fetal heart tracing quiz 10
The decelerations show a symmetric gradual decrease in the FHR, which begins at the peak of each contraction and ends 10 to 15 seconds after the contraction has returned to resting baseline. 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). Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. -Accelerations my be present or absent. Bradycardia in the range of 100 to 120 bpm with normal variability is not associated with fetal acidosis. Fetal scalp sampling for pH is recommended if there is no acceleration with scalp stimulation.11. -Rate increase by 15 beats for 15 seconds This is followed by occlusion of the umbilical artery, which results in the sharp downslope. Antepartum Fetal Assessment 10. Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. . Increase mainline IV Marked. Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. Auscultation of the fetal heart rate (FHR) is performed by external or internal means. A gradual decrease is defined as at least 30 seconds from the onset of the deceleration to the FHR nadir, whereas an abrupt decrease is defined as less than 30 seconds from the onset of the deceleration to the beginning of the FHR nadir.11, Early decelerations (Online Figure H) are transient, gradual decreases in FHR that are visually apparent and usually symmetric.11 They occur with and mirror the uterine contraction and seldom go below 100 bpm.11 The nadir of the deceleration occurs at the same time as the peak of the contraction. 6. EFM In-Depth. 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. These require attachment of fetal head electrodes; a recent randomized controlled trial and meta-analysis showed no improvement in neonatal outcomes or rates of operative or cesarean delivery.24,25, The National Institute of Child Health and Human Development terminology (revised in 2008) classifies continuous electronic fetal monitoring tracings using a three-tiered system and is the accepted national standard for continuous electronic fetal monitoring interpretation.5 Labor management depends on the continuous electronic fetal monitoring category and overall clinical scenario (Table 3).4,5,7, Interpretation of continuous electronic fetal monitoring tracings must include comments on uterine contractions, baseline FHR, variability (fluctuations in the FHR around the determined baseline during a 10-minute segment), presence of accelerations and/or decelerations, and trends of continuous electronic fetal monitoring patterns over time.2,5. A way to assess your babys overall health, fetal heart tracing is performed before and during the process of labor. What should be the nurse's next action? The nurse is caring for a low-risk primipara at 40 weeks' gestation and in active labor. 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. The nurse is instructing a new staff nurse on reassuring FHR patterns. Fetal tachycardia may be a sign of increased fetal stress when it persists for 10 minutes or longer, but it is usually not associated with severe fetal distress unless decreased variability or another abnormality is present.4,11,17. Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of labor. Describe the variability. 140 145 150 155 160 2. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. electronic fetal heart monitoring trivia quiz questions web mar 22 2022 questions and answers 1 according to awhonn the normal baseline fetal heart rate fhr is a 90 150 distribution of tributaries influences Whenever possible, they will implement measures to prevent an unfavorable outcome. After discussion regarding the FHR tracing, the resident and attending practitioner on duty determine that the FHR tracing is a Category II. c) On the basis of your answers, is it desirable to have the resistance of the two 120 V loads be equal? In 1991, the National Center for Health Statistics reported that EFM was used in 755 cases per 1,000 live births in the United States.2 In many hospitals, it is routinely used during labor, especially in high-risk patients. Issues such as hypoxia, however, might slow their heart rate. It involves using an electronic fetal monitor that records the fetal heart rate and the frequency and duration of uterine contractions. -6:Suspect lack of adequate oxygen, Repeat BPP in 24 hours & deliver if <= 6 Nonreassuring patterns such as fetal tachycardia, bradycardia and late decelerations with good short-term variability require intervention to rule out fetal acidosis. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate. Identify baseline fetal heart rate and presence of variability, both long-term and beat-to-beat (short-term). 4. Your obstetrician reviews the fetal heart tracing at regular time intervals. Recently, second-generation fetal monitors have incorporated microprocessors and mathematic procedures to improve the FHR signal and the accuracy of the recording.3 Internal monitoring is performed by attaching a screw-type electrode to the fetal scalp with a connection to an FHR monitor. 9. The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. From this information, we wish to predict where the fringe for n=50n=50n=50 would be located. The nurse understands that the test will be read as which of the following? Fetal tachycardia is defined as a baseline heart rate greater than 160 bpm and is considered a nonreassuring pattern (Figure 3). Turn the patient to the left side, stop the oxytocin infusion, and assess maternal vital signs. 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. Identify pattern of uterine contractions, including regularity, rate, intensity, duration and baseline tone between contractions. Contractions (C). The monitor calculates and records the FHR on a continuous strip of paper. Monochromatic light of wavelength \lambda is incident on a GP pair of slits separated by 2.40104m2.40 \times 10^{-4} \mathrm{~m}2.40104m and forms an interference pattern on a screen placed 1.80m1.80 \mathrm{~m}1.80m from the slits. 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). The reporting nurse states that the FHR baseline is 150 bpm with moderate variability, no decelerations are present, and episodic accelerations are occurring. -Contractions started by: IV pitocin or Nipple stimulation The nurse is assessing the fetal monitor tracings of a patient in labor. All Rights Reserved. -How? This is associated with certain maternal and fetal conditions, such as chorioamnionitis, fever, dehydration, and tachyarrhythmias. -Daily Fetal Kick Counts A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. A concern with continuous EFM is the lack of standardization in the FHR tracing interpretation.5,811 Studies demonstrate poor inter-rater reliability of experts, even in controlled research settings.12,13 A National Institute of Child Health and Human Development (NICHD) research planning workshop was convened in 1997 to standardize definitions for interpretation of EFM tracing.14 These definitions were adopted by the American College of Obstetricians and Gynecologists (ACOG) in 2002,5 and revisions were made in a 2008 workshop sponsored by NICHD, ACOG, and the Society for Maternal-Fetal Medicine.11 The Advanced Life Support in Obstetrics (ALSO) curriculum developed the mnemonic DR C BRAVADO (Table 3) to teach a systematic, structured approach to continuous EFM interpretation that incorporates the NICHD definitions.9,11. Decompression melting as the mantle rises, C. Melting of continental crust caused by an influx of mantle-derived magmas. 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. -Stress = uterine contractions This variability reflects a healthy nervous system, chemoreceptors, baroreceptors and cardiac responsiveness. Fetal heart tracing is also useful for eliminating unnecessary treatments. Decreased variability is defined as a variation of one to five bpm from baseline for at least 10 minutes5 (eFigure D). The nurse understands that this NST will be read as: A woman in active labor has just received an epidural. Perform a vaginal examination (check for cord prolapse, rapid descent of the head, or vaginal bleeding suggestive of placental abruption), 6. Which of the following information should be included? Category II tracings are defined as indeterminate, are common, and represent all tracings that do not fall into the Category I or III groups.2,5 They vary widely in level of concern for acidosis, so the family physician must determine the severity of the Category II tracing and take the appropriate action.2,5,7,35, There is a direct association between fetal acidosis, recurrent decelerations, and depth of decelerations2,5,34,36; however, 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.2,4,26,27,34,3638 For Category II tracings without spontaneous or provoked accelerations, minimal/absent variability, or deep decelerations (i.e., FHR drops to 70 bpm or less), immediate action is needed.3,4, A management algorithm30 (eFigure A) has been developed that is based on the suspected degree of fetal acidosis and ideally minimizes unnecessary interventions.7, A five-tiered classification/management scheme for management of Category II tracings has been developed (http://www.obapps.org).7,37,39 Each continuous electronic fetal monitoring tracing is color coded to represent the threat of acidosis based on the National Institute of Child Health and Human Development definitions, and Category II is broken into three separate severity and intervention subcategories based on the presence of accelerations and/or moderate variability.7,37 This classification has been shown to improve identification of fetal acidosis and newborns requiring immediate intervention after delivery.37, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation(Figure 1).2,7,16,21,27,3033 Lateral recumbent maternal positioning reduces compression of the maternal vena cava and aorta and the fetal umbilical cord.2,32,33 Intravenous fluid boluses up to 1 L have been shown to improve fetal oxygenation up to 30 minutes after administration.32,33 Maternal oxygen may be administered after other maneuvers, but it can be discontinued after tracing improvement because there is no evidence to support its routine use.2,32,33 Modification in maternal pushing efforts, such as initiating only with the urge to push and allowing for fetal recovery by pushing with every second or third contraction, can improve maternal and fetal oxygenation.40, Category III tracings, defined by a sinusoidal FHR pattern (Figure 37) or absent FHR variability (Figure 47) with recurrent late and/or variable decelerations or fetal bradycardia (see the Fetal Bradycardia section), require immediate intrauterine resuscitation and intervention.2,5,8,14,27,30,32,33,38,39 If the Category III tracing does not rapidly improve, expedited delivery is recommended. Palpate the abdomen to determine the position of the fetus (Leopold maneuvers), 2. -Fetal breathing movements The nurse would chart this change in baseline as which of the following? What is the peak current supplied by the emf Fetal heart rate monitoring is a process of monitoring the fetal heart rate during labor and delivery to assess the fetus's well-being. If one of the following is detected during structured intermittent auscultation for a low-risk patient, switch to continuous electronic fetal monitoring to assess the National Institute of Child Health and Human Development category and to determine necessary clinical management: Fetal tachycardia (> 160 beats per minute for > 10 minutes), Fetal bradycardia (< 110 beats per minute for > 10 minutes), Recurrent decelerations following contractions (> 50% of contractions) or prolonged deceleration (> 2 minutes but < 10 minutes). The figure in the next column shows a graph of TTT. Perform amnioinfusion for recurrent variable decelerations to reduce the risk of cesarean delivery. The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation. The number of migratory animals (in hundreds) counted at a certain checkpoint is given by. Treat placental fetal perfusion through intrauterine resuscitation before proceeding to immediate delivery for all Category II or III tracings with concern for fetal acidosis. References. Variable and inconsistent interpretation of tracings by clinicians may affect management of patients. to access the EFM tracing game and to take full advantage of all the resources available. Challenge yourself every tracing collection is FREE! The descent and return are gradual and smooth. The first uses Doppler ultrasound to monitor FHR patterns, while the second measures the duration and frequency of uterine contractions. Are there accelerations present? 1. Almost any stressful situation in the fetus evokes the baroreceptor reflex, which elicits selective peripheral vasoconstriction and hypertension with a resultant bradycardia. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. The EFM toolkit also offers EFM CE opportunities and C-EFM(R) certification information. Interventions to increase fetal activity fail, Reactive NST: Powered by. Prolonged FHR decelerations from baseline (more than two minutes but less than 10 minutes) may represent rapid cervical change and/or fetal descent, maternal hypotension, placental abruption, umbilical cord prolapse, or uterine rupture2,5,26 (Figure 77). Variable. Fetal heart rate. A student nurse is placing a tocotransducer on a woman for electronic fetal monitoring. What information about this assessment is most appropriate? Questions and Answers 1. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Influence of Gestational Age on Fetal Heart Rate 8. HESI - OB, Fetal Heart Rate: Interpretation 5.0 (1 review) A patient is in active labor with spontaneous contractions occurring every 2 minutes and lasting 90 to 100 seconds. Patient information: See related handout on intrapartum fetal monitoring, written by the authors of this article. The FHR recordings may be interpreted as reassuring, nonreassuring or ominous, according to the pattern of the tracing. Which of the following heart rate patterns would the nurse interpret as normal during the transitional phase of stage one? A woman has just received pain medication in labor. Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. She asks the nurse to explain the results. The nurse still interprets the FHR tracing as a Category III. Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. Differentiate maternal pulse from fetal pulse, 4. 1. The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. Shows all of the following: -Baseline FHR 110-160 BPM. A. Decelerations (D). The incoming nurse enters the patient's room to complete an initial assessment and sees that the FHR has been 80 bpm for the last 3 minutes and that variability is minimal to absent. A nurse notes the following fetal heart rate pattern on the external fetal monitor. Your doctor analyzes FHR by examining a fetal heart tracing according to baseline, variability, accelerations, and decelerations. The probe sends your babys heart sounds to a computer and shows FHR patterns. 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. Assessments. A late deceleration is a symmetric fall in the fetal heart rate, beginning at or after the peak of the uterine contraction and returning to baseline only after the contraction has ended (Figure 6). A meta-analysis showed that if there is absent or minimal variability without spontaneous accelerations, the presence of an acceleration after scalp stimulation or fetal acoustic stimulation indicates that the fetal pH is at least 7.20.19, If the FHR tracing remains abnormal, these tests may need to be performed periodically, and consideration of emergent cesarean or operative vaginal delivery is usually recommended.15 Measurements of cord blood gases are generally recommended after any delivery for abnormal FHR tracing because evidence of metabolic acidosis (cord pH less than 7.00 or base deficit greater than 12 mmol per L) is one of the four essential criteria for determining an acute intrapartum hypoxic event sufficient to cause cerebral palsy.20, When using continuous EFM, tracings should be reviewed by physicians and labor and delivery nurses on a regular basis during labor. The widespread use of continuous electronic fetal monitoring has increased operative and cesarean delivery rates without improved neonatal outcomes, but its use is appropriate in high-risk labor. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals ( Table 1). Fetal heart rate monitoring can be done either externally or internally. This type of deceleration has a uniform shape, with a slow onset that coincides with the start of the contraction and a slow return to the baseline that coincides with the end of the contraction. The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. The normal FHR range is between 120 and 160 beats per minute (bpm). A. The most important risk of EFM is its tendency to produce false-positive results. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles. JAMES J. ARNOLD, DO, AND BREANNA L. GAWRYS, DO. Fetal bradycardia is defined as a baseline heart rate less than 120 bpm. Category II tracings are indeterminate, are present in the majority of laboring patients, and can encompass monitoring predictive of clinically normal to rapidly developing acidosis. (They start and reach maximum value in less than 30 seconds.) Ominous patterns require emergency intrauterine fetal resuscitation and immediate delivery. No. Intraobserver variability may play a major role in its interpretation. -Positive Contraction Stress Test: Hasten fetal delivery. 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! An acceleration pattern preceding or following a variable deceleration (the shoulders of the deceleration) is seen only when the fetus is not hypoxic.15 Accelerations are the basis for the nonstress test (NST). Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. Fetal Tracing Quiz . A.True B.False According to the 2008 NICHD consensus report, the normal frequency of uterine contractions is which of the following? Baseline of 140 - 150 with decelerations to 120 noted beginning with the contraction and returning to baseline by the end of the contraction. Another area of interest is the use of computer analysis for key components of the fetal tracing,29 or decision analysis for the interpretation of the EFM tracing.30 These have not been demonstrated to improve clinical outcomes.29,30 Fetal pulse oximetry was developed to continuously monitor fetal oxygenation during labor by using an internal monitor, requiring rupture of membranes.31 Trials have not demonstrated a reduction in cesarean delivery rates or interventions with the use of fetal pulse oximetry.31. 1. 2023 National Certification Corporation. Turn off oxytocin (Pitocin) FHR baseline of 120-130 with V shaped decelerations to 100 noted before and after contractions. Fetal heart rate (FHR) may change as they respond to different conditions in your uterus. What is the most appropriate nursing response? They are the most commonly encountered patterns during labor and occur frequently in patients who have experienced premature rupture of membranes17 and decreased amniotic fluid volume.24 Variable decelerations are caused by compression of the umbilical cord. The FHR baseline is 130 bpm with moderate variability. Remember, the baseline is the average heart rate rounded to the nearest five bpm. Practice Quizzes 6-10 - Electronic Fetal Monitoring. It may also be performed using an external transducer, which is placed on the maternal abdomen and held in place by an elastic belt or girdle. 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. A systematic approach is recommended when reading FHR recordings to avoid misinterpretation (Table 2). Combine your ability to read fetal tracings with clinical management with some cases: Cases 1-5. -Fetal body movements Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. Theyll wrap a pair of belts around your belly. The EFM toolkit also offers EFM CE opportunities and C-EFM. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. Prolonged decelerations (Online Figures K and L) last longer than two minutes, but less than 10 minutes.11 They may be caused by a number of factors, including head compression (rapid fetal descent), cord compression, or uteroplacental insufficiency. Powered by. 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. 10. Determine Risk (DR). A patient is in active labor and is being continuously monitored with a fetal monitor. Because these events have a low prevalence, continuous electronic fetal monitoring has a false-positive rate of 99%. You scored 6 out of 6 correct. A. 1. 5. Fetal Tracing Index. Although these decelerations are not associated with fetal distress and thus are reassuring, they must be carefully differentiated from the other, nonreassuring decelerations. Count FHR between contractions for 60 seconds to determine average baseline rate, 6. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.020 When continuous EFM tracing is indeterminate, fetal scalp pH sampling or fetal stimulation may be used to assess for the possible presence of fetal acidemia.5 Fetal scalp pH testing is no longer commonly performed in the United States and has been replaced with fetal stimulation or immediate delivery (by operative vaginal delivery or cesarean delivery). Relevant ACOG Resources. comprehensive exam fetal tracing index references the maternal fetal triage index frequently asked questions web each of the ve levels has key questions with . All Rights Reserved. Author disclosure: No relevant financial affiliations. 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. : The presence of moderate variability and/or accelerations is predictive of a lack of fetal acidosis. 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. Contraction Stress Test (CST) Give intravenous fluids if not already administered; consider bolus, 7. The patient is being monitored by external electronic monitoring. Copyright 2023 American Academy of Family Physicians. -Reassuring for fetal well being The experienced nurse tells the new nurse that a Category III FHR tracing may include which characteristic? -Neither period yields adequate accelerations The nurse understands that this pattern is related to which of the following? Regardless of the depth of the deceleration, all late decelerations are considered potentially ominous. d. Places the tocotransducer over the uterine fundus, An NST in which two or more fetal heart rate (FHR) accelerations of 15 beats per minute (bpm) or more occur with fetal movement in a 20-minute period is termed. is part of the free online EFM toolkit at. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. 4. Tachysystole in term labor: incidence, risk factors, outcomes, and effect on fetal heart tracings. You have to lie down or sit in a reclined position for the test, which lasts about 20 minutes. A normal baseline rate ranges from 110 to 160 bpm. The purpose of initiating contractions in a CST is to. Patient Safety, Risk Management, and Documentation 11. Compared with structured intermittent auscultation, a period of EFM on maternity unit admission results in a lack of improved neonatal outcomes and increased interventions, including epidural analgesia (NNH = 19), continuous EFM (NNH = 7), and fetal blood scalp testing (NNH = 45). The patient is having contractions every 4 minutes, each lasting 50 seconds. What is the baseline of the FHT? 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). Tachycardia greater than 200 bpm is usually due to fetal tachyarrhythmia (Figure 4) or congenital anomalies rather than hypoxia alone.16 Causes of fetal tachycardia are listed in Table 5. Instruct the woman to drink 1 to 2 quarts of water. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. 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.
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