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Fetal Scalp pH

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161. Birth Trauma (Follow-up)

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

162. Hemolytic Disease of Newborn (Follow-up)

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

163. Birth Trauma (Treatment)

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

164. Meconium Aspiration Syndrome (Follow-up)

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

165. Pediatrics, Fever (Diagnosis)

, 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

166. Pediatrics, Bacteremia and Sepsis (Diagnosis)

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

167. Pediatrics, Bacteremia and Sepsis (Overview)

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

168. Pediatrics, Fever (Overview)

, 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

169. Pediatrics, Bacteremia and Sepsis (Follow-up)

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

170. Pediatrics, Fever (Follow-up)

, 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

171. Mirabegron (Myrbetriq)

Trade and Generic Name} 19 4.3 Preclinical Pharmacology/Toxicology The product is designated a Pregnancy category C, wherein use is recommended in pregnancy only where the potential benefit would outweigh the risks to patient and fetus. Reproductive toxicology studies showed some fetal effects but only at substantial multiples of exposure (e.g., 22-fold and 36-fold exposures at the maximum recommended human dose). Mirabegron was neither genotoxic nor carcinogenic. There were no significant efficacy

2012 FDA - Drug Approval Package

172. Diagnosis and management of headache in adults

in a trigeminal distribution. 16,32 They are associated with prominent ipsilateral cranial autonomic features. Cluster headache (CH) is the most common TAC (estimated prevalence 1 in 1,000). Paroxysmal hemicrania (PH) is probably under-recognised (estimated prevalence 1 in 50,000). 32 Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are very rare.8 DIAGNOSIS (...) -trigeminal (eg exercise) manoeuvres. Relapses and remissions are erratic. 16,32,33 SUNA is a proposed classification for patients with the headache characteristics of SUNCT, but with other cranial autonomic features. Secondary mimics are common and need to be excluded before a diagnosis of cluster headache, PH, SUNCT or SUNA can be made. For example, symptomatic cluster headache has been described after infections and with vascular and neoplastic lesions. In the case of PH a good response to indometacin

2008 SIGN

173. The Risks and Benefits of Internal Monitors in Laboring Patients. (PubMed)

The Risks and Benefits of Internal Monitors in Laboring Patients. The purpose of this study was to estimate the impact of internal monitors (fetal scalp electrode [FSE] and intrauterine pressure catheter [IUPC]) on maternal and neonatal outcomes.The study comprised a retrospective cohort of all women who were admitted for labor from 2004-2008. Women with internal monitors (FSE, IUPC, or both) were compared with women without internal monitors. Maternal outcomes were maternal fever and cesarean (...) delivery. Neonatal outcomes were a composite of 5-minute Apgar score of ≤3, cord pH <7.1, cord base excess ≤-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors with adjustment for confounding variables, including time in labor.Of 6445 subjects, 3944 women (61.2%) had internal monitors. Women with internal monitors were more likely to have a fever than women without internal monitors (11.7% vs 4.5%; adjusted odds ratio [AOR], 2.0; 95

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2013 American Journal of Obstetrics and Gynecology

174. 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

175. 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

176. Lactate production as a response to intrapartum hypoxia in the growth-restricted fetus. (PubMed)

Lactate production as a response to intrapartum hypoxia in the growth-restricted fetus. To analyse whether the increase in lactate in response to intrapartum hypoxia differs between small- (SGA), appropriate- (AGA) and large-for-gestational-age (LGA) fetuses.Observational cohort study.Ten obstetric units in Sweden.A cohort of 1496 women.A secondary analysis of a randomised controlled trial, in which 1496 women with fetal heart rate abnormalities, indicating fetal scalp blood sampling, were (...) randomised to lactate analyses. After delivery, the neonates were divided according to birthweight for gestational age into SGA, AGA and LGA groups.Lactate concentration in fetal scalp blood.Acid-base balance in cord artery blood and Apgar score <7 at 5 minutes.Median lactate concentrations in the SGA, AGA and LGA groups were 3.8, 3.0 and 2.2 mmol/l, respectively (SGA versus AGA, P = 0.017; LGA versus AGA, P = 0.009). In the subgroups with scalp lactate >4.8 mmol/l (lactacidaemia), the corresponding

Full Text available with Trip Pro

2012 BJOG Controlled trial quality: uncertain

177. In vitro myometrial contractility reflects indication for caesarean section. (PubMed)

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

178. Labour: when to worry. (PubMed)

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

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1978 Canadian Medical Association Journal

179. 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)

180. Management of Normal Delivery

after vacuum extraction. Other fetal risks with forceps include facial lacerations and facial nerve palsy, corneal abrasions, external ocular trauma, skull fracture, and intracranial hemorrhage ( , ). Fetal risks with vacuum extraction include scalp laceration, cephalohematoma formation, and subgaleal or intracranial hemorrhage; retinal hemorrhages and increased rates of hyperbilirubinemia have been reported. How to do and Repair an Episiotomy VIDEO An episiotomy is not routinely done for most (...) 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

2013 Merck Manual (19th Edition)

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