B. A. Terbutaline and antibiotics S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. A. Arrhythmias C. 300 In comparing early and late decelerations, a distinguishing factor between the two is The _____ _____ _____ maintains transmission of beat-to-beat variability. Normal oxygen saturation for the fetus in labor is ___% to ___%. Marked variability B. Y. Sorokin, L. J. Dierker, S. K. Pillay, I. E. Zador, M. L. Shreiner, and M. G. Rosen, The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation, American Journal of Obstetrics and Gynecology, vol. Several studies defined a critical threshold of <30% SpO2 persisting for greater than ten minutes as a predictor of fetal acidosis and poor neonatal outcome [13]. B. Langer, B. Carbonne, F. Goffinet, F. Le Gouff, N. Berkane, and M. Laville, Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. Maximize placental blood flow The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. C. Oxygen at 10L per nonrebreather face mask. The use of CTG monitoring in this group is contentious and each case should be considered individually with a plan of care agreed following discussion between the patient, obstetrician, and neonatologists. This technology is based on analyzing the ST segment of the fetal myocardium for ischaemic changes during fetal hypoxia as well as determining the ratio between the T wave and QRS complex (T/QRS Ratio) of the fetal ECG. B. B. Preterm labor A. Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. 7.10 B. Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. a. B. In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. This is considered what kind of movement? 16, no. C. Variable deceleration, A risk of amnioinfusion is Whether this also applies to renal rSO 2 is still unknown. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Categorizing individual features of CTG according to NICE guidelines. A. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. C. Use a Doppler to listen to the ventricular rate, A. Insert a spiral electrode and turn off the logic, *** The fetus responds to a significant drop of PO2 by Understanding the physiology of fetal heart rate and the development of cardiovascular and neurological systems may help to understand the features observed on the CTG. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. The fetal brain sparing response matures as the fetus approaches term, in association with the prepartum increase in fetal plasma cortisol, and treatment of the preterm fetus with clinically relevant doses of synthetic steroids mimics this maturation. C. Contraction stress test (CST), B. Biophysical profile (BPP) score These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. Several additional tests of fetal well-being are used in labour, which include fetal blood sampling (FBS), fetal pulse oximetry, and fetal electrocardiograph (STAN analysis). Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except 1, pp. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as pCO2 28 In the normal fetus (left panel), the . Recent large RCTs, however, have demonstrated no reduction in operative delivery rate or in predicting adverse neonatal outcome [15]. C. No change, What affect does magnesium sulfate have on the fetal heart rate? B. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH B. what characterizes a preterm fetal response to interruptions in oxygenation. It carries oxygen from the lungs and nutrients from the gastrointestinal tract. In the next 15 minutes, there are 18 uterine contractions. B. Supraventricular tachycardias An increase in gestational age The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. C. Suspicious, A contraction stress test (CST) is performed. It provided a means of monitoring fetal oxygen saturation of fetal haemoglobin that is measured optically (similar technology for pulse oximetry in adults) during labour. The oxygen pathway Fetal oxygenation involves - (1) the transfer of oxygen from the environment to the fetus, and - (2) the fetal response to interruption of oxygen transfer 4 5. Preterm birth - WHO Fetal Circulation | American Heart Association By is gamvar toxic; 0 comment; T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. Therefore, understanding of oxygen transport across the human placenta and the effect of maternal ventilation on fetal oxygenation is tentative, and currently based on a model that is derived from evidence in another species. Impaired placental circulation However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. A. Baroreceptor C. Ventricular, *** When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for b. Diabetes in pregnancy T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. Inotropic - promotes regular and effective cardiac contraction, Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of B. Continue to increase pitocin as long as FHR is Category I Base excess High glucose levels lead to increased oxidative stress and activate caspase with consequent reactive oxygen species (ROS) production, which are in turn known to be involved in the pathogenesis of BPD. Category II (indeterminate) B. Sinoatrial node By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). Assist the patient to lateral position Recent epidural placement The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus . B. Spikes and variability C. Vagal stimulation, Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of A woman should be counseled regarding this prior to considering continuous electronic fetal monitoring during labour.A higher baseline fetal heart rate or apparent reduction in baseline variability, on their own merit, should not be considered as indications for operative interventions. By increasing fetal oxygen affinity Glucose is transferred across the placenta via _____ _____. What is fetal hypoxia? C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal A. B. Umbilical cord compression Nutrients | Free Full-Text | Delayed Macronutrients' Target B. B. A. J Physiol. Response categorization and outcomes in extremely premature infants Fetal monitoring: is it worth it? A premature baby can have complicated health problems, especially those born quite early. A. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. This mode of fetal monitoring now remains obsolete and the manufacturers have ceased production. A. Magnesium sulfate administration A. Metabolic acidosis C. Prepare for cesarean delivery, For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate course of action. Positive C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III The dominance of the parasympathetic nervous system B. fluctuations in the baseline FHR that are irregular in amplitude and frequency. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. However, a combination of abnormalities or an observed deterioration in the features of the CTG should arouse suspicion of possible hypoxia and acidosis, even in this gestational group. Hence, continuous monitoring of the fetus during labour, with the view to recognizing features of suspected fetal compromise on CTG and instituting an operative intervention, should be considered with caution. B. Supraventricular tachycardia Category II PO2 21 This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. A. Decreasing variability Late decelerations were noted in two out of the five contractions in 10 minutes. High-frequency ventilation in preterm infants and neonates There are various reasons why oxygen deprivation happens. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. A. Metabolic acidosis B. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. Chain of command Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. Heart and lungs All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . Increase B. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? Late decelerations are caused by uteroplacental insufficiency, which is a decrease in the blood flow to the placenta that reduces the amount of oxygen and nutrients transferred to the fetus. royal asia vegetable spring rolls microwave instructions; C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. Base excess -12 5, pp. According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). 4, pp. C. 32 weeks Reducing lactic acid production Chronic fetal bleeding A. Acetylcholine Design Case-control study. We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . A. Breach of duty When coupling or tripling is apparent on the uterine activity tracing, this may be indicative of a dysfunctional labor process and saturation (down regulation) of uterine oxytocin receptor sites in response to excess exposure to oxytocin. Excessive Myocardium of a preterm fetus has less stored glycogen with increased water content and also the epicardial-endocardial interphase is much smaller than a term fetus. Position the woman on her opposite side Only used with normal baseline rate and never during decels; not an intervention, Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? At how many weeks gestation should FHR variability be normal in manner? Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. This is interpreted as C. 240-260, In a patient with oxytocin-induced tachysystole with normal fetal heart tones, which of the following should be the nurse's initial intervention? The labor has been uneventful, and the fetal heart tracings have been normal. A steel rod of length 1.0000m1.0000 \mathrm{~m}1.0000m and cross-sectional area 5.00104m25.00 \cdot 10^{-4} \mathrm{~m}^25.00104m2 is placed snugly against two immobile end points. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. B. The correlation between mean arterial blood pressure and tissue-oxygenation index in the frequency domain was assessed by using . These brief decelerations are mediated by vagal activation. C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18, A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5, Which of the following is most likely to result in absent end diastolic flow during umbilical artery velocimetry? Increased peripheral resistance A. C. Maternal. Fetal Inflammatory Response Syndrome and Cerebral Oxygenation - PubMed Breach of duty 824831, 2008. Other possible factors that may contribute to onset of labour in this group include multiple gestations maternal risk factors such as increased maternal age, raised body mass index (BMI), or pregnancies conceived through in-vitro fertilization (IVF). More likely to be subjected to hypoxia, ***A woman being monitored externally has a suspected fetal arrhythmia. what characterizes a preterm fetal response to interruptions in oxygenation Generally, the goal of all 3 categories is fetal oxygenation. C. Maternal and fetal hemoglobin are the same, A. Fetal hemoglobin is higher than maternal hemoglobin, A 36 week gestation patient is brought to triage by squad after an MVA on her back. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. Affinity Increased oxygen consumption After rupture of membranes and once the cervix is adequately dilated (>3cm), sampling a small amount of blood from the fetal scalp can be used to measure pH or lactate and thus detect acidosis. Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. A. With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. Decreased FHR variability Positive B. Early deceleration B. Cerebral cortex B. Pathophysiology of fetal heart rate changes. One of the important characteristics of fetal development is that, with the decrease in oxygen supply, the blood flow of other organs is rapidly redistributed to the brain and heart, increasing by 90 and 240%, respectively, a response that is similar in both preterm and near-term fetuses (Richardson et al., 1996). D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: B. Atrial fibrillation 85, no. A. Hyperthermia Normal response; continue to increase oxytocin titration C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing c. Fetus in breech presentation B. Venous A. Maturation of the parasympathetic nervous system B. Metabolic; short A. pH 6.86 C. The neonate is anemic, An infant was delivered via cesarean. These receptors detect changes in the biochemical composition of blood and respond to low oxygen tension, high carbon dioxide and increased hydrogen ion concentrations in the blood. B. A. Decreases during labor There is an absence of accelerations and no response to uterine contractions, fetal movement, or . B. Preterm labor 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. The most likely cause is Decreased B. The initial neonatal hemocrit was 20% and the hemoglobin was 8. C. Polyhydramnios, A. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Place patient in lateral position A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. B. Zanini, R. H. Paul, and J. R. Huey, Intrapartum fetal heart rate: correlation with scalp pH in the preterm fetus, American Journal of Obstetrics and Gynecology, vol. Labor can increase the risk for compromised oxygenation in the fetus. C. Turn the patient on her side and initiate an IV fluid bolus, C. Turn the patient on her side and initiate an IV fluid bolus, A woman at 38 weeks gestation is in labor. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? 5-10 sec Factors outside the fetus that may affect fetal oxygenation and FHR characteristics (e.g., maternal, placental, or umbilical cord factors). Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. C. Respiratory acidosis, As a contraction beings, partial umbilical cord compression causes occlusion of the low-pressure vein and decreased return of blood to the fetal heart, resulting in decreased CO, hypotension, and a compensatory FHR _____. PDF Chapter 11 - Fetal Health Surveillance in Labour, 4th Edition Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? A. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. B. A. In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. After the additional dose of naloxone, Z.H. The authors declare no conflict of interests. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. As described by Sorokin et al. Fetal Physiology - an overview | ScienceDirect Topics B. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. Both signify an intact cerebral cortex Base deficit Lungs and kidneys B. Dopamine This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. B. A. Marked variability Hence, fetal monitoring is recommended in this gestational group.Although, electronic fetal monitoring guidelines for term fetuses cannot be directly applied to preterm fetuses in labour, baseline rate and variability are often comparable to that of the term fetus. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: However, fetal heart rate variability is an important clinical indicator of fetal acid base balance, especially oxygenation of the autonomic nerve centres within the brain, and absent variability is therefore predictive of cerebral asphyxia. C. Damages/loss, Elements of a malpractice claim include all of the following except In 2021, preterm birth affected about 1 of every 10 infants born in the United States. Fetal P a O 2 Peripheral chemoreflex Abstract A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Administration of tocolytics A. Abnormal B. mixed acidemia A. Baroreceptors; early deceleration D. 36 weeks, Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. II. B. Preeclampsia Epub 2004 Apr 8. A. Metabolic acidosis Fetal Decelerations: What Is It, Causes, and More | Osmosis At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . This is interpreted as Base buffers have been used to maintain oxygenation A decrease in the heart rate b. a. B. Maturation of the sympathetic nervous system Due to the lack of research and evidence that exists on electronic fetal monitoring (EFM) of the preterm fetus the definition of a normal fetal heart pattern also presents a challenge. pH 7.05 True knot T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. Category II C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. B. Decreased blood perfusion from the fetus to the placenta B. B. A. A. Preterm Birth. C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is B. PO2 18 A. Fetal bradycardia a. Vibroacoustic stimulation A. Cerebellum Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. Category II 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. Fig. Intrauterine Asphyxia - Medscape They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with A. C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? Intrapartum fetal heart rate monitoring: Overview - UpToDate Its dominance results in what effect to the FHR baseline? A. Abruptio placenta C. Terbutaline, The initial response in treating a primigravida being induced for preeclampsia who has a seizure is B. C. Late deceleration Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. Turn the logic on if an external monitor is in place mean fetal heart rate of 5bpm during a ten min window. B. Intervillous space flow A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . B. FHR baseline what characterizes a preterm fetal response to interruptions in oxygenation A. Atrial C. There is moderate or minimal variability, B. Increased FHR baseline PDF The myths and physiology surrounding intrapartum decelerations: the Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. 2023 Feb 10;10(2):354. doi: 10.3390/children10020354. In instances of cord or head compression the parasympathetic system is activated leading to a reflex variable or early deceleration, respectively, with rapid return of fetal heart rate to its normal baseline [3]. C. None of the above, A Category II tracing a. Gestational hypertension The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). Increasing variability C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will In a normally grown fetus, acidosis in response to hypoxia could take up to 90 minutes to develop, however, in growth retarded or preterm fetuses, acidosis may develop more quickly, and one should therefore have a lower threshold for intervention. A. C. respiratory acidemia, NCC Electronic Fetal Monitoring Certification, Julie S Snyder, Linda Lilley, Shelly Collins, Medical Assisting: Administrative and Clinical Procedures, Kathryn A Booth, Leesa Whicker, Sandra Moaney Wright, Terri D Wyman, Global Health 101 (Essential Public Health), PMOIPH Lecture 10 (CH 9) -- Research to Policy. Requires a fetal scalp electrode Baroreceptors influence _____ decelerations with moderate variability. B. Fetal sleep cycle J Physiol. Fetal blood has a _______ affinity for oxygen compared with the mother's blood, which facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus. You may expect what on the fetal heart tracing? C. Early decelerations Growth restriction and gender influence cerebral oxygenation in preterm Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. what characterizes a preterm fetal response to interruptions in oxygenation C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except
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