Manejo de Disminución de Movimientos Fetales en pacientes del Área de Urgencias Obstétricas / Management of Decreased Fetal Movements in patients in the Obstetric Emergency Area

Los movimientos fetales son uno de los primeros signos de vitalidad fetal. Durante la gestación, éstos van apareciendo progresivamente. La adecuada adquisición y mantenimiento de los mismos durante la gestación indica un correcto desarrollo neuromuscular, así como de bienestar fetal1. La percepción materna de una Disminución de los Movimientos Fetales (DMF) constituye un motivo de consulta frecuente en los Servicios de Urgencias Obstétricas; toda paciente embarazada debe vigilar los movimientos fetales, mediante un conteo subjetivo de los movimientos del feto, a partir de las 24 semanas de gestación. La DMF constituye el 5 ­ 15% de motivos de consulta en los servicios de Urgencias en el tercer trimestre del embarazo. Hasta un 25% de fetos que presentan una DMF presentarán alguna complicación perinatal (malformaciones, retraso de crecimiento, parto prematuro, hemorragia fetomaterna, y éxitus fetal) incluso en población de bajo riesgo. El manejo inadecuado de la DMF representa un 10-15% de las muertes evitables a término1-3. Es por esto que ninguna paciente que consulte por Disminución de Movimientos Fetales debe ser dada de alta sin asegurarse del adecuado bienestar fetal.

Fetal movements are one of the first signs of fetal vitality. During gestation, they appear progressively. Adequate acquisition and maintenance of fetal movements during gestation indicates correct neuromuscular development, as well as fetal well-being1. Maternal perception of decreased fetal movements (DMP) is a frequent reason for consultation in Obstetric Emergency Departments; every pregnant patient should monitor fetal movements by subjectively counting fetal movements, starting at 24 weeks of gestation. FMD constitutes 5-15% of the reasons for consultation in the emergency department in the third trimester of pregnancy. Up to 25% of fetuses with FMD will present some perinatal complication (malformations, growth retardation, premature delivery, fetomaternal hemorrhage, and fetal death) even in low-risk populations. Inadequate management of FMD accounts for 10-15% of preventable deaths at term1-3. This is why no patient who consults for decreased fetal movements should be discharged without ensuring adequate fetal well-being.

Monitoring of birth defects in perinatal infants born during 2015-2019 in Huainan City, Anhui Province / 中国基层医药

Objective:To analyze birth defects in perinatal infants in Huainan city, Anhui province.Methods:The data of perinatal infants with birth defects born during 2015-2019 who were monitored in nine national and provincial birth defect monitoring hospitals in Huainan City were collected. The changes in birth defects, the incidence of birth defects in infants ≥ 28 weeks, urban and rural area distribution of birth defects, type of defects, and the related factors of birth defects during a 5-year study period were analyzed.Results:A total of 90 466 perinatal infants with the incidence of birth defects of 89.87/10 000 were monitored during 2015-2019. The incidence of birth defects in Anhui Province was 139.74/10 000. The proportion of preterm infants < 28 weeks with birth defects among full-term births with birth defects was 30.93% and the proportion increased year by year during 2015-2019, with the proportion of 14.84%, 31.69%, 34.83%, 32.84% and 34.02% respectively. The top five birth defects detected during 2015-2019 were multiple fingers (toes) ( n = 189, 20.89/10 000), cleft lip ( n = 96, 10.61/10 000), external ear deformity ( n = 79, 8.73/10 000), congenital heart disease ( n = 65, 7.19/10 000) and syndactyly ( n = 40, 4.42/10 000). The incidence of birth defects in males and females was 102.77/10 000 and 85.28/10 000, respectively. The incidence of birth defects in urban and rural areas were 107.38/10 000 and 79.60/10 000, respectively. Conclusion:The incidence of birth defects in preterm infants < 28 weeks in Huainan City was lower than that in the whole Anhui Province. The incidence of birth defects in Huainan City differed in different years. The incidence of birth defects in males was higher than that in females. From 2016, the incidence of birth defects in urban area was higher than that in rural area. Birth defects mainly consisted of multiple fingers (toes), external ear deformity, congenital heart disease, cleft lip and syndactyly. The detection rate of birth defects in preterm (< 28 weeks) patients was increased year by year. Early intervention effectively decreased the incidence of birth defects and improved the quality of the population in Huainan City.

A rare case of fetus papyraceous presenting in monozygotic biamniotic twins

Fetus papyraceous or compresses is characteristic of compressed mummified, parchment like remains of dead twin retained in utero after intrauterine death in the second trimester. It is an uncommon finding and we report in a G2P1L1 with 22 weeks with Monozygoticbiamniotic twins with fetus papyraceous stuck to left upper segment followed up to 36 weeks. The mother was advised regular antenatal visits and frequent feto-maternal monitoring was done. Patient delivered a single live baby and a placenta with mummified fetus within it. The incidence of fetus papyraceous is about 1 in 17000 to 1 in 20000 pregnancies. Early diagnosis of this condition helps in monitoring the surviving fetus.

Hemoperitoneo secundario a la ruptura espontánea de una variz uterina en una paciente con embarazo a término: reporte de un caso y revisión bibliográfica / Hemoperitoneum secondary to spontaneous rupture of a uterine varice in a patient with a full-term pregnancy: A case report and literature review

Resumen: ANTECEDENTES: La ruptura de una variz útero-ovárica durante el embarazo es un evento poco frecuente, pero con importantes implicaciones en la morbilidad y mortalidad materna y neonatal. Puede acontecer en cualquier momento del embarazo, aunque su frecuencia se incrementa en el tercer trimestre y durante el parto. CASO CLÍNICO: Paciente de 32 años, con 39 semanas de embarazo, en control prenatal, sin contratiempos, que acudió al servicio de Urgencias debido a un dolor abdominal generalizado e intenso, de dos horas de evolución. A la exploración física se encontraron: hipotensión, taquicardia y anemia moderada; hemoglobina de 8.9 g/dL y hematócrito de 35%. La evaluación fetal reportó: taquicardia y posterior bradicardia. Se decidió finalizar el embarazo por cesárea urgente, donde se objetivó hemoperitoneo de aproximadamente 1 L y sangrado activo procedente de la ruptura de un vaso en la parte posterior de la pared uterina que se suturó con puntos dobles. El desenlace materno y neonatal fue favorable. CONCLUSIONES: La rotura de las várices útero-ováricas puede originarse por hemoperitoneo masivo y resultar en consecuencias graves para la madre y el feto. La sospecha diagnóstica y la laparotomía de urgencia son decisivas para cohibir el sangrado y lograr un desenlace materno y fetal satisfactorios.

Abstract: BACKGROUND: The rupture of an utero-ovarian varicose vein during pregnancy is an infrequent event but it can have important implications for maternal and neonatal morbidity and mortality. It can occur at any time during pregnancy, although its frequency is increased in the third trimester and during labor. CLINICAL CASE: A single gestation of 39 weeks, with regular monitoring without incidents, who went to the emergency department for intense and generalized abdominal pain of two hours of evolution. The patient presented hypotension and tachycardia and moderate anemia with a hemoglobin of 8.9 g/dL and a hematocrit of 35%. Fetal monitoring showed fetal tachycardia with decreased variability and subsequent bradycardia. It was decided to end the pregnancy by an urgent caesarean section where a hemoperitoneum of approximately 1 liter was observed. As well, and active bleeding resulting from the rupture of a posterior uterine wall vein was noted and controlled with hemostatic sutures. The maternal and neonatal results were favorable. CONCLUSIONS: Spontaneous rupture of utero-ovarian varicose veins can be the cause of massive hemoperitoneum and can maternal and fetal serious consequences. A promptly suspected diagnosis and an urgent laparotomy are vital to restrain bleeding and achieve a good maternal and fetal result.

Patterns of Admission Cardiotocography Decisions and Associated Perinatal Outcomes in a Southern Nigerian Teaching Hospital

Aims: To determine the patterns of obstetric decisions based on Cardiotocography (CTG) findings and the effect of these decisions on labour outcomes. Study Design: Retrospective observational audit. Place and Duration of Study: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo. Data were obtained from all intrapartum CTG tracings done from January 2016 to December 2018. Methodology: A consecutive sampling technique was used and the case files, delivery register and follow up records of all included CTG tracings were used to obtain maternal and perinatal data. Data were analyzed using the SPSS version 21.0. Numerical data were expressed as mean ± standard deviation (SD). The Chi-square test was used to compare categorical variables while the independent T-test was used to compare means of groups studied. Binary logistic regression was used to assess the factors related to maternal and perinatal outcomes. The level of statistical significance was be set at p-value of <0.05. Results: There were 756 deliveries, but only 436 CTGs met the inclusion criteria. The prevalence of abnormal CTG was 130/436 (29.8%); 93/436(21.3%) were suspicious while 37/436 (8.5%) were pathological. On the basis of CTG; 300/436 (68.8%) of the parturients had intermittent fetal heart tone auscultation, 100/436 (22.9%) had continuous Electronic fetal monitoring (EFM) while labour was stopped in 36/436 (8.3%). The 5th minute APGAR score did not depend on the admission CTG finding (0.55), the decision to stop or continue labour (p=0.26) or the use of continuous EFM (P=0.66). Maternal near miss (MNM) was not a consequence of the decision to stop labour (P=0.98) or the use of continuous EFM (P=0.19). The mode of delivery outcome was however a consequence of decisions to continue or stop labour (P <0.001, AOR=0.202, 95%CI=0.153-0.265). Pregnancy risk was a consistent determinant of maternal outcomes; occurrence of MNM (P <0.001, AOR=0.002, 95%CI=0.000-0.032) and mode of delivery (P <0.001, AOR=0.015, 95%CI=0.005-0.043). Conclusion: Decisions based on admission CTG was associated with a high rate of operative deliveries, without any significant effect on fetal or maternal outcomes. CTG in labour should be restricted to pregnancies adjudged as high risk based on obstetric factors and CTG should be used as an adjunctive triaging instrument.

Cirurgias intrauterinas: alternativa de intervenção para as cardiopatias congênitas / Intrauterine surgeries: intervetion alternative for congenital cardiopathies

As cardiopatias congênitas são anormalidades estruturais ou funcionais do sistema cardiovascular, advindas desde o nascimento, mesmo que diagnosticadas posteriormente. Entre as malformações congênitas, as cardiopatias são as principais causas de mortalidade infantil nos Estados Unidos e em outros países desenvolvidos. Com o intuito de reduzir os efeitos progressivos dessas patologias, a intervenção intrauterina tem se destacado como opção terapêutica diante de resultados iniciais satisfatórios. O presente artigo teve por objetivo demonstrar a evolução da cirurgia intrauterina para correção cardíaca, a partir da avaliação dos benefícios ao feto e visando a riscos mínimos e aceitáveis para a mãe. Foi realizada uma pesquisa na base de dados Publisher Medline (PubMed), Scientific Electronic Library Online (SciELO) e Biblioteca Virtual da Saúde (BVS), incluindo artigos publicados entre 2008 e 2018; além da pesquisa efetuada no Manual de Medicina Fetal da SOGIMIG ­ 2018. Os critérios de elegibilidade são amplos. São necessários equipe multidisciplinar, equipamentos sofisticados e aperfeiçoamento da técnica, dessa forma dificulta-se a realização das cirurgias. Entretanto, diante dos resultados já demonstrados, a cirurgia intrauterina apresenta-se como alternativa terapêutica promissora.(AU)

The congenital cardiopathies are structural or functional abnormalities of the cardiovascular system, originated from birth, even when previously diagnosed. Among the congenic malformations, the cardiopathies are the main causes of infant mortality in the United States and in other developed countries. In order to reduce the progressive effects of these pathologies, intrauterine intervention has been highlighted as a therapeutic option in contempt of satisfactory initial results. This article has as goal to demonstrate the evolution of the intrauterine surgery for cardiac correction, based on the evaluation of the benefits to the fetus and aiming at minimum and acceptable risks to the mother. A research was made based on the Publisher Medline (PubMed) data base, Scientific Electronic Library Online (SciELO) and Biblioteca Virtual da Saúde (BVS), including published articles between 2008 and 2018. Beyond the research made on The fetal medicine manual from SOGIMIG ­ 2018. The eligibility criteria are broad. It is necessary a multidisciplinary team, sophisticated equipments and technique improvement, therefore interfering in the performance of surgeries. However, in contempt of the already demonstrated results the intrauterine surgery presents itself as a therapeutic promising alternative.(AU)

Differences in starting points of active phase and labor duration between preterm and full-term primiparae / 中华围产医学杂志

Objective@#To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management.@*Methods@#From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36+6 weeks) and equal number of full-term primiparae (full-term group, 37 to 41+6 weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test.@*Results@#The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=-5.835; (29.9±16.8) vs (34.2±17.2) min, t=-12.637; both P<0.001] and the active phase [M (P95): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P5): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=-2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%),109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively.@*Conclusions@#Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.

A comparative study on the effect of remote fetal monitoring and traditional outpatient monitoring of high-risk pregnancy / 中国实用妇科与产科杂志

OBJECTIVE: To compare the effect of remote fetal monitoring and outpatient monitoring of high-risk pregnancy.METHODS: A total of 222 pregnant women delivered in Shengjing Hospital of China Medical University from December 2017 to December 2018（44 cases of hypertensive disorder complicating pregnancy,40 cases of gestational diabetes mellitus,22 cases of placental abnormalities,20 cases of preventive cervical cerclage,16 cases of scar uterus pregnancy,12 cases of umbilical cord around neck for 3 weeks or more,6 cases of multiple pregnancy,10 cases of twin pregnancy with one fetus dead in uterus,52 cases of patients without complications）were divided into two groups.In the observation group the fetus was monitored remotely at home,while the control group went to the hospital for fetal heart monitoring.The monitoring effect and neonatal status of the two groups were compared.RESULTS: The incidence of neonatal mild asphyxia in observation group and control group was 1.80% vs.4.50%,and there was no severe neonatal asphyxia.There was no significant difference in the incidence of premature delivery,neonatal weight or vaginal delivery rate（P>0.05）.CONCLUSION: Compared with monitoring in outpatient department,remote fetal monitoring can detect abnormalities in time and intervention can be performed,so it is equally effective for high-risk pregnancy.

Intrapartum electronic fetal heart rate monitoring / 中国实用妇科与产科杂志

Intrapartum fetal monitoring is of great importance to ensuring the safety of the fetus during labor,timely discovering the fetal hypoxia and reducing the incidence of short-term and long-term adverse outcomes of the newborn. Cardiotocography has been widely recommended for fetal monitoring during labor in the world.The clinical interpretation of it includes the definition of the basic waveform,the physiological and pathological significance of the waveform,and the management according to the cardiotocography classifications. This paper summarizes intrapartum cardiotocography based on the relevant guidelines at home and abroad in recent years.

Assessment of fetal reserve in the perinatal period / 中国实用妇科与产科杂志

It is crucial to assess the fetal reserve function and intrauterine health status before and during labor,based on antenatal high risk factors and fetal surveillance methods such as intrapartum electronic fetal monitoring and fetal scalp stimulation,which can guide clinicians to intervene in a timely and effective manner,thus avoiding adverse outcomes due to fetal hypoxia.

Differences in starting points of active phase and labor duration between preterm and full-term primiparae / 中华围产医学杂志

Objective To compare the starting points of the active phase of labor and labor duration between preterm and full-term primiparae and to provide evidence for appropriate labor management. Methods From January 2013 to December 2016, 925 preterm primiparae (preterm group, 28 to 36+6 weeks) and equal number of full-term primiparae (full-term group, 37 to 41+6 weeks) who delivered in Tianjin Central Hospital of Gynecology Obstetrics were recruited. The starting point of the active labor was defined as the cervical dilatation at the turning point on the cervical dilatation curve where changing from almost flat to the biggest slope. Differences in the starting points and labor duration between the two groups were compared. Statistical analysis was performed using two independent sample t-test, one way analysis of variance and rank-sum test. Results The duration of the first and second stages [(5.7±2.5) vs (6.8±5.2) h, t=－5.835; (29.9±16.8) vs (34.2± 17.2) min, t=－12.637; both P<0.001] and the active phase [M (P95): 1.0 (3.2) vs 1.0 (4.5) h, Z=2.017, P=0.047] of the preterm primiparae were all significantly shorter than those of the full-term primiparae, and the average cervical dilatation rate was significantly accelerated during the active period [M (P5): 6.7 (1.8) vs 5.1 (1.6) cm/h, Z=－2.676, P<0.001]. In the preterm group, women whose starting points of the active phase were at 1 cm, 2 cm, 3 cm, 4 cm, 5 cm and ≥ 6 cm of cervical dilatation were 25 (2.7%), 275 (29.7%), 258 (27.9%), 203 (21.9%), 109 (11.8%) and 55 (5.9%), respectively. While in the full-term group, women whose starting points of the active phase were at 2 cm, 3 cm, 4 cm, 5 cm, 6 cm and >6 cm of cervical dilatation were 74 (8.0%), 208 (22.5%), 287 (31.0%), 168 (18.2%), 127 (13.7%) and 61(6.6%), respectively. In the preterm group, the starting points of the active phase at cervical dilatation≤3 cm, ≤4 cm and ≤5 cm accounted for 60.3% (558/925), 82.3% (761/925) and 94.1% (870/925), respectively. In the full-term group, the percentages of the active phase starting at cervical dilatation≤4 cm, ≤5 cm and ≤6 cm were 61.5% (569/925), 79.7% (737/925) and 93.4% (864/925), respectively. Conclusions Preterm primiparae may experience shorter labor duration and an earlier start of the active phase than full-term primiparae. The routine labor progression model for full-term primiparae should not be applied to preterm primiparae.

Labor Admission Test And Neonatal Outcome

Purpose: Purpose of the study is to study the Mode of Delivery and Perinatal outcome in relation to the admission test in the study group . Method: All women in latent phase of labor were subjected to admission test with CTG machine and tracing recorded. Any complication arising during labor and the perinatal out come were recorded. Results: Incidence of fetal distress, need for operative delivery, low apgar scores, low birth weight, admission to NICU and perinatal deaths are significantly more in non reactive admission test group. Conclusion: Admission test is economical, non invasive, and readily available screening test. Non reactive patterns predicts well the incidence of perinatal complications and Neonatal mortality.

March of the partogram / 中华围产医学杂志

In 1930s, Wolf created the first partogram. In 1950s, Friedman proposed the classical model of partogram that has been applied in clinical labor assessment ever since. Over the past ten years, Zhang has made great improvement in this field. Here, we reviewed the three different stages in partogram research (the first proposed stage, Friedman's classical stage and Zhang's stage) in terms of its background, demographic characteristics and clinical application. Moreover, this article also emphasized the necessity of partogram research and discussed the prospects for future research and clinical application based on the recent progress in China.

Diagnóstico matemático del trazado de la monitoria fetal fundamentado en la relación S/k de la entropía / Mathematical diagnosis of fetal monitoring tracing based on the S/k ratio of entropy

.Objetivo: el establecimiento de la interpretación del monitoreo de la frecuencia cardiaca fetal intraparto condujo a la creación de una metodología diagnóstica fundamentada en la probabilidad y la ley de entropía, que evalúa de manera objetiva y reproducible el trazado de la monitoria fetal. El objetivo del presente estudio es confirmar la reproducibilidad y aplicabilidad clínica de dicha metodología para evaluar el trazado de la monitoria fetal normal y anormal en un contexto físicomatemático.Materiales y métodos: se tomaron 40 trazados de monitorias fetales, divididas en dos grupos, 15 de ellas eran normales y 25 evidenciaban pérdida de bienestar fetal. Se calculó la frecuencia de aparición de las frecuencias cardiacas, presentadas en intervalos discretos de tiempo, a partir de la probabilidad y relaciones S/k de la entropía. Posteriormente, se aplicó el diagnóstico matemático para hacer distinciones entre dinámicas cardiacas fetales normales de patológicas.Resultados: los valores de las proporciones S/k de los trazados de monitorias fetales evaluadas, diferenciaron monitorias cardiacas fetales normales de anormales.Conclusiones: se confirmó con el diagnóstico matemático establecido, la reproducibilidad y aplicabilidad clínica de la metodología desarrollada para la evaluación del trazado de la monitoria fetal...(AU)

Objective: the establishment of the interpretation of intrapartum fetal heart rate monitoring led to the creation of a diagnostic methodology based on probability and entropy law, which evaluates the tracing of fetal monitoring in an objective and reproducible way. The objective of the present study is to confirm the reproducibility and clinical applicability of this methodology to evaluate the tracing of normal and abnormal fetal monitoring in a physical-mathematical context. Materials and methods: there were taken 40 traces of fetal monitoring, divided into two groups, 15 of which were normal and 25 showed loss of fetal well-being. The frequency of occurrence of cardiac frequencies, presented in discrete time intervals, was calculated from the probability and S / k ratios of the entropy. Subsequently, the mathematical diagnosis was applied to make distinctions between normal fetal cardiac dynamics and pathological ones. Results:the values of the S/k ratios of the fetal monitoring evaluated, differentiated normal from abnormal fetal cardiac monitoring. Conclusions: with the established mathematical diagnosis, the reproducibility and clinical applicability of the methodology developed for the evaluation of the tracing of fetal monitoring were confirmed...(AU)

Risk factors associated with the development of perinatal asphyxia in neonates at the Hospital Universitario del Valle, Cali, Colombia, 2010-2011 / Factores de riesgo asociados con el desarrollo de asfixia perinatal en neonatos en el Hospital Universitario del Valle, Cali, Colombia, 2010-2011

Abstract Introduction: Perinatal asphyxia is one of the main causes of perinatal mortality and morbidity worldwide and it generates high costs for health systems; however, it has modifiable risk factors. Objective: To identify the risk factors associated with the development of perinatal asphyxia in newborns at Hospital Universitario del Valle, Cali, Colombia. Materials and methods: Incident cases and concurrent controls were examined. Cases were defined as newborns with moderate to severe perinatal asphyxia who were older than or equal to 36 weeks of gestational age, needed advanced resuscitation and presented one of the following: early neurological disorders, multi-organ commitment or a sentinel event. The controls were newborns without asphyxia who were born one week apart from the case at the most and had a comparable gestational age. Patients with major congenital malformations and syndromes were excluded. Results: Fifty-six cases and 168 controls were examined. Premature placental abruption (OR=41.09; 95%CI: 4.61-366.56), labor with a prolonged expulsive phase (OR=31.76; 95%CI: 8.33-121.19), lack of oxytocin use (OR=2.57; 95% CI: 1.08 - 6.13) and mothers without a partner (OR=2.56; 95% CI: 1.21-5.41) were risk factors for the development of perinatal asphyxia in the study population. Social difficulties were found in a greater proportion among the mothers of cases. Conclusions: Proper control and monitoring of labor, development of a thorough partograph, and active searches are recommended to ensure that all pregnant women have adequate prenatal care with the provision of social support to reduce the frequency and negative impact of perinatal asphyxia.

Resumen Introducción: La asfixia perinatal constituye una de las principales causas de morbilidad y mortalidad perinatal en el mundo, tiene factores de riesgo modificables y genera altos costos para los sistemas de salud. Objetivo: Determinar los factores de riesgo asociados al desarrollo de asfixia perinatal en recién nacidos en el Hospital Universitario del Valle, Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio de casos incidentes y controles concurrentes. Los casos se definieron como neonatos con asfixia perinatal moderada a grave, de edad de gestación mayor o igual a 36 semanas, que requirieron reanimación avanzada y presentaron, al menos, una de las siguientes condiciones: alteraciones neurológicas tempranas, falla orgánica múltiple o aparición de un evento centinela. Los controles se definieron como neonatos sin diagnóstico de asfixia, nacidos hasta con una semana de diferencia con respecto al caso y de edad de gestación comparable. Se excluyeron los pacientes con malformaciones congénitas mayores y síndromes. Resultados: Se estudiaron 56 casos y 168 controles. El desprendimiento prematuro de la placenta (odds ratio, OR=41,09; IC95% 4,61-366,56), un trabajo de parto con fase expulsiva prolongada (OR=31,76; IC95% 8,33-121,19), no usar oxitocina (OR=2,57; IC95% 1,08-6,13) y ser madre soltera (OR=2,56; IC95% 1,21-5,41) fueron factores de riesgo para el desarrollo de asfixia perinatal en la población bajo estudio. En las madres de los casos se encontraron dificultades sociales en mayor proporción. Conclusiones: Se recomienda un control adecuado y una vigilancia apropiada del trabajo de parto, hacer un estricto partograma, y una búsqueda activa, de manera que cada mujer embarazada tenga un adecuado control prenatal y reciba apoyo social.

Non-invasive prenatal test in 2 949 intermediate risk women after traditional Down syndrome screening / 天津医药

Objective To explore the value of non-invasive prenatal test (NIPT) in pregnant women with intermediate risk after traditional Down syndrome screening. Methods From March 1 2015 to March 31 2016, a total of 2 949 pregnant women with intermediate risk after traditional Down syndrome screening who received NIPT as the second-line screening method at Shenzhen Maternity and Child Healthcare Hospital after informed consent were recruited for this study. Retrospective data analysis including the results of traditional Down syndrome screening, ultrasound, NIPT and invasive amniocentesis to fetal karyotype analysis were conducted, and pregnant outcomes were followed up. Results NIPT results were all obtained in 2 949 pregnant women with intermediate risk after traditional Down syndrome screening. Of 25 NIPT-positive cases, 24 cases received invasive amniocentesis to fetal karyotype analysis. Thirteen cases were confirmed with fetal chromosomal abnormalities including 5 cases of trisomy 21, 2 cases of trisomy 13, 4 cases of sex chromosomal abnormalities and 2 cases of other chromosomal abnormalities. In addition, 1 NIPT-positive case refused prenatal diagnosis was confirmed normal result after birth. The postnatal follow-up in NIPT-negative women did not find any newborn with chromosomal abnormality. The incidence of fetal chromosomal abnormalities in women with intermediate risk was 0.44% (13/2 949). Conclusion NIPT can be used as second-line screening method in pregnant women with intermediate risk after Down syndrome screening, which could lead to the prenatal detection of a higher proportion of fetal chromosomal abnormalities and a lower invasive-testing rate.

Effect of maternal exercises on biophysical fetal and maternal parameters: a transversal study / Efeito do exercício materno em parâmetros biofísicos maternofetais: um estudo transversal

ABSTRACT Objective To evaluate the acute effects of maternal and fetal hemodynamic responses in pregnant women submitted to fetal Doppler and an aerobic physical exercise test according to the degree of effort during the activity and the impact on the well-being. Methods Transversal study with low risk pregnant women, obtained by convenience sample with gestational age between 26 to 34 weeks. The participants carry out a progressive exercise test. Results After the exercise session, reduced resistance (p=0.02) and pulsatility indices (p=0.01) were identified in the umbilical artery; however, other Doppler parameters analyzed, in addition to cardiotocography and fetal biophysical profile did not achieve significant change. Maternal parameters obtained linear growth with activity, but it was not possible to establish a standard with the Borg scale, and oxygen saturation remained stable. Conclusion A short submaximal exercise had little effect on placental blood flow after exercise in pregnancies without complications, corroborating that healthy fetus maintains homeostasis even in situations that alter maternal hemodynamics.

RESUMO Objetivo Avaliar os efeitos agudos de respostas hemodinâmicas maternas e fetais em gestantes submetidas a Doppler fetal e a um teste de exercício físico aeróbio, de acordo com o grau de esforço durante a atividade e o impacto sobre o bem-estar. Métodos Estudo transversal desenvolvido com gestantes de baixo risco, por amostra de conveniência com idade gestacional entre 26 e 34 semanas. As participantes realizam um teste de esforço progressivo. Resultados Na artéria umbilical, após sessão de exercício físico, identificou-se a redução do índice de resistência (p=0,02) e do índice de pulsatilidade (p=0,01), mas os demais parâmetros Doppler analisados, além da cardiotocografia e do perfil biofísico fetal, não obtiveram alteração significativa. Os parâmetros maternos obtiveram crescimento linear com a atividade, mas não foi possível estabelecer padrão com a escala de Borg, e a saturação de oxigênio se manteve estável. Conclusão O esforço submáximo curto teve pouco efeito sobre o fluxo de sangue da placenta após o exercício em gestações sem complicações, corroborando que o feto hígido mantém a homeostase mesmo em situações que alterem a hemodinâmica materna.

Characteristics of long-range monitoring of fetal heart rate in third trimester with atypical non-stress test / 中华围产医学杂志

Objective To analyze the characteristics of long-range monitoring of fetal heart rate in the third trimester fetuses with atypical non-stress test (NST).Methods Long-range monitoring of fetal heart rate was performed in low-risk pregnant women who received antenatal care between April 2014 and October 2015 in Peking University Third Hospital.All subjects underwent NST from the 36th gestational week,and divided into normal NST (30 cases) and atypical NST (36 cases) groups according to the results of NST.The clinical data,including maternal age,gestational age at delivery,termination of pregnancy,neonatal asphyxia,hospitalization rate and umbilical cord blood peak-systolic/diastolic ratio value were collected.The data of long-range monitoring were analyzed by specially designed computer software.T test and Chi-square test were applied for statistical analysis.Results There were no differences in maternal age,gestational age at delivery,mode of delivery and incidence of neonatal asphyxia between the two groups (all P＞0.05).In atypical NST group,fetal heart rate baseline was higher [(138.05±5.65) vs (135.10±5.39) bpm] (t=-2.170,P＜0.05),and fetal heart rate baseline variability was lower than in normal NST group [(5.19±1.07) vs (6.28±1.15) bpm] (t=3.960,P＜0.001).Compared with normal NSTs,the percentage of mild baseline variability was significantly increased in atypical NST group [(40.79±9.97) vs (51.17± 10.84)％],while that of moderate variability was significantly decreased [(56.57±8.86) vs (46.72± 10.24)％] (t=-4.018 and 4.133,both P ＜ 0.001).In atypical NSTs,the average ratio of time of acceleration/the whole time of monitoring [(37.41 ±4.60)％] and acceleration area per unit time[(1.42±0.48) cm2/20 min] were decreased compared with normal NSTs [(40.78±4.23)％ and (2.03±0.67) cm2/20 min] (t=3.079 and 4.359,both P＜0.05).Conclusions Long-range monitoring of fetal heart rate in the third trimester fetuses with atypical NST is characterized by the declined fetal heart rate baseline variability,increased proportion of mild variability and unit time acceleration area;but these are not associated with pregnancy outcomes and short-term prognosis.

Development and Effects of Supplementary Material about Electronic Fetal Monitoring for Nursing Students

PURPOSE: This study aimed to develop supplementary material about the electronic fetal monitoring for nursing students, and to test the effects on electronic fetal monitoring related knowledge and confidence on nursing performance in delivery room. METHODS: Totally 58 nursing students were recruited either experimental group (n=30) or a control group (n=28). A non-equivalent control group pretest-posttest design was employed to test the effects on fetal monitoring related knowledge and confidence on nursing performance in delivery room. The supplementary material about the electronic fetal monitoring was developed based on Analysis, Design, Development, Implement and Evaluation (ADDIE) model. Fetal monitoring related knowledge and confidence on nursing performance in delivery room were self-reported by the scales that author developed. Data were collected at pre-test and after the 6-week intervention. RESULTS: There was significant difference in confidence on nursing performance in delivery room between two groups after intervention. CONCLUSION: These findings suggest the importance of the supplementary material about the electronic fetal monitoring for nursing students to improve confidence on nursing performance in delivery room.

Relação entre a contagem de eritroblastos no sangue do cordão umbilical e os resultados obstétricos e neonatais em fetos pequenos para a idade gestacional e com Doppler de artéria umbilical normal / Relation between nucleated red blood cell count in umbilical cord and the obstetric and neonatal outcomes in small for gestational age fetuses and with normal dopplervelocimetry of umbilical artery

OBJETIVO: Avaliar resultados obstétricos e neonatais em gestantes com fetos pequenos para a idade gestacional após 35 semanas segundo a contagem de eritroblastos (EB) no sangue de cordão umbilical.MÉTODOS: A contagem de EB por 100 leucócitos no sangue do cordão umbilical foi obtida de 61 gestantes com fetos pequenos para a idade gestacional e Doppler umbilical normal. Estas foram divididas em 2 grupos: EB≥10 (grupo estudo, n=18) e EB<10 (grupo controle, n=43). Resultados obstétricos e neonatais foram comparados entre os grupos. Para a análise estatística, foram utilizados teste do χ2e t de Student, com nível de significância adotado de 5%.RESULTADOS: A média±desvio padrão de EB por 100 leucócitos foi de 25,0±13,5 para o grupo estudo e de 3,9±2,2 para o grupo controle. Os grupos EB≥10 e EB<10 não diferiram estatisticamente em relação à idade materna (24,0 versus 26,0 anos), primiparidade (55,8 versus 50%), comorbidades (39,5 versus 55,6%) e idade gestacional no parto (37,4 versus 37,0 semanas). O grupo EB≥10 apresentou maior taxa de cesárea (83,3 versus 48,8%, p=0,02), sofrimento fetal (60 versus 0%, p<0,001) e pH<7,20 (42,9 versus11,8%, p<0,001). O peso de nascimento e o percentil de peso para a idade gestacional foram significativamente menores no grupo EB≥10 (2.013 versus 2.309 g; p<0,001 e 3,8 versus 5,1; p=0,004; respectivamente). Não houve nenhum caso de Apgar de 5º minuto abaixo de 7.CONCLUSÃO: A contagem de EB acima de 10 por 100 leucócitos no sangue do cordão umbilical foi capaz de identificar maior risco de parto cesárea, sofrimento fetal e acidose de nascimento em fetos pequenos para a idade gestacional com dopplervelocimetria de artéria umbilical normal.

PURPOSE: To analyze the obstetrical and neonatal outcomes of pregnancies with small for gestation age fetuses after 35 weeks based on umbilical cord nucleated red blood cells count (NRBC).METHODS: NRBC per 100 white blood cells were analyzed in 61 pregnancies with small for gestation age fetuses and normal Doppler findings for the umbilical artery. The pregnancies were assigned to 2 groups: NRBC≥10 (study group, n=18) and NRBC<10 (control group, n=43). Obstetrical and neonatal outcomes were compared between these groups. The χ2 test or Student's t-test was applied for statistical analysis. The level of significance was set at 5%.RESULTS: The mean±standard deviation for NRBC per 100 white blood cells was 25.0±13.5 for the study group and 3.9±2.2 for the control group. The NRBC≥10 group and NRBC<10 group were not significantly different in relation to maternal age (24.0 versus 26.0), primiparity (55.8 versus 50%), comorbidities (39.5 versus55.6%) and gestational age at birth (37.4 versus 37.0 weeks). The NRBC≥10 group showed higher rate of caesarean delivery (83.3 versus 48.8%, p=0.02), fetal distress (60 versus 0%, p<0.001) and pH<7.20 (42.9 versus11.8%, p<0.001). The birth weight and percentile of birth weight for gestational age were significantly lower on NRBC≥10 group (2,013 versus 2,309 g; p<0.001 and 3.8 versus 5.1; p=0.004; respectively). There was no case described of 5th minute Apgar score below 7.CONCLUSION: An NRBC higher than 10 per 100 white blood cells in umbilical cord was able to identify higher risk for caesarean delivery, fetal distress and acidosis on birth in small for gestational age fetuses with normal Doppler findings.