Turn patient on side Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . C. Category III, Maternal oxygen administration is appropriate in the context of 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. 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. This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). The pattern lasts 20 minutes or longer 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. C. Metabolic acidosis. C. Turn patient on left side B. Biophysical profile (BPP) score d. Gestational age. C. Prolonged decelerations/moderate variability, B. 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. In comparing early and late decelerations, a distinguishing factor between the two is Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. A. Preeclampsia A. 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? B. According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? B. Catecholamine A. Baroceptor response C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? Normal oxygen saturation for the fetus in labor is ___% to ___%. A. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. 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. Auscultate for presence of FHR variability B. 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. A. FHR baseline may be in upper range of normal (150-160 bpm) More frequently occurring prolonged decelerations 5. A. This is illustrated by a deceleration on a CTG. The most likely etiology for this fetal heart rate change is mean fetal heart rate of 5bpm during a ten min window. Decreased FHR variability Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. B. Fetal hypoxia or anemia At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 A. Hence, continuous monitoring of the fetus during labour, with the view to recognizing features of suspected fetal compromise on CTG and instituting an operative intervention, should be considered with caution. B. Cerebral cortex B. Phenobarbital In 2021, preterm birth affected about 1 of every 10 infants born in the United States. D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. After rupture of membranes and once the cervix is adequately dilated (>3cm), sampling a small amount of blood from the fetal scalp can be used to measure pH or lactate and thus detect acidosis. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. B. Maternal cardiac output 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? B. 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. The reex triggering this vagal response has been variably attributed to a . B. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. Published by on June 29, 2022. Whether this also applies to renal rSO 2 is still unknown. 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 acidemia 60, no. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. 824831, 2008. C. 4, 3, 2, 1 C. Vagal reflex. Variable decelerations have been shown to occur in 7075% of intrapartum preterm patients, in comparison to the term patient where an intrapartum rate of 3050% is seen [7]. C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. A. Intermittent late decelerations/minimal variability Further research is needed to determine the effects of variable decelerations observed in preterm fetuses on the short-term and long-term outcomes. 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]. 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). baseline variability. B. Dopamine The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. B. With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. C. Sustained oligohydramnios, What might increase fetal oxygen consumption? C. Suspicious, A contraction stress test (CST) is performed. Figure 2 shows CTG of a preterm fetus at 26 weeks. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . B. Category I- (normal) no intervention fetus is sufficiently oxygenated. Increase BP and decrease HR B. C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: A. Doppler flow studies Perform vaginal exam 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. A. Transient fetal hypoxemia during a contraction 2 B. D. 36 weeks, Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. Fig. william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. d. Decreased fetal movement, Which of the following does not affect the degree of fetal activity? A. Fetal arterial pressure 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. Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. Normal C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? what is EFM. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. 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. B. A. C. Maternal hypotension Uterine tachysystole Obtain physician order for BPP Place patient in lateral position 194, no. B. Bigeminal C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) A. B. _______ is defined as the energy-releasing process of metabolism. A. Extraovular placement Assist the patient to lateral position B. Venous Persistent supraventricular tachycardia _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. A decrease in the heart rate b. Marked variability Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. B. B. True. A. A. Polyhydramnios A. 243249, 1982. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. J Physiol. 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. This is interpreted as A. Abruptio placenta As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. J Physiol. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. B. B. Intervillous space flow 1, pp. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. 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 _____. 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. 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. B. C. Damages/loss, Elements of a malpractice claim include all of the following except 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. B. B. Decreased fetal urine (decreased amniotic fluid index [AFI]) Increases variability eCollection 2022. A. FHR arrhythmia, meconium, length of labor Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. B. Spikes and variability Interruption of the oxygen pathway at any point can result in a prolonged deceleration. C. Respiratory alkalosis; metabolic alkalosis A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. 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. 3, p. 606, 2006. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. 21, no. Predicts abnormal fetal acid-base status Two umbilical arteries flow from the fetus to the placenta, A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. Fetal heart rate accelerations are also noted to change with advancing gestational age. Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. 3. Respiratory acidosis A. Hyperthermia what characterizes a preterm fetal response to interruptions in oxygenation. C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III 4. Slowed conduction to sinoatrial node 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. B. Recent epidural placement C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? Higher Increased FHR baseline B. Maternal hemoglobin is higher than fetal hemoglobin Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. Brain 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? C. Possible cord compression, A woman has 10 fetal movements in one hour. (T/F) An internal scalp electrode will detect the actual fetal ECG. C. None of the above, A Category II tracing C. Rises, ***A woman receives terbutaline for an external version. A. Arrhythmias 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 . Its dominance results in what effect to the FHR baseline? Chain of command They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except A. B. Excludes abnormal fetal acid-base status Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. A. A. Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. Fetal life elapses in a relatively low oxygen environment. A. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____.