Antepartum and intrapartum fetal assessment:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1999
|
| Schriftenreihe: | Obstetrics and gynecology clinics of North America
26,4 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII S., S. 535 - 754 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Antepartum and intrapartum fetal assessment |c Gary A. Dildy guest ed. |
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Datensatz im Suchindex
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| adam_text | ANTEPARTUM AND INTRAPARTUM FETAL ASSESSMENT
CONTENTS
Preface xi
Gary A. Dildy III
Nonstress Testing and Contraction Stress Testing 535
Lawrence D. Devoe
Antepartum fetal heart rate (FHR) testing, including the nonstress
test and contraction stress test, has evolved in clinical usage over
the past 3 decades. Although the nonstress test has become a
standard of care in high risk pregnancy, it has been modified by
the use of fetal stimulation (vibroacoustic stimulation) and the
addition of automated fetal movement recording (actocardioto
cography). In all of its formats, antepartum FHR testing has been
associated with reduction of preventable fetal loss. More recently,
there have been attempts to improve test efficacy by computer
enhanced approaches. *
Fetal Biophysical Profile 557
Frank A. Manning
This article begins with an outline of the theoretie basis of the
fetal biophysical profile, the method for the biophysical profile
score (BPS), and the timing and frequency of testing. The article
further discusses the clinical management based on test scores;
modified methods of the BPS; and clinical application, predictive
accuracy, and impact on outcome of BPS. The authors specifically
examine the relationship between BPS and cerebral palsy. They
conclude with a discussion of adult sequelae and fetal adaptation
to asphyxia.
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA
VOLUME 26 • NUMBER 4 • DECEMBER 1999 V
Amniotic Fluid Volume Assessment in Singleton and
Twin Pregnancies 579
Everett F. Magann and James N. Martin, Jr
The best method of ultrasonic mensuration to identify abnormal
amniotic fluid volume (AFV) reliably in singletons and the indi¬
vidual sacs of diamniotic twins remains elusive. With respect to
twins, localization of the dividing membrane seems to be neces¬
sary for AFV assessments of each amniotic cavity. The relation¬
ship of ultrasonic estimates, actual AFV, and pregnancy outcome
remains undetermined. In the authors opinion, the subjective
assessment in twin gestation may be as accurate as semiquantita
tive ultrasonic estimates of AFV similar to the situation in single¬
ton pregnancies.
Vascular Doppler Techniques 595
Warwick B. Giles
Doppler ultrasound used for the assessment of the fetal umbilical
circulation in the human pregnancy has been reported in the
scientific literature since the early 1980s and has been rigorously
evaluated by randomized, controlled trials. The consensus of the
reviewers of these trials is that there do appear to be grounds
for including umbilical artery Doppler ultrasound studies in the
management of high risk pregnancies. There is no apparent bene¬
fit for low risk pregnancies or later gestation. Other fetal vascular
beds are currently undergoing prospective studies and some lim¬
ited randomized, controlled trials have been reported; but to date
they are not at a point of development to be considered part of
clinical management.
Fetal Movement Counts 607
Franklyn C. Christensen and William F. Rayburn
Monitoring fetal movement is an indirect measure of central
nervous system and integrity. Daily fetal kick counting helps to
determine the need for additional fetal testing, and to predict
abnormal FHR patterns and perhaps impending stillbirth, making
it especially useful in high risk gestations. Methods to record
and classify different activities are reviewed, and the relationship
between fetal movements and fetal heart rate accelerations and
external stimuli is described. Limitations to fetal kick counts and
future perspectives are discussed.
Intrapartum Fetal Heart Rate Monitoring 623
Frank H. Boehm
Intrapartum fetal heart rate monitoring is commonly used to
evaluate fetal status in labor, despite a lack of convincing random¬
ized studies to support its use. The National Institutes of Health
vi CONTENTS
have helped standardize fetal heart rate monitoring terminology
with their 1997 task force report, which will aid clinicians and
scientists in their goal of providing quality care and research.
The American College of Obstetricians and Gynecologists has
recommended the term nonreassuring fetal status for electronic
fetal monitor patterns that are not normal; however, Vanderbilt
continues to use the terms fetal stress and fetal distress, using
specific criteria for each. The approximately 30% of fetal heart
rate tracings labeled as fetal stress (or nonreassuring fetal status)
can be evaluated further by the use of fetal pulse oximetry, a new
technology currently under evaluation in this country.
Scalp Blood Gas Analysis 641
Keith R. Greene
The use of fetal blood sampling has been advocated widely to
improve the specificity of fetal heart rate monitoring, but it re¬
mains a clinically unpopular procedure. This article considers its
physiologic rationale and evidence base. Ft includes descriptions
of the technique with suggestions for improved clinical interpreta¬
tion and discusses the efficacy of fetal blood sampling with some
consideration of possible alternatives.
Vibroacoustic and Scalp Stimulation 657
T. Flint Porter and Steven L. Clark
Both vibroacoustic (VAS) and scalp stimulation are useful in the
evaluation of fetal compromise by decreasing the number of
falsely abnormal fetal heart rate (FHR) tests and limiting the
number of unnecessary interventions. In addition, they both im¬
prove the efficiency of antepartum and intrapartum FHR monitor¬
ing. As with all types of fetal assessment using FHR monitoring,
VAS and scalp stimulation have limitations and a lack of response
to them does not necessarily indicate fetal acidemia.
Continuous Intrapartum pH, pOz, pCOj, and SpO2
Monitoring 671
Helen M. Me Namara and Gary A. Dildy III
Experimental continuous methods of measurement of intrapar¬
tum fetal biochemical status have included continuous fetal pH,
continuous fetal pOz, and the development of continuous fetal
SpO2 using pulse oximetry. The main limitation of the continuous
pH studies was the lack of a user friendly electrode, whereas
continuous tcpO2 and tcpCO2 studies had problems with diffu¬
sion and the unpredictable effects of caput formation. Continuous
fetal noninvasive SpO2 has long been developed to the point
where it is unaffected by caput formation, offering a continuous
measurement of fetal oxygenation during labor.
CONTENTS vii
Umbilical Cord Blood Gas Analysis 695
James A. Thorp and R. Scott Rushing
Umbilical blood sampling at delivery has emerged as the most
objective measurement of utero placental function and fetal oxy
genation/acid base status at birth. Most depressed newborns
have completely normal umbilical cord blood gas values. In con¬
trast to the poor specificity of fetal heart rate monitoring and
Apgar scores, umbilical cord blood gas analysis defines the exact
acid base balance and differentiates perinatal asphyxia from other
conditions leading to immediate newborn depression and adverse
neurologic sequelae. This article discusses normal cord blood
gas values, pertinent acid base physiology, factors affecting these
values, and the advantages of universal versus selective sampling
strategies.
Clinical Implications of Perinatal Depression 711
T. Murphy Goodwin
The evaluation of the depressed newborn as a possible role in
intrapartum asphyxia must be based on the objective findings of
the fetal heart rate tracing, umbilical cord blood gas, and newborn
neurologic function. Using these points as a basis for long term
followup, the following principles have been elucidated: Intrapar¬
tum asphyxia is an uncommon cause of childhood neurologic
dysfunction, the intrapartum insult necessary to cause long term
neurologic dysfunction is profound, and the child who does not
manifest encephalopathy in the newborn period will not suffer
long term neurologic dysfunction that can be attributed to intra¬
partum asphyxia.
Intrapartum Fetal Surveillance: Is it Worthwhile? 725
James A. Low
Intrapartum fetal asphyxia with morbidity or mortality, although
an infrequent occurrence, is important because of the serious
implications of this complication. The benefits of intrapartum
fetal surveillance by predictive fetal heart rate (FHR) patterns
have not been established; however, harm may occur because of
unnecessary intervention. Prediction of most cases of intrapartum
fetal asphyxia by FHR patterns is possible but difficult. Because
of the large number of false positive FHR patterns, supplemen¬
tary tests are essential. Until additional fetal assessment tests are
validated, blood gas and acid base assessment of fetal blood is
the test that can provide a definitive diagnosis and identify false
positive predictions.
Cumulative Index 1999 741
Subscription Information Inside back cover
viii contents
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| spelling | Antepartum and intrapartum fetal assessment Gary A. Dildy guest ed. Philadelphia [u.a.] Saunders 1999 XII S., S. 535 - 754 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Obstetrics and gynecology clinics of North America 26,4 Pränatale Diagnostik (DE-588)4047000-3 gnd rswk-swf Risikogeburt (DE-588)4178225-2 gnd rswk-swf Geburtsüberwachung (DE-588)4410351-7 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Risikogeburt (DE-588)4178225-2 s Pränatale Diagnostik (DE-588)4047000-3 s DE-604 Geburtsüberwachung (DE-588)4410351-7 s Dildy, Gary A. Sonstige oth Obstetrics and gynecology clinics of North America 26,4 (DE-604)BV000617486 26,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008787227&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Antepartum and intrapartum fetal assessment Obstetrics and gynecology clinics of North America Pränatale Diagnostik (DE-588)4047000-3 gnd Risikogeburt (DE-588)4178225-2 gnd Geburtsüberwachung (DE-588)4410351-7 gnd |
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| title | Antepartum and intrapartum fetal assessment |
| title_auth | Antepartum and intrapartum fetal assessment |
| title_exact_search | Antepartum and intrapartum fetal assessment |
| title_full | Antepartum and intrapartum fetal assessment Gary A. Dildy guest ed. |
| title_fullStr | Antepartum and intrapartum fetal assessment Gary A. Dildy guest ed. |
| title_full_unstemmed | Antepartum and intrapartum fetal assessment Gary A. Dildy guest ed. |
| title_short | Antepartum and intrapartum fetal assessment |
| title_sort | antepartum and intrapartum fetal assessment |
| topic | Pränatale Diagnostik (DE-588)4047000-3 gnd Risikogeburt (DE-588)4178225-2 gnd Geburtsüberwachung (DE-588)4410351-7 gnd |
| topic_facet | Pränatale Diagnostik Risikogeburt Geburtsüberwachung Aufsatzsammlung |
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