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Fetal Scalp pH

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41. Comparative effect of pethidine, trichloroethylene, and Entonox on fetal and neonatal acid-base and PO2. (PubMed)

Comparative effect of pethidine, trichloroethylene, and Entonox on fetal and neonatal acid-base and PO2. The second stage of labour is associated with relative fetal hypoxia and progressive metabolic acidosis. Maternal analgesia can increase the danger, especially for the high-risk fetus.In 152 patients the effect on the fetus of pethidine alone, pethidine + trichloroethylene, or pethidine + Entonox was assessed by fetal scalp blood sampling. Fetal pH, Pco(2), and Po(2) were measured and base

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1971 British medical journal Controlled trial quality: uncertain

42. Fetal ST Segment and T Wave Analysis in Labor

concerns with the application of the technology to the United States. None of the randomized trials were performed in the United States where patient case-mix and obstetrical practice, such as the use of fetal scalp pH, differ from Europe, which may affect the impact of this technology on perinatal outcomes. Moreover, the results of the European studies are not uniformly positive. This protocol describes a randomized controlled trial of the STAN technology as an adjunct to electronic fetal heart rate (...) to Primary Outcome Measures : Number of Participants With Primary Composite Outcome [ Time Frame: From Delivery through 1 month of age ] Composite primary outcome of intrapartum fetal death, neonatal death, Apgar score <=3 at 5 minutes, neonatal seizure, umbilical artery blood pH <= 7.05 with base deficit >=12 mmol/L in extra-cellular fluid, intubation for ventilation at delivery, neonatal encelphalopathy Number of Intrapartum Fetal Deaths (Primary Outcome Component) [ Time Frame: During labor

2010 Clinical Trials

43. A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring. (PubMed)

with real-time alerts (intervention arm) or continuous CTG monitoring as previously performed (control arm). Electrocardiographic monitoring and fetal scalp blood sampling will be available in both arms. The primary outcome measure is the incidence of fetal metabolic acidosis (umbilical artery pH < 7.05, BDecf > 12 mmol/L). Secondary outcome measures are: caesarean section and instrumental vaginal delivery rates, use of fetal blood sampling, 5-minute Apgar score < 7, neonatal intensive care unit (...) A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring. Intrapartum fetal hypoxia remains an important cause of death and permanent handicap and in a significant proportion of cases there is evidence of suboptimal care related to fetal surveillance. Cardiotocographic (CTG) monitoring remains the basis of intrapartum surveillance, but its interpretation by healthcare professionals lacks reproducibility

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2010 BMC pregnancy and childbirth Controlled trial quality: predicted high

44. Management of Stroke in Neonates and Children

in the majority of neonates with hemorrhagic stroke, risk factors include postmaturity, emergency cesarean delivery, fetal distress, and male sex. , Mutations in COL4A1 should be considered in neonates with cerebral hemorrhage, porencephaly, glaucoma, or cataracts. , Some hemorrhagic lesions such as periventricular hemorrhagic venous infarction may actually represent hemorrhagic conversion of an arterial or venous infarction. Either acquired or congenital coagulopathy may lead to intracranial hemorrhage

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2019 American Heart Association

45. ShortGUIDE: Instrumental vaginal birth

station plus 2 cm and above the pelvic floor · Two subdivisions: o Rotation of 45º or less from the OA position o Rotation of more than 45º including the OP position Outlet · Fetal skull (not caput) has reached the pelvic floor · Fetal scalp visible without separating the labia · Sagittal suture is in the antero-posterior diameter or right or left OA or OP (rotation does not exceed 45º) Indications and contraindications for instrumental vaginal birth Aspect Consideration Indications · Women (...) minutes, intubation, mean umbilical artery pH, scalp injury, facial injury, intracranial injury, cephalohaematoma, retinal haemorrhage, jaundice, admission to neonatal intensive care unit No significant difference *32 RCT (n=6597 women). Not all comparisons included data on all outcomes. Outcome definitions varied among studies. Heterogeneity between some studies. CI confidence interval; n: number; RR: risk ratio; OR odds ratio. Instrument by type (vacuum or forceps) Instrument selection is dependent

2019 Queensland Health

46. Prevention of Early-Onset Group B Streptococcal Disease in Newborns

Prevention of Early-Onset Group B Streptococcal Disease in Newborns Prevention of Early-Onset Group B Streptococcal Disease in Newborns - ACOG Menu ▼ Prevention of Early-Onset Group B Streptococcal Disease in Newborns Page Navigation ▼ Number 782 (Replaces No. 485, April 2011) Committee on Obstetric Practice The American Academy of Pediatrics, the American College of Nurse-Midwives, the Association of Women’s Health, Obstetric and Neonatal Nurses, and the Society for Maternal-Fetal Medicine (...) ). In the 1970s, GBS emerged as an important cause of perinatal morbidity and mortality in newborns (2, , ). Two distinct clinical syndromes of invasive GBS disease in the newborn exist. One is GBS EOD, which presents within 7 days after birth and occurs secondary to vertical transmission, fetal or neonatal aspiration during labor and birth, or both; it is characterized primarily by sepsis, pneumonia, or less frequently meningitis and is most likely to manifest within the first 12–48 hours after birth (1, 10

2019 American College of Obstetricians and Gynecologists

47. Intrapartum fever

is recommended in case of intrapartum fever D Fetal scalp pH and -electrode should be used on regular obstetric indication. In case of specific infections where the potential risk of maternal- fetal transmission of infection is particularly relevant these monitoring modalities can be contraindicated. D We recommend ensuring progression in labor and delivery within hours in case of persistent fever. C-section on usual obstetric indications. C Since the rate of maternal complications increases with time after (...) urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. D Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine tenderness The individual signs have low predictive value. B Continuous CTG

2019 Nordic Federation of Societies of Obstetrics and Gynecology

48. Perineal care

floor muscle training OASIS Obstetric anal sphincter injury or injuries OR Odds ratio OT Operating theatre PR Per rectum RCT Randomised controlled trial RR Relative risk USS Ultrasound scan Definition of terms Accoucheur Clinician directly assisting with birth of baby. Anal manometry A test which measures the pressures of the anal sphincter muscles. Crowning When the widest part of the fetal head (biparietal diameter) has passed through the pelvic outlet. Deinfibulation A surgical procedure to cut (...) is not used routinely during spontaneous vaginal birth but only for specific conditions (e.g. selective use in instrumental deliveries or if fetal compromise). Sitz bath Warm bath to which salt has been added. Slow birth of fetal head Refers to measures taken to prevent rapid head expulsion at the time of crowning (e.g. counter pressure to the head (as needed) and minimising active pushing; it does not include measures such as fetal head flexion or the Ritgen manoeuvre). Queensland Clinical Guideline

2018 Queensland Health

49. Neonatal stabilisation for retrieval

service capability · Seek advice: o Contact RSQ o Phone 1300 799 127 Maternal risk · Severe hypertensive disorder · Antepartum haemorrhage · Other care requirements beyond service’s CSCF Fetal risk · Threatened preterm birth · Fetal anomalies · FGR · Multiple pregnancy · Other care requirements beyond service’s CSCF Yes Yes No No CSCF: Clinical services capability framework; FGR: Fetal growth restriction; QCG: Queensland Clinical Guidelines; RSQ: Retrieval Services Queensland Queensland Clinical (...) acidosis– pH 60 mmHg · Increasing apnoea and/ or bradycardia · Consider total clinical presentation Signs of CPAP failure? Yes No Contact Retrieval Services Queensland for advice or retrieval activation at any time Phone 1300 799 127 Yes Assess and monitor clinical condition Surfactant · Baby with HMD requiring intubation and ventilation from birth · Up to 24 hours of age · Continue IPPV Surfactant indicated/available? Wait for retrieval · Continue ongoing care as indicated · Discuss changes

2018 Clinical Practice Guidelines Portal

50. Fever during labor

tenderness The individual signs have low predictive value. B Continuous CTG is recommended in case of intrapartum fever D Fetal scalp pH and -electrode should be used on regular obstetric indication. In case of specific infections where the potential risk of maternal- fetal transmission of infection is particularly relevant these monitoring modalities can be contraindicated. D We recommend ensuring progression in labor and delivery within hours in case of persistent fever. C-section on usual obstetric (...) should be considered. D o All microbiotic tests may be valuable postpartum, but only urine dip-stick is of relevance in the acute phase. o Infection parameters can be considered, but are of limited diagnostic value in the acute phase. They might be valuable when monitoring development post partum. Suspicion on intrauterine infection in case of intrapartum fever and at least one of the folowing: • Fetal tachycardia >160 beats per minute • Foul smelling vaginal discharge/amniotic fluid • Uterine

2018 Nordic Federation of Societies of Obstetrics and Gynecology

52. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

against routine oocyte retrieval for fertility preservation of young TS girls before the age of 12 years (⨁◯◯◯). R 3.4. We recommend considering oocyte donation for fertility, only after thorough screening and appropriate counseling (⨁⨁⨁⨁). R 3.5. We recommend that management of pregnant women with TS should be undertaken by a multidisciplinary team including maternal–fetal medicine specialists and cardiologists with expertise in managing women with TS (⨁⨁⨁◯). R 3.6. We suggest that other options (...) of a dilated aorta with rapid increase in diameter (⨁◯◯◯). R 3.16. We suggest that in case of an acute ascending AoD before the fetus is viable, to perform emergency aortic surgery understanding that fetal viability may be at risk. If the fetus is viable, it is reasonable to perform cesarean section first, followed by aortic surgery, which should be performed under near-normothermia, pulsatile perfusion, high pump flow and avoidance of vasoconstrictors (⨁◯◯◯). R 3.17. We suggest that exercise testing

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2016 European Society of Human Reproduction and Embryology

53. Biologic therapy for psoriasis

at localised sites and associated with significant functional impairment and/or high levels of distress (for example nail disease or involvement of high-impact and difficult-to-treat sites such as the face, scalp, palms, soles, flexures and genitals) áá R5 Consider biologic therapy earlier in the treatment pathway (for example, if methotrexate has failed, is not tolerated or is contra-indicated) in people with psoriasis that fulfils the disease severity criteria and who also have active psoriatic arthritis (...) relate to other factors (for example, other co-therapies or the underlying disease) that the risk of fetal abnormalities in women with psoriasis who conceive on biologic therapy has not been adequately studied and therefore cannot be áá British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017 20 X For example http://www.medicinesinpregnancy.org/Medicine--pregnancy XI There are no known interactions between biologic therapies and contraceptive methods (see drug-specific

2017 British Association of Dermatologists

54. A new method for monitoring baby’s heart beat during labour probably not justified

) was a composite of intrapartum fetal death, neonatal death, Apgar score 3 or less at 5 minutes, neonatal seizure, metabolic acidosis (defined as umbilical arterial pH 7.05 or less, and extracellular fluid base deficit 12 mmol/L or greater), intubation for ventilation at delivery, or neonatal encephalopathy. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials, which included 26,529 laboring singletons with cephalic presentation at term, were analyzed. Compared with women who were randomized (...) .,Xodo, S.,Berghella, V. Obstet Gynecol , 2015 OBJECTIVE: To compare the effectiveness of cardiotocography plus ST analysis with cardiotocography alone during labor. DATA SOURCES: Randomized controlled trials were identified by searching electronic databases. METHODS OF STUDY SELECTION: We included all randomized controlled trials comparing intrapartum fetal monitoring with cardiotocography plus ST analysis with cardiotocography alone. The primary outcome (ie, perinatal composite outcome

2019 NIHR Dissemination Centre

55. MASAC Guidelines for Perinatal Management of Women with Bleeding Disorders and Carriers of Hemophilia A and B

and fetal risks of a vaginal delivery versus a planned caesarean delivery; the option of a planned caesarean delivery should be recommended when an affected or potentially affected male infant is anticipated.(9) (Grade B, Level III) In Those women who elect vaginal delivery, forceps and vacuum extraction, interventions that triple the risk of intracranial hemorrhage in affected male infants, should be avoided, as should fetal scalp electrode monitoring during labor. Umbilical Cord Blood Sampling (...) with bleeding disorders and possible carriers who plan to pursue a pregnancy. Women and their families should be acquainted with the various methods of diagnosing a potentially affected infant prior to delivery and the associated risks of each. Methods include preimplantation diagnosis, invasive prenatal diagnosis (chorionic villus sampling, amniocentesis, and cordocentesis), and ultrasound determination of fetal gender.(1-3) (Grade C, Level IV)* Pregnancy Management Pregnancy should be managed

2017 National Hemophilia Foundation

56. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

against routine oocyte retrieval for fertility preservation of young TS girls before the age of 12 years (⨁◯◯◯). R 3.4. We recommend considering oocyte donation for fertility, only after thorough screening and appropriate counseling (⨁⨁⨁⨁). R 3.5. We recommend that management of pregnant women with TS should be undertaken by a multidisciplinary team including maternal–fetal medicine specialists and cardiologists with expertise in managing women with TS (⨁⨁⨁◯). R 3.6. We suggest that other options (...) of a dilated aorta with rapid increase in diameter (⨁◯◯◯). R 3.16. We suggest that in case of an acute ascending AoD before the fetus is viable, to perform emergency aortic surgery understanding that fetal viability may be at risk. If the fetus is viable, it is reasonable to perform cesarean section first, followed by aortic surgery, which should be performed under near-normothermia, pulsatile perfusion, high pump flow and avoidance of vasoconstrictors (⨁◯◯◯). R 3.17. We suggest that exercise testing

2017 European Society of Endocrinology

57. Intrapartum care for healthy women and babies

tr ansferred (% of total transferred from each ansferred from each setting) setting) F From home rom home (n=3,529) (n=3,529) F From a freestanding rom a freestanding midwifery unit (n=2,457) midwifery unit (n=2,457) F From an alongside rom an alongside midwifery unit midwifery unit (n=4,401) (n=4,401) Delay during first or second stage of labour 1,144 (32.4%) 912 (37.1%) 1,548 (35.2%) Abnormal fetal heart rate 246 (7.0%) 259 (10.5%) 477 (10.8%) Request for regional analgesia 180 (5.1%) 163 (6.6 (...) on ultrasound) Abnormal fetal heart rate/doppler studies Ultrasound diagnosis of oligo-/polyhydramnios Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 13 of 89Previous gynaecological history Myomectomy Hysterotomy T T able able 8 Medical conditions indicating individual assessment when planning place of 8 Medical conditions indicating individual assessment when planning

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

58. A new method for monitoring baby’s heart beat during labour probably not justified

) was a composite of intrapartum fetal death, neonatal death, Apgar score 3 or less at 5 minutes, neonatal seizure, metabolic acidosis (defined as umbilical arterial pH 7.05 or less, and extracellular fluid base deficit 12 mmol/L or greater), intubation for ventilation at delivery, or neonatal encephalopathy. TABULATION, INTEGRATION, AND RESULTS: Six randomized controlled trials, which included 26,529 laboring singletons with cephalic presentation at term, were analyzed. Compared with women who were randomized (...) .,Xodo, S.,Berghella, V. Obstet Gynecol , 2015 OBJECTIVE: To compare the effectiveness of cardiotocography plus ST analysis with cardiotocography alone during labor. DATA SOURCES: Randomized controlled trials were identified by searching electronic databases. METHODS OF STUDY SELECTION: We included all randomized controlled trials comparing intrapartum fetal monitoring with cardiotocography plus ST analysis with cardiotocography alone. The primary outcome (ie, perinatal composite outcome

2018 NIHR Dissemination Centre

60. Clinical Guideline: Early onset Group B streptococcal disease

) refer to section 4.1 Obstetric procedures if GBS positive • Provided women with GBS risk factors are treated with IAP, there is insufficient evidence to recommend either avoidance of, or alterations of technique, in obstetric procedures (e.g. membrane sweeping, amniotomy, fetal scalp blood sampling or fetal scalp electrode) on the basis of positive GBS status 24,37 Chorioamnionitis • Do not inhibit labour, but consider hastening birth under broad spectrum intravenous antibiotic cover o Collect low (...) Adequacy of IAP • Due to the rapidity of some labours, especially in multiparous women, it can be difficult to confidently estimate the time-to-birth interval • Four hours prior to birth is commonly recommended as the interval required for adequate prophylaxis 3,4,24 but there is evidence that adequate fetal concentrations may be reached earlier (within 1–2 hours) 15,44-46 • In order to maximise the window for administration of IAP, this guideline recommends aiming for administration at least 4 hours

2016 Queensland Health

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