Although, clinical evidence-based guidelines and recommendations exist for monitoring term fetuses during labour, there is paucity of scientific evidence in the preterm group. ... What typical characteristics of preterm uterine activity may be present in a patient experiencing preterm labor? Medications such as pethidine, magnesium sulphate and even steroids have also been associated with reduced fetal heart rate variability. 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. 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. Do not have uniform appearance; their shape, duration, and degree of fall below baseline rate vary with regard to the contraction cycle. Electronic fetal monitoring to assess adequate oxygen delivery to the fetus occurs in approximately 89% of births in the United States. The brain of preterm infants is vulnerable to disturbances in perfusion and oxygenation. Copyright © 2011 Karolina Afors and Edwin Chandraharan. Although, the baseline heart rate is expected to be higher, any rate greater than 160 should be still considered to be tachycardic. In other words: change position and go to OR, Indeterminate (often described as equivocal or ambiguous data). these decelerations have a lower depth and duration, but can be seen frequently on intrapartum CTG tracings [4]. Reduction in fetal baseline variability in the preterm fetus has been described, however this has not been quantified. What is required when using internal fetal monitoring? Figure 2 shows CTG of a preterm fetus at 26 weeks. 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. Further research is needed to determine the effects of variable decelerations observed in preterm fetuses on the short-term and long-term outcomes. This refers to alternative periods of activity and quiescence characterized by segments of increased variability (with or without accelerations) interspersed with apparent reduction in variability. The latter would be signs of fetal stress (hypoxemia, asphyxia). Specifically, the fetal membrane functions to provide mechanical16, 17 and immune protection and acts as a barrier for microbial access.12, 18, 19 This protective role is supported by the biomarkers that are produced by fetal membranes during gestation and parturition. In cases of utero-placental insufficiency, where carbon dioxide and hydrogen ion accumulate with resultant decrease in oxygen concentrations, the chemo-receptors are activated. A fetal response to chorioamnionitis is associated with early survival after preterm birth. . A woman at 38 weeks gestation is in labor. Video Abstract CONTEXT: The International Liaison Committee on Resuscitation prioritized to review the initial fraction of inspired oxygen (Fio2) during the resuscitation of preterm newborns. Assess survival and long-term outcome at the. The autoregulatory capacity of the preterm neonatal brain remains unclear. 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. 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.