EFM EFM - Electronic Fetal Monitoring Special Populations and High-Risk Conditions Questions and Answers 2 — Questions and Answers
Question 1: A laboring patient develops a fever of 101.8°F (38.8°C). Which EFM change is MOST directly expected as a result of maternal fever?
- Fetal tachycardia (Correct answer)
- Fetal bradycardia
- Decreased variability only, no rate change
- Sinusoidal pattern
Correct answer: Fetal tachycardia
Maternal fever elevates fetal metabolic rate and increases fetal heart rate through direct thermal and inflammatory mechanisms, resulting in tachycardia.
Question 2: Which EFM pattern is classically associated with complete placental abruption?
- Prolonged deceleration or sudden bradycardia with loss of variability (Correct answer)
- Mild late decelerations with moderate variability
- Recurrent early decelerations
- Episodic accelerations with a high baseline
Correct answer: Prolonged deceleration or sudden bradycardia with loss of variability
Complete placental abruption causes sudden cessation of uteroplacental blood flow, producing a prolonged deceleration or sustained bradycardia with loss of variability.
Question 3: When caring for a laboring patient with a uterine rupture, which EFM finding typically occurs FIRST?
- A prolonged or sudden fetal bradycardia (Correct answer)
- Gradual increase in baseline rate
- Progressive loss of variability over hours
- Sinusoidal pattern preceding rupture
Correct answer: A prolonged or sudden fetal bradycardia
Uterine rupture often presents acutely with a sudden prolonged fetal bradycardia due to catastrophic disruption of uteroplacental circulation.
Question 4: In a patient receiving epidural anesthesia, which hemodynamic change most commonly affects the fetal heart rate tracing?
- Maternal hypotension causing late or prolonged decelerations (Correct answer)
- Maternal hypertension causing fetal tachycardia
- Maternal bradycardia causing fetal accelerations
- No fetal effect because the placenta filters anesthetic agents
Correct answer: Maternal hypotension causing late or prolonged decelerations
Epidural anesthesia can cause maternal hypotension due to sympathetic blockade, reducing uterine blood flow and causing late or prolonged fetal decelerations.
Question 5: A patient with polyhydramnios is being monitored with EFM. Which fetal heart rate concern is MOST associated with this condition?
- Cord prolapse causing sudden prolonged decelerations (Correct answer)
- Oligohydramnios-related cord compression
- Chronic uteroplacental insufficiency
- Fetal tachycardia due to increased fluid pressure
Correct answer: Cord prolapse causing sudden prolonged decelerations
Polyhydramnios increases the risk of cord prolapse, particularly with rupture of membranes, which would produce sudden and severe fetal heart rate decelerations.
Question 6: In a patient with a prior cesarean birth monitored with EFM during a trial of labor (TOLAC), which pattern most specifically raises concern for uterine scar dehiscence?
- Sudden onset of late or prolonged decelerations in a previously reassuring tracing (Correct answer)
- Mild variable decelerations during pushing
- Gradual increase in baseline from 130 to 145 bpm
- Loss of accelerations in the third trimester
Correct answer: Sudden onset of late or prolonged decelerations in a previously reassuring tracing
A sudden change to non-reassuring FHR patterns in a TOLAC patient should raise immediate suspicion for scar dehiscence or rupture disrupting fetal circulation.
EFM EFM - Electronic Fetal Monitoring Special Populations and High-Risk Conditions Questions and Answers 2
A laboring patient develops a fever of 101.8°F (38.8°C).
Which EFM change is MOST directly expected as a result of maternal fever?