Prolonged morphine exposure in utero causes fetal and placental vasoconstriction: a case report.

Vasoconstriction was observed in the fetal middle cerebral and umbilical arteries by Doppler assessment at 27 weeks gestation in a patient requiring continuous morphine infusion for pain control. Fetal heart tracings were also concerning. Fetal status improved after a change to fentanyl infusion, a shorter acting opioid. Caution is recommended when long-term chronic narcotic infusion is used in pregnancy.     

Prolonged morphine exposure in utero causes fetal and placental vasoconstriction: A case report

Vasoconstriction was observed in the fetal middle cerebral and umbilical arteries by Doppler assessment at 27 weeks gestation in a patient requiring continuous morphine infusion for pain control. Fetal heart tracings were also concerning. Fetal status improved after a change to fentanyl infusion, a shorter acting opioid. Caution is recommended when long-term chronic narcotic infusion is used in pregnancy.     

Fetal heart rate response to cordocentesis and pregnancy outcome: a prospective cohort.

OBJECTIVE: To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome. METHODS: 117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1 min after completion of cordocentesis and intermittently for 20 min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups. RESULTS: Women included in the study were 30.5+/-4.0 years old and had a gestational age of 23.7+/-2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1+/-0.8 ml. Fetal heart rate before cordocentesis was 149+/-8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145+/-30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n=12) and 6.0% (n=7), respectively. Fetal heart rate returned to normal levels in all cases at 相似文献   

Fetal heart rate monitoring in premature infants weighing 1,500 grams or less

Continuous monitoring tracings of fetal heart rate in 61 infants with birth weights of 1,500 grams or less were analyzed and related to newborn outcome. Reassuring heart rate patterns or good baseline variability correlated well with a normal unbilical artery pH. Fetal heart rate patterns and baseline variability were not related in a predictive way to central nervous system hemorrhage, respiratory distress syndrome, or neonatal death. Early intervention and operative delivery in cases demonstrating abnormal fetal heart rate patterns may have influenced the outcome in these infants. Fetal heart rate patterns can play an important role in the intrapartum assessment of the condition of the very-low-birth-weight infant and may be used to select those infants requiring prompt operative intervention and vigorous neonatal resuscitation.     

Nursing Assessment and Responsibilities in Monitoring the Preterm Pregnancy

Evaluating women for pregnancy-related problems that may result in preterm birth frequently requires electronic fetal monitoring at early gestational ages. Caution is needed to interpret information correctly from the preterm fetal heart rate and uterine activity tracings. Interpreting fetal heart rate tracings from preterm fetuses requires knowledge of fetal physiologic development. Obtaining clear tracings of preterm uterine activity remains a challenge and heightens the importance of thorough nursing assessment, including inquiry about risk factors for pregnancy complications.     

A case of fetal complete heart block recorded by magnetocardiography, ultrasonography and direct fetal electrocardiography

Fetal magnetocardiograms (FMCGs) were recorded in a case of fetal complete heart block (CHB) from the 30th to the 37th week of gestation using the multichannel SQUID system (Hitachi, Japan). M-mode ultrasonography and direct fetal electrocardiography using needle electrodes revealed fetal CHB. We identified independent fetal P-waves and QRS complexes in the FMCG recorded in the 32nd week of gestation when the fetal atriums were close to the FMCG sensor. We also recorded FMCG P-waves in the 37th week of gestation when the fetal heart was larger. Fetal heart position and size are important for obtaining a useful FMCG. To establish FMCG as a diagnostic tool of fetal arrhythmia, comparative studies with FECG are needed.     

Screening with Doppler velocimetry in labor

Doppler flow velocimetry was performed on 273 nonselected patients in labor. All patients were at least 2 cm dilated and 80% effaced (58% greater than 4 cm) and were delivered of infants within 24 hours. Fetal heart rate tracing performed at the same time was read by another observer and compared with Doppler flow velocity measurements (systolic/diastolic ratio, pulsatility index). A significant correlation was noted (r = 0.234, p less than 0.001) between the two modalities. Both fetal heart rate tracings and umbilical flow velocity measurements were correlated with fetal outcome. Significant associations were noted between the umbilical systolic/diastolic ratio and fetal distress. 5-minute Apgar scores, the need for intubation independent of gestational age, and umbilical arterial cord pH and base excess. It appears that the information obtained from flow velocimetry had additional benefits compared with that of fetal heart rate tracings alone.     

Fetal heart rate response to cordocentesis and pregnancy outcome: A prospective cohort

Objective.?To evaluate fetal cardiac response to cordocentesis and whether such changes may affect pregnancy outcome.

Methods.?117 singleton pregnant women requiring percutaneous trans-abdominal cordocentesis were prospectively included. Fetal heart rate was continuously evaluated by ultrasound for 1?min after completion of cordocentesis and intermittently for 20?min more. Fetal and pregnancy outcomes were analyzed by grouping fetal cardiac response to cordocentesis into bradycardia, normal heart rate and tachycardia groups.

Results.?Women included in the study were 30.5?±?4.0 years old and had a gestational age of 23.7?±?2.0 weeks. Fetal blood sample obtained by cordocentesis was 3.1?±?0.8?ml. Fetal heart rate before cordocentesis was 149?±?8 beats per minute (bpm), ranging from 130 to 169 bpm. Fetal heart rate post-cordocentesis was 145?±?30 bpm (from 32 to 175 bpm). The incidence of bradycardia and tachycardia was 10.3% (n?= 12) and 6.0% (n?= 7), respectively. Fetal heart rate returned to normal levels in all cases at ??5 minutes post-cordocentesis. In the tachycardia group, 6 cases had normal pregnancy outcome and one patient was lost to follow-up. In the bradycardia group, we observed two pregnancy terminations, one patient was lost to follow-up and nine were normal outcomes. In the group with normal heart rate (n?=?98), we observed one intrauterine fetal death, nine adverse fetal outcomes, eight pregnancy terminations and nine patients were lost to follow-up.

Conclusions.?Transient fetal tachycardia and bradycardia were uncommon and were not associated with adverse fetal or pregnancy outcomes.     

Technic and results of routine fetal electrocardiography during pregnancy

The principles on which the routine technic of fetal electrocardiography has been developed are use of the electrocardiographic apparatus without modification, application of electrodes to the extremities only, increase of the amplitude of waves and decrease of the fuzziness of tracings by simple means. The technic of obtaining and interpreting fetal electrocardiograms is described in detail. The difference between the results obtained by use of the usual technic and those obtained by use of special technic is illustrated in Figs. 1 to 3.Seventy fetal electrocardiograms were recorded from 52 patients during the last seventy days of pregnancy. Sixty-one or 87 per cent of the electrocardiograms were positive and 9 or 13 per cent were negative. During the last twenty days of pregnancy 40 out of 44 electrocardiograms or 91 per cent were positive. Between the twenty-first and seventieth day before delivery 21 out of 26 electrocardiograms or 81 per cent were positive. In cases of vertex presentation, during the last twenty days of pregnancy, 94 per cent of the electrocardiograms were positive and, between the twenty-first and seventieth days before delivery, 87 per cent were positive.Besides the usual Leads I, II and III, two more leads were used (right arm—right thigh; left arm—right thigh). The largest number of positive results were obtained in the third lead (46) and in the fifth lead (left arm—right thigh) (45) because they are most favorable in the left vertex position of the fetus which is the most frequent position.Twenty-five per cent of the positive fetal electrocardiograms were positive in only one lead, 31 per cent in two leads, 15 per cent in three leads and 29 per cent in four leads. In the last three weeks before delivery, 38 per cent of the tests were positive in four leads.As an example of the practical value of the fetal electrocardiogram, a case is described and the electrocardiogram is shown in which the fetal heart tones could not be heard through the stethoscope and the electrocardiogram gave evidence of a living fetus fifty-five, forty-three, and thirty-one days before the expected term.Fetal electrocardiography in pregnancy and labor gives objective graphic evidence regarding the viability of the fetus. This is of practical value in doubtful cases in which the older subjective methods, stethoscopic examiantion, and observation of fetal movements fail. By means of the technic presented, the rate, rhythm, and regularity of fetal heart action can be observed in the electrocardiogram. The scientific field of fetal electrocardiography might even be wider. Such a procedure renders possible observation of the fetus objectively under various conditions in pregnancy and labor. The relationship between maternal and fetal heart action can be easily studied.     

Lumbar epidural analgesia with bupivacaine in labor. Determination of drug concentration and pH in fetal scalp blood, and continuous fetal heart rate monitoring.

Lumbar epiduval analgesia with bupivacaine was given to 37 women for uncomplicated labor. After the blcokade serial determinations of pH and bupivacaine concentration were made in fetal scalp blood and maternal venous blood and there was continuous monitoring of the fetal heart rate. Fetal scalp blood pH was within normal limits and no pathologic FHR tracings were elicited by the blockade, although a temporary decrease of the baseline fetal heart rate irregularity was seen in about one-fifth of the cases. Fetal drug concentrations were low and about one-fourth of corresponding maternal values. After reinjection of bupivacaine the degree of drug accumulation was fairly similar in fetal and maternal blood.     

Telephone transmission of fetal heart rate monitor data. The experience at the University of Connecticut Health Center

This report reviews the experience at the University of Connecticut Health Center using the Fetal Assessment Consultative Transmission Service (FACTS) system during a 2 1/2-year period. This system, which permits direct transmission of antepartum and/or intrapartum fetal heart rate tracings via a telephone line, allows the obstetric staffs of smaller community hospitals to obtain an immediate consultation from the University of Connecticut Health Center on a 24 hour per day basis. A total of 511 fetal heart rate tracings were analyzed. Two hundred forty-five were intrapartum, 206 antepartum, and 60 were transmitted for educational purposes. The results indicate an imperative need for such a service from a tertiary care center to improve the quality of regional perinatal care and to determine the future direction of the regional educational program for physicians and nurses.     

Limitations of autocorrelation in fetal heart rate monitoring

Fetal heart rate monitors that use autocorrelation of the ultrasonic fetal signal usually produce a cleaner fetal heart rate record than that obtainable with conventional ultrasonic fetal monitors. However, since the autocorrelation function will emphasize any periodic signal originating from the fetus or the mother, in clinical situations the resultant fetal heart rate tracing may contain spurious data. To illustrate the limitations of the autocorrelation technique in fetal monitoring, we compared the autocorrelated ultrasound fetal heart rate records from 23 patients in active labor with the simultaneously recorded direct scalp fetal electrocardiogram tracings. The results indicate that every hour of recording contained, on the average, five instances in which data were missing (range, 0 to 13), four in which data were added (range, 0 to 23), and seven instances in which data were absent for greater than 1 minute (range, 0 to 26). The potential problem of misinterpretation of autocorrelated fetal heart rate data is discussed.     

产时Ⅱ类胎心监护的流程管理

Ⅱ类胎心监护是产程中常见的胎心监护图形，其形式多样，正确识别和评估Ⅱ类胎心监护，并根据具体临床情况进行针对性干预，可降低不良妊娠结局的发生。文章根据产时胎心监护三级评估系统，介绍产时Ⅱ类胎心监护的处理流程，并对不同类型Ⅱ类胎心监护的病因及干预措施进行了阐述，以指导临床实践。     

The relationship between hiccups and heart rate in the fetus.

OBJECTIVE: The purpose of this study was to determine the effect of fetal hiccups on fetal heart rate from 20 weeks of gestation onward. METHODS: One thousand four hundred and fifty-six collected fetal heart rate tracings from three cohorts that participated in longitudinal studies of fetal neurobehavioral development were reviewed retrospectively for fetal hiccups. Tracings were recorded at four-week intervals from 20 weeks. A hiccup-free period before or after the episode of hiccups was used as the control fetal heart rate; thus each fetus was used as its own control. The paired t-test was used for statistical analysis. RESULTS: From 28 weeks onward, the mean fetal heart rate increased with hiccups reaching statistical significance at 32 weeks. Fetal heart rate variability was unaffected by hiccups until 36 weeks, at which time it decreased during hiccup periods. CONCLUSION: This change in response to fetal hiccups may represent another neurodevelopment milestone for the fetus.     

Comparison of cord purine metabolites to maternal and neonatal variables of hypoxia.

Umbilical arterial concentrations of purine metabolites were evaluated prospectively as markers of hypoxia. The results suggest that hypoxanthine accumulates in association with fetal acidosis and reduced levels of buffer base (P less than .01). Acute hypoxemia defined by umbilical arterial oxygen pressure was accompanied by elevation of uric acid concentrations (P less than .01). Fetal heart rate tracings with characteristics classically associated with fetal stress correlated with increased concentrations of hypoxanthine and xanthine (P less than .01). Therefore, intrapartum events may occur that are not documented by standard markers of perinatal hypoxia at delivery.     

Visual analysis of antepartum fetal heart rate tracings: inter- and intra-observer agreement and impact of knowledge of neonatal outcome

OBJECTIVE: To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation. METHODS: One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data. RESULTS: Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones. CONCLUSION: Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.     

Fetal heart rate monitoring and neonatal mortality in the very preterm infant

A retrospective study was performed to determine the usefulness of intrapartum fetal heart rate patterns in managing infants of 26 to 30 weeks' gestational age by a comparison of intrapartum tracings with neonatal outcome. Fetal heart rate patterns of 26 infants who died were matched for gestational age with those of infants who did not die or demonstrate developmental abnormalities after a 1-year follow-up were analyzed. A normal fetal heart rate pattern was associated with a good outcome (p less than 0.05), the only deaths (three) being secondary to unrelated factors. An abnormal fetal heart rate tracing predicted 90% of deaths; however, an abnormal fetal heart rate tracing was also found in 15 of 31 infants with no mortality or morbidity. Evidence would thus suggest that the very preterm infant can tolerate the stress associated with normal labor and that a normal fetal heart rate pattern predicts good fetal outcome in the absence of unrelated perinatal abnormality. With significantly abnormal patterns, however, further parameters must be evaluated before the diagnosis of fetal distress associated with subsequent mortality can be made with certainty.     

Toluene abuse and renal tubular acidosis in pregnancy

Five gravidas presented with severe renal tubular acidosis from paint sniffing. Normal acid-base balance returned within 72 hours with cessation of toluene abuse and standard supportive measures. Fetal heart tracings and dynamic ultrasound parameters were normal in four of five cases. Three of five infants were growth-retarded at birth; two showed anomalies and neonatal hyperchloremic acidosis. These and previous cases of renal tubular acidosis in pregnancy suggest that toluene is teratogenic.     

Treatment of fetal distress during diabetic keto-acidosis.

A case of diabetic acidosis during pregnancy is presented in which the fetal heart rate tracing demonstrated late decelerations. Sodium bicarbonate, intravenous fluids and insulin treatment resulted in correction of both the maternal acidosis and the abnormal fetal heart rate tracings. The rationale for bicarbonate therapy for treatment of the presumed fetal distress is discussed.     

胎心监护与胎儿超声多普勒血流参数在胎儿监护方面的应用

胎心监护与胎儿超声多普勒血流参数测量是目前临床上最常用的胎儿监护方法,这2项监护技术具有无创、操作简单、阴性预测值高等特点,成为胎儿宫内状况评估最重要的手段。胎心监护广泛用于产前和产时的监护,而超声多普勒血流监测主要应用于产前的胎儿监护,尤其在生长受限胎儿的安全性监护方面有较高的预测价值。对于高危胎儿,胎心监护联合彩色多普勒血流参数可提高对胎儿缺氧的预测价值,并指导临床采取有效措施改善妊娠结局。