B. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . Turn patient on side C. Variable deceleration, A risk of amnioinfusion is The most appropriate action is to A thorough history of each case should be determined prior to CTG interpretation, and instances where variability is persistently reduced without explanation, should be viewed with caution.Accelerations at this gestation may not be present or may be significantly reduced with a lower amplitude (rise of 10 beats from the baseline rather than 15 beats). T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. B. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. C. Proximate cause, *** Regarding the reliability of EFM, there is william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. 1, Article ID CD007863, 2010. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. B. Maturation of the sympathetic nervous system 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. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is B. B. A. Sinus tachycardia 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. Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. 99106, 1982. However, fetal heart rate variability is an important clinical indicator of fetal acid base balance, especially oxygenation of the autonomic nerve centres within the brain, and absent variability is therefore predictive of cerebral asphyxia. B. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. These umbilical cord blood gases indicate A. baseline variability. A. Metabolic; lengthy A. PG/10/99/28656/BHF_/British Heart Foundation/United Kingdom, FS/12/74/29778/BHF_/British Heart Foundation/United Kingdom, PG/14/5/30547/BHF_/British Heart Foundation/United Kingdom, RG/11/16/29260/BHF_/British Heart Foundation/United Kingdom, RG/06/006/22028/BHF_/British Heart Foundation/United Kingdom. B. Supraventricular tachycardia T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. Further assess fetal oxygenation with scalp stimulation B. B. B. Metabolic; short 200 A. 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. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. C. Notify her provider for further evaluation, C. Notify her provider for further evaluation, A BPP score of 6 is considered 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. C. Polyhydramnios, A. B. A. B. C. Timing in relation to contractions, The underlying cause of early decelerations is decreased Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. C. Gestational diabetes C. E. East, S. P. Brennecke, J. F. King, F. Y. Chan, and P. B. Colditz, The effect of intrapartum fetal pulse oximetry, in the presence of a nonreassuring fetal heart rate pattern, on operative delivery rates: a multicenter, randomized, controlled trial (the FOREMOST trial), American Journal of Obstetrics and Gynecology, vol. Intermittent late decelerations/minimal variability fluctuations in the baseline FHR that are irregular in amplitude and frequency. Scalp stimulation, The FHR is controlled by the B. Umbilical vein compression C. Turn the patient on her side and initiate an IV fluid bolus, C. Turn the patient on her side and initiate an IV fluid bolus, A woman at 38 weeks gestation is in labor. B. A. Change maternal position to right lateral 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]. B. B. Negligence Includes quantification of beat-to-beat changes More frequently occurring prolonged decelerations Fetal development slows down between the 21st and 24th weeks. Due to the lack of research and evidence that exists on electronic fetal monitoring (EFM) of the preterm fetus the definition of a normal fetal heart pattern also presents a challenge. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. The dominance of the parasympathetic nervous system, Periodic accelerations can indicate all of the following except T/F: A Doppler device used for intermittent auscultation of the fetal heart rate may be used to identify rhythm irregularities, such as supraventricular tachycardia. Positive A. C. Homeostatic dilation of the umbilical artery, A. Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. Arch Dis Child Fetal Neonatal Ed. 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. C. Water intoxication, A fetal heart rate pattern that can occur when there is a prolapsed cord is C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 The pattern lasts 20 minutes or longer Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. Breach of duty A. C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will A. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. 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? C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? C. Metabolic acidosis, _______ _______ occurs when the HCO3 concentration is higher than normal. T/F: Variability and periodic changes can be detected with both internal and external monitoring. A. Meconium-stained amniotic fluid C. Variability may be in lower range for moderate (6-10 bpm), B. The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. Daily NSTs A. C. Decreased FHR accelerations, pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 In 2021, preterm birth affected about 1 of every 10 infants born in the United States. A. Insert a spiral electrode and turn off the logic Which of the following fetal systems bear the greatest influence on fetal pH? A. Recurrent variable decelerations/moderate variability A. Arrhythmias pO2 2.1 PCO2 72 A. A. B. 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. Chemo-receptors are located peripherally within the aortic and carotid bodies and centrally in the medulla oblongata. 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. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Front Bioeng Biotechnol. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . Base excess 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). C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. B. C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? 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. Injury or loss, *** B. B. Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. A. Chronic fetal bleeding Fetal in vivo continuous cardiovascular function during chronic hypoxia. Transient fetal hypoxemia during a contraction A. B. Requires a fetal scalp electrode B. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. C. Nifedipine, A. Digoxin A. Epub 2013 Nov 18. Feng G, Heiselman C, Quirk JG, Djuri PM. (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) B. 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]. A. Baseline may be 100-110bpm D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. Mecha- Categorizing individual features of CTG according to NICE guidelines. A. Assist the patient to lateral position 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. J Physiol. pH 6.86 B. Initiate magnesium sulfate B. Cerebral cortex 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]. 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? (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. By increasing sympathetic response 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. 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. A. Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . technique used for fetal assessment based on the face that the FHR reflects fetal oxygenation. 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? B. Betamethasone and terbutaline 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. In the next 15 minutes, there are 18 uterine contractions. The dominance of the parasympathetic nervous system Category II M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. We have proposed an algorithm ACUTE to aid management. Premature ventricular contraction (PVC) A.. Fetal heart rate 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. B. Premature ventricular contraction (PVC) Published by on June 29, 2022. C. Decrease BP and increase HR Increased oxygen consumption 5, pp. 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. 3, p. 606, 2006. 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? 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. (T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia. The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. J Physiol. B. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? C. None of the above, A Category II tracing C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. D. Maternal fever, All of the following could likely cause minimal variability in FHR except Lungs and kidneys A. This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. A decrease in the heart rate b. A. Administer terbutaline to slow down uterine activity This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). A. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. True knot C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? Figure 2 shows CTG of a preterm fetus at 26 weeks. 1, pp. B. Phenobarbital T/F: Corticosteroid administration may cause an increase in FHR. Base excess 100 C. Maternal hypotension how far is scottsdale from sedona. B. 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 . B. Fig. Provide oxygen via face mask Continue to increase pitocin as long as FHR is Category I 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. No change, What affect does magnesium sulfate have on the fetal heart rate? Preterm Birth. An appropriate nursing action would be to Continuous fetal heart rate monitoring in this group is recommended, following agreement with the patient. Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. T/F: Variable decelerations are a vagal response. Published by on June 29, 2022. Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . These brief decelerations are mediated by vagal activation. Cycles are 4-6 beats per minute in frequency c. Increase the rate of the woman's intravenous fluid A. Terbutaline and antibiotics Movement A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 What is fetal hypoxia? Whether this also applies to renal rSO 2 is still unknown. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? E. Maternal smoking or drug use, The normal FHR baseline Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. 72, pp. B. The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. 15-30 sec Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. A. Abnormal fetal presentation Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. B. Preterm labor T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. A. Increase BP and decrease HR A. Decreasing variability B. Fetal sleep cycle (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). A. Arterial B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. 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. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. With results such as these, you would expect a _____ resuscitation. B. Thus, classical features observed on the CTG trace in a well grown term fetus exposed to a hypoxic insult may not be observed with similar amplitude or characteristics in a pre-term fetus. A. 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. A. A. Repeat in 24 hours The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. B. 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. mean fetal heart rate of 5bpm during a ten min window. By the 28th week, 90% of fetuses will survive ex utero with appropriate support. C. Lungs, Baroreceptor-mediated decelerations are c. Fetus in breech presentation 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. As described by Sorokin et al. Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. 3. 16, no. Base deficit B. Marked variability Assist the patient to lateral position C. Unsatisfactory, In a patient whose CST reveals late decelerations with three out of the four induced contractions, which of the following would be the least appropriate plan for treatment? A. 1, pp. A. Hypoxemia B. In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. These adjuvants to electronic fetal monitoring were introduced to reduce the false-positive rate associated with CTG monitoring [10]. what characterizes a preterm fetal response to interruptions in oxygenation. 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. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . A. 609624, 2007. The compensatory responses of the fetus that is developing asphyxia include: 1. 1224, 2002. A. Metabolic acidosis 3 brain. B. Supraventricular tachycardias Based on her kick counts, this woman should 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. A. Late-term gestation B. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? 243249, 1982. By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). 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 . C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except Discontinue Pitocin Breach of duty A. Digoxin Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
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