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Fetal Scalp pH

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181. Management of Normal Labor

elevation or depression; either finding presumably indicates fetal hypoxemia and has a high sensitivity and specificity for fetal acidosis. For STAN, an electrode must be attached to the fetal scalp; then changes in the T wave and ST segment of the fetal ECG are automatically identified and analyzed. If manual auscultation of fetal HR is used, it must be done throughout labor according to specific guidelines, and one-on-one nursing care is needed. For low-risk pregnancies with normal labor, fetal HR (...) through the cervix; an electrode is attached to the fetal scalp to monitor HR, and a catheter is placed in the uterine cavity to measure intrauterine pressure. Usually, external and internal monitoring are similarly reliable. External devices are used for women in normal labor; internal methods are used when external monitoring does not supply enough information about fetal well-being or uterine contraction intensity (eg, if the external device is not functioning correctly). External electronic fetal

2013 Merck Manual (19th Edition)

182. Magnetoencephalography

neurons are needed. Since current dipoles must have similar orientations to generate magnetic fields that reinforce each other, it is often the layer of , which are situated perpendicular to the cortical surface, that gives rise to measurable magnetic fields. Bundles of these neurons that are orientated tangentially to the scalp surface project measurable portions of their magnetic fields outside of the head, and these bundles are typically located in the . Researchers are experimenting with various (...) extent of hand somatosensory cortex by stimulation of the individual digits. This agreement between invasive localization of cortical tissue and MEG recordings shows the effectiveness of MEG analysis and indicates that MEG may substitute invasive procedures in the future. Fetal [ ] MEG has been used to study cognitive processes such as , , and in fetuses and newborns. Comparison with related techniques [ ] MEG has been in development since the 1960s but has been greatly aided by recent advances

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2012 Wikipedia

183. Testosterone

women. Increased muscle strength and mass, shoulders become broader and rib cage expands, deepening of voice, growth of the . Enlargement of . This might cause acne, subcutaneous in face decreases. Pubic hair extends to thighs and up toward , development of ( , , ), loss of scalp hair (androgenetic alopecia), increase in , periareolar hair, hair, , . Adult [ ] Testosterone is necessary for normal development. It activates genes in , which promote differentiation of . It regulates acute HPA (...) of testosterone to estradiol regulates male aggression in during breeding season. Rats who were given anabolic steroids that increase testosterone were also more physically aggressive to provocation as a result of "threat sensitivity". Brain [ ] The brain is also affected by this sexual differentiation; the converts testosterone into that is responsible for of the brain in male mice. In humans, masculinization of the fetal brain appears, by observation of gender preference in patients with of androgen

2012 Wikipedia

184. Chemotherapy

the teratogenic risk and adverse effects on cognitive development, but it may increase the risk of various and fetal myelosuppression. In males previously having undergone chemotherapy or radiotherapy, there appears to be no increase in genetic defects or congenital malformations in their children conceived after therapy. The use of and might increase this risk. In females previously having undergone chemotherapy, miscarriage and congenital malformations are not increased in subsequent conceptions. However (...) to serious health risks. Many studies show that antineoplastic drugs could have many side effects on the reproductive system, such as fetal loss, congenital malformation, and infertility. Health care workers who are exposed to antineoplastic drugs on many occasions have adverse reproductive outcomes such as spontaneous abortions, stillbirths, and congenital malformations. Moreover, studies have shown that exposure to these drugs leads to menstrual cycle irregularities. Antineoplastic drugs may also

2012 Wikipedia

185. Sensitivity and specificity of intrapartum computerised FIGO criteria for cardiotocography and fetal scalp pH during labour: multicentre, observational study. (PubMed)

Sensitivity and specificity of intrapartum computerised FIGO criteria for cardiotocography and fetal scalp pH during labour: multicentre, observational study. To identify sensitivity and specificity of computerised cardiotocography (CTG) analysis for fetal acidosis during delivery.Retrospective observational study.Tertiary referral labour ward, Technical University München (TUM) and University Witten/Herdecke (UWH).All deliveries, which had at least one fetal scalp pH measurement (...) and electronically saved CTG traces, between 2000 and 2002 (TUM) and between 2004 and 2005 (UWH).Correlation analysis of fetal scalp pH values and computerised International Federation of Obstetrics and Gynecology (FIGO) classification using 'CTG Online' program of digitally saved CTG traces.Fetal scalp pH values, FIGO parameter (baseline, variability, acceleration and deceleration) using computerised analysis.Both collectives showed a high sensitivity (95.0%) for computerised FIGO classification 'suspect

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2008 BJOG

186. Hepatitis C in the Perinatal Period

linked to the use of a scalp electrode. However, as internal monitoring, including scalp pH measurement, constitutes a skin breaking procedure, it should be used only if deemed absolutely necessary for the assessment of fetal well-being. D. POSTPARTUM MANAGEMENT 1. General points Basic hygiene and the disposal of potentially infected material should be discussed with the patient. 2. Breastfeeding HCV RNA and anti-HCV antibodies have been detected in colostrum and breast milk. However, in multiple (...) . July 2003 Page 1 of 8 Hepatitis C in the Perinatal Period V. ASSESSING A WOMAN’S RISK FOR HCV 4. Effect of HCV infection on pregnancy Although there is currently little data on HCV infection in pregnancy, the available data does not suggest an increased risk of congenital malformation, fetal distress, stillbirth or prematurity. Women with HCV and their fetuses are at no greater risk of obstetric or perinatal complications compared with other women. There is no contraindication to pregnancy

2003 British Columbia Perinatal Health Program

187. Fetal Distress

outcomes. Fetal scalp blood sampling during labour, to measure lactate (in preference to pH if available), may be indicated for an abnormal intrapartum CTG [ ] . See separate article for details. A composite risk score, based on fetal Doppler flow resistance indices, has shown promise in identifying those fetuses antenatally who develop fetal distress intrapartum [ ] . Management There have been no recent trials of operative versus conservative management of suspected fetal distress [ ] . Signs (...) with suspected fetal compromise for improving outcomes. Cochrane Database Syst Rev. 2016 Jul 127:CD008968. doi: 10.1002/14651858.CD008968.pub3. ; NICE Clinical Guideline (November 2011) ; Decision-to-incision time and neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2014 Mar123(3):536-48. doi: 10.1097/AOG.0000000000000132. ; Crash emergency cesarean section: decision-to-delivery interval under 30 min and its effect on Apgar and umbilical artery pH. Arch Gynecol Obstet. 2005 Dec273(3

2008 Mentor

188. Intrapartum Fetal Monitoring

is: [ ] : Lactate (mmol/L) pH Interpretation ≤4.1 ≥7.25 Normal 4.2-4.8 7.21-7.24 Borderline ≥4.9 ≤7.20 Abnormal All fetal scalp blood estimations should be interpreted taking into account the previous measurement, the rate of progress in labour and the clinical features of the mother and baby. Normal: offer repeat fetal blood sample after at least 1 hour, if still indicated by CTG, or sooner if additional non-reassuring or abnormal features appear. Borderline: offer repeat fetal blood sample after 30 minutes (...) emergency cesarean section: decision-to-delivery interval under 30 min and its effect on Apgar and umbilical artery pH. Arch Gynecol Obstet. 2005 Dec273(3):161-5. Epub 2005 Jul 26. ; Intrapartum fetal scalp lactate sampling for fetal assessment in the presence of a non-reassuring fetal heart rate trace. Cochrane Database Syst Rev. 2010 Mar 17(3):CD006174. doi: 10.1002/14651858.CD006174.pub2. ; Scientific Impact Paper No 47, Royal College of Obstetricians and Gynaecologists, Jan 2015 ; NICE, Jun 2013

2008 Mentor

189. Labor induction with prostaglandin E-1 misoprostol compared with dinoprostone vaginal insert: a randomized trial

delivered vaginally within 12 hours compared with 22% of patients in the dinoprostone group (p<0.001). Tachysystole occurred more frequently in the misoprostol group (21.3%) than in the dinoprostone group (7%), (p<0.004).62% of operative vaginal deliveries in the misoprostol group were due to abnormalities in the FHR pattern, compared with 46.7% in the dinoprostone group, (p=0.51). No significant differences between the groups were noted in terms of mode of delivery, frequency of scalp pH sampling (...) indications for labour induction, (2)medical complications, (3) absence of active labour or fetal distress, (4) no previous caesarean delivery, (5) singleton pregnancy with vertex presentation and no contraindications to vaginal delivery. Setting Hospital. The study was carried out at the University Medical Center, Jacksonville, Florida, USA. Dates to which data relate Effectiveness and resource data were collected between 1 February and 30 October 1996. The price year was 1996. Source of effectiveness

1998 NHS Economic Evaluation Database.

190. Preinduction cervical ripening with commercially available prostaglandin E(2) gel: a randomized, double-blind comparison with a hospital-compounded preparation

(irrespective of dosages), as well as rates of labour as a result of preinduction cervical ripening alone and of vaginal deliveries not requiring oxytocin infusion, were all similar. (3)Neonatal and maternal outcomes (birthweights, cord pH and base excess, Apgar scores, NICU admission/days, and endometritis) - no significant differences were noted. (4) Intrapartum complications and mode of delivery (FHR abnormalities, dystocia, bleeding >500 ml, scalp pH, and mode of delivery) - similar results were found (...) ) years or to the compounded group(n=64), average (SD) age 24.1 (6.1) years. From a total of 201 women initially selected, 67 (33.3%) were ineligible due to frequent uterine contractions (20), previous cesareans (13), abnormal antepartum fetal testing breech presentations (3), under 18 years of age (10), substantial bleeding (6), or fevers of unknown origin (3). Study design This was a randomised controlled trial, carried out in a single centre. No loss to follow up was stated. The gels were applied

1995 NHS Economic Evaluation Database.

191. A French randomized controlled trial of ST-segment analysis in a population with abnormal cardiotocograms during labor (PubMed)

A French randomized controlled trial of ST-segment analysis in a population with abnormal cardiotocograms during labor OBJECTIVE: The purpose of this study was to assess whether knowledge of ST-segment analysis was associated with a reduction in operative deliveries for nonreassuring fetal status (NRFS) or with a need for at least 1 scalp pH during labor. STUDY DESIGN: Seven hundred ninety-nine women at term with abnormal cardiotocography or meconium-stained amniotic fluid (7%) were assigned (...) randomly to the intervention group (cardiotocography + STAN) or the control group (cardiotocography) in 2 university hospitals in Strasbourg, France. Scalp pH testing was optional in both groups. Abnormal neonatal outcome was pH <7.05 or umbilical cord blood artery base deficit of >12 or a 5-min Apgar score of <7 or neonatal intensive care unit admission or convulsions or neonatal death. Study power was 80% for the detection of a prespecified reduction from 50%-40% in operative delivery

2007 EvidenceUpdates Controlled trial quality: predicted high

192. Outcomes of women presenting in active versus latent phase of spontaneous labor. (PubMed)

and 2,697 latent phase women met the study criteria. More latent phase women were nulliparous (51 compared with 28%). Latent phase women had more cesarean deliveries (nulliparas 14.2% compared with 6.7%, multiparas 3.1% compared with 1.4%). Controlling for parity, latent phase women had more active phase arrest (odds ratio [OR] 2.2), oxytocin use (OR 2.3), scalp pH performed (OR 2.2), intrauterine pressure catheter placed (OR = 2.2), fetal scalp electrocardiogram monitoring (OR = 1.7), and amnionitis

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2005 Obstetrics and Gynecology

193. Delayed pushing with lumbar epidural analgesia in labour. (PubMed)

Delayed pushing with lumbar epidural analgesia in labour. Seventy-six primigravidae with epidural analgesia were randomly assigned to one of two groups for management in the second stage. In one group the women delayed pushing and in the other they were managed conventionally. The two groups were well matched for maternal and infant characteristics, including position and level of the presenting part at full dilatation and fetal scalp blood pH. The mean waiting time in the second stage before (...) pushing was increased from 27 min in the conventional group to 123 min in the delayed group. This delay was not associated with an increase in abnormal fetal heart rate abnormalities or any decrease in umbilical cord pH or Apgar scores. In contrast, the delay was associated with an increase in spontaneous deliveries and a decrease in forceps deliveries (P = 0.06). These findings suggest a need for redefining the management of the second stage of labour with epidural analgesia.

1983 British journal of obstetrics and gynaecology Controlled trial quality: uncertain

194. Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American College of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies. (PubMed)

nulliparous term parturients who were randomly allocated to spontaneous or elective low-forceps delivery. Patients with either maternal or fetal disorders that could affect the outcome were excluded. All deliveries were attended by three experienced obstetricians.Spontaneous and forceps delivery group were similar regarding maternal or gestational age, fetal scalp pH, antepartum maternal hemoglobin and hematocrit levels, maternal outcome, mean birth weight, and number of neonates with low Apgar scores (...) or cord arterial pH < 7.20. In the spontaneous delivery group the time elapsed since randomization to delivery was significantly longer (18 vs 10.2 minutes, p < 0.001) and the mean cord arterial pH was significantly lower (7.23 vs 7.27, p = 0.01) than in the forceps delivery group.Elective low forceps delivery may be used to shorten the second stage of labor without immediate maternal or neonatal side effects.

1995 American journal of obstetrics and gynecology Controlled trial quality: uncertain

195. STAN – ST Waveform Analysis Combined With Cardiotocography for Fetal Monitoring During Childbirth

A. Fetal heart rate patterns and ECG ST segment changes preceding metabolic acidaemia at birth. BJOG 2005;112(2):160-5. Luzietti R, Erkkola R, Hasbargen U, Mattsson LA, Thoulon JM, Rosen KG. European Community multi-Center Trial "Fetal ECG Analysis During Labor": ST plus CTG analysis. J Perinat Med 1999;27(6):431-40. Luttkus AK, Noren H, Stupin JH, Blad S, Arulkumaran S, Erkkola R et al. Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study. J Perinat (...) , it provides only an on-the-spot account. Since the situation can change quickly, there may be a need to repeat the test. STAN combines CTG with ST waveform analysis, ie, analysis of that part of the fetal ECG called the ST segment, which changes if the fetus experiences hypoxia (oxygen deficiency). Hence, STAN technology uses CTG to identify a high-risk group. The method is intended for fetal monitoring during childbirth when it has been determined that continuous monitoring via a scalp electrode

2006 Swedish Council on Technology Assessement

196. Fetal electrocardiogram (ECG) for fetal monitoring during labour. (PubMed)

electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis (three trials, 8872 women) was associated with fewer babies with severe metabolic acidosis at birth (cord pH less than 7.05 and base deficit greater than 12 mmol/L) (relative risk (RR) 0.64, 95% confidence interval (CI) 0.41 to 1.00, data from 8108 babies), fewer babies with neonatal encephalopathy (three trials, RR 0.33, 95% CI 0.11 to 0.95) although the absolute number of babies with encephalopathy was low (n = 17 (...) ), fewer fetal scalp samples during labour (three trials, RR 0.76, 95% CI 0.67 to 0.86) and fewer operative vaginal deliveries (three trials, RR 0.87, 95% CI 0.78 to 0.96). There was no statistically significant difference in caesarean section (three trials, RR 0.97, 95% CI 0.84 to 1.11), Apgar score less than seven at five minutes (three trials, RR 0.80, 95% CI 0.56 to 1.14), or admissions to special care unit (three trials, RR 0.90, 95% CI 0.75 to 1.08). Apart from a trend towards fewer operative

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2006 Cochrane

197. Birth technology: electronic fetal monitoring

in the field. They found no unpublished studies relevant to the review. Study selection Study designs of evaluations included in the review Randomised controlled trials (RCTs). Specific interventions included in the review Continuous EFM (external Doppler ultrasound transducer or fetal scalp electrode) with or without fetal blood sampling (FBS) in comparison with handheld auscultation, or continuous compared with intermittent EFM. Participants included in the review Pregnant women in labour. Outcomes (...) Birth technology: electronic fetal monitoring Birth technology: electronic fetal monitoring Birth technology: electronic fetal monitoring Crozier K, Sinclair M Authors' objectives To assess the effectiveness of electronic foetal monitoring (EFM). Searching The authors searched MEDLINE (1966 to 1998) using multiple MeSH terms, MIDIRS (midwifery database) and the Cochrane Database of Systematic Reviews for relevant studies. The authors also performed a manual search and consulted experts

1999 DARE.

198. Use of Intrapartum Biophysical Profile When Fetal Heart Rate Monitoring is Non-reassuring in Labor

is uncomfortable about or feels does not absolutely provide fetal reassurance. Inclusive FHR patterns will be repetitive late decelerations, recurrent moderate to severe variable decelerations, reduced long or short-term variability, prolonged bradycardia (<120/min) that resolves, persistent fetal tachycardia (>160/min for >60 min,) or any other FHR patterns necessitating further fetal well being evaluation (like scalp pH or scalp stimulation). Exclusion Criteria: Multiple gestation Gestational age < 35 weeks (...) Use of Intrapartum Biophysical Profile When Fetal Heart Rate Monitoring is Non-reassuring in Labor Use of Intrapartum Biophysical Profile When Fetal Heart Rate Monitoring is Non-reassuring in Labor - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove

2007 Clinical Trials

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

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 (...) 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

2003 Journal of Reproductive Medicine

200. Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth. (PubMed)

Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth. To estimate to what extent computerized fetal heart rate (FHR) parameters are affected by labor and to estimate the relationship between FHR parameters and the degree of fetal metabolic acidosis in laboring patients at term.Fifty-one women between 37 and 42 weeks' gestational age were recruited prospectively in the following groups: 1) nonlaboring women, and 2) laboring women requiring fetal scalp electrode (...) for continuous electronic FHR monitoring. Computerized FHR analysis was performed for 1 hour within 6 hours of delivery in the nonlaboring group and continuously throughout labor in the laboring group. Multiple linear regression analysis was used to determine the relationship between individual FHR parameters during the last hour before delivery and the degree of metabolic acidosis at birth.The umbilical cord artery base excess and pH did not show any significant correlation with any of the computer-derived

2003 Obstetrics and Gynecology

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