Assessment of Fetal Well-Being in Labor Fetal Heart Rate Patterns — Their Pathophysiology and Clinical Relevance
Miriam Katz, Israel Meizner, Vaclav Insler in Fetal Well-Being, 2019
In 1822, Kergaradec described auscultation of the fetal heart sound as the only method by which fetal life and well-being have been assessed. Half a century later, using improved equipment, Hon and Hess succeeded in recording fetal ECG continuously through the maternal abdominal wall. Their recordings allowed an analysis of the actual fetal cardiac activity with regard to its regularity and rhythm. Fetal activity and uterine contractions are monitored externally by a device which is strapped to the mother’s abdomen, preferable over the uterine fundus. The baseline fetal heart rate (FHR) represents a result of intrinsic rate of contractions of the fetal heart as modified by the mediatory action of both parts of the autonomic nervous system, the sympathetic and the parasympathetic. Fetal tachycardias may also be seen without any apparent etiological cause similar to paroxysmal atrial tachycardia of the adult. Sinusoidal pattern is characterized by the absence of short-term variability and preservation of the long-term variability of the FHR.
Third Stage Of Labor
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
Oxytocin has historically been the uterotonic of choice for postpartum hemorrhage prophylaxis, as it reduces blood loss and has fewer side effects compared with other agents such as ergot alkaloids and misoprostol. The third stage of labor involves separation of the placenta with capillary hemorrhage and shearing of the placental surface when the uterus contracts after delivery of the infant. Signs of separation include a gush of blood, cord lengthening, and the uterine fundus becoming more globular and firmer. Oxytocin binds to specific uterine receptors with immediate action, causing increasing strength and frequency of contractions. Ergot alkaloids cause sustained tonic contraction of uterine smooth muscle by stimulation of alpha-adrenergic myometrial receptors. Recent evidence suggests that numerous regimens of uterotonic agents, including oxytocin with ergot alkaloids, carbetocin alone, or oxytocin with misoprostol, are more effective at reducing blood loss at delivery than oxytocin alone.
The opioid neuropeptides in uterine fibroid pseudocapsules: a putative association with cervical integrity in human reproduction
Published in Gynecological Endocrinology, 2013
Antonio Malvasi, Carlo Cavallotti, Giuseppe Nicolardi, Marcello Pellegrino, Daniele Vergara, Marilena Greco, Ioannis Kosmas, Ospan A. Mynbaev, Jun Kumakiri, Andrea Tinelli
The myoma pseudocapsule (MP) is a fibro-vascular network rich of neurotransmitters, as a neurovascular bundle, surrounding fibroid and separating myoma from myometrium. We investigated the distribution of the opioid neuropeptides, as enkephalin (ENK) and oxytocin (OXT), in the nerve fibers within MP and their possible influence in human reproduction in 57 women. An histological and immunofluorescent staining of OXT and ENK was performed on nerve fibers of MP samples from the fundus, corpus and isthmian-cervical regions, with a successive morphometric quantification of OXT and ENK. None of the nerve fibers in the uterine fundus and corpus MPs contained ENK and the nerve fibers in the isthmian–cervical region demonstrated an ENK value of up to 94 ± 0.7 CU. A comparatively lower number of OXT-positive nerve fibers were found in the fundal MP (6.3 ± 0.8 CU). OXT-positive nerve fibers with OXT were marginally increased in corporal MP (15.0 ± 1.4 CU) and were substantially higher in the isthmian–cervical region MP (72.1 ± 5.1 CU) (p
Risk factors for relaparotomy after cesarean delivery and related maternal near-miss event due to bleeding
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2020
Mehmet Ozgur Akkurt, Bora Coşkun, Tuğberk Güçlü, Tayfur Çift, Engin Korkmazer
Aim: To define the risk factors for relaparotomy after cesarean delivery (RLACD) and related maternal near-miss event due to bleeding. Methods: In this retrospective descriptive case-control study, women who underwent RLACD (n = 46) only for bleeding between 2012 and 2017 were reviewed. Factors that could predict relaparotomy and related near-miss event were evaluated. Maternal characteristics, laboratory findings and surgical features were compared with a control group (n = 230) that included noncomplicated cesarean deliveries (CD). Logistic regression analysis was used to identify independent factors for relaparotomy. Results: RLACD for bleeding was required in 0.26% of patients and the incidence increased gradually over years (0.16% in 2013 versus 0.44% in 2017). Mean interval between CD and subsequent relaparotomy was 15.7 ± 3.2 hours. The sources of bleeding in descending order of frequency included; uterine fundus and placental bed (39.1%), cervix (21.7%), undetermined (17.3%), superior epigastric artery (13%), superficial epigastric artery (8.1%). Longer duration of CD (adjusted odd ratio (aOR) 1.82, 95% CI 1.02–2.53), increased number of prior CDs (aOR 2.51, 95% CI 1.09–5.78), preeclampsia (aOR 3.48, 95% CI 1.21–7.19) were found to be independent risk indicators for RLACD. Moreover, longer duration of interval between CD and relaparotomy (p = .005), longer relaparotomy duration (p = .012) and greater drop in hemoglobin level (p = .001) were found to be the predictors of maternal near-miss event. Conclusions: Patients with identified risk factors should be managed properly in order to prevent relaparotomy and near-miss event after CD. Also, urgent decision of surgical intervention might reduce the risk of maternal near-miss event.
Gynefix® tales: cervical perforation and repeated late expulsion with the Gynefix® device
Published in The European Journal of Contraception & Reproductive Health Care, 2008
Anjana Oswal, Ashwini Oswal, Sofronis Loizides, Christine Robinson
We describe two unusual cases; both patients wish to continue using the Gynefix® despite experiencing difficulty with the device. In case A, the marker string of the Gynefix® perforated the full thickness of the cervix and was visualized on the left lateral aspect of the cervix. Three months later the string had moved again and could no longer be visualized, but an ultrasound scan confirmed fundal implantation of the device. Case B demonstrates repeated late expulsion and failure of implantation of Gynefix®. Appropriateness of ultrasound with reference to measurement of the distance SS (between the peritoneal surface of the uterine fundus and the first copper sleeve of the Gynefix®), failure of implantation and problems with the new Gynefix® introducer are discussed.