9/30/2011 1 Supplemental slides for AFM Update 2011 ARTIFACT OR ARRHYTHMIA?
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9/30/2011
1
Supplemental slides for AFM Update 2011
ARTIFACT OR ARRHYTHMIA?
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WHAT DO YOU THINK…ARTIFACT OR ARRHYTHMIA???
ARRHYTHMIA is likely. IT IS ALSO A “CONVERSION PATTERN” WITH ABSENT VARIABILITY, AND ACCELS NOT RELATED TO A NORMAL NEUROLOGIC SYSTEM FOLLOWING HOURS OF SEVERE BRAIN COMPRESSION AND ISCHEMIA THAT RESULTED IN A DECREASE IN BARORECEPTOR SENSITIVITY AND A SHIFT FROM NORMAL VAGAL REGULATION OF THE SA NODE.
Arrhythmia
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WHAT DO YOU THINK???
MOM HAD BEEN GIVEN NUBAIN 10 MG BENIGN SINUSOIDAL
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ARE THESE THE SAME?
Lambda Pattern v. Checkmark Pattern
LambdaPattern
CheckmarkPattern
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Lambda Pattern v. Checkmark Pattern
Lambda pattern thought to be related to fetal BP and HR rate shift…They are innocuous
Checkmark PatternThe fetus is seizing
NAME THAT PATTERN
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BOTH THE CNM AND RN CALLED THEM VARIABLES…IS THERE CORD COMPRESSION?
FHR between 150 ‐ 155 bpm with spont accelabove 2nd UC and mild variable decels. MHR 92 ‐102 bpm and (uniform) accels with UCs.
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MHR 70 to 90, doubling x 25 seconds to 140 ‐ 160.
US limitation ‐MHR doubling
MHR near 87 bpm and doubling near 174. The fetus was dead on admission. Fetal life was not confirmed prior to monitor application.
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FHR near longWHAT DO YOU THINK THIS IS?
ARRHYTHMIA THEN ARTIFACT
The fetal ECG waveform is printed at the top of the FHR channel.
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Twin Offset
Is this rate at 120 bpm the fetus?
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Is this rate at 120 bpm the fetus?
No! The US was on top of the monitor picking up the fan’s movement!!
WHAT ARE THESE “SPIKES”?
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Escape beat
Supraventricular Tachycardia
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Maternal Doubling
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