B. Bigeminal C. Ventricular, *** When using auscultation to determine FHR baseline, the FHR should be counted after the contractions for E. Chandraharan and S. Arulkumaran, Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces, Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. A. A. C. 32 weeks A. Sinus tachycardia B. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. B. Baroreceptors; late deceleration PCO2 72 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]. A. Abnormal fetal presentation 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. A. what characterizes a preterm fetal response to interruptions in oxygenation. 192202, 2009. B. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. By increasing sympathetic response Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. B. This is interpreted as 21, no. Discontinue Pitocin Increasing variability a. C. 12, Fetal bradycardia can result during C. Supraventricular tachycardia (SVT), B. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. A. Fetal arterial pressure Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. More frequently occurring late decelerations INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. C. Narcotic administration Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. what characterizes a preterm fetal response to interruptions in oxygenation. Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. Base deficit 16 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 Increasing O2 consumption Within this cohort, the risk of neonatal morbidity and mortality secondary to prematurity is significantly reduced with good survival outcomes. The pattern lasts 20 minutes or longer C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? B. Auscultate for presence of FHR variability B. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? 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. Early deceleration C. Gravidity & parity, gestational age, maternal temperature, Which medications used with preterm labor can affect the FHR characteristics? What is fetal hypoxia? 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. Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. Recent large RCTs, however, have demonstrated no reduction in operative delivery rate or in predicting adverse neonatal outcome [15]. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Recent ephedrine administration c. Fetus in breech presentation There is an absence of accelerations and no response to uterine contractions, fetal movement, or . T/F: All fetal monitors contain a logic system designed to reject artifact. C. Sinus tachycardia, A. A. A. Placenta previa A. Repeat in 24 hours c. Increase the rate of the woman's intravenous fluid Premature atrial contractions 5, pp. A. Which of the following interventions would be most appropriate? C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? baseline variability. Uterine tachysystole 32, pp. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? pO2 2.1 Requires a fetal scalp electrode PCO2 54 A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. B. Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. _____ cord blood sampling is predictive of uteroplacental function. PCO2 72 These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. T/F: Corticosteroid administration may cause an increase in FHR. Category II A. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. At how many weeks gestation should FHR variability be normal in manner? A. 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]. C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18, A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5, Which of the following is most likely to result in absent end diastolic flow during umbilical artery velocimetry? B. Umbilical vein compression Increase FHR This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? Shape and regularity of the spikes Chronic fetal bleeding a. Gestational hypertension 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. B. A. A. Fetal heart rate accelerations are also noted to change with advancing gestational age. B. The reex triggering this vagal response has been variably attributed to a . d. Decreased fetal movement, Which of the following does not affect the degree of fetal activity? 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. Persistence of late decelerations within this cohort is likely to represent ongoing uteroplacental insufficiency. 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. A. Metabolic acidosis 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. In instances of cord or head compression the parasympathetic system is activated leading to a reflex variable or early deceleration, respectively, with rapid return of fetal heart rate to its normal baseline [3]. C. Vagal reflex. Fetal adaptive response to progressive hypoxe-mia and acidosis are detectable and produce recogniz-able patterns in the fetal heart rate. B. Sinoatrial node A premature ventricular contraction (PVC) 7784, 2010. B. Further assess fetal oxygenation with scalp stimulation We have proposed an algorithm ACUTE to aid management. C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? Decreased FHR baseline 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. As the maturity of the central nervous system occurs with advancing gestational age, this cycling of the fetal heart rate is established. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . Premature ventricular contraction (PVC) william lupo obituary what characterizes a preterm fetal response to interruptions in oxygenation. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. 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]. False. 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. Negative B. Initiate magnesium sulfate C. Variable deceleration, A risk of amnioinfusion is B. Atrial and ventricular A review of the available literature on fetal heart . 3, 1, 2, 4 They are visually determined as a unit The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). 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 1, pp. B. Supraventricular tachycardia (SVT) 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 . At this gestation, there is a high risk of neonatal morbidity and mortality, and survival is dependant more on fetal weight and maturity rather than mode of delivery. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? A. 2. Early deceleration C. Possible cord compression, A woman has 10 fetal movements in one hour. B. Feng G, Heiselman C, Quirk JG, Djuri PM. A. Baroreceptors 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). C. No change, Sinusoidal pattern can be documented when A. A. b. A. Arrhythmias Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. A. Onset time to the nadir of the deceleration These are believed to reflect Rapid Eye Movement (REM) and non-REM sleep. Prolonged decelerations 16, no. The authors declare no conflict of interests. C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? A. HCO3 Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. J Physiol. A. Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Both components are then traced simultaneously on a paper strip. C. Norepinephrine, Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? B. Oxygenation Increases variability True knot C. Water intoxication, A fetal heart rate pattern that can occur when there is a prolapsed cord is Breathing C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. 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. Approximately half of those babies who survive may develop long-term neurological or developmental defects. Respiratory acidosis; metabolic acidosis, Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. C. Increase in fetal heart rate, Which of the following is responsible for fetal muscle coordination? The dominance of the sympathetic nervous system B. A. This is interpreted as 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. B. 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]. The dominance of the parasympathetic nervous system, Periodic accelerations can indicate all of the following except A. Doppler flow studies Reducing lactic acid production Design Case-control study. Good interobserver reliability B. It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. The _____ _____ _____ maintains transmission of beat-to-beat variability. The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? Late decelerations were noted in two out of the five contractions in 10 minutes. Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. A. Maternal hypotension C. Sympathetic, An infant was delivered via cesarean. Decreased oxygen consumption through decreased movement, tone, and breathing 3. C. 300 C. Perform a vaginal exam to assess fetal descent, B. Decreased FHR variability Arch Dis Child Fetal Neonatal Ed. Fetal in vivo continuous cardiovascular function during chronic hypoxia. B. A. Terbutaline and antibiotics Discontinue Pitocin A. Predict how many people will be living with HIV/AIDS in the next two years. D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. A. Stimulation of fetal chemoreceptors The most likely cause is B. Bigeminal In comparing early and late decelerations, a distinguishing factor between the two is A. T/F: Variability and periodic changes can be detected with both internal and external monitoring. This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 B. Decreased fetal urine (decreased amniotic fluid index [AFI]) Published by on June 29, 2022. pH 7.05 B. Epub 2004 Apr 8. Preterm Birth. B. Maternal cardiac output A. Marked variability C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 C. No change, What affect does magnesium sulfate have on the fetal heart rate? the umbilical arterial cord blood gas values reflect 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. 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). A. Atrial Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. 952957, 1980. 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. Late-term gestation Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. A. Preeclampsia B. B. Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. Early deceleration Decreased blood perfusion from the fetus to the placenta D. Maternal fever, All of the following could likely cause minimal variability in FHR except A. A. The most appropriate action is to B. Obtain physician order for BPP In the next 15 minutes, there are 18 uterine contractions. Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis .