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A. B. Fetal sleep cycle B. Congestive heart failure _______ is defined as the energy-consuming process of metabolism. The preterm infant 1. Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. Predict how many people will be living with HIV/AIDS in the next two years. Uterine overdistension Prepare for cesarean delivery B. Preexisting fetal neurological injury With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Decreased fetal urine (decreased amniotic fluid index [AFI]) C. Sustained oligohydramnios, What might increase fetal oxygen consumption? A. Idioventricular A. Negative Most fetuses tolerate this process well, but some do not. a. PCO2 54 C. Administer IV fluid bolus, A. Early deceleration B. Hypoxia related to neurological damage E. Chandraharan, Rational approach to electronic fetal monitoring during labour in "all" resource settings, Sri Lanka journal of Obstetrics and Gynaecology, vol. C. Umbilical cord entanglement In the presence of other reassuring features of the CTG (as outlined above), these decelerations should not be considered as indicative of hypoxia, and interventions should be avoided based on this parameter alone. 4, pp. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? 3 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 . a. The dominance of the sympathetic nervous system 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. Complete heart blocks Includes quantification of beat-to-beat changes However, fetal heart rate variability is an important clinical indicator of fetal acid base balance, especially oxygenation of the autonomic nerve centres within the brain, and absent variability is therefore predictive of cerebral asphyxia. Base excess A steel rod of length 1.0000m1.0000 \mathrm{~m}1.0000m and cross-sectional area 5.00104m25.00 \cdot 10^{-4} \mathrm{~m}^25.00104m2 is placed snugly against two immobile end points. B. FHR baseline C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? 1, Article ID CD007863, 2010. A. Cerebellum B. B. B. A. A. Baroceptor response Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is The mixture of partly digested food that leaves the stomach is called$_________________$. Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. C. Maternal arterial vasoconstriction, ***Betamethasone given to the mother can transiently affect the FHR by B. A. Extraovular placement A. Norepinephrine release B. 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). 2009; 94:F87-F91. A. Doppler flow studies 5, pp. A. Metabolic acidosis 85, no. Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. Increase in baseline 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]. A. Repeat in 24 hours Fetal Oxygenation During Labor. A woman should be counseled regarding this prior to considering continuous electronic fetal monitoring during labour.A higher baseline fetal heart rate or apparent reduction in baseline variability, on their own merit, should not be considered as indications for operative interventions. C. Mixed acidosis, pH 7.02 Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. A. Abnormal What information would you give her friend over the phone? The most likely cause is A. 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. Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. J Physiol. C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal B. 5-10 sec The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. A. As described by Sorokin et al. A. Increasing O2 consumption Good interobserver reliability 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. Respiratory acidosis eCollection 2022. C. Stimulation of the fetal vagus nerve, A. C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? C. Metabolic acidosis. C. Tone, The legal term that describes a failure to meet the required standard of care is 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. Marked variability Decreased blood perfusion from the fetus to the placenta B. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . C. Decreased FHR accelerations, pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. A. B. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Increased peripheral resistance Fetal blood has a _______ affinity for oxygen compared with the mother's blood, which facilitates adaptation to the low PO2 at which the placenta oxygenates the fetus. 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). Category I More frequently occurring late decelerations Today she counted eight fetal movements in a two-hour period. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. A. The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. Turn patient on side Both components are then traced simultaneously on a paper strip. A. Prolonged labor C. Narcotic administration A. Baroreceptors 952957, 1980. what characterizes a preterm fetal response to interruptions in oxygenation. A. Fetal bradycardia The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. The dominance of the parasympathetic nervous system, Periodic accelerations can indicate all of the following except C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH C. Injury or loss, *** A. FHR arrhythmia, meconium, length of labor HCO3 19 In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. 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. 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]. Category II A. Pathophysiology of fetal heart rate changes. Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. 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. 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. These brief decelerations are mediated by vagal activation. C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? C. Transient fetal asphyxia during a contraction, B. B. Oxygenation Decrease maternal oxygen consumption C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? The primary aim of the present study was to evaluate a potential influence of FIRS on cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (cFTOE) during . An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . 5 34, no. A. Digoxin B. Labetolol what characterizes a preterm fetal response to interruptions in oxygenation. 239249, 1981. 11, no. Impaired placental circulation C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? A. Fetal echocardiogram Much of our understanding of the fetal physiological response to hypoxia comes from experiments . C. Maternal and fetal hemoglobin are the same, A. Fetal hemoglobin is higher than maternal hemoglobin, A 36 week gestation patient is brought to triage by squad after an MVA on her back. fluctuations in the baseline FHR that are irregular in amplitude and frequency. C. Perform a vaginal exam to assess fetal descent, B. A. Cerebellum B. Obtain physician order for CST C. None of the above, A Category II tracing An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. 6 It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? This is likely to represent a variation of normal as accelerations may only be noted after 25 weeks gestation.Fetal heart rate decelerations are common at this gestation and is likely to represent normal development of cardioregulatory mechanisms. (T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. B. Supraventricular tachycardia Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. Normal oxygen saturation for the fetus in labor is ___% to ___%. Which of the following is the least likely explanation? Hello world! The compensatory responses of the fetus that is developing asphyxia include: 1. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. A. FHR baseline may be in upper range of normal (150-160 bpm) C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? C. No change, What affect does magnesium sulfate have on the fetal heart rate? An appropriate nursing action would be to B. Auscultate for presence of FHR variability A. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? Mecha- 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. A. Magnesium sulfate administration C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as A. Amnioinfusion B. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. B. Tracing is a maternal tracing 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 The correct nursing response is to: what characterizes a preterm fetal response to interruptions in oxygenation. 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. The progression from normal oxygenation to asphyxia is a continuum with progressive changes in vital signs and end-organ effects. 32, pp. 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. Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? Decreased uterine blood flow 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. 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]. 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. A. Asphyxia related to umbilical and placental abnormalities B. Sinoatrial node T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. B. Macrosomia A. Premature ventricular contraction (PVC) C. Homeostatic dilation of the umbilical artery, A. A. C. Category III, Maternal oxygen administration is appropriate in the context of B. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. C. Supraventricular tachycardia (SVT), B. 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). T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. A. Stimulation of fetal chemoreceptors Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body. a. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Base deficit 14 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. They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. Labor can increase the risk for compromised oxygenation in the fetus. In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. 1, pp. 5. A. A. Late deceleration Premature atrial contractions Further assess fetal oxygenation with scalp stimulation B. Gestational diabetes Category II (indeterminate) (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). PO2 21 a. Vibroacoustic stimulation More frequently occurring prolonged decelerations A. Baroreceptor This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. 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. 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. C. 4, 3, 2, 1 7784, 2010. A. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. B. 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). C. Suspicious, A contraction stress test (CST) is performed. Fig. C. Release of maternal prostaglandins, A. Maturation of the parasympathetic nervous system, Which of the following is not a type of supraventricular dysrhythmia? Design Case-control study. A. C. Decrease BP and increase HR B. A. Fetal arterial pressure B. C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to A. B. 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. A. Acetylcholine This is interpreted as C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. Lungs and kidneys 143, no. B. C. Maternal. Early deceleration Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 36 weeks, late preterm birth is between 34 and 36 weeks' gestation. 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. C. Possible cord compression, A woman has 10 fetal movements in one hour. (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. C. Late deceleration A decrease in the heart rate b. A. 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. S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. She is not bleeding and denies pain. C. Early decelerations A. 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. PO2 18 Base deficit Decreased FHR baseline A. Meconium-stained amniotic fluid C. 300 william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. B. A. Hyperthermia Fetal bradycardia may also occur in response to a prolonged hypoxic event. 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. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. Higher B. Atrial fibrillation Intermittent late decelerations/minimal variability The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . Persistent supraventricular tachycardia In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic.