NCC EFM
Causes of uteroplacental perfusion decrease: - ANS• HTN
• Pregnancy
• DM
• Hypotension
• Excessive uterine contractions (hypertonus)
• Decreased surface area, edema, degenerative calcifications, infarcts, infection
FHR reflects fetal oxygenation from which extrinsic factors: - ANS• Maternal oxygenation
• Uterine blood flow
• Placental change
• Umbilical blood flow
FHR reflects oxygenation from which intrinsic factors: - ANS• Fetal circulation
• Oxygenation of tissues
• FHR regulation
Fetal shunts: - ANS• Ductus venosus- liver
• PFO- Right to left atria
• Ductus arteriosis- pulmonary a. to aorta
Oxygen depletion cascade: - ANS• Aerobic metabolism
• Hypoxemia
• Tissue hypoxia
• Anaerobic metabolism
• Lactic acid build up
• Metabolic acidosis
Sympathetic innervation: - ANS• Releases Eip/norepi
• Increases FHR
Parasympathetic/Vagal innervation: - ANS• Releases ach
• Decreases FHR and transmits variability
Early decel: - ANS• Fetal head compression
• ->vasovagal response
Variable decel: - ANS• Cord compression
• ->increase BP/HTN
• ->activation of baroreceptor
• ->decrease FHR, BP, and CO
Late decel: - ANS• Inadequate uteroplacental blood flow->decreased maternal fetal O2
transfer
• ->activation of chemoreceptors to respond due to increased PCO2, decreased PO2, and
decreased pH
, NCC EFM
• ->Fetal bradycardia and hypertension
Category I: - ANS• Normal fetal acid base status
• All the following are required:
• Moderate variability
• Baseline rate 110-160
• Late or variable decels are absent
• Early decels present or absent
• Accels present or absent
Category II: - ANS• Indeterminate compensatory response
• Not category I or II
Category III: - ANS• Abnormal fetal acid-base status
• Either required
• Absent variability with:
o Recurrent late decels, or
o Recurrent variable decels, or
o Bradycardia
• Sinusoidal pattern
In-Utero resuscitation: - ANS• Change maternal position
• Decrease uterine activity
• IV fluid bolus
• Correct maternal hypotension
• Oxygen administration
• Amnioinfusion
• Alteration in 2nd stage maternal pushing efforts
• If prolapsed cord, then elevate fetal presenting part while moving toward operative birth
Baseline FHR: - ANS• Approximate mean FHR excluding accelerations and decelerations or
periods of marked variability (>25 bpm)
• Minimum of 2 minutes of identifiable BL segments in any 10 min window
• May need to refer to previous 10 min window
Baseline variability: - ANS• Irregular fluctuation in baseline FHR in both amplitude and
frequency
• Absent- Undetectable
• Minimal- 0-5
• Moderate- 6-25
• Marked >25 -> alpha-adrenergic response to decreased uteroplacental blood flow or
ephedrine
Causes of minimal variability: - ANS• General anesthesia
• Smoking
• Quiet sleep
• Mag
Causes of uteroplacental perfusion decrease: - ANS• HTN
• Pregnancy
• DM
• Hypotension
• Excessive uterine contractions (hypertonus)
• Decreased surface area, edema, degenerative calcifications, infarcts, infection
FHR reflects fetal oxygenation from which extrinsic factors: - ANS• Maternal oxygenation
• Uterine blood flow
• Placental change
• Umbilical blood flow
FHR reflects oxygenation from which intrinsic factors: - ANS• Fetal circulation
• Oxygenation of tissues
• FHR regulation
Fetal shunts: - ANS• Ductus venosus- liver
• PFO- Right to left atria
• Ductus arteriosis- pulmonary a. to aorta
Oxygen depletion cascade: - ANS• Aerobic metabolism
• Hypoxemia
• Tissue hypoxia
• Anaerobic metabolism
• Lactic acid build up
• Metabolic acidosis
Sympathetic innervation: - ANS• Releases Eip/norepi
• Increases FHR
Parasympathetic/Vagal innervation: - ANS• Releases ach
• Decreases FHR and transmits variability
Early decel: - ANS• Fetal head compression
• ->vasovagal response
Variable decel: - ANS• Cord compression
• ->increase BP/HTN
• ->activation of baroreceptor
• ->decrease FHR, BP, and CO
Late decel: - ANS• Inadequate uteroplacental blood flow->decreased maternal fetal O2
transfer
• ->activation of chemoreceptors to respond due to increased PCO2, decreased PO2, and
decreased pH
, NCC EFM
• ->Fetal bradycardia and hypertension
Category I: - ANS• Normal fetal acid base status
• All the following are required:
• Moderate variability
• Baseline rate 110-160
• Late or variable decels are absent
• Early decels present or absent
• Accels present or absent
Category II: - ANS• Indeterminate compensatory response
• Not category I or II
Category III: - ANS• Abnormal fetal acid-base status
• Either required
• Absent variability with:
o Recurrent late decels, or
o Recurrent variable decels, or
o Bradycardia
• Sinusoidal pattern
In-Utero resuscitation: - ANS• Change maternal position
• Decrease uterine activity
• IV fluid bolus
• Correct maternal hypotension
• Oxygen administration
• Amnioinfusion
• Alteration in 2nd stage maternal pushing efforts
• If prolapsed cord, then elevate fetal presenting part while moving toward operative birth
Baseline FHR: - ANS• Approximate mean FHR excluding accelerations and decelerations or
periods of marked variability (>25 bpm)
• Minimum of 2 minutes of identifiable BL segments in any 10 min window
• May need to refer to previous 10 min window
Baseline variability: - ANS• Irregular fluctuation in baseline FHR in both amplitude and
frequency
• Absent- Undetectable
• Minimal- 0-5
• Moderate- 6-25
• Marked >25 -> alpha-adrenergic response to decreased uteroplacental blood flow or
ephedrine
Causes of minimal variability: - ANS• General anesthesia
• Smoking
• Quiet sleep
• Mag
