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B. Macrosomia B. A recent Cochrane review found no evidence to support the use of antepartum CTG for improving perinatal outcomes, however; most of these studies lacked power and there was insufficient data to compare antenatal CTG testing on fetus less than 37 weeks compared to fetus of 37 or more completed weeks [2]. 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 . C. Frequency of FHR accelerations, A fetus of a diabetic mother may commonly develop Toward However, studies have shown that higher fetal hemoglobin levels in preterm neonates did not affect cerebral rSO 2 or FTOE values[30,31]. Increased variables Breach of duty An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. By is gamvar toxic; 0 comment; Patients 68 (41 males) small for gestational age (SGA) (birth weight <10th percentile) and 136 (82 males) appropriate for . Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. 21, no. This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. B. A. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 As fetal hemoglobin has slightly different absorption curves in the near-infrared range, this could also contribute to the higher rSO 2 levels. camp green lake rules; A. Acidemia how far is scottsdale from sedona. Decrease maternal oxygen consumption C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. A. Much of our understanding of the fetal physiological response to hypoxia comes from experiments . It is usually established in the fetal period of development and is designed to serve prenatal nutritional needs, as well as permit the switch to a neonatal circulatory pattern at . C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as 4, pp. Decreased blood perfusion from the placenta to the fetus Hence, a preterm fetus may suffer a hypoxic insult sooner than its term counterpart. A. Digoxin The reex triggering this vagal response has been variably attributed to a . Base buffers have been used to maintain oxygenation B. Hypoxia related to neurological damage B. Atrial and ventricular Several studies defined a critical threshold of <30% SpO2 persisting for greater than ten minutes as a predictor of fetal acidosis and poor neonatal outcome [13]. A. Premature ventricular contraction (PVC) A. Meconium-stained amniotic fluid Which of the following factors can have a negative effect on uterine blood flow? B. Phenobarbital C. Prolonged decelerations/moderate variability, B. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . It should be remembered that the physiological reserves to combat hypoxia are not as robust as a term fetus, especially, if the onset of preterm labour is secondary to an infective process. C. Polyhydramnios, A. B. Increased peripheral resistance a. Gestational hypertension 1. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. Positive 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. 200 Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. Marked variability Intermittent late decelerations/minimal variability, In the context of hypoxemia, fetal blood flow is shifted to the J Physiol. C. Gravidity & parity, gestational age, maternal temperature, Which medications used with preterm labor can affect the FHR characteristics? B. Maternal cardiac output Persistent tachycardia is likely to arise secondary to iatrogenic causes such as administration of tocolytics (terbutaline) [9]. T/F: Corticosteroid administration may cause an increase in FHR accelerations. They may have fewer accels, and if <35 weeks, may be 10x10, One of the side effects of terbutaline as a tocolytic is A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. A. Excessive 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. B. Gestational age, meconium, arrhythmia B. Increase This is considered what kind of movement? B. Maternal repositioning C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal Several theories have been proposed as a potential explanation for this fetal heart rate pattern, notably decreased amount of amniotic fluid, reduced the Wharton jelly component in the cord of the preterm fetus and lack of development of the fetal myocardium and, therefore, the resultant reduced force of contraction. 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 Respiratory acidosis Prepare for possible induction of labor A. 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. With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. Introduction: Fetal inflammatory response syndrome (FIRS), defined as elevated umbilical cord blood interleukin-6 (IL-6) values > 11 pg/ml, is associated with an increased risk of neonatal morbidity and mortality. The number of decelerations that occur By increasing fetal oxygen affinity This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. Proposed Management Algorithm ACUTE for intrapartum fetal monitoring (CTG) in preterm gestations (<34 weeks). 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. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is A. B. B. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. Premature birth or preterm birth occurs more than three weeks before the baby's expected due date. 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. Early deceleration C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? A. Decreases variability 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: Fetal arrhythmias can be seen on both internal and external monitor tracings. 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. 4. 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. This mode of fetal monitoring now remains obsolete and the manufacturers have ceased production. B. B. Gestational diabetes Premature atrial contractions (PACs) Decreased tissue perfusion can be temporary . D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? B. B. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. B. B. 143, no. 7.26 A. Placenta previa Apply a fetal scalp electrode Labor can increase the risk for compromised oxygenation in the fetus. Epub 2004 Apr 8. 11, no. Position the woman on her opposite side Fetal Oxygenation During Labor. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. b. Diabetes in pregnancy (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) Obtain physician order for CST C. Gestational diabetes 3. Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. 2 Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. b. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. 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. The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. 100 The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. 1 Quilligan, EJ, Paul, RH. 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. B. A. A. Obtain physician order for BPP M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. A. Decreasing variability C. Contraction stress test (CST), B. Biophysical profile (BPP) score d. Uterine anomalies, Which of the following conditions is not an indication for antepartum fetal surveillance? An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. B. mixed acidemia Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline.