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Nonreassuring Fetal Status

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1. Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. (PubMed)

Trials Register (6 September 2012) and reference lists of all retrieved articles. We sought unpublished trials and abstracts submitted to major international congresses and contacted expert informants.All published and unpublished randomised trials that compared maternal and fetal/neonatal/infant outcomes when VAS was used to evaluate fetal status in the presence of a nonreassuring CTG trace during labour, compared with mock or no stimulation.Two review authors independently sought to assess (...) Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace. Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS

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2013 Cochrane

2. Nonreassuring Fetal Status

Nonreassuring Fetal Status Nonreassuring Fetal Status Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Nonreassuring Fetal Status (...) Nonreassuring Fetal Status Aka: Nonreassuring Fetal Status , Fetal Distress , Fetal Hypoxia , Birth Asphyxia From Related Chapters II. Causes Uterine Hyperstimulation accident Uteroplacental Insufficiency III. Definition: Nonreassuring Fetal Status (preferred term) suggestive of IV. Evaluation Fetal status Confirm findings with alternative monitoring Consider fetal scalp electrode Response to acoustic or scalp stimulation Consider (pH < 7.20 is abnormal) Maternal status Maternal s Vaginal examination (e.g

2018 FP Notebook

3. Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks' Gestation (PubMed)

Case with a Nonreassuring Fetal Status Induced by Massive Hematemesis due to Mallory-Weiss Tear That Required Emergency Cesarean Section at 38 Weeks' Gestation We describe a rare case of Mallory-Weiss tear with massive hematemesis at 38 weeks' gestation. A 35-year-old woman presented with epigastralgia followed by massive hematemesis. An emergency endoscopy indicated active pulsatile bleeding at the esophagocardial junction. Although an emergency endoscopic hemostasis was successful, late (...) decelerations without acceleration on cardiotocogram were observed. Therefore, the patient underwent emergency cesarean section, along with blood transfusion, following the endoscopic hemostasis. The hemoglobin level just before the operation was 5.1 g/dL. We suspected that massive hematemesis induced maternal acute anemia and hypovolemia, which resulted in a nonreassuring fetal status. Hence, urgent endoscopic hemostasis, adequate blood transfusion, and emergency cesarean section were needed. Mallory-Weiss

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2015 Case reports in obstetrics and gynecology

4. Nonreassuring fetal status during trial of labor after cesarean. (PubMed)

Nonreassuring fetal status during trial of labor after cesarean. Concern for uterine rupture has led to the decline in vaginal births after cesarean. Nonreassuring fetal status (NRFS) may precede uterine rupture. The objective of this study was to estimate the risks of uterine rupture, uterine dehiscence, and adverse fetal outcomes associated with NRFS during trial of labor after cesarean (TOLAC).In a retrospective cohort study of the previously reported Maternal-Fetal Medicine Units Network

2014 American Journal of Obstetrics and Gynecology

5. Fetal Brain Doppler to Predict Cesarean Delivery for Nonreassuring Fetal Status in Term Small-for-Gestational-Age Fetuses. (PubMed)

Fetal Brain Doppler to Predict Cesarean Delivery for Nonreassuring Fetal Status in Term Small-for-Gestational-Age Fetuses. To estimate the value of fetal brain Doppler in predicting the risk of cesarean delivery for nonreassuring fetal status and neonatal acidosis after labor induction in small-for-gestational-age fetuses with normal umbilical artery Doppler.Fetal brain Doppler parameters, including cerebral tissue perfusion measured by fractional moving blood volume, cerebroplacental ratio (...) , and middle cerebral artery pulsatility index, were evaluated before labor induction in a cohort of 210 term small-for-gestational-age fetuses with normal umbilical artery Doppler and 210 control participants matched by gestational age. The value of the cerebral Doppler indices to predict the risk of cesarean delivery, cesarean delivery for nonreassuring fetal status, and neonatal acidosis was analyzed.Overall, small-for-gestational-age fetuses showed a significant higher incidence of cesarean delivery

2011 Obstetrics and Gynecology

6. Nonreassuring Fetal Status

Nonreassuring Fetal Status Nonreassuring Fetal Status Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Nonreassuring Fetal Status (...) Nonreassuring Fetal Status Aka: Nonreassuring Fetal Status , Fetal Distress , Fetal Hypoxia , Birth Asphyxia From Related Chapters II. Causes Uterine Hyperstimulation accident Uteroplacental Insufficiency III. Definition: Nonreassuring Fetal Status (preferred term) suggestive of IV. Evaluation Fetal status Confirm findings with alternative monitoring Consider fetal scalp electrode Response to acoustic or scalp stimulation Consider (pH < 7.20 is abnormal) Maternal status Maternal s Vaginal examination (e.g

2015 FP Notebook

7. Effectiveness of pulse oximetry versus fetal electrocardiography for the intrapartum evaluation of nonreassuring fetal heart rate. (PubMed)

Effectiveness of pulse oximetry versus fetal electrocardiography for the intrapartum evaluation of nonreassuring fetal heart rate. To compare the effectiveness of pulse oximetry and fetal electrocardiography in the management of labor with nonreassuring fetal heart rate (NRFHR).This randomized experimental study consisted of two arms. In group 1 we used pulse oximetry and in group 2 we used STAN® technology. The participants in each group were 90 pregnant women with a full-term singleton fetus (...) , the 1-min Apgar score was 6 or lower in 17.8% of the group 1 neonates vs. 4.44% of the group 2 neonates (p<0.001). The groups also differed significantly in umbilical cord vein pH (7.23 vs. 7.27) and pCO₂ (57.27 vs. 46.86) at birth.Fetal electrocardiography with the STAN® 21 system was more effective in detecting good fetal status and thus in identifying cases in which labor could proceed safely. Intrapartum surveillance with the STAN® 21 system reduced the rate of emergency cesarean delivery.Crown

2011 European journal of obstetrics, gynecology, and reproductive biology

8. Effect of Oxygen vs Room Air on Intrauterine Fetal Resuscitation: A Randomized Noninferiority Clinical Trial

). Secondary outcomes were other umbilical artery gases, cesarean delivery for nonreassuring fetal status, and operative vaginal delivery.Of the 705 patients who met inclusion criteria, 277 (39.3%) were enrolled on admission. During labor, 114 patients (41.2% of the enrolled patients) developed category II tracings and were randomized to room air (57 patients; 50.0% of the randomized patients) or oxygen (57 patients; 50.0% of the randomized patients). A total of 99 patients (86.8% of the randomized (...) the hypothesis that room air is noninferior to oxygen in improving fetal metabolic status among patients with category II fetal heart tracings.This was a randomized, unblinded noninferiority clinical trial conducted between June 2016 and July 2017 in the labor and delivery ward of a single tertiary care center. Women with singleton pregnancies at 37 weeks' gestational age or more who were admitted for delivery were eligible. Of those who met inclusion criteria, the patients who developed category II tracings

2018 EvidenceUpdates

9. Placental Abruption With Delayed Fetal Compromise in Maternal Acetaminophen Toxicity. (PubMed)

the result of nonreassuring fetal status leading to delivery or stillbirth) occurring within 6 days of ingestion.Maternal acetaminophen overdose can be associated with delayed fetal compromise, suggesting the importance of continued fetal surveillance several days after ingestion. (...) Placental Abruption With Delayed Fetal Compromise in Maternal Acetaminophen Toxicity. After maternal acetaminophen overdose, fetal fulminant liver failure, stillbirth, neonatal death, or preterm delivery may occur.A 27-year-old woman, gravida 2 para 1, presented at 28 weeks of gestation after unintentional acetaminophen overdose. Four days after ingestion, her laboratory values worsened, including serum aspartate aminotransferase of 5,460 units/L, alanine aminotransferase of 4,936 units/L

2017 Obstetrics and Gynecology

10. Oxytocin and Fetal Heart Rate Changes

Details Study Description Go to Brief Summary: The reported risk of nonreassuring fetal heart trace following neuraxial analgesia is 3-23%. This variability may be due to fluid and oxytocin management prior to and during the initiation of neuraxial analgesia. The study hypothesis is that decreasing the oxytocin infusion rate by 50 % prior to initiation of combined spinal epidural analgesia will cause a reduction in the incidence of adverse fetal heart rate changes. Condition or disease Intervention (...) was not standardized. The combination of low-dose combined spinal epidural analgesia and the high/low dose oxytocin have not been evaluated. One of the proposed mechanisms for nonreassuring fetal heart a tracing after initiation of analgesia is that the pain relief from neuraxial analgesia causes a decrease in catecholamine release by the sympathetic nervous system. The subsequent decrease in the circulating epinephrine concentration contributes to an increase in uterine tone, as epinephrine is a potent tocolytic

2017 Clinical Trials

11. The Impact of Fetal Growth Restriction on Latency in the Setting of Expectant Management of Preeclampsia. (PubMed)

lung maturity. Two study groups were determined based on the presence or absence of fetal growth restriction. Patients were delivered when they developed persistent neurological symptoms, severe hypertension refractory to medical therapy, renal insufficiency, nonreassuring fetal status, pulmonary edema, or hemolysis elevated liver low platelet syndrome or when they reached 37 weeks if they remained stable without any other indication for delivery. Our primary outcome was the interval from diagnosis (...) The Impact of Fetal Growth Restriction on Latency in the Setting of Expectant Management of Preeclampsia. Fetal growth restriction is a common complication of preeclampsia. Expectant management for qualifying patients has been found to have acceptable maternal safety while improving neonatal outcomes. Whether fetal growth restriction influences the duration of latency during expectant management of preeclampsia is unknown.The objective of the study was to determine whether fetal growth

2016 American Journal of Obstetrics and Gynecology

12. Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid-Base Status: A Randomized Controlled Trial. (PubMed)

output was lower (P = 0.014) in the supine group.Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid-base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status. (...) Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid-Base Status: A Randomized Controlled Trial. Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining

2017 Anesthesiology

13. Fetal pulse oximetry for fetal assessment in labour. (PubMed)

status, several additional measures of evaluating fetal well-being have been considered. These have demonstrated some effect on reducing caesarean section rates, for example, fetal scalp blood sampling for pH estimation/lactate measurement. The adaptation of pulse oximetry for use in the unborn fetus could potentially contribute to improved evaluation during labour and therefore lead to a reduction in caesarean sections for nonreassuring fetal status, without any change in neonatal outcomes.To (...) ). Neonatal seizures and neonatal encephalopathy were rare in both groups. No studies reported details of long-term disability.There was evidence of a decrease in caesarean section for nonreassuring fetal status in the fetal pulse oximetry plus CTG group compared to the CTG group, gestation from 34 weeks (average RR (random-effects) 0.65, 95% CI 0.46 to 0.90, n = 4008, I² = 63%). There was no evidence of differences between groups in caesarean section for dystocia, although the overall incidence rates

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2014 Cochrane database of systematic reviews (Online)

14. Status epilepticus due to brain tumor during pregnancy (PubMed)

Status epilepticus due to brain tumor during pregnancy There is no consensus on the timing of delivery of an infant with nonreassuring fetal status that is associated with maternal status epilepticus. We herein describe a case of status epilepticus due to brain tumor at 28 weeks of gestation.

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2016 Clinical Case Reports

15. Fetal Growth Restriction (Overview)

% 4% 3% Survivors - No serious morbidity 86% 95% 95% Labor induction (< 36 wk) 12% 8% 5% Intrapartum high blood pressure (< 32 wk) 7% 2% 1% Cesarean delivery for nonreassuring fetal heart rate 15% 8% 3% Intubated in delivery room 6% 4% 3% Neonatal ICU admission 18% 9% 7% Respiratory distress syndrome 9% 4% 3% Intraventricular hemorrhage (grade III or IV) 2% < 1% < 1% Neonatal death 2% 1% 1% Gestational age at delivery 36.6 wk ± 3.5 wk 37.8 wk ± 2.9 wk 37.1 wk ± 3.3 wk Preterm birth ≤ 32 wk 14% 6 (...) Fetal Growth Restriction (Overview) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

16. Fetal Growth Restriction (Diagnosis)

% 4% 3% Survivors - No serious morbidity 86% 95% 95% Labor induction (< 36 wk) 12% 8% 5% Intrapartum high blood pressure (< 32 wk) 7% 2% 1% Cesarean delivery for nonreassuring fetal heart rate 15% 8% 3% Intubated in delivery room 6% 4% 3% Neonatal ICU admission 18% 9% 7% Respiratory distress syndrome 9% 4% 3% Intraventricular hemorrhage (grade III or IV) 2% < 1% < 1% Neonatal death 2% 1% 1% Gestational age at delivery 36.6 wk ± 3.5 wk 37.8 wk ± 2.9 wk 37.1 wk ± 3.3 wk Preterm birth ≤ 32 wk 14% 6 (...) Fetal Growth Restriction (Diagnosis) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

17. Fetal Growth Restriction (Treatment)

% 4% 3% Survivors - No serious morbidity 86% 95% 95% Labor induction (< 36 wk) 12% 8% 5% Intrapartum high blood pressure (< 32 wk) 7% 2% 1% Cesarean delivery for nonreassuring fetal heart rate 15% 8% 3% Intubated in delivery room 6% 4% 3% Neonatal ICU admission 18% 9% 7% Respiratory distress syndrome 9% 4% 3% Intraventricular hemorrhage (grade III or IV) 2% < 1% < 1% Neonatal death 2% 1% 1% Gestational age at delivery 36.6 wk ± 3.5 wk 37.8 wk ± 2.9 wk 37.1 wk ± 3.3 wk Preterm birth ≤ 32 wk 14% 6 (...) Fetal Growth Restriction (Treatment) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

18. Fetal Growth Restriction (Follow-up)

% 4% 3% Survivors - No serious morbidity 86% 95% 95% Labor induction (< 36 wk) 12% 8% 5% Intrapartum high blood pressure (< 32 wk) 7% 2% 1% Cesarean delivery for nonreassuring fetal heart rate 15% 8% 3% Intubated in delivery room 6% 4% 3% Neonatal ICU admission 18% 9% 7% Respiratory distress syndrome 9% 4% 3% Intraventricular hemorrhage (grade III or IV) 2% < 1% < 1% Neonatal death 2% 1% 1% Gestational age at delivery 36.6 wk ± 3.5 wk 37.8 wk ± 2.9 wk 37.1 wk ± 3.3 wk Preterm birth ≤ 32 wk 14% 6 (...) Fetal Growth Restriction (Follow-up) Fetal Growth Restriction: Overview, Causes of Intrauterine Growth Restriction, Perinatal Implications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjYxMjI2LW92ZXJ2aWV3

2014 eMedicine.com

19. Neonatal Acid-Base Status After C Section With Maternal Tilt vs. Supine

-laboring At term (>37 weeks gestation) with singleton pregnancies in cephalic presentation Scheduled for elective cesarean delivery under spinal anesthesia. Maternal height will be between 150 - 180 cm and the body mass index (BMI)≤ 40 kg/m2. Exclusion Criteria: Ruptured membranes Severe polyhydramnios or oligohydramnios Nonreassuring fetal heart rate Intrauterine growth restriction Abnormal lie - e.g. breech, transverse lie Multiple gestation Maternal comorbidities: hypertension, preeclampsia, other (...) Neonatal Acid-Base Status After C Section With Maternal Tilt vs. Supine Neonatal Acid-Base Status After C Section With Maternal Tilt vs. Supine - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Neonatal Acid

2014 Clinical Trials

20. Fetal Health Surveillance: Antepartum & Intrapartum Consensus Guideline

to prompt delivery, depending upon the overall clinical situation. (III-C) Recommendation 13: Fetal Scalp Blood Sampling 1. Where facilities and expertise exist, fetal scalp blood sampling for assessment of fetal acid–base status is recommended in women with “atypical/abnormal” fetal heart tracings at gestations > 34 weeks when delivery is not imminent, or if digital fetal scalp stimulation does not result in an acceleratory fetal heart rate response. (III-C) Recommendation 14: Umbilical Cord Blood (...) biophysical profile BPS biophysical status CHAT context, history, assessment, tentative plan CP cerebral palsy CST contraction stress test DV ductus venosus ECG electrocardiogram EDV end-diastolic velocity EFM electronic fetal monitoring FBS fetal blood sampling FHR fetal heart rate FPO fetal pulse oximetry HIE hypoxic-ischemic encephalopathy HRO high reliability organizations IUGR intrauterine growth restriction IUPC intrauterine pressure catheter IUT intrauterine transfusion MCA middle cerebral artery

2008 British Columbia Perinatal Health Program

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