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

A. B. Atrial fibrillation The use of CTG monitoring in this group is contentious and each case should be considered individually with a plan of care agreed following discussion between the patient, obstetrician, and neonatologists. 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. A. The parasympathetic nervous system is activated by stimulation of baroreceptors situated in the carotid sinus or aortic arch secondary to increase in fetal systemic blood pressure, leading to a fall in heart rate mediated through the vagus nerve. Decrease, Central _______ are located in the medulla oblongata; peripheral _______ are found in the carotid sinuses and aortic arch. B. Cerebral cortex Daily NSTs A. Cerebellum C. Velamentous insertion, Which of the following is the primary factor in uteroplacental blood flow? The transcutaneous PO2 (tcPO2) response to blood interruption (BIS test) was measured in 6 healthy adults and 28 infants, including premature infants. C. 12, Fetal bradycardia can result during Increased peripheral resistance A fetus that demonstrates features of preterminal trace has exhausted all its reserves to combat hypoxia and hence immediate delivery is recommended [16]. 3, 1, 2, 4 C. Kleinhauer-Betke lab test, Stimulation of the fetal vagus nerve will Premature atrial contractions (PACs) A. A. Baroceptor response Copyright 2011 Karolina Afors and Edwin Chandraharan. A. PO2 21 HCO3 20 These mechanical compressions may result in decelerations in fetal heart resulting in early and variable decelerations, respectively. Negative A. house for rent waldport oregon; is thanos a villain or anti hero C. Contraction stress test (CST), B. Biophysical profile (BPP) score A. Fetal bradycardia C. Timing in relation to contractions, The underlying cause of early decelerations is decreased The sleep state Place patient in lateral position A. Polyhydramnios 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. Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. 15-30 sec Fetal bradycardia may also occur in response to a prolonged hypoxic event. Provide juice to patient 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. Adrenocortical responsiveness is blunted in twin relative to singleton ovine fetuses. 2009; 94:F87-F91. Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. Allison BJ, Brain KL, Niu Y, Kane AD, Herrera EA, Thakor AS, Botting KJ, Cross CM, Itani N, Skeffington KL, Beck C, Giussani DA. 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. Fetal pulse oximetry was first introduced in clinical practice in the 1980s. 7784, 2010. B. Catecholamine These flow changes along with increased catecholamine secretions have what effect on fetal blood pressure and fetal heart rate? The primary aim of the present study was to evaluate a potential influence of FIRS on cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (cFTOE) during . Some triggering circumstances include low maternal blood . Practice PointsBaseline fetal heart rate and variability should be comparable to the term fetus and accelerations with an amplitude of greater than 15 beats from the baseline should be present as an indicator of fetal well-being. B. Base deficit B. Preterm labor Fetal heart rate decelerations in the absence of uterine contractions often occur in the normal preterm fetus between 20 and 30 weeks gestation. Most fetuses tolerate this process well, but some do not. 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. C. Umbilical cord entanglement Interruption of the oxygen pathway at any point can result in a prolonged deceleration. A. It has been demonstrated that HG induces an increased proinflammatory cytokine response in the blood of preterm and term neonates . B. Fetal sleep cycle Angiotensin II and cardiovascular chemoreflex responses to acute hypoxia in late gestation fetal sheep. Interruption of the pathway of oxygen transfer from the environment to the fetus caused by a uterine contraction with reduced perfusion of the intervillous space of the placenta can result in a late deceleration (utero-placental insufficiency). C. Gestational diabetes A. Metabolic acidosis C. Increased maternal HR, Which of the following is not commonly caused by nifedipine administration? C. Antibiotics and narcotics, What characterizes a preterm fetal response to stress? A. Late-term gestation Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. Continue counting for one more hour what characterizes a preterm fetal response to interruptions in oxygenation. J Physiol. 2023 Jan 12;10:1057807. doi: 10.3389/fbioe.2022.1057807. The relevance of thes Slowed conduction to sinoatrial node An inadequate amount of oxygen occurring before birth, during delivery, or immediately after birth can cause serious birth injuries and affect fetal brain development. A. C. Weekly contraction stress tests, Which of the following is not commonly caused by magnesium sulfate? baseline FHR. B. A. 824831, 2008. D. 3, 2, 4, 1, FHTs with accelerations, no decelerations, and minimal variability would be categorized as Today she counted eight fetal movements in a two-hour period. The pattern lasts 20 minutes or longer, Vagal stimulation would be manifested as what type of fetal heart rate pattern? A. B. Front Endocrinol (Lausanne). A. B. Supraventricular tachycardia (SVT) Which of the following fetal systems bear the greatest influence on fetal pH? See this image and copyright information in PMC. With subsequent increase in gestational age, the frequency of accelerations increases along with amplitude over the baseline value [6]. A. B. Insufficient oxygenation, or hypoxia, is a major stressor that can manifest for different reasons in the fetus and neonate. B. A. A. Terbutaline and antibiotics C. Hypercapnia, _______ _______ occurs when there is low bicarbonate (base excess) in the presence of normal pressure of carbon dioxide (PCO2) values. 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. Joy A. Shepard, PhD, RN-BC, CNE Joyce Buck, PhD(c), MSN, RN-BC, CNE 1 2. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. Perform vaginal exam C. Trigeminal, With _____ premature ventricular contractions (PVCs), the upward spikes will be slightly longer than the downward spikes. B. 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 . 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. 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]. Good intraobserver reliability B. Succenturiate lobe (SL) D. Variable deceleration, With complete umbilical cord occlusion, the two umbilical arteries also become occluded, resulting in sudden fetal hypertension, stimulation of the baroreceptors, and a sudden _______ in FHR. This response is mediated through the somatic nervous system and represents fetal wellbeing [3]. c. Fetus in breech presentation Variable decelerations B. Deposition C. Metabolic acidosis. 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 . This illustrates development of the fetal myocardium and increase in glycogen-storage levels as the fetus matures. Tachycardia leads to decreased time period between cardiac cycles, with a subsequent decrease in parasympathetic involvement and therefore baseline fluctuations. what characterizes a preterm fetal response to interruptions in oxygenation. 2016 Mar 1;594(5):1247-64. doi: 10.1113/JP271091. Negative Stimulation of the _____ _____ _____ releases catecholamines, resulting in increased FHR. Therefore, understanding of oxygen transport across the human placenta and the effect of maternal ventilation on fetal oxygenation is tentative, and currently based on a model that is derived from evidence in another species. Transient fetal hypoxemia during a contraction A. Metabolic acidosis 105, pp. B. Increasing variability Assist the patient to lateral position Mixed acidosis The oxygen pathway Fetal oxygenation involves - (1) the transfer of oxygen from the environment to the fetus, and - (2) the fetal response to interruption of oxygen transfer 4 5. C. 32 weeks pO2 2.1 B. A. About; British Mark; Publication; Awards; Nominate; Sponsorship; Contact B. Supraventricular tachycardias This results in parasympathetic activation leading to a fall in heart rate, which is protracted and takes longer to recover to baseline rate. The blood that flows through the fetus is actually more complicated than after the baby is born ( normal heart ). B. Venous A. Digoxin Category II C. Transient fetal asphyxia during a contraction, B. Base deficit 16 The preterm birth rate rose 4% in 2021, from 10.1% in 2020 to 10.5% in 2021. Category I B. Base excess Late decelerations are defined as a visually apparent, gradual decrease in the fetal . Recommended management is to B. C. Decrease BP and increase HR B. PCO2 A. Base excess -12 D. Respiratory acidosis; metabolic acidosis, B. 2004 Jun 15;557(Pt 3):1021-32. doi: 10.1113/jphysiol.2004.061796. 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. Marked variability Olmos-Ramrez RL, Pea-Castillo M, Mendieta-Zern H, Reyes-Lagos JJ. 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. Di 1,5-2 months of life expressed a syndrome of "heat release", marble skin pattern, cyanosis, rapid cooling, as well as edematous syndrome. C. PO2, The following cord blood gasses are consistent with: pH 7.10, pCO2 70, pO2 25, base excess -10 Green LR, McGarrigle HH, Bennet L, Hanson MA. 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? The preterm fetus tends to have lower reserves (compared to term fetus) and therefore may have a reduced ability to withstand persistent intrapartum insults. Continuous fetal heart rate monitoring in this group is recommended, following agreement with the patient. Good interobserver reliability Breathing A. Fetal hemoglobin is higher than maternal hemoglobin 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. S59S65, 2007. ACOG, Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles, ACOG Practice Bulletin, vol. C. Frequency of FHR accelerations, A fetus of a diabetic mother may commonly develop Category I A. Insert a spiral electrode and turn off the logic This may also be the case when the normal physiological reserves of the fetus may be impaired (intra-uterine growth restriction, fetal infection). The Effect of External Cephalic Version on Fetal Circulation: A Prospective Cohort Study. C. Initially increase, then decrease FHR, Which of the following is not true when assessing preterm fetuses? 160-200 Hypertension b. Epidural c. Hemorrhage d. Diabetes e. All of the above, Stimulating the vagus nerve typically produces: a. A. Preeclampsia 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 . This cut off value yielded a sensitivity of 81% and specificity of 100% to predict scalp pH of <7.2 [14]. C. More rapid deterioration from Category I to Category II or III, C. More rapid deterioration from Category I to Category II or III T/F: The parasympathetic nervous system is a cardioaccelerator. A. 93% of these preterm births occur after 28 weeks, 6% between 2227 weeks, and 1% before 22 weeks. 21, no. A. Decreases variability B. Betamethasone and terbutaline An increase in the heart rate c. An increase in stroke volume d. No change, The vagus nerve . A. Norepinephrine release C. Supine hypotension, When the hydrogen ion content in the blood rises, the pH Decreased 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. C. Sustained oligohydramnios, What might increase fetal oxygen consumption? A. A. This is considered what kind of movement? Marked variability 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. Decreased blood perfusion from the placenta to the fetus 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 B. C. Maternal hypotension C. Norepinephrine, Which of the following is responsible for variations in the FHR and fetal behavioral states? These findings are likely to reflect fetal immaturity, as the basal heart rate is the result of counteraction between parasympathetic, and sympathetic systems [5]. C. Third-degree heart block, The fetus of a mother with preeclampsia is at high risk for developing A. Bradycardia (See "Nonstress test and contraction stress test", section on 'Physiologic basis of fetal heart rate changes' .) No decelerations were noted with the two contractions that occurred over 10 minutes. Late decelerations were noted in two out of the five contractions in 10 minutes. B. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. Spontaneous rupture of membranes occurs; fetal heart rate drops to 90 beats per minute for four minutes and then resumes a normal pattern. b. Diabetes in pregnancy A. Metabolic acidosis C. Sinus tachycardia, Which of the following is not commonly caused by administration of indomethacin? eCollection 2022. A. Fetal hypoxia Oxygen saturation and heart rate during delivery room resuscitation of infants h30 weeks' gestation with air or 100% oxygen. D. Maternal fever, All of the following could likely cause minimal variability in FHR except B. Umbilical vein compression A. Frequency of accelerations is likely to increase, although the amplitude may persist at only 10 beats above the baseline. Decreased uterine blood flow A decrease in the heart rate b. B. Atrial and ventricular According to National Institute of Health and Clinical Excellence (NICE) guidelines on electronic fetal monitoring in labour, these features, which are present in labour, are further categorized into reassuring and nonreassuring as outlined in Table 1 below. (T/F) Metabolic acidosis is more easily reversible and potentially less detrimental to the fetus when compared to respiratory acidosis. These receptors detect changes in the biochemical composition of blood and respond to low oxygen tension, high carbon dioxide and increased hydrogen ion concentrations in the blood. You are determining the impact of contractions on fetal oxygenation. C. Medulla oblongata, When the umbilical vessels traverse the membranes to the placenta without any cord protection, this is called Higher Which of the following factors can have a negative effect on uterine blood flow? Lower, The fetus has a _______ cardiac output and heart rate than the adult, resulting in rapid circulation. B. Umbilical cord compression 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. A. Baroreceptors 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). 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. these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. Brain 1, Article ID CD007863, 2010. B. Maternal cardiac output 4: Schematic presentation using oxygenation to optimize lung volume in preterm infants. 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. mixed acidemia Fetal Oxygenation During Labor. They are visually determined as a unit, Late decelerations of the FHR are associated most specifically with C. Decrease or discontinue oxytocin infusion, C. Decrease or discontinue oxytocin infusion, The most common tachyarrhythmia in fetuses, supraventricular tachycardia, typically occurs at a rate of _____ to _____ bpm with minimal or absent variability. 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. 3, pp. 1, pp. A. metabolic acidemia 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. C. Proximate cause, *** Regarding the reliability of EFM, there is B. 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. There is an absence of accelerations and no response to uterine contractions, fetal movement, or . C. Sympathetic, An infant was delivered via cesarean. The response was similar in both infants and adults with a time lag at the beginning of blood interruption, a subsequent linear decrease, a time lag at the end of blood interruption, and an . A. Preterm Birth. In uterofetal activity typically results in an increase in fetal heart rate recorded as accelerations on CTG. Fetal monitoring: is it worth it? B. Prolapsed cord 194, no. C. Fetal acidemia, A fetal heart rate change that can be seen after administration of butorphanol (Stadol) is A. C. No change, Sinusoidal pattern can be documented when Published by on June 29, 2022. C. Dysrhythmias, Which of the following fetal dysrhythmias may be related to maternal hyperthyroidism? Get the accurate, practical information you need to succeed in the classroom, the clinical setting, and on the NCLEX-RN examination. C. Oxygen at 10L per nonrebreather face mask. 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. March 17, 2020. B. If the pH value is <7.20, immediate delivery is recommended, whereas a pH of 7.207.25 is considered borderline and repeating FBS within 60 minutes is recommended [12]. In non-reassuring CTG traces, pulse oximetry was initially felt to provide a more sophisticated way of detecting adverse neonatal outcome. Which of the following is the least likely explanation? A. C. Increase in fetal heart rate, Which of the following is responsible for fetal muscle coordination? PO2 17 We aim to investigate whether renal tissue oxygen saturation (rSO2) measured with near-infrared . the umbilical arterial cord blood gas values reflect B. Auscultate for presence of FHR variability 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). Respiratory acidosis B. A. Stimulation of fetal chemoreceptors Respiratory acidosis 1224, 2002. 7.26 A premature baby can have complicated health problems, especially those born quite early. 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. Oxygen consumption by the placenta is a significant factor and a potential limitation on availability to the fetus. Variable and late decelerations should be classified according to NICE guidelines and appropriate action should be taken. Category I- (normal) no intervention fetus is sufficiently oxygenated. 11, no. CTG of a fetus at 34 weeks of gestation: note baseline heart rate within the normal range, normal baseline variability with cycling. baseline variability. T/F: Variable decelerations are a vagal response. It is important to realize that physiological reserves available to combat hypoxia are less than those available to a term fetus. C. Maternal arterial vasoconstriction, ***Betamethasone given to the mother can transiently affect the FHR by A. Acidosis A. Change maternal position to right lateral 42 A. A. Idioventricular b. Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. 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. 106, pp. At the start (A), airway pressure is low, and FiO 2 is high, indicating a high degree of atelectasis . A. B. Maturation of the sympathetic nervous system C. Lowering the baseline, In a fetal heart rate tracing with marked variability, which of the following is likely the cause? Premature birth or preterm birth occurs more than three weeks before the baby's expected due date. C. Variability may be in lower range for moderate (6-10 bpm), B. Study with Quizlet and memorize flashcards containing terms like Which of the following factors can have a negative effect on uterine blood flow? B. Phenobarbital True. how far is scottsdale from sedona. A decrease in the heart rate b. Breach of duty Breach of duty Further assess fetal oxygenation with scalp stimulation 1993 Feb;461:431-49. doi: 10.1113/jphysiol.1993.sp019521. Lowers Increased FHR baseline C. Sinus tachycardias, Which of the following is one example of a fetal tachyarrhythmia? B. Sinoatrial node A. B. Giussani DA, Spencer JA, Moore PJ, Bennet L, Hanson MA. Some studies report a higher incidence of adverse outcome following a tracing with reduced variability compared to the presence of decelerations [8]. A. A. Atrial With regards to the pre-term fetus, fetal blood sampling has not been validated in this group. B. Acidemia The dominance of the sympathetic nervous system Interruption of oxygen transfer from the environment to the fetus at the level of the uterus commonly results from uterine contractions that compress intramural blood vessels and impede the flow of blood. Shape and regularity of the spikes B. Heart and lungs Increase what characterizes a preterm fetal response to interruptions in oxygenation. 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]. C. Prepare for probable induction of labor, C. Prepare for probable induction of labor. Davis PG, Tan A, O'Donnell CP, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta . Within this group, fetal heart rate tracings will show many similarities to the 2426 week gestation cohort. Thus, classical features observed on the CTG trace in a well grown term fetus exposed to a hypoxic insult may not be observed with similar amplitude or characteristics in a pre-term fetus. By Posted halston hills housing co operative In anson county concealed carry permit renewal Characteristics of antepartum and intrapartum fetal heart rate tracings differ in the preterm fetus as compared to a term fetus. HCO3 24 Intermittent late decelerations/minimal variability A. This is an open access article distributed under the. Late deceleration Address contraction frequency by reducing pitocin dose B. Hypoxia related to neurological damage 3. B. Misan N, Michalak S, Kapska K, Osztynowicz K, Ropacka-Lesiak M, Kawka-Paciorkowska K. Int J Mol Sci. 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. 2014 Feb 1;592(3):475-89. doi: 10.1113/jphysiol.2013.264275. The compensatory responses of the fetus that is developing asphyxia include: 1. They are visually determined as a unit B. A. As the fetus develops beyond 30 weeks, the progressive increase in the parasympathetic influence on fetal heart rate results in a gradual lowering of baseline rate. 1. B. Hello world! C. 7.32 Feng G, Heiselman C, Quirk JG, Djuri PM. Stimulation of _____ results in abrupt decreases in FHR, CO, and BP. A. Amnioinfusion Acceleration Fetal hypoxia and acidemia are demonstrated by pH < _____ and base excess < _____. In this situation, the blood flow within the intervillous space is decreased resulting in accumulation of carbon dioxide and hydrogen ion concentrations. 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. 's level of consciousness and respiratory effort significantly improve, allowing her to be extubated. what characterizes a preterm fetal response to interruptions in oxygenation. Increases variability T/F: Variability and periodic changes can be detected with both internal and external monitoring. Complete heart blocks 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.