EFM EFM - Electronic Fetal Monitoring Special Populations and High-Risk Conditions Questions and Answers 1 — Questions and Answers
Question 1: In a preterm fetus at 28 weeks gestation, which FHR characteristic differs from a term fetus and must be considered during EFM interpretation?
- Higher baseline heart rate and less pronounced variability are normal for gestational age (Correct answer)
- Accelerations must meet the same 15×15 criteria as a term fetus
- Late decelerations are expected and acceptable
- Bradycardia below 100 bpm is normal before 30 weeks
Correct answer: Higher baseline heart rate and less pronounced variability are normal for gestational age
Preterm fetuses normally have higher baseline heart rates and less variability due to immature autonomic nervous system development, requiring gestational-age-adjusted interpretation.
Question 2: When monitoring a patient with gestational diabetes on EFM, which fetal heart rate concern is MOST associated with macrosomia and shoulder dystocia risk?
- Prolonged second-stage decelerations indicating head compression with risk of cord entrapment at delivery (Correct answer)
- Persistent sinusoidal pattern
- Baseline tachycardia above 180 bpm throughout labor
- Absence of accelerations in the first stage
Correct answer: Prolonged second-stage decelerations indicating head compression with risk of cord entrapment at delivery
In macrosomic fetuses, prolonged or severe decelerations during pushing can signal cord or head compression that may be compounded by shoulder dystocia at delivery.
Question 3: In a twin gestation monitored with EFM, what is a major challenge unique to dual fetal monitoring?
- Signal cross-capture where one transducer picks up the other twin's heart rate (Correct answer)
- The inability to detect uterine contractions with an external tocometer
- Baseline FHR is always identical for both twins
- Only twin A can be monitored electronically
Correct answer: Signal cross-capture where one transducer picks up the other twin's heart rate
Signal cross-capture (cross-channel interference) can cause one monitor to display the other twin's FHR, leading to misinterpretation of fetal status.
Question 4: Which fetal heart rate pattern is MOST concerning in a patient with severe preeclampsia?
- Late decelerations with minimal variability (Correct answer)
- Accelerations with moderate variability
- Early decelerations only
- Mild variable decelerations with quick recovery
Correct answer: Late decelerations with minimal variability
In severe preeclampsia, uteroplacental insufficiency places the fetus at high risk, and late decelerations with minimal variability (Category III) indicate possible fetal acidemia.
Question 5: A patient at 41 weeks gestation is being monitored with EFM during oxytocin induction. Which pattern specifically increases risk in post-term fetuses?
- Variable decelerations due to oligohydramnios increasing cord compression risk (Correct answer)
- Moderate variability indicating fetal reserve
- Accelerations confirming fetal well-being
- Early decelerations from head compression
Correct answer: Variable decelerations due to oligohydramnios increasing cord compression risk
Post-term pregnancies are associated with oligohydramnios, which reduces the cushioning effect of amniotic fluid and increases the likelihood of umbilical cord compression causing variable decelerations.
Question 6: During EFM of a patient with intrauterine growth restriction (IUGR), which finding suggests the fetus has exhausted its compensatory reserves?
- Absent or minimal baseline variability with repetitive late decelerations (Correct answer)
- Moderate variability with occasional accelerations
- Early decelerations with normal baseline
- Increased fetal movement with reactive non-stress test
Correct answer: Absent or minimal baseline variability with repetitive late decelerations
In IUGR, absent variability combined with repetitive late decelerations indicates a decompensated fetus with likely metabolic acidosis and diminished reserve.
EFM EFM - Electronic Fetal Monitoring Special Populations and High-Risk Conditions Questions and Answers 1
In a preterm fetus at 28 weeks gestation, which FHR characteristic differs from a term fetus and must be considered during EFM interpretation?