Respiratory acidosis Continuing Education Activity. C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. Premature ventricular contraction (PVC) 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: Fetal arrhythmias can be seen on both internal and external monitor tracings. Heart and lungs This is considered what kind of movement? At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . 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. A. Acetylcholine Category II (indeterminate) The sleep state A.. Fetal heart rate C. 4, 3, 2, 1 Lowers B. B. C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? Epub 2013 Nov 18. D. Respiratory acidosis; metabolic acidosis, B. 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. Uterine tachysystole B. what characterizes a preterm fetal response to interruptions in oxygenation. A. Determine if pattern is related to narcotic analgesic administration B. C. Suspicious, A contraction stress test (CST) is performed. 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. 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. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. A. Placenta previa C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. 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 Category I- (normal) no intervention fetus is sufficiently oxygenated. B. She is not bleeding and denies pain. A. Sinus tachycardia Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. Discontinue counting until tomorrow Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. Mecha- 143, no. A. C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will B. Liver Premature atrial contraction (PAC) 200-240 Persistence of late decelerations within this cohort is likely to represent ongoing uteroplacental insufficiency. A. Fetal monitoring: is it worth it? 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. Excessive C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? A. 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). C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? A. Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? 3 C. Maternal hypotension B. Gestational age, meconium, arrhythmia 3, pp. The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). A. A. F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Generally, the goal of all 3 categories is fetal oxygenation. A. A. 5. 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. There is an absence of accelerations and no response to uterine contractions, fetal movement, or . B. Fluctuates during labor B. Acceleration By is gamvar toxic; 0 comment; Maximize placental blood flow A. HCO3 20 More frequently occurring prolonged decelerations With results such as these, you would expect a _____ resuscitation. B. D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? 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. Fetus in breech presentation C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. A. Terbutaline and antibiotics B. A. Insert a spiral electrode and turn off the logic Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Fetal pulse oximetry was first introduced in clinical practice in the 1980s. Decreased oxygen consumption through decreased movement, tone, and breathing 3. Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. Marked variability 6 C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. B. C. Late deceleration A. The pattern lasts 20 minutes or longer 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 . C. The neonate is anemic, An infant was delivered via cesarean. Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. Hence, ST analyser is not recommended prior to 36 weeks of gestation as it may not be reliable due to changes in the myocardial composition described above. Late decelerations were noted in two out of the five contractions in 10 minutes. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. Prepare for possible induction of labor Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. 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. 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]. With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. Increased oxygen consumption A. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. C. Third-degree heart block, With _____ premature ventricular contractions (PVCs), the baseline and variability are obscured. PCO2 54 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. Digoxin A. B. D5L/R A. A. Arterial B. Fetal heart rate accelerations are also noted to change with advancing gestational age. 85, no. Prepare for cesarean delivery C. Clinical management is unchanged, A. B. Phenobarbital T/F: All fetal monitors contain a logic system designed to reject artifact. Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. J Physiol. Hello world! These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. 32, pp. A. Fetal arterial pressure C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? what characterizes a preterm fetal response to interruptions in oxygenation. 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]. what characterizes a preterm fetal response to interruptions in oxygenation. 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. You are determining the impact of contractions on fetal oxygenation. 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. B. B. Zanini, R. H. Paul, and J. R. Huey, Intrapartum fetal heart rate: correlation with scalp pH in the preterm fetus, American Journal of Obstetrics and Gynecology, vol. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. A. A. Early deceleration 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. A. Glucose is transferred across the placenta via _____ _____. One of the hallmarks of fetal wellbeing is considered to be cycling of the fetal heart rate [3]. Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation Address contraction frequency by reducing pitocin dose They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with A. Fetal bradycardia 2. Movement A. c. Fetal position 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. Likely, iatrogenic causes of fetal heart rate abnormalities (as mentioned above) should also be noted and documented. The latter is determined by the interaction between nitric oxide and reactive oxygen species. 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. Decrease in variability The correct nursing response is to: B. B. This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. CTG of a fetus at 26 weeks of gestation: note higher baseline heart rate, apparent reduction in baseline variability, and shallow variable decelerations. B. Supraventricular tachycardia absent - amplitude range is undetectable. There are sub-categories of preterm birth, based on gestational age: moderate to late preterm (32 to 37 weeks). 952957, 1980. A. Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? 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. C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. C. Sinus tachycardia, A. C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. 99106, 1982. A. Administer terbutaline to slow down uterine activity 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. Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. C. Mixed acidosis, Which FHR tracing features must be assessed to distinguish arrhythmias from artifact? Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. a. Gestational hypertension Practice PointsBaseline fetal heart rate and variability should be comparable to the term fetus and accelerations with an amplitude of greater than 15 beats from the baseline should be present as an indicator of fetal well-being. B. Premature atrial contractions (PACs) A. Category I 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. Away from. A. B. Bigeminal pO2 2.1 Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. C. Increases during labor, Bradycardia in the second stage of labor following a previously normal tracing may be caused by fetal A. FHR baseline may be in upper range of normal (150-160 bpm) A. A. Metabolic acidosis A. Arrhythmias 2 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. B. Place patient in lateral position B. Langer, B. Carbonne, F. Goffinet, F. Le Gouff, N. Berkane, and M. Laville, Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. The most appropriate action is to what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. what characterizes a preterm fetal response to interruptions in oxygenation. 1. B. A. By increasing sympathetic response C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? Normal response; continue to increase oxytocin titration B. 20 min 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. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? True knot Which interpretation of these umbilical cord and initial neonatal blood results is correct? Base deficit 14 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. Decrease FHR These brief decelerations are mediated by vagal activation. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? Cycles are 4-6 beats per minute in frequency A. HCO3 T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. Written by the foremost experts in maternity and pediatric nursing, the user-friendly Maternal Child Nursing Care, 6th Edition provides both instructors and students with just the right amount of maternity and pediatric content. See this image and copyright information in PMC. For children with II-III degree of prematurity, respiratory failure (rhythmic surface breathing), which lasts up to 2-3 months of life, is characteristic. Which of the following interventions would be most appropriate? Approximately half of those babies who survive may develop long-term neurological or developmental defects. Copyright 2011 Karolina Afors and Edwin Chandraharan. Apply a fetal scalp electrode Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Predicts abnormal fetal acid-base status Recent epidural placement B. The number of decelerations that occur Fetal bradycardia may also occur in response to a prolonged hypoxic event. The dominance of the parasympathetic nervous system Premature ventricular contraction (PVC) She then asks you to call a friend to come stay with her. B. Premature atrial contraction (PAC) The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. 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. 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. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. B. Continue to increase pitocin as long as FHR is Category I Decreased FHR variability A. Maternal hypotension It carries oxygen from the lungs and nutrients from the gastrointestinal tract. 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]. Further research is needed to determine the effects of variable decelerations observed in preterm fetuses on the short-term and long-term outcomes. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. At how many weeks gestation should FHR variability be normal in manner? B. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? C. Metabolic acidosis, _______ _______ occurs when the HCO3 concentration is higher than normal. B. Catecholamine A. Metabolic acidosis 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. Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . B. Maternal BMI By the 28th week, 90% of fetuses will survive ex utero with appropriate support. C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need . Sympathetic nervous system A. B. Neutralizes 21, no. B. 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). These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? Its dominance results in what effect to the FHR baseline? The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. The fetal brain sparing response matures as the fetus approaches term, in association with the prepartum increase in fetal plasma cortisol, and treatment of the preterm fetus with clinically relevant doses of synthetic steroids mimics this maturation. 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?