fetal heart tracing quiz 10 fetal heart tracing quiz 10

Which of the following steps are included in this intervention? The transducer uses Doppler ultrasound to detect fetal heart motion and is connected to an FHR monitor. https://www.mayoclinic.org/tests-procedures/nonstress-test/about/pac-20384577 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. -Reassuring for fetal well being Variable decelerations associated with a nonreassuring pattern, Late decelerations with preserved beat-to-beat variability, Persistent late decelerations with loss of beat-to-beat variability, Nonreassuring variable decelerations associated with loss of beat-to-beat variability, Confirmed loss of beat-to-beat variability not associated with fetal quiescence, medications or severe prematurity, Administer oxygen through a tight-fitting face mask, Change maternal position (lateral or knee-chest), Administer fluid bolus (lactated Ringer's solution), Perform a vaginal examination and fetal scalp stimulation, When possible, determine and correct the cause of the pattern, Consider tocolysis (for uterine tetany or hyperstimulation), Consider amnioinfusion (for variable decelerations), Determine whether operative intervention is warranted and, if so, how urgently it is needed, A blunt acceleration or overshoot after severe deceleration, Late decelerations or late return to baseline (. Antepartum Fetal Assessment 10. 2. Management depends on the clinical picture and presence of other FHR characteristics.18, Overall Assessment (O). fetal heart tracing quiz 12. fetal heart tracing quiz 12. where are siegfried and roy buried; badlion client for cracked minecraft; florida man november 6, 2000; bulk tanker owner operator jobs; casselman river hatch chart; who makes carquest batteries; sacred heart southern missions mass cards; Depending on your health status and your babys, nonstress tests (one to two times a week, if not daily) might be a good idea. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. What action by the student indicates to the registered nurse that the student understands the procedure? -Positive Contraction Stress Test: Hasten fetal delivery. The average rate ranges from 110 to 160 beats per minute (bpm), with a variation of 5 to 25 bpm. To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles. Copyright 2023 American Academy of Family Physicians. A patient is in active labor and is being continuously monitored with a fetal monitor. The nurse's best response is, b. Accelerations are transient increases in the FHR (Figure 1). Minimal variability during the hour preceding fetal bradycardic events has been shown to be most predictive of fetal acidosis and need for emergent delivery.23 During periods of minimal variability, accelerations produced by scalp stimulation offer reassurance.15,23,26,41 Management of minimal variability includes intrauterine resuscitation and identifying and treating reversible causes (Table 7).2,7,16, Marked variability is defined as more than 25 bpm fluctuations in FHR around the determined baseline for more than 10 minutes and may represent hypoxic stress5,33 (eFigure E). Per the practitioner's order and the patient's request, the nurse has been monitoring the fetal heart rate by IA. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. This content is owned by the AAFP. -Positive: Repetitive; persistent late decelerations, Decelerations with more than half of contractions, Not due to uterine hyperstimulation, -Negative Contraction Stress Test: Reassuring for fetal well being, Follow daily Fetal Kick Counts 5 contractions in 10 minutes averaged over thirty minutes If the cause cannot be identified and corrected, immediate delivery is recommended. Fetal monitoring. 6. Instruct the woman to drink 1 to 2 quarts of water. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration of the FHR.15. Practice Quizzes 1-5. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions. Contractions are occurring every 3 minutes and lasting 60 seconds, and are of moderate intensity with a soft resting tone. The FHR is under constant variation from the baseline (Figure 1). What is the baseline of the FHT? The nurse understands that the primary intervention is to: The nurse notes that the fetal heart rate baseline is 120-130 with an increase in FHR to 145 bpm lasting 15 seconds. is part of the free online EFM toolkit at. Non-Reactive NST: Powered by. (SELECT ALL THAT APPLY), Baseline rate of 110-160 bpm Moderate variability. What is the peak voltage across the 3.0F3.0 \mu \mathrm{F}3.0F capacitor? On a drawing of the body locate the major body regions containing lymph nodes. Rate and decelerations B. Describe the variability. The organization's practice allows for IA if 1:1 nursing staff is available. Fetal heart rate. a) Recalculate the branch current in the 22 \Omega2 resistor, I2I _2I2. -How? Therefore, it is a vital clue in determining the overall fetal condition. Powered by. 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. Try your hand at the following quizzes. The nurse understands that this pattern is related to which of the following? Count FHR between contractions for 60 seconds to determine average baseline rate, 6. 4. The presence of a saltatory pattern, especially when paired with decelerations, should warn the physician to look for and try to correct possible causes of acute hypoxia and to be alert for signs that the hypoxia is progressing to acidosis.21 Although it is a nonreassuring pattern, the saltatory pattern is usually not an indication for immediate delivery.19. External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the FHR during a uterine contraction and for 30 seconds thereafter to identify fetal response. Be sure to ask any questions you might have beforehand. 2023 National Certification Corporation. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. Electronic fetal monitoring is performed in a hospital or doctors office. Variable and inconsistent interpretation of tracings by clinicians may affect management of patients. Obstetric Models and Intrapartum Fetal Monitoring in Europe NEW! Chemoreceptors located in the aortic and carotid bodies respond to hypoxia, excess carbon dioxide and acidosis, producing tachycardia and hypertension.15 The FHR is under constant and minute adjustment in response to the constant changes in the fetal environment and external stimuli. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. What is the most appropriate nursing response? Theyre empowered by these results to intervene and hopefully prevent an adverse outcome. https://www.acog.org/Patients/FAQs/Fetal-Heart-Rate-Monitoring-During-Labor?IsMobileSet=false Normal. Decelerations represent a decrease in FHR of more than 15 bpm in bandwidth amplitude. The resulting printout is known as a fetal heart tracing, which will be read and analyzed. Nonreassuring variable decelerations associated with the loss of beat-to-beat variability correlate substantially with fetal acidosis4 and therefore represent an ominous pattern. Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. The FHR tracing should be interpreted only in the context of the clinical scenario, and any therapeutic intervention should consider the maternal condition as well as that of the fetus. What should the nurse do before appropriate clinical interventions are initiated? What should be the nurse's next action? The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Fetal heart tracing is also useful for eliminating unnecessary treatments. How an individual's senses are elevated by arousing the central nervous system? 4 It is. Continuous electronic fetal monitoring has been shown to reduce the incidence of neonatal seizures, but there has been no beneficial effect in decreasing cerebral palsy or neonatal mortality. Late decelerations are associated with uteroplacental insufficiency and are provoked by uterine contractions. For more information on the use, interpretation and management of patients based on Fetal Heart Tracings check out the resources below. can you recognize these strip elements? to access the EFM tracing game and to take full advantage of all the resources available. 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. 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). Mucus plug: What is it and how do you know you've lost it during pregnancy? The normal range for baseline FHR is defined by NICHD as 110 to 160 beats per minute (bpm; Online Figure A). Determine Risk (DR). It is also characterized by a stable baseline heart rate of 120 to 160 bpm and absent beat-to-beat variability. What is the baseline of the FHT? 4. A. The EFM toolkit also offers EFM CE opportunities and C-EFM. 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. distribution of tributaries influences The key elements include assessment of baseline heart rate, presence or absence of variability, and interpretation of periodic changes. -Biophysical Profile c) On the basis of your answers, is it desirable to have the resistance of the two 120 V loads be equal? Self Guided Tutorial. Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. The FHR normally exhibits variability, with an average change of 6 to 25 bpm of the baseline rate, and is linked to the fetal central nervous system. Fetal pulse oximetry has not shown a reduction in cesarean delivery rates. The nurse teaches a pregnant woman that which diagnostic test evaluates the effect of fetal movement on fetal heart activity? Recurrent variable decelerations are frequently seen in association with maternal expulsive efforts in the 2nd stage of 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).4 It is equivalent to continuous EFM in screening for fetal compromise in low-risk patients.2,3,5 Safety in using structured intermittent auscultation is based on a nurse-to-patient ratio of 1:1 and an established technique for intermittent auscultation for each institution.4 Continuous EFM should be used when there are abnormalities in structured intermittent auscultation or for high-risk patients (Table 2).4 An admission tracing of electronic FHR in low-risk pregnancy increases intervention without improved neonatal outcomes, and routine admission tracings should not be used to determine monitoring technique.6. 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, Category II management should focus on first correcting reversible causes, including stopping uterotonic agents and placental fetal perfusion, through intrauterine resuscitation, Amnioinfusion has been shown to reduce cord compression, leading to resolution of FHR decelerations (RR = 0.53; 95% CI, 0.38 to 0.74; n = 1,000) and lowering the likelihood of cesarean delivery. Professionals using Electronic Fetal Monitoring in their practice should also take advantage of: The EFM Resources page with linked papers and articles including the NCC monograph Fetal Assessment and Safe Labor Management authored by Kathleen Rice Simpson, PhD, RNC-OB, CNS-BC, FAAN. Absent. For example, fetuses with intrauterine growth restriction are unusually susceptible to the effect of hypoxemia, which tends to progress rapidly.4, A growing body of evidence suggests that, when properly interpreted, FHR assessment may be equal or superior to measurement of fetal blood pH in the prediction of both good and bad fetal outcomes.13 Fetuses with a normal pH, i.e., greater than 7.25, respond with an acceleration of the fetal heart rate following fetal scalp stimulation. Accelerations (A). . Baseline is calculated as a mean of FHR segments that are the most horizontal, and also fluctuate the least. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. -Related to fetal movement The nurse's action after turning the patient to her left side should be: Applying oxygen per face mask at 8-10 L/min. Intermountain Healthcare - Interprofessional Continuing Education, Third Annual Advanced Fetal Heart Rate Interpretation Conference, 10/27/2023 12:00:00 PM - 10/27/2023 5:00:00 PM, This conference will discuss fetal heart rate variability including: pathophysiology of variability; extreme abnormalities of variability; variability in the Category II Fetal Heart Tracing Algorithm; and case . https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2015.06.020 All Rights Reserved. Everything You Need to Know, 2023 Flo Health Inc., Flo Health UK Limited. This pattern is most often seen during the second stage of labor. Interpretation of intrapartum electronic fetal heart rate (FHR) tracings has been hampered by interobserver and intraobserver variability, which historically has been high [].In 2008, the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the United States National Institute of Child Health and Human Development (NICHD . https://www.ncbi.nlm.nih.gov/pubmed/19546798 The patient's membranes ruptured 1 hour ago, and the fluid was clear. Electronic fetal monitoring may help detect changes in normal FHR patterns during labor. Theyll wrap a pair of belts around your belly. Decompression melting as the mantle rises, C. Melting of continental crust caused by an influx of mantle-derived magmas. The descent and return are gradual and smooth. -0-2: Deliver promptly, -Assesses fetal tolerance of stress Develop a plan, in the context of the clinical scenario, according to interpretation of the FHR. What should the nurse do next? What Do Contractions Feel Like? Recurrent deep variable decelerations can be corrected with amnioinfusion. Bradycardia in the range of 100 to 120 bpm with normal variability is not associated with fetal acidosis. -Relative: Multiple Gestation, History of classic cesarean section, -Negative (Normal): Adequate contractions, No concerning rate changes with contractions (no late decelerations) Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. The first uses Doppler ultrasound to monitor FHR patterns, while the second measures the duration and frequency of uterine contractions. 150 155 160 Remember, the baseline is the average heart rate rounded to the nearest five bpm. 5. e) lava dome. The physiology behind late deceleration is uteroplacental insufficiency.16,17 Transient late deceleration patterns may be seen with maternal hypotension or uterine hyperstimulation. Copyright 2023 American Academy of Family Physicians. Quizzes 6-10. Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. Copyright 2009 by the American Academy of Family Physicians. Interventions to increase fetal activity fail, Reactive NST: The patient is having contractions every 4 minutes, each lasting 50 seconds. Beta-adrenergic agonists used to inhibit labor, such as ritodrine (Yutopar) and terbutaline (Bricanyl), may cause a decrease in variability only if given at dosage levels sufficient to raise the fetal heart rate above 160 bpm.19 Uncomplicated loss of variability usually signifies no risk or a minimally increased risk of acidosis19,20 or low Apgar scores.21 Decreased FHR variability in combination with late or variable deceleration patterns indicates an increased risk of fetal preacidosis (pH 7.20 to 7.25) or acidosis (pH less than 7.20)19,20,22 and signifies that the infant will be depressed at birth.21 The combination of late or severe variable decelerations with loss of variability is particularly ominous.19 The occurrence of a late or worsening variable deceleration pattern in the presence of normal variability generally means that the fetal stress is either of a mild degree or of recent origin19; however, this pattern is considered nonreassuring. The fetal heart rate tracing shows EITHER of the following: Sinusoidal pattern OR absent variability with recurrent late decelerations, recurrent variable decelerations, or bradycardia. 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. Continuous electronic fetal monitoring (EFM), using external or internal transducers, became a part of routine maternity care during the 1970s; by 2002, about 85 percent of live births (3.4 million out of 4 million) were monitored by it.1 Continuous EFM has led to an increase in cesarean delivery and instrumental vaginal births; however, the incidences of neonatal mortality and cerebral palsy have not fallen, and a decrease in neonatal seizures is the only demonstrable benefit.2 The potential benefits and risks of continuous EFM and structured intermittent auscultation should be discussed during prenatal care and labor, and a decision reached by the pregnant woman and her physician, with the understanding that if intrapartum clinical situations warrant, continuous EFM may be recommended.3, There are several considerations when choosing a method of intrapartum fetal monitoring. 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! This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. This alone is not predictive of fetal acidosis unless accompanied by decreased variability and/or absent spontaneous or stimulated accelerations.2,5. They resemble the letter U, V or W and may not bear a constant relationship to uterine contractions. Heres how to tell if youre experiencing them. C. Evaluate the patient's understanding of the monitoring methods and notify the practitioner. Questions and Answers 1. Notify your provider if the baby's movement slows down, The nurse explains to the student that increasing the infusion rate of non-additive intravenous fluids can increase fetal oxygenation primarily by, A pregnant woman's biophysical profile score is 8. A scalp pH of less than 7.20 is considered abnormal and generally is an indication for intervention, immediate delivery, or both.12 A pH less than 7.20 should also be assumed in the absence of an acceleration following fetal scalp stimulation when fetal scalp pH sampling is not available. A new nurse is asking an experienced nurse about interpreting a Category III FHR tracing. Incorrect. See permissionsforcopyrightquestions and/or permission requests. The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? -Fetal body movements Early decelerations (mirror contraction, with nadir at peak of contraction, likely fetal head compression) and accelerations (FHR increase of 15 bpm or more over at least 15 seconds) may be present.2,5,7,34 No intervention is required for Category I tracings. While admitting a patient who is at 40 weeks' gestation, the nurse observes an FHR of 165 bpm with recurrent decelerations. 3/10/2017 Fetal Heart Tracing Quiz 1 Correct. The number of migratory animals (in hundreds) counted at a certain checkpoint is given by. May 2, 2022 The NCC EFM Tracing Game is part of the free online EFM toolkit at NCC-EFM.org. Decreased variability is defined as a variation of one to five bpm from baseline for at least 10 minutes5 (eFigure D). Variable decelerations may be classified according to their depth and duration as mild, when the depth is above 80 bpm and the duration is less than 30 seconds; moderate, when the depth is between 70 and 80 bpm and the duration is between 30 and 60 seconds; and severe, when the depth is below 70 bpm and the duration is longer than 60 seconds.4,11,24 Variable decelerations are generally associated with a favorable outcome.25 However, a persistent variable deceleration pattern, if not corrected, may lead to acidosis and fetal distress24 and therefore is nonreassuring. Although these decelerations are not associated with fetal distress and thus are reassuring, they must be carefully differentiated from the other, nonreassuring decelerations. Your obstetrician reviews the fetal heart tracing at regular time intervals. 1. If decelerations are not reversed by intrauterine resuscitation measures, immediate delivery is recommended.2,43, This article updates previous articles on this topic by Bailey44 and by Sweha, et al.45. 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. Practice basic fetal tracing analysis with some quizzes: Quizzes 1-5. 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. From this information, we wish to predict where the fringe for n=50n=50n=50 would be located. The patient's labor has been normal to this point. Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? 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. No. Powered by. None. Presence of moderate fetal heart rate variability and accelerations with absence of recurrent pathologic decelerations provides reassurance that acidosis is not present. You scored 6 out of 6 correct. B. Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns.11,12 Evaluation for immediate delivery is recommended for patients with ominous patterns. The patient is being monitored by external electronic monitoring. a streams response to precipitation. Continuous electronic fetal monitoring is the continuous monitoring of fluctuations of the fetal heart rate (FHR) in relation to maternal contractions and is considered standard practice. A more recent article on intrapartum fetal monitoring is available. The nurse understands that that if the woman has hypotension the fetal monitor tracing would indicate which of the following? Electronic fetal monitoring is performed in a hospital or doctors office. 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). 3. Continuous electronic fetal monitoring, compared with structured intermittent auscultation, has been shown to increase the need for cesarean delivery (number needed to harm = 56; RR = 1.63; 95% CI, 1.29 to 2.07; n = 18,861) and operative vaginal delivery (number needed to harm = 41; RR = 1.15; 95% CI, 1.01 to 1.33; n = 18,615), with no statistical decrease in fetal death or cerebral palsy.1 Continuous electronic fetal monitoring has also led to a 50% reduction in the incidence of neonatal seizure vs. structured intermittent auscultation, but this has no effect on long-term outcomes.1, Several adjuncts have been studied to overcome the high false-positive rate of continuous electronic fetal monitoring.