Intrapartum Fetal Surveillance
Gowri Dorairajan in 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.
Obstetric Management of Intrauterine Growth Retardation
Asim Kurjak, John M. Beazley in 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
Characterization Of Fluids And Gases
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Until fairly recently fetal blood sampling was the only available approach to objective acid-base balance determination. After rupture of the membranes under direct visualization of the presenting part, which in almost all cases in which this procedure is carried out is the head, a “stab” incision to about 2 mm depth with a scalp blade is made. Blood is collected in a 200-μl heparinized capillary tube and sent to the laboratory. Bleeding is checked by applying pressure on the scalp wound with a sponge. If the blood sample is correctly collected without air bubbles and the collection tube is immediately sealed on filling, a complete blood analysis can be done which includes blood gas estimations besides the pH. Although the reliability of the data obtained is good, obviously such a traumatic procedure cannot be recommended as a routine. Repetition to follow the fetal status is not often justified unless the pH falls below about 7.25. As a result, application is limited to those situations in which cardiotocography raises a suspicion of fetal distress but the FHR information is inconclusive. Clinical need has spurred research in search of more acceptable methods.
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).
Amitriptyline poisoning at 34 weeks of pregnancy
Published in Clinical Toxicology, 2018
Ka Yuen Tang
On arrival in the emergency department, she was drowsy with a Glasgow Coma Scale score of 9/15 (E2V2M5). She responded to painful stimuli only. Her blood pressure was 95/55 mmHg, with a pulse of 121 beats/min. Her body temperature was 36.5 °C. Oxygen saturation was 95% on room air. Her pupils were equal, reactive and 3 mm in size. She exhibited dry mucous membranes but normal bowel sounds. ECG showed a sinus tachycardia at 142 beats/min, QRS 109ms and a terminal R (4mm) in aVR. Her clinical features and ECG findings were typical of tricyclic antidepressant (amitriptyline) intoxication, with part of the sedation and tachycardia attributed to chlorpheniramine overdose. Ultrasound revealed a single fetus with a heart rate of 150/min. Repeated ECG in 15 min revealed further widening of the QRS complex to 116 ms (Figure 1). Therefore, 100 mEq of sodium bicarbonate was administered intravenously by bolus. She was transferred to the intensive care unit for further management. She became progressively less responsive and was intubated to protect her airway. Cardiotocography initially revealed a fetal heart rate of 140 bpm with decreased variability and occasional uterine contractions. However, fetal bradycardia developed subsequently at 7 hours post-ingestion and an emergency lower segment cesarean section was performed with the delivery of a live infant that appeared flaccid, with a heart rate of 70–75/min at birth. Apgar scores were 3 (1 min) and 6 (5 min). He was intubated and administered 4mEq sodium bicarbonate and normal saline.
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.
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