Maternity Nursing: Intrapartum Q 8
A maternity nurse is preparing to care for a pregnant client in labor who will be delivering twins. The nurse monitors the fetal heart rates by placing the external fetal monitor:
A. Over the fetus that is most anterior to the mother’s abdomen.
B. Over the fetus that is most posterior to the mother’s abdomen.
C. So that each fetal heart rate is monitored separately.
D. So that one fetus is monitored for a 15-minute period followed by a 15 minute fetal monitoring period for the second fetus.
Correct Answer: C. So that each fetal heart rate is monitored separately.
In a client with a multifetal pregnancy, each fetal heart rate is monitored separately. Simultaneous monitoring of twins is preferable to non simultaneous monitoring to discriminate between their separate FHRs (ACOG, 1989). Synchronizing the internal clocks of both monitors will help produce accurate documentation. Otherwise, time increments should be documented on both monitor tracings for later comparison, to ensure that each twin has been monitored. If the monitor strips are synchronous, portable real-time ultrasound can be used to verify that both twins are being monitored independently
Option A: Among the advantages of simultaneous twin monitoring is the increased likelihood that both twins are being monitored with potentially less nursing time.
Option B: The nonstress test (NST) is the most widely used method of evaluating twins for any of the aforementioned risk factors. Normative data for simultaneous twin NSTs show synchrony or similarity in the tracings with incidences of 57.14% and 58% in twins monitored from 27?weeks until term.
Option D: Synchrony is thought by some to occur because the first twin’s movement produces a vibration and stimulates movement and FHR accelerations in the second twin. Recently, this idea was supported in a limited investigation of twins in which vibratory acoustic stimulation evoked an immediate transition from asynchronous to synchronous FHR tracings in all 16 tests carried out in the study (Sherer, Abramowicz, D’Amico, Caverly, & Woods, 1991).