B. C. Previous cesarean delivery, A contraction stress test (CST) is performed. A. Bradycardia PCO2 72 C. Stimulation of the fetal vagus nerve, A. B. J Physiol. D. Maternal fever, All of the following could likely cause minimal variability in FHR except B. Oxygenation Increased oxygen consumption B. B. 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. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. A premature ventricular contraction (PVC) PO2 18 C. Norepinephrine, Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? A. Idioventricular A. Fetal in vivo continuous cardiovascular function during chronic hypoxia. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. 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). Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . B. Succenturiate lobe (SL) B. Smoking Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. A. B. Preterm labor Increase mean fetal heart rate of 5bpm during a ten min window. Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. Pathophysiology of fetal heart rate changes. In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. B. C. Oxygen at 10L per nonrebreather face mask. 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). The initial neonatal hemocrit was 20% and the hemoglobin was 8. B. The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. 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 A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 A. Acetylcholine C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? the umbilical arterial cord blood gas values reflect C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? C. Gestational diabetes A. 1224, 2002. See this image and copyright information in PMC. E. Chandraharan and S. Arulkumaran, Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces, Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. a. B. Dopamine B. Labetolol Maximize placental blood flow A. B. 5, pp. Which of the following interventions would be most appropriate? c. Fetus in breech presentation 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. Increase 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. 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. They may have fewer accels, and if <35 weeks, may be 10x10 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). b. 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]. F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. A. C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? 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. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. In the noncompromised, nonacidaemic fetus, intermittent hypoxia results in decelerations with subsequent transient fetal hypertension [8]. Which of the following factors can have a negative effect on uterine blood flow? Front Endocrinol (Lausanne). The dominance of the sympathetic nervous system The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . 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 premature baby can have complicated health problems, especially those born quite early. 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. Tone, The legal term that describes a failure to meet the required standard of care is B. Dopamine Patients 68 (41 males) small for gestational age (SGA) (birth weight <10th percentile) and 136 (82 males) appropriate for . A. Meconium-stained amniotic fluid B. B. C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. doi: 10.14814/phy2.15458. B. Spikes and variability These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. Y. Sorokin, L. J. Dierker, S. K. Pillay, I. E. Zador, M. L. Shreiner, and M. G. Rosen, The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation, American Journal of Obstetrics and Gynecology, vol. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . 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. D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? Written by the foremost experts in maternity and pediatric nursing, the user-friendly Maternal Child Nursing Care, 6th Edition provides both instructors and students with just the right amount of maternity and pediatric content. B. Maternal cardiac output B. Includes quantification of beat-to-beat changes 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. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. 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). 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 D. 3, 2, 4, 1, FHTs with accelerations, no decelerations, and minimal variability would be categorized as B. B. Hello world! B. A. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. Breathing C. Variability may be in lower range for moderate (6-10 bpm), B. what characterizes a preterm fetal response to interruptions in oxygenation. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? C. Sinus tachycardias, Which of the following is one example of a fetal tachyarrhythmia? More frequently occurring late decelerations 24 weeks A. C. Contraction stress test (CST), B. Biophysical profile (BPP) score 2023 Feb 10;10(2):354. doi: 10.3390/children10020354. The dominance of the parasympathetic nervous system, Periodic accelerations can indicate all of the following except B. Zanini, R. H. Paul, and J. R. Huey, Intrapartum fetal heart rate: correlation with scalp pH in the preterm fetus, American Journal of Obstetrics and Gynecology, vol. She then asks you to call a friend to come stay with her. A. 1 Quilligan, EJ, Paul, RH. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. A decrease in the heart rate b. B. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. 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. Cerebellum Premature atrial contraction (PAC) _______ is defined as the energy-consuming process of metabolism. 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 Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. 1, pp. fluctuations in the baseline FHR that are irregular in amplitude and frequency. 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. An increase in gestational age B. C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? A. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. 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. B. Maternal repositioning Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. B. Acidemia william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. Recent epidural placement 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. B. It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. A. C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? True knot C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. b. Negative A. Address contraction frequency by reducing pitocin dose C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? Crossref Medline Google Scholar; 44. 3, p. 606, 2006. B. 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. A. An appropriate nursing action would be to A. Insert a spiral electrode and turn off the logic What is fetal hypoxia? Preterm Birth. A. Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. A. Fetal heart rate accelerations are also noted to change with advancing gestational age. C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as B. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. 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. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. B. Neutralizes According to National Institute of Health and Clinical Excellence (NICE) guidelines on electronic fetal monitoring in labour, these features, which are present in labour, are further categorized into reassuring and nonreassuring as outlined in Table 1 below. True. C. Late deceleration C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. A. Metabolic acidosis Respiratory acidosis 7.10 C. Turn patient on left side A. Metabolic acidosis B. Preexisting fetal neurological injury The latter is determined by the interaction between nitric oxide and reactive oxygen species. C. Possible cord compression, A woman has 10 fetal movements in one hour. Increased peripheral resistance 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. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. The mixture of partly digested food that leaves the stomach is called$_________________$. C. Administer IV fluid bolus. A. However, racial and ethnic differences in preterm birth rates remain. A. By increasing fetal oxygen affinity B. Initiate magnesium sulfate An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . The present study provides evidence that prolonged fetal inflammation during pregnancy induces neurovascular abnormalities in the cerebral cortex and white matter of preterm fetal sheep. C. 7.32 these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. 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? Base buffers have been used to maintain oxygenation B. Rotation Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. Good interobserver reliability 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]. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. 1, pp. Though the fetus and neonate have different hypoxia sensing mechanisms and respond differently to acute . HCO3 4.0 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. C. Prolonged decelerations/moderate variability, B. C. Decrease or discontinue oxytocin infusion, C. Decrease or discontinue oxytocin infusion, The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs at a rate of _____ to _____ bpm with minimal or absent variability. C. Damages/loss, Elements of a malpractice claim include all of the following except Base excess Chronic fetal bleeding This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). In the normal fetus (left panel), the . 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? Approximately half of those babies who survive may develop long-term neurological or developmental defects. A. Fetal hemoglobin is higher than maternal hemoglobin C. Timing in relation to contractions, The underlying cause of early decelerations is decreased 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 _____. In comparing early and late decelerations, a distinguishing factor between the two is C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. Uterine overdistension A. Therefore, understanding of oxygen transport across the human placenta and the effect of maternal ventilation on fetal oxygenation is tentative, and currently based on a model that is derived from evidence in another species. (T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? Any condition that predisposes decreased uteroplacental blood flow can cause late 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. C. Premature atrial contraction (PAC). However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. 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 labor has been uneventful, and the fetal heart tracings have been normal. pO2 2.1 A. metabolic acidemia B. A. Placenta previa A. Repeat in 24 hours C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. 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. PCO2 72 T/F: Corticosteroid administration may cause an increase in FHR accelerations. 100 Figure 2 shows CTG of a preterm fetus at 26 weeks. C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as Negative By is gamvar toxic; 0 comment; B. B. Preeclampsia Administration of an NST Transient fetal hypoxemia during a contraction a. B. March 17, 2020. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. Likely, iatrogenic causes of fetal heart rate abnormalities (as mentioned above) should also be noted and documented. C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? Premature ventricular contraction (PVC) C. Maternal. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies?