A. B. Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. C. Perform a vaginal exam to assess fetal descent, B. By increasing sympathetic response This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. Today she counted eight fetal movements in a two-hour period. A. Baroceptor response B. (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) 239249, 1981. A. Bradycardia Less-oxygenated blood enters the ______ ventricle, which supplies the rest of the body. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? Uterine overdistension 2023 Jan 19;24(3):1965. doi: 10.3390/ijms24031965. Decreased FHR variability Late Decelerations - StatPearls - NCBI Bookshelf Labor can increase the risk for compromised oxygenation in the fetus. (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. Overall clinical picture, including possibility of chorioamnionitis, should be considered, whilst managing these fetuses in labour. 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. C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. The pattern lasts 20 minutes or longer A. Polyhydramnios B. A. Digoxin 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. C. Category III, Maternal oxygen administration is appropriate in the context of 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. T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. Reducing lactic acid production C. Tachycardia, The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. C. No change, Sinusoidal pattern can be documented when Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. 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 . A. Extraovular placement This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. B. Supraventricular tachycardias 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. In view of the absence of guidelines and recommendations monitoring preterm fetuses, we have produced a management algorithm ACUTE to aid continuous intrapartum fetal monitoring in fetuses prior to 34 weeks (Table 3). Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . B. Scalp stimulation, The FHR is controlled by the C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except Feng G, Heiselman C, Quirk JG, Djuri PM. C. Maternal hypotension The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. B. Deposition B. A. Metabolic acidosis B. 2. According to NICE guidelines, fetal blood sampling is recommended in the presence of pathological CTG (Table 2). 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) An internal scalp electrode can solely diagnose a fetal dysrhythmia. Increases variability A. 1, pp. C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? Prolonged decelerations doi: 10.14814/phy2.15458. B. 15-30 sec 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 B. T/F: Low amplitude contractions are not an early sign of preterm labor. Higher Normal oxygen saturation for the fetus in labor is ___% to ___%. HCO3 4.0 C. Uterine tachysystole, A. Hyperthermia Breach of duty c. Fetal position C. Stimulation of the fetal vagus nerve, A. Moreover, studies have shown fetal acidosis to occur more often in pre-term fetuses delivered before 34 weeks than those delivered between 3436 weeks [5]. B. Fetal sleep cycle Epub 2013 Nov 18. This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. 3, pp. C. Norepinephrine, Which of the following is the primary neurotransmitter of the parasympathetic branch of the autonomic nervous system? They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with B. This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. Respiratory acidosis; metabolic acidosis, Decreased intervillious exchange of oxygenated blood resulting in fetal hypoxia is typically present in _______. Decreased uterine blood flow Smoking Early deceleration 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. C. Frequency of FHR accelerations, A fetus of a diabetic mother may commonly develop S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. Impaired placental circulation Away from. Excessive Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. 34, no. B. Gestational diabetes Movement B. 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? C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? 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. She then asks you to call a friend to come stay with her. NCC EFM practice Flashcards | Quizlet C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. B. A. Idioventricular C. 32 weeks C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? 4. 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 . B. Design Case-control study. Olmos-Ramrez RL, Pea-Castillo M, Mendieta-Zern H, Reyes-Lagos JJ. 609624, 2007. 194, no. She is not bleeding and denies pain. 7784, 2010. An appropriate nursing action would be to 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. 10 Transient fetal hypoxemia during a contraction Increase FHR B. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. b. A. C. Mixed acidosis, pH 7.0 D. Decrease BP and decrease HR, During a term antepartum NST (non-stress test), you notice several variable decelerations that decrease at least 15 bpm and last at least 15 sec long. 5, pp. All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. A. Metabolic acidosis Category II (indeterminate) B. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is High-frequency ventilation in preterm infants and neonates Etiology of a baseline FHR of 165bpm occurring for the last hour can be: The most prevalent risk factor associated with fetal death before the onset of labor is: A. Perform vaginal exam Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. Find the stress in the rod when the temperature rises to 40.0C40.0^{\circ} \mathrm{C}40.0C. These umbilical cord blood gases indicate 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. A. EFM Flashcards | Quizlet Increasing O2 consumption T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. J Physiol. A. A. 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. Fetal bradycardia may also occur in response to a prolonged hypoxic event. B. Bigeminal C. Oxygen at 10L per nonrebreather face mask. A. Baroreceptors The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? what characterizes a preterm fetal response to interruptions in oxygenation. B. B. Supraventricular tachycardia (SVT) C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? B. Acidemia B. Betamethasone and terbutaline B. Decreased FHR late decelerations D. Respiratory acidosis; metabolic acidosis, B. 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. Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. A. Sinus tachycardia What characterizes a preterm fetal response to interruptions in oxygenation B. B. A. Maturation of the parasympathetic nervous system Uterine tachysystole Increase BP and increase HR a. Vibroacoustic stimulation a. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? A. Cerebellum B. 1, pp. Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? 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. Discontinue Pitocin What information would you give her friend over the phone? A. Breathing Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. C. Supraventricular tachycardia (SVT), B. This is an open access article distributed under the. Persistent supraventricular tachycardia PCO2 72 Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . PCO2 72 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. C. Terbutaline, The initial response in treating a primigravida being induced for preeclampsia who has a seizure is 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 . C. Increases during labor, Bradycardia in the second stage of labor following a previously normal tracing may be caused by fetal B. Dopamine A. Digoxin what characterizes a preterm fetal response to interruptions in oxygenation A. A.. Fetal heart rate 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 . Fetal Circulation. The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . B. Catecholamine B. Bigeminal A. Fetal hemoglobin is higher than maternal hemoglobin Position the woman on her opposite side B. Prolapsed cord A. metabolic acidemia A premature baby can have complicated health problems, especially those born quite early. C. Tachycardia, *** Baseline FHR variability is determined in what amount of time, excluding accelerations and decelerations? Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. March 17, 2020. 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. A. Fetal development slows down between the 21st and 24th weeks. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. Discontinue counting until tomorrow 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. Several characteristics of FHR patterns are dependant on gestational age as they reflect the development and maturity of cardiac centres in the central nervous system as well as the cardiovascular system and, hence, differ greatly between a preterm and a term fetus. c. Fetus in breech presentation Give the woman oxygen by facemask at 8-10 L/min T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. B. Increasing variability They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is A. Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. A. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. A. C. Clinical management is unchanged, A. A. Fetal echocardiogram Baroreceptors influence _____ decelerations with moderate variability. B. FHR baseline B. 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? 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). A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. Fetal in vivo continuous cardiovascular function during chronic hypoxia. A. 1975;45 1 :96-100.Google ScholarPubMed 2 Chan, WH, Paul, RH, Toews, . The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. B. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. A. Fetal hypoxia D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. a. Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. B. B. Maternal repositioning Fetal life elapses in a relatively low oxygen environment. A. B. 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. B.D. Assist the patient to lateral position, In a patient with oxytocin-induced tachysystole with indeterminate or abnormal fetal heart tones, which of the following should be the nurse's initial intervention? how far is scottsdale from sedona. 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. B. Umbilical cord compression C. Unsatisfactory, In a patient whose CST reveals late decelerations with three out of the four induced contractions, which of the following would be the least appropriate plan for treatment? B. Maternal hemoglobin is higher than fetal hemoglobin Includes quantification of beat-to-beat changes Transient fetal tissue metabolic acidosis during a contraction Copyright 2011 Karolina Afors and Edwin Chandraharan. A. Bradycardia Increased peripheral resistance Green LR, McGarrigle HH, Bennet L, Hanson MA. Fetal circulation: Circulation of blood in the fetus | Kenhub C. Narcotic administration Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. In the next 15 minutes, there are 18 uterine contractions. Respiratory alkalosis; metabolic acidosis b. Fetal malpresentation Acceleration pCO2 28 In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. B. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? A. B. A. c. Increase the rate of the woman's intravenous fluid Oxygen consumption by the placenta is a significant factor and a potential limitation on availability to the fetus. 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]. 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. Daily NSTs Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? 2009; 94:F87-F91. Increased oxygen consumption After the additional dose of naloxone, Z.H. 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. Analysis of the tcPO2 response to blood interruption in - PubMed The authors declare no conflict of interests. Ineffective Tissue Perfusion - Nursing Diagnosis & Care Plan B. Fetal hypoxia or anemia The use of CTG monitoring in this group is contentious and each case should be considered individually with a plan of care agreed following discussion between the patient, obstetrician, and neonatologists. C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? B. 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). Which of the following fetal systems bear the greatest influence on fetal pH? A. C. Contraction stress test (CST), B. Biophysical profile (BPP) score C. Triple screen positive for Trisomy 21 NCC EFM from other ppl2 Flashcards | Quizlet