RESUMO
Care of a pregnant woman with seizure disorder is a challenge for the maternal-child nurse. Epilepsy affects 0.5% of all pregnant women. These women face possible risks of increased seizure frequency, reduced anti-epileptic drug levels, and, although rare, life-threatening status epilepticus. Their neonates are at risk for congenital malformations and possible bleeding disorders. Comprehensive nursing care based on a sound understanding of medical, pharmacologic, and nursing principles is crucial for optimal maternal/neonatal outcomes. Specific nursing implications and interventions during the preconceptual, prenatal, intrapartal, and postpartal periods are presented.
Assuntos
Epilepsia/enfermagem , Complicações na Gravidez/enfermagem , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Epilepsia/classificação , Epilepsia/tratamento farmacológico , Feminino , Humanos , Planejamento de Assistência ao Paciente , GravidezRESUMO
The presence or absence of cyclic variation (cyclicity) of fetal heart rate patterns was prospectively investigated in fetuses between 25 and 32 weeks' gestation. All fetuses were delivered by cesarean section before the onset of labor. The relationship between the presence or absence of fetal heart rate cyclicity and fetal acidosis, as determined by cord pH measurements, was investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of this method in predicting fetal acidosis were: 100, 90, 50, and 100%, respectively. All fetuses with reactive nonstress tests also had fetal heart rate cyclicity present and none were acidotic at birth. The majority of fetuses (68.8%) with nonreactive nonstress tests had fetal heart rate cyclicity present and none were acidotic; fetuses with nonreactive nonstress tests and absence of fetal heart rate cyclicity were acidotic in 50% of the cases. These preliminary data suggest that the presence or absence of fetal heart rate cyclicity may help to select the healthy preterm fetuses with nonreactive nonstress testing who are in good condition and therefore in no need for further testing.
Assuntos
Acidose/diagnóstico , Sangue Fetal/análise , Doenças Fetais/diagnóstico , Frequência Cardíaca Fetal , Cesárea , Feminino , Monitorização Fetal , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Gravidez , Estudos ProspectivosRESUMO
The relationships among the fetal biophysical profile, umbilical cord blood pH, and Apgar scores were investigated in 124 patients undergoing cesarean section before the onset of labor. Based on a standard for the diagnosis of fetal acidosis of an umbilical cord arterial pH less than 7.20, the sensitivity, specificity, and positive and negative predictive values of the fetal biophysical profile score were 90%, 96%, 82%, and 98%, respectively. When the combination of a nonreactive nonstress test and absent fetal breathing was used as the "abnormal test," the sensitivity, specificity, and positive and negative predictive values were 100%, 92%, 71%, and 100%, respectively. The efficacy of the fetal biophysical profile to indicate fetal acidosis was found to be superior to the 1- and 5-minute Apgar scores in sensitivity and positive predictive value. These data suggest that the biophysical profile is very accurate in the identification of the fetus with acidemia. The first manifestations of fetal acidosis are nonreactive nonstress testing and loss of fetal breathing; in advanced acidemia fetal movements and fetal tone are compromised. A new protocol of antepartum fetal evaluation is suggested based on individual biophysical components rather than the score alone.
Assuntos
Acidose/diagnóstico , Índice de Apgar , Sangue Fetal/metabolismo , Doenças Fetais/diagnóstico , Monitorização Fetal/métodos , Feminino , Movimento Fetal , Frequência Cardíaca Fetal , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Gravidez , Estudos ProspectivosRESUMO
In a prospective study of 124 patients undergoing cesarean section before the onset of labor, the fetal biophysical profile was found to have a significant relationship with umbilical cord blood pH (artery and vein). Using cord arterial pH less than 7.20 as a standard for the diagnosis of fetal acidosis, the sensitivity, specificity, and positive and negative predictive values of the fetal biophysical profile score were 90, 96, 82, and 98%, respectively. When the combination of nonreactive nonstress test and absent fetal breathing was used as the "abnormal test," the sensitivity, specificity, and positive and negative predictive values were 100, 92, 71, and 100%, respectively. The first manifestations of fetal acidosis are nonreactive nonstress testing and loss of fetal breathing; in advanced acidemia, fetal movements and fetal tone are compromised. A protocol of antepartum fetal evaluation is suggested based upon the individual biophysical components rather than the score alone.
Assuntos
Sangue Fetal , Sofrimento Fetal/diagnóstico , Monitorização Fetal/métodos , Acidose/diagnóstico , Cesárea , Feminino , Sofrimento Fetal/fisiopatologia , Humanos , Concentração de Íons de Hidrogênio , Trabalho de Parto , GravidezRESUMO
Within the past 10 years, group B streptococcal disease has emerged as a major causative agent in neonatal morbidity and mortality. A brief history of this pathogen and its epidemiologic factors regarding maternal colonization and carriage is presented. Group B streptococcal disease in the neonate and concurrent treatment and prevention modalities also are presented. A case study is included. Suggestions for nursing assessment, intervention, and future considerations are offered.