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Fetal Scalp pH

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141. Vacuum Extraction (Follow-up)

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

142. Histiocytosis (Diagnosis)

. Patients with single system involvement were older than those with multisystem involvement. The mean age for development of polycystic sclerosing histiocytosis is between 55 and 60 years, but rare cases in the pediatric age group have been reported. Fetal and neonatal cases, although also rare, can occur. [ , ] Previous Next: Prognosis Risk stratification for Langerhans cell histiocytosis (LCH) requires evaluation of the site and extent of disease involvement and response to therapy. Involvement (...) . Expression of c-FLIP(L) and resistance to CD95-mediated apoptosis of monocyte-derived dendritic cells: inhibition by bisindolylmaleimide. Blood . 2000 Jun 1. 95(11):3478-82. . Romani N, Reider D, Heuer M, Ebner S, Kämpgen E, Eibl B, et al. Generation of mature dendritic cells from human blood. An improved method with special regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002

2014 eMedicine Pediatrics

143. Histiocytosis (Follow-up)

Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002. 86:195-225. . Irmler M, Thome M, Hahne M, Schneider P, Hofmann K, Steiner V, et al. Inhibition of death receptor signals by cellular FLIP. Nature . 1997 Jul 10. 388(6638):190-5. . Ingulli E, Mondino A, Khoruts A, Jenkins MK. In vivo detection of dendritic cell antigen presentation to CD4(+) T cells. J Exp Med . 1997 Jun 16. 185(12):2133-41. . . Reis e (...) AC, Davenport V, Gordon I, Smith M, et al. Successful in vivo immunolocalization of Langerhans cell histiocytosis with use of a monoclonal antibody, NA1/34. J Pediatr . 1994 Nov. 125(5 Pt 1):717-22. . Carstensen H, Ornvold K. The epidemiology of Langerhans cell histiocytosis in children in Denmark 1975-89. Med Pediatr Oncol . 1993. 21:387-8. Isaacs H Jr. Fetal and neonatal histiocytoses. Pediatr Blood Cancer . 2006 Aug. 47(2):123-9. . Arnaud L, Hervier B, Neel A, et al. CNS involvement

2014 eMedicine Pediatrics

144. Human Immunodeficiency Virus Infection (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 Pediatrics

145. Birth Trauma (Overview)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

146. Histiocytosis (Overview)

. Patients with single system involvement were older than those with multisystem involvement. The mean age for development of polycystic sclerosing histiocytosis is between 55 and 60 years, but rare cases in the pediatric age group have been reported. Fetal and neonatal cases, although also rare, can occur. [ , ] Previous Next: Prognosis Risk stratification for Langerhans cell histiocytosis (LCH) requires evaluation of the site and extent of disease involvement and response to therapy. Involvement (...) . Expression of c-FLIP(L) and resistance to CD95-mediated apoptosis of monocyte-derived dendritic cells: inhibition by bisindolylmaleimide. Blood . 2000 Jun 1. 95(11):3478-82. . Romani N, Reider D, Heuer M, Ebner S, Kämpgen E, Eibl B, et al. Generation of mature dendritic cells from human blood. An improved method with special regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002

2014 eMedicine Pediatrics

147. Hemolytic Disease of Newborn (Treatment)

the umbilical vein into the inferior vena cava and removal and replacement of 5- to 10-mL aliquots of blood sequentially, until about twice the volume of the neonate's circulating blood volume is reached (ie, double-volume exchange). This process removes approximately 70-90% of fetal RBCs. The amount of bilirubin removed directly varies with the pretransfusion bilirubin level and amount of blood exchanged. Because most of the bilirubin is in the extravascular space, only about 25% of the total bilirubin (...) maternal antibody titers are monitored until a critical titer of 1:32, which indicates that a high risk of fetal hydrops has been reached. At this point, the fetus requires very intense monitoring for signs of anemia and fetal hydrops. In Kell alloimmunization, hydrops can occur at low maternal titers because of suppressed erythropoiesis, and, thus, a titer of 1:8 has been suggested as critical. Hence, delta-OD 450 values are also unreliable in predicting disease severity in Kell alloimmunization

2014 eMedicine Pediatrics

148. Human Immunodeficiency Virus Infection (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 Pediatrics

149. Histiocytosis (Treatment)

regard to clinical applicability. J Immunol Methods . 1996 Sep 27. 196(2):137-51. . Defrance T, Casamayor-Pallejà M, Krammer PH. The life and death of a B cell. Adv Cancer Res . 2002. 86:195-225. . Irmler M, Thome M, Hahne M, Schneider P, Hofmann K, Steiner V, et al. Inhibition of death receptor signals by cellular FLIP. Nature . 1997 Jul 10. 388(6638):190-5. . Ingulli E, Mondino A, Khoruts A, Jenkins MK. In vivo detection of dendritic cell antigen presentation to CD4(+) T cells. J Exp Med . 1997 Jun (...) 767-9. . Kelly KM, Beverley PC, Chu AC, Davenport V, Gordon I, Smith M, et al. Successful in vivo immunolocalization of Langerhans cell histiocytosis with use of a monoclonal antibody, NA1/34. J Pediatr . 1994 Nov. 125(5 Pt 1):717-22. . Carstensen H, Ornvold K. The epidemiology of Langerhans cell histiocytosis in children in Denmark 1975-89. Med Pediatr Oncol . 1993. 21:387-8. Isaacs H Jr. Fetal and neonatal histiocytoses. Pediatr Blood Cancer . 2006 Aug. 47(2):123-9. . Arnaud L, Hervier B, Neel

2014 eMedicine Pediatrics

150. Labor and Delivery, Normal Delivery of the Newborn

, especially during contractions. Persistence of a fetal heart rate lower than 120 bpm defines fetal bradycardia; in labor, a heart rate >100 bpm with reassuring variation is not considered an emergency. Persistence of a rate >160 bpm is called fetal tachycardia. Internal fetal heart rate monitor (fetal scalp electrode) An internal fetal heart rate monitor may be placed to more accurately assess fetal heart rate patterns when the external monitor tracing may be inaccurate or difficult to trace. A small (...) electrode is passed through the cervix, after the membranes have ruptured, and placed on the fetal scalp. Intrauterine pressure catheter (IUPC) External monitoring of contractions only measures the timing of contractions. The strength of contractions can only be measured with an IUPC. This catheter is placed in the uterus transcervically, next to the fetal head. It allows for more accurate measurement of strength and timing of contractions. Delivery assistance (operative vaginal delivery) See the list

2014 eMedicine.com

151. Meconium Aspiration Syndrome (Treatment)

fluid. Obstet Gynecol . 2017 Mar. 129 (3):593-4. . Nangia S, Pal MM, Saili A, Gupta U. Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT. Resuscitation . 2015 Dec. 97:83-7. . Boujenah J, Oliveira J, De La Hosseraye C, Benbara A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Matern Fetal Neonatal Med . 2016 Dec. 29 (23):3875-8. . Liu J, Cao HY, Fu W (...) . [ , ] In patients with meconium aspiration syndrome (MAS), a thorough cardiac examination and echocardiography are necessary to evaluate for congenital heart disease and persistent pulmonary hypertension of the newborn (PPHN). Quantifying the degree of pulmonary hypertension, prior to instituting therapy, is essential. Prevention of MAS Prevention of MAS is paramount. Obstetricians should closely monitor fetal status in an attempt to identify fetal distress. When meconium is detected, amnioinfusion with warm

2014 eMedicine Pediatrics

152. Gonorrhea (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 Pediatrics

153. Gonococcemia (Diagnosis)

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

154. Pediatrics, Bacteremia and Sepsis (Treatment)

pathology, such as prematurity, maternal infections (eg, group B Streptococcus , sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode. Neonates who present with irritability, seizures, respiratory distress (...) , Wittler R. A comparison of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) . 2010 Mar. 49(2):172-6. . Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW. Pediatric emergency department nurses' perspectives on fever in children. Pediatr Emerg Care . 2000 Feb. 16(1):9-12. . Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Health Care . 2013 Mar 1. . American Academy of Pediatrics. Recommended

2014 eMedicine Emergency Medicine

155. Pediatrics, Fever (Treatment)

, maternal infections (eg, group B Streptococcus , sexually transmitted diseases such as genital herpes simplex), and congenital or chronic disease states. Neonates at risk for congenital herpes are those born to mothers with a history of recent genital infection and high-risk sexual activity; delivery-related risk factors include rupture of membranes for longer than 6 hours and use of a scalp electrode. Neonates who present with irritability, seizures, respiratory distress, jaundice, or a characteristic (...) of perceptions of fever and fever phobia by ethnicity. Clin Pediatr (Phila) . 2010 Mar. 49(2):172-6. . Poirier MP, Davis PH, Gonzalez-del Rey JA, Monroe KW. Pediatric emergency department nurses' perspectives on fever in children. Pediatr Emerg Care . 2000 Feb. 16(1):9-12. . Greensmith L. Nurses' knowledge of and attitudes towards fever and fever management in one Irish children's hospital. J Child Health Care . 2013 Mar 1. . American Academy of Pediatrics. Recommended Immunization Schedule for Children

2014 eMedicine Emergency Medicine

156. Normal Labor and Delivery (Diagnosis)

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

157. Shock and Pregnancy (Diagnosis)

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

158. Paraneoplastic Diseases (Diagnosis)

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

159. Platelet Disorders (Diagnosis)

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

160. Birth Trauma (Diagnosis)

sampling for pH or fetal scalp electrode for fetal heart monitoring, which has a low incidence of hemorrhage, infection, or abscess at the site of sampling. Cephalhematoma Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels between the skull and the periosteum; suture lines delineate its extent. Most commonly parietal, cephalhematoma may occasionally be observed over the occipital bone. The extent of hemorrhage may be severe enough to cause anemia and hypotension (...) and neurologic evaluation of the infant to establish whether additional injuries are present. Symmetry of structure and function should be assessed, the cranial nerves should be examined, and specifics such as individual joint range of motion and scalp/skull integrity should be evaluated. Next: Etiology The birth process is a blend of compression, contractions, torques, and traction. When fetal size, presentation, or neurologic immaturity complicates this event, such intrapartum forces may lead to tissue

2014 eMedicine Pediatrics

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