B. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. B. Cerebral cortex A. Baseline may be 100-110bpm B. Deposition C. Ventricular, *** When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for B. A. _______ is defined as the energy-consuming process of metabolism. A. Administer terbutaline to slow down uterine activity A. A. Generally, the goal of all 3 categories is fetal oxygenation. Premature atrial contractions (PACs) D. Vibroacoustic stimulation, B. D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. 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 . 5-10 sec what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. She is not bleeding and denies pain. B. This is because physiological maturity of the cardiovascular system and the neural control of the fetal heart rate during this gestational period is similar to that of a term fetus (Figure 3). C. Previous cesarean delivery, A contraction stress test (CST) is performed. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? B. 7.10 Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. B. Catecholamine Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation B. Chronic fetal bleeding 60, no. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. B. 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. Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. Based on her kick counts, this woman should 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. Continue to increase pitocin as long as FHR is Category I A. A. Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. Continuous electronic fetal monitoring of preterm fetuses poses a clinical dilemma to clinicians caring for these fetuses during labour. B. B. Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal Fetal Oxygenation During Labor. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. B. 143, no. B. Succenturiate lobe (SL) Decreased uterine blood flow 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. Abnormal fetal presentation d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? 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. a. B. 4. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. 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. Both components are then traced simultaneously on a paper strip. C. Use a Doppler to listen to the ventricular rate, A. Insert a spiral electrode and turn off the logic, *** The fetus responds to a significant drop of PO2 by Shape and regularity of the spikes A. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. The correct nursing response is to: The dominance of the sympathetic nervous system With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. A. Complete heart blocks We have proposed an algorithm ACUTE to aid management. Premature ventricular contraction (PVC) PO2 17 True. Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. 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 Chain of command C. Timing in relation to contractions, The underlying cause of early decelerations is decreased Good intraobserver reliability A. The poor-positive predictive value of CTG in addition to variation in CTG interpretation can often lead to unnecessary intervention and high-operative delivery rates [11]. C. Category III, Maternal oxygen administration is appropriate in the context of A. A. They may have fewer accels, and if <35 weeks, may be 10x10 C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? pO2 2.1 C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? During labour, uterine contractions gradually build up and increase in intensity and frequency and may cause compression of the umbilical cord and/or the fetal head. Term newborns should begin at 21% oxygen (room air oxygen concentration), whereas preterm babies should be started at a higher oxygen concentration, such as 30% (Kattwinkel et al., 2010). (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. C. Supraventricular tachycardia (SVT), B. 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. B. C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. B. FHR baseline Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. Late decelerations c. Uteroplacental insufficiency B. Maternal BMI Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. A. Heart and lungs 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. Metabolic; lengthy Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. C. Damages/loss, Elements of a malpractice claim include all of the following except Decrease FHR 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. C. Polyhydramnios, A. What is fetal hypoxia? B. Biophysical profile (BPP) score Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. Fetal tachycardia to increase the fetal cardiac output 2. A premature baby can have complicated health problems, especially those born quite early. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. Decreases variability B. C. Clinical management is unchanged, A. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . 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. All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . A. 5 segundos ago 0 Comments 0 Comments Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). Mixed acidosis A. Abnormal Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . Apply a fetal scalp electrode 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. B. 10 min B. Dopamine Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? B. Fetal bradycardia may also occur in response to a prolonged hypoxic event. Base buffers have been used to maintain oxygenation Copyright 2011 Karolina Afors and Edwin Chandraharan. Increase The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. B. 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 _____. Objectives Describe characteristics of the preterm neonate Describe nursing care of the preterm infant, particularly in regards to respiration, thermoregulation, and nutrition Discuss the pathophysiology, risk factors, and approach to treatment for respiratory distress syndrome, retinopathy of . Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. C. Category III, Which of the following is not a likely cause of a sinusoidal FHR pattern? 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]. Continuous fetal heart rate monitoring in this group is recommended, following agreement with the patient. B. A. Arrhythmias 3. B. D5L/R B. True knot Continue counting for one more hour A. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? The most likely etiology for this fetal heart rate change is C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? 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. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. Increased peripheral resistance A. The latter is altered secondary to release of potassium during glyocogenolysis in the fetal myocardium mediated through that catecholoamine surge, which occurs during hypoxic stress. Mecha- A. Early deceleration A. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 5. C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. 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. 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. A. Onset time to the nadir of the deceleration B. Negligence 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). These umbilical cord blood gases indicate B. Sinoatrial node B. C. 7.32 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? This is interpreted as A. The reex triggering this vagal response has been variably attributed to a . 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. Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. 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). Base deficit Prepare for cesarean delivery A. Hyperthermia Green LR, McGarrigle HH, Bennet L, Hanson MA. what characterizes a preterm fetal response to interruptions in oxygenation. B. B. Prolapsed cord Uterine overdistension T/F: All fetal monitors contain a logic system designed to reject artifact. B. A. 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. In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. A review of the available literature on fetal heart . C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? Respiratory acidosis; metabolic acidosis, Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. Decreased FHR variability B. Oxygenation C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? 11, no. Base excess -12 ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. B. C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? B. They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is 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. B. A. PO2 21 Uterine contractions and/or elevated baseline uterine tone are the most common causes of interruption of fetal oxygenation at this level. A. Asphyxia related to umbilical and placental abnormalities C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? 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. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. Intermittent late decelerations/minimal variability 1, pp. B. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. B. The most likely cause is Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. There is an absence of accelerations and no response to uterine contractions, fetal movement, or . 200-240 Lowers B. Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? B. Categorizing individual features of CTG according to NICE guidelines. Hence, pro-inflammatory cytokine responses (e.g . Which of the following factors can have a negative effect on uterine blood flow? Late Transient fetal tissue metabolic acidosis during a contraction At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . B. 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: 952957, 1980. 20 min B. A. 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. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Increasing O2 consumption 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. 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. 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. pH 6.86 This technology is based on analyzing the ST segment of the fetal myocardium for ischaemic changes during fetal hypoxia as well as determining the ratio between the T wave and QRS complex (T/QRS Ratio) of the fetal ECG. The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. 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. C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. Lungs and kidneys brain. C. 10 A. Decreases during labor 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. C. None of the above, A Category II tracing B. C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of By increasing sympathetic response Negative 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. The _____ _____ _____ maintains transmission of beat-to-beat variability. 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. 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. 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. A. Digoxin HCO3 19 T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. a. 2 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.
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