Strip Evaluation and Categorization
In this section, you will evaluate your knowlege and visual assessment skill. Fill in the blanks after each question then look at the correct responses on pages 185 and 186. Remember, visual assessment rarely has 100% agreement, so the numbers we state as correct may be slightly different from yours.
13.1 Strip 1.
1. What is the FHR at the nadirs in bpm? - bpm
2. Is the contraction peak-to-deceleration nadir lag time greater or less than 18 seconds? _______________
3. What is the recovery time from nadir to baseline? - seconds 4. What kind of decelerations are these?
Section 13 Strip Evaluation and Categorization 177
13.2 Strip 2.
5. What is the duration of the decelerations in seconds? - seconds 6. What is the depth of the nadirs in bpm? - bpm
7. What is the recovery time from nadir to baseline? - seconds 8. What kind of decelerations are these?
178 Essentials of Fetal Monitoring
13.3 Strip 3.
9. How long is the onset from baseline to nadir? seconds
10. What is the lag time between the contraction peak and the nadirs in seconds? - seconds 11. What is the recovery time from nadir to baseline? seconds
12. What kind of decelerations are these?
Section 13 Strip Evaluation and Categorization 179
13.4 Strip 4.
13. What is the baseline range? - bpm 14. Is short-term variability present or absent?
15. Classify long-term variability.
16. What is the FHR at the height of the accelerations? - bpm 17. What is the duration of the accelerations? - seconds
18. Are any of these reactive accelerations? ❏Yes or ❏No 19. Is this fetus metabolically acidotic? ❏Yes or ❏No
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13.5 Strip 5.
20. Is this a periodic or episodic (nonperiodic) deceleration?
21. What is the duration of the deceleration? minutes 22. What is the FHR at the nadir of the deceleration? bpm 23. What are the two most likely causes of this deceleration?
1. 2.
Section 13 Strip Evaluation and Categorization 181
13.6 Strip 6.
24. What kind of decelerations are these?
25. What is the contraction frequency? every minute(s) 26. What is the contraction duration? - seconds
27. What is the contraction strength/peak intrauterine pressure? - mm Hg 28. What is the resting tone? - mm Hg
29. What is this uterine activity called?
182 Essentials of Fetal Monitoring
13.7 Strip 7.
30. What would you record as the baseline? - bpm 31. Classify STV. STV is
32. Classify LTV. LTV is 33. Are there any accelerations?
34. Are there any decelerations?
35. Is this normal UA?
36. If no, what is this called?
Section 13 Strip Evaluation and Categorization 183
13.8 Strip 8.
37. Fill in each box for Strip 8
38. What is the most likely cause of this pattern?
a. head compression b. cord compression
c. inadequate uteroplacental perfusion
184 Essentials of Fetal Monitoring
BL STV LTV Accels Decels
ht bpm type
duration sec duration ____ sec
depth bpm
39. What actions would you take in response to this pattern (13.8)? (Circle the letter of all that apply) a. do nothing, it’s a normal fetal response f. apply oxygen by mask
b. turn the woman g. notify the midwife or doctor
c. discontinue Pitocin® h. perform a vaginal examination
d. increase IV fluids i. take maternal blood pressure
e. observe the pattern
13.9 Strip 9.
Fill in each box for strip 9. Demerol 25 mg IV push was administered 10 minutes ago. Prior to the pattern the fetal heart rate pattern was reassuring.
Section 13 Strip Evaluation and Categorization 185
BL STV LTV Accels Decels
ht bpm type
duration sec duration ____ sec
depth bpm
41. What is the most likely cause of this pattern (13.9)?
42. What actions would you take in response to this pattern?
a. do nothing f. apply oxygen by mask
b. turn the woman g. notify the midwife or doctor
c. discontinue Pitocin® h. perform a vaginal examination
d. increase IV fluids i. take maternal blood pressure
e. observe the pattern
13.10 Strip 10: This fetal heart rate pattern occurred within 7 minutes after the epidural test dose. The maternal blood pressure was 75/35.
186 Essentials of Fetal Monitoring
43. What 3 immediate actions would you take?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
44. If the FHR recovered to a rate greater than 160 bpm would the fetus be out of jeopardy?
45. Is the fetal heart rate adequate to perfuse the fetal brain?
Answers To Strip Evaluation
Section 13 Strip Evaluation and Categorization 187
ANSWERS
Strip 1
1. 120-125 2. less than 3. 40-50 4. early
Strip 2
5. 25-90 6. 75-100 7. 20-50 8. variable
Strip 3
9. 25-45 10. 45-60 11. 40-45 12. late
Strip 4
13. 120-130 14. present 15. average 16. 145-150 17. 25-45 18. yes 19. no
Strip 5
20. episodic/nonperiodic 21. 5
22. 66 (this is European scale paper) 23. umbilical cord compression, uterine
hyperstimulation
Strip 6 24. late 25. 1-4 26. 50-90 27. 75-100 28. 10-20
29. possible coupling at 0539-0540
Strip 7
30. 140-150
31. probably present, but this is an external ultrasound tracing
32. minimal to average 33. yes (see last minute) 34. no
35. no
36. LAHF waves or low amplitude high frequency waves or uterine irritability
Strip 8
37. 130-135 bpm (European scale paper), present STV, minimal LTV, no accels, only shoulders on variable decelerations, variable decels x 30 sec ⇓ 110-115 bpm 38. b
39. b, e, g if the pattern is unrelieved by your actions or she has a scarred uterus as variable decelerations are the most common deceleration pattern when the uterus is tearing (rupturing)
Strip 9
40. 125-140 bpm, 0 STV, 0 LTV, 0 accels, 0 decels
41. Demerol and uterine hyperstimulation with possible fetal hypoxia
42. b, c, d, e, f, g; remove oxygen once signs of fetal well-being return and the uterus is contracting normally
Strip 10
43. discontinue Pitocin®; call the surgeon, anesthesia provider, operating room crew, and pediatrician stat; provide an IV bolus of a non-glucose solution and Ephedrine® as ordered
44. no, that would be a rebound tachycardia which is highly unlikely with such profound bradycardia, suspect it’s maternal heart rate doubling 45. no
A score of 40 correct is excellent. If you scored less than 40 correct, go back and reevaluate the images.
Now, let's look at how one group tried to reach consensus in the definitions of some fetal monitoring concepts in Section 14.
188 Essentials of Fetal Monitoring