1
|
Okawa KS, Hirasawa T, Okawa S, Fujita M, Ishihara M. Real-time fetal monitoring using photoacoustic measurement of placental oxygen saturation in a rabbit hypoxia model. Placenta 2024; 146:110-119. [PMID: 38241840 DOI: 10.1016/j.placenta.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/28/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Ensuring adequate fetal oxygenation is an essential aim of fetal monitoring. The purpose of this study was to establish a basic technique for real-time measurement of blood oxygen saturation of the placenta by photoacoustic (PA) technique as a new fetal monitoring method. METHODS The hypoxia model established in our previous study was applied to 7 pregnant rabbits. Three phases were induced: normal phase, hypoxia phase, and recovery phase. Three methods were simultaneously used for real-time fetal monitoring: fetal heat rate (FHR) monitoring, oxygen saturation (SO2) measurement by near-infrared spectroscopy (SNO2), and placenta SO2 measured by PA technique (SplO2). The maternal hypoxia was assessed by skin SO2 measured by PA technique (SsO2), and arterial blood SO2 by blood gas analysis (SaO2). RESULTS The average of SplO2 in normal phase was 52.6 ± 13.9 %. The averages of SNO2, SSO2, and SplO2 in the seven rabbits changed in parallel from the normal phase to hypoxia phase. In the recovery phase, the SplO2 rose in parallel with recovery of SaO2. There was lag in increase of the FHR compared to the change in the other values. In the detailed analysis of PA signals from the labyrinth and decidua, a unique change in oxygen saturation was seen in one case. DISCUSSION Results of this study showed that sensitivity of our novel PA technique in detecting tissue hypoxia was similar to near-infrared spectroscopy (NIRS). As an advantage, unlike NIRS, monitoring with PA technique was unaffected by ischemia and surface changes in oxygen saturation because of its higher spatial resolution. We conclude that PA technique provides more accurate information about fetal blood placenta than NIRS. Ultrasound imaging, combined with oxygen saturation monitoring by PA technique, would improve fetal monitoring and fetal diagnosis in the future.
Collapse
Affiliation(s)
- Kiguna Sei Okawa
- Department of Obstetrics and Gynecology, Seirei Hamamatsu Hospital, 2-12-12 Sumiyoshi, Chuuou-ku, Hamamatsu, Shizuoka, Japan.
| | - Takeshi Hirasawa
- Department of Medical Engineering, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Shinpei Okawa
- Institute for Photonics Research, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan
| | - Masanori Fujita
- Division of Environmental Medicine, National Defense Medical College Research Institute, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan
| |
Collapse
|
2
|
Weinberger H, Nekave S, Hallak M, Naeh A, Gabbay-Benziv R. Single Sporadic Deceleration during Reactive Nonstress Test-Clinical Significance and Risk for Cesarean Delivery. J Clin Med 2023; 12:jcm12103387. [PMID: 37240493 DOI: 10.3390/jcm12103387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in reactive non-stress test (NST) is scarce, and optimal management has yet to be established. We aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for fetal heart rate decelerations during labor and the need for intervention. METHODS This was a retrospective, case-control study of singleton term pregnancies at one university-affiliated medical center in 2018. The study group consisted of all pregnancies with an SSD in an otherwise reactive NST. For each case, two consecutive pregnancies without SSD were matched in a 1:2 ratio. The primary outcome was the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate monitoring (NRFHRM). RESULTS 84 women with an SSD were compared to 168 controls. SSD during antenatal fetal surveillance did not increase the rate of CD overall or for NRFHRM (17.9% vs. 13.7% and 10.7% vs. 7.7%, respectively, p > 0.05). Rates of assisted deliveries and maternal and neonatal complications were similar between the groups. CONCLUSIONS SSD during a reactive NST in term pregnancies is not associated with an increased risk for adverse perinatal outcomes. SSD should not necessarily require induction of labor, and expectant management is a reasonable alternative.
Collapse
Affiliation(s)
- Hila Weinberger
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Shlomit Nekave
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Mordechai Hallak
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Amir Naeh
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Rinat Gabbay-Benziv
- Obstetrics and Gynecology Department, Hillel Yaffe Medical Center, Hadera 38100, Israel
- The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| |
Collapse
|
3
|
Lende MN, Morris BA, Lynch TA. Implementing American College of Obstetricians and Gynecologists Outpatient Antepartum Testing Recommendations: Can Your Clinic Handle It? Am J Perinatol 2022; 40:711-717. [PMID: 36470297 DOI: 10.1055/s-0042-1759706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study was conducted to determine the difference in the number of pregnancies that would qualify for outpatient fetal testing between our current academic practice and that of the 2021 American College of Obstetricians and Gynecologists (ACOG) antepartum recommendations. STUDY DESIGN We performed a retrospective study of all pregnancies that delivered and received prenatal care at our institution between January 1, 2019, and May 31, 2021. The timing and amount of outpatient antepartum testing was determined for each patient. Our current antepartum testing guidelines (clinic protocol) were compared with the 2021 ACOG recommendations (ACOG protocol). Statistical analysis was performed with descriptive statistics and z scoring to compare the total amount of antepartum testing utilized with each protocol. RESULTS A total of 1,335 pregnancies were included in the study. With the ACOG protocol, an additional 310 (23.2%) of pregnancies would qualify for antepartum testing (57.8% with ACOG protocol vs. 34.6% with clinic protocol). Most of the increased testing was due to maternal age with additional risk factors, hypertensive disorders, diabetes, prepregnancy body mass index ≥ 35, and complex fetal anomalies or aneuploidies. Overall, the ACOG protocol would require an additional 570 antepartum tests (z-score = 4.04, p = 0.000005) over the study period, which is equivalent to 19 additional tests per month and 5 per week. Only nine stillbirths occurred during this time, of which two would have had antepartum testing with both protocols, one would have only had testing per ACOG, and two would have had testing individualized per ACOG. CONCLUSION More pregnancies would require outpatient antenatal testing with adoption of the ACOG protocol. A 23% increase in testing would equate to five additional antepartum tests per week. Although this study cannot assess the clinical impact of additional testing, minimal scheduling resources are needed to accommodate this increase. KEY POINTS · Most pregnancies have risk factors for stillbirth.. · Most pregnancies qualify for fetal testing per ACOG.. · More resources are needed for this increased testing..
Collapse
Affiliation(s)
- Michelle N Lende
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Bruce A Morris
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| | - Tara A Lynch
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
| |
Collapse
|
4
|
Baschat AA, Galan HL, Lee W, DeVore GR, Mari G, Hobbins J, Vintzileos A, Platt LD, Manning FA. The role of the fetal biophysical profile in the management of fetal growth restriction. Am J Obstet Gynecol 2022; 226:475-486. [PMID: 35369904 DOI: 10.1016/j.ajog.2022.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7.25 with a 100% positive predictive value; an abnormal score on the other hand predicts current fetal acidemia with similar certainty. Between 30% and 70% of growth-restricted fetuses with a nonreactive heart rate require biophysical profile scoring to verify fetal well-being, and an abnormal score in 8% to 27% identifies the need for delivery, which is not suspected by Doppler findings. Future fetal well-being is not predicted by the biophysical profile score, which emphasizes the importance of umbilical artery Doppler and amniotic fluid volume to determine surveillance frequency. Studies with integrated surveillance strategies that combine frequent heart rate monitoring with biophysical profile scoring and Doppler report better outcomes and stillbirth rates of between 0% and 4%, compared with those between 8% and 11% with empirically determined surveillance frequency. The variations in clinical behavior and management challenges across gestational age are better addressed when biophysical profile scoring is integrated into the surveillance of fetal growth restriction. This review aims to provide guidance on biophysical profile scoring in the in- and outpatient management of fetal growth restriction.
Collapse
|
5
|
Indications for Outpatient Antenatal Fetal Surveillance: ACOG Committee Opinion, Number 828. Obstet Gynecol 2021; 137:e177-e197. [PMID: 34011892 DOI: 10.1097/aog.0000000000004407] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered. This Committee Opinion provides guidance on and suggests surveillance for conditions for which stillbirth is reported to occur more frequently than 0.8 per 1,000 (the false-negative rate of a biophysical profile) and which are associated with a relative risk or odds ratio for stillbirth of more than 2.0 compared with pregnancies without the condition. Table 1 presents suggestions for the timing and frequency of testing for specific conditions. As with all testing and interventions, shared decision making between the pregnant individual and the clinician is critically important when considering or offering antenatal fetal surveillance for individuals with pregnancies at high risk for stillbirth or with multiple comorbidities that increase the risk of stillbirth. It is important to emphasize that the guidance offered in this Committee Opinion should be construed only as suggestions; this guidance should not be construed as mandates or as all encompassing. Ultimately, individualization about if and when to offer antenatal fetal surveillance is advised.
Collapse
|
6
|
Valderrama CE, Ketabi N, Marzbanrad F, Rohloff P, Clifford GD. A review of fetal cardiac monitoring, with a focus on low- and middle-income countries. Physiol Meas 2020; 41:11TR01. [PMID: 33105122 PMCID: PMC9216228 DOI: 10.1088/1361-6579/abc4c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is limited evidence regarding the utility of fetal monitoring during pregnancy, particularly during labor and delivery. Developed countries rely on consensus ‘best practices’ of obstetrics and gynecology professional societies to guide their protocols and policies. Protocols are often driven by the desire to be as safe as possible and avoid litigation, regardless of the cost of downstream treatment. In high-resource settings, there may be a justification for this approach. In low-resource settings, in particular, interventions can be costly and lead to adverse outcomes in subsequent pregnancies. Therefore, it is essential to consider the evidence and cost of different fetal monitoring approaches, particularly in the context of treatment and care in low-to-middle income countries. This article reviews the standard methods used for fetal monitoring, with particular emphasis on fetal cardiac assessment, which is a reliable indicator of fetal well-being. An overview of fetal monitoring practices in low-to-middle income counties, including perinatal care access challenges, is also presented. Finally, an overview of how mobile technology may help reduce barriers to perinatal care access in low-resource settings is provided.
Collapse
Affiliation(s)
- Camilo E Valderrama
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | | |
Collapse
|
7
|
Furuya N, Hasegawa J, Imai H, Homma C, Kurasaki A, Kondo H, Suzuki N. Accuracy of predicting neonatal distress using a five-level classification of fetal heart rate monitoring. J Obstet Gynaecol Res 2020; 47:254-261. [PMID: 32939941 DOI: 10.1111/jog.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/09/2020] [Accepted: 09/02/2020] [Indexed: 12/17/2022]
Abstract
AIM To assess the accuracy of neonatal distress prediction using the five-level classification of fetal heart rate (FHR) and management protocol of the Japan Society of Obstetrics and Gynecology (JSOG). METHODS A case-control study was conducted. Vertex singleton pregnant women who delivered after 37 weeks' gestation from 2013 to 2015 were enrolled. The participants were categorized into two groups; controls were levels 1-3 (n = 1184), whereas cases were levels 4-5 (n = 117) group. Neonatal distress was defined as Apgar score < 8 points at 5 min or umbilical cord artery pH < 7.1. RESULTS There were 117 cases (9.0%). The frequency of the neonatal distress was observed in 1.3% controls and 6.8% cases (P < 0.01). Diagnostic accuracy of neonatal distress for cases showed a 6.8% positive-predictive value, 34.8% sensitivity, 91.5% specificity and 98.7% negative-predictive value. Among various obstetrical conditions, high sensitivity (100%) for prediction of neonatal distress was observed in women with chromosome abnormalities, placental abruption, umbilical cord abnormalities and excessive labor pain. Conversely, relatively low specificity (<50%) was observed in cases with oligohydramnios and excessive labor pain. CONCLUSION The five-level classification scheme was efficient for neonatal distress prediction. However, depending on the obstetric condition, the FHR findings and neonatal condition might be independent.
Collapse
Affiliation(s)
- Natsumi Furuya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Haruka Imai
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Chika Homma
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Akiko Kurasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Haruhiro Kondo
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| |
Collapse
|
8
|
Suresh SC, MacGregor CA, Ouyang DW. Urgent Cesarean Delivery Following Nonstress Test in a Patient with COVID-19 and Pregestational Diabetes. Neoreviews 2020; 21:e625-e630. [PMID: 32873658 DOI: 10.1542/neo.21-9-e625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Sunitha C Suresh
- NorthShore University HealthSystem, Evanston, IL, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine.,University of Chicago, Chicago, IL, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
| | - Caitlin A MacGregor
- NorthShore University HealthSystem, Evanston, IL, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine.,University of Chicago, Chicago, IL, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
| | - David W Ouyang
- University of Chicago, Chicago, IL, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
| |
Collapse
|
9
|
Abstract
Unexpected antepartum fetal demise remains one of the most tragic complications of pregnancy. Various approaches to antepartum fetal assessment have been developed as a means of either reassuring the clinician of fetal well-being or identifying potential fetal jeopardy and the need for delivery. As additional high-risk groups of women are identified, indications for antenatal testing continue to expand despite a paucity of good-quality data linking such testing to improved outcomes for women with these additional risk factors. The expansion of established antepartum testing protocols to include women with conditions such as advanced maternal age or obesity without additional, well-established indications for testing is not warranted, particularly because baseline rates of stillbirth seen with these conditions before 39 weeks of gestation are already lower than stillbirth rates achieved with current antepartum testing protocols. Beyond 39 weeks of gestation, if the established risks of stillbirth are deemed unacceptable, delivery is a more rational and evidence-based approach than antepartum testing.
Collapse
|
10
|
Zamstein O, Wainstock T, Sheiner E. Decreased fetal movements: Perinatal and long-term neurological outcomes. Eur J Obstet Gynecol Reprod Biol 2019; 241:1-5. [PMID: 31400643 DOI: 10.1016/j.ejogrb.2019.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND While maternal perception of decreased fetal movements during advanced stages of pregnancy may be an indicator for adverse perinatal outcome, the long-term neurological outcome of offspring of affected pregnancies remains largely unknown. OBJECTIVE To examine whether maternal complaint of decreased fetal movements is associated with adverse perinatal outcomes, and to assess the implications of decreased fetal movements on long-term neurological morbidity of the offspring. STUDY DESIGN A single center cohort analysis including deliveries between the years 1991-2014 was conducted. The association between decreased fetal movements and adverse perinatal outcome was evaluated using a general estimation equation (GEE) multivariable analyses. Incidence of hospitalizations (up to age 18 years) due to various neurological conditions was compared between offspring of affected pregnancies, and those who were not, using a Kaplan-Meyer survival curve. A Cox proportional hazards model was used to control for confounders. RESULTS 439 (0.18%) of 242,342 deliveries included in this study were accompanied by maternal complaint of decreased fetal movements. Perinatal outcome was comparable between the groups, with no cases of perinatal mortality observed among the exposed group. Total neurological-related hospitalization rate of the offspring, as well as hospitalizations due to movement disorders, were higher among the exposed group (Kaplan-Meyer log-rank test P < 0.05). This association between decreased fetal movements and increased long-term neurological hospitalization proved to be independent of potential confounders with an adjusted hazard ratio of 1.54 (95% CI 1.0-2.37). CONCLUSION Maternal complaint of decreased fetal movements does not predict adverse perinatal outcome but is associated with an elevated risk for long-term neurological morbidity of the offspring.
Collapse
Affiliation(s)
- Omri Zamstein
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
11
|
Yamashiro KJ, Galganski LA, Hirose S. What you need to know about maternal-fetal medicine. Semin Pediatr Surg 2019; 28:150822. [PMID: 31451176 DOI: 10.1053/j.sempedsurg.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The field of pediatric Surgery now encompasses fetal Surgery. The purpose of this article is to review aspects of antepartum care pertinent to the fetal and pediatric surgeon. We summarize antepartum screening, methods to assess the fetus, gestational disorders and variants of umbilical cord insertion sites and the placenta.
Collapse
Affiliation(s)
- Kaeli J Yamashiro
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA.
| | - Laura A Galganski
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA 95817, USA
| |
Collapse
|
12
|
Brunelli R, Perrone S, Perrone G, Galoppi P, De Stefano MG, Maragno AM, Cesarini M, De Carolis A, Masselli G, Vernia P. New-onset ulcerative colitis in pregnancy associated to toxic megacolon and sudden fetal decompensation: Case report and literature review. J Obstet Gynaecol Res 2019; 45:1215-1221. [PMID: 31064034 DOI: 10.1111/jog.13996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 04/14/2019] [Indexed: 12/15/2022]
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease rarely arising during gestation. Because the available information is based on case reports or small retrospective studies, diagnosis may be difficult and treatment is still controversial. A case of toxic megacolon developing in late pregnancy associated to a sudden fetal decompensation is described. Diagnostic and clinical topics of acute UC onset in pregnancy are debated.A primipara, 34 years old, 33/0 weeks of gestation, was admitted with a diagnosis of preterm labor, associated to acute bloody diarrhea (up to 10 daily motions) and cramping abdominal pain. A diagnosis of new-onset early-stage UC was made by sigmoidoscopy. An intensive care regimen including hydrocortisone, antibiotics and parenteral nutrition was immediately started. Magnetic resonance imaging of maternal abdomen, fostered by the worsening patient conditions, evidenced dilatation of the entire colon and a severely hampered of fetal muscular tone.Toxic megacolon complicated by superimposed Clostridium difficile infection was associated to a sudden fetal decompensation diagnosed by chance during maternal abdominal magnetic resonance imaging. An emergency cesarean section was mandatory. According to a senior surgeon's decision, total colectomy was not immediately performed following cesarean section with reference to the absence of colonic perforation. We obtained a good short-term maternal outcome and an uncomplicated neonatal course. Counseling of those patients must be focused on timely and multidisciplinary intervention in order to improve the course of maternal disease and to prevent fetal distress.
Collapse
Affiliation(s)
- Roberto Brunelli
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Seila Perrone
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Giuseppina Perrone
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Paola Galoppi
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Maria G De Stefano
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Anna M Maragno
- Department of Gynecological Obstetrical and Urological Sciences, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Monica Cesarini
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Aurora De Carolis
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Gabriele Masselli
- Radiology Dea Department, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| | - Piero Vernia
- Division of Gastroenterology, Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Umberto I Hospital, Rome, Italy
| |
Collapse
|
13
|
|
14
|
Emeruwa UN, Zera C. Optimal Obstetric Management for Women with Diabetes: the Benefits and Costs of Fetal Surveillance. Curr Diab Rep 2018; 18:96. [PMID: 30194499 DOI: 10.1007/s11892-018-1058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To elaborate on the risks and benefits associated with antenatal fetal surveillance for stillbirth prevention in women with diabetes. RECENT FINDINGS Women with pregestational diabetes have a 3- to 5-fold increased odds of stillbirth compared to women without diabetes. The stillbirth risk in women with gestational diabetes (GDM) is more controversial; while recent data suggest the odds for stillbirth are approximately 50% higher in women with GDM at term (37 weeks and beyond) than in those without GDM, it is unclear if this risk is seen in women with optimal glycemic control. Current professional society guidelines are broad with respect to fetal testing strategies and delivery timing in women with diabetes. The data supporting strategies to reduce the risk of stillbirth in women with diabetes are limited. Antepartum fetal surveillance should be performed to reduce stillbirth rates; however, the optimal test, frequency of testing, and delivery timing are not yet clear. Future studies of obstetric management for women with diabetes should consider not just individual but also system level costs and benefits associated with antenatal surveillance.
Collapse
Affiliation(s)
- Ukachi N Emeruwa
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, ASB 1-3, Boston, MA, 02115, USA.
| | - Chloe Zera
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| |
Collapse
|
15
|
Marzbanrad F, Stroux L, Clifford GD. Cardiotocography and beyond: a review of one-dimensional Doppler ultrasound application in fetal monitoring. Physiol Meas 2018; 39:08TR01. [PMID: 30027897 PMCID: PMC6237616 DOI: 10.1088/1361-6579/aad4d1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
One-dimensional Doppler ultrasound (1D-DUS) provides a low-cost and simple method for acquiring a rich signal for use in cardiovascular screening. However, despite the use of 1D-DUS in cardiotocography (CTG) for decades, there are still challenges that limit the effectiveness of its users in reducing fetal and neonatal morbidities and mortalities. This is partly due to the noisy, transient, complex and nonstationary nature of the 1D-DUS signals. Current challenges also include lack of efficient signal quality metrics, insufficient signal processing techniques for extraction of fetal heart rate and other vital parameters with adequate temporal resolution, and lack of appropriate clinical decision support for CTG and Doppler interpretation. Moreover, the almost complete lack of open research in both hardware and software in this field, as well as commercial pressures to market the much more expensive and difficult to use Doppler imaging devices, has hampered innovation. This paper reviews the basics of fetal cardiac function, 1D-DUS signal generation and processing, its application in fetal monitoring and assessment of fetal development and wellbeing. It also provides recommendations for future development of signal processing and modeling approaches, to improve the application of 1D-DUS in fetal monitoring, as well as the need for annotated open databases.
Collapse
Affiliation(s)
- Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash University, Clayton, VIC, Australia
| | | | | |
Collapse
|
16
|
Uchida T, Kanayama N, Kawai K, Mukai M, Suzuki K, Itoh H, Niwayama M. Reevaluation of intrapartum fetal monitoring using fetal oximetry: A review. J Obstet Gynaecol Res 2018; 44:2127-2134. [PMID: 30084196 DOI: 10.1111/jog.13761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
Abstract
AIM Although several studies reported the measurement of fetal oxygen saturation using fetal pulse oximetry (FPO) for evaluation of the fetal intrapartum condition, a systematic review of the seven randomized controlled trials (RCTs) provided no evidence to support FPO for intrapartum fetal monitoring. In the present review, we re-evaluate an overview for the use of FPO and seven RCTs of FPO. METHODS We reviewed numerous previous reports on FPO and seven RCTs of intrapartum FPO. RCTs were conducted with the main outcome measure being a reduction in the cesarean section rate. RESULTS The largest trial with 5341 entries failed to show any reduction. The negative result from this RCT may be explained by the use of a different cutoff value for fetal oxygen saturation compared to the other RCT; in addition, there were differences in the indications for cesarean section due to dystocia and in the definition of non-reassuring fetal status (NRFS). An abnormal FPO value, defined as the fetal oxygen saturation value <30% for at least 10 min, is useful for making a diagnosis of fetal acidosis. A newly developed device, an examiner's finger-mounted tissue oximetry, accurately measures tissue oxygen saturation while overcoming the drawbacks of FPO, such as infection risk and slipping off of the sensor during descent of the fetal head. CONCLUSION FPO (including the new device) with fetal heart rate monitoring in selected cases of NRFS may reduce the cesarean section rate.
Collapse
Affiliation(s)
- Toshiyuki Uchida
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kawai
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mari Mukai
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunao Suzuki
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroaki Itoh
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masatsugu Niwayama
- Department of Electrical and Electronics Engineering, Shizuoka University, Hamamatsu, Japan
| |
Collapse
|
17
|
Tanaka H, Furuhashi FH, Toriyabe K, Matsumoto T, Magawa S, Nii M, Watanabe J, Tanaka K, Umekawa T, Kamimoto Y, Ikeda T. Management of fetal growth restriction using the contraction stress test: a case-control study. J Matern Fetal Neonatal Med 2018; 32:3221-3225. [PMID: 29614894 DOI: 10.1080/14767058.2018.1461313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: Fetal growth restriction (FGR) is a concerning health issue. However, studies on FGR management are limited due to its rarity. We aimed to evaluate the efficacy of the contraction stress test (CST) for FGR management. Materials and methods: A case-control retrospective study design. Our institute innovated CST in FGR management in 2017. We included women in their 33rd-40th week of pregnancy with a diagnosis of FGR and retrospectively divided them into groups: the CST group (FGR management with CST) and no CST group (FGR management without CST) before and after CST development. Neonatal outcome, pH, and pO2 of umbilical artery (UA) were compared between the two groups. Results: No significant differences in the rate of birth weight, Apgar score <7 (5 minutes), neonatal death, hospitalization to newborn childhood intensive care unit (NICU), and UA pH were found between groups. Average UA pH was 7.29 ± 0.05 and 7.29 ± 0.04 in the CST and no CST groups, respectively (p = .864). Average UA pO2 values were 21.1 ± 8.6 and 15.7 ± 5.0 mmHg in the CST and no CST groups, respectively (p = .016), showing significant differences. Conclusions: Neonatal outcomes and UA pH were slightly different between the groups managed with and without CST. However, UA pO2 values significantly differed between the groups. For FGR management, the use of a CST may allow for early intervention before fetal acidemia and acidosis. For establishing the effects of a CST for FGR management, analysis including several cases and investigation of long-term outcomes of newborn infants is necessary.
Collapse
Affiliation(s)
- Hiroaki Tanaka
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Fumi H Furuhashi
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Kuniaki Toriyabe
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Takeshi Matsumoto
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Shoich Magawa
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Masafumi Nii
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Junko Watanabe
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Kayo Tanaka
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Takashi Umekawa
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Yuki Kamimoto
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| | - Tomoaki Ikeda
- a Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan
| |
Collapse
|
18
|
Doppler indices of the umbilical and fetal middle cerebral artery at 18-40 weeks of normal gestation: A pilot study. Med J Armed Forces India 2017; 73:232-241. [PMID: 28790780 DOI: 10.1016/j.mjafi.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 12/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Doppler indices form an integral component of noninvasive evaluation of fetal well-being. There is paucity of information about normal obstetric Doppler indices, particularly from the Indian subcontinent. The aim of the study was to find the values of pulsatility index (PI), resistive index (RI) of umbilical artery (UA), and fetal middle cerebral artery (MCA) and calculate cerebro-placental ratio (CP ratio) for 18-40 weeks of normal gestation so that a reference range of these Doppler values can be postulated. METHODS 200 patients were enrolled in the study for color Doppler study of UA and MCA and were serially followed up at 4-6 weeks interval for Doppler indices. Angle-independent Doppler indices like PI and RI for MCA and UA were obtained during each examination. CP ratio was calculated in each case. All the cases were followed up till delivery and the perinatal outcome was recorded. RESULTS & CONCLUSION The fetal MCA PI and RI showed a parabolic curve with plateau at 28-30 weeks of gestation. A significant correlation was noted between MCA PI and RI with gestational age. UA PI and RI showed a gradual fall over the gestational age with a strong negative correlation. There was a significant correlation between MCA PI and UA PI with their respective RI values. CP ratio has also shown a parabolic curve with turning point at 31-32 weeks of gestation. A significant correlation was noted between CP ratio and gestational age. CP ratio also showed a minimal positive correlation with MCA PI and a strong negative correlation with UA PI.
Collapse
|
19
|
Simpson L, Khati NJ, Deshmukh SP, Dudiak KM, Harisinghani MG, Henrichsen TL, Meyer BJ, Nyberg DA, Poder L, Shipp TD, Zelop CM, Glanc P. ACR Appropriateness Criteria Assessment of Fetal Well-Being. J Am Coll Radiol 2016; 13:1483-1493. [DOI: 10.1016/j.jacr.2016.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
|
20
|
Uchida T, Kanayama N, Mukai M, Furuta N, Itoh H, Suzuki H, Niwayama M. Examiner's finger-mounted fetal tissue oximetry: a preliminary report on 30 cases. J Perinat Med 2016; 44:745-749. [PMID: 25781515 DOI: 10.1515/jpm-2014-0297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe preliminary experience with a finger-mounted fetal tissue oximetry probe during the 2nd stage of labor. MATERIALS AND METHODS A total of 30 term pregnant women without pregnancy complications were recruited. We measured fetal tissue oxygen saturation (FtO2) by using a finger-mounted fetal tissue oximetry during cervical examinations in the 2nd stage of labor. The data capturing rate of FtO2 and the interclass correlation coefficient were also examined. The mean FtO2 was compared to the neonatal condition assessed by the levels of umbilical cord blood. RESULTS FtO2 was obtained in all cases, regardless of wetness, hair color, the part of the fetal head that was exposed, rotation of the fetus, color of amniotic fluid, and caput succedaneum. The mean FtO2 was 65.5%±8.58% in normal neonates [Apgar score >7 (1 min), n=25]. The mean FtO2 was significantly correlated with umbilical cord arterial pH (r=0.52, P=0.0030, n=30), but not with umbilical cord arterial partial pressure of oxygen. The interclass correlation coefficient was 0.94. CONCLUSIONS Tissue oxygen saturation of the fetal head was obtained easily by the examiner's finger-mounted fetal tissue oximetry.
Collapse
|
21
|
Herrera CA, Silver RM. Perinatal Asphyxia from the Obstetric Standpoint: Diagnosis and Interventions. Clin Perinatol 2016; 43:423-38. [PMID: 27524445 DOI: 10.1016/j.clp.2016.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Perinatal asphyxia is a general term referring to neonatal encephalopathy related to events during birth. Asphyxia refers to a deprivation of oxygen for a duration sufficient to cause neurologic injury. Most cases of perinatal asphyxia are not necessarily caused by intrapartum events but rather associated with underlying chronic maternal or fetal conditions. Of intrapartum causes, obstetric emergencies are the most common and are not always preventable. Screening high-risk pregnancies with ultrasound, Doppler velocimetry, and antenatal testing can aid in identifying fetuses at risk. Interventions such as intrauterine resuscitation or operative delivery may decrease the risk of severe hypoxia from intrauterine insults and improve long-term neurologic outcomes.
Collapse
Affiliation(s)
- Christina A Herrera
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA; Department of Maternal Fetal Medicine, Intermountain Healthcare, 121 Cottonwood Street, Murray, UT 84157, USA.
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA; Department of Maternal Fetal Medicine, Intermountain Healthcare, 121 Cottonwood Street, Murray, UT 84157, USA
| |
Collapse
|
22
|
Amorim-Costa C, Costa-Santos C, Ayres-de-Campos D, Bernardes J. Longitudinal evaluation of computerized cardiotocographic parameters throughout pregnancy in normal fetuses: a prospective cohort study. Acta Obstet Gynecol Scand 2016; 95:1143-52. [PMID: 27238561 DOI: 10.1111/aogs.12932] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/26/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The longitudinal cardiotocographic (CTG) changes throughout pregnancy in normal fetuses have never been fully described. We aimed at characterizing the evolution of CTG parameters in healthy fetuses, from 24 to 41 weeks of gestation. MATERIAL AND METHODS A prospective cohort study was conducted in singleton fetuses without structural abnormalities on second-trimester ultrasound. At least one CTG was performed in each of the following intervals: 24-26 weeks(+6d) , 27-29 weeks(+6d) , 30-32 weeks(+6d) , 33-35 weeks(+6d) , 36-38 weeks(+6d) and ≥39 weeks; tracings were analyzed by the OMNIVIEW-SISPORTO 3.6 system. Cases of preterm delivery, fetal death, birthweight under the 10th percentile, low five-minute Apgar, umbilical artery acidemia or neonatal intensive care unit admission were subsequently excluded. RESULTS A total of 1049 eligible tracings were obtained from 145 fetuses. There was a significant increase over time in average long-term variability (LTV), average short-term variability (STV), number of accelerations and uterine contractions. Conversely, fetal heart rate (FHR) baseline and number of decelerations decreased. A high inter-fetal variability was observed, but there was considerable intra-fetal consistency. Fetuses showing a marked decrease in FHR baseline and those with a marked increase in average LTV had a significantly lower birthweight. Cesarean section rate was significantly higher in cases with a decrease in average STV throughout gestation. CONCLUSIONS This prospective longitudinal study shows an evolution in computerized CTG parameters during pregnancy, indicating the need to adapt interpretation criteria based on gestational age. The high inter-fetal variability and considerable intra-fetal consistency suggests the possible value of using each fetus as its own reference in serial assessments.
Collapse
Affiliation(s)
- Célia Amorim-Costa
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal. .,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal. .,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.
| | - Cristina Costa-Santos
- Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Health Information and Decision Sciences, Porto Medical School, University of Porto, Porto, Portugal
| | - Diogo Ayres-de-Campos
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal
| | - João Bernardes
- Department of Obstetrics and Gynecology, Porto Medical School, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (I3S) and Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Porto Medical School, University of Porto, Porto, Portugal.,Department of Obstetrics and Gynecology, S. João Hospital, Porto, Portugal.,Department of Obstetrics and Gynecology, Hospital Pedro Hispano, Matosinhos, Portugal
| |
Collapse
|
23
|
Uchida T, Kanayama N, Kawai K, Niwayama M. Craniofacial tissue oxygen saturation is associated with blood pH using an examiner's finger-mounted tissue oximetry in mice. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:40502. [PMID: 27071413 DOI: 10.1117/1.jbo.21.4.040502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
Although fetal scalp blood sampling is an examination to assess fetal acidosis during the intrapartum period, it has not been widely used by obstetricians because of its invasiveness. We have developed a small, portable oximetry with a sensor attached to the examiner's finger. Our previous report using this oximetry concluded that fetal head tissue oxygen saturation (StO 2 StO2 ) correlated with umbilical cord artery blood pH. We investigated whether the association between StO 2 StO2 and blood pH in mice could be validated using this oximetry. Eleven the Institute for Cancer Research (ICR) mice were measured using a near-infrared spectroscopy probe at the craniofacial site in a closed polyethylene bag while changing the oxygen concentration. A total of nine blood samples were collected and analyzed for pH. The StO 2 StO2 and tissue blood pH showed a strong positive correlation (r=0.90 r=0.90 and P=0.0009 P=0.0009 ). The StO 2 StO2 and total hemoglobin index also showed a positive correlation (r=0.84 r=0.84 and P=0.0049 P=0.0049 ). Thus, the results of the present study support those of our previous report on clinical cases and allow examiners to easily check the status of fetal acidosis. Fetal management using this oximetry might gain popularity with obstetricians in the near future.
Collapse
Affiliation(s)
- Toshiyuki Uchida
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Naohiro Kanayama
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Kenta Kawai
- Hamamatsu University School of Medicine, Department of Obstetrics and Gynecology, 1-20-1 Handayama, Higashiku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Masatsugu Niwayama
- Shizuoka University, Department of Electrical and Electronic Engineering, 3-5-1 Johoku, Nakaku, Hamamatsu 432-8561, Japan
| |
Collapse
|
24
|
Amorim-Costa C, Cruz J, Ayres-de-Campos D, Bernardes J. Gender-specific reference charts for cardiotocographic parameters throughout normal pregnancy: a retrospective cross-sectional study of 9701 fetuses. Eur J Obstet Gynecol Reprod Biol 2016; 199:102-7. [DOI: 10.1016/j.ejogrb.2016.01.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/29/2016] [Indexed: 11/15/2022]
|
25
|
Kwon JY, Park IY. Fetal heart rate monitoring: from Doppler to computerized analysis. Obstet Gynecol Sci 2016; 59:79-84. [PMID: 27004196 PMCID: PMC4796090 DOI: 10.5468/ogs.2016.59.2.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/08/2022] Open
Abstract
The monitoring of fetal heart rate (FHR) status is an important method to check well-being of the baby during labor. Since the electronic FHR monitoring was introduced 40 years ago, it has been expected to be an innovative screening test to detect fetuses who are becoming hypoxic and who may benefit from cesarean delivery or operative vaginal delivery. However, several randomized controlled trials have failed to prove that electronic FHR monitoring had any benefit of reducing the perinatal mortality and morbidity. Also it is now clear that the FHR monitoring had high intra- and interobserver disagreements and increased the rate of cesarean delivery. Despite such limitations, the FHR monitoring is still one of the most important obstetric procedures in clinical practice, and the cardiotocogram is the most-used equipment. To supplement cardiotocogram, new methods of computerized FHR analysis and electrocardiogram have been developed, and several clinical researches have been currently performed. Computerized equipment makes us to analyze beat-to-beat variability and short term heart rate patterns. Furthermore, researches about multiparameters of FHR variability will be ongoing.
Collapse
Affiliation(s)
- Ji Young Kwon
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Affiliation(s)
- Seong Yeon Hong
- Department of Obstetrics and Gynecology, Catholic University of Daegu College of Medicine, Daegu, Korea
| |
Collapse
|
27
|
Booker W, Fox NS, Gupta S, Carroll R, Saltzman DH, Klauser CK, Rebarber A. Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2071-2075. [PMID: 26453124 DOI: 10.7863/ultra.14.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/01/2015] [Indexed: 06/05/2023]
Abstract
Objectives-The nonstress test is currently the most widely used modality for antenatal surveillance in twin pregnancies, with a quoted false-positive rate of 11%-12%. Our objective was to report our experience with the sonographic portion of the biophysical profile in twin pregnancies as the primary screening modality.Methods-Women with twin pregnancies delivered by a single maternal-fetal medicine practice from 2005 to 2013 were included. We excluded monoamniotic twins. Twin pregnancies began weekly sonography for the biophysical profile starting at 32 to 33 weeks, or earlier if indicated. The nonstress test was performed if the sonographic biophysical profile score was less than 8 of 8. We reviewed biophysical profile scores and outcomes for all patients who delivered at 33 weeks or later to assess the false-positive rate for the biophysical profile, as well as the incidence of intrauterine fetal death (IUFD) after initiation of antenatal surveillance.Results-A total of 539 twin pregnancies were included. The incidence of IUFD per patient was 2 per 539 (0.4%; 95% confidence interval [CI], 0.1%-1.3%), and the incidence of IUFD per fetus was 2 per 1078 (0.19%; 95% CI, 0.05%-0.7%). The overall positive screen rate was 24 per 539 (4.45%; 95% CI, 3.0%-6.5%). The false-positive screen rate, defined as an abnormal biophysical profile that did not diagnose an IUFD or lead to delivery, was 10 per 539 (1.9%; 95% CI, 1.0%-3.4%).Conclusions-In twin pregnancies the use of the sonographic biophysical profile for routine antenatal surveillance has a low false-positive rate, with a very low incidence of IUFD. The sonographic biophysical profile should be considered as a primary mode for antenatal surveillance in twin pregnancies, with a reflex nonstress test for an abnormal score.
Collapse
Affiliation(s)
- Whitney Booker
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Simi Gupta
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Rachel Carroll
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Daniel H Saltzman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Chad K Klauser
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.)
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
| |
Collapse
|
28
|
|
29
|
Parilla BV, McCulloch C, Sulo S, Curran L, McSherry D. Patterns of fetal growth in an Asian Indian cohort in the USA. Int J Gynaecol Obstet 2015; 131:178-82. [PMID: 26283226 DOI: 10.1016/j.ijgo.2015.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/23/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether a greater proportion of fetuses in an Asian Indian cohort are classified as small for gestational age than would be expected from a normally distributed population. METHODS A retrospective analysis of fetal growth pattern and neonatal outcome was conducted among Asian Indian women who were referred to a maternal-fetal medicine center in Park Ridge, IL, USA, for evaluation of fetal growth between January 1, 2012, and December 31, 2013. The primary outcome was an abdominal circumference or estimated weight of lower than the 10th percentile for gestational age according to the Hadlock formula. RESULTS Overall, 207 women and 210 fetuses were included. Forty-eight (22.9%) fetuses had an abdominal circumference lower than the 10th percentile. The total number of neonates classified as small for gestational age at delivery was 22 (10.5%), a value indicative of a normally distributed population. CONCLUSION Fetal size was smaller than expected among the present Asian Indian cohort, but most neonates were classified as appropriate for gestational age at birth. Population specific growth curves are needed to improve assessment of fetal growth.
Collapse
Affiliation(s)
- Barbara V Parilla
- Division of Maternal-Fetal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
| | - Colin McCulloch
- Division of Maternal-Fetal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Suela Sulo
- The James R. & Helen D. Russell Institute for Research & Innovation, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Leticia Curran
- Division of Maternal-Fetal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | | |
Collapse
|
30
|
Reference ranges of amniotic fluid index in late third trimester of pregnancy: what should the optimal interval between two ultrasound examinations be? J Pregnancy 2015; 2015:319204. [PMID: 25685558 PMCID: PMC4312643 DOI: 10.1155/2015/319204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. Very low values are associated with intrauterine growth restriction and renal anomalies of fetus, whereas high values may indicate fetal GI anomalies, maternal diabetes mellitus, and so forth. However, before deciding the cut-off standards for abnormal values for a local population, what constitutes a normal range for specific gestational age and the ideal interval of testing should be defined. Objectives. To establish reference standards for AFI for local population after 34 weeks of pregnancy and to decide an optimal scan interval for AFI estimation in third trimester in low risk antenatal women. Materials and Methods. A prospective estimation of AFI was done in 50 healthy pregnant women from 34 to 40 weeks at weekly intervals. The trend of amniotic fluid volume was studied with advancing gestational age. Only low risk singleton pregnancies with accurately established gestational age who were available for all weekly scan from 34 to 40 weeks were included in the study. Women with gestational or overt diabetes mellitus, hypertensive disorders of the pregnancy, prelabour rupture of membranes, and congenital anomalies in the foetus and those who delivered before 40 completed weeks were excluded from the study. For the purpose of AFI measurement, the uterine cavity was arbitrarily divided into four quadrants by a vertical and horizontal line running through umbilicus. Linear array transabdominal probe was used to measure the largest vertical pocket (in cm) in perpendicular plane to the abdominal skin in each quadrant. Amniotic fluid index was obtained by adding these four measurements. Statistical analysis was done using SPSS software (Version 16, Chicago, IL). Percentile curves (5th, 50th, and 95th centiles) were constructed for comparison with other studies. Cohen's d coefficient was used to examine the magnitude of change at different time intervals. Results. Starting from 34 weeks till 40 weeks, 50 ultrasound measurements were available at each gestational age. The mean (standard deviation) of AFI values (in cms) were 34 W: 14.59 (1.79), 35 W: 14.25 (1.57), 36 W: 13.17 (1.56), 37 W: 12.48 (1.52), 38 W: 12.2 (1.7), and 39 W: 11.37 (1.71). The 5th percentile cut-off was 8.7 cm at 40 weeks. There was a gradual decline of AFI values as the gestational age approached term. Significant drop in AFI was noted at two-week intervals. AFI curve generated from the study varied significantly when compared with already published data, both from India and abroad. Conclusion. Normative range for AFI values for late third trimester was established. Appreciable changes occurred in AFI values as gestation advanced by two weeks. Hence, it is recommended to follow up low risk antenatal women every two weeks after 34 weeks of pregnancy. The percentile curves of AFI obtained from the present study may be used to detect abnormalities of amniotic fluid for our population.
Collapse
|
31
|
Abstract
Contemporary management of HIV in pregnancy remains a moving target. With the development of newer antiretroviral agents with lower side-effect profiles and laboratory methods for detection and monitoring of HIV, considerable progress has been made. This review examines key concepts in the pathophysiology of HIV and pregnancy with emphasis on perinatal transmission and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and for those women with preexisting infection are discussed. Preconception counseling for HIV+ women as well as postpartum issues are addressed.
Collapse
|
32
|
Abstract
A major justification for the intentional delivery of a pregnancy before 39 weeks' gestation is a reduction in stillbirth. However, there is a considerable downside to late preterm or early term deliveries. Infants born before 39 weeks' gestation are at increased risk for numerous complications and even death. Thus, it is critical to identify which medical problems and circumstances place the fetus at high enough risk for stillbirth so as to justify late preterm or early term birth. This article highlights information pertinent to the pros and cons of iatrogenic preterm birth in pregnancies at risk for stillbirth.
Collapse
Affiliation(s)
- Sean F Edmunds
- Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 North 1900 East 2B200 SOM, Salt Lake City, UT 84132, USA
| | | |
Collapse
|
33
|
Sriram B, Mencer MA, McKelvey S, Siegel ER, Vairavan S, Wilson JD, Preissl H, Eswaran H, Govindan RB. Differences in the sleep states of IUGR and low-risk fetuses: An MCG study. Early Hum Dev 2013; 89:815-9. [PMID: 23907090 PMCID: PMC3816553 DOI: 10.1016/j.earlhumdev.2013.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/28/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is a fetal condition characterized by growth-rate reduction. Afflicted fetuses tend to display abnormalities in heart rate. OBJECTIVE To study the differences in the heart-rate variability of low-risk fetuses and IUGR fetuses during different behavioral states. METHODS A total of 40 fetal magnetocardiograms were analyzed from 20 low-risk and 20 IUGR fetuses recorded using a 151-sensor SQUID-array system. The maternal cardiac signals were attenuated using signal-space projection. Fetal R waves were identified using an adaptive Hilbert transform approach and fetal heart rate was calculated. In each three-minute window, the heart rate was classified into patterns reflective of quiet sleep (pattern A) and active sleep (pattern B) using the criteria of Nijhuis. Two adjacent 3-min windows exhibiting the same pattern were selected for analysis from every dataset. Heart-rate variability in that 6-min window was characterized using three measures, standard deviation of normal to normal (SDNN), root mean square of successive differences (RMSSD) and phase plane area (PPA). RESULTS All three measures tended to be lower in the IUGR group compared to the low-risk group. However, when the measures were analyzed in patterns, only PPA showed significant difference between the risk groups in pattern A, whereas both PPA and SDNN showed highly significant risk-group differences in pattern B. RMSSD did not show any significant risk-group difference. CONCLUSION The result signifies that the heart-rate variability of IUGR fetuses is different from that of low-risk fetuses, and only PPA was able to capture the HRV differences in both quiet and active states. The difference between these two groups of fetuses shows that the fetal-activity states are potential confounders when characterizing heart-rate variability.
Collapse
Affiliation(s)
- Bhargavi Sriram
- Graduate Institute of Technology, University of Arkansas at Little Rock, AR 72205, USA.
| | - Margret A Mencer
- SARA Research Center, Department of Ob/Gyn, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, Arkansas 72205-7199, USA
| | - Samantha McKelvey
- SARA Research Center, Department of Ob/Gyn, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, Arkansas 72205-7199, USA
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srinivasan Vairavan
- Graduate Institute of Technology, University of Arkansas at Little Rock, 2801 South University Ave, Little Rock, AR 72205, USA,Division of Fetal and Transitional Medicine, Children’s National Medical Center, 111 Michigan Avenue, N.W., Washington, DC 20010, USA
| | - James D. Wilson
- Graduate Institute of Technology, University of Arkansas at Little Rock, 2801 South University Ave, Little Rock, AR 72205, USA
| | - Hubert Preissl
- SARA Research Center, Department of Ob/Gyn, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, Arkansas 72205-7199, USA,MEG-Center, University of Tubingen, Tubingen 72074, Germany
| | - Hari Eswaran
- SARA Research Center, Department of Ob/Gyn, University of Arkansas for Medical Sciences, 4301 West Markham Street, #518, Little Rock, Arkansas 72205-7199, USA
| | - Rathinaswamy B. Govindan
- Division of Fetal and Transitional Medicine, Children’s National Medical Center, 111 Michigan Avenue, N.W., Washington, DC 20010, USA
| |
Collapse
|
34
|
Abstract
Despite widespread use of many methods of antenatal testing, limited evidence exists to demonstrate effectiveness at improving perinatal outcomes. An exception is the use of Doppler ultrasound in monitoring high-risk pregnancies thought to be at risk of placental insufficiency. Otherwise, obstetricians should proceed with caution and approach the initiation of a testing protocol by obtaining an informed consent. When confronted with an abnormal test, clinicians should evaluate with a second antenatal test and consider administering betamethasone, performing amniocentesis to assess lung maturity, and/or repeating testing to minimize the chance of iatrogenic prematurity in case of a healthy fetus.
Collapse
|
35
|
Arraut AME, Frias AE, Hobbs TR, McEvoy C, Spindel ER, Rasanen J. Fetal pulmonary arterial vascular impedance reflects changes in fetal oxygenation at near-term gestation in a nonhuman primate model. Reprod Sci 2012; 20:33-8. [PMID: 22991382 DOI: 10.1177/1933719112459224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We tested the hypothesis that fetal pulmonary arterial circulation reacts to changes in fetal oxygenation status at near-term gestation. STUDY DESIGN A total of 20 rhesus macaques underwent fetal Doppler ultrasonography at near-term gestation. Right pulmonary artery (RPA), umbilical artery (UA), ductus arteriosus (DA), and ductus venosus (DV) blood velocity waveforms were obtained, and pulsatility index (PI) values were calculated. Fetal right and left ventricular cardiac outputs were determined. Ultrasonographic data were collected during 3 maternal oxygenation states: room air (baseline), hyperoxemia, and hypoxemia. RESULTS Fetal RPA PI values increased (P < .05) during maternal hypoxemia and decreased (P < .05) during maternal hyperoxemia, compared with baseline. Maternal hyperoxemia increased (P < .05) DA PI values from baseline. Fetal cardiac outputs, UA, and DV PI values were not affected. CONCLUSIONS Our results demonstrate that at near-term gestation, fetal pulmonary arterial circulation is a dynamic vascular bed that reflects acute and short-term changes in fetal oxygenation.
Collapse
Affiliation(s)
- Amaryllis Maria Elpida Arraut
- Department of Obstetrics & Gynecology, Maternal Fetal Medicine Division, Oregon Health & Science University, Portland, OR, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Kase BA, Carreno CA, Blackwell SC. Customized estimated fetal weight: a novel antenatal tool to diagnose abnormal fetal growth. Am J Obstet Gynecol 2012; 207:218.e1-5. [PMID: 22835492 DOI: 10.1016/j.ajog.2012.06.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 04/17/2012] [Accepted: 06/06/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to apply customized standards to ultrasound-derived estimated fetal weight (EFW), and assess the frequency of abnormal growth when compared to population-based standards. We also evaluated association with adverse perinatal outcomes. STUDY DESIGN This was a historical cohort using prenatal ultrasound examination data at ≥24 weeks over a 1-year period. Ultrasound-derived EFW and growth percentile (population-based EFW [popEFW]) were reported and compared to a customized EFW (custEFW). RESULTS In all, 782 women met inclusion criteria. More fetuses were identified as small for gestational age (SGA) (15.1% vs 3.8%; P < .0001) and large for gestational age (LGA) (6.8% vs 1.7%; P < .0001) using custEFW, and adverse perinatal outcomes were more frequent among those identified by the custEFW compared to the popEFW. Both SGA and LGA diagnosed by custEFW were predictive of a neonatal SGA (positive likelihood ratio, 8.64) and LGA (positive likelihood ratio, 15.4). CONCLUSION CustEFW was a better predictor of abnormal birthweight and adverse outcomes compared to traditional popEFW standards.
Collapse
Affiliation(s)
- Benjamin A Kase
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Medical School at Houston, and Children's Memorial Hermann Hospital-Texas Medical Center, Houston, TX, USA
| | | | | |
Collapse
|
37
|
Kawakita T, Sasaki H, Hirabuki S, Asamoto A. Fetal growth restriction and reversed middle cerebral artery end-diastolic flow with subchorionic placental lake. J Obstet Gynaecol Res 2012; 39:578-82. [PMID: 22925471 DOI: 10.1111/j.1447-0756.2012.01994.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fetal growth restriction (FGR) is frequently associated with uteroplacental insufficiency. Placental lakes are avillous spaces filled with maternal venous blood that usually do not compromise the pregnancy outcome; however, a few reports describe FGR in association with placental lakes. Reversed middle cerebral artery (MCA) end-diastolic flow is a rare event and a potential indicator of poor fetal outcome due to placental insufficiency. We report a case of severe FGR associated with a huge subchorionic placental lake concomitant with reversed MCA end-diastolic flow. We also conducted a literature review.
Collapse
Affiliation(s)
- Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Center for Maternal Fetal Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
| | | | | | | |
Collapse
|
38
|
Pri-Paz S, Khalek N, Fuchs KM, Simpson LL. Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:648-653. [PMID: 21898637 DOI: 10.1002/uog.10093] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Polyhydramnios is present in approximately 2% of pregnancies and has been associated with a variety of adverse pregnancy outcomes. Our aim was to evaluate the association between the maximal amniotic fluid index (AFI) and the frequency of specific adverse outcomes. METHODS This was a retrospective chart review of 524 singleton pregnancies diagnosed with polyhydramnios and delivered in a single tertiary referral center between 2003 and 2008. Polyhydramnios was defined as either AFI ≥ 25 cm or a maximum vertical pocket (MVP) ≥ 8 cm even in the presence of AFI < 25 cm. The cohort was stratified into four groups based on the maximal AFI noted during the pregnancy: < 25 cm but with MVP ≥ 8 cm; 25-29.9 cm; 30-34.9 cm; and ≥ 35 cm. Data were collected to determine the frequency of the following adverse pregnancy outcomes: prenatally diagnosed congenital anomalies, fetal aneuploidy, preterm delivery, Cesarean delivery, low birth weight, 5-min Apgar score < 7 and perinatal mortality. RESULTS Higher AFI was associated with a statistically significant increase in the frequency of adverse pregnancy outcomes. The most severe form of polyhydramnios, as based on the maximal AFI (≥ 35 cm; n = 67), was associated with the highest rates of prenatally diagnosed congenital anomalies (79%), preterm delivery (46%), small-for-gestational-age neonate (16%), aneuploidy (13%) and perinatal mortality (27%). No significant association between degree of polyhydramnios and adverse outcome was demonstrated in cases of idiopathic polyhydramnios (n = 253). CONCLUSIONS There is an association between the frequencies of a variety of adverse pregnancy outcomes and the severity of polyhydramnios as reflected by the maximal AFI.
Collapse
Affiliation(s)
- S Pri-Paz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York 10032, USA.
| | | | | | | |
Collapse
|
39
|
Gruslin A, Lemyre B. Pre-eclampsia: Fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011; 25:491-507. [DOI: 10.1016/j.bpobgyn.2011.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/10/2011] [Indexed: 10/18/2022]
|
40
|
|
41
|
Goldenberg RL, McClure EM. Reducing intrapartum stillbirths and intrapartum-related neonatal deaths. Int J Gynaecol Obstet 2010; 107 Suppl 1:S1-3. [PMID: 19815207 DOI: 10.1016/j.ijgo.2009.07.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
42
|
Current world literature. Curr Opin Obstet Gynecol 2010; 21:541-9. [PMID: 20072097 DOI: 10.1097/gco.0b013e3283339a65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Wolfberg AJ, Norwitz ER. Probing the fetal cardiac signal for antecedents of brain injury. Clin Perinatol 2009; 36:673-84. [PMID: 19732620 DOI: 10.1016/j.clp.2009.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Obstetric care providers and researchers have long relied on analysis of the fetal heart rate tracing for insight into the fetal neurologic status. Although a normal fetal heart rate tracing does provide reassurance of intact neurologic function, an abnormal pattern is a very poor predictor of newborn brain injury. Indeed, if the clinical end point of interest is cerebral palsy, a non-reassuring fetal heart rate tracing has a 99% false positive rate. More recent analyses of fetal heart rate variability and fetal ECG waveforms, however, hold promise for improved diagnostic accuracy.
Collapse
Affiliation(s)
- Adam J Wolfberg
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Tufts Medical Center, Tufts Box 360, 800 Washington Street, Boston, MA 02111, USA.
| | | |
Collapse
|