Auscultation Of Fetal Heart Rate Research Articles

Implementasi Pada Kehamilan Dengan Hipertensi Kronis Superimposed Preeklampsia

Preeclampsia is a disorder that occurs in pregnant women and is a leading cause of maternal and perinatal mortality and morbidity up to fivefold after bleeding and infection. The research approach / design that has been carried out is a case study. Research has been conducted to determine the proper implementation of Mrs. J pregnant women at UPTD Puskesmas Plosoklaten Kediri Regency. The method of data collection that has been carried out is by means of anamnesis / interview, observation and documentation (SOAP). The review and implementation will be carried out in January 2023 in the MCH room. The results of the data collection of mothers complained of frequent dizziness, had a history of hypertension from biological mothers and currently Mrs.J suffers from chronic hypertension. History of previous childbirth by means of Sectio Caesarea (SC). Blood Pressure Results 140/80 mmHg, TD tilted: 120/60 mmHg, ROT 20 (positive), MAP 100 (positive), lila 23 cm and KSPR 18 (pregnant, SC, hypertension, distance between children 2 years). On the lower extremities there is oedema of the right and left legs. Fetal Heart Rate auscultation examination is 144 x / m, regular, strong. Based on the results of subjective data and objective data, analysis. Mrs. J is G2P1A0 gestational age 23-24 weeks single/live/intrauterine fetus, KU mother and fetus are both with chronic hypertension superimposed preeclampsia. The implementation given to Mrs. J G2P1A0 UK 23-24 weeks with chronic hypertension superimposed preeclampsia was carried out comprehensively and SOP for pregnancy check. Midwives have conducted initial screening and advised patients to check with doctors for therapy and make planned early referrals to prevent complications in mothers and babies.

The Effect of Photobiomodulation on Analgesia During Childbirth: A Controlled and Randomized Clinical Trial.

Background: Pain during labor can be a barrier when choosing vaginal delivery. In an attempt to relief pain during labor, several pharmacological and nonpharmacological methods are proposed. Objective: To assess the effect of light-emitting diode (LED) photobiomodulation on analgesia during labor. Methods: A clinical trial was conducted with 29 women who were divided into two groups: G1 (experimental group-LED) and G2 (control group-hot shower). In the experimental group, an LED plate with red and infrared merged [red 660 ± 20 nm, 5 mW/cm2, 3 J per LED (108 J) and infrared 850 ± 20 nm, 5 mW/cm2, 3 J per LED (108 J), total energy = 216 J] was placed on the subjects' dorsal region, at the level of T10 to S4, for 10 min, with the plate automatically turning off. Hot shower at controlled temperature was offered for 30 min. To verify the effect of LED on analgesia during labor, the following variables were assessed: (1) perception of pain, (2) fetal well-being assessed by cardiotocography or intermittent auscultation of fetal heart rate, (3) Apgar score at minutes 1 and 5 after birth, and (4) labor duration. Results: There was a statistically significant difference (p < 0.05) in pain reduction evidenced by a millimetric visual scale, before and after application on G1-LED (7.92 ± 1.78). Regarding the other variables, there was no statistical difference between the groups when comparing fetal well-being, Apgar score and labor duration. Conclusions: It is concluded that LED can be considered an alternative, since it caused pain reduction without changing other parameters during labor, compared with hot shower, a method included in hospital protocols, proving to be safe. Clinical Trial Registration number: NCT03496857.

In low-risk pregnant women in labor, does continuous fetal heart monitoring lead to improved maternal and perinatal outcomes compared to intermittent fetal heart rate auscultation?

In low-risk pregnant women in labor, does continuous fetal heart monitoring lead to improved maternal and perinatal outcomes compared to intermittent fetal heart rate auscultation?

Sepse durante o período gestacional

Objetivo: Realizar uma revisão de literatura sobre a ocorrência de sepse na gestação, considerando o desafio do diagnóstico e abordagem. Métodos: Foi realizada uma revisão de literatura consultando artigos científicos indexados nas bases eletrônicas LILACS e SCIELO. Resultados: A sepse é a terceira causa de morbimortalidade materna. A gestante tem diagnóstico dificultado devido às adaptações fisiológicas que ocorrem no estado gravídico que confundem-se com os critérios de sepse. As causas podem ser obstétricas ou não, sendo a infecção do trato urinário a principal. O diagnóstico precoce é imprescindível, podendo-se usar sinais clínicos que sugerem hipoperfusão, pois hipotensão e taquipnéia são esperados. A ausculta dos batimentos cardíacos fetais é relevante, pois taquicardia pode ser um sinal precoce de sepse. A prioridade do tratamento deve ser dada à gestante uma vez que o bem estar fetal depende da melhora dos parâmetros maternos. Considerações finais: As mortes maternas por sepse estão principalmente associadas a causas não obstétricas. Atrasos na identificação e no tratamento são importantes no prognóstico materno-fetal e passíveis de intervenção. É necessário alertar sobre as particularidades fisiológicas e critérios que podem ser usados para que haja reconhecimento precoce e melhor condução da sepse na gestação.

Does evidence from randomized controlled trials support the use of cardiotocography in pregnant women instead of intermittent auscultation of fetal heart rate?

Does evidence from randomized controlled trials support the use of cardiotocography in pregnant women instead of intermittent auscultation of fetal heart rate?

Female Genital Mutilation and Obstetric Outcomes in the Far-North Region, Cameroon: A Case - Control Study

Various forms of Female Genital Mutilations (FGMs) have been performed for several years and continue to be practiced with serious consequences.&#x0D; Aims: The study aimed at assessing the socio-demographic profile, prevalence, types of FGM, and associated obstetric outcomes in the Far North Region, Cameroon.&#x0D; Study Design: Case-control study.&#x0D; Place and Duration of Study: Four health facilities in the aforementioned region from 4th February, 2017 to 28th April 2017.&#x0D; Methods: We included 213 parturients matched for age and parity in a proportion of 1:2 (71 with FGM and 142 counterparts). Data was collected on their socio-demographic characteristics, knowledge of FGM and obstetric outcomes. Each parturient’s labor was monitored using a partograph and intermittent fetal heart rate auscultation. The mother-neonate dyads were followed up until discharge from the hospital. Data were analyzed using Epi Info™ version 7.&#x0D; Results: The mean age of parturients was 23.8 years (SD: 5.8 years). The prevalence of FGM was 28.7%. Most participants had FGM before the age of ten for the following reasons: cultural, marital, social acceptability and suppression of sexual desires. Female genital mutilation was significantly associated with Caesarian section (RR:2.91; 95% CI: 1.43-5.93; p=0.002), episiotomy (RR 8.0: 95% CI 1.56-17.26) P=0.03), perineal tears (RR: 3.67; 95% CI: 1.93-6.98; p&lt;0.001), prolonged labor (RR:2.7; 95% CI 1.44-5.09; p&lt;0.001), and neonatal resuscitation (RR:.44; 95% CI: 1.59-12.18; p=0.002). However, only perineal tears (Adjusted RR:5.58; 95% CI: 2.49-12.53; p&lt;0.001) and episiotomy (Adjusted RR 11.52; 95% CI: 1.16-114.69; p= 0.03) were independently associated with FGM on multivariate analysis.&#x0D; Conclusion: The prevalence of FGM was high. FGMs were associated with maternal and fetal morbidity. Therefore, mass sensitization on the consequences of FGM, utilization of ANC services and health facility child births should be encouraged.

Vigilancia fetal - Diagnóstico clínico y electrónico

Uno de los problemas más importantes de la obstetricia moderna es la exactitud de la evaluación de las condiciones de bienestar fetal, tanto en el período preparto y el parto, con el objetivo principal de la reducción de las tasas de morbilidad y mortalidad perinatal. La auscultación de la frecuencia cardíaca fetal se ha utilizado desde el comienzo del siglo como un medio de evaluar las condiciones fetales, que constituye el método más satisfactorio para controlar el producto conceptual durante la gestación y el parto.

Guidelines for the Management of a Pregnant Trauma Patient.

Abstract Objective Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. Outcomes Significant health and economic outcomes considered in comparing alternative practices. Evidence Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technologyrelated agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma

Room 101 – The only place for fetal monitoring in labour

British Journal of MidwiferyVol. 21, No. 6 BirthwriteRoom 101 – The only place for fetal monitoring in labourPaul LewisPaul LewisSearch for more papers by this authorPaul LewisPublished Online:27 Sep 2013https://doi.org/10.12968/bjom.2013.21.6.386AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alfirevic Z, Devane D, Gyte G (2007) Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database of Systematic Reviews 3: CD006066 Google ScholarFrancis R (2010) Mid Staffordshire NHS Foundation Trust Inquiry: January 2005–March 2009, Her Majesty's Stationery Office, London Google ScholarNational Institute for Health and Care Excellence (2007) Intrapartum Care: Care of healthy women and their babies. (NICE Clinical Guideline 55). www.nice.org.uk/cg55 (accessed 22 May 2013) Google ScholarNelson KB, Dambrosia JM, Ting TY, Grether JK (1996) Uncertain values of electronic fetal monitoring in predicting cerebral palsy. New England Journal of Medicine 334(10): 613–8 Crossref, Google ScholarSholapurkar SL (2010) Intermittent auscultation of fetal heart rate during labour – a widely accepted technique for low risk pregnancies: But are the current national guidelines robust and practical? Journal of Obstetrics and Gynaecology 30(6): 537–40 Crossref, Google ScholarWalsh D (2008) CTG use in intrapartum care: Assessing the evidence. British Journal of Midwifery 16(6): 367–9 Link, Google Scholar FiguresReferencesRelatedDetails 1 June 2013Volume 21Issue 6ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 27 September 2013 Published in print 1 June 2013 Information© MA Healthcare LimitedPDF download

Intermittent auscultation of fetal heart rate during labour – a widely accepted technique for low risk pregnancies: But are the current national guidelines robust and practical?

Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable.

Institute of Medicine Outlines Priorities for Comparative Effectiveness Research

fetal acid-base status; there isnotyet evidence to classify them as either normal or abnormal. Maconesnotedthis3-tierclassification systemisbasedonexpertopinion,notrigorousscientificevidence.“Despitethefact that it is used in 85% of births, there has been no new research in the last decade on fetal heart monitoring, so our document calls for more research,” he said. Such research appears long overdue. Macones and colleagues wrote that there are no randomized controlled trials comparing the benefits of electronic fetal monitoring with other forms of observation during labor and that benefits attributed to the technique are based on studies comparing it with intermittent fetal heart rate auscultation. Such studies indicate that electronicmonitoring,when compared with auscultation, reduces the risk of neonatal seizures. However, electronic fetal monitoring also increased the overall cesarean delivery rate as well as the risk of use of both vacuum and forceps operative techniques during a vaginal delivery, without reducing perinatal mortality or the risk of cerebral palsy. In addition, the false-positive rate of electronic monitoring for predicting cerebral palsy is greater than 99%, the guideline authors said. As for interpreting fetal heart rate tracings, Macones said work is needed to decrease variability and increase accuracy. The ACOG’s revision cited 1 study in which 4 obstetricians independently examined 50 tracings and reached similar interpretations in only 22% of the cases; 2 months later, in a review of the same 50 tracings, the obstetricians’ second interpretation differed from their initial evaluation in 21% of the tracings (Nielsen PV et al. Acta Obstet Gynecol Scand. 1987;66[5]:421-424). Thesamestudy foundthat reinterpretation of fetal heart rate tracings is subject to bias based on outcomes. The researchers foundthatareviewerwasmore likelytofindevidenceoffetalhypoxiaand tocriticizeanobstetrician’smanagement of the labor and delivery if the outcome for the fetuswaspoor insteadofgood.

Admission cardiotocography versus intermittent auscultation of fetal heart rate: Effects on neonatal Apgar score, on the rate of caesarean sections and on the rate of instrumental delivery—A systematic review

Objective The aim of this review was to determine whether intrapartum admission cardiotocography (CTG) in women at low obstetric risk can improve neonatal outcome (in terms of Apgar score) and whether it is associated with an increase in the incidence of instrumental delivery and caesarean section. Review methods The Cochrane Library, Medline (1966–November 2005), Embase (1980–November 2005) and the PubMed were searched for randomized control trials and systematic reviews of randomized control trials. Studies were assessed for quality. Outcomes considered the neonatal Apgar score at 5 min after delivery, caesarean section and instrumental delivery. A meta-analysis of the results of the randomized controlled trials was performed. Results The pooled relative risk for having an Apgar score less than 7 points at 5 min after delivery was higher in the admission CTG group (RR 1.35, 95% CI 0.85–2.13) but it was not statistically significant. The pooled relative risks for having a caesarean section-delivery (RR 1.2 95% CI 1.00–1.41) and an instrumental delivery (RR 1.1 95% CI 1.00–1.18) were both higher in the admission CTG group. Both these were statistically significant. Conclusion Intrapartum admission cardiotocography in women at low obstetric risk increases the risk of caesarean section and instrumental delivery. In addition, there is no evidence for neonatal benefit in terms of Apgar score at 5 min after delivery. A larger sample size would be needed in order to answer this important question.

Intrapartum auscultation of the fetal heart rate

A fetal heart rate recording containing a variable deceleration was played for 120 physicians and nurses. Although mean estimates for baseline and nadir of the fetal heart rate and duration of the deceleration were not significantly different from the actual values, individual estimates of the three parameters were widely distributed. Adjunctive techniques for intrapartum fetal heart rate auscultation are recommended.

Fetal Distress and the Condition of Newborn Infants

In a prospective audit of the obstetric management of 1210 consecutive deliveries the association was investigated between the need for operative delivery for fetal distress during labour and the condition of the newborn infant. Operative delivery was performed for only 11.5% of the newborn infants with severe acidosis birth (umbilical artery pH less than 7.12, base deficit greater than 12 mmol (mEq)/1), 24.1% of those with an Apgar score less than 7 one minute, and 15.8% of those with both severe acidosis and a one minute Apgar score less than 7. Most of the infants delivered operatively were in a vigorous condition birth and did not have severe acidosis. Fetal blood sampling was done in 4.0% of labours. As none of the fetal blood values were less than 7.20 and only three of the infants sampled in utero suffered severe acidosis birth, fetal blood sampling would have had to be performed much more often to provide a useful guide to metabolic state birth. While the large majority of at risk fetuses had continuous fetal heart rate monitoring in labour, this had not been provided in 48.7% of the labours of infants with severe acidosis, 38.7% of infants with a one minute Apgar score less than 7, and 47.4% of infants with both severe acidosis and a one minute Apgar score less than 7. Continuous fetal heart rate monitoring was associated with a much higher incidence of operative delivery for fetal distress than was intermittent fetal heart rate auscultation. These results suggest an urgent need to review present methods for assessing the intrapartum condition of the fetus, making the diagnosis of fetal distress, and assessing the condition of the infant birth.

Fetal distress and the condition of newborn infants.

In a prospective audit of the obstetric management of 1210 consecutive deliveries the association was investigated between the need for operative delivery for fetal distress during labour and the condition of the newborn infant. Operative delivery was performed for only 11.5% of the newborn infants with severe acidosis at birth (umbilical artery pH less than 7.12, base deficit greater than 12 mmol (mEq)/1), 24.1% of those with an Apgar score less than 7 at one minute, and 15.8% of those with both severe acidosis and a one minute Apgar score less than 7. Most of the infants delivered operatively were in a vigorous condition at birth and did not have severe acidosis. Fetal blood sampling was done in 4.0% of labours. As none of the fetal blood values were less than 7.20 and only three of the infants sampled in utero suffered severe acidosis at birth, fetal blood sampling would have had to be performed much more often to provide a useful guide to metabolic state at birth. While the large majority of "at risk" fetuses had continuous fetal heart rate monitoring in labour, this had not been provided in 48.7% of the labours of infants with severe acidosis, 38.7% of infants with a one minute Apgar score less than 7, and 47.4% of infants with both severe acidosis and a one minute Apgar score less than 7. Continuous fetal heart rate monitoring was associated with a much higher incidence of operative delivery for fetal distress than was intermittent fetal heart rate auscultation. These results suggest an urgent need to review present methods for assessing the intrapartum condition of the fetus, making the diagnosis of fetal distress, and assessing the condition of the infant at birth.