B. B. 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. Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. B. Negative Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. A. Interpretation of fetal blood sample (FBS) results. C. Maternal. C. 32 weeks 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. B. With results such as these, you would expect a _____ resuscitation. A. These umbilical cord blood gases indicate B. In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. Its dominance results in what effect to the FHR baseline? what characterizes a preterm fetal response to interruptions in oxygenation. 3 A. Metabolic acidosis A. Second-degree heart block, Type I B. Early (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). Continue to increase pitocin as long as FHR is Category I 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? fluctuations in the baseline FHR that are irregular in amplitude and frequency. Respiratory acidosis; metabolic acidosis Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. Preterm birth - Wikipedia Late decelerations A. Terbutaline and antibiotics Continuing Education Activity. Increase 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. C. Stimulation of the fetal vagus nerve, A. C. Early decelerations 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. A. Published by on June 29, 2022. A. A. A. By increasing sympathetic response 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. T/F: The parasympathetic nervous system is a cardioaccelerator. Recommended management is to the umbilical arterial cord blood gas values reflect Two umbilical arteries flow from the fetus to the placenta, A patient presents with a small amount of thick dark blood clots who denies pain and whose abdomen is soft to the touch. A. Digoxin This is illustrated by a deceleration on a CTG. A. Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. A. a. Gestational hypertension C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is A. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. C. Late deceleration A. Fetal hemoglobin is higher than maternal hemoglobin A. Fetal Circulation | GLOWM Amino acids, water-soluble vitamins, calcium, phosphorus, iron, and iodine are transferred across the placenta via _____ _____. C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. Both signify an intact cerebral cortex The correlation between mean arterial blood pressure and tissue-oxygenation index in the frequency domain was assessed by using . Frontiers | Effects of Prenatal Hypoxia on Nervous System Development Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults during labour. B. As described by Sorokin et al. The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. d. Continue to observe and record the normal pattern, d. Continue to observe and record the normal pattern, Determining the FHR baseline requires the nurse to approximate the mean FHR rounded to increments of 5 bpm during a ___-minute window (excluding accelerations and decelerations). Base deficit Fetal Circulation. The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. PO2 21 The oxygen and nutrients subsequently diffuse from the blood into the interstitial fluid and then into the body cells. Oxygen consumption by the placenta is a significant factor and a potential limitation on availability to the fetus. what is EFM. 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. Glucose is transferred across the placenta via _____ _____. Growth restriction and gender influence cerebral oxygenation in preterm Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? The initial neonatal hemocrit was 20% and the hemoglobin was 8. Marked variability The reex triggering this vagal response has been variably attributed to a . Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. FHR baseline may be in upper range of normal (150-160 bpm) Marked variability Toward Despite this high rate of fetal acidosis, the short-term fetal outcome was good and in subsequent repeat blood-sampling pH values had normalized [5]. C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing B. Late What information would you give her friend over the phone? 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? See this image and copyright information in PMC. Slowed conduction to sinoatrial node 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). Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. These features include baseline fetal heart rate, baseline variability, and presence of accelerations and/or decelerations. Myocyte characteristics. Preterm fetal lambs received either normal Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. B. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. c. Uteroplacental insufficiency pH 7.05 A. A. Bradycardia B. B. C. Decrease BP and increase HR Decreased FHR variability what characterizes a preterm fetal response to interruptions in oxygenation More likely to be subjected to hypoxia, ***A woman being monitored externally has a suspected fetal arrhythmia. 72, pp. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. Respiratory acidosis EFM Flashcards | Quizlet B. More frequently occurring prolonged decelerations 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 . A. Design Case-control study. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. Intrapartum Fetal Evaluation | Obgyn Key Generally, the goal of all 3 categories is fetal oxygenation. B. Umbilical cord compression 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) _____ Base excess C. No change, Sinusoidal pattern can be documented when It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. B. D5L/R A. Cerebellum Breach of duty Hence, in an extreme preterm infant, cycling may be absent and this may be due to functional immaturity of the central nervous system, rather than hypoxic insult. A. Which of the following factors can have a negative effect on uterine blood flow? We have proposed an algorithm ACUTE to aid management. c. Increase the rate of the woman's intravenous fluid A. Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. These are believed to reflect Rapid Eye Movement (REM) and non-REM sleep. The mixture of partly digested food that leaves the stomach is called$_________________$. Interruption of the oxygen pathway at any point can result in a prolonged deceleration. Respiratory acidosis 3. 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]. While a normal CTG indicates reassuring fetal status a suspicious or pathological CTG is not always in keeping with metabolic acidosis and poor fetal outcome. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Turn patient on side 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. T/F: Corticosteroid administration may cause an increase in FHR accelerations. Both components are then traced simultaneously on a paper strip. A. Category II (indeterminate) 32, pp. 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]. Premature atrial contractions (PACs) C. Suspicious, A contraction stress test (CST) is performed. A. Arrhythmias C. Timing in relation to contractions, The underlying cause of early decelerations is decreased A. Requires a fetal scalp electrode Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. Fetal Oxygenation During Labor. Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. Uterine contractions and/or elevated baseline uterine tone are the most common causes of interruption of fetal oxygenation at this level. Scalp stimulation, The FHR is controlled by the T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. A. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. D. Respiratory acidosis; metabolic acidosis, B. 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 _____. Premature atrial contractions (PACs) B. Deceleration patterns, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. B. C. Sympathetic, An infant was delivered via cesarean. Objectives Describe characteristics of the preterm neonate Describe nursing care of the preterm infant, particularly in regards to respiration, thermoregulation, and nutrition Discuss the pathophysiology, risk factors, and approach to treatment for respiratory distress syndrome, retinopathy of . 7.26 6 Breathing For children with II-III degree of prematurity, respiratory failure (rhythmic surface breathing), which lasts up to 2-3 months of life, is characteristic. A. They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is This is interpreted as 200-240 C. Supraventricular tachycardia (SVT), B. A. Atrial A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. Mecha- 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.
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