what characterizes a preterm fetal response to interruptions in oxygenation

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. Umbilical cord blood gases were: pH 6.88, PCO2 114, PO2 10, bicarbonate 15, base excess (-) 20. B. Intervillous space flow C. Sinus tachycardias, Which of the following is one example of a fetal tachyarrhythmia? Early deceleration C. Variable deceleration, A risk of amnioinfusion is A. Insert a spiral electrode and turn off the logic A. B. B. She is not bleeding and denies pain. 239249, 1981. 85, no. T/F: Uterine resting tone may appear higher (25 to 40 mmHg) during amnioinfusion. Most fetuses tolerate this process well, but some do not. A. B. C. Premature atrial contraction (PAC). O, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1 h episode of acute hypoxia (box) in 13 fetuses between 125 and 130 days of gestation, 6 fetuses between 135 and 140 days of gestation and 6 fetuses >140 days (term is, The data show meanSEM calculated every minute for the fetal heart rate, fetal arterial blood pressure, fetal femoral blood flow and fetal femoral vascular resistance during a 1h episode of acute hypoxia (box) in 14 fetuses at 1271 days of gestation (term is. A. Metabolic acidosis Kane AD, Hansell JA, Herrera EA, Allison BJ, Niu Y, Brain KL, Kaandorp JJ, Derks JB, Giussani DA. 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. In the next 15 minutes, there are 18 uterine contractions. Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. A thorough history of each case should be determined prior to CTG interpretation, and instances where variability is persistently reduced without explanation, should be viewed with caution.Accelerations at this gestation may not be present or may be significantly reduced with a lower amplitude (rise of 10 beats from the baseline rather than 15 beats). 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 . b. Diabetes in pregnancy D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: Premature atrial contractions (PACs) Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. A. A. Decreases during labor . The pattern lasts 20 minutes or longer Which interpretation of these umbilical cord and initial neonatal blood results is correct? Base deficit 14 Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. C. Timing in relation to contractions, The underlying cause of early decelerations is decreased Increased oxygen consumption D. Maternal fever, All of the following could likely cause minimal variability in FHR except Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Decreased uterine blood flow M. Westgren, P. Holmquist, N. W. Svenningsen, and I. Ingemarsson, Intrapartum fetal monitoring in preterm deliveries: prospective study, Obstetrics and Gynecology, vol. Within this guideline, the decision to monitor the preterm fetus remains vague with recommendations that each case requires discussion between obstetric and neonatal input, in addition to weighing up likelihood of severe morbidity of the preterm fetus (based on gestational age and fetal weight) and issues related to mode of delivery [1]. 192202, 2009. C. Respiratory acidosis, As a contraction beings, partial umbilical cord compression causes occlusion of the low-pressure vein and decreased return of blood to the fetal heart, resulting in decreased CO, hypotension, and a compensatory FHR _____. Predicts abnormal fetal acid-base status A. Acidemia Decreased b. Fetal malpresentation 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. 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]. F. Goupil, H. Legrand, and J. Vaquier, Antepartum fetal heart rate monitoring. B. Supraventricular tachycardia (SVT) A. Affinity baseline FHR. A. Bradycardia Predict how many people will be living with HIV/AIDS in the next two years. 10 min Transient fetal hypoxemia during a contraction, Assessment of FHR variability C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? What is fetal hypoxia? The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). C. 32 weeks Premature birth or preterm birth occurs more than three weeks before the baby's expected due date. 609624, 2007. Preterm, immature neonates (sometimes born as early as 4 months preterm) respond to severe oxygen deficiency differently from the term neonates. An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. _______ is defined as the energy-releasing process of metabolism. Oxygen, carbon dioxide, water, electrolytes, urea, uric acid, fatty acids, fat-soluble vitamins, narcotics barbiturates, anesthetics, and antibiotics are transferred across the placenta via _____ _____. B. It carries oxygen from the lungs and nutrients from the gastrointestinal tract. Increased peripheral resistance The nurse reviews the arterial gas results and concludes that the fetus had _____ acidosis. Turn the logic on if an external monitor is in place This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. She then asks you to call a friend to come stay with her. 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. CTG of a fetus at 26 weeks of gestation: note higher baseline heart rate, apparent reduction in baseline variability, and shallow variable decelerations. B. Liver Perform vaginal exam B. A. C. Notify the attending midwife or physician, C. Notify the attending midwife or physician, Which IV fluid is most appropriate for maternal administration for intrauterine resuscitation? 4. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. 1224, 2002. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. Hence, a preterm fetus may have a higher baseline fetal heart rate with apparent reduction of baseline variability due to unopposed action of sympathetic nervous system. The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. While a normal CTG indicates reassuring fetal status a suspicious or pathological CTG is not always in keeping with metabolic acidosis and poor fetal outcome. An increase in gestational age Base excess Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? Slowed conduction to sinoatrial node A. B. B. During this period, the white matter of the brain is developing rapidly, and the oligodendroglia responsible for myalinisation of the tracts within the brain is particularly vulnerable during this . B. Gestational diabetes B. Tracing is a maternal tracing B. A. Arrhythmias B. B. T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. Maximize placental blood flow The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . C. Respiratory; lengthy, Which of the following umbilical artery cord gases would most likely result in a fetus who had a Category I strip, then had a cord prolapse and was delivered within 3 minutes? B. C. Oxygen at 10L per nonrebreather face mask. This is interpreted as C. Category III, An EFM tracing with absent variability and intermittent late decelerations would be classified as 4, pp. This mode of fetal monitoring now remains obsolete and the manufacturers have ceased production. B. 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]. B. C. Possible cord compression, A woman has 10 fetal movements in one hour. 3. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . C. Rises, ***A woman receives terbutaline for an external version. C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? C. Suspicious, A contraction stress test (CST) is performed. The latter is determined by the interaction between nitric oxide and reactive oxygen species. It is not recommended in fetuses with bleeding disorders and is contraindicated in pregnancies complicated with HIV, Hepatitis B or C as it may increase vertical transmission. Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. A. 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. J Physiol. Immediately after birth with the initiation of breathing, the lung expands and oxygen availability to tissue rises by twofold, generating a physiologic oxidative stress. Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. 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, 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. A. Lactated Ringer's solution b. 7379, 1997. C. 10 C. Sympathetic, An infant was delivered via cesarean. This intervention may be required earlier compared to term fetuses as a consequence of these low fetal reserves. A. Decreases diastolic filling time This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. A. HCO3 24 Which of the following interventions would be most appropriate? B. Deposition A. C. Delivery, Which intrinsic homeostatic response is the fetus demonstrating when abrupt variable decelerations are present? Respiratory acidosis Low socioeconomic status B. C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. This is illustrated by a deceleration on a CTG. D. Oligohydramnios, All of the following are likely causes of prolonged decelerations except: B. Determine if pattern is related to narcotic analgesic administration

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