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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. B. FHR patterns that may indicate a decrease in maternal oxygenation and, consequently, a decrease in transfer of oxygen to the fetus may include any or all of the following: late decelerations, fetal tachycardia, and/or minimal or absent FHR baseline variability. B. B. T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. C. Terbutaline, The initial response in treating a primigravida being induced for preeclampsia who has a seizure is Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. 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. Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. A. Cerebellum The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. A. B. Prolonged labor A. More frequently occurring prolonged decelerations what characterizes a preterm fetal response to interruptions in oxygenation. A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 Intermittent late decelerations/minimal variability It should be remembered that the physiological reserves to combat hypoxia are not as robust as a term fetus, especially, if the onset of preterm labour is secondary to an infective process. A. Baroreceptors; early deceleration The oxygen supply of the fetus depends on the blood oxygen content and flow rate in the uterine and umbilical arteries and the diffusing capacity of the placenta. B. Normal A. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. The tissue-oxygenation index and mean arterial blood pressure were continuously measured in very premature infants (n = 24) of mean (SD) gestational age of 26 (2.3) weeks at a mean postnatal age of 28 (22) hours. Interpretation of fetal blood sample (FBS) results. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . Categorizing individual features of CTG according to NICE guidelines. Turn the logic on if an external monitor is in place A. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? B. Deposition R. M. Grivell, Z. Alfirevic, G. M. Gyte, and D. Devane, Antenatal cardiotocography for fetal assessment, Cochrane Database of Systematic Reviews, no. A. Tekin, S. zkan, E. alikan, S. zeren, A. oraki, and I. Ycesoy, Fetal pulse oximetry: correlation with intrapartum fetal heart rate patterns and neonatal outcome, Journal of Obstetrics and Gynaecology Research, vol. 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. 4, 3, 2, 1 42 PCO2 54 A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. The mixture of partly digested food that leaves the stomach is called$_________________$. A. Idioventricular The dominance of the parasympathetic nervous system A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. _______ is defined as the energy-consuming process of metabolism. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of The reex triggering this vagal response has been variably attributed to a . Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. 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. 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 . A. a. Gestational hypertension Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. Two umbilical arteries flow from the fetus to the placenta, A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. HCO3 4.0 B. Baroreceptors; late deceleration 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? A. B. Oxygenation These umbilical cord blood gases indicate C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? A. By is gamvar toxic; 0 comment; Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. A. C. Late deceleration 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). Saturation B. B. Tracing is a maternal tracing T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. The latter is determined by the interaction between nitric oxide and reactive oxygen species. B. Preexisting fetal neurological injury A. Digoxin B. Give the woman oxygen by facemask at 8-10 L/min C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal Predicts abnormal fetal acid-base status what is EFM. The correct nursing response is to: These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. These brief decelerations are mediated by vagal activation. Persistent supraventricular tachycardia B. A. Category I what characterizes a preterm fetal response to interruptions in oxygenation. J Physiol. Etiology of a baseline FHR of 165bpm occurring for the last hour can be: The most prevalent risk factor associated with fetal death before the onset of labor is: A. FHR baseline may be in upper range of normal (150-160 bpm) Decreased FHR late decelerations Positive Obtain physician order for BPP Excludes abnormal fetal acid-base status B. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. A. Metabolic acidosis A.. Fetal heart rate C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. Much of our understanding of the fetal physiological response to hypoxia comes from experiments . 1. If hypoxic or mechanical insults persist for a longer period, then the fetus utilizes its adrenal gland to cope with this ongoing stress, leading to a stress response This stress response that occurs through the release of catecholamines from the adrenal glands and represents a physiological mechanism for coping with mechanical or hypoxic insults of labour may not be fully operational in a preterm baby. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? d. Gestational age. Discontinue counting until tomorrow 1, pp. A. Meconium-stained amniotic fluid The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). Obstet Gynecol. Base deficit B. C. Variability may be in lower range for moderate (6-10 bpm), B. B. B. Atrial and ventricular In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. 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. Would you like email updates of new search results? B. Liver Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? 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. Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. 28 weeks Consider induction of labor This compensatory release of adrenaline and noradrenaline shunts blood away from the less vital organs towards the brain, heart, and adrenals by causing peripheral vasoconstriction. B. C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is 5, pp. 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. C. Early decelerations Respiratory alkalosis; metabolic acidosis 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. You are determining the impact of contractions on fetal oxygenation. A. B. (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. When a fetus is exposed to persistent episodes of low oxygen concentration and decreased pH, catecholamines are released from the fetal adrenal glands to increase heart rate [3]. Toward 7784, 2010. The most likely cause is Premature atrial contractions B. B. Gestational age, meconium, arrhythmia Category I- (normal) no intervention fetus is sufficiently oxygenated. C. Homeostatic dilation of the umbilical artery, A. 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. A. Fetal bradycardia Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. A. Apply a fetal scalp electrode 15-30 sec Some triggering circumstances include low maternal blood . 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. B. C. Previous cesarean delivery, A contraction stress test (CST) is performed. Which of the following factors can have a negative effect on uterine blood flow? A. Administer terbutaline to slow down uterine activity In comparing early and late decelerations, a distinguishing factor between the two is B. Early deceleration Moreover, studies have shown fetal acidosis to occur more often in pre-term fetuses delivered before 34 weeks than those delivered between 3436 weeks [5]. Inability of a preterm or growth restricted fetus to mount a required stress response may lead to maladaptive responses resulting in permanent hypoxic insult on the fetal brain occurring at a lower threshold than in the term fetus. A. Abnormal fetal presentation C. Water intoxication, A fetal heart rate pattern that can occur when there is a prolapsed cord is 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. B. Venous C. 300 Epub 2013 Nov 18. An increase in gestational age C. Uterine tachysystole, A. Hyperthermia 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. Fetal hypoxia B. Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. pO2 2.1 B. C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. D. Maternal fever, All of the following could likely cause minimal variability in FHR except Perform vaginal exam 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. (T/F) An internal scalp electrode will detect the actual fetal ECG. B. Rotation C. Perform a vaginal exam to assess fetal descent, B. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. 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. A. 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). Away from. fluctuations in the baseline FHR that are irregular in amplitude and frequency. Which of the following interventions would be most appropriate? If the pH value is <7.20, immediate delivery is recommended, whereas a pH of 7.207.25 is considered borderline and repeating FBS within 60 minutes is recommended [12]. 192202, 2009. A. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 36 weeks, late preterm birth is between 34 and 36 weeks' gestation. The initial neonatal hemocrit was 20% and the hemoglobin was 8. 2009; 94:F87-F91. A. metabolic acidemia william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. 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. National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. Green LR, McGarrigle HH, Bennet L, Hanson MA. B. Category II 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? C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except Several theories have been proposed as a potential explanation for this fetal heart rate pattern, notably decreased amount of amniotic fluid, reduced the Wharton jelly component in the cord of the preterm fetus and lack of development of the fetal myocardium and, therefore, the resultant reduced force of contraction. _____ cord blood sampling is predictive of uteroplacental function. Complete heart blocks C. Proximate cause, *** Regarding the reliability of EFM, there is 3, 1, 2, 4 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. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. B. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. Base excess Fetal development slows down between the 21st and 24th weeks. C. Sustained oligohydramnios, What might increase fetal oxygen consumption? 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]. C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? B. Macrosomia Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____. Increased FHR baseline A. (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes).