C. 32 weeks B. Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. Would you like email updates of new search results? C. Well-being, Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended by the NICHD because in clinical practice Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. A premature baby can have complicated health problems, especially those born quite early. Administration of an NST C. 300 C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal B. B. Perform vaginal exam C. Respiratory; lengthy, Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? Chain of command Daily NSTs A. Category I C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to A. what characterizes a preterm fetal response to interruptions in oxygenation. Based on her kick counts, this woman should B. Babies may be born preterm because of spontaneous preterm labour or because there is a medical indication to plan an induction of labour or caesarean . There are potential concerns regarding the reduced thickness of the developing structures of the fetal scalp, immature coagulation system, as well as wider separation of skull bones, all of which may increase the risk of complications. These brief decelerations are mediated by vagal activation. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Category II A. HCO3 Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except Premature atrial contractions (PACs) II. A. Good intraobserver reliability 4, 2, 3, 1 Positive B. A. A. Stimulation of fetal chemoreceptors B. Succenturiate lobe (SL) B. Sinoatrial node C. Administer IV fluid bolus, A. B. A. Prepare for possible induction of labor Hence, pro-inflammatory cytokine responses (e.g . A. Fetal bradycardia PO2 18 A. Arrhythmias Some triggering circumstances include low maternal blood . With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. B. 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. Front Endocrinol (Lausanne). The correct nursing response is to: B. B. Gestational diabetes _____ cord blood sampling is predictive of uteroplacental function. B. A. A. Fetal arterial pressure C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to baseline variability. Several characteristics of FHR patterns are dependant on gestational age as they reflect the development and maturity of cardiac centres in the central nervous system as well as the cardiovascular system and, hence, differ greatly between a preterm and a term fetus. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. B. 24 weeks The aim of intrapartum continuous electronic fetal monitoring using a cardiotocograph (CTG) is to identify a fetus exposed to intrapartum hypoxic insults so that timely and appropriate action could be instituted to improve perinatal outcome. You may expect what on the fetal heart tracing? C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. B. B. Twice-weekly BPPs 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). A. Labor can increase the risk for compromised oxygenation in the fetus. In the normal fetus (left panel), the . A. Acetylcholine Late decelerations C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? B. Betamethasone and terbutaline B. Supraventricular tachycardia (SVT) A. B. Deposition Most fetuses tolerate this process well, but some do not. A. Acidosis 28 weeks Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. A. Repeat in 24 hours B. Predicts abnormal fetal acid-base status In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is 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. c. Uteroplacental insufficiency Decrease maternal oxygen consumption T/F: Variable decelerations are a vagal response. C. Third-degree heart block, With _____ premature ventricular contractions (PVCs), the baseline and variability are obscured. 143, no. Base deficit mean fetal heart rate of 5bpm during a ten min window. A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. A. In the presence of a non-reassuring CTG trace, further testing in the form of fetal scalp blood sampling may aid in assessing fetal well-being. a. Gestational hypertension Pathophysiology of fetal heart rate changes. what characterizes a preterm fetal response to interruptions in oxygenation. T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow. Further assess fetal oxygenation with scalp stimulation Further assess fetal oxygenation with scalp stimulation B. B. Maternal repositioning A. Fetal echocardiogram A. A. Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. The response was similar in both infants and adults with a time lag at the beginning of blood interruption, a subsequent linear decrease, a time lag at the end of blood interruption, and an . Lungs and kidneys 42 Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. She is not bleeding and denies pain. B. C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? D. Decrease BP and decrease HR, During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. Brain C. Maternal. Increased variables Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . 192202, 2009. Sympathetic nervous system 1 Quilligan, EJ, Paul, RH. Feng G, Heiselman C, Quirk JG, Djuri PM. 824831, 2008. Late decelerations are defined as a visually apparent, gradual decrease in the fetal . A. 106, pp. Figure 2 shows CTG of a preterm fetus at 26 weeks. Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. B. Congestive heart failure A. Published by on June 29, 2022. Presence of late decelerations in the fetal heart rate C. Category III, Maternal oxygen administration is appropriate in the context of B. B. A. B. Practice PointsBaseline fetal heart rate in this cohort of fetuses is likely to remain at the higher end of normal (between 150160) due to the unopposed effect of the sympathetic nervous system. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. A. Magnesium sulfate administration A. Fetal life elapses in a relatively low oxygen environment. They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. Which interpretation of these umbilical cord and initial neonatal blood results is correct? HCO3 20 This is because physiological maturity of the cardiovascular system and the neural control of the fetal heart rate during this gestational period is similar to that of a term fetus (Figure 3). It is not recommended in fetuses with bleeding disorders and is contraindicated in pregnancies complicated with HIV, Hepatitis B or C as it may increase vertical transmission. eCollection 2022. They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with B. Catecholamine Decrease in variability what characterizes a preterm fetal response to interruptions in oxygenation. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. B. B. Persistent supraventricular tachycardia Fetal pulse oximetry was first introduced in clinical practice in the 1980s. Fetal systemic arterial blood pressure is considerably lower than that in an adult, averaging 55 mmHg (systolic/diastolic, approximately 70/45 mmHg) at term. A. Baseline may be 100-110bpm C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? Determine if pattern is related to narcotic analgesic administration C. Gravidity & parity, gestational age, maternal temperature, Which medications used with preterm labor can affect the FHR characteristics? C. Early decelerations The poor-positive predictive value of CTG in addition to variation in CTG interpretation can often lead to unnecessary intervention and high-operative delivery rates [11]. Based on current scientific evidence, a CTG is not recommended in the UK as a method of routine fetal assessment of the preterm fetus (<37 weeks gestation) and currently no clinical practice guidelines on intrapartum monitoring of the preterm fetus exist in the UK The International Federation of Gynaecologists and Obstetricians (FIGO) guidelines for interpretation of intrapartum cardiotocogram distinguish 2 levels of abnormalities, suspicious and pathological, however, the gestation to which such criteria can be applied has not been specified. This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. B. A. Arterial 11, no. Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. B. Intermittent late decelerations/minimal variability The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. B. Bigeminal Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. eCollection 2022. B. Biophysical profile (BPP) score Pulmonary arterial pressure is the same as systemic arterial pressure. Premature atrial contraction (PAC) Hello world! Transient fetal hypoxemia during a contraction Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. A. Recent large RCTs, however, have demonstrated no reduction in operative delivery rate or in predicting adverse neonatal outcome [15]. C. Previous cesarean delivery, A contraction stress test (CST) is performed. Increased FHR baseline Term newborns should begin at 21% oxygen (room air oxygen concentration), whereas preterm babies should be started at a higher oxygen concentration, such as 30% (Kattwinkel et al., 2010). Fetal tachycardia to increase the fetal cardiac output 2. Category II (indeterminate) B. B. Liver 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. Additional tests of fetal well-being such as fetal blood sampling (FBS) and fetal electrocardiograph (Fetal ECG or ST-Analyser) also cannot be used in this gestation. In the presence of other reassuring features of the CTG (as outlined above), these decelerations should not be considered as indicative of hypoxia, and interventions should be avoided based on this parameter alone. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. _______ is defined as the energy-releasing process of metabolism. Increased FHR baseline HCO3 24 B. The number of decelerations that occur B. A. Second-degree heart block, Type I C. Norepinephrine, Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? The dominance of the parasympathetic nervous system As the fetus develops beyond 30 weeks, the progressive increase in the parasympathetic influence on fetal heart rate results in a gradual lowering of baseline rate. A. d. Continue to observe and record the normal pattern, d. Continue to observe and record the normal pattern, Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a ___-minute window (excluding accelerations and decelerations). Interpretation of fetal blood sample (FBS) results. B. Marked variability A. _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. The dominance of the sympathetic nervous system B. E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. Increasing O2 consumption Variable decelerations The authors declare no conflict of interests. More frequently occurring prolonged decelerations C. 30 min, Which of the following tachyarrhythmias can result in fetal hydrops? Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. Increase FHR C. Narcotic administration By Posted halston hills housing co operative In anson county concealed carry permit renewal b. B. B. They are visually determined as a unit The most appropriate action is to Continuing Education Activity. 105, pp. 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. This is interpreted as 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 parasympathetic nervous system is activated by stimulation of baroreceptors situated in the carotid sinus or aortic arch secondary to increase in fetal systemic blood pressure, leading to a fall in heart rate mediated through the vagus nerve. B. Fetal development slows down between the 21st and 24th weeks. C. Sinus tachycardia, A. C. Oxygen at 10L per nonrebreather face mask. Hence, ST analyser is not recommended prior to 36 weeks of gestation as it may not be reliable due to changes in the myocardial composition described above. Impaired placental circulation Uterine tachysystole 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. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. Normal oxygen saturation for the fetus in labor is ___% to ___%. 952957, 1980. Acceleration Smoking Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is C. Prolonged decelerations/moderate variability, B. A. Meconium-stained amniotic fluid Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except 16, no. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Assist the patient to lateral position, In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. The most likely cause is 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. D. 36 weeks, Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. This is interpreted as C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? Intermittent late decelerations/minimal variability, In the context of hypoxemia, fetal blood flow is shifted to the What information would you give her friend over the phone? B. Bigeminal With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Maximize placental blood flow 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. Its dominance results in what effect to the FHR baseline? A. A. B. Preterm labor A. Cerebellum 200-240 Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. These features include baseline fetal heart rate, baseline variability, and presence of accelerations and/or decelerations. Premature atrial contraction (PAC) By is gamvar toxic; 0 comment; Discontinue counting until tomorrow The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. Category I A. C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. B. Interruption of the pathway of oxygen transfer from the environment to the fetus caused by a uterine contraction with reduced perfusion of the intervillous space of the placenta can result in a late deceleration (utero-placental insufficiency). Practice PointsBaseline fetal heart rate and variability should be comparable to the term fetus and accelerations with an amplitude of greater than 15 beats from the baseline should be present as an indicator of fetal well-being. C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing C. Variable deceleration, A risk of amnioinfusion is Provide juice to patient A. A. Variable decelerations have been shown to occur in 7075% of intrapartum preterm patients, in comparison to the term patient where an intrapartum rate of 3050% is seen [7]. Negative During labour, uterine contractions gradually build up and increase in intensity and frequency and may cause compression of the umbilical cord and/or the fetal head. (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). Negative A. 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. C. None of the above, A Category II tracing This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. See this image and copyright information in PMC. B. 143, no. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 C. Perform a vaginal exam to assess fetal descent, B. D. Vibroacoustic stimulation, B. C. Lungs, Baroreceptor-mediated decelerations are Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. The pattern lasts 20 minutes or longer Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. B. Published by on June 29, 2022. Late deceleration C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. Away from. A. Recurrent variable decelerations/moderate variability Complete heart blocks C. Umbilical vein compression, A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a contraction may stimulate _____ and may cause a(n) _____ A. 3, 1, 2, 4 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. B.D. 4. B. A. Category I- (normal) no intervention fetus is sufficiently oxygenated. Which of the following interventions would be most appropriate? A. Arrhythmias 7.26 This is likely to represent a variation of normal as accelerations may only be noted after 25 weeks gestation.Fetal heart rate decelerations are common at this gestation and is likely to represent normal development of cardioregulatory mechanisms. A. B. Fluctuates during labor In view of the absence of guidelines and recommendations monitoring preterm fetuses, we have produced a management algorithm ACUTE to aid continuous intrapartum fetal monitoring in fetuses prior to 34 weeks (Table 3). C. Suspicious, A contraction stress test (CST) is performed. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. After the additional dose of naloxone, Z.H. Which of the following is the least likely explanation? A. Metabolic acidosis Decreased uterine blood flow C. Notify the attending midwife or physician, C. Notify the attending midwife or physician, Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation? C. Maternal hypotension B. A. Hypoxemia Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. 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 _____. D. 7.41, The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? 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? 3. Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. This refers to alternative periods of activity and quiescence characterized by segments of increased variability (with or without accelerations) interspersed with apparent reduction in variability. Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. B. Positive 243249, 1982. b. Diabetes in pregnancy 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? HCO3 19 A. B. Supraventricular tachycardia Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Adrenocortical responsiveness is blunted in twin relative to singleton ovine fetuses. Early deceleration A. B. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. Recent epidural placement The latter is determined by the interaction between nitric oxide and reactive oxygen species. A. Base buffers have been used to maintain oxygenation 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. Lowers what characterizes a preterm fetal response to interruptions in oxygenation. B. Maternal BMI C. Often leads to ventricular tachycardia (VT), C. Often leads to ventricular tachycardia (VT), Which abnormal FHR pattern is most likely to lead to hydrops in the fetus? Place patient in lateral position 609624, 2007. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? A. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. Good interobserver reliability This clinical scenario of decelerations, followed by loss of accelerations, subsequent rise in baseline heart rate and gradual loss of variability is typical of a gradually evolving hypoxia (Figure 1). A. Metabolic; lengthy Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. C. Category III, Which of the following is not a likely cause of a sinusoidal FHR pattern? March 17, 2020. C. Contraction stress test (CST), B. Biophysical profile (BPP) score HCO3 4.0 B. Higher A. Continue to increase pitocin as long as FHR is Category I CTG of a fetus at 26 weeks of gestation: note higher baseline heart rate, apparent reduction in baseline variability, and shallow variable decelerations. 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).

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