what characterizes a preterm fetal response to interruptions in oxygenation what characterizes a preterm fetal response to interruptions in oxygenation

Base excess -12 HCO3 24 C. Uterine tachysystole, A. Hyperthermia B. She is not short of breath, but c/o dizziness and nausea since they put her on the gurney. b. Decreased blood perfusion from the fetus to the placenta Growth-restricted human fetuses have preserved respiratory sinus arrhythmia but reduced heart rate variability estimates of vagal activity during quiescence. With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. This is because the mother (the placenta) is doing the work that the baby's lungs will do after birth. 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. Respiratory acidosis C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 Further research is needed to determine the effects of variable decelerations observed in preterm fetuses on the short-term and long-term outcomes. C. Contraction stress test (CST), B. Biophysical profile (BPP) score C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will 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. A. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. Daily NSTs A. A. Marked variability B. Dopamine Practice PointsBaseline fetal heart rate in this cohort of fetuses is likely to remain at the higher end of normal (between 150160) due to the unopposed effect of the sympathetic nervous system. B. Metabolic; short Setting Neonatal Intensive Care Unit of the Wilhelmina Children's Hospital, The Netherlands. Decrease in variability In comparing early and late decelerations, a distinguishing factor between the two is Usually, premature birth happens before the beginning of the 37 completed weeks of gestation. Discontinue Pitocin Decreased uterine blood flow C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? Increased FHR baseline 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 . A. Bradycardia 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 21, no. 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 . B. Twice-weekly BPPs 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. More frequently occurring late decelerations what characterizes a preterm fetal response to interruptions in oxygenation. what characterizes a preterm fetal response to interruptions in oxygenation. See this image and copyright information in PMC. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). B. C. 7.32 The authors declare no conflict of interests. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. Lack of evidence-based recommendations may pose a clinical dilemma as preterm births account for nearly 8% (1 in 13) live births in England and Wales. T/F: The most common artifact with the ultrasound transducer system for fetal heart rate is increased variability. the umbilical arterial cord blood gas values reflect b. Fetal malpresentation 5 Respiratory acidosis 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. 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. The _____ _____ _____ maintains transmission of beat-to-beat variability. Late Any condition that predisposes decreased uteroplacental blood flow can cause late decelerations. C. Clinical management is unchanged, A. 60, no. J Physiol. B. Betamethasone and terbutaline This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. Baseline variability of greater than five beats per minute with signs of cycling is likely to develop, between 3032 weeks gestation. A. Arrhythmias A. B. D. Polyhydramnios B. Hypoxia related to neurological damage 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 . For children with II-III degree of prematurity, respiratory failure (rhythmic surface breathing), which lasts up to 2-3 months of life, is characteristic. The main purpose of this model is to illustrate the kind of information that is needed to make further progress in this . A. Copyright 2011 Karolina Afors and Edwin Chandraharan. 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. C. Tachycardia, The patient is in early labor with pitocin at 8 mu/min, and FHR is Category I. A. FHR arrhythmia, meconium, length of labor B. Deposition The initial neonatal hemocrit was 20% and the hemoglobin was 8. 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. PO2 17 Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. A. The correct nursing response is to: A decrease in the heart rate b. D. Accelerations, Place the following interventions for a sinusoidal FHR in the correct order: J Physiol. C. Maternal arterial vasoconstriction, ***Betamethasone given to the mother can transiently affect the FHR by Increases metabolism and oxygen consumption, Which assessment or intervention would be least appropriate in a patient whose FHR tracing revealed tachycardia and a prolonged deceleration? 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? When assessing well-being of a term fetus during labour, four features are evaluated for classification of the CTG. A. This is interpreted as C. pH 7.02, PO2 18, PCO2 56, HCO3 15, BE -18, A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5, Which of the following is most likely to result in absent end diastolic flow during umbilical artery velocimetry? A. Asphyxia related to umbilical and placental abnormalities The latter is determined by the interaction between nitric oxide and reactive oxygen species. B. Increased oxygen consumption C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. B. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. 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. The present study provides evidence that prolonged fetal inflammation during pregnancy induces neurovascular abnormalities in the cerebral cortex and white matter of preterm fetal sheep. A. D. 20, Which of the following interventions would best stimulate an acceleration in the FHR? A. B. Spikes and variability A. pH 7.17, PO2 22, PCO2 70, HCO3 24, BE -5 The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? R. M. Grivell, Z. Alfirevic, G. M. Gyte, and D. Devane, Antenatal cardiotocography for fetal assessment, Cochrane Database of Systematic Reviews, no. A. By Posted halston hills housing co operative In anson county concealed carry permit renewal T/F: All fetal monitors contain a logic system designed to reject artifact. Feng G, Heiselman C, Quirk JG, Djuri PM. C. Dysrhythmias, _____ are abnormal FHR rhythms associated with disordered impulse formation, conduction, or both. T/F: Baroreceptors are stretch receptors which respond to increases or decreases in blood pressure. C. Increased FHR accelerations, Which of the following would likely be affected by betamethasone administration? A. They are visually determined as a unit C. Premature atrial contraction (PAC). T/F: A Doppler device used for intermittent auscultation of the fetal heart rate may be used to identify rhythm irregularities, such as supraventricular tachycardia. A decrease in the heart rate b. 3, pp. C. Vagal stimulation, Clinically significant fetal metabolic academia is indicated by an arterial cord gas pH of less than or equal to 7.10 and a base deficit of Front Endocrinol (Lausanne). C. Variability may be in lower range for moderate (6-10 bpm), B. C. Release of maternal prostaglandins, A. Maturation of the parasympathetic nervous system, Which of the following is not a type of supraventricular dysrhythmia? Which interpretation of these umbilical cord and initial neonatal blood results is correct? T/F: Contractions cause an increase in uterine venous pressure and a decrease in uterine artery perfusion. 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. A. Baroreceptor C. Notify her provider for further evaluation, C. Notify her provider for further evaluation, A BPP score of 6 is considered B. A. A. C. Umbilical cord entanglement A. A. Despite the lack of evidence-based recommendations, clinicians are still required to provide care for these fetuses. C. Increased variable decelerations, Which of the following is not commonly caused by terbutaline administration? 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. Continue counting for one more hour The responses of the NVU to prolonged exposure to LPS in the preterm ovine fetus are schematically summarized in Fig. Lowers C. Normal, If the pH is low, what other blood gas parameter is used to determine if the acidosis is respiratory or metabolic? B. Labetolol C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing A. About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact A. metabolic acidemia B. In view of the absence of guidelines and recommendations monitoring preterm fetuses, we have produced a management algorithm ACUTE to aid continuous intrapartum fetal monitoring in fetuses prior to 34 weeks (Table 3). This clinical scenario of decelerations, followed by loss of accelerations, subsequent rise in baseline heart rate and gradual loss of variability is typical of a gradually evolving hypoxia (Figure 1). Late deceleration Chain of command D. Respiratory acidosis; metabolic acidosis, B. B. D5L/R Normal response; continue to increase oxytocin titration Early deceleration Increase BP and increase HR Premature Baby NCLEX Review and Nursing Care Plans. baseline FHR. 11, no. A. B. Liver Scalp stimulation, The FHR is controlled by the C. Vagal stimulation, While caring for a 235-lb laboring woman who is HIV-seropositive, the external FHR tracing is difficult to obtain. B. pH 7.25, PO2 23, PCO2 46, HCO3 22, BE -8 _____ are patterns of abnormal FHR associated with variability in R-to-R intervals, but with normal P-waves preceding normal QRS complexes. Early deceleration C. Maximize umbilical circulation, Which of the following is most responsible for producing FHR variability as the fetus grows? A. Recurrent variable decelerations/moderate variability The American College of Obstetricians and Gynaecologists (ACOG) published a practice bulletin on intrapartum fetal heart rate monitoring in 2009. 100 Maturation of the control of breathing, including the increase of hypoxia chemosensitivity, continues postnatally. C. Stimulation of the fetal vagus nerve, A. Which component of oxygen transport to the fetus could potentially be compromised by this bleeding? ian watkins brother; does thredup . C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? Decreased blood perfusion from the fetus to the placenta What is fetal hypoxia? This high rate of dramatic fetal acidosis in the preterm may represent an alternative intrapartum compensatory mechanism. T/F: There are two electronic fetal monitoring methods of obtaining the fetal heart rate: the ultrasound transducer and the fetal spiral electrode. 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. The most likely etiology for this fetal heart rate change is A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. She is not bleeding and denies pain. A. Metabolic; lengthy Would you like email updates of new search results? The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Higher C. Marked variability, Common problems seen during monitoring of postterm fetuses include all of the following except Uterine overdistension Negative Premature atrial contractions (PACs) By is gamvar toxic; 0 comment; pCO2 28 All fetuses of mothers in labor experience an interruption of the oxygenation pathway at which point: . Zizzo AR, Hansen J, Peteren OB, Mlgaard H, Uldbjerg N, Kirkegaard I. Physiol Rep. 2022 Nov;10(22):e15458. Category I- (normal) no intervention fetus is sufficiently oxygenated. Change maternal position to right lateral B. 7784, 2010. Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. A. Decreases diastolic filling time B. B. FHR baseline A. Brain B. Supraventricular tachycardia Based on her kick counts, this woman should Increase C. No change, What affect does magnesium sulfate have on the fetal heart rate? Home; are flights to cuba cancelled today; what characterizes a preterm fetal response to interruptions in oxygenation Interruption of the oxygen pathway at any point can result in a prolonged deceleration. 106, pp. Respiratory alkalosis; metabolic acidosis In the normal fetus (left panel), the . Increased variables B. Fluctuates during labor Interpretation of fetal blood sample (FBS) results. Base deficit 14 Gardner DS, Jamall E, Fletcher AJ, Fowden AL, Giussani DA. Pre-term fetus may exhibit accelerations with a peak of only 10 beats per minute lasting for 10 seconds [6]. Category II Intrauterine growth restriction (IUGR), High resting tone may occur with an IUPC because of all of the following except A. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. A.. Fetal heart rate Fetal in vivo continuous cardiovascular function during chronic hypoxia. what characterizes a preterm fetal response to interruptions in oxygenation. C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called Studies reporting on early signs of renal disturbances in FGR are sparse and mostly include invasive measurements, which limit the possibility for early identification and prevention. Increased FHR baseline A. Metabolic acidosis Late decelerations were noted in two out of the five contractions in 10 minutes. c. Uteroplacental insufficiency B. Heart and lungs Good interobserver reliability Prolonged decelerations B. Sinoatrial node A. 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. Includes quantification of beat-to-beat changes C. 30-60 sec, A woman who is 34 weeks' gestation is counting fetal movements each day. Determine if pattern is related to narcotic analgesic administration Figure 2 shows CTG of a preterm fetus at 26 weeks. 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. Variability may also be decreased secondary to the effect of fetal tachycardia present in preterm fetuses. 1827, 1978. B. Auscultate for presence of FHR variability A. Idioventricular 42 Categories . B. B. Supraventricular tachycardias Both components are then traced simultaneously on a paper strip. C. By reducing fetal perfusion, Which medication is used to treat fetal arrhythmias? B. Catecholamine Decreased FHR variability B. B. Preterm labor By the 24th week, the fetus weighs approximately 1.3 pounds (600 g). B. Increase BP and decrease HR Uterine activity modifies the response of the fetal autonomic nervous system at preterm active labor. a. Fetal circulation, unlike postnatal circulation, involves the umbilical cord and placental blood vessels which carry fetal blood between the fetus and the placenta . However, racial and ethnic differences in preterm birth rates remain. 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. (T/F) Vibroacoustic stimulation may be less effective for preterm fetuses or when membranes have been ruptured. Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. A. A. At how many weeks gestation should FHR variability be normal in manner? Physiological control of fetal heart rate and the resultant features observed on the CTG trace differs in the preterm fetus as compared to a fetus at term making interpretation difficult. Respiratory acidosis C. Metabolic alkalosis, _______ _______ occurs when there is high PCO2 with normal bicarbonate levels. B. Epub 2004 Apr 8. You may expect what on the fetal heart tracing? 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. B. _____ cord blood sampling is predictive of uteroplacental function. The rod is initially placed when the temperature is 0C0^{\circ} \mathrm{C}0C. B. B. Gestational diabetes 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. 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). An appropriate nursing action would be to Fetal Circulation. A. Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. Smoking 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. Understanding these normal physiological characteristics is key in correctly interpreting fetal heart rate patterns. Category I 2 Further assess fetal oxygenation with scalp stimulation 99106, 1982. A. what characterizes a preterm fetal response to interruptions in oxygenation. B. Phenobarbital T/F: Low amplitude contractions are not an early sign of preterm labor. The sleep state B. 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. Breathing Well-oxygenated fetal blood enters the _____ ventricle, which supplies the heart and brain. T/F: Variability and periodic changes can be detected with both internal and external monitoring. 143, no. C. Normal saline, An EFM tracing with absent variability and no decelerations would be classified as T. Wheeler and A. Murrills, Patterns of fetal heart rate during normal pregnancy, British Journal of Obstetrics and Gynaecology, vol. Increasing O2 consumption 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]. D. Fetal isoimmunization, Which of the following factors is not likely to cause uteroplacental insufficiency? 824831, 2008. 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. A. eCollection 2022. In the next 15 minutes, there are 18 uterine contractions. B. Cerebral cortex A. C. Gestational diabetes No decelerations were noted with the two contractions that occurred over 10 minutes. B. 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? Provide juice to patient a. Gestational hypertension An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . B. B. C. Lungs, Baroreceptor-mediated decelerations are Toward The number of decelerations that occur Epub 2013 Nov 18. C. Multiple gestations, Which of the following is the primary neurotransmitter of the sympathetic branch of the autonomic nervous system? A. 15-30 sec Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. 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. C. Trigeminal, Which of the following dysrhythmias may progress to atrial fibrillation or atrial flutter? Continuous fetal heart rate monitoring in this group is recommended, following agreement with the patient. Afferent and efferent components of the cardiovascular reflex responses to acute hypoxia in term fetal sheep. Extremely preterm neonates born at 22-26 weeks gestation demonstrate improved oxygenation in response to inhaled nitric oxide at a rate comparable to term infants, particularly during the . C. Administer IV fluid bolus, A. More frequently occurring prolonged decelerations Category I B. Premature ventricular contraction (PVC), Which is the most common type of fetal dysrhythmia? Decreased FHR late decelerations _______ is defined as the energy-releasing process of metabolism. 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]. C. None of the above, A Category II tracing Premature atrial contraction (PAC) B. Tracing is a maternal tracing A second transducer is placed on the mothers abdomen over the uterine fundus to record frequency and duration of uterine contractions. These umbilical cord blood gases indicate B. B. T/F: Fetal arrhythmias can be seen on both internal and external monitor tracings. Fetal pulse oximetry was first introduced in clinical practice in the 1980s. A. Persistent supraventricular tachycardia B. 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. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. A. Affinity 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. B. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . 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. 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 . J Physiol. B. Cerebral cortex (T/F) Sinus bradycardias, sinus tachycardias, and sinus arrhythmias are all associated with normal conduction (normal P-waves followed by narrow QRS complexes). what characterizes a preterm fetal response to interruptions in oxygenation. B. 1998 Mar 15;507 ( Pt 3)(Pt 3):857-67. doi: 10.1111/j.1469-7793.1998.857bs.x. The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. The oxygen and nutrients subsequently diffuse from the blood into the interstitial fluid and then into the body cells. C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. B. Macrosomia Increases variability C. Category III, FHTs with minimal variability, absent accelerations, and a 3-minute prolonged deceleration would be categorized as 1224, 2002. Insufficient arterial blood flow causes decreased nutrition and oxygenation at the cellular level. C. Variable deceleration, A risk of amnioinfusion is A. Magnesium sulfate administration It should be remembered that the physiological reserves to combat hypoxia are not as robust as a term fetus, especially, if the onset of preterm labour is secondary to an infective process. 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]. A. Preeclampsia B. B. The progression from normal oxygenation to asphyxia is a continuum with progressive changes in vital signs and end-organ effects. True. Much of our understanding of the fetal physiological response to hypoxia comes from experiments . 143, no. Category I Y. Sorokin, L. J. Dierker, S. K. Pillay, I. E. Zador, M. L. Shreiner, and M. G. Rosen, The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation, American Journal of Obstetrics and Gynecology, vol. C. Atrioventricular node Which of the following is the least likely explanation? In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. One of the important characteristics of fetal development is that, with the decrease in oxygen supply, the blood flow of other organs is rapidly redistributed to the brain and heart, increasing by 90 and 240%, respectively, a response that is similar in both preterm and near-term fetuses (Richardson et al., 1996). T/F: Corticosteroid administration may cause an increase in FHR accelerations. Base excess These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. Its dominance results in what effect to the FHR baseline? Based on current scientific evidence, a CTG is not recommended in the UK as a method of routine fetal assessment of the preterm fetus (<37 weeks gestation) and currently no clinical practice guidelines on intrapartum monitoring of the preterm fetus exist in the UK The International Federation of Gynaecologists and Obstetricians (FIGO) guidelines for interpretation of intrapartum cardiotocogram distinguish 2 levels of abnormalities, suspicious and pathological, however, the gestation to which such criteria can be applied has not been specified. C. Timing in relation to contractions, The underlying cause of early decelerations is decreased