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Fetal Scalp pH

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121. Shock and Pregnancy (Treatment)

results in respiratory alkalosis with compensatory renal excretion of bicarbonate. The arterial carbon dioxide pressure reaches a plasma level of 28-32 mm Hg, and bicarbonate is decreased to 18-21 mmol/L, maintaining an arterial pH in the range of 7.40-7.47. Mild hypoxemia might occur in the supine position. Oxygen consumption increases at the beginning of the first trimester and increases 20-33% by term because of fetal demands and increased maternal metabolic processes. [ ] In active labor (...) of maternal hypoxemia and decreased cardiac output has a profoundly deleterious effect on fetal oxygenation. Variations in maternal pH also influence oxygen delivery; alkalosis causes vasoconstriction of the uterine artery, resulting in decreased fetal oxygen delivery. The interaction of maternal and fetal circulations in the placenta most likely follows a concurrent exchange mechanism. This is less efficient than a countercurrent exchange mechanism and helps explain why the PaO 2 of the fetal umbilical

2014 eMedicine.com

122. Childhood HIV Disease (Treatment)

affect or be affected by absorption kinetics. Didanosine contains an aluminum and magnesium buffer that may affect the absorption of other drugs (eg, ciprofloxacin). Delavirdine, atazanavir, and rilpivirine are poorly absorbed when the pH of the GI tract increases. Many ARD pharmacokinetic interactions alter the cytochrome P450 (CYP) metabolic enzyme system. Cytochromes are metabolic enzymes in the liver, and CYP denotes the specific enzyme. The CYP system is classified into families, 3 of which (...) infection Viral load >10,000 Cigarette smoking Illicit IV drug use Viral load < 1000 Zidovudine treatment Neutralizing antibodies Perinatal Rupture of membranes for >4 h Chorioamnionitis Emergency cesarean delivery Surgical delivery Episiotomy Use of scalp electrodes Elective cesarean delivery with zidovudine treatment Neonatal Prematurity Low birth weight First-born twin Full-term Second-born twin Postdelivery Breastfeeding ART Transmission can occur during 3 periods: prenatal or in utero, perinatal

2014 eMedicine.com

123. Hyperthyroidism (Treatment)

(albeit rarely) with cloacal and scalp (cutis aplasia) abnormalities when given during early gestation. [ , ] Generally, if a nonpregnant woman who is receiving methimazole desires pregnancy, she should be switched to propylthiouracil before conception. After 12 weeks of gestation, she can be switched back to methimazole, with frequent monitoring. Propylthiouracil remains the drug of choice in uncommon situations of life-threatening severe thyrotoxicosis (ie, thyroid storm) because of the additional (...) radiation to the breast from radioactive iodine for a few months after ceasing lactation; accordingly, initiation of this therapy should be delayed. It is standard practice to check for pregnancy before starting radioactive iodine therapy and to recommend that the patient not become pregnant for at least 3-6 months after the treatment or until thyroid functions normalize. No excess fetal malformations or increased miscarriage rates have been found in women previously treated with radioactive iodine

2014 eMedicine.com

124. Normal Labor and Delivery (Treatment)

be accomplished with blood sampling from fetal scalp capillaries. This procedure allows for a direct assessment of fetal oxygenation and blood pH. A pH of < 7.20 warrants further investigation for the fetus' well-being and for possible resuscitation or surgical intervention. Routine laboratory studies of the parturient, such as complete blood cell (CBC) count, blood typing and screening, and urinalysis, are usually performed. Intravenous (IV) access is established. Previous Next: Intrapartum Management (...) cardiotocography. This review concluded that continuous cardiotocography during labor is associated with a reduction in neonatal seizures but not cerebral palsy or infant mortality; however, continuous monitoring is associated with increased cesarean and operative vaginal deliveries. [ ] If nonreassuring fetal heart rate tracings by cardiotography (eg, late decelerations) are noted, a fetal scalp electrode may be applied to generate sensitive readings of beat-to-beat variability. However, a fetal scalp

2014 eMedicine.com

125. Paraneoplastic Diseases (Treatment)

have papillomatous thickening of the oral mucosa. Patients who have AN associated with malignancies also have skin changes involving the scalp, areolae, and eyelids. The appearance of paraneoplastic AN usually coincides with the presence of malignancy, but it can precede or follow the diagnosis of cancer and thus may signal a relapse in patients with a history of cancer. Diagnosis The diagnosis of AN is based on clinical findings alone and can be supported by the histopathologic changes (...) include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface

2014 eMedicine.com

126. Vacuum Extraction (Treatment)

position or station not resolved by examination or real-time ultrasound study Suspicion of fetopelvic disproportion (advanced cranial molding, bone overlap, caput) An inappropriate fetal presentation (eg, breech, face, brow) A known or suspected fetal bleeding diathesis or demineralizing bone disease Relative contraindications are as follows: Prior scalp sampling Prior failed forceps Gestational diabetes or pregestational diabetes Known or suspected fetal macrosomia Definitions The American Congress (...) of Obstetricians and Gynecologists (ACOG) has established standard definitions for instrumental delivery operations. These include outlet, low, and midpelvic operations. While the guidelines were originally written for forceps procedures, the same descriptions are easily applied to vacuum extraction operations with minor modifications. [ ] Outlet forceps/vacuum The leading point of the fetal skull has reached the pelvic floor, and at or on the perineum, the scalp is visible at the introitus without separating

2014 eMedicine.com

127. Platelet Disorders (Treatment)

The prevalence of neonatal alloimmune thrombocytopenia is approximately one case in 200 term pregnancies; for clinically apparent disease, the prevalence is one case in 1500 term pregnancies. It is the most common cause of severe neonatal thrombocytopenia. [ ] This disorder occurs when maternal antibodies against fetal platelet antigens inherited from the father but absent in the mother cross the placenta and induce severe thrombocytopenia. Most cases of neonatal alloimmune thrombocytopenia are due

2014 eMedicine.com

128. Paraneoplastic Diseases (Overview)

have papillomatous thickening of the oral mucosa. Patients who have AN associated with malignancies also have skin changes involving the scalp, areolae, and eyelids. The appearance of paraneoplastic AN usually coincides with the presence of malignancy, but it can precede or follow the diagnosis of cancer and thus may signal a relapse in patients with a history of cancer. Diagnosis The diagnosis of AN is based on clinical findings alone and can be supported by the histopathologic changes (...) include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface

2014 eMedicine.com

129. Gonococcal Infections (Overview)

unprotected intercourse with new partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact (...) . Neisserial organisms disseminate to the blood due to a variety of predisposing factors, such as host physiologic changes, virulence factors of the organism itself, and failures of the host's immune defenses. [ ] For example, changes in the vaginal pH that occur during menses and pregnancy and the puerperium period make the vaginal environment more suitable for the growth of the organism and provide increased access to the bloodstream. (Three fourths of the cases of DGI occur in women; susceptibility

2014 eMedicine.com

130. Gonococcus (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) disseminate to the blood due to a variety of predisposing factors, such as host physiologic changes, virulence factors of the organism itself, and failures of the host's immune defenses. [ ] For example, changes in the vaginal pH that occur during menses and pregnancy and the puerperium period make the vaginal environment more suitable for the growth of the organism and provide increased access to the bloodstream. (Three fourths of the cases of DGI occur in women; susceptibility is increased

2014 eMedicine.com

131. Gonococcemia (Overview)

partners frequently enough to sustain the infection in a community are defined as core transmitters. Neonatal and pediatric gonococcal infection Neonatal gonococcal infection may follow conjunctival infection, which is obtained during passage through the birth canal. In addition, direct infection may occur through the scalp at the sites of fetal monitoring electrodes. In children, infection may occur from sexual abuse by an infected individual or possibly nonsexual contact in the child's household (...) organisms disseminate to the blood due to a variety of predisposing factors, such as host physiologic changes, virulence factors of the organism itself, and failures of the host's immune defenses. [ ] For example, changes in the vaginal pH that occur during menses and pregnancy and the puerperium period make the vaginal environment more suitable for the growth of the organism and provide increased access to the bloodstream. (Three fourths of the cases of DGI occur in women; susceptibility is increased

2014 eMedicine.com

132. Blue Nevi (Overview)

, and the epitheliod blue nevus. [ ] Next: Pathophysiology Although definitive experimental evidence is lacking, blue nevi are believed to represent dermal arrest in embryonal migration of neural crest melanocytes that fail to reach the epidermis. Collections of melanocytes can be found in fetal dermis, but they involute during later gestation. Because of the variation of blue nevi in different populations, a genetic predisposition has been suggested. However, familial cases of blue nevi are exceedingly rare (...) . 49(2):310-2. . Di Cesare A, Sera F, Gulia A, Coletti G, Micantonio T, Fargnoli MC, et al. The spectrum of dermatoscopic patterns in blue nevi. J Am Acad Dermatol . 2011 Oct 24. . Dailey VL, Hameed O. Blue nevus of the prostate. Arch Pathol Lab Med . 2011 Jun. 135(6):799-802. . Cooper PH. Deep penetrating (plexiform spindle cell) nevus. A frequent participant in combined nevus. J Cutan Pathol . 1992 Jun. 19(3):172-80. . Munoz C, Quintero A, Sanchez JL, Ruiz-Santiago H. Persistent blue nevus

2014 eMedicine.com

133. Shock and Pregnancy (Overview)

results in respiratory alkalosis with compensatory renal excretion of bicarbonate. The arterial carbon dioxide pressure reaches a plasma level of 28-32 mm Hg, and bicarbonate is decreased to 18-21 mmol/L, maintaining an arterial pH in the range of 7.40-7.47. Mild hypoxemia might occur in the supine position. Oxygen consumption increases at the beginning of the first trimester and increases 20-33% by term because of fetal demands and increased maternal metabolic processes. [ ] In active labor (...) of maternal hypoxemia and decreased cardiac output has a profoundly deleterious effect on fetal oxygenation. Variations in maternal pH also influence oxygen delivery; alkalosis causes vasoconstriction of the uterine artery, resulting in decreased fetal oxygen delivery. The interaction of maternal and fetal circulations in the placenta most likely follows a concurrent exchange mechanism. This is less efficient than a countercurrent exchange mechanism and helps explain why the PaO 2 of the fetal umbilical

2014 eMedicine.com

134. Vacuum Extraction (Overview)

position or station not resolved by examination or real-time ultrasound study Suspicion of fetopelvic disproportion (advanced cranial molding, bone overlap, caput) An inappropriate fetal presentation (eg, breech, face, brow) A known or suspected fetal bleeding diathesis or demineralizing bone disease Relative contraindications are as follows: Prior scalp sampling Prior failed forceps Gestational diabetes or pregestational diabetes Known or suspected fetal macrosomia Definitions The American Congress (...) of Obstetricians and Gynecologists (ACOG) has established standard definitions for instrumental delivery operations. These include outlet, low, and midpelvic operations. While the guidelines were originally written for forceps procedures, the same descriptions are easily applied to vacuum extraction operations with minor modifications. [ ] Outlet forceps/vacuum The leading point of the fetal skull has reached the pelvic floor, and at or on the perineum, the scalp is visible at the introitus without separating

2014 eMedicine.com

135. Platelet Disorders (Overview)

The prevalence of neonatal alloimmune thrombocytopenia is approximately one case in 200 term pregnancies; for clinically apparent disease, the prevalence is one case in 1500 term pregnancies. It is the most common cause of severe neonatal thrombocytopenia. [ ] This disorder occurs when maternal antibodies against fetal platelet antigens inherited from the father but absent in the mother cross the placenta and induce severe thrombocytopenia. Most cases of neonatal alloimmune thrombocytopenia are due

2014 eMedicine.com

136. Platelet Disorders (Follow-up)

The prevalence of neonatal alloimmune thrombocytopenia is approximately one case in 200 term pregnancies; for clinically apparent disease, the prevalence is one case in 1500 term pregnancies. It is the most common cause of severe neonatal thrombocytopenia. [ ] This disorder occurs when maternal antibodies against fetal platelet antigens inherited from the father but absent in the mother cross the placenta and induce severe thrombocytopenia. Most cases of neonatal alloimmune thrombocytopenia are due

2014 eMedicine.com

137. Normal Labor and Delivery (Follow-up)

be accomplished with blood sampling from fetal scalp capillaries. This procedure allows for a direct assessment of fetal oxygenation and blood pH. A pH of < 7.20 warrants further investigation for the fetus' well-being and for possible resuscitation or surgical intervention. Routine laboratory studies of the parturient, such as complete blood cell (CBC) count, blood typing and screening, and urinalysis, are usually performed. Intravenous (IV) access is established. Previous Next: Intrapartum Management (...) cardiotocography. This review concluded that continuous cardiotocography during labor is associated with a reduction in neonatal seizures but not cerebral palsy or infant mortality; however, continuous monitoring is associated with increased cesarean and operative vaginal deliveries. [ ] If nonreassuring fetal heart rate tracings by cardiotography (eg, late decelerations) are noted, a fetal scalp electrode may be applied to generate sensitive readings of beat-to-beat variability. However, a fetal scalp

2014 eMedicine.com

138. Paraneoplastic Diseases (Follow-up)

have papillomatous thickening of the oral mucosa. Patients who have AN associated with malignancies also have skin changes involving the scalp, areolae, and eyelids. The appearance of paraneoplastic AN usually coincides with the presence of malignancy, but it can precede or follow the diagnosis of cancer and thus may signal a relapse in patients with a history of cancer. Diagnosis The diagnosis of AN is based on clinical findings alone and can be supported by the histopathologic changes (...) include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface

2014 eMedicine.com

139. Childhood HIV Disease (Follow-up)

affect or be affected by absorption kinetics. Didanosine contains an aluminum and magnesium buffer that may affect the absorption of other drugs (eg, ciprofloxacin). Delavirdine, atazanavir, and rilpivirine are poorly absorbed when the pH of the GI tract increases. Many ARD pharmacokinetic interactions alter the cytochrome P450 (CYP) metabolic enzyme system. Cytochromes are metabolic enzymes in the liver, and CYP denotes the specific enzyme. The CYP system is classified into families, 3 of which (...) infection Viral load >10,000 Cigarette smoking Illicit IV drug use Viral load < 1000 Zidovudine treatment Neutralizing antibodies Perinatal Rupture of membranes for >4 h Chorioamnionitis Emergency cesarean delivery Surgical delivery Episiotomy Use of scalp electrodes Elective cesarean delivery with zidovudine treatment Neonatal Prematurity Low birth weight First-born twin Full-term Second-born twin Postdelivery Breastfeeding ART Transmission can occur during 3 periods: prenatal or in utero, perinatal

2014 eMedicine.com

140. Hyperthyroidism (Follow-up)

(albeit rarely) with cloacal and scalp (cutis aplasia) abnormalities when given during early gestation. [ , ] Generally, if a nonpregnant woman who is receiving methimazole desires pregnancy, she should be switched to propylthiouracil before conception. After 12 weeks of gestation, she can be switched back to methimazole, with frequent monitoring. Propylthiouracil remains the drug of choice in uncommon situations of life-threatening severe thyrotoxicosis (ie, thyroid storm) because of the additional (...) radiation to the breast from radioactive iodine for a few months after ceasing lactation; accordingly, initiation of this therapy should be delayed. It is standard practice to check for pregnancy before starting radioactive iodine therapy and to recommend that the patient not become pregnant for at least 3-6 months after the treatment or until thyroid functions normalize. No excess fetal malformations or increased miscarriage rates have been found in women previously treated with radioactive iodine

2014 eMedicine.com

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