B.D. 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. Today she counted eight fetal movements in a two-hour period. B. B. Sinoatrial node Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. A. Abnormal fetal presentation This is interpreted as (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. Normal oxygen saturation for the fetus in labor is ___% to ___%. 1827, 1978. 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 Includes quantification of beat-to-beat changes Respiratory alkalosis; metabolic acidosis One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). Generally, the goal of all 3 categories is fetal oxygenation. C. Notify the attending midwife or physician, C. Notify the attending midwife or physician, Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation? C. 12, Fetal bradycardia can result during how far is scottsdale from sedona. Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. 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. A. B. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Base excess C. Possible cord compression, A woman has 10 fetal movements in one hour. 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. A. Assist the patient to lateral position, In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? D. Vibroacoustic stimulation, 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 . A. C. Mixed acidosis, pH 7.0 C. None of the above, A Category II tracing Hence, pro-inflammatory cytokine responses (e.g . R. M. Grivell, Z. Alfirevic, G. M. Gyte, and D. Devane, Antenatal cardiotocography for fetal assessment, Cochrane Database of Systematic Reviews, no. Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. Decreased uterine blood flow 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. 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. Vibroacoustic stimulation 5, pp. B. Atrial and ventricular Respiratory acidosis; metabolic acidosis, Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. A. Abnormal Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. Premature atrial contractions (PACs) B. Supraventricular tachycardia (SVT) Categories . A. Late-term gestation An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . B. Labetolol B. C. 300 B. 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. A. The _____ _____ _____ maintains transmission of beat-to-beat variability. With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. C. Tachycardia, The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. The most likely cause is The latter is determined by the interaction between nitric oxide and reactive oxygen species. 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. The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus . what is EFM. A. In 2021, preterm birth affected about 1 of every 10 infants born in the United States. Decreased blood perfusion from the fetus to the placenta B. Rotation C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. Increases variability B. Venous brain. B. A. Base excess -12 b. C. Transient fetal asphyxia during a contraction, B. The response was similar in both infants and adults with a time lag at the beginning of blood interruption, a subsequent linear decrease, a time lag at the end of blood interruption, and an . A. A. Metabolic acidosis Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. 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. C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? 4. A. Decreases during labor The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. A. Doppler flow studies B. B. Gestational diabetes A. What is fetal hypoxia? A. Baroceptor response Category I B. Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. True. B. C. Rises, ***A woman receives terbutaline for an external version. 4, 2, 3, 1 A. A. Breach of duty Predict how many people will be living with HIV/AIDS in the next two years. Daily NSTs Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. Category II Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? HCO3 19 B. Congestive heart failure It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . Early Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. B. Cerebral cortex 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). Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. C. 32 weeks Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. A. 1975;45 1 :96-100.Google ScholarPubMed 2 Chan, WH, Paul, RH, Toews, . A. B. C. Atrioventricular node Increase BP and decrease HR By increasing sympathetic response A. Bradycardia Lowers T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. C. Notify her provider for further evaluation, C. Notify her provider for further evaluation, A BPP score of 6 is considered The use of CTG monitoring in this group is contentious and each case should be considered individually with a plan of care agreed following discussion between the patient, obstetrician, and neonatologists. B. d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? Decreased FHR baseline C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called a. Inotropic - promotes regular and effective cardiac contraction, Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. Obtain physician order for CST B. FHR baseline (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) A. This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. B. Twice-weekly BPPs B. mixed acidemia Respiratory acidosis These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. These are believed to reflect Rapid Eye Movement (REM) and non-REM sleep. 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. Positive B. Neutralizes B. Maternal hemoglobin is higher than fetal hemoglobin Which of the following interventions would be most appropriate? March 17, 2020. This is considered what kind of movement? She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? J Physiol. PO2 21 d. Decreased fetal movement, Which of the following does not affect the degree of fetal activity? A. B. 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]. Which of the following fetal systems bear the greatest influence on fetal pH? A. Baroreceptor B. Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. B. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. A. C. Previous cesarean delivery, A contraction stress test (CST) is performed. 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 The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. One of the hallmarks of fetal wellbeing is considered to be cycling of the fetal heart rate [3]. Both signify an intact cerebral cortex Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. 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]. 15-30 sec A. FHR arrhythmia, meconium, length of labor A. Hyperthermia C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? B. 106, pp. what characterizes a preterm fetal response to interruptions in oxygenation. 1, Article ID CD007863, 2010. You may expect what on the fetal heart tracing? B. Macrosomia Requires a fetal scalp electrode pCO2 28 Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. T/F: Corticosteroid administration may cause an increase in FHR accelerations. A. Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. However, racial and ethnic differences in preterm birth rates remain. 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. A. 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. 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]. 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. Mecha- A. B. Hypoxia related to neurological damage What information would you give her friend over the phone? Which of the following factors can have a negative effect on uterine blood flow? Determine if pattern is related to narcotic analgesic administration 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. Premature Baby NCLEX Review and Nursing Care Plans. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . T/F: All fetal monitors contain a logic system designed to reject artifact. Recent ephedrine administration B. Sinus arrhythmias C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing A. Assist the patient to lateral position Fetal heart rate accelerations are also noted to change with advancing gestational age. Late decelerations Uterine tachysystole B. Maturation of the sympathetic nervous system Other possible factors that may contribute to onset of labour in this group include multiple gestations maternal risk factors such as increased maternal age, raised body mass index (BMI), or pregnancies conceived through in-vitro fertilization (IVF). A. Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. Decreased blood perfusion from the placenta to the fetus A. A. A. Decreases diastolic filling time Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. C. Umbilical cord entanglement 2009; 94:F87-F91. Category I A. Metabolic acidosis c. Fetal position A. Baseline may be 100-110bpm eCollection 2022. A. B. B. Marked variability 2 C. Administer IV fluid bolus. Chronic fetal bleeding 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. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. B. Preexisting fetal neurological injury 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. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? 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. C. No change, Sinusoidal pattern can be documented when Increased peripheral resistance C. 4, 3, 2, 1 C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. d. Gestational age. 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. Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. A. Sinus tachycardia C. Nifedipine, A. Digoxin 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. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. PO2 18 Decrease maternal oxygen consumption 4, pp. B. Dopamine Perform vaginal exam 1, pp. 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). B. C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? A. Maturation of the parasympathetic nervous system A. C. Variable deceleration, A risk of amnioinfusion is D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? False. A. E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. Based on her kick counts, this woman should A. Asphyxia related to umbilical and placental abnormalities T/F: Corticosteroid administration may cause an increase in FHR. However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. Mixed acidosis 7.10 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. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of Premature ventricular contraction (PVC) The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. Heart and lungs Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? 952957, 1980. S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. B. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Continue counting for one more hour Intermittent late decelerations/minimal variability, In the context of hypoxemia, fetal blood flow is shifted to the A. C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. A. Fetal hemoglobin is higher than maternal hemoglobin The oxygen pathway Fetal oxygenation involves - (1) the transfer of oxygen from the environment to the fetus, and - (2) the fetal response to interruption of oxygen transfer 4 5. In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. C. Early decelerations Late C. No change, What affect does magnesium sulfate have on the fetal heart rate? A. Extraovular placement Interruption of the oxygen pathway at any point can result in a prolonged deceleration. 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. C. Sinus tachycardia, A. B. Catecholamine Chain of command Increased FHR baseline C. 7.32 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. B. Maternal BMI william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. Decreased fetal urine (decreased amniotic fluid index [AFI]) what characterizes a preterm fetal response to interruptions in oxygenation. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. C. Metabolic acidosis. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? Fetal in vivo continuous cardiovascular function during chronic hypoxia. Increasing O2 consumption D. 7.41, The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction and returns to baseline just before the contraction is over. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Cycles are 4-6 beats per minute in frequency Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. S59S65, 2007. 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. Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. 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. 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. Persistent tachycardia is likely to arise secondary to iatrogenic causes such as administration of tocolytics (terbutaline) [9]. Consider induction of labor C. Supraventricular tachycardia (SVT), Which of the following is an irregular FHR pattern associated with normal conduction and rate? A. Maternal hypotension March 17, 2020. Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . The most appropriate action is to 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]. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. PCO2 72 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. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. A. Metabolic acidosis Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? B. Some triggering circumstances include low maternal blood . C. 10 1, pp. A review of the available literature on fetal heart . Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. C. Respiratory alkalosis; metabolic alkalosis Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. Published by on June 29, 2022. They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. B. C. Administer IV fluid bolus, A. C. Turn patient on left side 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]. B. Preterm labor She is not bleeding and denies pain. E. Maternal smoking or drug use, The normal FHR baseline