C. Contraction stress test (CST), B. Biophysical profile (BPP) score This is interpreted as 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. C. Administer IV fluid bolus, A. A review of the available literature on fetal heart . Download scientific diagram | Myocyte characteristics. 28 weeks T/F: Variability and periodic changes can be detected with both internal and external monitoring. Discontinue Pitocin These brief decelerations are mediated by vagal activation. The number of decelerations that occur These adjuvants to electronic fetal monitoring were introduced to reduce the false-positive rate associated with CTG monitoring [10]. Would you like email updates of new search results? Decrease FHR Change maternal position to right lateral A decrease in the heart rate 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]. 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. Which of the following factors can have a negative effect on uterine blood flow? Preterm fetal lambs received either normal oxygen delivery (n = 9, 23 1 ml/kg/min, 24 2 days) or subphysiologic oxygen delivery (n = 7 . Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. A. A. B. C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? C. Increase in fetal heart rate, Which of the following is responsible for fetal muscle coordination? D. 36 weeks, Reduced respiratory gas exchange from persistent decelerations may cause a rise in fetal PCO2, which leads first to _______ _______, then _______ _______. C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is 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. A. A. Approximately half of those babies who survive may develop long-term neurological or developmental defects. Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. 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 _____. B. A. 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. C. Sympathetic, An infant was delivered via cesarean. A. Fetal hypoxia A. 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. The most likely etiology for this fetal heart rate change is A. Norepinephrine release Hello world! Normal oxygen saturation for the fetus in labor is ___% to ___%. C. Stimulation of the fetal vagus nerve, A. 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. A. A. Idioventricular what characterizes a preterm fetal response to interruptions in oxygenation. 194, no. B. Neutralizes Late decelerations Understanding the physiology of fetal heart rate and the development of cardiovascular and neurological systems may help to understand the features observed on the CTG. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? Discontinue counting until tomorrow Base deficit 16 C. Possible cord compression, A woman has 10 fetal movements in one hour. T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. 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. 32, pp. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. Normal response; continue to increase oxytocin titration B. Fetal life elapses in a relatively low oxygen environment. The parasympathetic nervous system is activated by stimulation of baroreceptors situated in the carotid sinus or aortic arch secondary to increase in fetal systemic blood pressure, leading to a fall in heart rate mediated through the vagus nerve. 5 segundos ago 0 Comments 0 Comments Category I Obstet Gynecol. Lowers C. Frequency of FHR accelerations, A fetus of a diabetic mother may commonly develop 1, Article ID CD007863, 2010. Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. D. 3, 2, 4, 1, FHTs with accelerations, no decelerations, and minimal variability would be categorized as It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . D. Polyhydramnios Decreased oxygen consumption through decreased movement, tone, and breathing 3. 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. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. B. Umbilical cord compression Predicts abnormal fetal acid-base status 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). Base excess Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . A. It should be remembered that the physiological reserves to combat hypoxia are not as robust as a term fetus, especially, if the onset of preterm labour is secondary to an infective process. It carries oxygen from the lungs and nutrients from the gastrointestinal tract. B. C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. Includes quantification of beat-to-beat changes T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. A. Cerebellum B. A. Requires a fetal scalp electrode Copyright 2011 Karolina Afors and Edwin Chandraharan. B. Cerebral cortex The oxygen and nutrients subsequently diffuse from the blood into the interstitial fluid and then into the body cells. 6 Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. 1. C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body. B. Early deceleration Discontinue Pitocin B. C. Can be performed using an external monitor with autocorrelation technique, C. Can be performed using an external monitor with autocorrelation technique, The "overshoot" FHR pattern is highly predictive of B. mixed acidemia A. Meconium-stained amniotic fluid Most fetuses tolerate this process well, but some do not. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. C. 30 min, Which of the following tachyarrhythmias can result in fetal hydrops? 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. A. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. Decreased tissue perfusion can be temporary . C. Proximate cause, *** Regarding the reliability of EFM, there is C. Perform a vaginal exam to assess fetal descent, B. B. Preexisting fetal neurological injury The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. A. 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. C. Mixed acidosis, pH 7.0 As the fetus develops beyond 30 weeks, the progressive increase in the parasympathetic influence on fetal heart rate results in a gradual lowering of baseline rate. Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. 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. C. Decrease BP and increase HR 4, 2, 3, 1 Premature atrial contraction (PAC) (T/F) An internal scalp electrode will detect the actual fetal ECG. True knot B.D. 42 T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. 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. D. Variable deceleration, With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. Decrease in variability A. Abnormal Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. Decreased FHR late decelerations A. Early deceleration 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. Fetal tachycardia to increase the fetal cardiac output 2. Glucose is transferred across the placenta via _____ _____. C. Metabolic acidosis. A. Fetal echocardiogram Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. With increasing gestation the baseline fetal heart rate is likely to decrease from the upper limits of the normal range. baseline variability. Hello world! However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. More frequently occurring late decelerations Categories . Generally, the goal of all 3 categories is fetal oxygenation. Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. The oxygen supply of the fetus depends on the blood oxygen content and flow rate in the uterine and umbilical arteries and the diffusing capacity of the placenta. Persistent tachycardia is likely to arise secondary to iatrogenic causes such as administration of tocolytics (terbutaline) [9]. A. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. In the fetoplacental circulation, most of the oxygenated blood flows from the placenta through the umbilical vein and is shunted away from the high-resistance pulmonary circuit of the lungs, via the foramen ovale and the ductus arteriosus . B. B. Succenturiate lobe (SL) B. Maternal cardiac output Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. A. C. Nifedipine, A. Digoxin As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. Late These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? 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. Bradycardia 143, no. Breach of duty B. Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. 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. B. 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. A. Lactated Ringer's solution Positive 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. baseline FHR. Base excess D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: By increasing sympathetic response B. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. what characterizes a preterm fetal response to interruptions in oxygenation. A. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? 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. Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. C. Prolonged decelerations/moderate variability, B. 7.26 T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. B. C. Gestational diabetes C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as In the next 15 minutes, there are 18 uterine contractions. A. Acidosis Prolonged decelerations Decreased blood perfusion from the fetus to the placenta Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. Positive HCO3 20 A. Metabolic acidosis A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 Breach of duty Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. A. Hypoxemia Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. B. Macrosomia B. B. B. Category I A. Repeat in one week A. T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. A. HCO3 A. Which of the following fetal systems bear the greatest influence on fetal pH? Further assess fetal oxygenation with scalp stimulation S59S65, 2007. 1, pp. C. Lungs, Baroreceptor-mediated decelerations are 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. A. Arrhythmias C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III Increase They may have fewer accels, and if <35 weeks, may be 10x10 B. Bigeminal Premature ventricular contraction (PVC) B. B. Category I This is an open access article distributed under the. B. _______ is defined as the energy-consuming process of metabolism. T/F: Variable decelerations are a vagal response. Transient fetal hypoxemia during a contraction 60, no. B. Higher 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. During fetal development, the sympathetic nervous system that is responsible for survival (fight or flight response) develops much earlier than the parasympathetic nervous system (rest and sleep) that develops during the third trimester. 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. A. Metabolic acidosis C. Well-being, Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended by the NICHD because in clinical practice Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. 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. T/F: Corticosteroid administration may cause an increase in FHR. Fetal Oxygenation During Labor. 1827, 1978. brain. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. Excessive B. T/F: The parasympathetic nervous system is a cardioaccelerator. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. You may expect what on the fetal heart tracing? A. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. Likely, iatrogenic causes of fetal heart rate abnormalities (as mentioned above) should also be noted and documented. Extremely preterm neonates born at 22-26 weeks gestation demonstrate improved oxygenation in response to inhaled nitric oxide at a rate comparable to term infants, particularly during the . A. B. Sinus arrhythmias A. 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. C. Premature atrial contraction (PAC). Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. By increasing fetal oxygen affinity 192202, 2009. A. Amnioinfusion What is fetal hypoxia? Apply a fetal scalp electrode C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. B. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . Increased peripheral resistance C. There is moderate or minimal variability, B. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? Brain HCO3 19 Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. Low socioeconomic status B. Front Endocrinol (Lausanne). 243249, 1982. Fetal monitoring: is it worth it? Breach of duty Published by on June 29, 2022. Good intraobserver reliability In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. Decreased FHR variability Movement J Physiol. Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). A. Stimulation of fetal chemoreceptors C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? 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.