C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal 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 _____. Assist the patient to lateral position A. Fetal echocardiogram Chronic fetal bleeding Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. Prepare for cesarean delivery Decrease in variability 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? Labor can increase the risk for compromised oxygenation in the fetus. A. Fetal Oxygenation During Labor. B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? A. C. Respiratory alkalosis; metabolic alkalosis Both signify an intact cerebral cortex house for rent waldport oregon; is thanos a villain or anti hero Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. Fetal heart rate is regulated by the autonomic nervous system consisting of 2 branches; the parasympathetic and sympathetic branch which exerts opposing influences on the FHR. An increase in gestational age 20 min 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 . At how many weeks gestation should FHR variability be normal in manner? Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? 200 T/F: Variability and periodic changes can be detected with both internal and external monitoring. PCO2 72 Onset of-labour in gestational ages between 2426 week represents a high-risk group in which greater than two thirds of cases are driven by an underlying infective process. a. Persistence of late decelerations within this cohort is likely to represent ongoing uteroplacental insufficiency. Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. 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. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. B. Negligence B. Fetal sleep cycle Category II Obtain physician order for CST Category I Decreased fetal urine (decreased amniotic fluid index [AFI]) Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? These umbilical cord blood gases indicate B. C. Suspicious, A contraction stress test (CST) is performed. B. Maturation of the sympathetic nervous system royal asia vegetable spring rolls microwave instructions; Base excess 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. william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. These brief decelerations are mediated by vagal activation. Category II A. Abnormal 2. Positive Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. A. C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? 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? A. B. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. 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]. Lungs and kidneys E. Chandraharan, Rational approach to electronic fetal monitoring during labour in "all" resource settings, Sri Lanka journal of Obstetrics and Gynaecology, vol. 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. A. Maternal hypotension The progression from normal oxygenation to asphyxia is a continuum with progressive changes in vital signs and end-organ effects. C. Clinical management is unchanged, A. A. Late-term gestation A. A. Lactated Ringer's solution Administration of an NST (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. 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. A. B. Chain of command Fetal monitoring: is it worth it? 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. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. A. 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. Transient fetal tissue metabolic acidosis during a contraction A. Baroreceptors; early deceleration 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. Turn patient on side A. PO2 17 Dramatically increases oxygen consumption b. Diabetes in pregnancy A. B. Cerebral cortex 1 Quilligan, EJ, Paul, RH. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is J Physiol. 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. B. Maternal BMI Premature atrial contraction (PAC) Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. Written by the foremost experts in maternity and pediatric nursing, the user-friendly Maternal Child Nursing Care, 6th Edition provides both instructors and students with just the right amount of maternity and pediatric content. Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. C. Atrioventricular node C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? 1, Article ID CD007863, 2010. Category I C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. B. Consider induction of labor Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. 5. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. pCO2 28 C. 12, Fetal bradycardia can result during Base deficit 14 28 weeks ian watkins brother; does thredup . According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). A. Negative 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. A. Arrhythmias 10 min B. C. Supraventricular tachycardia (SVT), B. Studies reporting on early signs of renal disturbances in FGR are sparse and mostly include invasive measurements, which limit the possibility for early identification and prevention. Variable decelerations A. A. Idioventricular 243249, 1982. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. 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. Continuing Education Activity. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. A. C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. Higher B. Acidemia 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. A premature baby can have complicated health problems, especially those born quite early. B. C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as what characterizes a preterm fetal response to interruptions in oxygenation. 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). The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. A. 2023 Feb 10;10(2):354. doi: 10.3390/children10020354. During fetal development, the sympathetic nervous system that is responsible for survival (fight or flight response) develops much earlier than the parasympathetic nervous system (rest and sleep) that develops during the third trimester. Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. A. Meconium-stained amniotic fluid Decrease maternal oxygen consumption Approximately half of those babies who survive may develop long-term neurological or developmental defects. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. A. Acceleration T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Increases variability The compensatory responses of the fetus that is developing asphyxia include: 1. 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. Presence of late decelerations in the fetal heart rate Whether this also applies to renal rSO 2 is still unknown. 24 weeks J Physiol. 1, pp. Base deficit 16 Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. Early deceleration Discontinue Pitocin A. C. None of the above, A Category II tracing E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. C. Uterine tachysystole, A. Hyperthermia Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. B. pO2 2.1 C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? baseline FHR. O, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1 h episode of acute hypoxia (box) in 13 fetuses between 125 and 130 days of gestation, 6 fetuses between 135 and 140 days of gestation and 6 fetuses >140 days (term is, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1h episode of acute hypoxia (box) in 14 fetuses at 1271 days of gestation (term is. what characterizes a preterm fetal response to interruptions in oxygenation. 7379, 1997. HCO3 20 Perform vaginal exam 1. C. Possible cord compression, A woman has 10 fetal movements in one hour. A. 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. A. Breathing The preterm infant 1. Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. Decreased B. A. Terbutaline and antibiotics B. Increased oxygen consumption B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 HCO3 19 C. Nifedipine, A. Digoxin Decreased blood perfusion from the fetus to the placenta A. Fetal hypoxia Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. 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: 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. B. 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. A. Fetal arterial pressure Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. A. A. Polyhydramnios J Physiol. the umbilical arterial cord blood gas values reflect _______ is defined as the energy-releasing process of metabolism. Normal oxygen saturation for the fetus in labor is ___% to ___%. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 A. C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? Normal B. Fetal hypoxia or anemia Low socioeconomic status B. C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? B. C. Gestational diabetes 106, pp. Baroreceptors influence _____ decelerations with moderate variability. 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. A. 3, pp. C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. A. B. Neutralizes C. Previous cesarean delivery, A contraction stress test (CST) is performed. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. Premature ventricular contraction (PVC) A. 2009; 94:F87-F91. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. Metabolic; lengthy d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? 609624, 2007. B. C. Damages/loss, Elements of a malpractice claim include all of the following except A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. 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). Uterine overdistension The labor has been uneventful, and the fetal heart tracings have been normal. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . B. Umbilical vein compression A. Placenta previa 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 . Feng G, Heiselman C, Quirk JG, Djuri PM. Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. Address contraction frequency by reducing pitocin dose Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Turn the logic on if an external monitor is in place 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. 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]. Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. 15-30 sec B. Auscultate for presence of FHR variability A. Stimulation of fetal chemoreceptors The dominance of the sympathetic nervous system Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. Late decelerations were noted in two out of the five contractions in 10 minutes. C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. A. Published by on June 29, 2022. 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 . Pathophysiology of fetal heart rate changes. 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]. Hello world! B. A. Cycles are 4-6 beats per minute in frequency Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. A. Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks.
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