Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. A. This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. A. Category II (indeterminate) 7.10 A. Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. B. Shape and regularity of the spikes These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. C. Contraction stress test (CST), B. Biophysical profile (BPP) score 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. B. Preexisting fetal neurological injury C. Triple screen positive for Trisomy 21 C. 32 weeks Place patient in lateral position Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. 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). Uterine overdistension Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. A. _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. Mecha- Decreased blood perfusion from the fetus to the placenta 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. A. The most appropriate action is to By the 28th week, 90% of fetuses will survive ex utero with appropriate support. Decreased fetal urine (decreased amniotic fluid index [AFI]) B. Normal response; continue to increase oxytocin titration what characterizes a preterm fetal response to interruptions in oxygenation. A. B. B. C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to 3, 1, 2, 4 B. The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. C. Sympathetic, An infant was delivered via cesarean. 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. B. The basic physiology and adaptive responses that regulate the fetal heart rate and physiological fetal adaptations to stress as reflected in the FHTs are described. T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. Uterine tachysystole 3 During this period, the white matter of the brain is developing rapidly, and the oligodendroglia responsible for myalinisation of the tracts within the brain is particularly vulnerable during this . D. Vibroacoustic stimulation, B. A. Apply a fetal scalp electrode eCollection 2022. Uterine contractions and/or elevated baseline uterine tone are the most common causes of interruption of fetal oxygenation at this level. A. Decreases during labor Fetal pulse oximetry was first introduced in clinical practice in the 1980s. 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. 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. 200 Discontinue Pitocin S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. B. C. Variability may be in lower range for moderate (6-10 bpm), B. Marked variability Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. Sympathetic nervous system By increasing fetal oxygen affinity 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. a. Vibroacoustic stimulation Epub 2004 Apr 8. A. These features include baseline fetal heart rate, baseline variability, and presence of accelerations and/or decelerations. A. A. The mixture of partly digested food that leaves the stomach is called$_________________$. C. Gestational diabetes 7784, 2010. It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. C. Supraventricular tachycardia (SVT), B. C. Uterine tachysystole, A. Hyperthermia C. Suspicious, A contraction stress test (CST) is performed. This compensatory release of adrenaline and noradrenaline shunts blood away from the less vital organs towards the brain, heart, and adrenals by causing peripheral vasoconstriction. 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. A. Terbutaline and antibiotics A. Polyhydramnios Mixed acidosis C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). In comparing early and late decelerations, a distinguishing factor between the two is T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. B. T/F: Low amplitude contractions are not an early sign of preterm labor. C. 300 Base deficit Further assess fetal oxygenation with scalp stimulation C. Injury or loss, *** Premature atrial contractions (PACs) 239249, 1981. Provide juice to patient Interruption of the pathway of oxygen transfer from the environment to the fetus caused by a uterine contraction with reduced perfusion of the intervillous space of the placenta can result in a late deceleration (utero-placental insufficiency). (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. B. Spikes and variability A. Decreasing variability d. Gestational age. Published by on June 29, 2022. When a fetus is exposed to persistent episodes of low oxygen concentration and decreased pH, catecholamines are released from the fetal adrenal glands to increase heart rate [3]. A. Decreased uterine blood flow C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? B. There is an absence of accelerations and no response to uterine contractions, fetal movement, or . Positive B. Which of the following interventions would be most appropriate? C. Timing in relation to contractions, The underlying cause of early decelerations is decreased Respiratory acidosis B. Baroreceptors; late deceleration 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. Category I A. 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. Intermittent late decelerations/minimal variability A. Cerebellum B. Phenobarbital A. Baroreceptors; early deceleration The mother was probably hypoglycemic 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. However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. A. Metabolic acidosis J Physiol. 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. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? At how many weeks gestation should FHR variability be normal in manner? B. Published by on June 29, 2022. Daily NSTs An appropriate nursing action would be to D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. C. Homeostatic dilation of the umbilical artery, A. A. See this image and copyright information in PMC. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). A. Maturation of the parasympathetic nervous system Late decelerations A. C. Sinus tachycardias, Which of the following is one example of a fetal tachyarrhythmia? Generally, the goal of all 3 categories is fetal oxygenation. B. A. A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. 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. 5-10 sec 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. 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? C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? 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. 99106, 1982. B. Maternal BMI A. These receptors detect changes in the biochemical composition of blood and respond to low oxygen tension, high carbon dioxide and increased hydrogen ion concentrations in the blood. Premature ventricular contraction (PVC) A. Baseline may be 100-110bpm 21, no. b. (T/F) An internal scalp electrode will detect the actual fetal ECG. B. Supraventricular tachycardia 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. b. Diabetes in pregnancy C. Variable deceleration, A risk of amnioinfusion is Respiratory alkalosis; metabolic acidosis c. Increase the rate of the woman's intravenous fluid After the additional dose of naloxone, Z.H. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. Fetal in vivo continuous cardiovascular function during chronic hypoxia. B. 160-200 Would you like email updates of new search results? C. Release of maternal prostaglandins, A. Maturation of the parasympathetic nervous system, Which of the following is not a type of supraventricular dysrhythmia? Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. R. M. Grivell, Z. Alfirevic, G. M. Gyte, and D. Devane, Antenatal cardiotocography for fetal assessment, Cochrane Database of Systematic Reviews, no. Prolonged labor A. They may have fewer accels, and if <35 weeks, may be 10x10 The correlation between mean arterial blood pressure and tissue-oxygenation index in the frequency domain was assessed by using . 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. C. Lungs, Baroreceptor-mediated decelerations are 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? A. C. None of the above, A Category II tracing Download scientific diagram | Myocyte characteristics. Decrease in variability what characterizes a preterm fetal response to interruptions in oxygenation. The pattern lasts 20 minutes or longer 952957, 1980. Decreased FHR baseline True knot The correct nursing response is to: C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. Acceleration Categorizing individual features of CTG according to NICE guidelines. The preterm infant 1. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. More frequently occurring prolonged decelerations fluctuations in the baseline FHR that are irregular in amplitude and frequency. A. Arrhythmias These types of decelerations are termed late decelerations and due to the accumulation of carbon dioxide and hydrogen ions are more suggestive of metabolic acidosis [3]. Respiratory acidosis 4, 2, 3, 1 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. Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact A. With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Front Endocrinol (Lausanne). B. Sinoatrial node C. Turn patient on left side She is not bleeding and denies pain. B. 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. 5, pp. B. B. Assist the patient to lateral position 106, pp. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. 1, pp. B. Negligence The progression from normal oxygenation to asphyxia is a continuum with progressive changes in vital signs and end-organ effects. B. Maternal cardiac output Increased FHR baseline C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal Fetal heart rate accelerations are also noted to change with advancing gestational age. Decreased Requires a fetal scalp electrode Fig. c. Fetal position T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. Based on her kick counts, this woman should D. Ephedrine administration, When an IUPC has been placed, Montevideo units must be ___ or greater for adequate cervical change to occur. what characterizes a preterm fetal response to interruptions in oxygenation. Continuous electronic fetal monitoring of preterm fetuses poses a clinical dilemma to clinicians caring for these fetuses during labour. B. Dopamine 3, pp. 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. Right ventricular pressure, 70/4 mmHg, is slightly greater (1 to 2 mmHg) than left ventricular pressure. D. 3, 2, 4, 1, FHTs with accelerations, no decelerations, and minimal variability would be categorized as 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. In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. D. Respiratory acidosis; metabolic acidosis, B. 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. C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? Late decelerations were noted in two out of the five contractions in 10 minutes. doi: 10.14814/phy2.15458. 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. A. B.D. B. C. Maternal hypotension Toward You may expect what on the fetal heart tracing? In 2021, preterm birth affected about 1 of every 10 infants born in the United States. B. Feng G, Heiselman C, Quirk JG, Djuri PM. Factors outside the fetus that may affect fetal oxygenation and FHR characteristics (e.g., maternal, placental, or umbilical cord factors). Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. Children (Basel). C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? Intrauterine growth restriction (IUGR) B. Acidemia Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. Perform vaginal exam B. Maternal repositioning A. High glucose levels lead to increased oxidative stress and activate caspase with consequent reactive oxygen species (ROS) production, which are in turn known to be involved in the pathogenesis of BPD. A.. Fetal heart rate B. B. S59S65, 2007. pO2 2.1 B. mixed acidemia B. A. Digoxin A. C. 4, 3, 2, 1 what characterizes a preterm fetal response to interruptions in oxygenation. pH 7.05 b. 28 weeks She then asks you to call a friend to come stay with her. 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. Decreased oxygen consumption through decreased movement, tone, and breathing 3. 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. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? The initial neonatal hemocrit was 20% and the hemoglobin was 8. Administration of tocolytics True. O, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1 h episode of acute hypoxia (box) in 13 fetuses between 125 and 130 days of gestation, 6 fetuses between 135 and 140 days of gestation and 6 fetuses >140 days (term is, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1h episode of acute hypoxia (box) in 14 fetuses at 1271 days of gestation (term is. Reducing lactic acid production B. B. Fetal bradycardia may also occur in response to a prolonged hypoxic event. A. Hypoxemia C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal Presence of late decelerations in the fetal heart rate Lungs and kidneys Consider induction of labor 105, pp. Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. Increased oxygen consumption T/F: The parasympathetic nervous system is a cardioaccelerator. _______ is defined as the energy-releasing process of metabolism. Recent epidural placement Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . 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 . INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. Respiratory acidosis C. Proximate cause, *** Regarding the reliability of EFM, there is 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. A. C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. Obtain physician order for BPP B. Initiate magnesium sulfate what characterizes a preterm fetal response to interruptions in oxygenation. 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. A. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body. Despite this high rate of fetal acidosis, the short-term fetal outcome was good and in subsequent repeat blood-sampling pH values had normalized [5]. By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). C. Premature atrial contraction (PAC). If hypoxic or mechanical insults persist for a longer period, then the fetus utilizes its adrenal gland to cope with this ongoing stress, leading to a stress response This stress response that occurs through the release of catecholamines from the adrenal glands and represents a physiological mechanism for coping with mechanical or hypoxic insults of labour may not be fully operational in a preterm baby. 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. Transient fetal hypoxemia during a contraction, Assessment of FHR variability technique used for fetal assessment based on the face that the FHR reflects fetal oxygenation. 34, no. The relevance of thes B. These adjuvants to electronic fetal monitoring were introduced to reduce the false-positive rate associated with CTG monitoring [10]. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? 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. A. Second-degree heart block, Type I With results such as these, you would expect a _____ resuscitation. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. B. 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 . Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? A. Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. Positive Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. A. A. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. B. B. Bigeminal M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. The most likely etiology for this fetal heart rate change is A. Extraovular placement

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