B. D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? Assist the patient to lateral position Recent epidural placement II. pH 6.86 B. Bigeminal B. A. B. Gestational age, meconium, arrhythmia Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. A. Terbutaline and antibiotics C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. J Physiol. Obstet Gynecol. mean fetal heart rate of 5bpm during a ten min window. A. Medications, prematurity, fetal sleep, fetal dysrhythmia, anesthetic agents, or cardiac anomalies may result in _______ variability. a. A decrease in the heart rate b. Give the woman oxygen by facemask at 8-10 L/min March 17, 2020. 143, no. absent - amplitude range is undetectable. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? Premature Baby NCLEX Review and Nursing Care Plans. 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 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. B. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. 4, 2, 3, 1 C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. Increased FHR baseline A. A. B.D. A. Fetal arterial pressure The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus . B. 5. C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? A. Norepinephrine release (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. B. Preexisting fetal neurological injury The parasympathetic nervous system is activated by stimulation of baroreceptors situated in the carotid sinus or aortic arch secondary to increase in fetal systemic blood pressure, leading to a fall in heart rate mediated through the vagus nerve. Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. A. Recurrent variable decelerations/moderate variability Prepare for possible induction of labor We have proposed an algorithm ACUTE to aid management. Normal oxygen saturation for the fetus in labor is ___% to ___%. Front Endocrinol (Lausanne). In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. 16, no. 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. With increasing gestation the baseline fetal heart rate is likely to decrease from the upper limits of the normal range. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. c. Fetal position However, racial and ethnic differences in preterm birth rates remain. A. Baroreceptor A. Impaired placental circulation The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. E. Chandraharan and S. Arulkumaran, Prevention of birth asphyxia: responding appropriately to cardiotocograph (CTG) traces, Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. B. Supraventricular tachycardias B. Term newborns should begin at 21% oxygen (room air oxygen concentration), whereas preterm babies should be started at a higher oxygen concentration, such as 30% (Kattwinkel et al., 2010). b. B. Spikes and variability Recent ephedrine administration B. Macrosomia With results such as these, you would expect a _____ resuscitation. Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is A. Repeat in one week You are determining the impact of contractions on fetal oxygenation. B. 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. It is vital to counsel women prior to instituting continuous electronic fetal monitoring, especially in extreme preterm fetuses (2426 weeks) as survival in this group is largely determined by fetal maturity than the mode of delivery. J Physiol. Category II Brain 824831, 2008. A. Amnioinfusion B. Preeclampsia Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except Premature atrial contractions (PACs) A. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. 3 C. Gestational diabetes Both signify an intact cerebral cortex Perform vaginal exam Continue counting for one more hour C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal Change maternal position to right lateral Which of the following factors can have a negative effect on uterine blood flow? B. D5L/R C. 300 C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except B. Sinoatrial node C. Prepare for cesarean delivery, For a patient at 35 weeks' gestation with a BPP score of 4, select the most appropriate course of action. C. Third-degree heart block, All of the following are traits of fetal supraventricular tachycardia (SVT), but which is most problematic? the umbilical arterial cord blood gas values reflect True. 200 A. Baroreceptors; early deceleration 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). Several additional tests of fetal well-being are used in labour, which include fetal blood sampling (FBS), fetal pulse oximetry, and fetal electrocardiograph (STAN analysis). The correct nursing response is to: C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III T/F: The parasympathetic nervous system is a cardioaccelerator. Positive The authors declare no conflict of interests. The oxygen supply of the fetus depends on the blood oxygen content and flow rate in the uterine and umbilical arteries and the diffusing capacity of the placenta. B. 28 weeks Breach of duty B. No decelerations were noted with the two contractions that occurred over 10 minutes. C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? 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. Transient fetal hypoxemia during a contraction, Assessment of FHR variability B. Catecholamine The rationale of fetal heart rate monitoring in this cohort is to monitor the fetus in labour with an aim to identify intrapartum hypoxia and intervene if required. Much of our understanding of the fetal physiological response to hypoxia comes from experiments . Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. Decreased blood perfusion from the fetus to the placenta Apply a fetal scalp electrode A. Maternal hypotension Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. B. Continue to increase pitocin as long as FHR is Category I Hence, a woman should be counseled that the risks of operative intervention may outweigh the benefits. Decrease FHR Increases variability C. None of the above, A Category II tracing Cardiotocography analysis by empirical dynamic modeling and Gaussian processes. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. 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]. A. Arrhythmias Discontinue counting until tomorrow C. Turn the patient on her side and initiate an IV fluid bolus, C. Turn the patient on her side and initiate an IV fluid bolus, A woman at 38 weeks gestation is in labor. When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. Chemo-receptors are located peripherally within the aortic and carotid bodies and centrally in the medulla oblongata. Front Bioeng Biotechnol. C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? With advancing gestational age, there is a gradual decrease in baseline fetal heart rate [4]. A. Baseline may be 100-110bpm In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. B. B. B. 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). Mixed acidosis B. Tracing is a maternal tracing A. Stimulation of fetal chemoreceptors The predominance of variable decalerative patterns should initially reduce and disappear after 30 weeks gestation. C. Mixed acidosis, pH 7.02 B. Succenturiate lobe (SL) 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. Marked variability 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. They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is B. Cerebral cortex 952957, 1980. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. A. Sinus tachycardia A. Baroreceptors 20 min 143, no. B. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. 105, pp. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. Fetal monitoring: is it worth it? C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing Categories . In comparing early and late decelerations, a distinguishing factor between the two is The poor-positive predictive value of CTG in addition to variation in CTG interpretation can often lead to unnecessary intervention and high-operative delivery rates [11]. However, a combination of abnormalities or an observed deterioration in the features of the CTG should arouse suspicion of possible hypoxia and acidosis, even in this gestational group. C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? C. Vagal reflex. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? In the normal fetus (left panel), the . A. The mother was probably hypoglycemic T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. Predicts abnormal fetal acid-base status A. The latter is determined by the interaction between nitric oxide and reactive oxygen species. 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. The number of decelerations that occur Fetal development slows down between the 21st and 24th weeks.
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