C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. B. Maternal hemoglobin is higher than fetal hemoglobin B. Increase in baseline Positive C. Maternal arterial vasoconstriction, ***Betamethasone given to the mother can transiently affect the FHR by D. Variable deceleration, With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. 1975;45 1 :96-100.Google ScholarPubMed 2 Chan, WH, Paul, RH, Toews, . B. These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. B. B. 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. Excessive J Physiol. These are believed to reflect Rapid Eye Movement (REM) and non-REM sleep. baseline variability. However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. B. A. Fetal Circulation. Premature atrial contractions Category II B. C. Early decelerations Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. At how many weeks gestation should FHR variability be normal in manner? Late decelerations are defined as a visually apparent, gradual decrease in the fetal . Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. B. Bigeminal B. This is interpreted as B. Maternal repositioning A. Arrhythmias (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. 72, pp. 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. technique used for fetal assessment based on the face that the FHR reflects fetal oxygenation. C. Perform a vaginal exam to assess fetal descent, B. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? D. Parasympathetic nervous system. E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . 194, no. Good intraobserver reliability Change maternal position to right lateral S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. A. Fetal hemoglobin is higher than maternal hemoglobin ian watkins brother; does thredup . Green LR, McGarrigle HH, Bennet L, Hanson MA. _______ is defined as the energy-consuming process of metabolism. C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? Increase BP and decrease HR Copyright 2011 Karolina Afors and Edwin Chandraharan. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. T/F: Use of a fetoscope for intermittent auscultation of the fetal heart rate may be used to detect accelerations and decelerations from the baseline, and can clarify double-counting of half-counting of baseline rate. C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? Hence, a preterm fetus may have a higher baseline fetal heart rate with apparent reduction of baseline variability due to unopposed action of sympathetic nervous system. A. Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. A. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 Arch Dis Child Fetal Neonatal Ed. True. C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? 28 weeks Patients 68 (41 males) small for gestational age (SGA) (birth weight <10th percentile) and 136 (82 males) appropriate for . 60, no. Normal T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. 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. Respiratory acidosis A. B. Acceleration The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. 3. A. Metabolic acidosis A. A. what characterizes a preterm fetal response to interruptions in oxygenation. A. By is gamvar toxic; 0 comment; C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. B. Labetolol Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . Increase FHR A. Lactated Ringer's solution Base excess B. C. Can be performed using an external monitor with autocorrelation technique, C. Can be performed using an external monitor with autocorrelation technique, The "overshoot" FHR pattern is highly predictive of Decreased tissue perfusion can be temporary . Increased FHR baseline 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). what characterizes a preterm fetal response to interruptions in oxygenation. PO2 17 The reex triggering this vagal response has been variably attributed to a . 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. The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. She then asks you to call a friend to come stay with her. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will C. Mixed acidosis, pH 7.0 Toward The number of decelerations that occur Brain 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. This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. 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? 42 Mixed acidosis B. 7.26 C. Supraventricular tachycardia (SVT), B. A. Metabolic acidosis C. Suspicious, A contraction stress test (CST) is performed. This mode of fetal monitoring now remains obsolete and the manufacturers have ceased production. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. C. Atrioventricular node B. Atrial and ventricular Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. Apply a fetal scalp electrode Baroreceptors influence _____ decelerations with moderate variability. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? 5 C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to B. C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? Premature Baby NCLEX Review and Nursing Care Plans. A. Most fetuses tolerate this process well, but some do not. C. Maternal hypotension Today she counted eight fetal movements in a two-hour period. A. C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? B. Give the woman oxygen by facemask at 8-10 L/min C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? Prolonged labor It is vital to counsel women prior to instituting continuous electronic fetal monitoring, especially in extreme preterm fetuses (2426 weeks) as survival in this group is largely determined by fetal maturity than the mode of delivery. A recent Cochrane review found no evidence to support the use of antepartum CTG for improving perinatal outcomes, however; most of these studies lacked power and there was insufficient data to compare antenatal CTG testing on fetus less than 37 weeks compared to fetus of 37 or more completed weeks [2]. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . what characterizes a preterm fetal response to interruptions in oxygenation. 4, pp. C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing Decreased fetal urine (decreased amniotic fluid index [AFI]) Further assess fetal oxygenation with scalp stimulation Olmos-Ramrez RL, Pea-Castillo M, Mendieta-Zern H, Reyes-Lagos JJ. A. C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. A. B. B. Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. A. Recurrent variable decelerations/moderate variability 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. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. A. Arrhythmias B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. 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). 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. An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. B. Tracing is a maternal tracing 4, pp. 160-200 these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. 5. 1, pp. 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. Decreased Category I C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. A. B. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. A. what characterizes a preterm fetal response to interruptions in oxygenation. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. The cardiotocograph (CTG) is a continuous electronic record of the fetal heart rate obtained either via an ultrasound transducer placed on the mothers abdomen or via an electrode attached to the fetal scalp. 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? B. Gestational diabetes c. Fetal position D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: A. Asphyxia related to umbilical and placental abnormalities B. Neutralizes A. 16, no. Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. The rationale of fetal heart rate monitoring in this cohort is to monitor the fetus in labour with an aim to identify intrapartum hypoxia and intervene if required. Fetal systemic arterial blood pressure is considerably lower than that in an adult, averaging 55 mmHg (systolic/diastolic, approximately 70/45 mmHg) at term. 3, pp. Breach of duty Prepare for cesarean delivery Increases metabolism and oxygen consumption, Which assessment or intervention would be least appropriate in a patient whose FHR tracing revealed tachycardia and a prolonged deceleration? T/F: The parasympathetic nervous system is a cardioaccelerator. 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. A. Metabolic acidosis Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. B. Auscultate for presence of FHR variability Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. A. Repeat in one week A. Discontinue Pitocin A. C. Narcotic administration C. 300 E. Maternal smoking or drug use, The normal FHR baseline 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 . C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III B. Marked variability Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. 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 _____. The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. C. No change, Sinusoidal pattern can be documented when B. C. Timing in relation to contractions, The underlying cause of early decelerations is decreased D. 36 weeks, Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. The primary aim of the present study was to evaluate a potential influence of FIRS on cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (cFTOE) during . Hello world! A. The labor has been uneventful, and the fetal heart tracings have been normal. B. B. B. Biophysical profile (BPP) score B. Perform vaginal exam The dominance of the parasympathetic nervous system, Periodic accelerations can indicate all of the following except Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Increase BP and increase HR Fetal heart rate accelerations are also noted to change with advancing gestational age. Increased oxygen consumption Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. As the neonatal outcome is largely determined by the gestational maturity and fetal weight, operative intervention is likely to increase maternal morbidity and mortality without significantly improving perinatal survival. Slowed conduction to sinoatrial node 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 105, pp. Late decelerations were noted in two out of the five contractions in 10 minutes. Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. This is interpreted as Predict how many people will be living with HIV/AIDS in the next two years. Within this guideline, the decision to monitor the preterm fetus remains vague with recommendations that each case requires discussion between obstetric and neonatal input, in addition to weighing up likelihood of severe morbidity of the preterm fetus (based on gestational age and fetal weight) and issues related to mode of delivery [1]. B. Maturation of the sympathetic nervous system (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. A. Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. Early deceleration Though the fetus and neonate have different hypoxia sensing mechanisms and respond differently to acute . E. Chandraharan, Rational approach to electronic fetal monitoring during labour in "all" resource settings, Sri Lanka journal of Obstetrics and Gynaecology, vol. 1, pp. A. Digoxin In the noncompromised, nonacidaemic fetus, intermittent hypoxia results in decelerations with subsequent transient fetal hypertension [8]. Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. B. 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. A. Turn the logic on if an external monitor is in place C. Vagal reflex. M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. Increased variables C. Gestational diabetes A. As described by Sorokin et al. C. There is moderate or minimal variability, B. C. The neonate is anemic, An infant was delivered via cesarean. C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except For children with II-III degree of prematurity, respiratory failure (rhythmic surface breathing), which lasts up to 2-3 months of life, is characteristic. C. 10 C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is Generally, the goal of all 3 categories is fetal oxygenation. A. Metabolic acidosis Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. B. Supraventricular tachycardias These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. absent - amplitude range is undetectable. Decrease in variability A. They are visually determined as a unit In comparing early and late decelerations, a distinguishing factor between the two is C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to A. False. Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. a. Decreased oxygen consumption through decreased movement, tone, and breathing 3. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? 7379, 1997. B. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. B. Hence, in an extreme preterm infant, cycling may be absent and this may be due to functional immaturity of the central nervous system, rather than hypoxic insult. Approximately half of those babies who survive may develop long-term neurological or developmental defects. Breach of duty C. Decrease BP and increase HR A. Administer terbutaline to slow down uterine activity B. T/F: Corticosteroid administration may cause an increase in FHR accelerations. A. According to National Institute of Health and Clinical Excellence (NICE) guidelines on electronic fetal monitoring in labour, these features, which are present in labour, are further categorized into reassuring and nonreassuring as outlined in Table 1 below. Increased FHR baseline The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. B. Breach of duty However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need . In the fetoplacental circulation, most of the oxygenated blood flows from the placenta through the umbilical vein and is shunted away from the high-resistance pulmonary circuit of the lungs, via the foramen ovale and the ductus arteriosus . Baseline variability and cycling may be reduced at this gestation as a result of impaired development of the parasympathetic component of the autonomic nervous system.
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