scoring systems may be useful in the management of low-risk parturients continuous monitoring during labor (Koong et al., 1997). In European centers, an additional strategy for identifying high-risk parturients is the analysis of a fetal heart rate (FHR) tracing at the time of admission; if the FHR tracing is normal, they may receive less monitoring, and if the tracing is abnormal, patients receive intensive monitoring (Gourounti & Sandall, 2007).
The magnitude of risk for intrapartum fetal neurologic injury is controversial. In 2003, the American College of Obstetricians and Gynecologists (ACOG) Task Force on Neonatal Encephalopathy and Cerebral Palsy concluded that 70% of these types of fetal neurologic injuries result from events that occur before the onset of labor (American College of Obstetricians and Gynecologists, 2004; American College of Obstetricians and Gynecologists Task Force on Neonatal Encephalopathy and Cerebral Palsy, 2003). Examples of antepartum events that may cause fetal
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A uterine contraction can result in a decreased uteroplacental blood flow. A placenta with borderline function before labor may be unable to maintain gas exchange adequate to prevent fetal asphyxia during labor. The healthy fetus may compensate for the effects of hypoxia during labor (Parer & Livingston, 1990; Court & Parer, 1984). The compensatory response includes (1) decreased oxygen consumption, (2) vasoconstriction of nonessential vascular beds, and (3) redistribution of blood flow to the vital organs (e.g., brain, heart, , placenta adrenal glands) (Peeters et al., 1979; Cohn et al., 1974). Humoral responses (e.g., release of vasopressin and endogenous opioids, release of epinephrine from the adrenal medulla) may enhance fetal cardiac function during hypoxia (Parer, 1997). Prolonged or severe hypoxia overwhelms these compensatory mechanisms, resulting in fetal injury or
According to the World Health Organization (WHO, 2016), preterm birth are the birth that happened before 37 ended weeks of pregnancy and is one of the number reason of newborn deaths and the second prominent cause of deaths in children below five. The preterm babies have chances of an amplified risk of illness, disability and death. In the first weeks, the complications of premature birth may include: breathing problems, heart problems, brain problems, temperature control problems, gastrointestinal problems, blood problems, metabolism problems, immune system problems. Long-term complications includes cerebral palsy, impaired cognitive skills, vision problem, hearing problems, dental problems, behavioral and psychological problems, chronic health issues.
Injuries occurring during birth are denoted to as birth trauma or obstetrical injuries and they are associated with different etiological causes. The important causes of birth trauma are macrosomia, breech presentation, shoulder dystocia, and forceps-assisted deliveries [3]. Traumatizing maneuvers during the deliveries will result in these fractures in the assisted deliveries [4]. The trauma may occur due to use of forces, excessive traction or pulling, unintended pressure on soft organs such as eyes. Trauma to the limb usually occurs when the limb is pulled in cases of obstructed labor or shoulder dystocia (Head out, shoulder stuck). An Indian study on birth trauma revealed that the fractured clavicle was commonest bone fractured
Vacuum assisted deliveries are a method to help facilitate a vaginal birth even if the mother is becoming to exhausted to push or if the baby has reached a difficult position during labor and is prevented from progressing. While the vacuum may be helpful for the labor it runs the risk of causing a subgaleal hemorrhage (SHG) in newborns this condition is a result of the connection between the sinuses of the scalp and the veins of the brain have been ruptured which causes bleeding and swelling of the head and can lead to severe hypovolemia and death (Davis, 2001). SGH occurrences after vacuum delivery are in the range of 26 to 45 per 1000 vaginal deliveries (Modanlou, 2010). In order to treat and correct SGH nurses are
Maternity Care and Delivery is a totally different situation that involves the health and well being of two patients, the mom and the baby. The procedures we code for would include the monitoring
Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).
Once this distinction is made, contractions must continually be monitored because fetal well-being is assessed by monitoring fetal response (FHR) during contractions. Also, the frequency, duration and intensity of the contractions provide information about the progression of labor.
The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s
A commonly known procedure when it comes to hospital births are epidurals. An epidural is an injection of a drug between the “epidural space” which causes
When a baby is in Utero, the oxygen saturation is well below what it should be after birth (Lee, 2015). There is a
| Use of electrocardiography to record the fetal heart rate during labor is part of:
I found this particularly interesting because after evaluating several cesarean deliveries, I noticed that doctors normally only order cord gases in severe situations. The umbilical cord blood gas analysis is an accurate and validated tool for the evaluation of neonatal acidemia at the time of delivery. It is likely that with diverse approaches amongst medical professionals, some cases of neonatal acidemia are not detected. Many facilities and medical professionals today rely heavily on the results of the Apgar score to assess the condition of the neonate. The collection of fetal cord blood gases should become a more standardized practice in order to identify neonatal academia before it can progress to a severe
Several studies done by Albers, Feinstein & Trepaniq, (2000, 2012), said that intermittent auscultation of FHR during labor is regarded as the safe and effective method of fetal monitoring in low-risk pregnancies. The decelerations of the fetal heart rate in labor were detected more reliably with a Doppler ultrasound monitor than with a fetal stethoscope(Mohamed et al., 1994).
It is recommended to check bishop score before doing the induction of labour, with monitoring of fetal heart rate pattern. This should be confirmed by using electronic fetal monitoring {{303 Laughon,S.K. 2011}}.
In many U.S. hospitals today the patient care that women receive during management of labor and delivery doesn’t look very evidenced based. Electronic fetal heart rate monitoring (EFM) is the most common form of intrapartal fetal assessment in the United States. We continue to see widespread use of EFM in low risk pregnancies. Electronic fetal monitoring is standard procedure despite numerous randomized controlled trials that have disproven its validity. It is routinely used, yet does not decrease neonatal morbidity or mortality compared to the use of intermittent auscultation. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. So why do we use continuous EFM in the low risk pregnancy and what does the best evidence support and how can nurses apply the best available evidence to practice? As a patient advocate it is the nurses responsibility to answer these questions and provide the low-risk pregnant woman with current evidence about options for fetal heart rate assessment during labor.
monitor fetal heartbeat. In the first stage of labor , the neck of the uterus,