EFM - Electronic Fetal Monitoring Intrauterine Resuscitation Techniques Questions and Answers — Questions and Answers
Question 1: A laboring patient with an EFM tracing showing recurrent late decelerations and minimal variability is placed in a left lateral position. What is the primary physiological goal of this intervention?
- To alleviate direct compression of the umbilical cord.
- To increase maternal cardiac output and improve uteroplacental perfusion. (Correct answer)
- To dislodge the fetal head from the pelvis.
- To stimulate a fetal vagal response and lower the heart rate.
Correct answer: To increase maternal cardiac output and improve uteroplacental perfusion.
Placing the patient in a lateral position, particularly the left lateral, displaces the gravid uterus off the inferior vena cava and aorta. This action increases venous return to the heart, boosts maternal cardiac output, and consequently improves blood flow to the placenta, which helps to correct the uteroplacental insufficiency indicated by late decelerations.
Question 2: Which of the following intrauterine resuscitation techniques is specifically indicated for the management of recurrent variable decelerations believed to be caused by umbilical cord compression?
- Administration of a 500 mL IV fluid bolus of lactated Ringer's.
- Discontinuation of oxytocin infusion.
- Application of 10 L/min of oxygen via a non-rebreather mask.
- Instillation of warmed normal saline via an intrauterine pressure catheter (Amnioinfusion). (Correct answer)
Correct answer: Instillation of warmed normal saline via an intrauterine pressure catheter (Amnioinfusion).
Amnioinfusion is the instillation of fluid into the uterine cavity to supplement amniotic fluid volume. This is primarily performed to cushion the umbilical cord, thereby relieving the compression that is the underlying cause of recurrent variable decelerations.
Question 3: A patient receiving oxytocin for labor augmentation develops uterine tachysystole (six contractions in 10 minutes) accompanied by recurrent late decelerations. What is the FIRST priority nursing intervention?
- Administer a subcutaneous dose of terbutaline.
- Increase the rate of the primary IV infusion.
- Discontinue the oxytocin infusion. (Correct answer)
- Place the patient in a Trendelenburg position.
Correct answer: Discontinue the oxytocin infusion.
The first and most critical intervention for uterine tachysystole caused by oxytocin is to stop the causative agent. Discontinuing the oxytocin infusion is the fastest way to begin reducing uterine activity and improve blood flow to the fetus, which can resolve the associated late decelerations. Other resuscitative measures may follow, but stopping the oxytocin is the priority.
Question 4: When supplemental oxygen is administered as an intrauterine resuscitation measure for a Category II or III fetal heart rate tracing, what is the generally recommended method and flow rate?
- 5 L/min via a simple face mask.
- 10 L/min via a non-rebreather face mask. (Correct answer)
- 2-4 L/min via nasal cannula.
- 100% FiO2 via a bag-valve-mask.
Correct answer: 10 L/min via a non-rebreather face mask.
For intrauterine resuscitation, the goal is to maximize maternal hyperoxygenation to increase the oxygen gradient and subsequent transfer to the fetus. A non-rebreather face mask at a flow rate of 10 L/min is recommended to achieve this, as it delivers a higher concentration of inspired oxygen compared to a nasal cannula or simple face mask.
Question 5: A G1P0 patient at 39 weeks gestation develops hypotension (BP 85/50 mmHg) immediately following epidural placement. The EFM tracing shows a prolonged deceleration to 70 bpm. In addition to notifying the provider, which combination of interventions is most appropriate?
- Administer terbutaline and initiate amnioinfusion.
- Start oxytocin and perform a cervical exam.
- Initiate left lateral positioning and administer an IV fluid bolus. (Correct answer)
- Apply fundal pressure and encourage the patient to push.
Correct answer: Initiate left lateral positioning and administer an IV fluid bolus.
Epidural-induced hypotension is a common cause of fetal distress due to reduced uteroplacental perfusion. The primary interventions are aimed at correcting the hypotension. This is achieved by administering a rapid IV fluid bolus to increase intravascular volume and by changing the maternal position (typically to left lateral) to displace the uterus from the great vessels, which improves venous return and cardiac output.
Question 6: The primary purpose of administering an intravenous (IV) fluid bolus of an isotonic solution during intrauterine resuscitation is to:
- Increase maternal intravascular volume to improve placental perfusion. (Correct answer)
- Correct fetal dehydration.
- Dilute meconium in the amniotic fluid.
- Decrease the intensity of uterine contractions.
Correct answer: Increase maternal intravascular volume to improve placental perfusion.
An IV fluid bolus, typically with a solution like Lactated Ringer's or Normal Saline, expands the mother's intravascular fluid volume. This action can help correct relative or absolute hypovolemia (e.g., from dehydration or epidural-induced vasodilation), thereby increasing maternal blood pressure and improving blood flow through the uterine arteries to the placenta.
EFM - Electronic Fetal Monitoring Intrauterine Resuscitation Techniques Questions and Answers
A laboring patient with an EFM tracing showing recurrent late decelerations and minimal variability is placed in a left lateral position.
What is the primary physiological goal of this intervention?