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1.
J Med Life ; 14(1): 2-6, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33767778

RESUMO

Meningiomas are common primary tumors of the central nervous system. The incidence at the age of fertility is low, although there are some hormonal mechanisms involved. Growth in size was observed during the luteal phase of the menstrual cycle, which could lead to developing new symptoms during pregnancy or worsening of the already existing ones. Visual impairment is the chief complaint, followed by headache, nausea, vomiting, and seizures. Diagnosis is based on neurological examination, ophthalmoscopy, imaging techniques like gadolinium-enhanced magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) scans, bearing in mind the patient's irradiation and prejudice on the fetus together with the histopathological examination. The objective of the review is to determine the influence of meningioma on pregnancy and vice-versa and provide a strategy of follow-up for maternal-fetal specialists and not only. We performed a systematic review by searching relevant information in PubMed and Wiley databases using keywords as meningioma, pregnancy, progesterone receptors. The results showed that besides a similar incidence of meningioma in pregnant and non-pregnant women, symptoms might flare during pregnancy due to water retention, engorgement of vessels, and the presence of sex hormone receptors on tumor cells. Meningioma may impact the route of pregnancy with adverse effects on the fetus. Thus, fetal monitoring by biophysical profile and cardiotocography (CTG) is needed. The preferred treatment option is surgery, but gestational age and the woman's status must be taken into consideration.


Assuntos
Neoplasias Meníngeas/terapia , Meningioma/terapia , Gestantes , Feminino , Monitorização Fetal , Seguimentos , Humanos , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/patologia , Meningioma/cirurgia , Gravidez
2.
Biomed Eng Online ; 20(1): 26, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726745

RESUMO

BACKGROUND: Fresh stillbirths (FSB) and very early neonatal deaths (VEND) are important global challenges with 2.6 million deaths annually. The vast majority of these deaths occur in low- and low-middle income countries. Assessment of the fetal well-being during pregnancy, labour, and birth is normally conducted by monitoring the fetal heart rate (FHR). The heart rate of newborns is reported to increase shortly after birth, but a corresponding trend in how FHR changes just before birth for normal and adverse outcomes has not been studied. In this work, we utilise FHR measurements collected from 3711 labours from a low and low-middle income country to study how the FHR changes towards the end of the labour. The FHR development is also studied in groups defined by the neonatal well-being 24 h after birth. METHODS: A signal pre-processing method was applied to identify and remove time periods in the FHR signal where the signal is less trustworthy. We suggest an analysis framework to study the FHR development using the median FHR of all measured heart rates within a 10-min window. The FHR trend is found for labours with a normal outcome, neonates still admitted for observation and perinatal mortality, i.e. FSB and VEND. Finally, we study how the spread of the FHR changes over time during labour. RESULTS: When studying all labours, there is a drop in median FHR from 134 beats per minute (bpm) to 119 bpm the last 150 min before birth. The change in FHR was significant ([Formula: see text]) using Wilcoxon signed-rank test. A drop in median FHR as well as an increased spread in FHR is observed for all defined outcome groups in the same interval. CONCLUSION: A significant drop in FHR the last 150 min before birth is seen for all neonates with a normal outcome or still admitted to the NCU at 24 h after birth. The observed earlier and larger drop in the perinatal mortality group may indicate that they struggle to endure the physical strain of labour, and that an earlier intervention could potentially save lives. Due to the low amount of data in the perinatal mortality group, a larger dataset is required to validate the drop for this group.


Assuntos
Monitorização Fetal/instrumentação , Monitorização Fetal/métodos , Frequência Cardíaca Fetal , Trabalho de Parto , Natimorto , Feminino , Coração/fisiopatologia , Humanos , Recém-Nascido , Masculino , Gravidez , Probabilidade , Processamento de Sinais Assistido por Computador
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 608-611, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017915

RESUMO

Fetal electrocardiography is a valuable alternative to standard fetal monitoring. Suppression of the maternal electrocardiogram (ECG) in the abdominal measurements, results in fetal ECG signals, from which the fetal heart rate (HR) can be determined. This HR detection typically requires fetal R-peak detection, which is challenging, especially during low signal-to-noise ratio periods, caused for example by uterine activity. In this paper, we propose the combination of a convolutional neural network and a long short-term memory network that directly predicts the fetal HR from multichannel fetal ECG. The network is trained on a dataset, recorded during labor, while the performance of the method is evaluated both on a test dataset and on set-A of the 2013 Physionet /Computing in Cardiology Challenge. The algorithm achieved a positive percent agreement of 92.1% and 98.1% for the two datasets respectively, outperforming a top-performing state-of-the-art signal processing algorithm.


Assuntos
Frequência Cardíaca Fetal , Memória de Curto Prazo , Eletrocardiografia , Feminino , Monitorização Fetal , Humanos , Gravidez , Processamento de Sinais Assistido por Computador
4.
Artigo em Inglês | MEDLINE | ID: mdl-33017916

RESUMO

A sufficient oxygen supply of the fetus is necessary for a proper development of the organs. Transabdominal fetal pulse oximetry is a method that allows to measure the oxygenation of the fetal blood non-invasively by placing the light sources and photodetectors on the belly of the pregnant woman. The shape of the measured fetal pulse wave is needed to extract parameters for the estimation of the oxygen saturation. This work presents an extension of our previously presented signal processing strategy that allows to extract an average shape of the fetal pulse wave from noisy mixed photoplethysmograms (PPG) with dominating maternal and very weak fetal signal components. An adaptive noise canceller and a comb filter are used to suppress the maternal component. The quality of the resulting fetal signal is sufficient to identify single pulse waves in time domain. Further processing demonstrates the extraction of the mean shape of a single fetal pulse wave by synchronous averaging of several detected pulses. The method is evaluated with different datasets of several simulated and synthetic signals measured with a tissue mimicking phantom. The feasibility of the approach is demonstrated by preparing the mixed PPGs to perform fetal pulse oximetry in future studies. However, clinical measurements are needed to finally evaluate the proposed system beyond synthetic datasets.


Assuntos
Monitorização Fetal , Oxigênio , Feminino , Frequência Cardíaca , Humanos , Oximetria , Gravidez , Cuidado Pré-Natal
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 621-624, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018064

RESUMO

The use of fetal heart rate (FHR) recordings for assessing fetal wellbeing is an integral component of obstetric care. Recently, non-invasive fetal electrocardiography (NI-FECG) has demonstrated utility for accurately diagnosing fetal arrhythmias via clinician interpretation. In this work, we introduce the use of data-driven entropy profiling to automatically detect fetal arrhythmias in short length FHR recordings obtained via NI-FECG. Using an open access dataset of 11 normal and 11 arrhythmic fetuses, our method (TotalSampEn) achieves excellent classification performance (AUC = 0.98) for detecting fetal arrhythmias in a short time window (i.e. under 10 minutes). We demonstrate that our method outperforms SampEn (AUC = 0.72) and FuzzyEn (AUC = 0.74) based estimates, proving its effectiveness for this task. The rapid detection provided by our approach may enable efficient triage of concerning FHR recordings for clinician review.


Assuntos
Monitorização Fetal , Frequência Cardíaca Fetal , Arritmias Cardíacas/diagnóstico , Entropia , Feminino , Humanos , Gravidez , Processamento de Sinais Assistido por Computador
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4483-4486, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018990

RESUMO

This paper proposes a detection method of fetal breathing movement (FBM) as an important data of fetal well-being. To analyze the chaotic nature of the individual episodes, the frequency band has been split into single test frequencies in order to find its starting point (SP) as a signal free (quiet) zone. Computing some features of the signal the sound will be distinguishable from the disturbing signals as hiccups, body's rotation and limb movements or even additional noises of maternal heart beats. The SPs of the episodes are characterized by an approximation process in order to select the real ones.Clinical relevance- The method is an irradiation free measurement, carried out on the maternal abdomen. Furthermore, connected with the fetal phonocardiographic (fPCG) monitoring the method offers a non-invasive way for FBM detection applicable also at home. More than 50 pregnancies were examined with the proposed method for at least for 20-min with synchronous measurements by the proposed phonographic device and a 3D ultrasound machine in the third trimester.


Assuntos
Monitorização Fetal , Movimento Fetal , Feminino , Feto , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Respiração
7.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
8.
PLoS One ; 15(8): e0236982, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745099

RESUMO

BACKGROUND: Continuous intrapartum fetal monitoring is challenging and its clinical benefits are debated. The project evaluated whether short-term-variation (STV) and other computerised fetal heart rate (FHR) parameters (baseline FHR, long-term-variation, accelerations and decelerations) predicted acidaemia at birth. The aims of the study were to assess the changes in FHR pattern during labour and determine the feasibility of undertaking a definitive trial by reporting the practicalities of using the monitoring device, participant recruitment, data collection and staff training. METHODS: 200 high-risk women carrying a term singleton, non-anomalous fetus, requiring continuous FHR monitoring in labour were consented to participate from the Jessop Wing maternity unit, Sheffield, UK. The trans-abdominal fetal ECG monitor was placed as per clinical protocol. During the monitoring session, clinicians were blinded to the computerised FHR parameters. We analysed the last hour of the FHR and its ability to predict umbilical arterial blood pH <7.20 using receiver operator characteristics (ROC) curves. RESULTS: Of 200 women, 137 cases were excluded as either the monitor did not work from the onset of labour (n = 30), clinical staff did not return or used the monitor on another patient (n = 37), umbilical cord blood not obtained (n = 25), FHR data not recorded within an hour of birth (n = 34) and other reasons (n = 11). In 63 cases included in the final analysis, the computer-derived FHR parameters did not show significant correlation with umbilical artery cord pH <7.20. Labour was associated with a significant increase in short and long term variation of FHR and number of deceleration (P<0.001). However, baseline FHR decreased significantly before delivery (P<0.001). CONCLUSIONS: The project encountered a number of challenges, with learning points crucial to informing the design of a large study to evaluate the potential place of intrapartum computerised FHR parameters, using abdominal fetal ECG monitor before its clinical utility and more widespread adoption can be ascertained.


Assuntos
Eletroencefalografia/instrumentação , Monitorização Fetal/métodos , Frequência Cardíaca Fetal/fisiologia , Acidose/fisiopatologia , Adulto , Cardiotocografia , Eletrocardiografia , Estudos de Viabilidade , Feminino , Sangue Fetal , Doenças Fetais/fisiopatologia , Feto/fisiopatologia , Humanos , Concentração de Íons de Hidrogênio , Trabalho de Parto , Gravidez
9.
PLoS One ; 15(7): e0226755, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722675

RESUMO

Digital Infrared Thermal Imaging (DITI) has much potential in the field of maternal-fetal health and wellbeing research. The fact that it is totally non-invasive is particularly important in this context. The purpose of this study was, for the first time, to assess DITI's ability to record fetal presentation and position, and other pregnancy-related physiological factors, via their superficial thermal prints. Ten healthy pregnant women (approximately 34-37 weeks of gestation) were recorded with two thermal imaging cameras (Flir C3 and i3 TE-Q1) from five different viewpoints. Participants' views about the use of DITI in research and clinical practice were also assessed by a completion of a survey. Free hand polygon region of interests (ROIs) were drawn in order to include the entire anatomical area for investigation. The use of free hand polygon ROIs showed high reliability. Thermal images analysis revealed that fetuses presenting cephalically can be identified by the use of DITI, under specific conditions. Fetal movements influenced the thermal patterns that were produced. Future studies need to verify the heat patterns on the skin related to the placenta location, in order to understand the produced thermal recordings. Pregnant women rated the idea of using DITI in research and clinical practice very highly. This work represents a first contribution towards the use of DITI for the recording of fetal presentation and position. As it does not require direct contact and since it is completely non-invasive, it could be used to record maternal-fetal dynamic dyadic interaction in pregnancy. However, although the preliminary results are promising, further trans-disciplinary studies with a well-established protocol, more sophisticated thermal cameras, and bigger cohorts are needed.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico , Feto/diagnóstico por imagem , Termografia/métodos , Adolescente , Adulto , Temperatura Corporal , Estudos de Viabilidade , Feminino , Monitorização Fetal/métodos , Movimento Fetal , Idade Gestacional , Inquéritos Epidemiológicos , Humanos , Processamento de Imagem Assistida por Computador , Apresentação no Trabalho de Parto , Gravidez , Adulto Jovem
10.
Obstet Gynecol ; 136(5): 1016-1020, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32649505

RESUMO

BACKGROUND: The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection. CASES: The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful. CONCLUSION: Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness.


Assuntos
Infecções por Coronavirus , Monitorização Fetal/métodos , Hidropisia Fetal/diagnóstico , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Pele/diagnóstico por imagem , Adulto , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Idade Gestacional , Humanos , Imunoglobulina M/sangue , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pessoa de Meia-Idade , Placenta/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Respiração Artificial/métodos , Resultado do Tratamento , Ultrassonografia Pré-Natal/métodos
11.
J Pregnancy ; 2020: 3631808, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695513

RESUMO

Background: Obstructed or prolonged labor is a major cause of maternal deaths. Prolonged and obstructed labor contributed to 13% of global maternal deaths which can be reduced by proper utilization of a partograph during labor. Obstetric caregivers' use of the partograph during labor has paramount importance in identifying any deviation during labor. Even though partograph use is influenced by different factors as obtained from the literatures, the magnitude of partograph utilization and the factors associated with its use are not well determined in the health facilities of Wolaita Zone. Objective: To assess the magnitude of partograph utilization and factors that affect its utilization among obstetric caregivers in public health facilities of Wolaita Zone, Ethiopia, 2017. Methods: An institution-based cross-sectional study was conducted on obstetric caregivers. A pretested and structured questionnaire was used to collect data. Data was entered to EpiData version 3.01 and exported to SPSS version 23.0 for further analysis. Logistic regression analyses were used to see the association of different variables. Result: A total of 269 obstetric caregivers participated in the study. Among those who were utilizing the partograph, 193 (71.7%) routinely used it for all laboring mothers and 76 (28.3%) of participants reported that they do not routinely utilize it. Greater number of service years (AOR = 4.93, 95% CI: 1.53-15.88), on-the-job training (AOR = 0.16, 95% CI: 0.06-0.43), good knowledge (AOR = 3.35, 95% CI: 1.61-6.97), and favorable attitude towards partograph utilization (AOR = 2.99, 95% CI: 1.28-7.03) were significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization among obstetric caregivers in the public health facilities was good. Greater years of work experience, in-service training, having good knowledge, and favorable attitude towards partograph utilization among obstetric caregivers independently determined partograph utilization. Provision of on-the-job training to make obstetric caregivers improve knowledge and skill on partograph utilization, maintaining caregivers' retention to decrease turnover by providing different incentives to more experienced obstetric care providers, and establishing favorable attitude could improve the proper use of the tool.


Assuntos
Monitorização Fetal/métodos , Monitorização Fetal/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Trabalho de Parto , Complicações do Trabalho de Parto/prevenção & controle , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Competência Clínica , Estudos Transversais , Etiópia/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Humanos , Gravidez , Inquéritos e Questionários
12.
PLoS One ; 15(6): e0233179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584813

RESUMO

Currently available fetal echocardiographic reference values are derived mainly from North American and European population studies, and there is a lack of reference z-score for fetal echocardiographic measurement in Asian populations. The aim of this study was to establish normal ranges of echocardiographic measurements and z-scores in healthy Asian fetuses. A total of 575 healthy pregnant Taiwanese with an estimated gestational age from 14 to 38 weeks were enrolled voluntarily for this observational study. Standard two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries of the developing fetuses. In contrast to past studies, our sample was more evenly distributed for estimated gestational age (p<0.001). We present percentile graphs for 13 fetal echocardiographic measurements from the knowledge of estimated gestational age, biparietal distance, head circumference, abdominal circumference, and femur length. Most cardiac structures and developmental markers had linear models as the best-fitting, except for transverse aortic isthmus by estimated gestational age and transverse ductus arteriosus by femur length. Our findings indicate that estimated gestational age was generally the best model for fetal heart development, while head circumferences could be used as an optimal developmental marker to predict left atrium, right atrium, right ventricle, pulmonary annulus, and ductus arteriosus. Lastly, we developed nomograms for each of the 13 fetal heart measurements by each developmental markers. This is the first study providing echocardiographic reference ranges and nomograms for Asian fetuses. Computing z-scores from nomograms helps in standardizing comparisons and adds additional prognostic information to the diagnosis of congenital heart disease.


Assuntos
Ecocardiografia/normas , Monitorização Fetal/métodos , Grupo com Ancestrais do Continente Asiático , Ecocardiografia/métodos , Feminino , Desenvolvimento Fetal , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Modelos Lineares , Gravidez , Valores de Referência , Ultrassonografia Pré-Natal/métodos
13.
Obstet Gynecol ; 136(5): 962-964, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32590725

RESUMO

BACKGROUND: In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. CASE: A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. CONCLUSION: Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.


Assuntos
Infecções por Coronavirus , Trabalho de Parto Induzido/métodos , Trabalho de Parto , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Respiração Artificial/métodos , Adulto , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Sedação Profunda/métodos , Feminino , Monitorização Fetal/métodos , Idade Gestacional , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Seleção de Pacientes , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Resultado do Tratamento
15.
Anaesth Crit Care Pain Med ; 39(3): 345-349, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32405520
16.
Obstet Gynecol ; 135(6): 1454-1456, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459438

RESUMO

BACKGROUND: Fetal tachycardia can occur with maternal fever (hyperthermia); therefore, a low maternal temperature (hypothermia) might produce fetal bradycardia. CASES: Five cases of fetal bradycardia are presented in gestations complicated by maternal hypothermia. The fetal heart rate (FHR) tracings demonstrated stable baselines of 88-96 beats per minute with moderate variability and accelerations. All baselines returned to normal after maternal warming measures. CONCLUSION: A possible cause for fetal bradycardia with a stable baseline and moderate variability is maternal hypothermia, a pattern not indicative of fetal hypoxia. Delivery is not indicated, and maternal warming results in FHR baseline normalization.


Assuntos
Bradicardia/etiologia , Frequência Cardíaca Fetal , Hipotermia/fisiopatologia , Complicações na Gravidez/fisiopatologia , Adulto , Feminino , Hipóxia Fetal/etiologia , Monitorização Fetal/métodos , Humanos , Gravidez
17.
Artigo em Inglês | MEDLINE | ID: mdl-32299728

RESUMO

Continuous electronic fetal monitoring (EFM) was first introduced commercially over 50 years ago with the hope of improving perinatal outcomes during labor. However, despite the increased use of EFM, definitive improvements in perinatal outcomes have not been demonstrated. Variance in tracing interpretation and intervention has led to increased rates of cesarean and operative vaginal deliveries and perhaps increased maternal and neonatal morbidity. Since its inception, several strategies have been developed in hopes of optimizing EFM and improving these outcomes. We discuss the current standards of intrapartum fetal monitoring and review optimization strategies and technologies in development to improve intrapartum fetal monitoring.


Assuntos
Cardiotocografia , Frequência Cardíaca Fetal/fisiologia , Trabalho de Parto , Parto Obstétrico , Feminino , Monitorização Fetal , Humanos , Gravidez
18.
Acta Obstet Gynecol Scand ; 99(10): 1411-1416, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32274792

RESUMO

INTRODUCTION: Cardiotocography (CTG) is currently the most commonly used method for intrapartum fetal monitoring during labor. However, a high false-positive rate of fetal acidosis indicated by CTG leads to an increase in obstetric interventions. We developed a microdialysis probe that is integrated into a fetal scalp electrode allowing continuous measurement of lactate subcutaneously, thus giving instant information about the oxygenation status of the fetus. Our aim was to establish proof of concept in an animal model using a microdialysis probe to monitor lactate subcutaneously. MATERIAL AND METHODS: We performed an in vivo study in adult male wild-type Wistar rats. We modified electrodes used for CTG monitoring in human fetuses to incorporate a microdialysis membrane. Optimum flow rates for microdialysis were determined in vitro. For the in vivo experiment, a microdialysis probe was inserted into the skin on the back of the animal. De-oxygenation and acidosis were induced by lowering the inspiratory oxygen pressure. Oxygenation and heart rate were monitored. A jugular vein cannula was inserted to draw blood samples for analysis of lactate, pH, pco2 , and saturation. Lactate levels in dialysate were compared with plasma lactate levels. RESULTS: Baseline blood lactate levels were around 1 mmol/L. Upon de-oxygenation, oxygen saturation fell to below 40% for 1 h and blood lactate levels increased 2.5-fold. Correlation of dialysate lactate levels with plasma lactate levels was 0.89 resulting in an R2 of .78 in the corresponding linear regression. CONCLUSIONS: In this animal model, lactate levels in subcutaneous fluid collected by microdialysis closely reflected blood lactate levels upon transient de-oxygenation, indicating that our device is suitable for subcutaneous measurement of lactate. Microdialysis probe technology allows the measurement of multiple compounds in the dialysate, such as glucose, albumin, or inflammatory mediators, so this technique may offer the unique possibility to shed light on fetal physiology during the intrapartum period.


Assuntos
Monitorização Fetal/instrumentação , Lactatos/análise , Membranas Artificiais , Microdiálise , Tela Subcutânea/química , Acidose/diagnóstico , Animais , Feminino , Doenças Fetais/diagnóstico , Monitorização Fetal/métodos , Modelos Animais , Oximetria , Gravidez , Ratos Wistar
19.
PLoS One ; 15(4): e0230478, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240197

RESUMO

BACKGROUND: Approximately one-third of the global stillbirth burden occurs during intrapartum period. The ability to assess obstetric parameters including effacement, dilatation, uterine contraction, decent, rupture of the uterus, and moulding of the foetal head are among the essential competencies required by obstetric service providers admitting women for labour in health facilities. Misdiagnosis of these conditions could result in unnecessary obstetric interventions and unfavourable obstetric outcomes including intrapartum stillbirth. This study aimed to assess associations between missed diagnosis plus complication of labour on admission and intrapartum stillbirth. METHODS: A case-control study using primary data from chart review of medical records of women who experienced intrapartum stillbirth in 20 public health centres and three public hospitals of Addis Ababa between 01 July 2010 and 30 June 2015 was conducted. Data were collected from charts of all cases meeting the inclusion criteria. Medical records of women with livebirths were randomly selected and reviewed from each public health facilities in two to one (2:1) control to case ratio. Accordingly, 728 cases of stillbirth out of 1,056 charts met the inclusion criteria whereas 1,551 controls out of 1,705 were also considered in the study. RESULTS: Proportionally, more women in the stillbirth group (39.4%) than in the livebirth group (30.2%) experienced ruptured membrane on admission, with the difference being statistically significant (OR 1.7, 95% CI 1.37-2.03). Significantly higher proportion of women in the intrapartum stillbirth group experienced FRH lower than 110/min, a result suggestive of foetal distress on admission. Proportionally, more women in the intrapartum stillbirth group (14.5%) than in the livebirth group (4.5%) had breech foetal presentation on admission for labour, the difference being statistically significant (aOR 3.26 95% CI 1.93-5.50). Intrapartum stillbirth was slightly higher among women with cervical dilatation 4cm or more on admission (OR 1.2, 95% CI 1.00-1.45). This could be owing to delay in seeking obstetric care or misdiagnosis of the condition, a situation that seeks more rigorous study to determine the underlying causal links. Diagnosis of foetal member was missed among more cases than controls where the difference was statistically significant (aOR 1.51, CI 1.03-2.19). CONCLUSION: Low FHR, non-vertex foetal presentations and ruptured cervical membrane were predictors of intrapartum stillbirth. Health facilities could avert unnecessary foetal loss by undertaking timely actions to manage obstetric emergencies on admission to labour.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Morte Fetal/etiologia , Instalações de Saúde/estatística & dados numéricos , Complicações do Trabalho de Parto/fisiopatologia , Natimorto/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia , Feminino , Morte Fetal/prevenção & controle , Coração Fetal/fisiologia , Monitorização Fetal/métodos , Humanos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-32188037

RESUMO

High-quality intrapartum care, including intermittent monitoring of fetal heart rates (FHR) to detect and manage abnormalities, is recommended by WHO and the Government of Tanzania (GoT) and creates potential to save newborn lives in Tanzania. Handheld Doppler devices have been investigated in several low-resource countries as an alternative to Pinard stethoscope and are more sensitive to detecting accelerations and decelerations of the fetal heart as compared to Pinard. This study assessed perspectives of high-level Tanzanian policymakers on facilitators and barriers to scaling up use of the hand-held Doppler for assessing FHR during labor and delivery. From November 2018-August 2019, nine high-level policymakers and subject matter experts were interviewed using a semi-structured questionnaire, with theoretical domains drawn from Proctor's implementation outcomes framework. Interviewees largely saw use of Doppler to improve intrapartum FHR monitoring as aligning with national priorities, though they noted competing demands for resources. They felt that GoT should fund Doppler, but prioritization and budgeting should be driven from district level. Recommended ways forward included learning from scale up of Helping Babies Breathe rollout, making training approaches effective, using clinical mentoring, and establishing systematic monitoring of outcomes. To be most effective, introduction of Doppler must be concurrent with improving case management practices for abnormal intrapartum FHR. WHO's guidance on scale-up, as well as implementation science frameworks, should be considered to guide implementation and evaluation.


Assuntos
Cardiotocografia , Frequência Cardíaca Fetal , Feminino , Monitorização Fetal , Humanos , Recém-Nascido , Gravidez , Tanzânia , Ultrassonografia Doppler
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