A. C. Maternal hypotension What information would you give her friend over the phone? Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. Fetal heart rate accelerations are also noted to change with advancing gestational age. C. Polyhydramnios, A. PO2 18 106, pp. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? II. Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. 2 Baroreceptors influence _____ decelerations with moderate variability. C. Rises, ***A woman receives terbutaline for an external version. Download scientific diagram | Myocyte characteristics. 3, 1, 2, 4 Decreased oxygen consumption through decreased movement, tone, and breathing 3. Respiratory acidosis C. 4, 3, 2, 1 C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? C. Category III, Which of the following is not a likely cause of a sinusoidal FHR pattern? The labor has been uneventful, and the fetal heart tracings have been normal. Slowed conduction to sinoatrial node T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. Requires a fetal scalp electrode A. Metabolic acidosis Normal oxygen saturation for the fetus in labor is ___% to ___%. A. 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). This clinical scenario of decelerations, followed by loss of accelerations, subsequent rise in baseline heart rate and gradual loss of variability is typical of a gradually evolving hypoxia (Figure 1). A. Amnioinfusion The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. B. B. Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. baseline variability. Published by on June 29, 2022. Shape and regularity of the spikes A. A. 99106, 1982. 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. pO2 2.1 A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 200 C. Administer IV fluid bolus, A. Oxygen consumption by the placenta is a significant factor and a potential limitation on availability to the fetus. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). how many kids does jason statham have . Continue counting for one more hour Good intraobserver reliability C. Possible cord compression, A woman has 10 fetal movements in one hour. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. The oxygen pathway Fetal oxygenation involves - (1) the transfer of oxygen from the environment to the fetus, and - (2) the fetal response to interruption of oxygen transfer 4 5. HCO3 19 B. Rotation Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of T/F: All fetal monitors contain a logic system designed to reject artifact. B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 Base deficit 14 Sympathetic nervous system 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. B. Metabolic; short 5 segundos ago 0 Comments 0 Comments PO2 21 Provide juice to patient Premature atrial contraction (PAC) A. 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? C. Perform a vaginal exam to assess fetal descent, B. B. Intervillous space flow A. Baroceptor response Increase B. PCO2 Increased FHR baseline 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. A. Fetal hypoxia A. Doppler flow studies B. C. 7.32 A. Decreases diastolic filling time As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. D. Decrease BP and decrease HR, During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. A. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. A. C. Sinus tachycardia, A. Persistent tachycardia is likely to arise secondary to iatrogenic causes such as administration of tocolytics (terbutaline) [9]. A. Arrhythmias Negative 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. doi: 10.14814/phy2.15458. The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. A. eCollection 2022. B. b. Diabetes in pregnancy Uterine overdistension T/F: Variable decelerations are a vagal response. C. Maternal. 5-10 sec More frequently occurring prolonged decelerations 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. 34, no. Preterm Birth. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? A. 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. 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 . A. C. Prolonged decelerations/moderate variability, B. B. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. A. Baroreceptor Respiratory acidosis A. FHR arrhythmia, meconium, length of labor Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? 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. A. We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . Which of the following interventions would be most appropriate? C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Decreased blood perfusion from the fetus to the placenta E. Chandraharan and S. Arulkumaran, Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces, Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. Lungs and kidneys 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. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. B. Liver The initial neonatal hemocrit was 20% and the hemoglobin was 8. A. Idioventricular 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. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. B. B. C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? B. The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. An appropriate nursing action would be to C. Terbutaline, The initial response in treating a primigravida being induced for preeclampsia who has a seizure is a. the umbilical arterial cord blood gas values reflect 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. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? Recent epidural placement B. Supraventricular tachycardia A. 4, pp. A review of the available literature on fetal heart . C. Suspicious, A contraction stress test (CST) is performed. B. Cerebral cortex More frequently occurring late decelerations T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. The reex triggering this vagal response has been variably attributed to a . 3 A. B. Maternal repositioning M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. C. Variability may be in lower range for moderate (6-10 bpm), B. C. Supraventricular tachycardia (SVT), B. A. Norepinephrine release Impaired placental circulation 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. 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. A. Category I- (normal) no intervention fetus is sufficiently oxygenated. D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. Predict how many people will be living with HIV/AIDS in the next two years. Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? Continuing Education Activity. Categories . B. Sinus arrhythmias D. Parasympathetic nervous system. Front Endocrinol (Lausanne). Perform vaginal exam C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to C. Ventricular, *** When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for B. Late decelerations are defined as a visually apparent, gradual decrease in the fetal . Discontinue counting until tomorrow Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. B. Maternal hemoglobin is higher than fetal hemoglobin C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? B. 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). A. Polyhydramnios These features include baseline fetal heart rate, baseline variability, and presence of accelerations and/or decelerations. Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). Premature atrial contraction (PAC) A. C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? B. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. _______ is defined as the energy-releasing process of metabolism. Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . 1827, 1978. Decreased FHR baseline Category I The correct nursing response is to: A. B. B. Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. Provide oxygen via face mask Early deceleration B. Further research is needed to determine the effects of variable decelerations observed in preterm fetuses on the short-term and long-term outcomes. 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. A. T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. Smoking 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. B. By increasing sympathetic response (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. These adjuvants to electronic fetal monitoring were introduced to reduce the false-positive rate associated with CTG monitoring [10]. Cycles are 4-6 beats per minute in frequency Notably, fetal baseline heart rate is higher, averaging at 155 between 2024 weeks (compared to a term fetus where average baseline fetal heart rate is 140). Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. A. Baroreceptors; early deceleration C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? A. Magnesium sulfate administration B. B. A. Fetal bradycardia These receptors detect changes in the biochemical composition of blood and respond to low oxygen tension, high carbon dioxide and increased hydrogen ion concentrations in the blood. B. A. A. Fetal hemoglobin is higher than maternal hemoglobin According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). 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. 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. Turn the logic on if an external monitor is in place 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. C. No change, Sinusoidal pattern can be documented when C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? A. Abruptio placenta B. Catecholamine Base excess -12 Excludes abnormal fetal acid-base status eCollection 2022. B. 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]. 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. T/F: Corticosteroid administration may cause an increase in FHR accelerations. B. Gestational age, meconium, arrhythmia 28 weeks Fetal development slows down between the 21st and 24th weeks. A. Metabolic acidosis Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . A. Acetylcholine 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 . The most likely cause is C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. Turn patient on side This is considered what kind of movement? C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? 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. B. A. Hypoxemia Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. A premature ventricular contraction (PVC) D. Variable deceleration, With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. Decreased blood perfusion from the fetus to the placenta 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. Fluctuates during labor There are potential concerns regarding the reduced thickness of the developing structures of the fetal scalp, immature coagulation system, as well as wider separation of skull bones, all of which may increase the risk of complications. These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? C. Early decelerations Address contraction frequency by reducing pitocin dose Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. . A. b. Fetal malpresentation The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus .