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Abnormal Labour
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Continuous electronic fetal monitoring is critical in every case of abnormal labour. While external cardiotocography is usually adequate, placement of a fetal scalp electrode is an option in the late part of the first stage.
Use of the birth pool during labour and delivery
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
The use of electrical equipment for monitoring the fetal heart rate during water births is contraindicated. A portable Doppler Sonicaid can be used to auscultate the fetal heart before, during and after a contraction with the woman standing out of the water and dried. A cardiotocograph recording of at least 10-20 min can be made every 4 h as an adjunct to intermittent monitoring.
Obstetric Management of Intrauterine Growth Retardation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
Evaluation of fetal heart rate takes into account baseline heart rate, variability, periodic changes, and decelerations. Several of the available scoring systems are illustrated in Table 2, but the simple approach of dividing fetal heart rate patterns into a “reactive” and a “nonreactive” test has been demonstrated to be as good a predictor of fetal condition as the more complicated scoring systems and is to be preferred.90–93 Nonstressed test, or antenatal cardiotocography, utilizes the Doppler technique to record fetal heart movements from the mother’s abdomen. A test is described as “normal” or “reactive” if the fetal baseline heart rate and variability are within normal limits;93 and the fetal heart responds, with accelerations of at least 15 beats per min, to fetal movements or uterine contractions. This type of heart rate pattern has been considered a reliable indication of fetal well-being, and fetal demise within a week of a reactive test is considered uncommon.94,95
Association between interleukin-6 levels in amniotic fluid after rupture of membranes during labour at term pregnancy and successful vaginal delivery: a prospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Min Jung Lee, Min Kyung Kim, Hyo Jin Lee, Kwang Hee Ahn, Hyeon Ji Kim, Jee Yoon Park
This prospective study included 50 consecutive patients who had undergone labour at term gestation (≥37 weeks) at Seoul National University Bundang Hospital from September 2019 to December 2020. Patients planning elective caesarean section without a trial of labour were not included. Cases with premature ROM, multifetal pregnancy, clinical chorioamnionitis with maternal fever, and major congenital anomalies were excluded. All patients were continuously monitored with cardiotocography for foetal heart rate tracing and observation of uterine contractions until delivery. Maternal baseline characteristics (age, parity, gestational age, hypertensive disorder, gestational diabetes, oligohydramnios, etc.) and obstetric outcomes (gestational age at delivery, delivery modes, neonatal birth weight, Apgar scores, neonatal intensive care unit (NICU) admission, etc.) were followed up and collected. The primary outcome of this study was the rate of successful vaginal delivery. The study protocol was approved by the Institutional Review Board of the Seoul National University Bundang Hospital (B-1803/456-301).
Foetal Pillow associated uterine and bladder rupture
Published in Journal of Obstetrics and Gynaecology, 2022
Adelle Jordan, Nelson Herbert, Dayle Rundle-Thiele, Sean Holland, Audris Wong
When she presented in spontaneous labour, cardiotocograph (CTG) was normal. Clinical assessment demonstrated 4 cm cervical dilatation, 4:10 strong regular uterine contractions and intact amniotic membranes. Artificial rupture of membranes (ARM) was performed 6 hours after presentation at 9 cm cervical dilatation and revealed meconium stained liquor. Oxytocin was not used in her labour at any stage. Stage 1 labour lasted 9 hours and 30 minutes. Stage 2 labour lasted 3 hours and 5 minutes. At full dilatation of the cervix, 1 hour was allowed for passive head descent. Reassessment after 2 hours of active pushing revealed an obstructed labour with the foetal head at station-1. A decision was made to proceed with an emergency caesarean section. After injection of a spinal anaesthetic a FP was placed as per the manufacturer’s guidelines. As soon as the FP was inserted frank blood was seen in the catheter and the urinary bag. A foetal bradycardia was immediately audible on doppler at 70 beats per minute. Intraoperatively, extensive adhesions and a Bandl’s ring were encountered. Entry to the peritoneal cavity revealed that the lower segment of the uterus had ruptured into the bladder, with foetal parts present within the bladder cavity and abdomen. The uterus was incised transversely below the Bandl’s ring and extended with a midline inverted T-incision. A left lateral inferior angle extension was noted towards the cervix and a forked lateral extension was noted on the right lateral angle.
Ovarian cysts in pregnancy: a narrative review
Published in Journal of Obstetrics and Gynaecology, 2021
Sachintha Senarath, Alex Ades, Pavitra Nanayakkara
Any surgery during a pregnancy warrants consideration of the wellbeing of the fetal. Preoperative, intraoperative and postoperative fetal monitoring is recommended in abdominal surgery in a mother with a viable foetus (Pearl et al. 2017). Prior to 26 weeks of gestation, Doppler auscultation is adequate, however, after 26 weeks a cardiotocograph is usually performed but this is centre-dependent. Although this has not been found to improve mortality, it does allow for early identification of fetal problems (Juhasz-Böss et al. 2014). Tocolytics should not be used prophylactically in pregnant women undergoing surgery but should be considered perioperatively when signs of preterm labour are present or other risk factors for this exist (Pearl et al. 2017). Furthermore, antibiotics should be prescribed as for non-pregnant patients with the exception of teratogenic agents. Maternal corticosteroids for fetal lung maturation for surgery between 24 to 34 weeks should be provided if time permitting (Juhasz-Böss et al. 2014; Naqvi and Kaimal 2015).