China
Africa
Explore chapters and articles related to this topic
Intrapartum Fetal Monitoring
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Nandini Raghuraman, Alison G. Cahill
Amnioinfusion is the process of infusing fluid into the amniotic cavity after ROM. The goal of amnioinfusion is to provide fluid and buoyancy in order to relieve possible umbilical cord compression, usually during labor after ROM. This technique consists of introducing normal saline or Ringer’s lactate transcervically through a catheter into the uterine cavity. Intrapartum amnioinfusion is used in the setting of repetitive variable decelerations after ROM. Transcervical amnioinfusion can be done by bolus or continuous infusion technique, with similar ability to relieve recurrent variable decelerations. Either lactated Ringer’s solution or normal saline can be used to place a crystalloid solution into the uterus without altering the neonatal electrolyte balance [58].
Ethics Consultations in a Fetal Health Center
Published in The American Journal of Bioethics, 2022
Brian S. Carter, Shika Kalevor
An example of the latter has been several consults around the fetal diagnosis of bilateral renal disease and associated severe oligohydramnios, or frank anhydramnios, that could present as early as 15–16 weeks of gestation. Innovative efforts to place a shunt to drain an obstructed bladder or urinary tract, or to decompress cystic renal malformations, or even perform an in-utero laser ablation of posterior urethral valves all were considered. Additionally, the question of whether serial amnioinfusion should be provided, and if so, how often, arose. Perhaps they should be done weekly. But many so affected pregnancies could not be sustained as there was chronic leakage of amniotic fluid, the development of sepsis, or fatal preterm labor and delivery in the face of severe pulmonary hypoplasia. How well were parents being informed of the long odds of adequate fetal lung development and working through or around the often life-limiting condition of pulmonary hypoplasia and neonatal respiratory failure? Did they simply hear that this was the only path forward toward a hoped for, but far from likely, course to involve neonatal and infant dialysis and a race against the clock to obtain a kidney transplant at age two years? As true informed consent requires an ability to make a free choice unencumbered by bias or coercion, could these parents give informed consent? As we all await the results of the Renal Anhydramnios Fetal Therapy (RAFT) trial uncertainty seemed to collide with desperate hope.
Death Shortly after Delivery Caused by Congenital High Airway Obstruction Syndrome
Published in Fetal and Pediatric Pathology, 2020
Francesco Lupariello, Giancarlo Di Vella, Giovanni Botta
To date in the literature there are very few individual case reports of CHAOS [9]. The most important message of these cases is that prenatal USG has a vital role because it is fundamental to plan a correct therapeutic strategy. Indeed, only after a correct prenatal diagnosis physicians can program an ex-utero intrapartum treatment (EXIT) that consists of securing an airway when the baby is still in connection with the placenta through the umbilical cord [4, 10, 11]. In particular, in the first steps of the EXIT procedure physicians usually preserve uterine volume allowing only the delivery of the head and the shoulders. In addition, in this phase umbilical cord compression is prevented through amnioinfusion. High concentrations of inhalational anesthetics and tocolytic agents are used to obtain uterine relaxation. The aim of these procedures is the preservation uteroplacental circulation [10]. Therefore, even if the infant will still need surgical corrections of the congenital abnormality after birth, his/her survival will depend on prenatal planning and perinatal execution of these procedures.
Amnioinfusion for variable decelerations caused by umbilical cord compression without oligohydramnios but with the sandwich sign as an early marker of deterioration
Published in Journal of Obstetrics and Gynaecology, 2019
Daisuke Katsura, Yuichiro Takahashi, Shigenori Iwagaki, Rika Chiaki, Kazuhiko Asai, Masako Koike, Ryuhei Nagai, Shunsuke Yasumi, Madoka Furuhashi
Antepartum variable decelerations (VD) caused by umbilical cord compression are significantly associated with decelerations in labour, subsequently leading to other adverse effects such as foetal distress and intestinal perforation (Judge et al. 1989; Kai et al. 2009). Repeated umbilical cord compression produces chronic foetal asphyxia resulting in hypoxic-ischemic encephalopathy and pulmonary arterial hypertension after birth (Soifer et al. 1987; Takahashi T et al. 2006). Oligohydramnios (amniotic fluid index [AFI] < 5) and anhydramnios are major ultrasonography features that alert us about the subsequent adverse situations and help in diagnosing these situations. Emergency delivery is the only option when these severe situations occur. New markers that can be detected on ultrasonography are needed to prevent these urgent situations. Localised oligohydramnios and a stuck cord, also known as a sandwich umbilical cord, are possible candidates for these ultrasonography markers. Amnioinfusion (AI) has been found to be effective for treating VD caused by umbilical cord compression with oligohydramnios (Gabbe et al. 1976; Miyazaki and Nevarez 1985; Nageotte et al. 1991; Sarno et al. 1995; Vergani et al. 1996; Takahashi et al. 2014). We report the promising efficacy of AI for improving umbilical cord compression without oligohydramnios.