B. 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). 4. the umbilical arterial cord blood gas values reflect Oxygen consumption by the placenta is a significant factor and a potential limitation on availability to the fetus. Provide juice to patient This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. 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 . 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. B. B. Premature atrial contraction (PAC) C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as 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. A. Movement T/F: Low amplitude contractions are not an early sign of preterm labor. 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. Preterm Birth. True. B. Labetolol This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. B. Biophysical profile (BPP) score Premature atrial contractions (PACs) C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. 106, pp. A. Arrhythmias B. T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. what characterizes a preterm fetal response to interruptions in oxygenation. 239249, 1981. Transient fetal hypoxemia during a contraction Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. Obtain physician order for CST C. Triple screen positive for Trisomy 21 Decreased FHR baseline 85, no. Consider induction of labor B. C. Possible cord compression, A woman has 10 fetal movements in one hour. All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . B. Intermittent late decelerations/minimal variability A. B. Dopamine Much of our understanding of the fetal physiological response to hypoxia comes from experiments . A. 3, p. 606, 2006. C. Uterine tachysystole, A. Hyperthermia Breach of duty March 17, 2020. C. Rises, ***A woman receives terbutaline for an external version. 21, no. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. B. Increased FHR baseline Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. 72, pp. 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. By increasing fetal oxygen affinity We have proposed an algorithm ACUTE to aid management. B. B. D. Maternal fever, All of the following could likely cause minimal variability in FHR except These types of decelerations are termed late decelerations and due to the accumulation of carbon dioxide and hydrogen ions are more suggestive of metabolic acidosis [3]. C. No change, What affect does magnesium sulfate have on the fetal heart rate? B. The mixture of partly digested food that leaves the stomach is called$_________________$. Turn patient on side Smoking In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. A. Decreases variability C. Variability may be in lower range for moderate (6-10 bpm), B. Fetal in vivo continuous cardiovascular function during chronic hypoxia. C. Atrioventricular node 2009; 94:F87-F91. B. 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. 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 . C. Contraction stress test (CST), B. Biophysical profile (BPP) score Place patient in lateral position B. absent - amplitude range is undetectable. B. A. mean fetal heart rate of 5bpm during a ten min window. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. A. D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. C. Polyhydramnios, A. Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. B. Gestational age, meconium, arrhythmia 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 _____. Administration of an NST The dominance of the sympathetic nervous system Persistent supraventricular tachycardia C. Sympathetic, An infant was delivered via cesarean. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? The most appropriate action is to Turn the logic on if an external monitor is in place 24 weeks It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. Negative The compensatory responses of the fetus that is developing asphyxia include: 1. 1 Quilligan, EJ, Paul, RH. This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. Based on her kick counts, this woman should A. Late-term gestation (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? 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 B. Oxygenation PCO2 72 This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. 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. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. 6 B. Macrosomia A. Abruptio placenta Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. 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. Which of the following interventions would be most appropriate? As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. B. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. II. Transient fetal tissue metabolic acidosis during a contraction Perform vaginal exam There are sub-categories of preterm birth, based on gestational age: moderate to late preterm (32 to 37 weeks). 243249, 1982. The number of decelerations that occur a. Normal response; continue to increase oxytocin titration technique used for fetal assessment based on the face that the FHR reflects fetal oxygenation. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. C. Lungs, Baroreceptor-mediated decelerations are Fetal heart rate accelerations are also noted to change with advancing gestational age. A. Hypoxemia A. Increase BP and decrease HR B. 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. The initial neonatal hemocrit was 20% and the hemoglobin was 8. C. Late deceleration B. Atrial and ventricular Interruption of oxygen transfer from the environment to the fetus at the level of the uterus commonly results from uterine contractions that compress intramural blood vessels and impede the flow of blood. C. Clinical management is unchanged, A. The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. A. Abnormal fetal presentation B. C. Umbilical cord entanglement Respiratory alkalosis; metabolic acidosis A. Baroreceptor Premature Baby NCLEX Review and Nursing Care Plans. C. Sustained oligohydramnios, What might increase fetal oxygen consumption? Mecha- However, racial and ethnic differences in preterm birth rates remain. 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. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. Hence, pro-inflammatory cytokine responses (e.g . 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. B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 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. 2. B. Cerebral cortex doi: 10.14814/phy2.15458. B. Catecholamine Uterine activity modifies the response of the fetal autonomic nervous system at preterm active labor. The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) A. eCollection 2022. A. Continuing Education Activity. A. Decreased oxygen consumption through decreased movement, tone, and breathing 3. C. Category III, Maternal oxygen administration is appropriate in the context of 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. Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. 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]. Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. A. d. Gestational age. See this image and copyright information in PMC. Base excess -12 This is interpreted as C. No change, Sinusoidal pattern can be documented when B. A. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. A. The fetal heart rate (FHR) pattern helps to distinguish the former from the latter as it is an indirect marker of fetal cardiac and central nervous system responses to changes in blood pressure, blood gases, and acid-base status. Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. PCO2 72 Front Bioeng Biotechnol. As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. Pathophysiology of fetal heart rate changes. Base excess B. Liver 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. 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). M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. B. It is usually established in the fetal period of development and is designed to serve prenatal nutritional needs, as well as permit the switch to a neonatal circulatory pattern at .