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Antepartum Testing
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
If biophysical profile testing is performed, the managing physician should be willing to act on the test results. Management by BPS follows a protocol that relates fetal condition, assumed perinatal risks, gestational age, and recommended action (Table 58.3). When BPS is persistently 8/10 on serial testing with the same variable missing, specific inquiry should be made about cause. In some cases, that is obvious from the clinical context (e.g., oligohydramnios in preterm premature rupture of membranes with normal fetal status). In other cases, it is not so clear. As suggested by Table 58.4, equivocal results in the preterm fetus call for repeated testing, transfer to appropriate neonatal resources, antenatal steroid administration, and so on, before moving to delivery. In high-risk fetuses, delivery can wait for valuable maturation time with normal BPS of 8/8 or 10/10 as proof that the fetus is not acidotic [64]. On the other hand, a BPS of 0–2/10 or 4/10 repeatedly, should justify delivery at local thresholds of viability in absence of a transient cause [65]. If very premature gestational age (e.g., <26 weeks) means delivery is not mandated by BPS no matter how low the score, then we advise not to utilize BPS for fetal monitoring.
Gestational hypertension and pre-eclampsia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
In an attempt to provide a safe and less expensive alternative to hospital care for women with pre-eclampsia, some home-care programs were initiated in the mid-1980s. Helewa and associates (62) reported their experience with one such program. Patients eligible for home-care management included those with blood pressure of <150/100 mmHg, protein level of <0.6 g in a 24-hour collection of urine, absence of symptoms of severe pre-eclampsia, platelet count of >120,000/mm3 and liver enzymes of <50 U/L. Enrolled patients were visited at home by a trained nurse. The nurse measured the blood pressure and fetal heart rate, reviewed fetal movement counts, tested for the presence and amount of protein in the urine, and checked for signs and symptoms of pre-eclampsia. An assessment of the fetal biophysical profile and biochemical profile and a visit to the attending physician were carried out on a weekly basis. The program nurse contacted the physician if clinical deterioration was noted. Labor was induced electively at term when the patient had a favorable cervix or whenever pre-eclampsia became severe or there were signs of fetal distress. In this study, 321 patients met the criteria and were enrolled in the home-care program. A total of 141 patients (44%) were admitted to the antepartum unit for inpatient monitoring: nine had severe pre-eclampsia. The mean length of enrollment in the home-care program was 11.5 days (1–42 days). Hospital stay was reduced from 5.7 days to 3.7 days, and cost was reduced by 74%.
DRCOG OSCE for Circuit C Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Fetal well-being may be monitored by the biophysical profile (fetal movements, fetal breathing movements, fetal tone, amniotic fluid volume, fetal cardiotocograph), by the cardiotocograph alone and by Doppler waveform studies of the fetal circulation.
The relationship of foetal superior mesenteric artery blood flow and the time to first meconium passage in newborns with late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Melih Velipasaoğlu, Ozge Surmeli Onay, Adviye Cakil Saglık, Ozge Aydemir, Huseyin Mete Tanır, Ayşe Neslihan Tekin
The pregnant women who agreed to participate in the study were evaluated twice weekly with Doppler ultrasound and biophysical profile scoring. The Doppler velocimetry parameters including PI and resistance index (RI) of UA, MCA and SMA, cerebroplacental ratio (CPR) (MCA PI/UA PI) and the ratios of UA PI/SMA PI, MCA PI/SMA PI were studied in each examination and percentiles according to the gestational weeks were noted (Ebbing et al. 2007; Ebbing et al. 2009b; Kivilevitch et al. 2011). Umbilical artery Doppler acquisitions were made from free loop of the umbilical cord. Middle cerebral artery was located by colour Doppler in the Willis polygon and acquisitions were performed from the proximal part of the MCA. To identify the SMA, in sagittal plane of the foetus Doppler frame was placed on the abdominal aorta and two unpaired branches of abdominal aorta were visualised: truncus coeliacus and SMA. Superior mesenteric artery is placed caudally to the truncus coeliacus.
Cerebroplacental doppler ratio and perinatal outcome in late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Ozge Kahramanoglu, Oya Demirci, Mucize Eric Ozdemir, Agnese Maria Chiara Rapisarda, Munip Akalin, Ali Sahap Odacilar, Hayal Ismailov, Gizem Elif Dizdarogullari, Aydin Ocal
The CPR may predict earlier delivery in late-onset FGR. Among our patients, 49% of those with abnormal CPR gave birth before term. However, only less than one of five patients in the normal CPR group had a preterm birth. One possible explanation is that the abnormal CPR group had a significantly higher rate of oligohydramnios resulting in a lower biophysical profile score. Accordingly, foetuses with abnormal CPR had a lower birth weight. Both findings may be explained with the association of low CPR and placental insufficiency. Khalil (2017) studied the association between adverse perinatal outcomes and CPR. They evaluated 7944 pregnancies, retrospectively. They didn’t state whether they exclude pregnancies with congenital/chromosomal abnormality. Similar to our results, the mean birth weight of the foetuses with abnormal CPR was lower than those with normal CPR.
Evaluation of Fetal Serum Thiol/Disulfide Homeostasis and Ischemia-Modified Albumin Levels in Fetal Distress
Published in Fetal and Pediatric Pathology, 2022
Seyit Ahmet Erol, Atakan Tanacan, Orhan Altinboga, Filiz Halici Ozturk, Burcin Salman Ozgu, Yasemin Tasci, Salim Neselioglu, Ozcan Erel, Dilek Sahin
Identification of fetal/neonatal distress may be challenging for physicians. Intrapartum fetal heart rate monitoring, fetal biophysical profile, contraction stress test, Doppler velocimetry, fetal scalp blood sampling, Apgar score, and umbilical cord blood acid–base analysis have been used for the estimation of fetal/neonatal distress with conflicting results for many years. However, there is no consensus on the optimal method for the diagnosis of fetal/neonatal distress at present. Timely diagnosis of fetal/neonatal distress is crucial to establish favorable management protocols. Deciding the optimal time and route of delivery, organizing neonatology staff for further interventions after delivery, selecting appropriate cases for advanced treatment options like neonatal therapeutic hypothermia are key steps in achieving favorable outcomes. Appropriate assessment of fetal/neonatal hypoxia is important to protect physicians from medico-legal pressure. Thus, researchers all over the world have been working on novel methods to help physicians in the objective estimation of fetal/neonatal status. Analysis and interpretation of hypoxia-related blood markers seem to be a promising option according to the findings of recent studies. In the present study, we investigated the association of fetal serum thiol/disulfide homeostasis and IMA levels with FD to evaluate their possible role reflecting fetal/neonatal hypoxia. Hereby, they may give clues to clinicians about the possible time of intrauterine ischemic condition and they may reveal some of the complex pathologic metabolic processes behind fetal/neonatal hypoxia.