupt (onset to peak < 30 seconds) increase in FHR from the most recently calculated baseline, Peak 15 bpm above baseline, duration 15 seconds, but < 2 minutes from onset to return to baseline; before 32 weeks gestation: peak 10 bpm above baseline, duration 10 seconds, Approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding periodic or episodic changes, periods of marked variability, and segments of baseline that differ by > 25 bpm, In any 10-minute window, the minimum baseline duration must be 2 minutes, or the baseline for that period is indeterminate (refer to the previous 10-minute segment for determination of baseline), The nadir of the deceleration occurs at the same time as the peak of the contraction, The nadir of the deceleration occurs after the peak of the contraction, Abrupt decrease in FHR; if the nadir of the deceleration is 30 seconds, it cannot be considered a variable deceleration, Moderate baseline FHR variability, late or variable decelerations absent, accelerations present or absent, and normal baseline FHR (110 to 160 bpm), Continue current monitoring method (SIA or continuous EFM), Baseline FHR changes (bradycardia [< 110 bpm] not accompanied by absent baseline variability, or tachycardia [> 160 bpm]), Tachycardia: medication, maternal anxiety, infection, fever, Bradycardia: rupture of membranes, occipitoposterior position, post-term pregnancy, congenital anomalies, Consider expedited delivery if abnormalities persist, Change in FHR variability (absent and not accompanied by decelerations; minimal; or marked), Medications; sleep cycle; change in monitoring technique; possible fetal hypoxia or acidemia, Change monitoring method (internal monitoring if doing continuous EFM, or EFM if doing SIA), No FHR accelerations after fetal stimulation, FHR decelerations without absent variability, Late: possible uteroplacental insufficiency; epidural hypotension; tachysystole, Absent baseline FHR variability with recurrent decelerations (variable or late) and/or bradycardia, Uteroplacental insufficiency; fetal hypoxia or acidemia, 2. francis gray poet england, 350 legend ar upper 18 inch, shooting in wilmington, nc yesterday,
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