Cause Of Fetal Distress Research Articles

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

True umbilical cord knot and tight nuchal cord loops as a cause of fetal distress and emergent cesarean delivery: A Case report

Justification of Cesarean section in fetal distress: Experience in a tertiary care military hospital in Bangladesh

Background: The trend of Caesarean section (CS) carried out is rising worldwide. One of the most common indications of CS is fetal distress which is based on the cardiotocograph (CTG) recording, abnormal fetal heart rate pattern and meconium stained liquor. The aim of this study was to carry out an audit of CS performed due to fetal distress in a tertiary care military hospital with a view to justify the methods for diagnosis of fetal distress to fetal outcome.
 Methods: This cross-sectional observational study was carried out over a period of 1 year and 6 months (July 2013 to January 2015) in the Combined Military Hospital (CMH), Dhaka. All pregnant women at or beyond 37 weeks of gestation who underwent CS for fetal distress were included. Neonatal outcome were assessed based on APGAR score and neonatal intensive care admission.
 Results: Among the 260 (100%) women who underwent CS due to fetal distress, mean age was 27.8 ± 5.3 years. More than half (54.6%) of the women were primigravida. Majority (48%) of the patients presented with spontaneous onset of labor and in 43% cases labor was induced by medical methods. In the majority (40%) of the patients, fetal distress was diagnosed by seeing abnormal patterns in CTG. During CS, signs of fetal distress was found in the majority (64.6%) of the patients (meconium stained liquor 42.3%, cord abnormality 13.5% and placental abnormality 8.8%). APGAR score of the newborn babies was abnormal (<7) in the majority (60%) cases. More than half of the newborn babies required admission in neonatal intensive care unit for different diagnosis. There was only 4 (1.5%) cases of neonatal death.
 Conclusion: The rate of CS for fetal distress in this study was comparable to other study findings and within recommendation of WHO. The high rate of identifiable causes of fetal distress as well as neonatal outcome justifies doing CS in these cases.
 Birdem Med J 2020; 10(1): 60-63

THE IMPORTANCE OF VITAMIN D DEFICIENCY AND PROCALCITONIN LEVELS IN PREDICTING PLACENTAL DYSFUNCTION IN PREGNANT WOMEN WITH A RISK OF INTRAUTERINE INFECTION

Placental dysfunction (PD) is a polyetiological pathology, which continues to be the main cause of fetal distress and antenatal fetal death. Pathogenetic mechanisms of its development are actively studied and probable background processes can be vitamin D(VD) deficiency syndrome and intrauterine infection (IUI).Objective. Determination of procalcitonin and calcitriol levels and their possible interrelation in pregnant women with placental dysfunction and risk of intrauterine infection.Materials and methods. 56 women with PD and with a risk of intrauterine infection implementation (main group) and 40 women with physiological pregnancy were examined. Serum levels of procalcitonin and total vitamin D (25 (OH) D) were determined by ELISA.Results. The procalcitonin level was significantly higher in pregnant women of the main group than in the control group (0.24 ± 0.15 ng / ml and 0.063 ± 0.19 ng / ml, p <0.05). In the control group, the prokalcitonin score did not exceed the norm in any of the cases. The level of procalcitonin was significantly higher in women of the main group with VD deficiency status than in women with an optimal level of calcitriol in the same group (0.47 ± 0.077 ng / ml VS 0.143 ± 0.076 ng / ml; p <0.05).Conclusions Vitamin D deficiency or insufficiency are associated with an increase of procalcitonin level in pregnant women with the presence of intrauterine infection risk factors. Determination of procalcitonin may probably be a promising avenue in predicting the development of placental dysfunction in this group of women.

Velamentous Cord Insertion – A Case Report

Normally the umbilical cord is inserted into the central portion of placenta; at times the cord is inserted distally from the margin; onto the fetal membranes, called velamentous insertion. After the insertion the umbilical vessels traverse unsupported for a variable distance between amnion and chorion before reaching the placenta. These vessels can get compressed and torn especially in labour resulting in acute fetal distress and at times fetal death. We report a case where the cause of fetal distress during labour was compression of these vessels. There is a strong case of finding out site of cord insertion when the antenatal cases are undergoing routine sonography. Once abnormal insertion is detected then these pregnancies should be monitored closely as the chances of both antenatal and intranatal complications are higher in such pregnancies.

Case control study of nucleated RBC’s in cord blood as a predictor of perinatal asphyxia its severity and outcome

Background: Perinatal asphyxia word derived from the greek word a-spyxos, meaning born without an evident pulse, is one of the most important causes of fetal distress. Inspite of major advances in technology and knowledge of fetal and perinatal medicine, it is one of the significant causes of mortality and long-term morbidity. World health organization (WHO) has defined perinatal asphyxia as a failure to initiate and sustain breathing at birth. HIE is one of the most common complication in an asphyxiated neonate because of its serious longterm neuromotor sequalae among the survivors. A detailed classification of HIE staging in term neonate was proposed by Sarnat and Sarnat.Methods: The present study was prospective case control study conducted in neonatal intensive care unit of Department of Pediatrics at SGRD institute of medical sciences and research over a period of one year from September 2016 to august 2017. Total of 100 newborns among which 50 asphyxiated babies were designated to case group and rest 50 normal term babies to control group. The NRBC count of the case and control groups is compared. The NRBC’s of subjects belonging to different stages of HIE is then compared. The results were analysed statistically chi-square analysis for variance (qualitative analysis), t-test (compare mean NRBC’s in different stages) by SPSS version 20 software for biostatistic and p-value of &lt;0.05 was considered statistically significant.Results: Among total 100 babies included in the study, the male and female distribution was 22 (44%) and 28 (56%) in cases and 23 (46%) and 27 (54%) in controls respectively. In our study, the NRBC /100 WBC count for normal newborn was 0.88±1.35 and in case group it was 21.40±20.Conclusions: In present study, the cord blood NRBC count was shown to be a good predictor of perinatal asphyxia with sensitivity of 86%, specificity of 100%, positive predictive value of 100% and negative predictive value of 87.72%. NRBC’s can be used for early detection of HIE and its grading in asphyxiated neonates.

Spontaneous cord hematoma: report of two cases

Abstract Spontaneous hematoma of the umbilical cord due to rupture of an umbilical cord vessel is a rare obstetrical complication which represents a severe cause of fetal distress with a 50% of reported fetal demise. Although several risk factors have been suggested, the cause of this disorder remains unknown. Herein we describe two cases of term deliveries with spontaneous umbilical cord hematomas which resulted in live births. In both cases the diagnosis was made intrapartum and was confirmed by a histopathologic examination.

Answers to MCQs

The nuchal cord is often blamed for problems that are encountered during delivery and is often cited as a major cause of fetal distress and perinatal mortality. However, the actual significance of nuchal cord on the outcome of an infant is controversial. A retrospective study was done to investigate the actual frequency of nuchal cords encountered in a hospital setting and to determine its effect on an infant as it passes through the birth canal and immediately after delivery.A retrospective study was carried out in 350 deliveries (out of total 367 deliveries) including 65 cases of nuchal cord from July to December 2005. Nuchal cord group was divided into loose nuchal cord (cord could easily be uncoiled before delivery of the newborn) group and tight nuchal cord (cord was needed to be clamped and cut before delivery) group. The mode of delivery, complications and fetal outcome of nuchal cord groups was compared with rest of the deliveries. Seventeen cases (including three cases of nuchal cord) having complications as intrauterine growth retardation, oligohydramnios (AFI <5), antepartum haemorrhage, severe pregnancy induced hypertension and maternal medical complications were excluded.We found that the loose nuchal cord group did not have any significant difference in mode of delivery or fetal outcome as compared to control group however the group having tight cord around the neck had significantly higher proportion of fetal distress and low Apgar scores at one minute.Loose nuchal cord doesn't increase the chances of cesarean delivery whereas tight cord around the neck may result in lower Apgar scores at one minute and increased incidence of fetal distress.

Nuchal cord: A retrospective analysis

Background: The nuchal cord is often blamed for problems that are encountered during delivery and is often cited as a major cause of fetal distress and perinatal mortality. However, the actual significance of nuchal cord on the outcome of an infant is controversial. A retrospective study was done to investigate the actual frequency of nuchal cords encountered in a hospital setting and to determine its effect on an infant as it passes through the birth canal and immediately after delivery. Methods: A retrospective study was carried out in 350 deliveries (out of total 367 deliveries) including 65 cases of nuchal cord from July to December 2005. Nuchal cord group was divided into loose nuchal cord (cord could easily be uncoiled before delivery of the newborn) group and tight nuchal cord (cord was needed to be clamped and cut before delivery) group. The mode of delivery, complications and fetal outcome of nuchal cord groups was compared with rest of the deliveries. Seventeen cases (including three cases of nuchal cord) having complications as intrauterine growth retardation, oligohydramnios (AFI <5), antepartum haemorrhage, severe pregnancy induced hypertension and maternal medical complications were excluded. Result: We found that the loose nuchal cord group did not have any significant difference in mode of delivery or fetal outcome as compared to control group however the group having tight cord around the neck had significantly higher proportion of fetal distress and low Apgar scores at one minute. Conclusion: Loose nuchal cord doesn't increase the chances of cesarean delivery whereas tight cord around the neck may result in lower Apgar scores at one minute and increased incidence of fetal distress.

Chemosensitivity of normal human trophoblasts evaluated by a newly developed ATP-based luminescence assay.

Trophoblast injury may be one of the possible causes of fetal distress associated with chemotherapy administered during pregnancy. The purpose of this study was to investigate the ex vivo chemosensitivity of normal trophoblasts (NTB) against commonly used antineoplastic agents. Using the newly developed ex vivo ATP-based trophoblast assay (ATP-TBA), 31 NTB freshly sampled from human placentas (gestational week 7-42) were tested against dactinomycin (Act-D), 5-fluorouracil (5-FU), 4-OOH-cyclophosphamide (4-HC), vincristine (VCR) and methotrexate (MTX) alone or in combination with calcium folate (LV). All agents were studied at concentrations relevant to clinical dosages normally used for chemotherapy of solid neoplasms. Of 31 samples studied with the ATP-TBA, 20 (65%) were evaluable. VCR, Act-D and 4-HC were the most active drugs with 55, 45 and 45% of samples responding ex vivo. Antimetabolites were less active, producing ex vivo response rates of 25 (MTX) and 20% (5-FU), respectively. MTX activity was largely neutralized by adding LV. The chemosensitivity of NTB showed considerable inter-individual variations and did not decrease with increasing gestational age. We therefore conclude that NTB of any gestational age exhibit considerable ex vivo sensitivity against common anticancer agents which is comparable to that observed for various solid tumors. The ATP-TBA may be helpful in planning future trials with both single agents and drug combinations in order to standardize and optimize chemotherapy during pregnancy.

Renal venous thrombosis: an unusual cause of fetal distress

Renal venous thrombosis (RVT) is a rare event in neonates and infants. Its incidence varies from 0.5‰ concerning admissions in neonatal intensive care units to 0.5% in autopsic findings. Some cases may occur in the antenatal period. Clinical presentation in infants includes a mass in the flank, hematuria and thrombocytopenia. We report a case of RVT which was diagnosed at 34 weeks' gestation by ultrasound in a fetus showing cardiotocographic signs of fetal distress. We observed the typical pattern reported by pediatric radiologists: renal enlargement, loss of the cortico-medullary boundary, echoic streaks following the direction of interlobular veins, lack of definition of renal sinus echoes and loss of venous flow in the right kidney by Doppler velocimetry. After delivery by caesarean section and transient hyperbilirubinemia and moderately impaired renal function the infant weighing 2435 g had a full recovery at 1 week and a normal evolution at 1 month of life.

Possible Causes Linking Asphyxia, Thick Meconium and Respiratory Distress

The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium-stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium-stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection). Of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection. The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium-stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.

Conservative treatment of intrapartum fetal acidosis with a betamimetic agent

553 cases of intrapartum fetal acidosis (pH < 7.25) were treated with a betamimetic agent (ritodrine 250–300 μg/min). In 403 cases (72.8%), an improvement of fetal pH greater than 0.05 pH U was observed. Improvement was comparable in cases where the cause of fetal distress was abnormal uterine activity and in those where this was not the cause. Indeed, the recovery rate was the same, independent of the percentage of uterine activity inhibition. The neonatal condition was better in the pH recovered versus not recovered group. We suggest that conservative treatment of fetal distress with betamimetic drugs is a reasonable measure for improvement of fetal and neonatal condition.

Prolonged pregnancy: I. Observations concerning the causes of fetal distress

During a 2-year prospective investigation of prolonged pregnancy in 727 women, 59 (8%) were delivered by cesarean section for fetal distress. This condition was diagnosed by means of electronic fetal heart rate monitoring in 47 of the women, and the patterns were unexpectedly characteristic of umbilical cord compression rather than uteroplacental insufficiency. Blinded sonar examinations were performed in 213 women, and the incidence of cesarean section for fetal distress as now described was significantly increased in those with oligohydramnios (two or fewer 1 cm pockets of amniotic fluid). We conclude that the pathophysiology of fetal distress in prolonged pregnancy is typically oligohydramnios that leads to compromised umbilical cord perfusion, rather than uteroplacental insufficiency.

Listeria amnionitis as a cause of fetal distress

Listeria amnionitis as a cause of fetal distress

Fetal cervical hyperextension in breech presentation

I read with considerable interest the article by Dr. J. G. B. Russell and Dr. Margaret R. C. Aird in the British Journal of Radiology of July 1976 on the above subject. It has been my experience over several years that hyperextension of the cervical spine of the fetus in the antenatal radiograph is sometimes associated with the presence of the umbilical cord being wound round the fetal neck and it may well be a cause of fetal distress during labour.

Nuchal encirclement by the umbilical cord.

SummaryNuchal encirclement by the umbilical cord is a common cause of fetal distress, and may result in neonatal depression and acidaemia. Severe irregularity of the fetal heart gives prolonged warning of the condition. The temporal relationship of transient episodes of bradycardia to uterine contractions is not helpful in differentiating cord entanglement from other causes of fetal hypoxaemia.

THE CAUSES OF FETAL DISTRESS

From the Division of Laboratories, Providence Lying-In Hospital and the Institute for Health Sciences, Brown University, Providence, Rhode Island

THE CAUSES OF FETAL DISTRESS

THE CAUSES OF FETAL DISTRESS