Method Of Fetal Monitoring Research Articles

5 - Anaesthesia and Analgesia for the Active Management of Labour

SUMMARY Factors which will influence the use of analgesic agents during labour are evaluated with special reference to the maternal physiological and psychological changes of pregnancy, patient education and the modern management of labour. The advantages and disadvantages of systemic forms of analgesia are considered in addition to the use of inhalational agents and local blockades. Special attention has been given to the place of paracervical block, pudendal block and epidural analgesia in modern obstetric management. General anaesthesia is also discussed and its importance in policies of active labour management are clarified. Throughout the chapter emphasis is laid upon the need for co-operation between the anaesthetist, the obstetrician and the midwife. The importance of coupling modern methods of fetal monitoring with modern anaesthetic techniques has been continually stressed.

The use of the oxytocin challenge test for antepartum clinical evaluation of uteroplacental respiratory function

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of “stress” monitoring (monitoring in the presence of uterine contractions) are presented. The term “oxytocin challenge test” is used in reference to “stressed” monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.

Osteomyelitis and Sepsis: Severe Complications of Fetal Monitoring

Sophisticated modern methods of fetal monitoring during labor have improved the prognosis for high-risk infants, but the possible adverse side effects have not yet been fully documented. One infant with osteomyelitis and one with streptococcal sepsis are reported. In the future, greater attention should be paid to such potential complications and new noninvasive techniques of fetal monitoring should be developed.

Multiphasic fetal monitoring: A preliminary evaluation

In an effort to improve our ability to determine the state of fetal health and behavior, 13 biophysical techniques seldom used in obstetrics were evaluated in either antenatal clinics or labor wards. Fetal reponse to sound, systolic time intervals, arterial pulse propagation, and recording of fetal activity patterns were found to be the most promising techniques. Since no fetal monitoring method has been demonstrated to conclusively be of clinical benefit, a plea is made for regional plans in which many different promising biophysical techniques are evaluated by different institutions. Perhaps certain techniques will then be found to be helpful and thus justify the cost and effort that monitoring requires.

New Approach to Amnioscopy

To the Editor.— Amnioscopy for evaluation of intrauterine fetal status has slowly gained acceptance in this country since the original description of the method by Saling in 1962.1In general, amnioscopy is considered a simple, safe, and useful method of intrauterine fetal monitoring. The technique involves the visualization of the amniotic fluid through a partially dilated cervix and intact membranes. The main aim of amnioscopy is the detection of meconium within the amniotic fluid which presumably signifies fetal distress. Validity of meconium stained amniotic fluid as a sign of fetal distress in the absence of other associated stigmata such as alteration in fetal heart rate has remained a matter of much debate.2,3In addition amnioscopy may provide information, such as the presence of blood or bilirubin in the amniotic fluid in the case of abruptio placenta and erythroblastosis fetalis, respectively. According to our experience, amnioscopy is also of