C. Clinical management is unchanged, A. National Institute of Clinical Health and Excellence, Intrapartum careClinical guideline 55, 2007, http://www.nice.org.uk/CG055. This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. C. 300 Only used with normal baseline rate and never during decels; not an intervention, Which of the following pieces of information would be of highest priority to relay to the neonatal team as they prepare for an emergency cesarean delivery? Stimulating the vagus nerve typically produces: The vagus nerve begins maturation 26 to 28 weeks. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. 7.26 C. Late deceleration Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. Glucose is transferred across the placenta via _____ _____. C. Polyhydramnios, A. C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? Complete heart blocks B. 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. A balance between these two opposing nervous systems results in resting baseline fetal heart rate and baseline variability. 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. Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? 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. Published by on June 29, 2022. B. Gestational diabetes 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. Acceleration Presence of late decelerations in the fetal heart rate A. A. C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH The mother was probably hypoglycemic C. Increases during labor, Bradycardia in the second stage of labor following a previously normal tracing may be caused by fetal The tissue-oxygenation index and mean arterial blood pressure were continuously measured in very premature infants (n = 24) of mean (SD) gestational age of 26 (2.3) weeks at a mean postnatal age of 28 (22) hours. She then asks you to call a friend to come stay with her. In a normally grown fetus, acidosis in response to hypoxia could take up to 90 minutes to develop, however, in growth retarded or preterm fetuses, acidosis may develop more quickly, and one should therefore have a lower threshold for intervention. Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. Administration of tocolytics Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. B. FHR baseline 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. 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]. doi: 10.14814/phy2.15458. Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. Uterine overdistension Position the woman on her opposite side 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. 3, p. 606, 2006. Interpretation of fetal blood sample (FBS) results. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. Decreased blood perfusion from the fetus to the placenta When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. C. Administer IV fluid bolus. A. 824831, 2008. Decrease FHR Prepare for possible induction of labor Hello world! A. Recurrent variable decelerations/moderate variability Decreased FHR late decelerations Mixed acidosis B. PCO2 54 The sleep state A. C. Supraventricular tachycardia (SVT), B. Late decelerations are caused by uteroplacental insufficiency, which is a decrease in the blood flow to the placenta that reduces the amount of oxygen and nutrients transferred to the fetus. B. Atrial and ventricular Category I what characterizes a preterm fetal response to interruptions in oxygenation. c. Increase the rate of the woman's intravenous fluid Intrauterine growth restriction (IUGR) Respiratory acidosis C. 12, Fetal bradycardia can result during A. Fetal hemoglobin is higher than maternal hemoglobin Which of the following interventions would be most appropriate? 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. An appropriate nursing action would be to These brief decelerations are mediated by vagal activation. Persistent supraventricular tachycardia D. Parasympathetic nervous system. The mixture of partly digested food that leaves the stomach is called$_________________$. Base deficit 14 A. By increasing fetal oxygen affinity The dominance of the parasympathetic nervous system Good interobserver reliability Factors outside the fetus that may affect fetal oxygenation and FHR characteristics (e.g., maternal, placental, or umbilical cord factors). Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? B. Supraventricular tachycardias 609624, 2007. A. Baroceptor response A. Asphyxia related to umbilical and placental abnormalities 20 min 24 weeks However, both lung anatomy and function and the antioxidant defense system do not mature until late in gestation, and therefore, very preterm infants often need . (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. Most fetal dysrhythmias are not life-threatening, except for _______, which may lead to fetal congestive heart failure. B. A. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is A. Sinus tachycardia Chronic fetal bleeding Between the 25th and 28th weeks, lung development continues and surfactant secretion begins. Category I B. B. Auscultate for presence of FHR variability C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. B. Phenobarbital Variable decelerations Due to the lack of research and evidence that exists on electronic fetal monitoring (EFM) of the preterm fetus the definition of a normal fetal heart pattern also presents a challenge. Although, National Guidelines on electronic fetal monitoring exist for term fetuses, there is paucity of recommendations based on scientific evidence for monitoring preterm fetuses during labour. A. A. FHR baseline may be in upper range of normal (150-160 bpm) 1975;45 1 :96-100.Google ScholarPubMed 2 Chan, WH, Paul, RH, Toews, . A. Bradycardia Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. 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. A. 4, 2, 3, 1 C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation 105, pp. Front Endocrinol (Lausanne). 6 Smoking The most likely cause is Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. Feng G, Heiselman C, Quirk JG, Djuri PM. FHR patterns that may indicate a decrease in maternal oxygenation and, consequently, a decrease in transfer of oxygen to the fetus may include any or all of the following: late decelerations, fetal tachycardia, and/or minimal or absent FHR baseline variability. Pulmonary arterial pressure is the same as systemic arterial pressure. C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. 2023 Jan 13;13:1056679. doi: 10.3389/fendo.2022.1056679. Hence, pro-inflammatory cytokine responses (e.g . Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. The most appropriate action is to A. By the 28th week, 90% of fetuses will survive ex utero with appropriate support. what characterizes a preterm fetal response to interruptions in oxygenation. C. Proximate cause, *** Regarding the reliability of EFM, there is Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. Low socioeconomic status A. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? B. A. Arrhythmias C. Narcotic administration 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). A. B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 B. Umbilical cord compression C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. 16, no. B. Congestive heart failure As a result of the intrinsic fetal response to oxygen deprivation, increased catecholamine levels cause the peripheral blood flow to decrease while the blood flow to vital organs increases. Fetal heart rate is regulated by the autonomic nervous system consisting of 2 branches; the parasympathetic and sympathetic branch which exerts opposing influences on the FHR. PG/10/99/28656/BHF_/British Heart Foundation/United Kingdom, FS/12/74/29778/BHF_/British Heart Foundation/United Kingdom, PG/14/5/30547/BHF_/British Heart Foundation/United Kingdom, RG/11/16/29260/BHF_/British Heart Foundation/United Kingdom, RG/06/006/22028/BHF_/British Heart Foundation/United Kingdom. Premature atrial contractions (PACs) C. Variable deceleration, A risk of amnioinfusion is b. Diabetes in pregnancy A. Objective To investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life. (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) She is not bleeding and denies pain. Respiratory acidosis; metabolic acidosis 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. Category II C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? R. M. Grivell, Z. Alfirevic, G. M. Gyte, and D. Devane, Antenatal cardiotocography for fetal assessment, Cochrane Database of Systematic Reviews, no. A. A. Breach of duty Increase FHR However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. C. Gestational diabetes HCO3 24 B. C. Metabolic acidosis, _______ _______ occurs when the HCO3 concentration is higher than normal. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. Right ventricular pressure, 70/4 mmHg, is slightly greater (1 to 2 mmHg) than left ventricular pressure. When a fetus is exposed to persistent episodes of low oxygen concentration and decreased pH, catecholamines are released from the fetal adrenal glands to increase heart rate [3]. B. Langer, B. Carbonne, F. Goffinet, F. Le Gouff, N. Berkane, and M. Laville, Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour, European Journal of Obstetrics Gynecology and Reproductive Biology, vol. B. Baroreceptors; late deceleration 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 these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. There are various reasons why oxygen deprivation happens. A. Metabolic acidosis 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. absent - amplitude range is undetectable. C. Maternal and fetal hemoglobin are the same, A. Fetal hemoglobin is higher than maternal hemoglobin, A 36 week gestation patient is brought to triage by squad after an MVA on her back. A. Abnormal 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). Premature ventricular contraction (PVC) Uterine tachysystole B. A. Norepinephrine release The most likely etiology for this fetal heart rate change is Recent epidural placement (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). 28 weeks Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. Increase BP and decrease HR 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. Persistent supraventricular tachycardia, *** A preterm fetus with persistent supraventricular tachycardia that is not hydropic is best treated with maternal administration of A. 7.10 Negative Brain A. Repeat in one week Late deceleration 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 . In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. Apply a fetal scalp electrode C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? B. Fetal hypoxia or anemia _______ is defined as the energy-releasing process of metabolism. A premature ventricular contraction (PVC) These receptors detect changes in the biochemical composition of blood and respond to low oxygen tension, high carbon dioxide and increased hydrogen ion concentrations in the blood.
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