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Fetal Scalp pH

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181. Amnioinfusion

Related Chapters II. Indications Oligohydramnios with or without Preterm prolonged Recurrent s Cephalic presentation Thick particulate Meconium staining of amniotic fluid III. Contraindication Amnioinfusion should not delay definitive management (e.g. , ) Scalp pH < 7.20 s Uterine anomaly Undiagnosed IV. Efficacy Heavy meconium stained fluid Improved perinatal outcome Reduced risk Decreased NICU admissions Decreased risk of Cord Compression suspected Reduces s Lowers rate of ceserean sections V (...) . Technique Cervical exam Evaluate dilation and presentation Evaluate for Place fetal scalp electrode Place double lumen intrauterine pressure catheter Initial Bolus Warmed at 10-20 ml/minute Stop bolus at 250 to 500 cc Maintenance infusion of warmed Rate: 3 cc/min or 50 to 60 cc/hour Document intrauterine pressure continuously Goal: Maintain amniotic fluid index of 8-12 cm VI. Adverse Effects Uterine scar rupture VII. References Images: Related links to external sites (from Bing) These images

2015 FP Notebook

182. Eclamptic Seizure Management

in best option for control Concurrent anticonvulsant depresses respiration Avoid if possible Consider anticonvulsant if prolonged (caution adverse fetal effects) Amobarbital 250 mg IV in 10cc NS over 3 minutes 5-10 mg IV slow push 125mg IV Airway and respiratory management Protect airway from aspiration Place patient in left lateral decubitus position Suction oral secretions Anesthesia or other skilled clinician (e.g. emergency medicine) at bedside for possible intubation Consider Avoid unless pH (...) <7.10 Prevent injury Padding on side rails of bed Other post- measures Internal fetal monitor (Internal Scalp electrode) Consider catheter Single does not mandate cesarean delivery IV. Complications Maternal mortality Mortality in U.S.: 0.4% of cases Mortality in Mexico: 14% of ecamplsia cases : 5.5 to 23% of cases Fetal anoxia with severe neurologic deficits: 7% V. References Fontaine (2000) in ALSO, B:1-36 Sibai in Gabbe (2002) Obstetrics, p. 945-74 Images: Related links to external sites (from

2015 FP Notebook

183. Labour: when to worry. Full Text available with Trip Pro

of prolonged labour and its risks to both mother and fetus. The role of intrapartum monitoring of the fetal heart rate, measurement of the pH in the fetus's scalp blood and assessment of amniotic fluid is discussed, as is the monitoring of maternal well-being. (...) the incidence of fetal prematurity in these cases. A long interval between rupture of the membranes and delivery continues to be a danger to both mother and fetus. Delivery is recommended when gestation is beyond 36 weeks or when there are signs of incipient infection, and once labour has begun antibiotics should be used prophylactically. Failure of labour to progress should be recognized and managed aggressively in its early stages. Amniotomy and oxytocin infusion have reduced considerably the incidence

1978 Canadian Medical Association Journal

184. Hyperthyroidism

, when methimazole is used in dosages of < 20 mg/day, agranulocytosis is less common; with propylthiouracil , agranulocytosis may occur at any dosage. Methimazole has been used successfully in pregnant and nursing women without fetal or infant complications, but rarely methimazole has been associated with scalp and GI defects in neonates and with a rare embryopathy. Because of these complications, propylthiouracil is used in the 1st trimester of pregnancy. Propylthiouracil is preferred (...) Overview of Physiologic pH and Buffers SOCIAL MEDIA Add to Any Platform Loading , MD, MS, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Hyperthyroidism is characterized by hypermetabolism and elevated serum levels of free thyroid hormones. Symptoms are many and include tachycardia, fatigue, weight loss, nervousness, and tremor. Diagnosis is clinical and with thyroid function tests. Treatment depends on cause

2013 Merck Manual (19th Edition)

185. Management of Normal Labor

amniotomy (artificial rupture of membranes) routinely during the active phase. As a result, labor may progress more rapidly, and meconium-stained amniotic fluid may be detected earlier. Amniotomy during this stage may be necessary for specific indications, such as facilitating internal fetal monitoring to confirm fetal well-being. Amniotomy should be avoided in women with HIV infection or hepatitis B or C, so that the fetus is not exposed to these organisms. During the 1st stage of labor, maternal heart (...) rate and BP and fetal heart rate should be checked continuously by electronic monitoring or intermittently by auscultation, usually with a portable Doppler ultrasound device (see ). Women may begin to feel the urge to bear down as the presenting part descends into the pelvis. However, they should be discouraged from bearing down until the cervix is fully dilated so that they do not tear the cervix or waste energy. The 2nd stage is the time from full cervical dilation to delivery of the fetus

2013 Merck Manual (19th Edition)

186. Management of Normal Delivery

delivery of a fetus with . The cord should be double-clamped and cut between the clamps, and a plastic cord clip should be applied about 2 to 3 cm distal from the cord insertion on the infant. If fetal or neonatal compromise is suspected, a segment of umbilical cord is doubly clamped so that arterial blood gas analysis can be done. An arterial pH > 7.l5 to 7.20 is considered normal. Delaying clamping of the umbilical cord for 30 to 60 seconds is recommended to increase iron stores, which provides (...) of the Fetus A vaginal examination is done to determine position and station of the fetal head; the head is usually the presenting part (see Figure: ). When effacement is complete and the cervix is fully dilated, the woman is told to bear down and strain with each contraction to move the head through the pelvis and progressively dilate the vaginal introitus so that more and more of the head appears. When about 3 or 4 cm of the head is visible during a contraction in nulliparas (somewhat less in multiparas

2013 Merck Manual (19th Edition)

187. Comparison of neonatal outcome in women with severe pre-eclampsia undergoing caesarean section under spinal or general anaesthesia. (Abstract)

for estimating neonatal blood- gas parameters. Complete data was available in 82 women. Both the groups were comparable in terms of general demographic data, except that percentage of women having an induced labour was significantly more in the general anaesthesia group. Induction of anaesthesia and delivery interval was prolonged for the spinal group. Mean dose of phenylephrine was significantly higher for the spinal anaesthesia group. Preoperative maternal blood-gas parameters and foetal scalp blood pH (...) were comparable in between groups. Difference in neonatal umbilical artery base deficit in between groups was not statistically significant (p = 0.99). Correlation coefficient between maternal base deficit and foetal base deficit was 0.414 (p = 0.01) and 0.06 (p > 0.1) respectively for general and spinal anaesthesia. Subgroup analysis in the population with pre-operative scalp blood pH < 7.2, neonatal umbilical artery base deficit was significantly higher in general anaesthesia group. Five minutes

2011 Journal of the Indian Medical Association Controlled trial quality: uncertain

188. In vitro myometrial contractility reflects indication for caesarean section. (Abstract)

whose caesarean section was for fetal distress/acidosis (scalp pH <7.2) contracted with more force than those from women whose caesarean section was for delay in the first stage of labour (P < 0.001). For repeat, nonlabouring caesarean sections, samples from women whose first caesarean section was for fetal distress/acidosis also contracted with more force than did samples from women whose first caesarean section was for delay in the first stage of labour (P = 0.03).These findings suggest (...) that the myometrium contracts with greater force in women who have a caesarean section for fetal distress.© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

2011 BJOG

189. 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

190. Magnetoencephalography Full Text available with Trip Pro

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

2012 Wikipedia

191. Testosterone

descriptions are somewhat arbitrary, as there is a great deal of mutual overlap between them). Anabolic effects include growth of and strength, increased and strength, and stimulation of linear growth and . Androgenic effects include of the , particularly the and the formation of the in the fetus, and after birth (usually at ) a deepening of the , growth of (such as the ) and . Many of these fall into the category of male . Testosterone effects can also be classified by the age of usual occurrence (...) of the gland and . During the second trimester, androgen level is associated with formation. This period affects the femininization or masculinization of the fetus and can be a better predictor of feminine or masculine behaviours such as sex typed behaviour than an adult's own levels. A mother's testosterone level during pregnancy is correlated with her daughter's sex-typical behavior as an adult, and the correlation is even stronger than with the daughter's own adult testosterone level. Early infancy

2012 Wikipedia

192. Antenatal allopurinol for reduction of birth asphyxia induced brain damage (ALLO-Trial); a randomized double blind placebo controlled multicenter study. Full Text available with Trip Pro

diagnosed by the clinician as an abnormal or non-reassuring foetal heart rate trace, preferably accompanied by either significant ST-wave abnormalities (as detected by the STAN-monitor) or an abnormal foetal blood scalp sampling (pH < 7.20).Primary outcome measures are the amount of S100B (a marker for brain tissue damage) and the severity of oxidative stress (measured by isoprostane, neuroprostane, non protein bound iron and hypoxanthine), both measured in umbilical cord blood. Secondary outcome (...) of suspected intra-uterine hypoxia, both animal and human studies suggest that maternal administration of allopurinol immediately prior to delivery reduces hypoxic-ischaemic encephalopathy.The proposed trial is a randomized double blind placebo controlled multicenter study in pregnant women at term in whom the foetus is suspected of intra-uterine hypoxia.Allopurinol 500 mg IV or placebo will be administered antenatally to the pregnant woman when foetal hypoxia is suspected. Foetal distress is being

2010 BMC pregnancy and childbirth Controlled trial quality: predicted high

193. [Pulse oximetry as an additive procedure in modern fetal assessment during labour]. (Abstract)

((R))" software five consecutive deliveries were simultaneously analysed by the FIGO score and the saturation rate of fetal pulse oximetry. All CTGs were classified as pathological and at least one fetal scalp pH measurement was carried out. Fetal outcome and results of the fetal scalp pH values were evaluated against the fetal pulse oximetry rates.Signal loss was low at less than 5%. No fetus showed a hypoxic state. Only 0.98% of the fetal pulse oximetry saturation rates were below 30% oxygen (...) saturation. No fetus showed an oxygen saturation of below 35% for 10 min duration or more.Fetal pulse oximetry saturation rates can be another helpful marker for fetal well-being in a modern labour ward. Further studies are required to verify whether fetal pulse oximetry saturation rates can improve the specificity of CTG for fetal acidosis.

2009 Zeitschrift für Geburtshilfe und Neonatologie Controlled trial quality: uncertain

194. Maternal allopurinol during fetal hypoxia lowers cord blood levels of the brain injury marker S-100B. Full Text available with Trip Pro

women in labor (54 fetuses) with a gestational age of >36 weeks and fetal hypoxia, as indicated by abnormal/nonreassuring fetal heart rate tracing or fetal scalp pH of <7.20, received 500 mg of allopurinol or placebo intravenously. Severity of fetal hypoxia, brain damage and free radical formation were assessed by arterial cord blood lactate, S-100B and non-protein-bound-iron concentrations, respectively. At birth, maternal and cord blood concentrations of allopurinol and its active metabolite (...) Maternal allopurinol during fetal hypoxia lowers cord blood levels of the brain injury marker S-100B. Fetal hypoxia is an important determinant of neonatal encephalopathy caused by birth asphyxia, in which hypoxia-induced free radical formation plays an important role.Maternal treatment with allopurinol, will cross the placenta during fetal hypoxia (primary outcome) and reduce S-100B and free radical formation (secondary outcome).In a randomized, double-blind feasibility study, 53 pregnant

2009 Pediatrics Controlled trial quality: predicted high

195. 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

196. 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.

197. 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.

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

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 (...) for NRFS. RESULTS: The operative delivery (cesarean or instrumental) rate for NRFS did not differ between the 2 groups: 33.6% (134/399) in the cardiotocography + STAN analysis group vs 37% (148/400) in the cardiotocography group (relative risk, 0.91; 95% CI, 0.75-1.10). The rate of operative delivery for dystocia was also similar in both groups. The percentage of women whose fetus had at least 1 scalp pH measurement during labor was substantially lower in the group with ST-segment analysis: 27

2007 EvidenceUpdates Controlled trial quality: predicted high

199. Outcomes of women presenting in active versus latent phase of spontaneous labor. (Abstract)

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

2005 Obstetrics and Gynecology

200. Delayed pushing with lumbar epidural analgesia in labour. (Abstract)

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

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