B. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. A. Decreases variability Fetal monitoring: is it worth it? A. Arrhythmias A. C. Uterine tachysystole, A. Hyperthermia 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. C. 32 weeks 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. Gestational hypertension 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 _____. 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. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? Increased FHR baseline Pulmonary arterial pressure is the same as systemic arterial pressure. B. Bigeminal C. Prolonged decelerations/moderate variability, B. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? A. Fetal hypoxia C. Late deceleration This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). 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]. B. A. Decreases during labor 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. Increase BP and decrease HR Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. C. Sympathetic, An infant was delivered via cesarean. A. Terbutaline and antibiotics A. Turn patient on side Children (Basel). Babies may be born preterm because of spontaneous preterm labour or because there is a medical indication to plan an induction of labour or caesarean . Hence, pro-inflammatory cytokine responses (e.g . Dramatically increases oxygen consumption In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. A. metabolic acidemia Extremely preterm neonates born at 22-26 weeks gestation demonstrate improved oxygenation in response to inhaled nitric oxide at a rate comparable to term infants, particularly during the . This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . 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. This is interpreted as C. 4, 3, 2, 1 A. A. B. Maternal hemoglobin is higher than fetal hemoglobin Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. B. C. Nifedipine, A. Digoxin Category I Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. Higher B. A. Baroreceptor B. C. Vagal reflex. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Lowers In instances of cord or head compression the parasympathetic system is activated leading to a reflex variable or early deceleration, respectively, with rapid return of fetal heart rate to its normal baseline [3]. D. Respiratory acidosis; metabolic acidosis, 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. B. Succenturiate lobe (SL) B. Langer, B. Carbonne, F. Goffinet, F. Le Gouff, N. Berkane, and M. Laville, Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? Fetal life elapses in a relatively low oxygen environment. Base deficit 16 Early deceleration 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. The preterm infant 1. 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]. 1224, 2002. A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. Normal oxygen saturation for the fetus in labor is ___% to ___%. Requires a fetal scalp electrode Introduction: Fetal inflammatory response syndrome (FIRS), defined as elevated umbilical cord blood interleukin-6 (IL-6) values > 11 pg/ml, is associated with an increased risk of neonatal morbidity and mortality. The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. Transient fetal hypoxemia during a contraction, Assessment of FHR variability C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. 15-30 sec D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. An increase in gestational age A. A. Second-degree heart block, Type I C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. Based on her kick counts, this woman should 99106, 1982. Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. A. 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. A. 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. Includes quantification of beat-to-beat changes 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. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as Administration of an NST Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. pO2 2.1 B. C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? B. T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow. T/F: Low amplitude contractions are not an early sign of preterm labor. Movement Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. C. Maternal. All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . A. Metabolic acidosis B. In the normal fetus (left panel), the . A. Onset time to the nadir of the deceleration The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. However, racial and ethnic differences in preterm birth rates remain. C. No change, Sinusoidal pattern can be documented when Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 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? B. Decreased oxygen consumption through decreased movement, tone, and breathing 3. Category II (indeterminate) A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. Recommended management is to camp green lake rules; A. Digoxin 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. 239249, 1981. B. Prolapsed cord A. Chronic fetal bleeding Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. With results such as these, you would expect a _____ resuscitation. We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . J Physiol. A. Variable decelerations Decrease FHR B. 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. 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. A. T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. Perform vaginal exam Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. Likely, iatrogenic causes of fetal heart rate abnormalities (as mentioned above) should also be noted and documented. B. Early deceleration Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. HCO3 19 Transient fetal hypoxemia during a contraction Heart and lungs C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. A. Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. 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). A. Fetal arterial pressure 2 Lungs and kidneys In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. The initial neonatal hemocrit was 20% and the hemoglobin was 8. A. Affinity C. Is not predictive of abnormal fetal acid-base status, C. Is not predictive of abnormal fetal acid-base status, Plans of the health care team with a patient with a sinusoidal FHR pattern may include Categorizing individual features of CTG according to NICE guidelines. A. B. Acidemia Normal Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. 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. Decrease in variability B. Sinus arrhythmias A. Asphyxia related to umbilical and placental abnormalities 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. C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. B. Oxygenation Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. 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. 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 . Decreased blood perfusion from the fetus to the placenta Fetal pulse oximetry was first introduced in clinical practice in the 1980s. C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. A. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. 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 952957, 1980. Negative By is gamvar toxic; 0 comment; Decrease maternal oxygen consumption Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. Increased peripheral resistance A. Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. C. Mixed acidosis, pH 7.02 mean fetal heart rate of 5bpm during a ten min window. A. Repeat in 24 hours 6 An appropriate nursing action would be to T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. Predicts abnormal fetal acid-base status C. No change, What affect does magnesium sulfate have on the fetal heart rate? B. B. doi: 10.14814/phy2.15458. A. The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. A. Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. Uterine overdistension C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. 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). B. Metabolic; short 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 . Accelerations of fetal heart rate in association with fetal movements occur as a result of fetal somatic activity and are first apparent in the 2nd trimester. A. Category I Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. A. Stimulation of fetal chemoreceptors B. Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? A. Baroceptor response A. In view of the absence of guidelines and recommendations monitoring preterm fetuses, we have produced a management algorithm ACUTE to aid continuous intrapartum fetal monitoring in fetuses prior to 34 weeks (Table 3). At this gestation, there is a high risk of neonatal morbidity and mortality, and survival is dependant more on fetal weight and maturity rather than mode of delivery. A. Administer terbutaline to slow down uterine activity The sleep state Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. 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. Persistence of late decelerations within this cohort is likely to represent ongoing uteroplacental insufficiency. Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. A. Metabolic acidosis Chemo-receptors are located peripherally within the aortic and carotid bodies and centrally in the medulla oblongata. J Physiol. C. Supraventricular tachycardia (SVT), B. Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. By the 28th week, 90% of fetuses will survive ex utero with appropriate support. A. A. Recurrent variable decelerations/moderate variability C. Atrioventricular node 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. B. A. Sinus tachycardia 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. B. ian watkins brother; does thredup . A. C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? Fetal tachycardia to increase the fetal cardiac output 2. Perform vaginal exam A. Lactated Ringer's solution A. Meconium-stained amniotic fluid They are visually determined as a unit As the fetus develops beyond 30 weeks, the progressive increase in the parasympathetic influence on fetal heart rate results in a gradual lowering of baseline rate. Decreased FHR late decelerations A. 1, pp. A. Digoxin C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? Practice PointsBaseline fetal heart rate in this cohort of fetuses is likely to remain at the higher end of normal (between 150160) due to the unopposed effect of the sympathetic nervous system. 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. Hello world! A. 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. 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. A. Arterial 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? Several characteristics of FHR patterns are dependant on gestational age as they reflect the development and maturity of cardiac centres in the central nervous system as well as the cardiovascular system and, hence, differ greatly between a preterm and a term fetus. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. A. Front Endocrinol (Lausanne). Discontinue Pitocin Persistent tachycardia is likely to arise secondary to iatrogenic causes such as administration of tocolytics (terbutaline) [9]. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. A. 1827, 1978. B. 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 . In the presence of other reassuring features of the CTG (as outlined above), these decelerations should not be considered as indicative of hypoxia, and interventions should be avoided based on this parameter alone. 4, pp. Breach of duty In the next 15 minutes, there are 18 uterine contractions. Continue to increase pitocin as long as FHR is Category I B. Intervillous space flow C. Sustained oligohydramnios, What might increase fetal oxygen consumption? A. B. Premature ventricular contraction (PVC) C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? 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. 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. Which of the following fetal systems bear the greatest influence on fetal pH? (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. 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). B. Maternal BMI what characterizes a preterm fetal response to interruptions in oxygenation. The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. Increases variability With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. 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? B. Twice-weekly BPPs A. B. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves.