You are evaluating a patient in the Prenatal Testing Department who has just completed a biophysical profile (BPP). Create engaging Jeopardy-style quiz games in minutes or choose from millions of existing Jeopardy game templates. Health care professionals play the game to hone and test their EFM knowledge and skills. What interventions would you take after evaluating this strip and why? contraction. if accel is 10 min+, it is a baseline change, 15 bpm above baseline w duration of 15 sec or more but less than 2 min. -*hypertonus*: abnormally high resting tone >25 mmhg or MVU >400 Abrupt decrease, > 15 bpm, The average rate ranges from 110 to 160 beats per minute (bpm), with a variation of 5 to 25 bpm. Healthcare providers usually start listening for a babys heart rate at the 10- to 12-week prenatal visit using a Doppler machine. No. A fetal heart rate gives you and your healthcare team information about your baby's health during pregnancy. Place the Doppler over the area of maximal intensity of fetal heart tones, 3. Your doctor evaluates the situation by reviewing fetal heart tracing patterns. Continuous EFM reduced neonatal seizures (NNT = 661), but not the occurrence of cerebral palsy. delayed after uterine Minimal. Fetal heart rate is a term that refers to a baby's heartbeat while they're in the uterus. Your doctor can then take steps to manage the underlying medical problem. -prolonged decel *can be due to umbilical cord prolapse*. External monitoring (unless noted differently), paper speed is 3cm/min. For additional quantities, please contact [emailprotected] While it is not always a cause for concern, fetal heart rates outside the normal range may also indicate fetal distress. -prolonged decel >2 min but <10 min V. Fetal heart rate patterns in the second stage of labor. Accelerations last from 15 seconds to 10 minutes, and the majority occur in conjunction with fetal movements. Symmetrical gradual decrease and return of the FHR associated with a uterine contraction. *fetal stimulation: digital scalp stim, vibroacoustic stim* Count FHR after uterine contraction for 60 seconds (at 5-second intervals) to identify fetal response to active labor (this may be subject to local protocols), Abnormal umbilical artery Doppler velocimetry, Maternal motor vehicle collision or trauma, Abnormal fetal heart rate on auscultation or admission, Intrauterine infection or chorioamnionitis, Post-term pregnancy (> 42 weeks' gestation), Prolonged membrane rupture > 24 hours at term, Regional analgesia, particularly after initial bolus and after top-ups (continuous electronic fetal monitoring is not required with mobile or continuous-infusion epidurals), High, medium, or low risk (i.e., risk in terms of the clinical situation), Rate, rhythm, frequency, duration, intensity, and resting tone, Bradycardia (< 110 bpm), normal (110 to 160 bpm), or tachycardia (> 160 bpm); rising baseline, Reflects central nervous system activity: absent, minimal, moderate, or marked, Rises from the baseline of 15 bpm, lasting 15 seconds, Absent, early, variable, late, or prolonged, Assessment includes implementing an appropriate management plan, Visually apparent, abrupt (onset to peak < 30 seconds) increase in FHR from the most recently calculated baseline, Peak 15 bpm above baseline, duration 15 seconds, but < 2 minutes from onset to return to baseline; before 32 weeks gestation: peak 10 bpm above baseline, duration 10 seconds, Approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding periodic or episodic changes, periods of marked variability, and segments of baseline that differ by > 25 bpm, In any 10-minute window, the minimum baseline duration must be 2 minutes, or the baseline for that period is indeterminate (refer to the previous 10-minute segment for determination of baseline), The nadir of the deceleration occurs at the same time as the peak of the contraction, The nadir of the deceleration occurs after the peak of the contraction, Abrupt decrease in FHR; if the nadir of the deceleration is 30 seconds, it cannot be considered a variable deceleration, Moderate baseline FHR variability, late or variable decelerations absent, accelerations present or absent, and normal baseline FHR (110 to 160 bpm), Continue current monitoring method (SIA or continuous EFM), Baseline FHR changes (bradycardia [< 110 bpm] not accompanied by absent baseline variability, or tachycardia [> 160 bpm]), Tachycardia: medication, maternal anxiety, infection, fever, Bradycardia: rupture of membranes, occipitoposterior position, post-term pregnancy, congenital anomalies, Consider expedited delivery if abnormalities persist, Change in FHR variability (absent and not accompanied by decelerations; minimal; or marked), Medications; sleep cycle; change in monitoring technique; possible fetal hypoxia or acidemia, Change monitoring method (internal monitoring if doing continuous EFM, or EFM if doing SIA), No FHR accelerations after fetal stimulation, FHR decelerations without absent variability, Late: possible uteroplacental insufficiency; epidural hypotension; tachysystole, Absent baseline FHR variability with recurrent decelerations (variable or late) and/or bradycardia, Uteroplacental insufficiency; fetal hypoxia or acidemia, 2. A meta-analysis showed that if there is absent or minimal variability without spontaneous accelerations, the presence of an acceleration after scalp stimulation or fetal acoustic stimulation indicates that the fetal pH is at least 7.20.19, If the FHR tracing remains abnormal, these tests may need to be performed periodically, and consideration of emergent cesarean or operative vaginal delivery is usually recommended.15 Measurements of cord blood gases are generally recommended after any delivery for abnormal FHR tracing because evidence of metabolic acidosis (cord pH less than 7.00 or base deficit greater than 12 mmol per L) is one of the four essential criteria for determining an acute intrapartum hypoxic event sufficient to cause cerebral palsy.20, When using continuous EFM, tracings should be reviewed by physicians and labor and delivery nurses on a regular basis during labor. Tachycardia is certainly not always indicative of fetal distress or hypoxia, but this fetal tracing is ominous. Accelerations represent a sudden increase in FHR of more than 15 bpm in bandwidth amplitude. Fetal Heart Rate Monitoring - Freeman 2012 "Fetal heart rate monitoring is widely used by almost every obstetrician as a way to document the case and to help decrease health care costs. While it can be an important tool to assess fetal wellbeing, it is also limited by its high false-positive rate. What are the two most important characteristics of the FHR? Here's what University of Michigan Medical Students said about the SecondLookTM concept: "The Second Look (files) have been a godsend. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. List three primary interventions for fetal tachycardia. According to AWHONN, the normal baseline Fetal Heart Rate (FHR) is A. This article reviews normal fetal heart rate, how it is measured, who should monitor it, and what causes variations. Adequate documentation is necessary, and many institutions are now employing flow sheets (e.g., partograms), clinical pathways, or FHR tracing archival processes (in electronic records). Prior . Buttocks. Understanding the physiology of fetal oxygenation and various influences on fetal heart rate control supports nurses, midwives, and physicians in interpreting and managing electronic fetal heart rate tracings during labor and birth. Best of luck! List three ways in which you can determine that an FHR pattern is pseudo sinusoidal and NOT sinusoidal. Assuming the same amount of 14C{ }^{14} \mathrm{C}14C was initially present in the artifact as is now contained in the fresh sample, determine the age of the artifact. - 100-110 can be sustained for long periods if normal variability Perineal massage: What you need to know before giving it a go. (They start and reach maximum value in less than 30 seconds.) Injection Gone Wrong: Can You Spot The Mistakes? Any type of abnormality spotted in a fetal heart tracing could indicate an inadequate supply of oxygen or other medical issues. Patient information: See related handout on electronic fetal monitoring, written by the author of this article. We cant believe weve already reached the 4th and final week of our Countdown to Intern Year series! Category II : Indeterminate. Health care professionals play the game to hone and test their EFM knowledge and skills. Place the Doppler over the area of maximal intensity of fetal heart tones 3. early decels present or absent Decrease in FHR is 15 bpm or greater, lasting 15 seconds, and < 2 minutes in duration. Variability and accelerations C. Variability and decelerations D. Rate and variability 3. A normal fetal heart tracing would reassure both you and your obstetrician that its safe to proceed with labor and delivery. meconium stained amniotic fluid is present in 10-20% of births, and most neonates don't experience issues. Itis called fetal tachycardia when it is greater than 180 BPM. determination of *fetal blood pH or lactate: scalp blood sample* Every piece of content at Flo Health adheres to the highest editorial standards for language, style, and medical accuracy. Category II tracings may represent an appreciable fraction of those encountered in clinical care. ", "The Second Look was a fantastic review for the exam, for both structure and function. accelerations: present or absent, -bradycardia not accompanied by absent baseline variability Healthcare providers measure fetal heart rate by the number of fetal (baby) heartbeats per minute (BPM) during pregnancy. This web game uses NICHD terminology to identify tracing elements and categorize EFM tracings. Fetal heart rate monitoring measures the heart rate and rhythm of your baby (fetus). Questions and Answers 1. External and internal heart rate monitoring of the fetus. The probe sends your babys heart sounds to a computer and shows FHR patterns. The EFM toolkit also offers EFM CE opportunities and C-EFM(R) certification information. Join the nursing revolution. Monitoring fetal heart rate during pregnancy has been a focus for doctors and midwives since the 1800s. ", "The Second Look files are phenomenal and were an excellent way to test my knowledge after I had studied a bit.". Early. A change in baseline FHR is said to occur when the change persists for 10 minutes or longer. Subtle, shallow late decelerations can be difficult to visualize, but can be detected by holding a straight edge along the baseline. The baseline will be stable with a ten-beat variability, for instance 120 to 130, or 134 to 144. Fetal heart tracing is also useful for eliminating unnecessary treatments. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. BASIC Fetal Heart Monitoring This workshop was developed for the RN with 0-6 months experience in L&D. The course will define methods of monitoring, instrumentation, physiology and pathophysiology of the FHR, FHR characteristics, as well as review common antenatal testing methods. While caring for a gestational diabetic patient, you encounter a conflict with the attending physician because he refuses to order blood sugars on the patient. Tracings meeting these criteria are predictive of normal fetal acid-base balance at the time of observation. 1. Fetal bradycardia is defined as a baseline heart rate of less than 110 bpm. 140 145 150 155 160 2. Hornberger, L. K., & Sahn, D. J. Onset, nadir, and recovery of the deceleration occur after the beginning, peak, and ending of the contraction, respectively. 30 min-2hrs The inner tags must be closed before the outer ones. House Bill 645 would make it a misdemeanor punishable with a $500 fine to donate or accept blood . External monitoring is performed using a hand-held Doppler ultrasound probe to auscultate and count the. Your doctor uses special types of equipment to conduct electronic fetal monitoring. fundal height 30 cm b. fetal movement count 12 kicks in 12 hours c. fetal heart rate 136/min d. . Fetal heart tracing is a type of nonstress test that doesnt require any specific preparation. Palpate the abdomen to determine the position of the fetus (Leopold maneuvers), 2. Nadir of the deceleration = peak of the contraction. Your doctor will explain the steps of the procedure. Q: What is the most common obstetric procedure in the United States? Your program should process a It can provide lots of information about your babys health during pregnancy. Whats a Normal Fetal Heart Rate During Pregnancy? -tachycardia, -minimal baseline variability These are called maternal causes and may include: The following methods are used to listen to a fetal heart rate: External monitoring means checking the fetal heart rate through the mothers abdomen (belly). It means your fetus is neurologically responsive and doesnt have an oxygen deficiency. Continuous monitoring of your babys heart rate is conducted during labor and delivery as well. What interventions would you take after evaluating this strip? For examples, please see the Perinatology website'sIntrapartum Fetal Heart Rate Monitoring page. EFM Tracing Game. Postpartum Hemorrhage MCQ Quiz Questions And Answers, Ectopic pregnancy quiz questions and answers. Give amnioinfusion for recurrent, moderate to severe variable decelerations, 9. is part of the free online EFM toolkit at. Content adapted from relevant ACOG Practice Bulletins and AAFP Guidelines. Healthcare providers usually start listening for a baby's heart rate at the 10- to 12-week prenatal visit using a Doppler machine. Relevant ACOG Resources, American College of Obstetricians and Gynecologists In addition, you must know what is causing each type of deceleration, such as uteroplacental insufficiency or umbilical cord compression. The American College of Obstetrics and Gynecologists. Assess fetal pH (fetal scalp stimulation, scalp pH, or acoustic stimulation), 8. The Fetal Heart Rate Tracing SecondLookTM app will display a prompt if new updates are available for download. They continue to monitor it during prenatal appointments and during labor. Copyright 2009 by the American Academy of Family Physicians. Yes, and the strip is reactive. The 2008 National Institute of Child Health and Human Development Workshop Report on Electronic Fetal . If any problems arise, reviews are done more frequently. International Journal of Gynecology & Obstetrics. < 32 weeks EGA: peak 10 bpm above baseline, duration 10 seconds but < 2 minutes from onset of the acceleration to return to baseline. Theyll wrap a pair of belts around your belly. Internal FHR monitoring is accom-plished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. During labor, they may give the mother oxygen or change her position to see if that helps the baby or if they need to intervene. The average rate ranges from 110 to 160 beats per minute (bpm), with a variation of 5 to 25 bpm. presence of at least *2 accels, lasting for 15+ seconds* above baseline and peaking at 15+ bpm in a *20 min window*, >25 bpm variation (Monday through Friday, 8:30 a.m. to 5 p.m. What is the primary goal of effective communication in the care of the intrapartum patient? Amnioinfusion for umbilical cord compression in the presence of decelerations reduced: fetal heart rate decelerations (NNT = 3); cesarean delivery overall (NNT = 8); Apgar score < 7 at five minutes (NNT = 33); low cord arterial pH (< 7.20; NNT = 8); neonatal hospital stay > three days (NNT = 5); and maternal hospital stay > three days (NNT = 7). - 160-200 generally well tolerated w normal variability, Contraction forces are usually reported as, montevideo units *(MVUs)*: represent *total intensity of each contraction over 10 min* period 1. These segments help establish an estimated baseline (for a duration of 10 minutes) which is expressed in beats per minute. -recurrent late decel w moderate baseline variability Visually apparent, abrupt (onset to peak < 30 seconds) increase in FHR from baseline. ____ Prolonged D.)Gradual decrease; nadir If the heart rate is out of the normal range, the team can do an ultrasound or order blood work. The Doppler machine is an example of external monitoring and can be used during prenatal visits or labor. Data from: Macones GA, Hankins GD, Spong CY, et al. Bradycardia not accompanied by absent baseline variability, Absent baseline variability with no recurrent decelerations, Absence of induced accelerations after fetal stimulation, Recurrent variable decelarations accompanied by minimal or moderate baseline variability, Prolonged deceleration more than 2 minutes but less than 10 minutes, Recurrent late declarations with moderate baseline variability, Variable decelerations with other characteristics such as slow return to baseline, overshoots, or "shoulders". Light application of water to a turfgrass. The first set explains the basics of a fetal heart rate tracing. third stage: delivery of placenta, gradual: onset to nadir in 30 secs+ 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 workshop introduced a new classification scheme for decision making with regard to tracings. The EFM toolkit also offers EFM CE opportunities and C-EFM. How can you tell if a fetus is in distress? Enter your email address below and hit "Submit" to receive free email updates and nursing tips. Have you tested your EFM skills lately? Bulk pricing was not found for item. Intraobserver variability may play a major role in its interpretation. The first uses Doppler ultrasound to monitor FHR patterns, while the second measures the duration and frequency of uterine contractions. Impact of maternal exercise during pregnancy on offspring chronic disease susceptibility. Monique Rainford, MD, isboard-certified in obstetrics-gynecology, and currently serves as an Assistant Clinical Professor at Yale Medicine. While EFM use may be common and widespread, there is controversy about its efficacy, interobserver and intraobserver variability, and management algorithms. Intrapartum fetal monitoring was developed in the 1960s to identify events that might result in hypoxic ischemic encephalopathy, cerebral palsy, or fetal death. Additionally, you may have difficulty detecting the heart rate even when the baby is perfectly fine. Gilstrap LC 3rd, Hauth JC, Hankins GD, Beck AW. Management depends on the clinical picture and presence of other FHR characteristics.18, Overall Assessment (O). Challenge yourself every tracing collection is FREE! Am I Having Depression During Pregnancy? You are turning on Local Settings. Copyright 2023 RegisteredNurseRN.com. ET). -medicated through vagus nerve w sudden release of ACh at fetal SA node, resulting in characteristic sharp decel What kind of variability and decelerations are noted in this strip? ____ Late A.) The definition of a significant deceleration was [10]: Journal of Ultrasound in Medicine. Marked. FHR tracing, nonstress test, and ultrasound Teen pregnancy and consent issues: mother has consent over anything related to her pregnancy but anything apart . Print Worksheet. You suspect that there could be chronic fetal asphyxia because the score is below. Get started for free! Mild to moderate heart rate changes in otherwise healthy women generally do not negatively affect the babys heart rate. Verywell Health's content is for informational and educational purposes only. The clinical risk status (low, medium, or high) of each fetus is assessed in conjunction with the interpretation of the continuous EFM tracing. Variable. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Remember, the baseline is the average heart rate rounded to the nearest five bpm.140 145 150 155 160 FHT Quiz 1 Fetal Tracing Quiz Perfect! Sometimes, you may not be as far along as you thought and its just too early to hear the heartbeat. Abdomen. Continuous EFM increased cesarean delivery rates overall (NNH = 20) and instrumental vaginal births (NNH = 33). What qualifies as a rapid fetal heart rate? Auscultation of the fetal heart rate (FHR) is performed by external or internal means. Tracing patterns can and will change! --recurrent late decels Visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 35 per minute which persists for 20 minutes or more. In addition, she explains how to identify each decelerations which makes learning this material very easy to remember. If you have any feedback on our Countdown to Intern Year series, please reach out to Samhita Nelamangala at [emailprotected] Although continuous EFM remains the preferred method for fetal monitoring, the following methodologies are active areas of research in enhancing continuous EFM or developing newer methodologies for fetal well-being during labor. Fetal heart rate patterns identify which fetuses are experiencing difficulties by measuring their cardiac and central nervous system responses to changes in blood pressure and gases. Sometimes, a fetal heart rate is abnormal because of something happening in the mothers body. FETAL HEART TRACING. This website provides entertainment value only, not medical advice or nursing protocols. Find and create gamified quizzes, lessons, presentations, and flashcards for students, employees, and everyone else. Fetal heart rate monitoring may be performed exter-nally or internally. Late decelerations (Online Figure J) are visually apparent, usually symmetric, and have the characteristic feature of onset of the deceleration after the onset of the uterine contraction.11 The timing of the deceleration is delayed, with the nadir of the deceleration occurring after the peak of the contraction.11 The onset, nadir, and recovery of the deceleration usually occur after the beginning, peak, and ending of the contraction, respectively. -amnioinfusion can treat it in cases of oligohydramnios or when ROM has occurred to decrease rate of decels and C-sections, Recurrent decel (variable, early, late) defined as, decels occuring w >50% of uterine contractions in any 20 min segment, decrease in FHR >15 bpm measured from most recently determined baseline rate, *lasting >2 min, but <10 min* *nonreflex*: greater degree of relative hypoxemia and result in hypoxic depression of myocardium coupled w vagal response Abrupt increases in the FHR are associated with fetal movement or stimulation and are indicative of fetal well-being11 (Online Table B, Online Figure G). The electronic fetal monitor uses an external pressure transducer or an intrauterine pressure catheter (IUPC) to measure amplitude and frequency of contractions. We have other quizzes matching your interest. Be sure to ask any questions you might have beforehand. 4. Corticosteroid administration may cause an increase in FHR accelerations. Back. A normal baseline rate ranges from 110 to 160 bpm. -up to 4 hours Every 15 to 30 minutes in active phase of first stage of labor; every 5 minutes in second stage of labor with pushing, Assess FHR before: initiation of labor-enhancing procedure; ambulation of patient; administration of medications; or initiation of analgesia or anesthesia, Assess FHR after: admission of patient; artificial or spontaneous rupture of membranes; vaginal examination; abnormal uterine activity; or evaluation of analgesia or anesthesia, 1. Routine care. For each opening tag, such as

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. However, you don't need to worry about this right now especially if you prepare well with the help of our amazing quiz! While handheld fetal Dopplers are available over the counter, it is best to consult your healthcare provider before using one. The Fetal Heart Rate Tracing SecondLookTM app consists of three slide sets, which cover the basic interpretation of FHR tracings including the determination of baseline and variability, various types of acceleration and decelerations, and some examples and practice cases. 2023 Annual Clinical & Scientific Meeting, Congressional Leadership Conference (CLC), Countdown to Intern Year, Week 4: Fetal Heart Tracings, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles, Management of Intrapartum Fetal Heart Rate Tracings, Anti-Racism Resources: Articles, Videos, Podcasts, Novels Etc, Alliance for Innovation on Maternal Health, Postpartum Contraceptive Access Initiative, Baseline fetal heart rate (FHR) variability, Changes or trends of FHR patterns over time, Frequency and intensity of uterine contractions, Normal: five contractions or less in 10 minutes, averaged over a 30-minute window, Tachysystole: more than five contractions in 10 minutes, averaged over a 30-minute window, Always include presence or absence of associated FHR decelerations, Applies to both spontaneous and stimulated labor. This content is owned by the AAFP. The next step is to identify whether there are significant decelerations present. Contractions (C). Issues such as hypoxia, however, might slow their heart rate. Perform a vaginal examination (check for cord prolapse, rapid descent of the head, or vaginal bleeding suggestive of placental abruption), 6. . This lets your healthcare provider see how your baby is doing. -*associated w decreased or absent FHR variability*, 110-160 bpm See our full, Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), IV Drug Use Complications & Dangers: (Endocarditis, Infection, Infectious Diseases). Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. -marked baseline variability, absence of induced accels after fetal stimulation, Periodic or episodic decels in category II, -recurrent variable decels w minimal-moderate baseline variability Are there accelerations present? . --bradycardia 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. To provide a systematic approach to interpreting the electronic fetal monitor tracing, the National Institute of Child Health and Human Development convened a workshop in 2008 to revise the accepted definitions for electronic fetal monitor tracing. On the NCLEX exam and in your maternity OB nursing lecture classes, you will have to know how to identify each fetal heart rate tone deceleration. -physiologic, -onset, nadir, recovery occur after the contraction E Jauniaux, F Prefumo. Please try reloading page. Fetal heart tracing allows your doctor to measure the rate and rhythm of your little ones heartbeat. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 The fetal heart rate acts as a screening tool for the healthcare team. The information is reviewed in a stepwise fashion to guide the learner through the evaluation of this commonly-used diagnostic procedure and discusses different clinical scenarios and their impact on patient care. Accelerations (A). To learn what we do to deliver the best health and lifestyle insights to you, check out our content review principles. Thank you, {{form.email}}, for signing up. Describe the variability. Tracings of the normal fetal heart rate are between 120 and 160. A. Maxwell Spadafore is a fourth-year medical student at the University of Michigan Medical School. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. Early fetal development. Tracing patterns can and will change! NICDH definitions of decelerations: She is the former chief of obstetrics-gynecology at Yale Health. -transition: 8-10 cm. Depending on your health status and your babys, nonstress tests (one to two times a week, if not daily) might be a good idea.