EFM NCC
Why use fetal monitoring? - ANSPrimary goal is to prevent fetal and maternal morbidity and
mortality (prevent injury and death to mother and/ or baby), to prevent bad patient outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored,
develop cerebral palsy? - ANS3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? - ANSPoor communication between providers. Most
errors are traceable back to communication errors.
Sentinel events - ANSbad things that happen to patients due to a human or equipment error,
and not due to the reason that they came into the hospital (disease process)
Equipment - ANSyour hands (palpation) use fingertips, ultrasound transducer, FSE,
tocodynamometer, Intrauterine Pressure Catheter, Auscultation (fetoscope, hand held
doppler device).
What if you can not get contractions? - ANSpalpate and readjust
IUPC resting tone - ANS20-25
IUPC resting tone with aminoinfusion - ANSshould not be above 40, troubleshoot if this is
higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or recurrent variables -
ANSamnioinfusion
Auscultation tools - ANSintermittent monitoring, use fetoscope or hand help doppler to trace.
Only true auscultation tool - ANSfetoscope, the reason is it is the only tool that listens to the
open and close of the fetal heart valve
Using the doppler or fetoscope - ANScount the FHR before, during, and after a contraction.
Document the baseline rate (range), regular vs irregular, increases or decreases. Do NOT
document variability, accels, or decels
doppler category 1 - ANSnormal FHR baseline, regular rhythm, presence of increases from
FHR baseline, no decreases from baseline
doppler category 2 - ANSincludes ANY of the following: irregular rhythm, presence of FHR
decreases, tachycardia, bradycardia (i feel the need to intervene, I feel like I can't walk out of
the room)
, doppler category 3 - ANSthere is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM - ANSexternal monitoring: goal is to detect fetal heart movement (efm)
Autocorrelation - ANShow the monitor adjusts with every third beat using a mathematical
formula, that it is still monitoring this baby. Detected what is normal for this baby and is
making the appropriate adjustments.
What does the FSE measure? - ANSDirectly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval - ANSfetal tachycardia
Prolonged R-R interval - ANSfetal bradycardia
FSE contraindications - ANScommunicable diseases: hepatitis and HIV
Normal uterine activity - ANSNormal activity: less than 5 ctx in a 10 minute period averaged
over a 30 minutes period (5,5,6 OK but 6,5,6 NOT OK)
Excessive uterine activity - ANSTachysystole (not hyperstim), hypertonus (with IUPC resting
tone does not go below 20 mmHG-IUPC, 20-25mmhg shouldn't be higher..if higher usually
due to inadequate relation time), inadequate relaxation time, tetanic contractions(cxn greater
than 2 minutes)
What do you do with tachysystole? - ANSturn down pitocin (reposition etc)
Reduce blood flow through the intervillous space - ANSMild Contractions (30 mmHG)
No blood flow through the intervillous space - ANSModerate Contractions (50 mmHG)
Adequate MVUS - ANS200-300...greater than 200, spontaneous labor less than 280 for the
first stage but up to 400 for the second stage. Typically less than 300 (so 200-300).
Importance of doing multiple interventions sooner than later - ANSyou see tachysystole or
deceleration, turn pitocin off & IV bolus & resposition. Multiple interventions are important.
Why would it be in your best interest to bolus, turn off pit, and reposition? - ANSwill resolve
tachysystole and decelerations faster
Troubleshooting tips? - ANScheck cables, check connections (avoid wrapping too tightly),
check patient position/ fetal position, palpate abdomen, check maternal pulse, listen to
maternal hr vs fetal hr, run the monitors self test feature, document what you did!
Monitoring patients FHR, after assessment done for admission, you see FHR that is tracing
90 for the last 30 minutes. What would you do? - ANSVerify maternal HR. If bradycardic
tracing, always verify maternal heart rate
Why use fetal monitoring? - ANSPrimary goal is to prevent fetal and maternal morbidity and
mortality (prevent injury and death to mother and/ or baby), to prevent bad patient outcomes.
What percent of babies who experience a suboptimal event while being fetal monitored,
develop cerebral palsy? - ANS3% of babies with poor tracing develop cerebral palsy
What are most sentinel events due to? - ANSPoor communication between providers. Most
errors are traceable back to communication errors.
Sentinel events - ANSbad things that happen to patients due to a human or equipment error,
and not due to the reason that they came into the hospital (disease process)
Equipment - ANSyour hands (palpation) use fingertips, ultrasound transducer, FSE,
tocodynamometer, Intrauterine Pressure Catheter, Auscultation (fetoscope, hand held
doppler device).
What if you can not get contractions? - ANSpalpate and readjust
IUPC resting tone - ANS20-25
IUPC resting tone with aminoinfusion - ANSshould not be above 40, troubleshoot if this is
higher, weigh pads, make sure there is fluid return.
Not meant for meconium or thick mec, they are used for variables or recurrent variables -
ANSamnioinfusion
Auscultation tools - ANSintermittent monitoring, use fetoscope or hand help doppler to trace.
Only true auscultation tool - ANSfetoscope, the reason is it is the only tool that listens to the
open and close of the fetal heart valve
Using the doppler or fetoscope - ANScount the FHR before, during, and after a contraction.
Document the baseline rate (range), regular vs irregular, increases or decreases. Do NOT
document variability, accels, or decels
doppler category 1 - ANSnormal FHR baseline, regular rhythm, presence of increases from
FHR baseline, no decreases from baseline
doppler category 2 - ANSincludes ANY of the following: irregular rhythm, presence of FHR
decreases, tachycardia, bradycardia (i feel the need to intervene, I feel like I can't walk out of
the room)
, doppler category 3 - ANSthere is none! auscultation because there is no variabile
determination with auscultation
goal of external EFM - ANSexternal monitoring: goal is to detect fetal heart movement (efm)
Autocorrelation - ANShow the monitor adjusts with every third beat using a mathematical
formula, that it is still monitoring this baby. Detected what is normal for this baby and is
making the appropriate adjustments.
What does the FSE measure? - ANSDirectly monitors R to R ratio (with scalp lead),
definitively measures baby's heartbeat and when the heart is firing
Narrow R-R interval - ANSfetal tachycardia
Prolonged R-R interval - ANSfetal bradycardia
FSE contraindications - ANScommunicable diseases: hepatitis and HIV
Normal uterine activity - ANSNormal activity: less than 5 ctx in a 10 minute period averaged
over a 30 minutes period (5,5,6 OK but 6,5,6 NOT OK)
Excessive uterine activity - ANSTachysystole (not hyperstim), hypertonus (with IUPC resting
tone does not go below 20 mmHG-IUPC, 20-25mmhg shouldn't be higher..if higher usually
due to inadequate relation time), inadequate relaxation time, tetanic contractions(cxn greater
than 2 minutes)
What do you do with tachysystole? - ANSturn down pitocin (reposition etc)
Reduce blood flow through the intervillous space - ANSMild Contractions (30 mmHG)
No blood flow through the intervillous space - ANSModerate Contractions (50 mmHG)
Adequate MVUS - ANS200-300...greater than 200, spontaneous labor less than 280 for the
first stage but up to 400 for the second stage. Typically less than 300 (so 200-300).
Importance of doing multiple interventions sooner than later - ANSyou see tachysystole or
deceleration, turn pitocin off & IV bolus & resposition. Multiple interventions are important.
Why would it be in your best interest to bolus, turn off pit, and reposition? - ANSwill resolve
tachysystole and decelerations faster
Troubleshooting tips? - ANScheck cables, check connections (avoid wrapping too tightly),
check patient position/ fetal position, palpate abdomen, check maternal pulse, listen to
maternal hr vs fetal hr, run the monitors self test feature, document what you did!
Monitoring patients FHR, after assessment done for admission, you see FHR that is tracing
90 for the last 30 minutes. What would you do? - ANSVerify maternal HR. If bradycardic
tracing, always verify maternal heart rate
