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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.
Fetal Physical Parameters
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
A good blood circulation is important for fetal well being. Fetal heart rate is an indicator of cardiac function and is related to blood circulation. Although widely used in monitoring because of the relative simplicity of the procedure and equipment, it gives far from adequate information when a detailed circulatory assessment is called for. One such situation is the early determination of intrauterine growth retardation (IUGR). In the early stages of pregnancy the fetal heart is immature and FHR variations in a non stress test is unreliable. In these cases measurement of fetal blood flow can give valuable diagnostic information. Evolution of the field has not been according to the demands based upon physiological needs, but rather as per the capabilities or equipment and techniques emerging. Presently blood flow in the umbilical artery and vein and most of the major fetal blood vessels can be determined. Mainly ultrasonic technology is employed but it is likely that other principles such as nuclear magnetic resonance may also come in use.
Abnormal Cardiac Rhythm
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
Normal fetal heart rate is between 110 and 160 bpm. Periods of transient bradycardia or tachycardia are common and are of no clinical significance. When a fetal cardiac arrhythmia is diagnosed, extracardiac causes of tachycardia such as maternal medication (salbutamol, terbutaline), maternal pyrexia, and hyperthyroidism must first be excluded.
Intake of eggs, choline, lutein, zeaxanthin, and DHA during pregnancy and their relationship to fetal neurodevelopment
Published in Nutritional Neuroscience, 2023
Danielle N. Christifano, Lynn Chollet-Hinton, Dirk Hoyer, Alexander Schmidt, Kathleen M. Gustafson
The autonomic nervous system is a basic neural system that is affected by choline by way of acetylcholine19 and a system through which choline affects both physiological and behavioral outcomes.20 Early in development, fetal heart rate is largely under sympathetic control.21 At about 30 weeks gestational age (GA), increasing vagal influence results in lower HR, greater HRV and the emergence of distinct HR patterns attributable to fetal activity states.22 This developmental shift to greater cardiac vagal activity reflects the ability of the integrated nervous system to mediate physiological and in utero behavioral and regulatory activity. The ability to flexibly adjust HR and other complex, integrated oscillatory systems (breathing, suck/swallow) in response to challenges during the transition to life outside the womb, gives the newborn an adaptive advantage. A newborn with more mature autonomic-central nervous system integration is better able to maintain homeostasis, coordinate sucking and breathing, have more optimal sleep-wake state profiles and in general, experiences a smoother transition to extrauterine life.23
Obesity decreases the EC50 of epidural ropivacaine when combined with dexmedetomidine for labor analgesia
Published in Expert Review of Clinical Pharmacology, 2021
Xiaojun Chen, Meng Cai, Xiaofeng Lei, Jin Yu
The venous access of the left upper limb was established for each parturient in the delivery room. Vital signs, such as respiratory rate, heart rate, blood pressure, and pulse oxygen saturation (SpO2), were collected every 5 minutes by a monitor (BeneVision N12, Mindray, China). Fetal heart rate was recorded by a doppler monitor (M2702A, M2703A, Philips, Germany). Epidural analgesia was administered to the parturient at L2-3 interspace with an 18-gauge Tuohy needle in the left lateral position, followed by cephalad insertion of an epidural catheter (3–4 cm) into the epidural space. A test dose of lidocaine (1%, 5 mL) was administered after a negative confirmation of an aspirate test for blood and cerebrospinal fluid. A loading dose of 5 mL ropivacaine with 0.5 µg/mL dexmedetomidine was administered. Thereafter, the mixed solution was infused continuously with a patient-controlled-analgesia pump (PCA-100B, Zhejiang Chenhe Medical Devices Corp., China) at 10 mL/h. The parturients were instructed to use the pump for bolus dose on demand, which was set at 1.5 mL bolus dosage with 15 minutes lockout time. The local anesthetic solutions were prepared by an anesthesia nurse, and investigators were blind to these solutions.
Prehospital Transfusion of Low-Titer O + Whole Blood for Severe Maternal Hemorrhage: A Case Report
Published in Prehospital Emergency Care, 2020
Ryan Newberry, C. J. Winckler, Ryan Luellwitz, Leslie Greebon, Elly Xenakis, William Bullock, Michael Stringfellow, Julian Mapp
The patient arrived at the community hospital’s emergency department at 0055 with ongoing resuscitation with LTO + WB. Her vital signs at 0055 were a pulse of 97 bpm, blood pressure of 100/56 mmHg, respiratory rate of 18, oxygen saturation (O2) 99% and shock index of 1.0. Initial serum labs revealed a hemoglobin of 9.5 g/dL and hematocrit of 28.0%. Her chemistry panel and coagulation studies were within normal limits. Pelvic examination performed by the emergency physician noted coagulated blood in the vaginal vault with minimal active bleeding. A fetal heart rate was found to be 140 bpm. The remainder of her emergency department course included administration of 1.5 grams of cefuroxime, 30 mL of citric acid/sodium citrate and 1000 mL of Lactated Ringers solution. The patient was then transferred to the operating suite for emergent cesarean section.