NM704 EXAM 2 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
What are the ACNM recommendations IA
monitoring during first and second stage of labor?
First Stage q15-30m
Second stage q15m and q5m for pushing
IA Relative to contractions
In order to hear and appreciate changes that are associate with contractions, especially
decelerations, it is recommended to listen
a. Through the end of the contraction
b. For at least 30 seconds after the end of the contraction to check the baseline rate
Components of FHR assessment
1. Assess the baseline
2. Detecting changes from baseline
What factors cannot be assessed with IA?
There are some FHR attributes that can only be reliably assessed visually, and
therefore require CEFM. These include:
a. Baseline variability
b. Categorization of FHR deceleration as early, variable, or late
AWHONN advises:
,a. Based on available research, IA is appropriate to assess FHR baseline rate, rhythm,
and increases or decreases from baseline
b. But NOT variability or types of declarations because they are based on visual
interpretation of FHR data
c. If auscultation of decreased FHR causes provider concern, a visual assessment of
FHR may be warranted and EFM may be initiated.
What categories are used in IA
1. Only Category I or Category II designations are used for IA
2. Cannot use IA, for Category III because it requires visual assessment of variability or
a sinusoidal pattern
ALL of the following must be met
1. Normal FHR baseline 110-160 bpm
2. Regular rhythm
3. Presence OR absence of accelerations
4. Absence of decelerations
What is a category II in IA
Any of the following:
1. Tachycardia (baseline >160 for >10 min)
2. Bradycardia (baseline <110 for >10 mins)
3. Irregular rhythm
4. Presence of decelerations
What 5 things must occur for optimal maternal-fetal gas exchange?
,1. Adequate flow of well-oxygenated maternal blood into the intervillous space
2. Large enough placental area for exchange
3. Efficient diffusion of gases across the placental tissues that separate maternal and
fetal circulations
4. Unimpaired umbilical vein circulation into fetus
5. Adequate oxygen transport capacity in the fetus
Define asphyxia
1. Extreme deficiency of oxygen and carbon dioxide excess
2. Caused by impaired gas exchange
3. Asphyxia is a continuum described by degrees of acidosis.
4. Clinically, the term is typically used only when tissue damage or death occurs.
What are reasons fetuses usually becoming hypoxic (4 most common and 2 less
common)?
1. A decrease in oxygen content in maternal blood
2. Insufficient uterine/placental blood flow
3. Insufficient umbilical blood flow
4. Abnormal uterine contraction pattern -intrapartum
Less common
5. Fetal anemia -which decreases oxygen-carrying capacity
6. Pyrexia -which results in increased oxygen consumption
Explain neonatal encephalopathy (NE) (3 points)
1. A complex disease of the newborn associated with multi-organ dysfunction that
occurs in approximately 3 per 1000 live births in high-income nations
, 2. A clinically defined syndrome of disturbed neurologic functions in the earliest
days of life in the infant born at or beyond 35 weeks of gestation
3. S&S: subnormal level of consciousness or seizures, accompanied by difficulty with
initiating and maintaining respirations and depression of tone and reflexes
What percentage of patients in US hospitals do EFM?
90%
What are the differences of outcomes between EFM and IA? (3 significant
differences)
1. EFM associated with approx. 50% increase in C/S
2. EFM has slight increase in operative vaginal birth
3. EFM decrease in neonatal seizures (1.8% in EFM compared to 4.1% in IA group)
No difference in APGAR scores, CP or perinatal mortality
How often is EFM monitored for "low risk" patients? First and second stage of
labor? Per ACOG
First stage q30m
Second stage Q15min
How often is EFM monitored for "high risk" patients? First and second stage of
labor? Per ACOG
First stage q15m
Second stage q5min
Define periodic changes
Include early and late decelerations, that occur in association with uterine
contractions.
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
What are the ACNM recommendations IA
monitoring during first and second stage of labor?
First Stage q15-30m
Second stage q15m and q5m for pushing
IA Relative to contractions
In order to hear and appreciate changes that are associate with contractions, especially
decelerations, it is recommended to listen
a. Through the end of the contraction
b. For at least 30 seconds after the end of the contraction to check the baseline rate
Components of FHR assessment
1. Assess the baseline
2. Detecting changes from baseline
What factors cannot be assessed with IA?
There are some FHR attributes that can only be reliably assessed visually, and
therefore require CEFM. These include:
a. Baseline variability
b. Categorization of FHR deceleration as early, variable, or late
AWHONN advises:
,a. Based on available research, IA is appropriate to assess FHR baseline rate, rhythm,
and increases or decreases from baseline
b. But NOT variability or types of declarations because they are based on visual
interpretation of FHR data
c. If auscultation of decreased FHR causes provider concern, a visual assessment of
FHR may be warranted and EFM may be initiated.
What categories are used in IA
1. Only Category I or Category II designations are used for IA
2. Cannot use IA, for Category III because it requires visual assessment of variability or
a sinusoidal pattern
ALL of the following must be met
1. Normal FHR baseline 110-160 bpm
2. Regular rhythm
3. Presence OR absence of accelerations
4. Absence of decelerations
What is a category II in IA
Any of the following:
1. Tachycardia (baseline >160 for >10 min)
2. Bradycardia (baseline <110 for >10 mins)
3. Irregular rhythm
4. Presence of decelerations
What 5 things must occur for optimal maternal-fetal gas exchange?
,1. Adequate flow of well-oxygenated maternal blood into the intervillous space
2. Large enough placental area for exchange
3. Efficient diffusion of gases across the placental tissues that separate maternal and
fetal circulations
4. Unimpaired umbilical vein circulation into fetus
5. Adequate oxygen transport capacity in the fetus
Define asphyxia
1. Extreme deficiency of oxygen and carbon dioxide excess
2. Caused by impaired gas exchange
3. Asphyxia is a continuum described by degrees of acidosis.
4. Clinically, the term is typically used only when tissue damage or death occurs.
What are reasons fetuses usually becoming hypoxic (4 most common and 2 less
common)?
1. A decrease in oxygen content in maternal blood
2. Insufficient uterine/placental blood flow
3. Insufficient umbilical blood flow
4. Abnormal uterine contraction pattern -intrapartum
Less common
5. Fetal anemia -which decreases oxygen-carrying capacity
6. Pyrexia -which results in increased oxygen consumption
Explain neonatal encephalopathy (NE) (3 points)
1. A complex disease of the newborn associated with multi-organ dysfunction that
occurs in approximately 3 per 1000 live births in high-income nations
, 2. A clinically defined syndrome of disturbed neurologic functions in the earliest
days of life in the infant born at or beyond 35 weeks of gestation
3. S&S: subnormal level of consciousness or seizures, accompanied by difficulty with
initiating and maintaining respirations and depression of tone and reflexes
What percentage of patients in US hospitals do EFM?
90%
What are the differences of outcomes between EFM and IA? (3 significant
differences)
1. EFM associated with approx. 50% increase in C/S
2. EFM has slight increase in operative vaginal birth
3. EFM decrease in neonatal seizures (1.8% in EFM compared to 4.1% in IA group)
No difference in APGAR scores, CP or perinatal mortality
How often is EFM monitored for "low risk" patients? First and second stage of
labor? Per ACOG
First stage q30m
Second stage Q15min
How often is EFM monitored for "high risk" patients? First and second stage of
labor? Per ACOG
First stage q15m
Second stage q5min
Define periodic changes
Include early and late decelerations, that occur in association with uterine
contractions.
