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Midwifery and obstetrics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Beverley Gordon, Gareth Thomas
Labour is managed actively by means of four-hourly vaginal examinations. If progress appears to be slow then corrective measures are taken, such as the provision of better pain relief or the administration of oxytocic drugs. Reexamination is then brought forward by two hours. Further failure to progress in the first stage then necessitates an EmLSCS. Difficulties arise when progress does not actually stop but slows considerably in the later stages of the active phase or in the second stage. The fetus is at risk of becoming hypoxic and acidotic (fetal distress) and there comes a point where continuation of the labour runs the risk of fetal asphyxia. Under such circumstances fetal well-being is monitored by cardiotocography (CTG), which consists of a continuous print-out of fetal heart rate and a qualitative assessment of uterine activity (see page 123) The technique is inexact. Often there is no obvious time to intervene and a small number of neonates are bom in a poor physiological state.
Obstetric and Gynaecological Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Assess the fetus during the secondary survey after initial resuscitation of the mother. Examine fundal height, uterine tenderness, fetal movement, fetal heart rate and strength of contractions.Use a fetal stethoscope, Doppler ultrasound or cardiotocograph to assess the fetal heart rate. Fetal distress is indicated by: bradycardia <110 beats/min (normal 120–160 beats/min)loss of fetal heart acceleration to fetal movement, or late deceleration after uterine contractions.
Disorders of vitamin B6 metabolism
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Almost all PNPO-deficient patients have a severe and acute early neonatal presentation with convulsions, myoclonus, rotatory eye movements, and sudden clonic contractions [4, 7]. It is important to note that many but not all patients are born prematurely between 22 and 35 weeks’ gestation. Fetal distress is common, as are “signs of asphyxia”. Most have had a low Apgar score and/or required intubation. Thus, PNPO deficiency must enter the differential diagnosis of hypoxic–ischemic encephalopathy (HIE) in a prematurely born infant. Seizures are resistant to conventional anticonvulsant therapy and can be fatal. EEG shows a burst-suppression pattern. There is often metabolic (lactic) acidosis as well as a tendency to hypoglycemia. There may be gastrointestinal problems such as abdominal distension, even ileus and vomiting. Very similar is the presentation of babies affected with the vitamin B6-dependent epilepsy caused by mutations in PROSC [6].
Pregnancy, labor, and delivery outcomes of women with and without spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Amie B. McLain, Lena Zhang, Jan Troncale, Yu Ying Chen, Claire Kalpakjan
The two most important disability-specific issues that impact maternal-fetal outcomes are AD and the high frequency of urinary tract infections.6 By far the most critical complication of labor and delivery in women with SCI is AD. It has been reported that 60–80%, of women with SCI with levels of injury above Thoracic vertebral level 6 (T6) and a small percentage below T6, will experience AD during uterine contractions of labor and delivery. Sequelae of fetal distress, maternal intracranial hemorrhage, coma, seizures, and even death have been described when this condition went unrecognized and untreated.26 In this study however, AD was only described in one PW-SCI participant and no further related complications occurred. This may be more from the fact that AD surveillance is discussed more in the literature27 so that treatment/management is expeditiously initiated with minimal symptoms recorded in the record.
Biomarkers of disease in human nails: a comprehensive review
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Sarahi Jaramillo Ortiz, Michael Howsam, Elisabeth H. van Aken, Joris R. Delanghe, Eric Boulanger, Frédéric J. Tessier
Maternal stress during pregnancy and, by extension, fetal stress in utero, has been linked to premature births and may even play a role in the child’s risk of disease later in life. In a cohort study of 80 mother-and-child nail pairs collected in the first 3 weeks after birth, LC-MS/MS analyses revealed higher concentrations of DHEA in nails from babies whose mothers had experienced stress during pregnancy [93]. In a later, prospective cohort study of 79 healthy mothers, the same team compared cortisol, cortisone, and DHEA in maternal hair samples with infants’ postnatal nail samples to examine the endpoints of maternal depression and infant irritability at 3 months postpartum [95]. Stress in the 2nd or 3rd trimester of pregnancy was related to maternal hair cortisone levels, and these predicted depression symptoms at 3 months postpartum, while elevated ungual DHEA in infants predicted maternal stress in the 1st trimester and infant irritability 3-months postpartum. In addition, infants’ ungual cortisol levels were positively associated with the cortisol: cortisone ratio in mothers’ hair and negatively correlated with their birth weight. This work offers a noninvasive approach to study predictive and risk biomarkers in neonates of postnatal disorders resulting from pre- and perinatal stress. An excellent review recently focused on cortisol accumulation in the hair and nails of mothers and babies [96] while Liu & Doan [97] have examined the relationship between stress biomarkers in hair and nails.
Liver failure in pregnancy: a review of 25 cases
Published in Journal of Obstetrics and Gynaecology, 2021
Mengyao Luo, Lei Gao, Junqi Niu, Chen Chen, He Wang, Ying Chen
In the present study, AFL and viral hepatitis were the main causes of liver failure in pregnancy. Hypoproteinaemia, infection, anaemia, metabolic acidosis and hyperbilirubinaemia were also present, which can increase the risk of foetal distress, leading to foetal brain damage, stillbirth and other complications (Sullivan and Rockey 2017; Watchko 2017). Liver failure is associated with an increased risk of bacterial and fungal infections (Righi 2018), which can result in postnatal complications, and multiple organ failure. All patients involved in the study met the Chinese Guidelines for the diagnosis of liver failure. There are some differences on the focus between Chinese Guidelines and the Swansea diagnostic criteria, Chinese Guidelines pay more attention to the aggravation of coagulation and encephalopathy, otherwise, Swansea diagnostic criteria use a score list to show it. It can be observed that both two diagnostic criteria could screen out pregnant women with liver failure, and Swansea score ≥6 is consistent with the diagnostic criteria for liver failure in China. Patients with higher Swansea scores had more complications and higher mortality. Swansea diagnostic criteria can evaluate the patient conditions more systematically and conveniently and further assess the need to do for the equivalent effect of different diagnostic criteria of liver failure.