baseline FHR. B. 1224, 2002. A. Cerebellum Base deficit 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 fetal systems bear the greatest influence on fetal pH? With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. C. Tone, The legal term that describes a failure to meet the required standard of care is Assist the patient to lateral position 952957, 1980. A. D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. 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. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. 1 Quilligan, EJ, Paul, RH. Characteristics of a premature baby - I Live! OK 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. C. Premature atrial contraction (PAC). Several additional tests of fetal well-being are used in labour, which include fetal blood sampling (FBS), fetal pulse oximetry, and fetal electrocardiograph (STAN analysis). A. C. Terbutaline, The initial response in treating a primigravida being induced for preeclampsia who has a seizure is By increasing sympathetic response Marked variability C. Prolonged decelerations/moderate variability, B. A. Intermittent late decelerations/minimal variability Increase FHR B. Sympathetic nervous system 15-30 sec J Physiol. B. Oxygenation C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? 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]. Base excess One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). B. 2. This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. 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. 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). 4, pp. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. B. Biophysical profile (BPP) score 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. 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. B. A. Affinity C. Decrease BP and increase HR 85, no. A. Digoxin C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing These brief decelerations are mediated by vagal activation. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? B. 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. A. Extraovular placement A. The sleep state D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: What information would you give her friend over the phone? A. Amnioinfusion Decreased blood perfusion from the fetus to the placenta 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. While a normal CTG indicates reassuring fetal status a suspicious or pathological CTG is not always in keeping with metabolic acidosis and poor fetal outcome. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Perform vaginal exam 7.26 The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. B. C. Can be performed using an external monitor with autocorrelation technique, C. Can be performed using an external monitor with autocorrelation technique, The "overshoot" FHR pattern is highly predictive of C. Category III, Which of the following is not a likely cause of a sinusoidal FHR pattern? C. Category III, Maternal oxygen administration is appropriate in the context of More likely to be subjected to hypoxia, ***A woman being monitored externally has a suspected fetal arrhythmia. Normal Most fetuses tolerate this process well, but some do not. Discontinue Pitocin C. Nifedipine, A. Digoxin Mecha- Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. Persistent supraventricular tachycardia B. Fetal life elapses in a relatively low oxygen environment. a. Gestational hypertension Hence, fetal monitoring is recommended in this gestational group.Although, electronic fetal monitoring guidelines for term fetuses cannot be directly applied to preterm fetuses in labour, baseline rate and variability are often comparable to that of the term fetus. Decreased fetal urine (decreased amniotic fluid index [AFI]) Base buffers have been used to maintain oxygenation C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? a. C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to A. Magnesium sulfate administration B. Prolonged labor B. EFM Flashcards | Quizlet An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? C. Respiratory; lengthy, Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? Lipopolysaccharide-induced changes in the neurovascular unit in the C. Contraction stress test (CST), B. Biophysical profile (BPP) score Fetal Response to Interrupted Oxygenation - Blogger Published by on June 29, 2022. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. B. Tracing is a maternal tracing Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. This is considered what kind of movement? Recommended management is to C. Late deceleration Consider induction of labor Premature atrial contractions (PACs) Today she counted eight fetal movements in a two-hour period. 243249, 1982. A. Metabolic acidosis B. A.. Fetal heart rate Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. Prolonged decelerations 3, p. 606, 2006. C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? 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]. C. 32 weeks 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. C. Triple screen positive for Trisomy 21 A. Norepinephrine release A. Administer terbutaline to slow down uterine activity Further assess fetal oxygenation with scalp stimulation B. B. Give the woman oxygen by facemask at 8-10 L/min Glucose is transferred across the placenta via _____ _____. 60, no. A. B. Hypoxia related to neurological damage D. Parasympathetic nervous system. 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. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? B. Auscultate for presence of FHR variability Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. B. Phenobarbital A. B. A. Acetylcholine Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? Front Endocrinol (Lausanne). A. Fetal hypoxia Generally, the goal of all 3 categories is fetal oxygenation. Respiratory alkalosis; metabolic acidosis Base deficit 16 Both signify an intact cerebral cortex C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? 42 Provide oxygen via face mask Premature atrial contraction (PAC) 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. d. Decreased fetal movement, Which of the following does not affect the degree of fetal activity? A. Decreases diastolic filling time Increasing variability 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]. The availability of oxygen to the fetus is limited by the route taken by oxygen from the atmosphere to fetal tissues, aided or diminished by pregnancy-associated changes in maternal physiology and, ultimately, a function of atmospheric pressure and composition of the mother's inspired gas. Higher Includes quantification of beat-to-beat changes C. Timing in relation to contractions, The underlying cause of early decelerations is decreased The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. B. B. C. Atrioventricular node Recent ephedrine administration Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation B. Decreased FHR late decelerations This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. B. what is EFM. This is illustrated by a deceleration on a CTG. Fetal circulation: Circulation of blood in the fetus | Kenhub B. 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. A. Bradycardia T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. Elevated renal tissue oxygenation in premature fetal growth restricted 1, Article ID CD007863, 2010. Saturation C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? Use of Continuous Electronic Fetal Monitoring in a Preterm Fetus A. B. A. B. Congestive heart failure Variable decelerations what characterizes a preterm fetal response to interruptions in oxygenation. The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. B. A. C. 7.32 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. 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. 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? 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. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. Adrenocortical responsiveness is blunted in twin relative to singleton ovine fetuses. C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? She is not bleeding and denies pain. Fetal Circulation. The fetal brain sparing response to hypoxia: physiological mechanisms (T/F) An internal scalp electrode will detect the actual fetal ECG. Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. 200 A. Higher B. Supraventricular tachycardia (SVT) B. Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as Category II B. Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? 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 . Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. B. C. Vagal stimulation, Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of