Anesthetic and obstetric management of high-risk pregnancy by Sanjay Datta

By Sanjay Datta

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1. 9. Decreased variability of the fetal heart rate (FHR). In addition to asphyxia, other causes of altered variability include anencephaly, fetal drug effect (secondary to morphine, meperidine, diazepam, and magnesium sulfate), vagal blockade (due to atropine or scopolamine), and interventricular conduction delays (complete heart block). Periodic changes in FHR occur in association with uterine contractions. 10). The descent of the FHR is usually not more than 20 beats/min below the baseline. The cause is presumed to be a vagal reflex caused by a mild hypoxia but is not associated with fetal compromise.

Positive: persistent late decelerations (even when the contractions are less frequent than three contractions within 10 min), possible absence of FHR variability. 3. Suspicious: intermittent late deceleration or variable decelerations, abnormal baseline FHR 4. Unsatisfactory: poor quality recording or inability to achieve three contractions within 10 min 5. 99 As does the NST, the CST also has a high false-positive rate (50%), but the treatment, if delivery is indicated, can be a trial of induction of labor.

Fetal blood sampling during the third trimester of pregnancy. Br J Obstet Gynaecol 1984;91:118–121. Powell MC, Worthington BS, Buckley JM, Symonds EM. Magnetic resonance imaging (MRI) in obstetrics. II. Fetal anatomy. Br J Obstet Gynaecol 1988;95:38–46. Marx JL. Imaging technique passes muster. Science 1987;238:888–889. Lindfors KK, Gorczyca DP, Hanson FW, Tennant FR, McGahan JP, Peterson AG. The roles of ultrasonography and amniocentesis in evaluation of elevated maternal serum alpha-fetoprotein.

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