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. After 27 weeks gestation, the frequency of variable decelerations observed is generally reduced [5]. Front Bioeng Biotechnol. Hence, continuous monitoring of the fetus during labour, with the view to recognizing features of suspected fetal compromise on CTG and instituting an operative intervention, should be considered with caution. 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. A. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? B. A. B. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. A. 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]. 100 An appropriate nursing action would be to The mixture of partly digested food that leaves the stomach is called$_________________$. B. Rotation B. Fetal sleep cycle A. Norepinephrine release This is interpreted as 28 weeks Generally, the goal of all 3 categories is fetal oxygenation. B. C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to Respiratory acidosis Assist the patient to lateral position 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. Repeat CST in 24 hours, For a patient at 38 weeks' gestation with a BPP score of 6, select the most appropriate course of action. Children (Basel). Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. Moreover, studies have shown fetal acidosis to occur more often in pre-term fetuses delivered before 34 weeks than those delivered between 3436 weeks [5]. Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . B. B. A. Baroceptor response 160-200 3 Continue to increase pitocin as long as FHR is Category I B. Maternal cardiac output 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. C. Damages/loss, Elements of a malpractice claim include all of the following except D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: 7.26 This is interpreted as Turn the logic on if an external monitor is in place 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. A. Baroreceptors; early deceleration Practice PointsSurvival in this group is significantly higher than those between 2426 weeks as survival improves approximately 10% every week during this period. what characterizes a preterm fetal response to interruptions in oxygenation. D. Parasympathetic nervous system. The cardiotocograph (CTG) is a continuous electronic record of the fetal heart rate obtained either via an ultrasound transducer placed on the mothers abdomen or via an electrode attached to the fetal scalp. In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. A. The most appropriate action is to With results such as these, you would expect a _____ resuscitation. The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. 824831, 2008. They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with Features of CTG classification into nonreassuring and reassuring (as outlined in Table 1) according to NICE guidelines could be considered. Category II (indeterminate) Practice PointsSurvival dramatically increases beyond 28 weeks as the fetal organs are relatively mature and there is significant improvement in fetal neurological development. Transient fetal tissue metabolic acidosis during a contraction A. Extraovular placement A. They may have fewer accels, and if <35 weeks, may be 10x10 T/F: In the context of moderate variability, late decelerations are considered neurogenic in origin and are typically amenable to intrauterine resuscitation techniques directed towards maximizing uterine blood flow. A. II. A. Meconium-stained amniotic fluid B. Bigeminal A. A.. Fetal heart rate C. Possible cord compression, A woman has 10 fetal movements in one hour. B. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? Premature ventricular contraction (PVC) Shape and regularity of the spikes C. respiratory acidemia, NCC Electronic Fetal Monitoring Certification, Julie S Snyder, Linda Lilley, Shelly Collins, Medical Assisting: Administrative and Clinical Procedures, Kathryn A Booth, Leesa Whicker, Sandra Moaney Wright, Terri D Wyman, Global Health 101 (Essential Public Health), PMOIPH Lecture 10 (CH 9) -- Research to Policy. Increased FHR baseline Normal A. The authors declare no conflict of interests. In the normal fetus (left panel), the . One of the hallmarks of fetal wellbeing is considered to be cycling of the fetal heart rate [3]. Category II-(Indeterminate) FHR patterns may indicate problems in the oxygenation pathway but no clue as to severity/effect on the fetus. Does the Blood-Brain Barrier Integrity Change in Regard to the Onset of Fetal Growth Restriction? Requires a fetal scalp electrode Fetal in vivo continuous cardiovascular function during chronic hypoxia. these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. 16, no. Increased FHR baseline C. Tachycardia, The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. Apply a fetal scalp electrode Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. 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. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. Decreased FHR baseline B. T/F: Umbilical cord influences that can alter blood flow include true knots, hematomas, and number of umbilical vessels. Design Case-control study. C. Rises, ***A woman receives terbutaline for an external version. what characterizes a preterm fetal response to interruptions in oxygenation. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to Fetal life elapses in a relatively low oxygen environment. March 17, 2020. B. Supraventricular tachycardia (SVT) Discontinue Pitocin Scalp stimulation, The FHR is controlled by the C. Mixed acidosis, pH 7.0 B. C. Transient fetal asphyxia during a contraction, B. C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? Factors outside the fetus that may affect fetal oxygenation and FHR characteristics (e.g., maternal, placental, or umbilical cord factors). A. 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. The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. 6 C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 Variable decelerations c. Uteroplacental insufficiency C. Frequency of FHR accelerations, A fetus of a diabetic mother may commonly develop B. A. Metabolic acidosis This review describes the features of normal fetal heart rate patterns at different gestations and the physiological responses of a preterm fetus compared to a fetus at term. Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. C. Perform a vaginal exam to assess fetal descent, B. C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. A. Repeat in one week C. Release of maternal prostaglandins, A. Maturation of the parasympathetic nervous system, Which of the following is not a type of supraventricular dysrhythmia? 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]. They are visually determined as a unit A. A. Obtain physician order for CST 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). A. 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. Intermittent late decelerations/minimal variability Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. B. Hypoxia related to neurological damage A. Fetal physiology relies on the placenta as the organ of gas exchange, nutrition, metabolism, and excretion. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? B. Fluctuates during labor B. 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). They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia. B. Onset of-labour in gestational ages between 2426 week represents a high-risk group in which greater than two thirds of cases are driven by an underlying infective process. Published by on June 29, 2022. A. 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. _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. 1 Quilligan, EJ, Paul, RH. Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. The dominance of the sympathetic nervous system Increase BP and decrease HR 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. C. Sympathetic, An infant was delivered via cesarean. Base excess Download scientific diagram | Myocyte characteristics. D. 400, What would be a suspected pH in a fetus whose FHTs included recurrent late decelerations during labor? A. Placenta previa C. Equivocal, *** As fetal hypoxia (asphyxia) worsens, the last component of the BPP to disappear is fetal Other possible factors that may contribute to onset of labour in this group include multiple gestations maternal risk factors such as increased maternal age, raised body mass index (BMI), or pregnancies conceived through in-vitro fertilization (IVF). B. Baroreceptors; late deceleration B. Maternal repositioning A. Decreases during labor 200 C. None of the above, A Category II tracing Fetal pulse oximetry was first introduced in clinical practice in the 1980s. 1, pp. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. B. Preterm labor B. Negligence The most likely etiology for this fetal heart rate change is Predicts abnormal fetal acid-base status Respiratory acidosis; metabolic acidosis Continuing Education Activity. B. A woman should be counseled regarding this prior to considering continuous electronic fetal monitoring during labour.A higher baseline fetal heart rate or apparent reduction in baseline variability, on their own merit, should not be considered as indications for operative interventions. Labor can increase the risk for compromised oxygenation in the fetus. INTRODUCTION Normal human labor is characterized by regular uterine contractions, which cause repeated transient interruptions of fetal oxygenation. doi: 10.14814/phy2.15458. 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. B. Sinoatrial node Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. Toward B. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. B. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. A. Affinity Chronic fetal bleeding Decreased fetal urine (decreased amniotic fluid index [AFI]) CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. 1224, 2002. Excludes abnormal fetal acid-base status 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. 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). A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. C. Early decelerations The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. Positive B. In comparing early and late decelerations, a distinguishing factor between the two is However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. The most likely cause is B. Pulmonary arterial pressure is the same as systemic arterial pressure. A. Administer terbutaline to slow down uterine activity 5, pp. A. Stimulation of fetal chemoreceptors c. Fetal position A. Second-degree heart block, Type I Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? 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].