Fetal Acidosis Research Articles

Heart rate markers for prediction of fetal acidosis in an experimental study on fetal sheep

To overcome the difficulties in interpreting fetal heart rate (FHR), several tools based on the autonomic nervous system and heart rate variability (HRV) have been developed. The objective of this study was to use FHR and HRV parameters for the prediction of fetal hypoxia. It was an experimental study in the instrumented fetal sheep. Repeated umbilical cord occlusions were performed to achieve severe acidosis. Hemodynamic parameters, ECG, and blood gases were analyzed. The variables used were heart rate baseline, HRV analysis (RMSSD, SDNN, LF, HF, HFnu, Fetal Stress Index (FSI), …), and morphological analysis of decelerations. The gold standard used to classify hypoxia was the fetal arterial pH (pH < 7.10). Different multivariable statistical methods (logistic regression and decision trees) were applied for the detection of acidosis. 21 lambs were instrumented. A total of 130 pairs of FHR/fetal pH analysis were obtained of which 29 in the acidosis group and 101 in the non-acidosis group. After logistic regression model with bootstrap resampling and stepwise backward selection, only one variable was selected, FSI. The AUC of FSI alone in this model was 0.81 with a sensitivity of 0.66, specificity of 0.88, PPV of 0.61, and NPV of 0.90 considering a threshold of 68. Decision trees with CHAID and CART algorithms showed a sensitivity of 0.48 and 0.59, respectively, and a specificity of 0.94 for both. All employed methods identified HRV variables as the most predictive of acidosis. The primary variables selected automatically were those from the HRV. Supporting the use of FHRV measures for the screening of fetal acidosis during labour is interesting.

Study of Oligohydramnios and Perinatal Outcome in Term Pregnancy

BACKGROUND&#x0D; Oligohydramnios is associated with an increased risk of adverse pregnancy outcomes. The perinatal mortality rate in oligohydramnios is high. Oligohydramnios is also associated with fetal heart conduction abnormalities, meconium staining of the amniotic fluid, umbilical cord compression, lower Apgar scores, poor tolerance of labour and fetal acidosis. We wanted to assess the perinatal outcome in term pregnancies complicated with oligohydramnios in this study.&#x0D; METHODS&#x0D; A prospective cohort study was conducted among 200 cases of pregnant women with singleton term pregnancy with intact membranes and AFI &lt; 5cm admitted from January 2019 to June 2020 in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. Antenatal patients with oligohydramnios confirmed by USG were induced within 24 hrs based on the Bishops score. History and examination findings were recorded in a predesigned proforma. Mode of delivery and APGAR scores were also noted. Neonatal complications and the need for ICU admission were studied up until their NICU admission or hospital stay.&#x0D; Statistical Analysis: Statistical tests of association using SPSS (version 20.0) were employed at the level of significance of 5 %.&#x0D; RESULTS&#x0D; The majority of patients in this study were primigravida (60.5 %) and belonged to the age group 20-29 yrs (73.5 %). There was a higher rate of induction (67.5 %) in oligohydramnios patients. Around 26 % had meconium-stained amniotic fluid. The rate of caesarean section was found to be 22.5 % and that of instrumental delivery was 3.5 %. Oligohydramnios was associated with a higher rate of NICU admission (27.5 %). The most common complications noted were jaundice (9.8 %), birth asphyxia (4.9 %), meconium aspiration syndrome (3.4 %) and respiratory distress syndrome (1 %). Only 1 case of neonatal mortality was seen in this study.&#x0D; CONCLUSIONS&#x0D; Oligohydramnios adversely affects the maternal and perinatal outcome. It is associated with higher rates of induction, caesarean section, meconium-stained amniotic fluid, low APGAR scores, fetal distress and perinatal morbidity and mortality. However, the outcome can be improved by good antepartum and intrapartum monitoring and neonatal care.

Laparoscopic Treatment of Benign Adnexal Masses During Pregnancy: A Comprehensive Evaluation of Treatment Basics, Efficacy and Surgical Techniques.

This review summarizes the evidence-based recommendations for how to approach and laparoscopically treat adnexal masses during pregnancy. We conducted a comprehensive review of studies related to the laparoscopic management of adnexal masses during pregnancy. Selected studies were independently reviewed by two authors. The overall incidence of ovarian tumors in pregnancy ranges between 0.05% and 5.7%, of which less than 5% are malignant. Diagnosis is based mainly on routine transvaginal ultrasound. More than 64% of simple cysts, less than 6 cm in diameter, will spontaneously resolve in less than 16 weeks. However, for persistent and complex tumors, the risk of acute complications can reach up to 9%. Surgical indications are similar to those in the non-gravidic setting, and include acute complications (torsion, rupture, hemorrhage), suspected malignancy and large (over 6 cm) persistent masses. Surgery must be scheduled between 16 and 20 weeks to allow for the spontaneous resolution of functional cysts. Furthermore, within that period, pregnancy becomes independent of the corpus luteum and enlargement of the uterus gives sufficient exposure for the surgery to be performed safely. A recent meta-analysis found that, compared to open surgery, laparoscopy is associated with significantly less preterm labor, blood loss and hospital stay, without differences in pregnancy loss or preterm birth rate. Since the main concerns about maternal-fetal safety are related to increased intraperitoneal pressure and the effects of hypercarbia (maternal hypertensive complications, fetal acidosis), a lower CO2 pressure (10 to 12 mmHg) and reduced operative times (less than 30 minutes) are recommended.

Development of a comprehensive database for research on foetal acidosis

ObjectiveTo develop a research database for mother-and-child clinical and laboratory data and digital foetal heart rate (FHR) recordings. MethodsThe Base Bien Naître (BBN) database was derived from a single-centre health data warehouse. It contains exhaustive data on all parturients with a singleton pregnancy, a vaginal or caesarean delivery in labour with a cephalic presentation after at least 37 weeks of amenorrhea, and a live birth between February 1st, 2011, and December 31st, 2018. On arrival in the delivery room, the FHR was recorded digitally for at least 30 min. A cord blood sample was always taken in order to obtain arterial pH (pHa). More than 6,000 recordings were analyzed visually for the risk of foetal acidosis and classified into five groups (according to the French College of Gynaecologists and Obstetricians (CNGOF) classification) or three groups (according to the International Federation of Gynaecology and Obstetrics (FIGO) classification). ResultsOf the 16,089 files in the health data warehouse, 11,026 were complete and met the BBN’s inclusion criteria. The FHR digital recordings were of good quality, with low signal loss (median [interquartile range]: 7.0% [4.3;10.9]) and a median recording time of 304 min [190;438]). In 3.7% of the children, the pHa was below 7.10. We selected a subset of 6115 records with good-quality FHR recordings over 120 min and reliable cord blood gas data: 692 (11.3%) had at least a significant risk of acidosis (according to the CNGOF classification), and 1638 (26.8%) were at least suspicious (according to the FIGO classification). ConclusionThe BBN database has been designed as a searchable tool with data reuse. It currently contains over 11,000 records with comprehensive data.

Peripartum Severe COVID-19 Pneumonia: Fetal and Neonatal Implications.

Peripartum Severe COVID-19 Pneumonia: Fetal and Neonatal Implications.

284 Do new paradigms on cardiotocography interpretation based on the pathophysiology of fetal acidosis have an impact on obstetric practices?

Introduction: There is currently a paradigm shift in the cardiotocography (CTG) interpretation with some promoting a return to an analysis based on the pathophysiology of fetal acidosis. The teaching of this interpretation method is booming with the emergence of many specific training. Thus, the usefulness of second-line methods has been tacitly questioned. Objective: Determine the impact of CTG trainings on obstetric practices. Method: This was a multicentric pilot study based on online questionnaires.

Is fetal CTG a reliable indicator of fetal distress? A prospective study on relationship between CTG suspected fetal distress and immediate postpartum umbilical cord blood pH.

Introduction Perinatal asphyxia is one of the major causes of neonatal morbidity and mortality. Fetal Cardiotocography (CTG) has been used for long to predict fetal asphyxia. Despite its popularity, it has not been proved to be an ideal tool for monitoring as, although a normal trace is indicative of a normal acid-base status at birth, in about 98% of cases, an abnormal trace has a low positive predictive value in term of fetal acidosis (pH less than 7.25) .An undisputed evidence of perinatal asphyxia is metabolic acidosis on arterial cord blood or very early neonatal samples: pH< 7 and base deficit >12 mmol/L Aim To see the correlation between suspicious/pathological CTG and umbilical cord blood pH at birth in term pregnancies. Material and methods This was a hospital based prospective randomized observational study over a period of 1 year. It was conducted on 165 pregnant women with singleton term pregnancy admitted to labour ward for delivery and having suspicious / pathological CTG trace or meconium stained liquor with normal CTG trace. Immediately after the birth of the neonate, umbilical cord was clamped, cut and umbilical artery cord blood was collected in a pre - heparinized syringe and sent for pH analysis. Cord blood pH of less than 7.2 was interpreted as acidosis. Results The number of acidotic cases (as determined by cord blood pH less than 7.2) was 2(5.6%) in normal traces whereas 34 cases (94.4%) of normal traces were non acidotic. In the suspicious traces, 2 cases (3.2%) were acidotic and 59 cases (96.8%) were non acidotic. In the pathological category, 13 cases (19.1%) were acidotic and 55 cases (80.9%) were non acidotic. There was no significant association of CTG category with cord blood pH, acidosis, pO2 or pCo2 values but that with presence of MSL and grade of MSL was statistically significant. Conclusion Abnormal CTG while being a good predictor of the presence of MSL and also the grade of MSL, is a poor predictor of the presence of fetal acidosis and neonatal status after birth. Fetal monitoring using cardiotocography was associated with considerable false positive results. Thus, using fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress during labour is a contributing factor of increasing rate of cesarean sections.

A Review on Magnetic Induction Spectroscopy Potential for Fetal Acidosis Examination.

Fetal acidosis is one of the main concerns during labor. Currently, fetal blood sampling (FBS) has become the most accurate measurement of acidosis detection. However, it is invasive and does not provide a real time measurement due to laboratory procedures. Delays in diagnosis of acidosis have caused serious injury to the fetus, especially for the brain and the heart. This paper reviews the new technique in diagnosis of acidosis non-invasively. Magnetic Induction Spectroscopy (MIS) has been proposed to be a new device for acidosis detection in recent years. This paper explains the basic principle of MIS and outlines the design specifications and design considerations for a MIS pH probe. It is expected that readers will gain a basic understanding of the development of a MIS pH probe from this review.

English

BACKGROUND Regional anaesthesia has become the preferred technique for caesarean section because of higher incidence of maternal mortality and morbidity associated with general anaesthesia. Spinal hypotension occurs as a result of sympathetic blockade and decreased venous return due to decreased systemic vascular resistance and venous pooling. Such episodes of hypotension have been shown to cause decreased Apgar scores and foetal acidosis. Preloading with intravenous fluids, left uterine displacement and prophylactic/ therapeutic vasopressors have all been used in the prevention and management of hypotension traditionally. However no single method has been proved satisfactory. In terms of neonatal and maternal outcomes, prevention of hypotension is considered superior to treatment of established hypotension. In this study, we compare the efficacy of preloading of crystalloids with Ephedrine infusion in prevention of hypotension following spinal block in caesarean patients. Objectives- Primary objective is to determine the incidence of hypotension following spinal anaesthesia in patients receiving preloading with crystalloids and preloading with Ephedrine. Secondary objective is to compare intraoperative maternal and foetal adverse effects of pre-treatment with crystalloids and Ephedrine. METHODS An observational study was conducted in 90 patients belonging to ASA I and II categories undergoing elective LSCS. One category received 10ml/kg Ringer Lactate and other category 10mg Ephedrine in 10ml/kg Ringer Lactate 15-30 minutes prior to spinal block. All patients received SAB with 22.2ml 0.5% Bupivacaine heavy at L3-L4 space. HR and BP were monitored periodically and fall in MAP of ≥20% was noted and managed with rescue Ephedrine. Maternal adverse events, foetal APGAR scores and umbilical blood gas analysis noted. RESULTS Incidence of hypotension was significantly less in Ephedrine category as compared to crystalloid category. Incidence of maternal adverse events as well as foetal parameters was not significantly different. CONCLUSIONS Preloading with Ephedrine decreases the incidence of maternal hypotension when compared to crystalloids alone. KEY WORDS Caesarean Section, Crystalloids; Ephedrine, Foetal Acidosis, Mean Arterial BP, Preloading, Spinal Hypotension.

A Comparative Study of Ephedrine and Phenylephrine in Averting Hypotension during Cesarean Section under Spinal Anesthesia

Maternal haemodynamic variations are communal during caesarean section by spinal anesthesia. Several measures are adopted to treat hypotension. The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C-section by spinal anesthesia and its outcome on the condition of the fetus. Place and Duration: In the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six-months duration from July 2021 to December 2021. Methods: 120 total ASA grade-I patients with normal single pregnancy over 36 weeks who endured planned caesarean-section under spinal-anesthesia were randomized into 2 groups equally. Group I was given 5 mg rescue bolus and 10 mg prophylactic bolus dose of ephedrine intravenously during intrathecal block. Group II received 50 µg of rescue bolus and 100 µg of an intravenous dose of prophylactic phenylephrine bolus during intrathecal block. Haemodynamic variables such as heart rate and blood pressure were documented after every-2-mints until birth and every 5-minutes thereafter. The neonatal score was measured using the 1- and 5-minute Apgar scale and the pH value of the neonatal blood in the umbilical cord. Results: There were no differences in the treatment of hypotension among the 2 groups. The bradycardia incidence was greater in the group of phenylephrine. The variances in Apgar score, birth weight and umbilical cord pH amid the 2 groups were not statistically significant. Conclusions: Ephedrine and phenylephrine are similarly operative in the treatment of hypotension during elective caesarean section given spinal anesthesia. No statical variance in the occurrence of true fetal acidosis between the two vasopressors was noticed. Both groups have good neonatal outcome. Key words: Fetal acidosis, ephedrine, phenylephrine, hypotension and spinal anesthesia.

New possibilities for ST analysis – A post-hoc analysis on the Dutch STAN RCT

BackgroundThe diagnostic value of ST analysis of the fetal electrocardiogram (fECG) during labor is uncertain. False alarms (ST events) may be explained by physiological variation of the fetal electrical heart axis. Adjusted ST events, based on a relative rather than an absolute rise from baseline, correct for this variation and may improve the diagnostic accuracy of ST analysis. AimsDetermine the optimal cut-off for relative ST events in fECG to detect fetal metabolic acidosis. Study designPost-hoc analysis on fECG tracings from the Dutch STAN trial (STAN+CTG branch). Subjects1328 term singleton fetuses with scalp ECG tracing during labor, including 10 cases of metabolic acidosis. Outcome measuresCut-off value for relative ST events at the point closest to (0,1) in the receiver operating characteristic (ROC) curve with corresponding sensitivity and specificity. ResultsRelative baseline ST events had an optimal cut-off at an increment of 85% from baseline. Relative ST events had a sensitivity of 90% and specificity of 80%. ConclusionsAdjusting the current definition of ST events may improve ST analysis, making it independent of CTG interpretation.

Diagnosis and Management of Pregnant Women With Placental Abruption and Neonatal Outcomes.

BackgroundPlacenta abruptio (PA) remains a serious materno-fetal complication. According to progress realized in maternal-fetal medicine, we aimed to evaluate the diagnosis and management of PA and neonatal outcomes.MethodsWe conducted a retrospective study that involved all the patients that were diagnosed with PA in a tertiary maternity hospital between 2006 and 2013. Data were analyzed to determine mean and standard deviation and statistically analyzed using the Chi-square test.ResultsIn total, 201 patients were diagnosed with PA out of 35184 deliveries (0.56%). The mean age of patients was 30 years and most of them were multiparous (56.2%). Thirty-six out of 201 patients (17.9%) smoked tobacco or consumed alcohol during the pregnancy. Three patients came from their homes. Twenty-eight patients had preeclampsia and 105 presented with high blood pressure. Furthermore, 117 patients presented metrorrhagia (58.2%) and 39% of patients exhibited abdominal pain. We reported fetal heart rate abnormalities in 57% of the cases. Ultrasound examination revealed PA in only 48 patients (23.9%). One hundred eighty out of 201 patients (84.6%) underwent an emergency caesarean section. One hundred sixty-seven fetuses were born prematurely. Thirteen out of 201 fetuses died, and 98 newborns needed neonatal resuscitation. In total, 31 fetuses had an umbilical artery (UA) with pH ≤ 7 (31/188). The mean time for delivery was 18.7 min. However, UA pH did not differ when the delivery time was shorter (p = 0.09). Seventy-six percent of cases came from their homes. The mean UA pH was significantly lower for PA cases who came from their homes compared to hospitalized women (p = 0.0015). Histological examination of the placenta confirmed the diagnosis in 71 out of 148 cases (47.9%). The mean duration of hospital stay of the newborns was 17 days.ConclusionPA remains a serious materno-fetal emergency with a bad fetal prognosis for many newborns. Many fetuses either died or exhibited severe acidosis. Clinical signs and radiological images of PA are absent in many cases. There was more fetal acidosis for mothers who came from their homes at the time of delivery. We recommend that the delivery should not be delayed and a cesarean section must be the preferred mode of delivery. Pregnant women with vascular and metabolic diseases should be carefully monitored and informed on the risk of PA.

Prenatal evaluation for the diagnosis of X-Linked myotubular myopathy in a known affected sibling: A case report

X-linked myotubular myopathy, a rare disorder is part of a group of congenital myopathies that present in the neonatal period. While the clinical presentation in the antenatal period may be varied, the postnatal presentation is of a delayed cry, hypotonia and weakness resembling fetal hypoxia and acidosis. The presence of such features without any factors predisposing towards hypoxia, or a recurring phenotype should prompt a detailed evaluation of the neonate, including genetic evaluation in selected cases. A genetic diagnosis will also aid in evaluation of family members, including an early prenatal diagnosis in future siblings. Keywords: X-linked myotubular myopathy; MTM1; prenatal diagnosis.

Delivery Room ST Segment Analysis to Predict Short Term Outcomes in Near-Term and Term Newborns.

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement. Methods: Observational study in Tanzania, between 2013–2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG morphology in relation to perinatal variables or short-term outcomes. Results: A total of 494 resuscitated and 25 healthy infants were included. ST-elevations were commonly seen both in healthy infants (7/25; 28%) and resuscitated (320/494; 65%) infants. The apparent ST-elevations were not associated with perinatal variables or short-term outcomes. Among the 32 (6.4%) resuscitated infants with “other ST-segment abnormalities”, duration of BMV was longer, 1-min Apgar score lower and normal outcomes less frequent than in the resuscitated infants with normal ECG or ST-elevations. Conclusions: ST-segment elevation was commonly seen and not associated with negative outcomes when using one-lead dry-electrode ECG. Other ST-segment abnormalities were associated with prolonged BMV and worse outcome. ECG with appropriate bandwidth and automated analysis may potentially in the future aid in the identification of severely asphyxiated infants.

Neonatal outcomes following prophylactic administration of phenylephrine or noradrenaline in women undergoing scheduled caesarean delivery: A randomised clinical trial.

There is limited evidence to support the use of noradrenaline over phenylephrine during elective caesarean section with regards to its impact on foetal acidosis. Concerns regarding a deleterious effect of noradrenaline on foetal blood gas analysis because of its β-mimetic activity cannot currently be ruled out by data from randomised controlled trials. We hypothesised that noradrenaline would be associated with higher umbilical artery base excess values and less foetal acidosis compared with phenylephrine. This study aimed to observe the effect of prophylactic infusions of phenylephrine or noradrenaline in low-risk elective caesarean delivery on umbilical artery blood gas analysis. A prospective, randomised, double-blind trial. Labour room operating theatre of tertiary care hospital in Northern India from April 2020 to November 2020. Full-term, nonlabouring pregnant women, scheduled for elective caesarean delivery under spinal anaesthesia. Equipotent prophylactic infusions of either phenylephrine 100 μg min-1 or noradrenaline 5 μg min-1 were administered to maintain maternal SBP between 90 and 110% of baseline using a predefined algorithm. The primary outcome was umbilical artery base excess in noradrenaline versus the phenylephrine group. The incidence of foetal acidosis defined as umbilical artery base excess less than -6 mmol l-1 was also assessed for noradrenaline versus phenylephrine. Median [IQR] umbilical artery base excess was significantly higher in the noradrenaline group: -5.4 [-6.6 to -4.03] versus -6.95 [-9.02 to -4.53] in the phenylephrine group (P = 0.014). No significant difference in the incidence of foetal acidosis was observed between noradrenaline and phenylephrine groups: 36 versus 54% (P 0.07); difference 18% (95% CI, -1.4 to 35.6%). Prophylactic noradrenaline 5 μg min-1 infusion resulted in higher base excess values compared with phenylephrine 100 μg min-1 infusion. A comparable incidence of foetal acidosis was observed in women receiving either noradrenaline or phenylephrine. Maternal bradycardia was more pronounced with phenylephrine while targeting blood pressure goals. CTRI/2020/03/023986.

Uterine contraction frequency in the last hour of labor: how many contractions are too many?*

Objective Increased frequency of uterine contractions is a component in the cluster of causal conditions that can lead to fetal hypoxia and acidosis and increase the risk for neonatal neurologic injury. For most international obstetrical societies, 5 contractions per 10 min averaged over 30 min is considered as the upper limit of normal uterine activity. We hypothesize that it might be safer to adopt an upper limit of 4 contractions per 10 min. Methods We reviewed our 1970’s research database containing 475 patients with closely monitored and well-documented labor and neonatal assessments that included cord blood (CB) pH, base excess (BE), and continuous recording of neonatal heart rate (NHR). Using data segregated by the proportion of the last hour before delivery when uterine contraction frequency (UCF) exceeded 4 and 5 contractions per 10 min respectively, we evaluated outcomes (CB BE, pH, Apgar scores at 1 min, the status of NHR at 16 min after birth, and the proportion of births that did not the result from normal spontaneous vaginal deliveries (NSVDs). ANOVA established relationships between UCF cutoffs and these outcomes. Our sample size is sufficiently large to provide the ability of UCF, per se, to accurately detect an alpha region of .05 88% of the time with an effect size of .15. Results During the last hour prior to delivery, a UCF cutoff at 4 contractions per 10 min performed better than a UCF cutoff at 5 contractions per 10 min to enable the earlier identification of risks for abnormal outcomes. The longer UCF was increased, the worse were the outcomes that were measured, and the region >4 but ≤5 contractions identifies the beginnings of worsening conditions in a variety of measures of poor outcomes. Conclusion Lowering the recommended threshold for UCF from 5 to 4 contractions per 10-minute period as averaged over 30 min facilitates earlier detection of potentially compromised fetuses and is also an important contributor to a multicomponent contextualized approach to risk assessment.

LABOUR ANALGESIA BY NEUROAXIAL BLOCKADE TECHNIQUE AND ITS LABOUR OUTCOME

BACKGROUND:Pain relief during labour is an important component of modern obstetric care and can be produced by neuraxial, systemic or inhalational analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique.A good labour analgesia should aim at good pain relief during delivery process,at the same time not causing foetal acidosis,ensures safe for both mother and the baby. AIM OF THE STUDY:To study the influence of epidural analgesia on maternal and neonatal outcome MATERIALS AND METHODS:The study was conducted in the depar tment of Obstet r ics and Gynecology,GOVT.Stanley Medical College,Govt.RSRM LYING IN HOSPITAL,CHENNAI over a period of eight months from July 2019 to February 2021. The study was performed in 120 selected subjects. The study subjects were divided based on intervention – labour analgesia into 2 study groups. In this study,change in vital parameters,fetal heart rate,assessment of pain score,Duration of first and second stage of labour,mode of delivery,APGAR score and the need for NICU admission were noted and recorded.Any complications during the course of labour were also recorded. RESULTS:In this study,there was no significant difference in the mean duration of first and second stage of labour in both the study and control groups.The mean Apgar score of babies at one minute was 7.02 and at 5 minutes was 8.07 in the labour analgesia group and showed no significance.Maternal satisfaction for the effect of epidural analgesia,60.00% of the patients of epidural analgesia, the incidence of satisfactory/very satisfactory experience was meaningfully and significantly more in labour analgesia group subjects compared to control group subjects by 30 % with a 2 fold increase. CONCLUSION: As per this study labour analgesia using neuroaxial blockade technique are more likely to encounter increasing maternal satisfaction and good quality labour pain reduction.

Comparison of intravenous bolus doses of phenylephrine vs ephedrine along with crystalloid co-loading in the prevention of hypotension during spinal anesthesia for caesarean section

Caesarean section was the first obstetrical operation that saves the life of the baby when normal delivery fails. Spinal anaesthesia is the most appropriate method for caesarean section. But hypotension is the most common side effect of it in patient with pregnant uterus. To compare the vasopressor effects of ephedrine and phenylephrine in ameliorating hypotension in elective caesarean delivery receiving crystalloid coloading, during intrathecal bupivacaine injection.: Study participants were randomly divided into two groups of 50 patients each. After subarachnoid block, all the parturients were given rapid administration of ringer lactate solution 20ml/kg, during the initial 5 minutes of surgery the parameters such as oxygen saturation, blood pressure and pulse rate recorded for every one minute followed by every five minutes until the completion of the surgery. The incidence of hypotension, bradycardia, nausea/vomiting, block height and requirements of vasopressor (ephedrine and phenylephrine) were recorded. Apgar score, and blood sample from umbilical cord was taken and sent for blood gas analyses to determine the neonatal outcome.: Vasopressor consumption was more in phenylephrine group (92±112 µg) compared to ephedrine group (4.8±5.5 mg) which was statistically significant p=0.0001. The neonatal outcome was statistically significant regarding umbilical cord pH (Group E-7.2±0.06 and Group P-7.37±0.04 with p=0.002) but clinically no true fetal acidosis in either groups and no significant changes regarding Apgar score in the two groups.: Thus we conclude that that ephedrine 6 mg and phenylephrine 100 µg does not differ in their efficacy to manage hypotension during spinal anaesthesia for caesarean delivery. However, maternal bradycardia was more in the phenylephrine group with equal incidence of fetal acidosis in the study groups.

Proposed cutoff for fetal scalp blood lactate in intrapartum fetal surveillance based on neonatal outcomes: a large prospective observational study.

Determination of lactate in fetal scalp blood (FBS) during labour has been recognised since the 1970s. The internationally accepted cutoff of >4.8 mmol/l indicating fetal acidosis is exclusive for the point-of-care device (POC) LactatePro™, which is no longer in production. The aim of this study was to establish a new cutoff for scalp lactate based on neonatal outcomes with the use of the StatstripLactate® /StatstripXpress® Lactate system, the only POC designed for hospital use. Observational study. January 2016 to March 2020 labouring women with indication for FBS were prospectively included from seven Swedish and one Australian delivery unit. Inclusion criteria: singleton pregnancy, vertex presentation, ≥35+0 weeks of gestation. Based on the optimal correlation between FBS lactate and cord pH/lactate, only cases with ≤25 minutes from FBS to delivery were included in the final calculations. Metabolic acidosis in cord blood defined as pH <7.05 plus BDecf >10 mmol/l and/or lactate >10 mmol/l. A total of 3334 women were enrolled of whom 799 were delivered within 25 minutes. The areas under the receiver operating characteristics curves (AUC) and corresponding optimal cutoff values were as follows; metabolic acidosis AUC 0.87 (95% CI 0.77-0.97), cutoff 5.7 mmol/l; pH <7.0 AUC 0.83 (95% CI 0.68-0.97), cutoff 4.6 mmol/l; pH <7.05 plus BDecf ≥12 mmol/l AUC 0.97 (95% CI 0.92-1), cutoff 5.8 mmol/l; Apgar score <7 at 5 minutes AUC 0.74 (95% CI 0.63-0.86), cutoff 5.2 mmol/l; and pH <7.10 plus composite neonatal outcome AUC 0.76 (95% CI 0.67-0.85), cutoff 4.8 mmol/l. A scalp lactate level <5.2 mmol/l using the StatstripLactate® /StatstripXpress® system will safely rule out fetal metabolic acidosis. Scalp blood lactate <5.2 mmol/l using the StatstripLactate® /StatstripXpress system has an excellent ability to rule out fetal acidosis.

Initial Results on Primary Field Cancellation of Magnetic Induction Spectroscopy Technique for Fetal Acidosis Detection using COMSOL Multiphysics

Monitoring of fetal condition during labor could save hundred lives in a single year. During labor, fetus is at critical condition as acidosis may occur suddenly without any early symptoms. Invasive method such as Fetal Blood Sampling (FBS) has been used to detect the decline in pH level of fetus. However, fetal loss rate after FBS may range from 1.4% up to 25%. In this paper, magnetic field induction spectroscopy was implemented to determine fetal acidosis by using primary magnetic field cancellation technique. Magnetic Induction Spectroscopy (MIS) probe was design where transmitter coil (TX) is perpendicular to receiver coil (RX). The result shows that the secondary magnetic field produced have been successfully measured without any interruption from primary magnetic field. By using transmitter input 1A, it shows that voltage is inversely proportional to the blood pH due to the conductivity properties of blood.