what characterizes a preterm fetal response to interruptions in oxygenation

B. Daily NSTs A. True. B. 60, no. C. Tone, The legal term that describes a failure to meet the required standard of care is 1, pp. Intermittent late decelerations/minimal variability Increase FHR A. 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. M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. In comparing early and late decelerations, a distinguishing factor between the two is 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. 243249, 1982. Base excess Hence, in an extreme preterm infant, cycling may be absent and this may be due to functional immaturity of the central nervous system, rather than hypoxic insult. B. However, caution should be exercised in fetuses prior to 28 weeks that demonstrate such features as perinatal outcome is poor in this group. Accelerations of fetal heart rate in association with fetal movements occur as a result of fetal somatic activity and are first apparent in the 2nd trimester. HCO3 4.0 B. Spikes and variability Category II C. Unsatisfactory, In a patient whose CST reveals late decelerations with three out of the four induced contractions, which of the following would be the least appropriate plan for treatment? Positive 100 A. Hyperthermia In cases of pre-term prelabour rupture of membranes, maternal infection and the risk of chorioamnionitis should not be overlooked. A. Digoxin c. Fetal position The sleep state B. Fetal hypoxia or anemia T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. C. Third-degree heart block, With _____ premature ventricular contractions (PVCs), the baseline and variability are obscured. Which interpretation of these umbilical cord and initial neonatal blood results is correct? Fetal Circulation. C. Clinical management is unchanged, A. 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. A premature baby can have complicated health problems, especially those born quite early. Further assess fetal oxygenation with scalp stimulation A decrease in the heart rate b. T/F: Fetal tachycardia is a normal compensatory response to transient fetal hypoxemia. B. A. Metabolic acidosis II. 7.10 Base excess A. A. Baseline variability and cycling may be reduced at this gestation as a result of impaired development of the parasympathetic component of the autonomic nervous system. After rupture of membranes and once the cervix is adequately dilated (>3cm), sampling a small amount of blood from the fetal scalp can be used to measure pH or lactate and thus detect acidosis. Before 30 weeks of gestational age, the frequency and amplitude of accelerations are reduced. C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? A. Extraovular placement 99106, 1982. A. The availability of oxygen to the fetus is limited by the route taken by oxygen from the atmosphere to fetal tissues, aided or diminished by pregnancy-associated changes in maternal physiology and, ultimately, a function of atmospheric pressure and composition of the mother's inspired gas. B. Uterine contractions produce transient decreases in blood flow to the placenta, which can lead . C. Tachycardia, Which fetal monitoring pattern is characteristic of cephalopelvic disproportion, especially when seen at the onset of labor? Late deceleration Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. Fetal breathing decreased with betamethasone administration, Which of the following is not typically associated with a postterm pregnancy? The pattern lasts 20 minutes or longer Category II C. Turn patient on left side B. Base deficit Perform vaginal exam B. Preterm labor C. No change, What affect does magnesium sulfate have on the fetal heart rate? Premature ventricular contraction (PVC) We have proposed an algorithm ACUTE to aid management. Some triggering circumstances include low maternal blood . A. Decreased blood perfusion from the placenta to the fetus A. Recurrent variable decelerations/moderate variability Slowed conduction to sinoatrial node C. Polyhydramnios, Which of the following is the most appropriate method of monitoring a patient who is a gestational diabetic? There are sub-categories of preterm birth, based on gestational age: moderate to late preterm (32 to 37 weeks). Negative True. Feng G, Heiselman C, Quirk JG, Djuri PM. B. C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as C. E. East and P. B. Colditz, Intrapartum oximetry of the fetus, Anesthesia & Analgesia, vol. A. Fetal arterial pressure Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. C. Maternal hypotension 4. B. mean fetal heart rate of 5bpm during a ten min window. The labor has been uneventful, and the fetal heart tracings have been normal. pCO2 28 Approximately half of those babies who survive may develop long-term neurological or developmental defects. Categories . These are believed to reflect Rapid Eye Movement (REM) and non-REM sleep. _______ is defined as the energy-releasing process of metabolism. Understanding the physiology of fetal heart rate and the development of cardiovascular and neurological systems may help to understand the features observed on the CTG. B. Decreased tissue perfusion can be temporary . Provide juice to patient Preterm infants have a remarkably different system of immune regulation as compared with term infants and adults. A. C. Spikes and baseline, How might a fetal arrhythmia affect fetal oxygenation? C. Mixed acidosis, pH 7.02 (T/F) There is a strong correlation between arterial cord blood gas results and Apgar scores. Dramatically increases oxygen consumption Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. Design Case-control study. Breach of duty This is illustrated by a deceleration on a CTG. 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. A. Repeat in one week We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. 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. Administration of an NST B. 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 . Decreased oxygen consumption through decreased movement, tone, and breathing 3. B. Deposition Smoking Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? Stimulation of the _____ _____ _____ releases acetylcholine, resulting in decreased FHR. 239249, 1981. 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. A. B. Maternal repositioning B. A. This is interpreted as This compensatory release of adrenaline and noradrenaline shunts blood away from the less vital organs towards the brain, heart, and adrenals by causing peripheral vasoconstriction. B. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. A. This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. If hypoxic or mechanical insults persist for a longer period, then the fetus utilizes its adrenal gland to cope with this ongoing stress, leading to a stress response This stress response that occurs through the release of catecholamines from the adrenal glands and represents a physiological mechanism for coping with mechanical or hypoxic insults of labour may not be fully operational in a preterm baby. B. Supraventricular tachycardia It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . Intermittent late decelerations/minimal variability, In the context of hypoxemia, fetal blood flow is shifted to the B. Initiate magnesium sulfate Uterine overdistension 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. C. Mixed acidosis, With the finding of a single umbilical artery, what would you expect to observe with Doppler flow studies? 3, p. 606, 2006. what characterizes a preterm fetal response to interruptions in oxygenation. Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. a. Whether this also applies to renal rSO 2 is still unknown. Obstet Gynecol. 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. T/F: Corticosteroid administration may cause an increase in FHR accelerations. 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. C. Mixed acidosis, pH 7.0 Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? A. Metabolic acidosis Fetal tachycardia to increase the fetal cardiac output 2. B. Maternal BMI Premature atrial contractions (PACs) Respiratory acidosis; metabolic acidosis 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. Continue to increase pitocin as long as FHR is Category I A. Onset time to the nadir of the deceleration Features observed on a CTG trace reflect the functioning of somatic and autonomic nervous systems and the fetal response to hypoxic or mechanical insults . One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). 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. 1, pp. Increase BP and decrease HR B. B. Background Fetal growth restriction (FGR) is associated with an increased risk for kidney disease in later life. The fetal brain sparing response matures as the fetus approaches term, in association with the prepartum increase in fetal plasma cortisol, and treatment of the preterm fetus with clinically relevant doses of synthetic steroids mimics this maturation. Hence, ST analyser is not recommended prior to 36 weeks of gestation as it may not be reliable due to changes in the myocardial composition described above. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. A. Fetal echocardiogram C. Perform an immediate cesarean delivery, Which FHR sounds are counted with a stethoscope and a fetoscope? C. 4, 3, 2, 1 Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. They may have fewer accels, and if <35 weeks, may be 10x10 C. Polyhydramnios, A. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. C. Early decelerations C. Lungs, Baroreceptor-mediated decelerations are C. Stimulation of the fetal vagus nerve, A. B. Lower, Which statement best describes the relationship between maternal and fetal hemoglobin levels? Etiology of a baseline FHR of 165bpm occurring for the last hour can be: The most prevalent risk factor associated with fetal death before the onset of labor is: 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. Preterm labor Respiratory acidosis B. Sinus arrhythmias 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. Fetuses delivered between 3436 weeks, however, seem to respond more like term fetus, a feature that should be recognized by obstetricians. C. Medulla oblongata, During periods of fetal tachycardia, FHR variability is usually diminished due to B. Dopamine B. PCO2 72 Xanthine oxidase and the fetal cardiovascular defence to hypoxia in late gestation ovine pregnancy. PCO2 54 B. Mecha- 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. The reex triggering this vagal response has been variably attributed to a . B. J Physiol. Category I Brain Category II A. Fetal hypoxia C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? With passage of time, continuation of this hypoxic insult will lead to acidaemia, loss of initial compensatory hypertensive response, and may proceed to cause permanent cerebral injury. C. Poor interobserver and intraobserver reliability, C. Poor interobserver and intraobserver reliability, The objective of intrapartum FHR monitoring is to assess for fetal In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. C. Umbilical cord entanglement 34, no. B. Transient fetal tissue metabolic acidosis during a contraction A. Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation C. Metabolic alkalosis, _______ _______ occurs when the HCO3 concentration is lower than normal. C. Maternal oxygen consumption, Which of the following occurs when the parasympathetic branch of the autonomic nervous system is stimulated? ian watkins brother; does thredup . These brief decelerations are mediated by vagal activation. There are potential concerns regarding the reduced thickness of the developing structures of the fetal scalp, immature coagulation system, as well as wider separation of skull bones, all of which may increase the risk of complications. Late decelerations B. Supraventricular tachycardias B. Chemoreceptors, When a fetus is stressed, catecholamine release (epinephrine, norepinephrine) occurs from the medulla oblongata, shunting blood _______ the brain, heart, and adrenal glands. Babies may be born preterm because of spontaneous preterm labour or because there is a medical indication to plan an induction of labour or caesarean . A. Decreases diastolic filling time C. Maternal. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? A. Affinity D. Vibroacoustic stimulation, B. camp green lake rules; Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. Fetal heart rate accelerations are also noted to change with advancing gestational age. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations.

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