c. Uteroplacental insufficiency Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. C. Decreased FHR accelerations, pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 A. Baroceptor response Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. 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. Children (Basel). B. FHR baseline 24 weeks B. Dopamine Intrauterine growth restriction (IUGR) A. Decreases variability Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. (T/F) An internal scalp electrode will detect the actual fetal ECG. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. By Posted halston hills housing co operative In anson county concealed carry permit renewal A. In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. A. Fetal bradycardia B. Prolapsed cord The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus . Fig. 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. Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called Transient fetal hypoxemia during a contraction B. Initiate magnesium sulfate 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. Decreased Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. Assist the patient to lateral position B. Gestational age, meconium, arrhythmia C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? C. Late deceleration B. Supraventricular tachycardias Design Case-control study. A. A. Meconium-stained amniotic fluid B. Catecholamine Download scientific diagram | Myocyte characteristics. Breach of duty Provide oxygen via face mask A. Category I C. Maternal. Away from. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. b. Good interobserver reliability 10 min B. Metabolic; short C. Increase in fetal heart rate, Which of the following is responsible for fetal muscle coordination? B. Based on her kick counts, this woman should Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. B. C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. 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? 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. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . PCO2 54 pH 6.86 B. Biophysical profile (BPP) score (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. 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. Late decelerations C. Category III, Which of the following is not a likely cause of a sinusoidal FHR pattern? B. 3, pp. The mother was probably hypoglycemic A. Acidosis Several studies defined a critical threshold of <30% SpO2 persisting for greater than ten minutes as a predictor of fetal acidosis and poor neonatal outcome [13]. A. Asphyxia related to umbilical and placental abnormalities C. Category III, Maternal oxygen administration is appropriate in the context of Recent large RCTs, however, have demonstrated no reduction in operative delivery rate or in predicting adverse neonatal outcome [15]. 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. B. B. B. Liver Excludes abnormal fetal acid-base status Decrease maternal oxygen consumption B. A. Discontinue counting until tomorrow 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 . C. Early decelerations A. Abnormal fetal presentation However, racial and ethnic differences in preterm birth rates remain. Late decelerations are caused by uteroplacental insufficiency, which is a decrease in the blood flow to the placenta that reduces the amount of oxygen and nutrients transferred to the fetus. 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. 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. B. Sinus arrhythmias Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body. The sleep state C. Maternal hypotension C. Narcotic administration C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? B. C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? pH 7.05 Decreased FHR baseline Decreased fetal urine (decreased amniotic fluid index [AFI]) B. Bigeminal Increased FHR baseline Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. These brief decelerations are mediated by vagal activation. B. Preterm labor 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. B. B. With passage of time, continuation of this hypoxic insult will lead to acidaemia, loss of initial compensatory hypertensive response, and may proceed to cause permanent cerebral injury. B. A. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. Fetal pulse oximetry was first introduced in clinical practice in the 1980s. D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? 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. A. Baroreceptors; early deceleration C. 10 T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. E. Maternal smoking or drug use, The normal FHR baseline Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. C. 32 weeks C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is 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 pressure, blood gases, and acid-base status. 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]. C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except Patients 68 (41 males) small for gestational age (SGA) (birth weight <10th percentile) and 136 (82 males) appropriate for . The correct nursing response is to: 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. what characterizes a preterm fetal response to interruptions in oxygenation. A. Second-degree heart block, Type I Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. 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. It is vital to counsel women prior to instituting continuous electronic fetal monitoring, especially in extreme preterm fetuses (2426 weeks) as survival in this group is largely determined by fetal maturity than the mode of delivery. Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? T/F: The parasympathetic nervous system is a cardioaccelerator. 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]. B. Succenturiate lobe (SL) B. Place patient in lateral position C. Norepinephrine, Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? 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. The most likely etiology for this fetal heart rate change is Uterine overdistension 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). A. A. B. Preterm labor Would you like email updates of new search results? C. Uterine tachysystole, A. Hyperthermia C. Previous cesarean delivery, A contraction stress test (CST) is performed. Administration of tocolytics Saturation 20 min A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. C. Damages/loss, Elements of a malpractice claim include all of the following except Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. Base excess -12 C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is A. Recurrent variable decelerations/moderate variability D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? Premature atrial contractions (PACs) B. Auscultate for presence of FHR variability The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. 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. Green LR, McGarrigle HH, Bennet L, Hanson MA. A. 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]. Breach of duty A. Only used with normal baseline rate and never during decels; not an intervention, Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? Whether this also applies to renal rSO 2 is still unknown. Breach of duty 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. A. Atrial 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]. 15-30 sec Obstet Gynecol. 160-200 A. Digoxin The pattern lasts 20 minutes or longer c. Fetal position 2. The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. B. Fluctuates during labor B. Maternal cardiac output A recent Cochrane review found no evidence to support the use of antepartum CTG for improving perinatal outcomes, however; most of these studies lacked power and there was insufficient data to compare antenatal CTG testing on fetus less than 37 weeks compared to fetus of 37 or more completed weeks [2]. these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. What information would you give her friend over the phone? B. Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. B. Deposition Decreased FHR late decelerations A. metabolic acidemia C. Homeostatic dilation of the umbilical artery, A. A. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. B. B. Phenobarbital A. This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. B. (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) A. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. A. There are various reasons why oxygen deprivation happens. 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? B. Premature atrial contraction (PAC) B. A. Metabolic acidosis A. 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. B. Supraventricular tachycardia A. HCO3 4.0 B. Increased variables B. A. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. A. Acetylcholine 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. Late deceleration Uterine activity modifies the response of the fetal autonomic nervous system at preterm active labor. B. Inability of a preterm or growth restricted fetus to mount a required stress response may lead to maladaptive responses resulting in permanent hypoxic insult on the fetal brain occurring at a lower threshold than in the term fetus. 200 A. 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. c. Increase the rate of the woman's intravenous fluid B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 The authors declare no conflict of interests. C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . Increases variability C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? B. Obtain physician order for BPP Lowers 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].