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Abnormalities of Second Stage
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
A good part of the journey and rotation of the head occurs in the second stage of labour. If features of disproportion become manifest by the end of the passive phase, then active bearing down may be terminated in favour of an emergency caesarean section. The fetal heart rate needs to be monitored continuously by the electronic monitor or every 5 minutes by intermittent auscultation. The woman should never be left alone in the second stage of labour. Adequate time should be given for descent to happen passively. Premature attempts at active bearing down may make an obstetrician impatient and might result in unnecessary operative instrumentation. According to the recent guidelines by the consortium of labour, the second stage can be extended to 3 hours in a primigravida and 2 hours in a multigravida, provided there are no maternal and fetal compromise and there are no signs of disproportion on abdominal or internal examination. Active bearing down as soon as the second stage begins may be necessary if there is the presence of any alerting features and if the head is already at the lower station. Earlier intervention by operative delivery or caesarean delivery may become necessary in some situations with fetal heart rate abnormalities.
Fetal echocardiography
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Caroline K. Lee, Erik C. Michelfelder, Gautam K. Singh
Fetal arrhythmia causing tachycardia is an important cause of fetal morbidity and mortality (66–69). Fetal tachycardia is defined as a fetal heart rate ≥200 beats per minute (bpm) (69). Both sustained tachycardia (present ≥12 consecutive hours) (70) as well as intermittent tachycardias are risk factors for fetal congestive heart failure (67,71).
Obstetrics: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
ECV is a safe option in breech presentation. There is an association between ECV and transient abnormal fetal heart rate patterns. Very occasionally, this may lead to fetal compromise and the need to deliver the baby immediately (1).
Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment
Published in Nutritional Neuroscience, 2023
Danielle N. Christifano, Lynn Chollet-Hinton, Dirk Hoyer, Alexander Schmidt, Kathleen M. Gustafson
The autonomic nervous system is a basic neural system that is affected by choline by way of acetylcholine19 and a system through which choline affects both physiological and behavioral outcomes.20 Early in development, fetal heart rate is largely under sympathetic control.21 At about 30 weeks gestational age (GA), increasing vagal influence results in lower HR, greater HRV and the emergence of distinct HR patterns attributable to fetal activity states.22 This developmental shift to greater cardiac vagal activity reflects the ability of the integrated nervous system to mediate physiological and in utero behavioral and regulatory activity. The ability to flexibly adjust HR and other complex, integrated oscillatory systems (breathing, suck/swallow) in response to challenges during the transition to life outside the womb, gives the newborn an adaptive advantage. A newborn with more mature autonomic-central nervous system integration is better able to maintain homeostasis, coordinate sucking and breathing, have more optimal sleep-wake state profiles and in general, experiences a smoother transition to extrauterine life.23
Obesity decreases the EC50 of epidural ropivacaine when combined with dexmedetomidine for labor analgesia
Published in Expert Review of Clinical Pharmacology, 2021
Xiaojun Chen, Meng Cai, Xiaofeng Lei, Jin Yu
The venous access of the left upper limb was established for each parturient in the delivery room. Vital signs, such as respiratory rate, heart rate, blood pressure, and pulse oxygen saturation (SpO2), were collected every 5 minutes by a monitor (BeneVision N12, Mindray, China). Fetal heart rate was recorded by a doppler monitor (M2702A, M2703A, Philips, Germany). Epidural analgesia was administered to the parturient at L2-3 interspace with an 18-gauge Tuohy needle in the left lateral position, followed by cephalad insertion of an epidural catheter (3–4 cm) into the epidural space. A test dose of lidocaine (1%, 5 mL) was administered after a negative confirmation of an aspirate test for blood and cerebrospinal fluid. A loading dose of 5 mL ropivacaine with 0.5 µg/mL dexmedetomidine was administered. Thereafter, the mixed solution was infused continuously with a patient-controlled-analgesia pump (PCA-100B, Zhejiang Chenhe Medical Devices Corp., China) at 10 mL/h. The parturients were instructed to use the pump for bolus dose on demand, which was set at 1.5 mL bolus dosage with 15 minutes lockout time. The local anesthetic solutions were prepared by an anesthesia nurse, and investigators were blind to these solutions.
Prehospital Transfusion of Low-Titer O + Whole Blood for Severe Maternal Hemorrhage: A Case Report
Published in Prehospital Emergency Care, 2020
Ryan Newberry, C. J. Winckler, Ryan Luellwitz, Leslie Greebon, Elly Xenakis, William Bullock, Michael Stringfellow, Julian Mapp
The patient arrived at the community hospital’s emergency department at 0055 with ongoing resuscitation with LTO + WB. Her vital signs at 0055 were a pulse of 97 bpm, blood pressure of 100/56 mmHg, respiratory rate of 18, oxygen saturation (O2) 99% and shock index of 1.0. Initial serum labs revealed a hemoglobin of 9.5 g/dL and hematocrit of 28.0%. Her chemistry panel and coagulation studies were within normal limits. Pelvic examination performed by the emergency physician noted coagulated blood in the vaginal vault with minimal active bleeding. A fetal heart rate was found to be 140 bpm. The remainder of her emergency department course included administration of 1.5 grams of cefuroxime, 30 mL of citric acid/sodium citrate and 1000 mL of Lactated Ringers solution. The patient was then transferred to the operating suite for emergent cesarean section.