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Intrapartum Fetal Surveillance
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
The introduction of cardiotocography in the 1970s was one of the most important landmarks in the evolution of intrapartum fetal monitoring. The meta-analysis and the systematic reviews do not show any significant reduction in the major outcomes such as perinatal mortality or long-term neurological morbidity (cerebral palsy). However, its use is still advocated by most professional bodies for surveillance during labour and delivery. It should not be regarded as a substitute for good clinical judgement and observation nor as an excuse to leave a labouring mother alone. It is also used to assess the risk of major perinatal events in labour at the time of admission (admission CTG) even though there is a lack of evidence to continue such practice. In women with high-risk factors either before or during labour or when they are found to have an abnormality on intermittent auscultation, continuous CTG is advocated as the preferred method of monitoring the fetus in labour.
Assisted Vaginal Breech Delivery
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
If a decision has been made to proceed with an AVBD, then spontaneous onset of labour should be anticipated up to 40 weeks of gestation. Induction or augmentation of labour should be avoided as much as possible, because fetopelvic disproportion may be masked and may possibly lead to complications at the delivery of the fetus. Poor progress of labour may be a sign of fetopelvic disproportion, and this is an indication for caesarean delivery. The neonatal team should be alerted in case the neonate needs to be resuscitated. The fetus must be continuously monitored during labour by cardiotocography. The fetal membranes should be left intact for as long as possible, and the high risk of cord prolapse which could occur with spontaneous rupture of membranes or with amniotomy should be kept in mind (discussed in Chapter 2).
Obstetric Management of Intrauterine Growth Retardation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
In growth-retarded fetuses, blood-flow velocity waveform analysis shows a significant reduction, and often lacks in the diastolic component of the Doppler shift obtained from the fetal descending aorta and umbilical vessels.131,132 This is thought to reflect increased placental resistance, and this new technique may considerably improve the detection rate of the small-for- gestational-age fetus at risk of perinatal asphyxia and subsequent handicap. Recent studies have also suggested that blood flow velocity waveform analysis is an earlier and more sensitive predictor of fetal compromise than conventional cardiotocography.99 This implies that Doppler ultrasound may assist not only in reducing mortality, but, more importantly, morbidity in this group of infants and further developments in this field are awaited with interest.
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).
Pheochromocytoma diagnosed during pregnancy: a case report
Published in Gynecological Endocrinology, 2020
Giulia Misasi, Federica Pancetti, Andrea Giannini, Tommaso Simoncini, Paolo Mannella
Upon admission, she presented increased blood pressure (191/104 mmHg with cardiac frequency at 78 beats per minute [bpm]) yet denied headache, abdominal pain or scotoma. Further investigations did not demonstrate proteinuria in the 24 h urine sample (300 mg/24h–310 mg/24h) and her liver exams, creatinine and platelet counts were all in normal range. Fetal assessment with ultrasound and cardiotocography was reassuring. During her hospital stay, blood pressure was in normal range, except for some daily peaks of high pressure (164/105 mmHg, 89 bpm; 175/104 mmHg, 90 bpm; 183/106 mmHg, 71 bpm; 133/95 mmHg, 95 bpm) that were associated with palpitations and sweating of rapid spontaneous remission. Patient was discharged after nine days of admission with normal blood pressure and without symptoms. At 38 weeks of gestation, patient was admitted again for an elective cesarean section (she had two previous cesarean sections) and surgery was performed in the same day. During the surgical procedure, blood pressure raised to 240/210 mmHg which was promptly treated with intravenous urapridil 250 mg. A healthy masculine infant weighing 3690 g was obtained with an Apgar score of 9 at 5 min.
Evaluation of obstetric outcomes and prognostic significance of graft function in kidney transplant recipient pregnancies
Published in Hypertension in Pregnancy, 2020
Riza Madazlı, Didem Kaymak, Verda Alpay, Hakan Erenel, M. Tamer Dincer, Nurhan Seyahi
The gestational age of the pregnancies was based on the precise date of the last menstrual period and an ultrasound measurement of the crown-rump length in the first trimester. Routine follow-up of pregnancies increased to monthly until 24 weeks of gestation, then twice a month until the 32nd week, and then weekly until delivery. During the antenatal follow-up of the patients, a scanning test between the 11th and 14th weeks in the first trimester, a fetal anomaly scanning and uterine artery Doppler recordings between the 20th and 22nd weeks, and gestational diabetes scanning with 50 g oral glucose between the 24th and 28th weeks were applied. Fetal wellbeing was monitored by cardiotocography, modified biophysical profile or Doppler ultrasonography weekly or bi-weekly according to gestational status. Fetal distress was diagnosed by taking into account of fetal growth, cardiotocography, modified biophysical profile and Doppler findings together in an individualized manner. Serum creatinine, urea, hemoglobin levels, urinary protein quantification, and estimated glomerular filtration rates (eGFR) calculated using the Modification of Diet in Renal Disease formula (6) in the first, second, third trimesters were performed. First, second and third trimesters were defined as gestational ages between 6 and 14, 15–27, and ≥28 weeks, respectively.