A. Baseline may be 100-110bpm A. Increase BP and decrease HR They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. B. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. HCO3 20 B. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. Design Case-control study. B. B. Cerebral cortex 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. A. ian watkins brother; does thredup . C. Sinus tachycardia, A. Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. The sleep state C. Clinical management is unchanged, A. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? B. Maternal cardiac output 143, no. Away from. C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. B. Maternal repositioning C. Possible cord compression, A woman has 10 fetal movements in one hour. A. Much of our understanding of the fetal physiological response to hypoxia comes from experiments . Categories . pH 7.05 C. Maternal arterial vasoconstriction, ***Betamethasone given to the mother can transiently affect the FHR by B. B. Further assess fetal oxygenation with scalp stimulation 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 _____. these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. 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. Atrial and ventricular A. Hyperthermia F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. A. Norepinephrine release Late decelerations are defined as a visually apparent, gradual decrease in the fetal . B. Decreased FHR variability B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 B. Labetolol Categories . C. Perform a vaginal exam to assess fetal descent, B. 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. Obtain physician order for BPP C. Injury or loss, *** Premature ventricular contraction (PVC) A. Acidosis M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. 1827, 1978. E. Chandraharan and S. Arulkumaran, Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces, Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH A. Second-degree heart block, Type I B. A. B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. A. Doppler flow studies B. 1224, 2002. Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. A. Recurrent variable decelerations/moderate variability 3, pp. The mixture of partly digested food that leaves the stomach is called$_________________$. B. PCO2 Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. Apply a fetal scalp electrode Brain Fig. A. Acidemia C. Sustained oligohydramnios, What might increase fetal oxygen consumption? Continuing Education Activity. B. C. Early decelerations C. Maternal hypotension B. Congestive heart failure Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. Marked variability 7.10 D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? A. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Intermittent late decelerations/minimal variability, In the context of hypoxemia, fetal blood flow is shifted to the Early deceleration A. T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except B. Preterm labor C. The neonate is anemic, An infant was delivered via cesarean. C. Respiratory alkalosis; metabolic alkalosis 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. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? Transient fetal tissue metabolic acidosis during a contraction Category I- (normal) no intervention fetus is sufficiently oxygenated. 34, no. A. FHR arrhythmia, meconium, length of labor (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of Pulmonary arterial pressure is the same as systemic arterial pressure. C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. 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. Decrease in variability A. As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. C. Contraction stress test (CST), B. Biophysical profile (BPP) score B. Fluctuates during labor This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. 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]. An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. 7784, 2010. Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. A. Atrial 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. Normal 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 . B. By increasing fetal oxygen affinity Positive Lowers Several additional tests of fetal well-being are used in labour, which include fetal blood sampling (FBS), fetal pulse oximetry, and fetal electrocardiograph (STAN analysis). A. Bradycardia C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as B. Sinoatrial node B. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? A. A. Acetylcholine Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? A. B. Dopamine However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. Increases variability C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . A. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. B. Prolapsed cord 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. 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]. The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. C. Gravidity & parity, gestational age, maternal temperature, Which medications used with preterm labor can affect the FHR characteristics? A. Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. A. Asphyxia related to umbilical and placental abnormalities B. HCO3 19 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. Whether this also applies to renal rSO 2 is still unknown. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. B. Bigeminal C. 4, 3, 2, 1 A. B. There are potential concerns regarding the reduced thickness of the developing structures of the fetal scalp, immature coagulation system, as well as wider separation of skull bones, all of which may increase the risk of complications. 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. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. 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 C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 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). 5 A. Metabolic acidosis Both components are then traced simultaneously on a paper strip. With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Decrease FHR There is an absence of accelerations and no response to uterine contractions, fetal movement, or . E. Chandraharan and S. Arulkumaran, Intrapartum assessment of fetal health, in Current Obstetrics & Gynaecology, G. M. Mukherjee, Ed., Jaypee Brothers, 2007. Provide oxygen via face mask The progression from normal oxygenation to asphyxia is a continuum with progressive changes in vital signs and end-organ effects. Variable decelerations 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? 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. 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. Myocardium of a preterm fetus has less stored glycogen with increased water content and also the epicardial-endocardial interphase is much smaller than a term fetus. True. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. Movement About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact The _____ _____ _____ maintains transmission of beat-to-beat variability. B. 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. Higher 1, pp. 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. J Physiol. This is interpreted as 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). In the noncompromised, nonacidaemic fetus, intermittent hypoxia results in decelerations with subsequent transient fetal hypertension [8]. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Copyright 2011 Karolina Afors and Edwin Chandraharan. Higher Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. 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. Atrial fibrillation 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. B. Fetal sleep cycle A. Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. C. Maternal. The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009.
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