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Fetal Heart Tracing

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1041. Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases. (Abstract)

Influence of carbon monoxide poisoning on the fetal heart monitor tracing: a report of 3 cases. The diagnosis of carbon monoxide poisoning in the third trimester of pregnancy requires an index of suspicion, and the appearance of the fetal heart monitor tracing may help in this regard.Three cases of third-trimester acute carbon monoxide poisoning occurred. In each pregnancy, the fetal heart monitor tracing on admission was correlated with the maternal carboxyhemoglobin level, and how the pattern (...) changed following the institution of therapy was analyzed.In all 3 cases, the initial fetal heart rate pattern demonstrated decreased variability with an elevated baseline and an absence of accelerations and decelerations. Within 45-90 minutes of treatment onset, the baseline fetal heart rate dropped by 20-40 beats per minute, the variability became moderate, and accelerations occurred. Absent accelerations with minimal variability, if caused by uteroplacental insufficiency, are usually preceded

2009 Journal of Reproductive Medicine

1042. Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. (Abstract)

Intrapartum nonreassuring fetal heart rate tracing and prediction of adverse outcomes: interobserver variability. We determined interobserver variability in the classification of fetal heart rate (FHR) tracing with periodic deceleration as being reassuring or nonreassuring and in the ability to predict emergency cesarean delivery (ECD) or umbilical arterial pH < 7.00.Five clinicians reviewed 100 FHR tracings 1 hour before abnormalities and, if applicable, the hour before delivery. We calculated (...) weighted Kappa coefficients (WKC) to assess interobserver variability and likelihood ratio of FHR tracing to identify ECD and low pH.Among 100 parturients, 46% of the women had ECD, and 2% of the women had low pH. The WKC for the classification of the FHR tracing as reassuring or nonreassuring in early labor was -0.12 and before delivery was 0.15. The WKC for ECD was 0.26 and for low pH was 0.21. The likelihood ratio for these 2 outcomes was < 2.0.There was poor agreement among the clinicians who

2008 American Journal of Obstetrics and Gynecology

1043. Fetal heart rate tracing patterns associated with congenital hypothyroidism. (Abstract)

Fetal heart rate tracing patterns associated with congenital hypothyroidism. This study was undertaken to determine fetal heart rate (FHR) tracing patterns associated with congenital hypothyroidism.FHR patterns of 59 women whose babies were diagnosed with congenital hypothyroidism were retrospectively compared with tracings of 78 of their siblings. Tracings were interpreted during the first stage of labor. Multivariable analysis was used to control for confounders.Neonates with congenital (...) hypothyroidism had significantly higher rates of reduced variability in FHR tracing patterns as compared with those without congenital hypothyroidism (49.2% vs 3.8%; odds ratio, 24.1; 95% confidence interval, 6.8-85.3; P < .001). No significant differences were noted between the groups regarding decelerations or baseline abnormalities. The significant association between congenital hypothyroidism and reduced variability persisted after controlling for confounders such as treatment with pethidine, MgSO4

2009 American Journal of Obstetrics and Gynecology

1044. Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes. (Abstract)

Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes. The objective of the study was to evaluate, in labors complicated by thick meconium-stained amniotic fluid, the association between specific fetal heart rate (FHR) patterns and adverse perinatal outcomes.A retrospective cohort study of patients with FHR tracing data (n = 1638) from a previously reported randomized controlled trial of amnioinfusion (...) for the prevention of meconium aspiration syndrome.The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and/or neonatal morbidity (moderately abnormal: adjusted odds ratio [OR], 1.67; 95% confidence interval [CI], 1.18-2.37; markedly abnormal: adjusted OR, 2.97; 95% CI, 1.88-4.67). Specific abnormalities that were associated with the risk of perinatal mortality and/or neonatal morbidity included prolonged decelerations (OR, 1.22; 95% CI, 1.02-1.48), severe

2008 American Journal of Obstetrics and Gynecology

1045. Effects of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate tracings as measured by computer analysis. (Abstract)

Effects of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate tracings as measured by computer analysis. To evaluate the effect of narcotic and non-narcotic continuous epidural anesthesia on intrapartum fetal heart rate (FHR) tracings as measured by computer analysis.We studied 37 women with uncomplicated pregnancies at term with reactive FHR tracings. The women were randomized to receive epidural anesthesia with either bupivicaine with fentanyl (...) .In early first stage of labor, there was no significant difference in pre- and postepidural anesthesia FHR baseline, accelerations of 10 and 15 beats per minute, episodes of high and low variation, and short- and long-term variation when using either narcotic or non-narcotic anesthetic agents.Thus, the clinician can consider the use of narcotic as well as non-narcotic continuous epidural anesthesia in the dosages used in our study with its attendant advantages without fear of obscuring the fetal heart

1997 The Journal of maternal-fetal medicine Controlled trial quality: uncertain

1046. Comparison of the effects of meperidine and nalbuphine on intrapartum fetal heart rate tracings. (Abstract)

Comparison of the effects of meperidine and nalbuphine on intrapartum fetal heart rate tracings. To examine the effects of meperidine and nalbuphine on intrapartum fetal heart rate (FHR) tracings using computer analysis.We studied 28 women with uncomplicated pregnancies in early labor at term with reactive FHR tracings. The women were randomized to receive either meperidine 50 mg or nalbuphine 10 mg intravenously on request. One-hour FHR recordings were obtained before and immediately after (...) ). Meperidine had no significant effect on any FHR characteristic.In the early intrapartum period of normal term pregnancies and at commonly used dosages, nalbuphine had a significant effect on FHR tracings, whereas meperidine had no effect, as determined by computer analysis.

1995 Obstetrics and Gynecology Controlled trial quality: uncertain

1047. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. (Abstract)

Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. There are no randomized studies on neonatal outcome after spinal versus general anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. This study examined both markers of neonatal hypoxia and maternal hemodynamics.Seventy patients were randomized to general (n = 35) or spinal anesthesia (n = 35 (...) (7.20 vs. 7.23) after spinal anesthesia. Post hoc analysis showed that if maternal diastolic blood pressure on admission was greater than 110 mmHg, neonatal umbilical arterial base deficit was greater after spinal anesthesia. There was no difference in the number of patients with Apgar scores less than 7 at 1 or 5 min or umbilical arterial pH less than 7.2 or in the requirements for resuscitation.In preeclamptic patients with a nonreassuring fetal heart trace, spinal anesthesia for cesarean delivery

2003 Anesthesiology Controlled trial quality: uncertain

1048. Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Compliance with ACOG guidelines. (Abstract)

Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Compliance with ACOG guidelines. To review the English-language literature from 1990 to 2000 on cesarean delivery for "fetal distress" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines.A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded (...) from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information.Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result

2003 Journal of Reproductive Medicine

1049. ST-segment analysis of the fetal electrocardiogram improves fetal heart rate tracing interpretation and clinical decision making. (Abstract)

ST-segment analysis of the fetal electrocardiogram improves fetal heart rate tracing interpretation and clinical decision making. Since its introduction into clinical use, the efficacy of electronic fetal heart rate (FHR) monitoring (EFM) has been questionable. This has been due partly to the marked variation in interpretation of the FHR pattern and subsequent decisions for obstetric intervention, (e.g., the need for prompt delivery). Current application of EFM is limited to the assessment (...) the decision for and timing of obstetric interventions. The incorporation of ST segment data with the standard FHR tracing may reduce the number of unneeded obstetric interventions when fetal compromise is absent.

2004 The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Controlled trial quality: uncertain

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