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These adjuvants to electronic fetal monitoring were introduced to reduce the false-positive rate associated with CTG monitoring [10]. Continuous electronic fetal monitoring of preterm fetuses poses a clinical dilemma to clinicians caring for these fetuses during labour. 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 . The mixture of partly digested food that leaves the stomach is called$_________________$. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. The sleep state Which of the following factors can have a negative effect on uterine blood flow? Increases variability These umbilical cord blood gases indicate Negative In addition, with ongoing development of the autonomic nervous system, variability should often be within the normal range. B. C. Chemoreceptors; early deceleration, The primary physiologic goal of interventions for late decelerations is to a. Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. B. FHR baseline B. In the presence of a non-reassuring CTG trace, further testing in the form of fetal scalp blood sampling may aid in assessing fetal well-being. The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. 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. (T/F) An internal scalp electrode can solely diagnose a fetal dysrhythmia. C. Sympathetic and parasympathetic nervous systems, All of the following are components of liability except 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). Fetal hypoxia, also known as intrauterine hypoxia, occurs when a fetus is starved of oxygen. C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? C. Prolonged decelerations/moderate variability, B. C. Sinusoidal-appearing, The FHR pattern that is likely to be seen with maternal hypothermia is Fetal Circulation. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . B. Higher Fetal monitoring: is it worth it? Decrease FHR A. Magnesium sulfate administration C. Polyhydramnios, A. The placenta accepts the blood without oxygen from the fetus through blood vessels that leave the fetus . Myocardium of a preterm fetus has less stored glycogen with increased water content and also the epicardial-endocardial interphase is much smaller than a term fetus. E. Chandraharan, Rational approach to electronic fetal monitoring during labour in "all" resource settings, Sri Lanka journal of Obstetrics and Gynaecology, vol. 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. 4, pp. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. A. Abruptio placenta A. Lungs and kidneys _____ cord blood sampling is predictive of uteroplacental function. Today she counted eight fetal movements in a two-hour period. C. Use a Doppler to listen to the ventricular rate, A. Insert a spiral electrode and turn off the logic, *** The fetus responds to a significant drop of PO2 by _______ is defined as the energy-consuming process of metabolism. 2009; 94:F87-F91. Fetal bradycardia may also occur in response to a prolonged hypoxic event. 3, pp. C. Maternal. Marked variability fluctuations in the baseline FHR that are irregular in amplitude and frequency. C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. One of the hallmarks of fetal wellbeing is considered to be cycling of the fetal heart rate [3]. The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. Further assess fetal oxygenation with scalp stimulation A. Metabolic acidosis B. March 17, 2020. B. Dopamine A. Hyperthermia B. Maternal cardiac output The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. C. Variable, An appropriate initial treatment for recurrent late decelerations with moderate variability during first stage labor is C. Well-being, Use of the terms "beat-to-beat" variability and "long-term" variability is not recommended by the NICHD because in clinical practice C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? A. Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. The preterm infant 1. Two variable decelerations were seen on the FHR tracing and there were four contractions in 10 minutes. C. Late deceleration Respiratory acidosis Notably, fetal baseline heart rate is higher, averaging at 155 between 2024 weeks (compared to a term fetus where average baseline fetal heart rate is 140). b. Diabetes in pregnancy 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. Fetal systemic arterial blood pressure is considerably lower than that in an adult, averaging 55 mmHg (systolic/diastolic, approximately 70/45 mmHg) at term. Mixed acidosis Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. Late deceleration Fetal in vivo continuous cardiovascular function during chronic hypoxia. A. Late-term gestation B. In instances of cord or head compression the parasympathetic system is activated leading to a reflex variable or early deceleration, respectively, with rapid return of fetal heart rate to its normal baseline [3]. Obstet Gynecol. 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. Hello world! B. A. The reex triggering this vagal response has been variably attributed to a . Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. C. Triple screen positive for Trisomy 21 T/F: All fetal monitors contain a logic system designed to reject artifact. _______ is defined as the energy-releasing process of metabolism. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. B. c. Fetus in breech presentation A. Hypoxemia 5, pp. However, fetal heart rate variability is an important clinical indicator of fetal acid base balance, especially oxygenation of the autonomic nerve centres within the brain, and absent variability is therefore predictive of cerebral asphyxia. T/F: Variable decelerations are the most frequently seen fetal heart rate deceleration pattern in labor. A. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. 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. In the fetoplacental circulation, most of the oxygenated blood flows from the placenta through the umbilical vein and is shunted away from the high-resistance pulmonary circuit of the lungs, via the foramen ovale and the ductus arteriosus . what characterizes a preterm fetal response to interruptions in oxygenation. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. Category II Premature birth or preterm birth occurs more than three weeks before the baby's expected due date. B.D. B. C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? B. Maternal repositioning 20 min A. Maternal hypotension An appropriate nursing action would be to C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? Categories . A. Decreasing variability T/F: Corticosteroid administration may cause an increase in FHR. S. M. Baird and D. J. Ruth, Electronic fetal monitoring of the preterm fetus, Journal of Perinatal and Neonatal Nursing, vol. 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]. Baseline variability may be affected due to incomplete development of autonomic nervous system and subsequent interplay between parasympathetic and sympathetic systems. B. Fetal hypoxia or anemia A. C. Possible cord compression, A woman has 10 fetal movements in one hour. b. They are visually determined as a unit what characterizes a preterm fetal response to interruptions in oxygenation trigonometric ratios sin, cos and tan calculator. Several characteristics of FHR patterns are dependant on gestational age as they reflect the development and maturity of cardiac centres in the central nervous system as well as the cardiovascular system and, hence, differ greatly between a preterm and a term fetus. A. Maturation of the parasympathetic nervous system A. 7784, 2010. Fetal development slows down between the 21st and 24th weeks. Decreased blood perfusion from the placenta to the fetus B. Atrial fibrillation Continuous fetal heart rate monitoring in this group is recommended, following agreement with the patient. II. About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact Inotropic - promotes regular and effective cardiac contraction, Fetal hydrops may present on ultrasound as fetal scalp edema and increased abdominal fluid as a results of Base excess C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. 1, pp. The latter is determined by the interaction between nitric oxide and reactive oxygen species. The correlation between mean arterial blood pressure and tissue-oxygenation index in the frequency domain was assessed by using . 192202, 2009. Design Case-control study. Olmos-Ramrez RL, Pea-Castillo M, Mendieta-Zern H, Reyes-Lagos JJ. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? C. Timing in relation to contractions, The underlying cause of early decelerations is decreased 3, 1, 2, 4 C. Narcotic administration C. Metabolic acidosis. Positive A. Baseline may be 100-110bpm C. Perform a vaginal exam to assess fetal descent, B. The labor has been uneventful, and the fetal heart tracings have been normal. Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. Figure 2 shows CTG of a preterm fetus at 26 weeks. A. A. (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores.