Fetal distress Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(8):381-385
DOI 10.1590/S0100-72032012000800007
PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):513-526
DOI 10.1590/S0100-72032009001000008
The present context of medical practice demands from the obstetrician and gynecologist broad understanding of the scientific and technological advances of the area. The main purpose of prenatal evaluation is to identify fetuses at risk for adverse events or death, for preventive action to avoid mishappenings. The determination of fetal biophysical profile reaches its maximum efficiency when applied within the clinical context of each case. In high risk gestations, the Doppler velocimetry of the umbilical artery has shown to be useful to improve perinatal outcome. In the fetal growth deficit, due to severe placentary insufficiency, Doppler velocimetry of the venous duct has been showing to be an important tool in handling of the cases before the 34th week of gestation. Although no test itself is considered the best to evaluate the fetus's prenatal vitality, the joint analysis of all methods may lead to a better understanding of the fetal response to hypoxia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):513-526
DOI 10.1590/S0100-72032009001000008
The present context of medical practice demands from the obstetrician and gynecologist broad understanding of the scientific and technological advances of the area. The main purpose of prenatal evaluation is to identify fetuses at risk for adverse events or death, for preventive action to avoid mishappenings. The determination of fetal biophysical profile reaches its maximum efficiency when applied within the clinical context of each case. In high risk gestations, the Doppler velocimetry of the umbilical artery has shown to be useful to improve perinatal outcome. In the fetal growth deficit, due to severe placentary insufficiency, Doppler velocimetry of the venous duct has been showing to be an important tool in handling of the cases before the 34th week of gestation. Although no test itself is considered the best to evaluate the fetus's prenatal vitality, the joint analysis of all methods may lead to a better understanding of the fetal response to hypoxia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):77-81
DOI 10.1590/S0100-72031998000200004
Electronic fetal heart rate monitoring (EFM) is the most widely used method of direct fetal surveillance especially during labor. In an attempt to elucidate the effect of EFM on cesarean section (CS) rates, a retrospective study was performed at the University Hospital of Santa Maria (HUSM). We studied two groups of patients, consisting of 2114 pregnant women: EFM group (n=517) and intermittent auscultation (IA) group (n=1597). In the EFM group we observed 38.0% of CS vs. 27.2% in the IA group. For all patients, the CS rate was 29.9%. Fetal distress was the most common indication for CS in the EFM group (40.6%), while previous CS was the third cause (10.1%). On the IA group, fetal distress was the third cause in CS (14.3%), while previous CS was the most common cause (32.4%). On the basis of this study, we believe that EFM has no effect in itself on cesarean section rates considering overall deliveries at HUSM. With proper education of the clinician and correct interpretation of the findings, EFM would not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum fetal well-being.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(2):77-81
DOI 10.1590/S0100-72031998000200004
Electronic fetal heart rate monitoring (EFM) is the most widely used method of direct fetal surveillance especially during labor. In an attempt to elucidate the effect of EFM on cesarean section (CS) rates, a retrospective study was performed at the University Hospital of Santa Maria (HUSM). We studied two groups of patients, consisting of 2114 pregnant women: EFM group (n=517) and intermittent auscultation (IA) group (n=1597). In the EFM group we observed 38.0% of CS vs. 27.2% in the IA group. For all patients, the CS rate was 29.9%. Fetal distress was the most common indication for CS in the EFM group (40.6%), while previous CS was the third cause (10.1%). On the IA group, fetal distress was the third cause in CS (14.3%), while previous CS was the most common cause (32.4%). On the basis of this study, we believe that EFM has no effect in itself on cesarean section rates considering overall deliveries at HUSM. With proper education of the clinician and correct interpretation of the findings, EFM would not increase cesarean section rates, but rather should allow for a more accurate description of intrapartum fetal well-being.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):161-163
DOI 10.1590/S0100-72031998000300007
A tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(3):161-163
DOI 10.1590/S0100-72031998000300007
A tocolytic treatment is described with the use of terbutaline in a case of cardiotocographic prolonged deceleration of fetal heart rate with successful outcome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
DOI 10.1590/S0100-72031998000900005
Purpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):517-524
DOI 10.1590/S0100-72031998000900005
Purpose: to determine the behavior of doppler velocimetry during the course of risk pregnancies and to compare the perinatal results obtained for concepti with retarded intrauterine growth (RIUG) with those for concepti considered adequate for gestational age (AGA). Methods: a prospective study of the evolution of doppler ultrasound was made in 38 pregnant women with of idiopathic intrauterine growth retardation (IUGR) in previous pregnancy. A relationship was established between this antecedent and the new pregnancy. The pregnant women studied were divided into two groups in agreement with their neonates birthweight. Group 1 was associated with IUGR and group 2 with adequate birth weight. IUGR was confirmed in 23.7% of the cases. Umbilical and uterine artery doppler velocimetry was performed from 20 to 40 weeks of gestation. Middle cerebral artery doppler velocimetry was analyzed after 28 weeks of gestation, twice a month, being the last valued examination before birth. Results: the uterine and umbilical artery ratio at 24 and 28 weeks of gestation, respectively, correlated with the presence of IUGR. There was no difference between the two groups regarding the presence or absence of a small notch in the uterine artery wave form and middle cerebral artery doppler velocimetry ratio, at the last examination before birth. There was a relationship between neonatal stay in hospital for more than three days and the presence of IUGR. Conclusions: doppler ultrasound should be used in the follow-up of cases with a high risk of IUGR. It allows the detection of the fetuses at high risk of hypoxia and, by interrupting the pregnancy, fetal distress-related complications may be avoided.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):141-146
DOI 10.1590/S0100-72031999000300004
Purpose: to study fetal oxygen saturation (SpO2) levels during labor by continuous pulse oximetry tecnique, and its relation to umbilical artery (UA) pH. Patients and Methods: fetal SpO2 levels were measured during labor by the pulse oximetry technique in 50 subjects. Average values of SpO2 were compared between the first and second stage of labor, with the first stage further subdivided into phases, according to cervical dilatation of (<=4 cm, 5-7 cm and 8-9 cm). SpO2 values were studied in relation to umbilical artery pH at birth ( > or = 7.20 and <7.20). SpO2 > or = 30.0% was considered normal. Results: fetal SpO2 averages during the first stage were 53.0 ± 7.3% and 44.2 ± 6.8% (UA pH > or = 7.20 and <7.20, respectively; p<0.01). When the first stage was subdivided, the fetal SpO2 averages (UA pH > or = 7.20) were 55.1 ± 5.1% (<=4 cm), 52.3 ± 4.6% (5-7 cm) and 51.5 ± 7.2% (8-9 cm); for UA pH <7.20, the fetal SpO2 averages were 46.3 ± 5.1% (<=4 cm), 43.6 ± 6.7% (5-7 cm) and 42.8 ± 5.8% (8-9 cm). Considering the UA pH, these differences were statistically significant (p<0.01). Conclusion: a significant decrease of oxygen saturation values was observed during labor when fetal pulse oximetry was used.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):141-146
DOI 10.1590/S0100-72031999000300004
Purpose: to study fetal oxygen saturation (SpO2) levels during labor by continuous pulse oximetry tecnique, and its relation to umbilical artery (UA) pH. Patients and Methods: fetal SpO2 levels were measured during labor by the pulse oximetry technique in 50 subjects. Average values of SpO2 were compared between the first and second stage of labor, with the first stage further subdivided into phases, according to cervical dilatation of (<=4 cm, 5-7 cm and 8-9 cm). SpO2 values were studied in relation to umbilical artery pH at birth ( > or = 7.20 and <7.20). SpO2 > or = 30.0% was considered normal. Results: fetal SpO2 averages during the first stage were 53.0 ± 7.3% and 44.2 ± 6.8% (UA pH > or = 7.20 and <7.20, respectively; p<0.01). When the first stage was subdivided, the fetal SpO2 averages (UA pH > or = 7.20) were 55.1 ± 5.1% (<=4 cm), 52.3 ± 4.6% (5-7 cm) and 51.5 ± 7.2% (8-9 cm); for UA pH <7.20, the fetal SpO2 averages were 46.3 ± 5.1% (<=4 cm), 43.6 ± 6.7% (5-7 cm) and 42.8 ± 5.8% (8-9 cm). Considering the UA pH, these differences were statistically significant (p<0.01). Conclusion: a significant decrease of oxygen saturation values was observed during labor when fetal pulse oximetry was used.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(4):238-243
DOI 10.1590/S0100-72032006000400006
PURPOSE: to evaluate the relationship between S/A ratio in ductus venosus (DV) and perinatal outcomes in fetuses with brain sparing reflex. METHODS: the study was designed as an observational, sectional study with prospectively collected data. Forty-one fetuses with brain sparing reflex and gestational age between 25 and 33 weeks were studied between November 2002 and July 2005. The newborns were observed during the neonatal period in the intensive care unit of "Clínica Perinatal Laranjeiras" in order to find adverse outcomes. The study population was divided into two groups according to DV assessment. In the normal group all the fetuses with S/A ratio values of 3.6 or less were included, and in the abnormal group the fetuses with values of S/A ratio greater than 3.6. The statistical analysis was performed by the Mann-Whitney U-test, chi2 test and Fisher exact test. The results were considered significant when p<0.05. Gestational age, birth weight and Apgar score less than 7 at 5 min were evaluated. Perinatal outcome parameters were: intrauterine death, neonatal mortality, seizures, intraventricular hemorrhage, leukomalacia, need of surfactant, mechanical ventilation, myocardical failure, necrotizing enterocolitis, and length of stay in the intensive care unit. RESULTS: among the assessed 41 fetuses, 26 (63.4%) showed normal DV S/A ratio and the other 15 (36.6%) developed an abnormal DV S/A ratio (>3.6). There was no statistically signicant difference between the groups according to gestational age at delivery and Apgar <7. The only significant association was between abnormal DV S/A ratio and neonatal death (p=0.049; Fisher's exact test). No statistically significant association was observed for the other studied variables. CONCLUSIONS: our results suggest that abnormal DV blood flow detected by Doppler examination is not associated with adverse perinatal outcomes, except for neonatal mortality. This association may be considered statistically borderline (p=0.049). Excluding fetuses with birth weight less than 400 g, there was no other association between DV and neonatal mortality. The abnormal DV S/A ratio was not associated, in our study, with perinatal mortality in viable preterm fetuses.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(4):238-243
DOI 10.1590/S0100-72032006000400006
PURPOSE: to evaluate the relationship between S/A ratio in ductus venosus (DV) and perinatal outcomes in fetuses with brain sparing reflex. METHODS: the study was designed as an observational, sectional study with prospectively collected data. Forty-one fetuses with brain sparing reflex and gestational age between 25 and 33 weeks were studied between November 2002 and July 2005. The newborns were observed during the neonatal period in the intensive care unit of "Clínica Perinatal Laranjeiras" in order to find adverse outcomes. The study population was divided into two groups according to DV assessment. In the normal group all the fetuses with S/A ratio values of 3.6 or less were included, and in the abnormal group the fetuses with values of S/A ratio greater than 3.6. The statistical analysis was performed by the Mann-Whitney U-test, chi2 test and Fisher exact test. The results were considered significant when p<0.05. Gestational age, birth weight and Apgar score less than 7 at 5 min were evaluated. Perinatal outcome parameters were: intrauterine death, neonatal mortality, seizures, intraventricular hemorrhage, leukomalacia, need of surfactant, mechanical ventilation, myocardical failure, necrotizing enterocolitis, and length of stay in the intensive care unit. RESULTS: among the assessed 41 fetuses, 26 (63.4%) showed normal DV S/A ratio and the other 15 (36.6%) developed an abnormal DV S/A ratio (>3.6). There was no statistically signicant difference between the groups according to gestational age at delivery and Apgar <7. The only significant association was between abnormal DV S/A ratio and neonatal death (p=0.049; Fisher's exact test). No statistically significant association was observed for the other studied variables. CONCLUSIONS: our results suggest that abnormal DV blood flow detected by Doppler examination is not associated with adverse perinatal outcomes, except for neonatal mortality. This association may be considered statistically borderline (p=0.049). Excluding fetuses with birth weight less than 400 g, there was no other association between DV and neonatal mortality. The abnormal DV S/A ratio was not associated, in our study, with perinatal mortality in viable preterm fetuses.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):381-384
DOI 10.1590/S0100-72031999000700003
Purpose: to study the correlation between fetal oxygen saturation measured by pulse oximetry during second stage of labor and umbilical artery pH at birth. Patients and Methods: fetal oxygen saturation (FSpO2) was monitored by pulse oximetry during the second stage of labor in 64 singleton pregnancies at term, with vertex presentation. Umbilical blood was sampled immediately after delivery for subsequent measurement of venous and arterial blood gases and pH. All fetuses maintained FSpO2 > or = 30% through the first stage of labor, until the start of second stage. Results: the mean FSpO2 at the second stage of labor correlated significantly with umbilical artery pH at birth (n = 64, r = 0.79, p <0.001). There was no significant corre-lation between FSpO2 at the second stage of labor and umbilical artery oxygen saturation at birth. Conclusion: fetal oxygen saturation measured by pulse oximetry during second stage of labor has a good correlation with umbilical artery pH at birth.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):381-384
DOI 10.1590/S0100-72031999000700003
Purpose: to study the correlation between fetal oxygen saturation measured by pulse oximetry during second stage of labor and umbilical artery pH at birth. Patients and Methods: fetal oxygen saturation (FSpO2) was monitored by pulse oximetry during the second stage of labor in 64 singleton pregnancies at term, with vertex presentation. Umbilical blood was sampled immediately after delivery for subsequent measurement of venous and arterial blood gases and pH. All fetuses maintained FSpO2 > or = 30% through the first stage of labor, until the start of second stage. Results: the mean FSpO2 at the second stage of labor correlated significantly with umbilical artery pH at birth (n = 64, r = 0.79, p <0.001). There was no significant corre-lation between FSpO2 at the second stage of labor and umbilical artery oxygen saturation at birth. Conclusion: fetal oxygen saturation measured by pulse oximetry during second stage of labor has a good correlation with umbilical artery pH at birth.
