Correlation of Umbilical Cord Whole Blood Viscosity and the Presence of Fetal Distress at Birth: A Mathematical Modelling Study

This study was designed to investigate the relationship between umbilical cord blood viscosity and clinical parameters such as maternal parity, maternal smoking, mode of delivery, sex of infant and the incidence of fetal distress at birth using mathematical modelling. The results demonstrated vaginal delivery, male infants, infants of primigravidas and low cord whole blood viscosity at a high shear rate were covariables and were associated with an increased incidence of fetal distress and low Apgar scores.     

脐带形态学异常对胎儿结局的影响研究进展

脐带是胎儿和胎盘组织之间的重要连接,是母体与胎儿进行物质交换的纽带。近年来,国内外大量研究显示,脐带形态学异常可引起胎儿循环障碍从而导致胎儿和新生儿严重不良结局的发生,如胎儿生长受限、胎儿窘迫、新生儿窒息或死亡,以往有报道脐带异常新生儿病死率为28.5%,由此可见,正确认识脐带异常非常重要。综述脐带形态学异常与胎儿结局的关系,发现脐带长度异常、脐带缠绕、脐带扭转、脐带打结、脐带附着异常、单脐动脉等均能导致胎儿和新生儿不良结局的发生。     

Umbilical Cord and Maternal Serum Levels of Mezlocillin in Term and Preterm Deliveries in Mothers Diagnosed with Chorioamnionitis

Recent investigations have demonstrated decreased morbidity in the newborn following maternal administration of antibiotics to mothers with a diagnosis of chorioamnionitis. These benefits are based upon transplacental passage of antibiotics. Fifteen preterm and term women with the diagnosis of chorioamnionitis were given 3 or 4 g of mezlocillin intravenously every 4 to 6 h. Maternal serum and umbilical cord samples were collected at delivery and the concentrations of antibiotics were determined by high-pressure liquid chromatography. Peak serum levels of mezlocillin in the cord and mother occurred within 60 min, but were eliminated more rapidly in the mother. Umbilical cord levels, while initially lower with the 3 g dose, were present longer than 4 hr for both regimens. Placental transfer of antibiotics appeared to be affected by the aging placenta with decreased initial levels and slower fetal clearance at term.     

Umbilical Cord Haematoma: A Serious Pregnancy Complication

EDITORIAL COMMENT: We accepted this report for publication because it informs readers that umbilical cord haematoma is yet another cause of acute fetal hypoxia which may present as diminished fetal movements where cardiotocography can indicate the need for prompt delivery and save a life. We hope that further follow-up of the infant in Case 1 will not reveal evidence of cerebral palsy. Diminished fetal movements is the indication for about 15% of antepartum cardiotocographs; evidence of critical fetal reserve as in Case I was found in 1% of such cases (24 of 2,601)^A. The 2 cases reported here are very uncommon. There was no case of cord haematoma causing cardiotocographic evidence of fetal hypoxia in the large series referred to above.
A. Chew FTK; Beischer NA. Antepartum cardiotocographic surveillance of patients with diminished fetal movements. Aust NZ J Obstet Gynaecol 1992; 32: 107-113.
Summary: The 2 cases presented show the potential morbidity and mortality which may be associated with umbilical cord haematoma. That timely diagnoses and delivery can save such an affected fetus is seen in Case 1. If fetal movements are absent, both a nonstress cardiotocograph and ultrasound scan may lead to the correct management.     

Umbilical Cord Blood Banking: A Current Perspective

Placental and umbilical cord blood (UCB) is becoming an important source of haematopoietic stem cells for use in clinical transplantation. Now that over 500 cord blood transplantations have occurred worldwide, clinical experience is demonstrating some distinct advantages to these cells over the traditional bone marrow sources. These advantages include distinctive proliferative capacities which favour engraftment. Umbilical cord blood use is associated with a reduced incidence and severity of Graft versus Host disease, and recipients may tolerate a greater number of HLA mismatches than with bone marrow source stem cells.Umbilical cord blood stem cells have also opened up areas of active laboratory and clinical investigation that could ultimately result in further therapeutic options. The most exciting areas are those of ex vivo cell expansion and a variety of applications involving stem cells as vehicles for potential gene therapy.Cord blood banks can retain these separated stem and progenitor cells to provide an additional, immediately accessible resource to a bone marrow registry. In Europe, NETCORD links three cord blood banks to its bone marrow donor worldwide registry, and in the United States, three cord blood banks are also linked to a central bone transplant registry. In Canada, the Bone Marrow Transplant Registry, administered by The Canadian Red Cross, is investigating options for a similar structure. However, there is no established funding at this time for a Canadian system of this scale.     

脐血流测定对脐带绕颈的产时监护

目的 :研究脐血流测定对脐带绕颈的产时监护作用。方法 :对 5 5 0例单胎足月妊娠孕妇进行脐血流测定 ,其中脐带绕颈 138例。分A、B、C 3组 ,分析其产时胎儿宫内窘迫发生率 (简称 :胎窘率 )及剖宫产率 ,并动态观察 14 0例(其中脐带绕颈 5 2例 ,无绕颈 88例 )产妇 ,产程中的脐血流变化。结果 :3组脐带长度、绕颈周数、新生儿Apgar评分 ,差异无显著性 (P >0 0 5 )。B组与C组的产时胎窘率及剖宫产率均较A组高 (P <0 0 1,P <0 0 5 )。产程中 ,S/D升高 >0 1,有脐带绕颈组明显高于无绕颈组 (P <0 0 1) ,S/D >3 0与 2 70 相似文献   

A Study of Hepatitis E in Pregnancy: Maternal and Fetal Outcome

Purpose

HEV infection, a major public health concern, is known to cause large-scale epidemic and sporadic cases of acute viral hepatitis in developing countries. The infection occurs primarily in young adults and is generally mild and self-limiting; however, the case fatality rate is reportedly higher among women, especially during the second or third trimesters of pregnancy.

Methods

This study, a prospective observational study, was conducted at the Dr. D. Y. Patil Medical College Hospital and Apple Saraswati Multispeciality hospital, in Kolhapur for over a period of 3 years (Jan 2010 to Jan 2013) to find out the prevalence and clinical outcome in a series of HEV-infected pregnant women.

Results

A total of fifty-five symptomatic Anti-HEV IgM-positive women were included, and the maternal-fetal outcome was analyzed. The maternal mortality was 5 % including one antenatal death. Prematurity (80 %) and PROM (11 %) were the commonest fetal complications noted with a vertical transmission rate of 28 %.

Conclusion

Variations in maternal morbidity and mortality between different studies indicate a need to subtype the viral genotype according to its virulence and morbidity.

     

脐带真结的产科因素及妊娠结局

目的:探讨脐带真结的危险因素及其妊娠结局。方法:回顾性分析2000年1月至2005年7月间分娩的脐带真结孕妇17例。结果:脐带真结的发生率为0.24%。Logistic回归相关分析发现脐带真结的发生与男性胎儿、羊水过多、脐带绕颈、脐带过长有关。脐带真结胎儿发生死胎、胎儿窘迫、剖宫产的风险较无脐带真结者明显增加(P<0.01)。结论:怀有男性胎儿、脐带过长、脐带绕颈、羊水过多的孕妇发生脐带真结的风险增加,应仔细地进行B超和彩色多普勒检查以排除脐带真结可能。     

Fetal Distress in the First Stage of Labour Associated with Early Fetal Heart Rate Decelerations and a Short Umbilical Cord

Summary: Five cases of fetal distress early in the first stage of labour associated with a primary short umbilical cord (less than 35 cm) are described. These are used to illustrate the difficulty of correlating changes in fetal heart rate patterns with fetal distress in labour. The importance of fetal blood sampling as the final arbiter in the diagnosis of fetal hypoxia is emphasised.     

Prolapse and Presentation of the Umbilical Cord

Summary: The outcome of pregnancies with prolapse and presentation of the umbilical cord at Tsan Yuk Hospital, Hong Kong, 1976 to 1982, was reviewed. The incidence was 0.17%, 70 of 41,939 deliveries; 98% of cases were diagnosed in hospital. Breech presentation, low birth-weight and artificial rupture of membranes were found to be significant associations; 78% of cases were discovered by vaginal examination and the diagnosis-delivery interval was less than 30 minutes in 75%. There were 8 perinatal deaths and 3 of these occurred in babies whose birth-weights were less than 1,000 g; 2 stillbirths were associated with presentation of the cord. The corrected perinatal mortality was 8.6% with a corresponding Caesarean section rate of 73.3%. 80% of the babies born by Caesarean section had 5 minutes Apgar scores of 7 or more. It was concluded that early diagnosis of umbilical cord prolapse followed by prompt treatment are effective in reducing the perinatal mortality rate. Energetic intrapartum monitoring is also essential in order that patients with occult prolapse or presentation of the umbilical cord be diagnosed early and treated promptly.     

Accuracy of Estimated Fetal Weight below 1,000g

EDITORIAL COMMENT: We accepted this paper for publication because it gives useful information on the interpretation of ultrasonographic estimates of fetal weight when considering whether fetal viability is such that Caesarean section is indicated on fetal grounds as the method of delivery in a complicated pregnancy.
Summary: The Wars of formula is 1 of 3 currently recommended by the Australian Society for Ultrasound in Medicine for the routine estimation of fetal weight. However, this formula was derived using mostly large fetuses, and its accuracy in extremely low birth-weight fetuses is not known. Using this formula, we studied 184 infants delivering within 14 days of an estimated fetal weight (EFW) <1,000 G, The mean percent error in EFW was 11.7% underestimation, with 80% of infants underestimated and 61% of estimates within 15% error. The percent error was consistent at 9.6% throughout the first 9 days, but increased to 32% after 10 days post scan (p<0.0001). There was a significant association between the accuracy of EFW and maternal height, but not with placental position, liquor volume or multiple pregnancy. EFW underestimated birth-weight on average by 9.6% during the first week, and this error appeared to be mainly due to the formula. The error in EFW became unacceptable after 9 days and repeating the estimate before 10 days is recommended. A different formula may be more suitable for extremely low birth-weight fetuses.     

Nursing Management of Umbilical Cord Prolapse

Advances in the management of umbilical cord prolapse hold promise for reducing perinatal morbidity and mortality. This article reviews traditional nursing management of umbilical cord prolapse and introduces the use of real-time ultrasound and bladder filling as additional methods of nursing management. A case report is provided.
Time is of the essence in the nursing management of UCP. Although traditional nursing interventions are effective for the management of UCP, real-time ultrasound and bladder filling have been proven in the medical literature and clinical studies to reduce the perinatal morbidity and mortality in such instances. In accordance with nurse practice acts and institutional policies, nurses can be qualified to perform these advanced assessments and implementations. For nurses in offices, clinics, and rural hospitals, bladder filling can be an effective intervention that will allow time for the necessary transportation of the patient and preparations for cesarean delivery. With these advances in patient care, nurses can be instrumental in promoting positive perinatal outcomes for patients with UCP.