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Wang J, Yan TT, Feng YL, He YL, Yang Y, Liu JF, Yao NJ, Zhu YG, Zhao YR, Chen TY. [The effect of maternal HBV DNA levels on HBV intrauterine transmission and fetal distress]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:873-878. [PMID: 36207944 DOI: 10.3760/cma.j.cn501113-20190610-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aim: To identify the key risk factors of intrauterine hepatitis B virus transmission (HBV) and its effect on the placenta and fetus. Methods: 425 infants born to hepatitis B surface antigen (HBsAg)-positive pregnant women who received combined immunization with hepatitis B immunoglobulin and hepatitis B vaccine between 2009 to 2015 were prospectively enrolled in this study. The intrauterine transmission situation was assessed by dynamic monitoring of infants HBV DNA load and quantitative HBsAg. Univariate and multivariate regression analysis was used to determine the high risk factors for intrauterine transmission. Stratified analysis was used to determine the relationship between maternal HBV DNA load and fetal distress. Transmission electron microscopy was used to observe HBV Effects on placental tissue. Results: HBV intrauterine infection rate was 2.6% (11/425). Multivariate analysis result showed that the maternal HBV DNA load was an independent risk factor for intrauterine infection among infants (P=0.011). Intrauterine infection and distress rate was significantly higher in infants with with maternal HBV DNA>106 IU/ml than those with HBV DNA <106 IU/ml (12.2% vs. 1.8%; χ2=11.275, P=0.006), and (24.4% vs. 16.0%, χ2=3.993, P=0.046). Transmission electron microscopy showed that mitochondrial edema, endoplasmic reticulum expansion and thicker basement membrane were apparent when the maternal HBV DNA>106 IU/ml than that of maternal HBV DNA<106 IU/ml (960 nm vs. 214 nm, Z=-2.782, P=0.005) in the placental tissue. Conclusion: Maternal HBV DNA>106 IU/ml is associated not only with intrauterine infection, but also with increased incidence of intrauterine distress and placental sub-microstructural changes, providing strong clinical and histological evidence for pregnancy avoidance and treatment in this population.
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Affiliation(s)
- J Wang
- The Department of Rheumatology, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - T T Yan
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - Y L Feng
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - Y L He
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - Y Yang
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - J F Liu
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - N J Yao
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - Y G Zhu
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - Y R Zhao
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
| | - T Y Chen
- The Department of Infectious Disease, First Affiliated Hospital of Medicine College, Xi'an Jiaotong University, Xi'an 710061,China
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2
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Abstract
BACKGROUND Uterine tachysystole (more than 5 contractions per 10 minutes in 2 consecutive intervals) is common during labour, particularly with use of labour-stimulating agents. Tachysystole may reduce fetal oxygenation by interrupting maternal blood flow to the placenta during contractions. Reducing uterine contractions may improve placental blood flow, improving fetal oxygenation. This review aimed to evaluate the use of tocolytics to reduce or stop uterine contractions for improvement of the condition of the fetus in utero. This new review supersedes an earlier Cochrane Review on the same topic. OBJECTIVES To assess the effects of the use of acute tocolysis during labour for uterine tachysystole or suspected fetal distress, or both, on fetal, maternal and neonatal outcomes. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (2 February 2018), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating acute tocolysis for uterine tachysystole, intrapartum fetal distress, or both. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. MAIN RESULTS We included eight studies (734 women), conducted in hospital settings, predominantly in high-income countries (USA, Austria, Uruguay). Two trials were conducted in upper and lower middle-income countries (South Africa, Sri Lanka). The hospital facilities all had the capacity to perform caesarean section. Overall, the studies had a low risk of bias, except for methods to maintain blinding. All of the trials used a selective beta2 (ß2)-adrenergic agonist in one arm, however the drug used varied, as did the comparator. Limited information was available on maternal outcomes.Selective ß2-adrenergic agonist versus no tocolytic agent, whilst awaiting emergency deliveryThere were two stillbirths, both in the no tocolytic control group (risk ratio (RR) 0.23, 95% confidence interval (CI) 0.01 to 4.55; 2 studies, 57 women; low-quality evidence). One had gross hydrocephalus and the second occurred with vaginal delivery after waiting 55 minutes for caesarean section. The decision for caesarean section delivery was an inclusion criterion in both studies so we could not assess this as an outcome under this comparison. Abnormal fetal heart trace is probably lower with tocolytic treatment (RR 0.28, 95% CI 0.08 to 0.95; 2 studies, 43 women; moderate-quality evidence). The effects on the number of babies with Apgar score below seven were uncertain (low-quality evidence).Intravenous (IV) atosiban versus IV hexoprenaline (1 study, 26 women) One infant in the hexoprenaline group required > 24 hours in the neonatal intensive care unit (NICU) following a forceps delivery (RR 0.33, 95% CI 0.01 to 7.50; low-quality evidence). There were no fetal or neonatal mortalities and no Apgar scores below seven. There was one caesarean delivery in the IV hexoprenaline group (RR 0.33, 95% CI 0.01 to 7.50; low-quality evidence), and one case of abnormal fetal heart score in the atosiban group (RR 3.00, 95% CI 0.13 to 67.51; very low-quality evidence).IV fenoterol bromhydrate versus emergency delivery (1 study, 390 women) No data were reported for perinatal death, severe morbidity or fetal or neonatal mortality. IV fenoterol probably increases the risk of caesarean delivery (RR 1.12, 95% CI 1.04 to 1.22; moderate-quality evidence). Fenoterol may have little or no effect on the risk of Apgar scores below seven (RR 1.28, 95% CI 0.35 to 4.68; low-quality evidence).IV hexoprenaline versus no tocolytic agent, whilst awaiting emergency delivery (1 study, 37 women) No data were reported for perinatal death or severe morbidity. There were two fetal deaths in the no tocolytic control group (RR 0.23, 95% CI 0.01 to 4.55; low-quality evidence). The rate of caesarean delivery was not reported. There were two babies with Apgar scores below seven in the control group and none in the hexoprenaline group (RR 0.24, 95% CI 0.01 to 4.57; 35 women; low-quality evidence).Subcutaneous terbutaline versus IV magnesium sulphate (1 study, 46 women)No data were reported for perinatal death, severe morbidity or fetal or neonatal mortality. The decision for caesarean section was an inclusion criterion, so we could not assess this. The effects on abnormal fetal heart trace are uncertain (very low-quality evidence).Subcutaneous terbutaline with continuation of oxytocic infusion versus cessation of oxytocic infusion without tocolytic agent (1 study, 28 women) No data were reported for perinatal death, severe morbidity or fetal or neonatal mortality. There may be little or no difference in the rates of caesarean delivery in the subcutaneous terbutaline (8/15) and control groups (4/13) (RR 1.73, 95% CI 0.68 to 4.45; low-quality evidence). There were no cases of Apgar scores below seven or abnormal fetal heart trace.Subcutaneous terbutaline versus no tocolytic agent, whilst awaiting emergency delivery (1 study, 20 women) No data were reported for perinatal death or severe morbidity. There were no fetal or neonatal mortalities. The decision for caesarean section was an inclusion criterion, so we could not assess this. There were two babies with Apgar scores below seven in the control group and none in the terbutaline group (RR 0.17, 95% CI 0.01 to 3.08; low-quality evidence).IV terbutaline versus IV nitroglycerin (1 study, 110 women)No data were reported for perinatal death or severe morbidity or fetal or neonatal mortality. There may be little or no difference in the rates of caesarean delivery between the IV terbutaline (30/57) and control groups (29/53) (RR 0.96, 95% CI 0.68 to 1.36; low-quality evidence). There were no cases of Apgar scores below seven. AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of tocolytics for uterine tachysystole or suspected fetal distress during labour. The clinical significance for some of the improvements in measures of fetal well-being with tocolytics is unclear. The sample sizes were too small to detect effects on neonatal morbidity, mortality or serious adverse effects. The majority of studies are from high-income countries in facilities with access to caesarean section, which may limit the generalisability of the results to lower-resource settings, or settings where caesarean section is not available.Further well-designed and adequately powered RCTs are required to evaluate clinically relevant indicators of maternal and neonatal morbidity and mortality.
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Affiliation(s)
| | - Joshua P Vogel
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
| | - Thach Son Tran
- Garvan Institute of Medical ResearchClinical Studies and Epidemiology, Bone Biology Division384 Victoria StreetDarlinghurstNew South WalesAustraliaNSW 2010
| | - G Justus Hofmeyr
- Walter Sisulu University, University of the Witwatersrand, Eastern Cape Department of HealthEast LondonSouth Africa
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3
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Abstract
BACKGROUND Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress. OBJECTIVES The objective of this review was to assess the effects of piracetam for suspected fetal distress in labour on method of delivery and perinatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012). SELECTION CRITERIA Randomised trials of piracetam compared with placebo or no treatment for suspected fetal distress in labour. DATA COLLECTION AND ANALYSIS Both review authors assessed eligibility and trial quality. MAIN RESULTS One study of 96 women was included. Piracetam compared with placebo was associated with a trend to reduced need for caesarean section (risk ratio 0.57, 95% confidence interval 0.32 to 1.03). There were no statistically significant differences between the piracetam and placebo group for neonatal morbidity (measured by neonatal respiratory distress) or Apgar score. AUTHORS' CONCLUSIONS There is not enough evidence to evaluate the use of piracetam for fetal distress in labour.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of FortHare, Eastern Cape Department of Health, East London, South Africa.
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Witter FR, Zimmerman AW, Reichmann JP, Connors SL. In utero beta 2 adrenergic agonist exposure and adverse neurophysiologic and behavioral outcomes. Am J Obstet Gynecol 2009; 201:553-9. [PMID: 19961985 DOI: 10.1016/j.ajog.2009.07.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 06/18/2009] [Accepted: 07/06/2009] [Indexed: 11/16/2022]
Abstract
Beta 2 adrenergic receptor overstimulation during critical periods of prenatal development can induce a permanent shift in the balance of sympathetic-to-parasympathetic tone. This is a biologically plausible mechanism whereby beta 2 adrenergic agonists can induce functional and behavioral teratogenesis, which explains their association with increases in autism spectrum disorders, psychiatric disorders, poor cognitive, motor function and school performance, and changes in blood pressure in the offspring. The use of beta 2 adrenergic agonists should be limited to proven indications when alternate drugs are ineffective or unavailable; the risks of untreated disease to the mother and fetus are greater than the risk of the beta 2 adrenergic agonist.
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Affiliation(s)
- Frank R Witter
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Pullen KM, Riley ET, Waller SA, Taylor L, Caughey AB, Druzin ML, El-Sayed YY. Randomized comparison of intravenous terbutaline vs nitroglycerin for acute intrapartum fetal resuscitation. Am J Obstet Gynecol 2007; 197:414.e1-6. [PMID: 17904983 DOI: 10.1016/j.ajog.2007.06.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/05/2007] [Accepted: 06/28/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare terbutaline and nitroglycerin for acute intrapartum fetal resuscitation. STUDY DESIGN Women between 32-, 42 weeks' gestation were assigned randomly to 250 microg of terbutaline or 400 microg nitroglycerin intravenously for nonreassuring fetal heart rate tracings in labor. The rate of successful acute intrapartum fetal resuscitation and the maternal hemodynamic changes were compared. Assuming a 50% failure rate in the terbutaline arm, we calculated that a total of 110 patients would be required to detect a 50% reduction in failure in the nitroglycerin group (50% to 25%), with an alpha value of .05, a beta value of .20, and a power of 80%. RESULTS One hundred ten women had nonreassuring fetal heart rate tracings in labor; 57 women received terbutaline, and 53 women received nitroglycerin. Successful acute resuscitation rates were similar (terbutaline 71.9% and nitroglycerin 64.2%; P = .38). Terbutaline resulted in lower median contraction frequency per 10 minutes (2.9 [25-75 percentile, 1.7- 3.3] vs 4 [25-75 percentile, 2.5- 5]; P < .002) and reduced tachysystole (1.8% vs 18.9%; P = .003). Maternal mean arterial pressures decreased with nitroglycerin (81-76 mm Hg; P = .02), but not terbutaline (82-81 mm Hg; P = .73). CONCLUSION Although terbutaline provided more effective tocolysis with less impact on maternal blood pressure, no difference was noted between nitroglycerin and terbutaline in successful acute intrapartum fetal resuscitation.
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Affiliation(s)
- Kristin M Pullen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
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6
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Lominadze AA, Sharvashidze NK. [Assessment of fetus' hypoxia treatment with actovegin]. Georgian Med News 2006:65-8. [PMID: 17057302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The condition of fetus dramatically impairs in the case of pregnancy pathologies, when uterine-placental blood circulation impairment reveals, as it happens during placental presentation followed by bleeding, chronic anemia, heart and lung diseases of mother and pneumonia. Fetus' hypoxia develops when blood circulation in the vessels of cord is impaired, placental blood circulation disorders reveal. Preventive measures of fetus intra-natal hypoxia lay in elimination of obstetric and extra-genital causes. For the treatment of fetus hypoxia the solution Actovegin 4.0+5% glucose 400.0+vitamin "C" 4.0 in dosage of 15-20 drops per minute was applied. Out of 36 pregnant patients treatment was effective in 24 cases. In 12 cases a Caesarean section was performed. In cases of fetus hypoxia Actovegin allows to transfer metabolic processes in the form of anaerobic glycolysis, thus protecting vital centers from oxygen deprivation.
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7
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Zhao SC, Li F, Ai LY. [Significance of infusion of sodium bicarbonate in amniotic cavity under continuous internal fetal heart rate monitoring for management of fetal distress during labor]. Zhonghua Fu Chan Ke Za Zhi 2006; 41:391-4. [PMID: 16831361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To investigate the effect of infusion of sodium bicarbonate in amniotic cavity and exchange of amniotic fluid for fetus with distress and acidosis. METHODS The patients included 40 cases of oligohydramnios with mild and serious abnormality of fetal heart rate and amniotic fluid contamination of degree II or more during the labor. The 40 cases had exchange of amniotic fluid with infusion under continuous monitoring. Twenty of them had infusion with 5% sodium bicarbonate into amniotic cavity; the other 20 cases received 5% sodium bicarbonate intravenous in fusion. After the labor all the patients had test of arterial blood gas in umbilical cord and the fetuses were evaluated with Apgar score. RESULTS (1) the effective rate was 88% in the group of infusion into amniotic cavity and 85% in the group of exchange of amniotic fluid. (2) The arterial blood pH, PO(2), HCO(3)(-), ABE, SBE in the group of amniotic cavity infusion with 5% sodium bicarbonate were all higher than group of IV infusion, however PCO(2) was significantly lower than the group of IV (P < 0.05). CONCLUSION Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis.
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Affiliation(s)
- San-cun Zhao
- Department of Obstetrics, Maternal and Children's Health Hospital of Shanxi Province, Xi'an 710003, China
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8
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Anderer G, Hellmeyer L, Tekesin I, Schmidt S. Kombinationstherapie einer fetalen supraventrikulären Tachykardie mit Flecainid und Digoxin. Z Geburtshilfe Neonatol 2005; 209:34-7. [PMID: 15731979 DOI: 10.1055/s-2005-837798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Persistent fetal supraventricular tachycardia (SVT) with more than 210 bpm frequently leads to congestive heart failure. We report on a case with SVT and congestive heart failure that converted into sinus rhythm within 19 days of therapy with flecainide and beta-acetyldigoxin. A 32-year-old II gravida I para (25 + 1 weeks of gestation) presented with fetal SVT of 267 bpm. A non-immunologic hydrops fetalis was diagnosed by ultrasound showing ascites, pleural and pericardial effusion and tricuspid regurgitation. Within 19 days of combination therapy with flecainide and digoxin, cardioversion was achieved. After 36 days of therapy no more signs of cardiac failure could be detected. A healthy boy was born at 38 + 6 weeks of gestation. Although cardioversion is expected after 72 h of therapy according to the literature, this fetus converted into sinus rhythm on day 19 of therapy. This indicates that patients should not be considered resistant to treatment within the first 3 - 4 days.
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Affiliation(s)
- G Anderer
- Klinik für Geburtshilfe und Perinatalmedizin, Philipps Universität Marburg
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9
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Romeo E, D'Alto M, Russo MG, Sarubbi B, Cardaropoli D, Paladini D, Pacileo G, Annunziata A, Calabrò R. Fetal supraventricular tachycardia diagnosed and treated at twenty-four weeks of gestation and after birth: a case report. Ital Heart J 2004; 5:777-80. [PMID: 15626276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Supraventricular tachycardia is the most common clinically significant fetal tachycardia. The diagnosis is usually made at routine sonographic workup during the second-third trimester of pregnancy. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal supraventricular tachycardia diagnosed at 24 weeks of gestation. The first-line treatment was oral maternal digoxin and sotalol. This therapy was not sufficient for complete control of the tachycardia. Hence, second-line treatment with digoxin and flecainide was started and successfully achieved conversion to sinus rhythm. No adverse maternal side effects were noted during the 14 weeks of therapy. A normal male infant was delivered at elective cesarean section performed for obstetric indications at 38 weeks of gestation. A persistent junctional reciprocating tachycardia with a ventriculo-atrial/atrioventricular ratio > 1 was diagnosed following delivery at transesophageal electrophysiological study. At the age of 8 months the child is on therapy with sotalol (4 mg/kg/day) and flecainide (3 mg/kg/day) and is in good clinical conditions.
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Affiliation(s)
- Emanuele Romeo
- Chair of Cardiology, Second University of Naples, Italy.
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Afschar P, Schöll W, Bader A, Bauer M, Winter R. A prospective randomised trial of atosiban versus hexoprenaline for acute tocolysis and intrauterine resuscitation. BJOG 2004; 111:316-8. [PMID: 15008765 DOI: 10.1111/j.1471-0528.2004.00095.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy and side effect profile of atosiban with hexoprenaline when used for intrauterine resuscitation of intrapartum fetal distress. STUDY DESIGN Women in labour with acute intrapartum fetal distress detected by cardiotocography were randomly assigned to receive intravenous atosiban or hexoprenaline. SETTING Department of Obstetrics and Gynecology, Karl Franzens University of Graz and General Hospital Graz, Austria. POPULATION OR SAMPLE One thousand and four hundred and thirty-one women with singleton pregnancy at term and cephalic presentation were enrolled in the study during October 2000 and May 2001. METHODS A prospective, randomised, pilot study with no a priori sample size calculation. MAIN OUTCOME MEASURE Efficacy of treatment for stopping uterine contractions and the resumption of contractions determined by fetal heart rate monitoring. RESULTS Tocolysis was achieved in 92% (12/13) of the women receiving atosiban and 100% (13/13) of those receiving hexoprenaline. Maternal tachycardia developed in 1/13 women, receiving atosiban and 10/13 women hexoprenaline. Hypertension occurred in 1/13 on atosiban and 3/13 women on hexoprenaline. Palpitations were only reported by 10/13 women receiving hexoprenaline. Uterine contractions resumed after 8 minutes (+/-3) in the atosiban group and 14 minutes (+/-4) in the hexoprenaline group (P < 0.001). CONCLUSION Atosiban and hexoprenaline were similarly effective for stopping uterine contractions. Women receiving atosiban had significantly fewer adverse events than those receiving hexoprenaline. Uterine contractions resumed more promptly in the atosiban group. Considering the low incidence of mild maternal adverse events, atosiban may be an option for acute intrapartum tocolysis for fetal distress.
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Affiliation(s)
- Pedram Afschar
- Department of Obstetrics and Gynecology, Karl Franzens University of Graz, General Hospital Graz, Austria
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11
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Abstract
In twin pregnancies, the use of beta-adrenergics is associated with a significantly higher incidence of cardiovascular complications, and calcium channel blockers as well as oxytocin antagonists currently appear as first line agents. After extreme preterm delivery of the first twin and in selected patients, the birth of second twin may be delayed with a mean gain of 10-50 days. In cases of symptomatic placenta previa with mild-to-moderate bleeding, tocolytic agents may be associated with a prolongation of pregnancy and increased birth weight without significant impact on frequency or severity of bleeding. Calcium channel blockers are the drugs of choice in the event of diabetes. Indomethacin is a potent tocolytic, in particular in patients with polyhydramnios. However, it may cause oligohydramnios, premature closure of the ductus arteriosus and intrauterine fetal death when high doses are administered for a duration exceeding 48 to 72 hours, particularly beyond 32 weeks' gestation. The neonatal complications of indomethacin occur frequently. Tocolysis appears to reduce the failure rate of external cephalic version at term.
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Affiliation(s)
- L Carbillon
- Service de Gynécologie Obstétrique, Hôpital Jean-Verdier, Bondy.
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12
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Abstract
Pregnancy in the setting of pulmonary hypertension and Eisenmenger physiology is associated with a substantial maternal and fetal risk. Such patients are advised against pregnancy. We report a case of a woman with an Eisenmenger atrial septal defect diagnosed during the last trimester of pregnancy. On presentation, she was critically ill and there was evidence of fetal distress. She was emergently treated with IV epoprostenol, and her status improved. She underwent cesarean section and delivered a male infant with Apgar scores of 8 and 9. Her dyspnea improved, and she was characterized as World Health Organization functional class II on a subsequent clinical visit. Although pregnancy should be discouraged in women with Eisenmenger syndrome, we have demonstrated that IV epoprostenol successfully treated a woman with Eisenmenger syndrome diagnosed in the third trimester.
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Affiliation(s)
- Chris Geohas
- Division of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, Chicago, IL 60612, USA
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13
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Abstract
The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration. The absence of reliable predictors of fetal hydrops (FH) has led most centers to initiate treatment as soon as the diagnosis of FT has been established, although a small minority advocate nonintervention. As the primary form of pharmacological intervention, oral maternal transplacental therapy is generally preferred. Digoxin is the most common drug used to treat FT; however, effectiveness remains a point of discussion. After digoxin, sotalol seems to be the most promising agent, specifically in atrial flutter and nonhydropic supraventricular tachycardia (SVT). Flecainide is a very effective drug in the treatment of fetal SVT, although concerns about possible pro-arrhythmic effects have limited its use. Amiodarone has been described favorably, but is frequently excluded due to its poor tolerability. Verapamil is contraindicated as it may increase mortality. Conclusions on other less frequently used drugs cannot be drawn. In severely hydropic fetuses and/or therapy-resistant FT, direct fetal therapy is sometimes initiated. To minimize the number of invasive procedures, fetal intramuscular or intraperitoneal injections that provide a more sustained release are preferred. Based on these data we propose a drug protocol of sotalol 160 mg twice daily orally, increased to a maximum of 480 mg daily. Whenever sinus rhythm is not achieved, the addition of digoxin 0.25 mg three times daily is recommended, increased to a maximum of 0.5 mg three times daily. Only in SVT complicated by FH, either maternal digoxin 1 to 2mg IV in 24 hours, and subsequently 0.5 to 1 mg/day IV, or flecainide 200 to 400 mg/day orally is proposed. Initiating direct fetal therapy may follow failure of transplacental therapy.
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Affiliation(s)
- Martijn A Oudijk
- Department of Obstetrics, University Medical Center, Utrecht 3508 AB, 3584 EA, The Netherlands
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14
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Hofmeyr GJ, Kulier R. Piracetam for fetal distress in labour. Cochrane Database Syst Rev 2002:CD001064. [PMID: 11869588 DOI: 10.1002/14651858.cd001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Piracetam is thought to promote the metabolism of brain cells when they are hypoxic. It has been used to prevent adverse effects of fetal distress. OBJECTIVES The objective of this review was to assess the effects of piracetam for suspected fetal distress in labour on method of delivery and perinatal morbidity. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2001) were searched. Date of last search: September 2001. SELECTION CRITERIA Randomised trials of piracetam compared with placebo or no treatment for suspected fetal distress in labour. DATA COLLECTION AND ANALYSIS Both reviewers assessed eligibility and trial quality. MAIN RESULTS One study of 96 women was included. Piracetam compared with placebo was associated with a trend to reduced need for caesarean section (relative risk 0.57, 95% confidence interval 0.32 to 1.03). There were no statistically significant differences in relative risk between the piracetam and placebo group for neonatal morbidity (measured by neonatal respiratory distress) or Apgar score. REVIEWER'S CONCLUSIONS There is not enough evidence to evaluate the use of piracetam for fetal distress in labour.
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Affiliation(s)
- G J Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Frere/Cecilia Makiwane Hospitals, Private Bag 9047, East London 5200, Eastern Cape, South Africa.
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Schaap AH, Wolf H, Bruinse HW, Smolders-De Haas H, Van Ertbruggen I, Treffers PE. Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants. Obstet Gynecol 2001; 97:954-60. [PMID: 11384702 DOI: 10.1016/s0029-7844(01)01343-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants. METHODS This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insufficiency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26-32 weeks during the years 1984-1991. Infants who had been treated antenatally with corticosteroids more than 24 hours and less than 7 days before birth were matched by birth weight, sex, and year of birth with infants whose mothers had been admitted more than 24 hours before delivery but were not treated antenatally with steroids. The main outcome measure was survival without disability or handicap at 2 years corrected age. A sample of 60 case-control pairs would give 81% power to demonstrate 50% increase of this outcome [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire. RESULTS The study group and control group consisted of 62 infants each. Survival without disability or handicap at 2 years' corrected age was more frequent in the corticosteroid group [OR 3.2, confidence interval (CI) 1.1, 11.2]. In the long-term follow-up at school age there was a statistically significant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected. CONCLUSION Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.
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Affiliation(s)
- A H Schaap
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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16
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Abstract
Sjögren syndrome (SS), the second most common autoimmune rheumatic disease, refers to keratoconjunctivitis sicca and xerostomia resulting from immune lymphocytes that infiltrate the lacrimal and salivary glands. However, differential diagnosis remains confusing due to the high prevalence of vague symptoms of dryness, fatigue, and myalgias in the general population. The problems of diagnosis are further compounded by the finding of "positive" antinuclear antibodies in a high percent of the general population. Unless minor salivary gland biopsies are read by experienced observers, nonspecific changes of sialadenitis are frequently confused with the focal lymphocytic infiltrates that are characteristic of SS. The distinction between fibromyalgia patients with low titer antinuclear antibodies and primary SS remains difficult. Even in patients fulfilling strict criteria for SS, the genomic search for critical genes has proven difficult due to the multigenic pattern of inheritance and strong role of currently undefined environmental factors. No single environmental factor has been detected in the majority of SS patients. SS-like syndrome has been detected in certain patients with HTLV-1 and hepatitis C infection, providing clues to pathogenesis. Even in SS patients with marked sicca symptoms, minor salivary gland biopsy shows that almost 50% of glandular cells are still detected on biopsy. These results imply the importance of immune factors such as cytokines and autoantibodies in decreasing neuro-secretory circuits and induction of glandular dysfunction. Of potential importance, an antibody against muscarinic M3 receptor that can decrease secretory function when injected into rodents is frequently found in the sera of SS patients. Newly developed topical and oral therapies can ease the oral and ocular dryness. Orally administered agonists of the muscarinic M3 receptor (pilocarpine and cevimeline) have recently been approved by the US Food and Drug Administration to increase salivary secretion. Topical ocular use of low-dose corticosteroids or cyclosporin may decrease conjunctival surface inflammation. In a Phase II double-blind study, orally administered interferon alpha (150 U) led to improved saliva flow and symptoms. In pregnant patients with evidence of fetal distress, oral dexamethasone is preferred because this agent crosses the placenta effectively. In animal models, antagonists of tumor necrosis factor and inhibitors of de novo pyrimidine synthesis appear promising.
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Affiliation(s)
- R I Fox
- Allergy and Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, California 92037, USA.
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17
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Abstract
BACKGROUND Prophylactic tocolysis with betamimetics and other agents has become widespread as a treatment for fetal distress. Uterine relaxation may improve placental blood flow and therefore fetal oxygenation. However there may also be adverse maternal cardiovascular effects. OBJECTIVES The objective of this review was to assess the effects of tocolytic therapy for suspected fetal distress on fetal, maternal and perinatal outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: February 1999. SELECTION CRITERIA Randomised trials comparing tocolytic therapy with no treatment or treatment with another tocolytic agent for suspected fetal distress. DATA COLLECTION AND ANALYSIS Two reviewers assessed trial quality and extracted data. MAIN RESULTS Three studies were included. Compared with no treatment, there were fewer failed improvements in fetal heart rate abnormalities with tocolytic therapy (relative risk 0.26, 95% 0.13 to 0.53). Betamimetic therapy compared with magnesium sulphate showed a non-significant trend towards reduced uterine activity (relative risk 0.07, 95% confidence interval 0.00 to 1.10). REVIEWER'S CONCLUSIONS Betamimetic therapy appears to be able to reduce the number of fetal heart rate abnormalities and perhaps reduce uterine activity. However there is not enough evidence based on clinically important outcomes to evaluate the use of betamimetics for suspected fetal distress.
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Affiliation(s)
- R Kulier
- Departement de Gynecologie et d'Obstetrique, Hopitaux Universitaires de Geneve, Boulevard de la Cluse 32, Geneve 14, Switzerland, 1211.
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18
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Abstract
OBJECTIVE Intrapartum fetal distress is an obstetric emergency traditionally managed by immediate delivery by either the vaginal route or cesarean section. However, there is usually time to attempt intrauterine resuscitation. The purpose of this study was to report the utilization of magnesium sulfate for intrauterine resuscitation. METHOD Twenty-one fetuses received magnesium sulfate 4-g intravenous bolus in mothers awaiting cesarean section for fetal distress in the labor room of the Complejo Hospitalario Metropolitano de la Caja de Seguro Social de Panamá, from March through August 1997. Fetal distress in labor was defined as the presence of repetitive late decelerations, persistent loss of baseline variability, severe variable decelerations, or bradycardia. RESULTS Twenty-one fetuses received magnesium sulfate 4-g intravenous bolus in mothers awaiting cesarean section for fetal distress. Uterine activity ceased in seven patients, diminished in 13 patients and did not change in one. In all cases, but one, there was recovery of the FHR within 4 min; furthermore there was rose reactive of FHR in nine patients. The 1-min Apgar scores were 7 or above in 18 cases and the 5-min Apgar scores were 7 or above in 20 patients. CONCLUSIONS In summary, magnesium sulfate may be useful in the management of acute intrapartum fetal distress when there is evidence of increased uterine activity.
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Affiliation(s)
- P Vigil-De Gracia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Metropolitano de la Caja de Seguro Social, Panama City, Panama
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19
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Li X, Zhuang Y, Chang C. [Effect of Salvia Miltiorrhiza injection on umbilical artery hemodynamics during fetal distress in ewe]. Zhongguo Zhong Xi Yi Jie He Za Zhi 1998; 18:543-5. [PMID: 11475732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To study the effect of Salvia Miltiorrhiza injection (SMI) on umbilical artery hemodynamics during fetal distress in ewe. METHODS Intrauterine surgery were performed at 116-125 gestational days in 3 pregnancy sheep for insertion of vascular catheters at abdominal aorta from femoral artery and for implantation of a electromagnetic flowmetre probe around umbilical artery. Gelatin microsphere injection to abdominal aorta through vascular catheter for obstruction of placental-fetal circulation. 2 ml of SMI was used 6 times(2 times each sheep), and the signs of umbilical artery blood flow and wave forms of fetal abdominal aorta blood pressure were recorded before and after injections of gelatin microsphere or SMI. The fast Fourier translation (FFT) was used to turn signs in time domain into powers spectral of input impedance in frequency domain for resistance and characteristic impedance of umbilical artery. RESULTS After the SMI was injected into fetal abdominal aorta, the resistance of umbilical artery was significantly reduced (P < 0.05), and the changes of resistance was significantly relative with the resistance before SMI injected (r = -0.85, P < 0.001). But there were no significantly different impedance between before and after SMI treatment (P > 0.05). CONCLUSIONS The SMI to fetal abdominal aorta can decrease umbilical artery blood flow resistance and the changes of resistance was significantly relative to that before SMI treatment.
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Affiliation(s)
- X Li
- Hospital of Obstetrics and Gynecology, Shanghai Medical University, Shanghai 200011
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20
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Jaeggi E, Fouron JC, Fournier A, van Doesburg N, Drblik SP, Proulx F. Ventriculo-atrial time interval measured on M mode echocardiography: a determining element in diagnosis, treatment, and prognosis of fetal supraventricular tachycardia. Heart 1998; 79:582-7. [PMID: 10078085 PMCID: PMC1728734 DOI: 10.1136/hrt.79.6.582] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether M mode echocardiography can differentiate fetal supraventricular tachycardia according to the ventriculo-atrial (VA) time interval, and if the resulting division into short and long VA intervals holds any relation with clinical presentation, management, and fetal outcome. DESIGN Retrospective case series. SUBJECTS 23 fetuses with supraventricular tachycardia. MAIN OUTCOME MEASURES A systematic review of the M mode echocardiograms (for VA and atrioventricular (AV) interval measurements), clinical profile, and final outcome. RESULTS 19 fetuses (82.6%) had supraventricular tachycardia of the short VA type (mean (SD) VA/AV ratio 0.34 (0.16); heart rate 231 (29) beats/min). Tachycardia was sustained in six and intermittent in 13. Hydrops was present in three (15.7%). Digoxin, the first drug given in 14, failed to control tachycardia in five. Three of these then received sotalol and converted to sinus rhythm. All fetuses of this group survived. Postnatally, supraventricular tachycardia recurred in three, two having Wolff-Parkinson-White syndrome. Four fetuses (17.4%) had long VA tachycardia (VA/AV ratio 3.89 (0.82); heart rate 226 (10) beats/min). Initial treatment with digoxin was ineffective in all, but sotalol was effective in two. Heart failure caused fetal death in one and premature delivery in one. All three surviving fetuses had recurrences of supraventricular tachycardia after birth: two had the permanent form of junctional reciprocating tachycardia and one had atrial ectopic tachycardia. CONCLUSIONS Careful measurement of ventriculo-atrial intervals on fetal M mode echocardiography can be used to distinguish short from long VA supraventricular tachycardia and may be helpful in optimising management. Digoxin, when indicated, may remain the drug of choice in the short VA type but appears ineffective in the long VA type.
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Affiliation(s)
- E Jaeggi
- Department of Paediatrics, Sainte-Justine Hospital, University of Montreal, Côte Ste Catherine, Quebec, Canada
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21
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22
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Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79:576-81. [PMID: 10078084 PMCID: PMC1728723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To review the management and outcome of fetal tachycardia, and to determine the problems encountered with various treatment protocols. STUDY DESIGN Retrospective analysis. SUBJECTS 127 consecutive fetuses with a tachycardia presenting between 1980 and 1996 to a single tertiary centre for fetal cardiology. The median gestational age at presentation was 32 weeks (range 18 to 42). RESULTS 105 fetuses had a supraventricular tachycardia and 22 had atrial flutter. Overall, 52 fetuses were hydropic and 75 non-hydropic. Prenatal control of the tachycardia was achieved in 83% of treated non-hydropic fetuses compared with 66% of the treated hydropic fetuses. Digoxin monotherapy converted most (62%) of the treated non-hydropic fetuses, and 96% survived through the neonatal period. First line drug treatment for hydropic fetuses was more diverse, including digoxin (n = 5), digoxin plus verapamil (n = 14), and flecainide (n = 27). The response rates to these drugs were 20%, 57%, and 59%, respectively, confirming that digoxin monotherapy is a poor choice for the hydropic fetus. Response to flecainide was faster than to the other drugs. Direct fetal treatment was used in four fetuses, of whom two survived. Overall, 73% (n = 38) of the hydropic fetuses survived. Postnatally, 4% of the non-hydropic group had ECG evidence of pre-excitation, compared with 16% of the hydropic group; 57% of non-hydropic fetuses were treated with long term anti-arrhythmics compared with 79% of hydropic fetuses. CONCLUSIONS Non-hydropic fetuses with tachycardias have a very good prognosis with transplacental treatment. Most arrhythmias associated with fetal hydrops can be controlled with transplacental treatment, but the mortality in this group is 27%. At present, there is no ideal treatment protocol for these fetuses and a large prospective multicentre trial is required to optimise treatment of both hydropic and non-hydropic fetuses.
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Affiliation(s)
- J M Simpson
- Department of Fetal Cardiology, Guy's Hospital, London, UK
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23
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Brown CE. Intrapartal tocolysis: an option for acute intrapartal fetal crisis. J Obstet Gynecol Neonatal Nurs 1998; 27:257-61. [PMID: 9620817 DOI: 10.1111/j.1552-6909.1998.tb02647.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Tocolytic drugs are commonly used by the obstetric community to produce uterine quiescence in premature labor. The use of tocolytic agents has been expanded to intrapartal emergencies. Intrapartal tocolysis has implications for obstetric nurses, which include possession of knowledge of the pharmacologic and physiologic effects of these drugs. Intrapartal tocolysis offers a beneficial management strategy that can be used in an acute intrapartal fetal crisis. The use of tocolytics provides valuable time for the health care team to assess the etiology of a nonreassuring fetal heart rate pattern, increase options for the birth, and mobilize resources for delivery.
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Affiliation(s)
- C E Brown
- School of Nursing, West Virginia University, Morgantown 26506-9620, USA
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24
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Mercier FJ, Dounas M, Bouaziz H, Lhuissier C, Benhamou D. Intravenous nitroglycerin to relieve intrapartum fetal distress related to uterine hyperactivity: a prospective observational study. Anesth Analg 1997; 84:1117-20. [PMID: 9141942 DOI: 10.1097/00000539-199705000-00030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
During a 1-yr period, we evaluated prospectively the use of nitroglycerin (NTG) to relieve severe intrapartum fetal distress related to uterine hyperactivity. Sixty to ninety micrograms of NTG were injected intravenously (i.v.) within 2-5 min after onset of severe fetal distress after oxygen administration, left lateral decubitus, and discontinuation of any ongoing oxytocin infusion (62%) had failed to resolve the fetal heart rate abnormality. A second dose (60 or 90 micrograms) was used 2-3 min later as required. NTG was completely effective in 22 cases (fetal distress resolution within 4-5 min with restoration of normal uterine activity) and partially but sufficiently effective in the remaining 2 cases (fetal distress resolution within 4-5 min with residual mild uterine hyperactivity). However, a second dose was required for nine parturients (38%). Six parturients (25%) developed hypotension 2 min after the first NTG injection, with a mean nadir of 93.2 mm Hg (minimum 85 mm Hg). Hypotension was always rapidly reversed with a small single dose of ephedrine (4.5-6 mg). In conclusion, we found small doses (60-180 micrograms) of IV NTG to be associated with resolution of severe fetal distress related to uterine hyperactivity along with negligible side effects.
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Affiliation(s)
- F J Mercier
- Département d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Clamart, France
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25
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Abstract
The objective of the study was to investigate if a single dose of Hexoprenaline administered to patients diagnosed as having fetal distress improves neonatal outcome and whether there are any side effects and complications related to hexoprenaline injection. Patients with fetal distress diagnosed by electronic fetal heart rate monitoring with a gestational age of 35 weeks or more in active labor were eligible. Once the decision to deliver the patient by Cesarean section was made, patients were approached and randomised by sealed opaque envelopes to hexoprenaline or control groups. Ten micrograms of hexoprenaline were administered intravenously to study patients. Main outcomes were cord blood gas values, Apgar scores, the need for resuscitation and admission to intensive care. There were no statistically significant differences in the main outcome measures between the two groups. Fewer babies in the hexoprenaline group had a pH of < 7.2 and a base excess of < -10, but this was not statistically significant. The fetal heart rate pattern was improved in significantly more patients after hexoprenaline administration than controls. In conclusion, despite the statistically significant improvement in fetal heart rate tracings, Apgar scores and blood gas values showed only a trend towards improvement in the hexoprenaline group.
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Affiliation(s)
- R Kulier
- Department of Obstetrics and Gynecology, Coronation/JG Strijdom, Johannesburg, South Africa
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26
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Abstract
The effect of phenobarbital on cerebral blood flow (CBF) was investigated by the intravenous Xenon133 clearance technique in seven term newborn infants with signs of mild to moderate hypoxic ischaemic encephalopathy, all on sustained spontaneous ventilation. Phenobarbital treatment had no significant effect on CBF 60 min after loading dosage (20 mg/kg i.v.). Likewise, no significant change in mean arterial blood pressure, heart rate or transcutaneous gas tensions was observed. Though slight changes in CBF of short duration cannot be excluded, conventional dosage of phenobarbital to term newborn infants with foetal distress apparently imposes no risk of cerebrovascular damage.
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Affiliation(s)
- K Andersen
- Department of Paediatrics, Alborg Hospital, Denmark
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27
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Abstract
Amnioinfusion is a commonly practiced technique used for intrapartum improvement of the fetal condition. Room temperature normal saline (0.9 per cent) infused through an intrauterine pressure catheter has been used to alleviate variable decelerations, dilute thick meconium, and improve the intrauterine environment. Randomized studies comparing amnioinfusion to no therapy have shown that amnioinfusion is associated with lower cesarean delivery rates, decreased numbers of operative deliveries, and improved umbilical artery and venous blood gas values. Amnioinfusion also has been suggested as means to instill antibiotics into an infected uterine cavity, or the uterine cavity of a woman with preterm premature rupture of the membranes. Transabdominal amnioinfusion may be used to improved prenatal ultrasound evaluation in pregnancies associated with oligohydramnios. Complications of amnioinfusion include umbilical cord prolapse, uterine overdistention, fetal bradycardia, and one report of possible amniotic fluid embolism. Overall, amnioinfusion seems to be a safe and effective technique to improve the intrauterine milieu.
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Affiliation(s)
- L N Lameier
- UNC School of Medicine, Department of Obstetrics and Gynecology, Chapel Hill 27599-7570
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28
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Zhang CL. [Prospective study of intrauterine fetal resuscitation with aminophylline]. Zhonghua Fu Chan Ke Za Zhi 1992; 27:76-9, 123-4. [PMID: 1395889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
80 cases of fetal distress were divided at random into group A and B. Group A was treated with the traditional three drugs combination treatment. Group B was treated with intravenous injection of aminophylline slowly. FHR CTG and BPS were monitored and analysed. The results were as follows: (1) The differences before and after treatment in group B were significant. (2) Only FHR in group A showed difference before and after treatment. (3) The changes after treatment between group A and B were significant. These suggested that the effect of aminophylline on intrauterine fetal resuscitation is better method.
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29
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Affiliation(s)
- C V Smith
- University of Nebraska College of Medicine, Omaha
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30
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Abstract
Human and animal studies have demonstrated an association between decreased amniotic fluid and the occurrence of variable decelerations in the fetal heart rate. Amnioinfusion is a new investigational technique directed at decreasing the number and severity of variable decelerations by infusion of a normal saline solution into the uterine cavity. The technique may provide a mechanism for protecting the umbilical cord from compression and, thereby, ameliorating fetal distress. This article describes amnioinfusion and discusses related nursing implications for patients undergoing the procedure.
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Affiliation(s)
- K L Haubrich
- Miami University, Department of Nursing, Hamilton, OH 45011
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31
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Burke MS, Porreco RP, Day D, Watson JD, Haverkamp AD, Orleans M, Luckey D. Intrauterine resuscitation with tocolysis. An alternate month clinical trial. J Perinatol 1989; 9:296-300. [PMID: 2681580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Fifty patients were compared for the purpose of investigating the usefulness of intrauterine resuscitation with tocolysis (IURT). Terbutaline was given, as an intravenous bolus, to 31 women in labor in whom fetal distress was diagnosed and urgent delivery by cesarean section was indicated. In alternate months, a control group of 19 women with similar diagnoses was urgently delivered after standard interventions such as maternal positioning, oxygen administration, hydration, and discontinuation of oxytocin. Improvement in perinatal outcome was shown in infants after IURT. Apgar scores were less than 7 in 42% of the study group and in 71% of the control group at 1 minute (P = .04). Five-minute Apgar scores less than 7 occurred in 7% of the study group and 24% of the control group. A low venous pH was seen in 55% of the control group compared with 29% of the infants resuscitated with terbutaline. Estimated maternal blood loss and hematocrit change was not different in the two groups. Maternal blood pressure and pulse changes following IURT were modest and of doubtful significance. We conclude that intravenous terbutaline administered as a bolus injection at the time of fetal distress in labor improves infant outcome as evidenced by more vigorous Apgar scores and less acidemia without significant adverse physiologic effects on the mother.
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Affiliation(s)
- M S Burke
- Department of Obstetrics and Gynecology, Denver General Hospital, CO
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32
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Greenspoon JS, Buchanan D. Fetal distress associated with the anticardiolipin antibody and a history of intrauterine fetal demise. A case report. J Reprod Med 1989; 34:311-4. [PMID: 2715994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A woman with a history of fetal demise, an elevated anticardiolipin antibody titer, lupus anticoagulant but no evidence of systemic lupus erythematosus received anticoagulation with heparin in adjusted subcutaneous doses. Daily fetal monitoring demonstrated reactive nonstress tests and normal biophysical profiles initially. At 30 weeks' gestation, however, repeated spontaneous decelerations developed, and fetal bradycardia necessitated delivery. The combination of a poor obstetric history and the presence of high cardiolipin antibody titers requires close fetal surveillance. The benefits of anticoagulation in this setting deserve further study.
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Affiliation(s)
- J S Greenspoon
- Department of Obstetrics and Gynecology, University of Southern California School of Medicine
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33
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Abstract
beta 2-Sympathomimetics have been used in acute intrapartum fetal distress to abolish uterine contractions and thus enable the fetal metabolism to recover before delivery. Because some serious complications were reported when a terbutaline intravenous bolus (0.25 mg) was used as a tocolytic, we assessed its safety and efficacy when used in patients not affected by cardiovascular disease, tachycardia greater than 100 beats/min, thyrotoxicosis, fluid overload, corticoids, atropine, or severe abruptio placentae. No maternal or fetal complications occurred in the 36 patients studied; a well-tolerated tachycardia developed in most patients. Fetal heart rate tracings and pH improved in 32 patients. Thirty-four neonates were delivered in good clinical and metabolic condition. We conclude that terbutaline intravenous bolus 0.25 mg is a safe and efficacious procedure when the proper indications and contraindications are followed.
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Affiliation(s)
- A Shekarloo
- Department of Obstetrics and Gynecology, Chicago Medical School, University of Health Sciences, IL
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34
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Platt MP, Anand KJ, Aynsley-Green A. The ontogeny of the metabolic and endocrine stress response in the human fetus, neonate and child. Intensive Care Med 1989; 15 Suppl 1:S44-5. [PMID: 2723248 DOI: 10.1007/bf00260885] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Evidence of an endocrine and metabolic response to stress is evident from the mid trimester of fetal life. The ontogeny of this response is seen in the different patterns of response evident in the fetus, neonate, infant and child. These data raise important issues concerning the management of pain and stress in early life.
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Affiliation(s)
- M P Platt
- Department of Child Health, University of Newcastle upon Tyne, Medical School, UK
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35
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Moise KJ, Carpenter RJ. Methylergonovine-induced hypertonus in term pregnancy. A case report. J Reprod Med 1988; 33:771-3. [PMID: 3172085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The administration of methylergonovine maleate to a patient at term is rare. A patient received the drug at 36 weeks' gestation, with subsequent development of fetal distress secondary to uterine tetany. Treatment with terbutaline and magnesium sulfate was unsuccessful in alleviating the uterine hypertonus, necessitating cesarean section.
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Affiliation(s)
- K J Moise
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030
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36
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Weissman A, Zimmer EZ. Fetal resuscitation with ritodrine during maternal seizures in labor. A case report. J Reprod Med 1988; 33:731-2. [PMID: 3139876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Uterine hypertonia with severe fetal distress occurred during maternal seizures in labor. The administration of ritodrine resulted in quick relaxation of the uterus and recovery of the compromised fetus.
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Affiliation(s)
- A Weissman
- Department of Obstetrics and Gynecology B, Rambam Medical Center, Faculty of Medicine, Haifa, Israel
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37
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Abstract
A randomized study on the effect of terbutaline on fetal distress was carried out in 20 patients who showed evidence of ominous fetal heart rate patterns and fetal scalp blood pH values of less than 7.25. Of those, 11 received terbutaline (study group) and nine did not (control group). There was a significant improvement in the acid-base status of the fetus in the study group compared with those in the control group (p less than 0.01). No significant maternal or fetal morbidity occurred in the study group. Apgar scores at 1 minute were 7 or greater in 10 of the 11 study subjects whereas only four of the nine control subjects had a score of 7 or greater. These results suggest that terbutaline may become a useful agent in the treatment of intrauterine fetal distress.
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38
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Abstract
Patients with a diagnosis of severe intrapartum fetal distress by fetal heart rate and capillary blood pH monitoring received beta 2-sympathomimetics to inhibit uterine contractions (tocolysis) while the obstetric team was preparing to deliver the fetus. Fetal heart rate and acidosis significantly improved after tocolysis; these fetuses were subsequently delivered in very good metabolic and clinical condition. The favorable effect of tocolysis on fetal homeostasis is attributed to the suppression of the ischemic effect of contractions on the placental circulation. The few fetuses having an extremely compromised placental function showed no improvement in heart rate or acidosis with tocolysis and were immediately delivered. Considering the mild side effects observed, the lack of maternal complications, and the remarkable perinatal outcome obtained, we recommend using tocolysis before delivering distressed fetuses.
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39
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Lipshitz J, Shaver DC, Anderson GD. Hexoprenaline tocolysis for intrapartum fetal distress and acidosis. J Reprod Med 1986; 31:1023-6. [PMID: 3100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hexoprenaline, a selective beta 2-sympathomimetic drug, was administered to 12 patients with severe distress in labor. The fetal distress was documented by fetal heart rate abnormalities in association with a fetal scalp blood pH of less than 7.20. The mean fetal scalp pH was 7.17 +/- 0.17 before treatment. A 7.5- to 10-micrograms intravenous bolus of hexoprenaline was followed by an intravenous infusion titrated to inhibit uterine contractions. According to protocol, all patients delivered by cesarean section approximately 40 minutes after the bolus injection. The mean cord blood pH was 7.31 +/- 0.06. No infant had a five-minute Apgar score of less than 8, and there were no significant maternal or fetal side effects.
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Lipshitz J, Klose CW. Use of tocolytic drugs to reverse oxytocin-induced uterine hypertonus and fetal distress. Obstet Gynecol 1985; 66:16S-18S. [PMID: 2862618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The use of oxytocin in labor has the inherent danger of producing uterine hyperstimulation with resultant fetal distress. When produced by gradual titration of intravenous oxytocin, discontinuation of the medication is usually sufficient to reverse the process. However, the rapid administration of a large intravenous dose of oxytocin, as occurred in this patient, may result in hypertonic uterine contractions and fetal distress unresponsive to traditional measures. The rationale for using a tocolytic drug to reverse the uterine hypertonus, produce intrauterine fetal resuscitation, and prevent cesarean section is discussed in this report.
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Caritis SN, Lin LS, Wong LK. Evaluation of the pharmacodynamics and pharmacokinetics of ritodrine when administered as a loading dose. On establishing a potentially useful drug administration regimen in cases of fetal distress. Am J Obstet Gynecol 1985; 152:1026-31. [PMID: 4025448 DOI: 10.1016/0002-9378(85)90552-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Inhibition of labor during the intrapartum period has been suggested as a method of managing acute fetal distress. In such cases, rapid tocolysis is desirable but, in high doses, beta-adrenergic-receptor agonists, such as ritodrine, may cause severe maternal hypotension that could aggravate the existing fetal distress. We undertook the present study to establish a safe infusion protocol for ritodrine that achieves high plasma concentration rapidly. Twelve nonpregnant female volunteers received, on separate days, three infusions of ritodrine, that is, 1, 2, and 3 mg, during a 2-minute period. The peak plasma concentration measured by high-performance liquid chromatography with electrochemical detection averaged 37, 74, and 100 ng/ml after the 1, 2, and 3 mg doses, respectively. Ritodrine concentrations decreased rapidly and with the 3 mg dose the ritodrine concentration was only 14 ng/ml after 15 minutes. The elimination phase half-life of ritodrine averaged 6.11 hours. None of the doses significantly affected systolic blood pressure but ritodrine increased heart rate and the plasma glucose level and decreased diastolic blood pressure and the plasma potassium concentration. Even at the highest infusion rate, the maximal changes in cardiovascular and metabolic variables were short-lived and clinically modest; heart rate increased 29 bpm, diastolic blood pressure decreased 8 mm Hg, glucose level increased 26 mg/dl, and potassium concentration decreased 0.6 mEq/L. These data indicate that high plasma concentrations of ritodrine can be achieved rapidly without serious side effects.
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Tejani NA, Verma UL, Chatterjee S, Mittelmann S. Terbutaline in the management of acute intrapartum fetal acidosis. J Reprod Med 1983; 28:857-61. [PMID: 6663586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A beta 2-mimetic agent, terbutaline, was used before full cervical dilatation in 10 of 18 cases of fetal distress evidenced by fetal scalp blood pH (FSB-pH) less than 7.25. A reduction in uterine activity with an improvement in the fetal heart rate trace was seen in all the cases. In addition, a significant improvement in FSB-pH, when compared with umbilical artery pH (p less than 0.05), was noted whereas there was no significant change in the untreated cases. An Apgar score of less than or equal to 6 at five minutes occurred in two of eight untreated patients but not in any treated patients.
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Tocolytics. Eur J Obstet Gynecol Reprod Biol 1983; 15:395-408. [PMID: 6137424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
A double-blind study was performed on ninety-six parturients of the Lima Maternity Hospital, Peru, with some evidence of foetal distress who were given indistinguishably piracetam or a placebo at random in order to investigate the effects of the drug on the foetus. The conditions of the new-born babies who had received piracetam were superior to those of the babies treated with the placebo, as evaluated with the Apgar at 1, 5 and 10 minutes after birth and on the basis of the neurological and clinical examination as from 24 hours until they were released. In addition, the reduction of the duration of the labour in the patients treated with piracetam as compared with the control group was obvious.
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Gummerus M. [Subpartal tocolysis in fetal distress situations]. Z Geburtshilfe Perinatol 1982; 186:249-55. [PMID: 6891154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
43 patients in 31-42 weeks of gestation showed fetal distress confirmed by fetal scalp blood measurements and/or cardiotocography. In addition to conventional treatment of intrapartum fetal distress a beta-adrenergic receptor stimulator, fenoterol was given, 1. as iv. bolus of 25 micrograms in two min. 2. iv. bolus of 25 micrograms + iv. infusion of 3-4 micrograms/min or 3. iv. infusion of 3-4 micrograms/min. The suppression of labor was sufficient in 88 per cent and the improvement of fetal condition allowed the avoidance of an emergency operation in 84 per cent. The diagnosis was confirmed in addition to CTG, by fetal scalp blood pH measurements in 65 per cent of cases. The fetal blood pH was 7,20 and BE - 8,77 before therapy, after tocolytic therapy pH 7,23 and BE - 7,53 and in umbilical cord arterial blood pH 7,21 and BE - 12,12. Apgar scores at 1' and 5' averaged 8,0 and 9,1.
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Abstract
The potential value of a bolus injection of ritodrine in the management of fetal distress was examined in 24 patients. Following the injection of ritodrine, uterine activity measured over a period of 14.7 +/- 6.3 (SD) min was reduced to 22 (+/- 12.4 SD)% of the pre-existing values. The cardiotocographic tracings showed a reversion to a normal or less ominous pattern in 14 of the 16 patients where this could be evaluated. The infants in the ritodrine group took less time to establish regular respirations. The perinatal neurobehaviour in the ritodrine and control groups did not differ. Two mothers who were given ritodrine and who received atropine premedication developed tachycardia and marked systolic hypertension. The administration of a bolus of ritodrine may have a place in the management of fetal distress when caesarean section is unavoidably delayed, but atropine premedication must be avoided as the combination can lead to potentially serious cardiovascular complications.
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Abstract
In this prospective study we evaluate the role of serum bile acids in the investigation and management of cholestasis of pregnancy in a detailed study of 18 patients. Bile acids were the most sensitive diagnostic test. The increased incidence of fetal distress (33.3% in this series) and meconium-stained fluid (58.3%) did not correlate with very high values of bile acids in maternal serum, umbilical cord serum, or amniotic fluid. Treatment of pruritus with cholestyramine and/or phenobarbital is ineffective in this condition, induction of labor is suggested once fetal lung maturity is established.
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