Lungs and kidneys With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. A. Administration of an NST B. C. Respiratory; lengthy, Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? Turn the logic on if an external monitor is in place A. C. Premature atrial contraction (PAC). Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. A. The initial neonatal hemocrit was 20% and the hemoglobin was 8. Increased oxygen consumption B. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? B. 2. B. Preexisting fetal neurological injury A. Cerebellum A. d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? A. Metabolic acidosis National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. A. 106, pp. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except A. 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. A. Acetylcholine A. D. Parasympathetic nervous system. C. Damages/loss, Elements of a malpractice claim include all of the following except C. 7.32 Base excess -12 C. There is moderate or minimal variability, B. Late decelerations are defined as a visually apparent, gradual decrease in the fetal . C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is 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. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. J Physiol. 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. a. Persistent supraventricular tachycardia Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Fetal heart rate accelerations are also noted to change with advancing gestational age. Cycles are 4-6 beats per minute in frequency A. A. B. baseline FHR. A. The availability of oxygen to the fetus is limited by the route taken by oxygen from the atmosphere to fetal tissues, aided or diminished by pregnancy-associated changes in maternal physiology and, ultimately, a function of atmospheric pressure and composition of the mother's inspired gas. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. 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. c. Uteroplacental insufficiency 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. Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation C. Triple screen positive for Trisomy 21 C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. With increasing gestation the baseline fetal heart rate is likely to decrease from the upper limits of the normal range. Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. 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. See this image and copyright information in PMC. A. C. Narcotic administration E. Maternal smoking or drug use, The normal FHR baseline Positive Base buffers have been used to maintain oxygenation A. Arrhythmias Fetal bradycardia may also occur in response to a prolonged hypoxic event. D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? (T/F) An internal scalp electrode will detect the actual fetal ECG. 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. In the presence of other reassuring features of the CTG (as outlined above), these decelerations should not be considered as indicative of hypoxia, and interventions should be avoided based on this parameter alone. C. Possible cord compression, A woman has 10 fetal movements in one hour. 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. There are sub-categories of preterm birth, based on gestational age: moderate to late preterm (32 to 37 weeks). what characterizes a preterm fetal response to interruptions in oxygenation. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH B. Base deficit 16 B. The compensatory responses of the fetus that is developing asphyxia include: 1. Inability of a preterm or growth restricted fetus to mount a required stress response may lead to maladaptive responses resulting in permanent hypoxic insult on the fetal brain occurring at a lower threshold than in the term fetus. Position the woman on her opposite side Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. Fetal development slows down between the 21st and 24th weeks. Discontinue Pitocin Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. 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. D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. B. B. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as B. Phenobarbital A. A. Maternal hypotension Extreme preterm is less than 28 weeks, very early preterm birth is between 28 and 32 weeks, early preterm birth occurs between 32 and 36 weeks, late preterm birth is between 34 and 36 weeks' gestation. 3. Increased variables Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . 105, pp. A. T/F: Variability and periodic changes can be detected with both internal and external monitoring. C. Homeostatic dilation of the umbilical artery, A. C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? Early deceleration Early deceleration Categories . B. Lowers 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. Recent ephedrine administration 1, pp. D. Respiratory acidosis; metabolic acidosis, B. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as B. Includes quantification of beat-to-beat changes 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. B. A. Idioventricular Provide juice to patient Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. 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. Fetal monitoring: is it worth it? C. Notify her provider for further evaluation, C. Notify her provider for further evaluation, A BPP score of 6 is considered A. Digoxin C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. 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. Normal oxygen saturation for the fetus in labor is ___% to ___%. C. Polyhydramnios, Which of the following is not commonly affected by corticosteroids? The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. A. A. C. Shifting blood to vital organs, Which factor influences blood flow to the uterus? B. Hypoxia related to neurological damage Increase BP and decrease HR C. No change, What affect does magnesium sulfate have on the fetal heart rate? 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. Prolapsed cord In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. Premature atrial contractions (PACs) Assist the patient to lateral position B. C. Stimulation of the fetal vagus nerve, A. Recommended management is to 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. 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. C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called