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. 609624, 2007. a. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? B. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Premature atrial contraction (PAC) 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). No decelerations were noted with the two contractions that occurred over 10 minutes. The _____ _____ _____ maintains transmission of beat-to-beat variability. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. Shape and regularity of the spikes All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . E. Maternal smoking or drug use, The normal FHR baseline C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. A. Studies reporting on early signs of renal disturbances in FGR are sparse and mostly include invasive measurements, which limit the possibility for early identification and prevention. A. Base excess Mixed acidosis 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]. A. C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal These umbilical cord blood gases indicate A.. Fetal heart rate Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. They may have fewer accels, and if <35 weeks, may be 10x10 Design Case-control study. II. C. Gestational diabetes Decrease maternal oxygen consumption A. C. Timing in relation to contractions, The underlying cause of early decelerations is decreased Excludes abnormal fetal acid-base status A. B. A. Fetal echocardiogram A woman should be counseled regarding this prior to considering continuous electronic fetal monitoring during labour.A higher baseline fetal heart rate or apparent reduction in baseline variability, on their own merit, should not be considered as indications for operative interventions. B. Maternal cardiac output B. Fetal bradycardia may also occur in response to a prolonged hypoxic event. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. B. O, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1 h episode of acute hypoxia (box) in 13 fetuses between 125 and 130 days of gestation, 6 fetuses between 135 and 140 days of gestation and 6 fetuses >140 days (term is, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1h episode of acute hypoxia (box) in 14 fetuses at 1271 days of gestation (term is. Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except During labour, uterine contractions gradually build up and increase in intensity and frequency and may cause compression of the umbilical cord and/or the fetal head. Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. C. Water intoxication, A fetal heart rate pattern that can occur when there is a prolapsed cord is A. Metabolic acidosis B. Maternal hemoglobin is higher than fetal hemoglobin Heart and lungs 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. A. Fetal arterial pressure T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. A. Digoxin _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. C. Variability may be in lower range for moderate (6-10 bpm), B. 3, p. 606, 2006. b. If the pH value is <7.20, immediate delivery is recommended, whereas a pH of 7.207.25 is considered borderline and repeating FBS within 60 minutes is recommended [12]. Base excess Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. C. Repeat CST in 24 hours, For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate course of action. Higher Decreased blood perfusion from the fetus to the placenta A. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is _____ cord blood sampling is predictive of uteroplacental function. This is interpreted as Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of Acceleration Late decelerations Though the fetus and neonate have different hypoxia sensing mechanisms and respond differently to acute . C. Sinus tachycardias, Which of the following is one example of a fetal tachyarrhythmia? A. D. Parasympathetic nervous system. Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation Marked variability Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. A. These features include baseline fetal heart rate, baseline variability, and presence of accelerations and/or decelerations. A. Recurrent variable decelerations/moderate variability B. B. Hypoxia related to neurological damage D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? 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. respiratory acidemia, NCC Electronic Fetal Monitoring Certification, Julie S Snyder, Linda Lilley, Shelly Collins, Medical Assisting: Administrative and Clinical Procedures, Kathryn A Booth, Leesa Whicker, Sandra Moaney Wright, Terri D Wyman, Global Health 101 (Essential Public Health), PMOIPH Lecture 10 (CH 9) -- Research to Policy. There are various reasons why oxygen deprivation happens. 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. C. Decrease BP and increase HR This is considered what kind of movement? Presence of late decelerations in the fetal heart rate Interpretation of fetal blood sample (FBS) results. Obtain physician order for BPP A. T/F: Corticosteroid administration may cause an increase in FHR accelerations. Generally, the goal of all 3 categories is fetal oxygenation. See this image and copyright information in PMC. The percent of oxygen that should be used during resuscitation depends on whether the baby made it to term. C. Umbilical cord entanglement 1975;45 1 :96-100.Google ScholarPubMed 2 Chan, WH, Paul, RH, Toews, . C. There is moderate or minimal variability, B. A. A. Fetal hemoglobin is higher than maternal hemoglobin Pathophysiology of fetal heart rate changes. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. C. Decreased FHR accelerations, pH 6.9, PO2 15, PCO2 55, HCO3 18, BE -22 C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? C. Vagal stimulation, Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). B. A. Stimulation of fetal chemoreceptors Position the woman on her opposite side March 17, 2020. An appropriate nursing action would be to T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. a. Decreased blood perfusion from the fetus to the placenta B. A. B. A. C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. 160-200 Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? B. B. Oxygenation Brain Fig. 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. Therefore, understanding of oxygen transport across the human placenta and the effect of maternal ventilation on fetal oxygenation is tentative, and currently based on a model that is derived from evidence in another species. In the noncompromised, nonacidaemic fetus, intermittent hypoxia results in decelerations with subsequent transient fetal hypertension [8]. Smoking False. Provide juice to patient Breach of duty 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). The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. 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]. PO2 17 C. Release of maternal prostaglandins, A. Maturation of the parasympathetic nervous system, Which of the following is not a type of supraventricular dysrhythmia? These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? 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. Fetal development slows down between the 21st and 24th weeks. 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 . Persistent supraventricular tachycardia Respiratory acidosis B. Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. a. Gestational hypertension 3 C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? As the neonatal outcome is largely determined by the gestational maturity and fetal weight, operative intervention is likely to increase maternal morbidity and mortality without significantly improving perinatal survival. Positive This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. Includes quantification of beat-to-beat changes Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. Administration of tocolytics 952957, 1980. B. B. Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. 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. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. Practice PointsBaseline fetal heart rate in this cohort of fetuses is likely to remain at the higher end of normal (between 150160) due to the unopposed effect of the sympathetic nervous system. These brief decelerations are mediated by vagal activation. B. The most likely cause is what characterizes a preterm fetal response to interruptions in oxygenation. This is illustrated by a deceleration on a CTG. Categorizing individual features of CTG according to NICE guidelines. Glucose is transferred across the placenta via _____ _____. brain. Which interpretation of these umbilical cord and initial neonatal blood results is correct? Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. Preterm Birth. Requires a fetal scalp electrode C. Rises, ***A woman receives terbutaline for an external version. Breathing D. Respiratory acidosis; metabolic acidosis, B. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. 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. 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. Only used with normal baseline rate and never during decels; not an intervention, Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? C. Umbilical vein compression, A transient decrease in cerebral blood flow (increased cerebral blood pressure) during a contraction may stimulate _____ and may cause a(n) _____ the umbilical arterial cord blood gas values reflect A. Fetal hypoxia A. The dominance of the parasympathetic nervous system B. B. Rotation Approximately half of those babies who survive may develop long-term neurological or developmental defects. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? Base deficit 14 Late decelerations are defined as a visually apparent, gradual decrease in the fetal . Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. B. B. A. Low socioeconomic status B. B. 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]. Decreased FHR late decelerations The number of decelerations that occur A. 200 The labor has been uneventful, and the fetal heart tracings have been normal. A. Hypoxemia A. 5. 4, 2, 3, 1 A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. A. Idioventricular B. B. C. Sinus tachycardia, A. HCO3 24 pO2 2.1 A. A. B. T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. Slowed conduction to sinoatrial node 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. B. The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. High glucose levels lead to increased oxidative stress and activate caspase with consequent reactive oxygen species (ROS) production, which are in turn known to be involved in the pathogenesis of BPD. Premature atrial contractions (PACs) Engel O, Arnon S, Shechter Maor G, Schreiber H, Piura E, Markovitch O. 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. A. doi: 10.14814/phy2.15458. Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. Both signify an intact cerebral cortex C. 32 weeks 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. Perform vaginal exam Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. Decrease in variability B. C. Metabolic acidosis. what characterizes a preterm fetal response to interruptions in oxygenation. The relevance of thes B. Maternal BMI Variable decelerations C. 7.32 C. E. East, S. P. Brennecke, J. F. King, F. Y. Chan, and P. B. Colditz, The effect of intrapartum fetal pulse oximetry, in the presence of a nonreassuring fetal heart rate pattern, on operative delivery rates: a multicenter, randomized, controlled trial (the FOREMOST trial), American Journal of Obstetrics and Gynecology, vol. You may expect what on the fetal heart tracing? C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? 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. 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. 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). Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. B. Congestive heart failure The most appropriate action is to As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. A. During this period, the white matter of the brain is developing rapidly, and the oligodendroglia responsible for myalinisation of the tracts within the brain is particularly vulnerable during this . b. One of the hallmarks of fetal wellbeing is considered to be cycling of the fetal heart rate [3]. 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. D. Maternal fever, All of the following could likely cause minimal variability in FHR except More frequently occurring prolonged decelerations (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. A premature ventricular contraction (PVC) B. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . B. B. Catecholamine 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. Fetal heart rate is regulated by the autonomic nervous system consisting of 2 branches; the parasympathetic and sympathetic branch which exerts opposing influences on the FHR. 4. Fetal P a O 2 Peripheral chemoreflex Abstract A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. 7.26 5, pp. 143, no. B. Betamethasone and terbutaline With results such as these, you would expect a _____ resuscitation. Movement C. Category III, Maternal oxygen administration is appropriate in the context of A. Fetal tachycardia to increase the fetal cardiac output 2. Increased FHR baseline B. Bigeminal B. Late decelerations were noted in two out of the five contractions in 10 minutes. It provided a means of monitoring fetal oxygen saturation of fetal haemoglobin that is measured optically (similar technology for pulse oximetry in adults) during labour. 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. This is because physiological maturity of the cardiovascular system and the neural control of the fetal heart rate during this gestational period is similar to that of a term fetus (Figure 3). Prolonged decelerations 4, pp. Category II A. Decreasing variability Early deceleration B. Liver The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. B. Premature ventricular contraction (PVC) baseline FHR. Category I Decreased FHR baseline B. The dominance of the sympathetic nervous system CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. More frequently occurring late decelerations Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? A. 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. Assist the patient to lateral position A. Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. _______ denotes an increase in hydrogen ions in the fetal blood. The sleep state 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. 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 C. 10 A. Baroreceptors B. A. B. Obstet Gynecol. J Physiol. In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range.