Acidemia Can Occur Despite Category I Tracing

2019 ◽  
Vol 37 (07) ◽  
pp. 762-768
Author(s):  
Ann M. Bruno ◽  
Julia D. López ◽  
Molly J. Stout ◽  
Methodius G. Tuuli ◽  
George A. Macones ◽  
...  
Keyword(s):  
A Priori ◽  
Secondary Analysis ◽  
Fetal Monitoring ◽  
Well Being ◽  
Knowing That ◽  
Arterial Ph ◽  
Electronic Fetal Monitoring ◽  
Term Monitoring ◽  
Rule Out ◽  
Singleton Pregnancies

Objective Electronic fetal monitoring (EFM) is intended to assess fetal well-being during labor. Our objective was to test the hypothesis that findings of a category I tracing at any time in the 60 minutes prior to delivery would rule out neonatal acidemia. Study Design This was a planned secondary analysis of a single-center prospective cohort study of 8,580 singleton pregnancies undergoing labor with nonanomalous infants at term. Monitoring was reviewed by obstetric research nurses at 10-minute intervals in the 60 minutes prior to delivery. The primary outcome was acidemia, defined as an umbilical cord arterial pH of 7.10 or less. Results Of the 4,274 patients included, 42 (0.98%) infants had acidemia at birth. Of the 42 infants with acidemia, 13 (31%) had category I tracings in the 30 minutes prior to delivery. Three (7%) infants had neonatal acidemia despite category I tracing for >40 minutes in the 60 minutes prior to delivery. Conclusion Even in the presence of category I tracing in the 60 minutes prior to delivery, neonatal acidemia can still occur. Periods of category I should be interpreted within the clinical context of a priori risk for acidemia, knowing that it does not completely rule out acidemia.

Effect of Oligohydramnios on Fetal Heart Rate Patterns during Term Labor Induction

2018 ◽  
Vol 36 (07) ◽  
pp. 715-722
Author(s):  
Janine S. Rhoades ◽  
Molly J. Stout ◽  
George A. Macones ◽  
Alison G. Cahill
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Secondary Analysis ◽  
Neonatal Morbidity ◽  
Fetal Monitoring ◽  
Secondary Outcome ◽  
Significant Difference ◽  
Electronic Fetal Monitoring ◽  
Consecutive Term

Objective To estimate the effect of oligohydramnios on fetal heart rate (FHR) patterns in patients undergoing induction of labor (IOL) at term. Study Design Secondary analysis of a prospective cohort study of consecutive term, singleton deliveries from 2010 to 2015. We included all patients who underwent IOL. Our primary outcomes were electronic fetal monitoring (EFM) characteristics in the 2 hours preceding delivery. Outcomes were compared between those induced with oligohydramnios and those induced without a diagnosis of oligohydramnios. Our secondary outcome was composite neonatal morbidity. Logistic regression was used to control for confounders. Results Of 3,787 patients who underwent IOL, 147 had a diagnosis of oligohydramnios and 3,640 were included in the no oligohydramnios group. There was no significant difference in EFM characteristics between the two groups. There was no difference in composite neonatal morbidity. In patients with oligohydramnios, EFM patterns with baseline tachycardia for 30 minutes or greater were significantly associated with composite neonatal morbidity (31.3 vs. 5.3% adjusted odds ratio 8.63, 95% confidence interval 2.18, 34.1]). Conclusion Term patients undergoing IOL with oligohydramnios had EFM patterns that did not differ from their induced peers.

scholarly journals Electronic Fetal Monitoring and Neonatal Outcomes when a Nuchal Cord Is Present at Delivery

2019 ◽  
Vol 37 (04) ◽  
pp. 378-383
Author(s):  
Ebony B. Carter ◽  
Cheryl S. Chu ◽  
Zach Thompson ◽  
Methodius G. Tuuli ◽  
George A. Macones ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Fetal Heart ◽  
Neonatal Morbidity ◽  
Fetal Monitoring ◽  
Neonatal Outcomes ◽  
Nuchal Cord ◽  
Electronic Fetal Monitoring ◽  
Adverse Neonatal Outcomes ◽  
Morbidity Index ◽  
Singleton Pregnancies

Objective This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes. Study Design This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders. Result Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; p = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; p < 0.01). Conclusion Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.

Association of Fetal Heart Rate Baseline Change and Neonatal Outcomes

2017 ◽  
Vol 34 (09) ◽  
pp. 879-886 ◽  
Author(s):  
Molly Stout ◽  
Julia López ◽  
Ryan Colvin ◽  
George Macones ◽  
Alison Cahill ◽  
...  
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Neonatal Intensive Care ◽  
Fetal Heart ◽  
Fetal Monitoring ◽  
Neonatal Outcomes ◽  
Arterial Ph ◽  
Electronic Fetal Monitoring ◽  
Nicu Admission ◽  
Normal Neonates

Objective The objective of this study was to describe the incidence of baseline change within normal range during labor and its prediction of neonatal outcomes. Materials and Methods This was a prospective cohort of singleton, nonanomalous, term neonates with continuous electronic fetal monitoring and normal baseline fetal heart rate throughout the last 2 hours of labor. We determined baseline in 10-minute segments using Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria. We evaluated baseline changes of ≥ 20 and ≥ 30 bpm for association with acidemia (umbilical cord arterial pH ≤ 7.10) and neonatal intensive care unit (NICU) admission. Finally, we performed a sensitivity analysis of normal neonates, excluding those with acidemia, NICU admission, or 5-minute Apgar < 4. Results Among all neonates (n = 3,021), 1,267 (41.9%) had change ≥ 20 bpm; 272 (9.0%) had ≥ 30 bpm. Among normal neonates (n = 2,939), 1,221 (41.5%) had change ≥20 bpm. Acidemia was not associated with baseline change of any direction or magnitude. NICU admission was associated with decrease ≥ 20 bpm (adjusted odds ratio [aOR]: 2.93; 95% confidence interval [CI]: 1.19 – 7.21) or any direction ≥ 20 bpm (aOR: 4.06; 95% CI: 1.46–11.29). For decrease ≥ 20 bpm, sensitivity and specificity were 40.0 and 81.7%; for any direction ≥ 20 bpm, 75.0 and 58.3%. Conclusion Changes of normal baseline are common in term labor and poorly predict morbidity, regardless of direction or magnitude.

Enabling Community Well-being Self-Monitoring in the Context of Mining: The Naskapi Nation of Kawawachikamach

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Robert Klinck ◽  
Ben Bradshaw ◽  
Ruby Sandy ◽  
Silas Nabinacaboo ◽  
Mannie Mameanskum ◽  
...  
Keyword(s):  
Indigenous Peoples ◽  
Well Being ◽  
Aboriginal Community ◽  
Self Monitoring ◽  
Community Engaged Research ◽  
The Past ◽  
Mineral Development ◽  
Iron Deposits ◽  
Term Monitoring

The Naskapi Nation of Kawawachikamach is an Aboriginal community located in northern Quebec near the Labrador Border. Given the region’s rich iron deposits, the Naskapi Nation has considerable experience with major mineral development, first in the 1950s to the 1980s, and again in the past decade as companies implement plans for further extraction. This has raised concerns regarding a range of environmental and socio-economic impacts that may be caused by renewed development. These concerns have led to an interest among the Naskapi to develop a means to track community well-being over time using indicators of their own design. Exemplifying community-engaged research, this paper describes the beginning development of such a tool in fall 2012—the creation of a baseline of community well-being against which mining-induced change can be identified. Its development owes much to the remarkable and sustained contribution of many key members of the Naskapi Nation. If on-going surveying is completed based on the chosen indicators, the Nation will be better positioned to recognize shifts in its well-being and to communicate these shifts to its partners. In addition, long-term monitoring will allow the Naskapi Nation to contribute to more universal understanding of the impacts of mining for Indigenous peoples.

Evaluation of Normal Heart Rate in Early Pregnancy Corresponding to Gestational Age between Six to Eight Weeks

Med Phoenix ◽  
2017 ◽  
Vol 2 (1) ◽  
pp. 34-37
Author(s):  
Akhilesh Kumar Jha ◽  
Bikranta Rimal ◽  
Tarannum Khatun
Keyword(s):  
Heart Rate ◽  
Early Pregnancy ◽  
Well Being ◽  
Clinical Decision ◽  
First Trimester ◽  
Normal Heart ◽  
Normal Heart Rate ◽  
First Trimester Of Pregnancy ◽  
Singleton Pregnancies

Background: Ultrasonography is the reliable and safe way for the evaluation of pregnancy. Heart rate can be detected more confidently from the Ultrasonography. Heart rate is an important parameter for the evaluation of early pregnancy. The purpose of this study was to evaluate the normal heart rate in embryos/fetuses between 6 and 8 weeks of gestation.Method: In our region people are poor and most of them do not know the benefit of regular follow up examination during pregnancy. So most of pregnant women come to our centre at late stage of pregnancy. The number of pregnancy cases is good in our centre but the number of early pregnancy cases coming to regular follow up examination is low. Thus the study was conducted in 51 normal singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. The duration of study was 6 weeks.Result: Out of 51 singleton pregnancies, 20 cases (39.2%) heart rate were between 131-150 beat per minute and 25 cases (49.0 %) heart rate were between 151-170 beat per minute. However 4 cases (7.8%) were between 110-120 beat per minute and 2 cases (3.9%) were more than 171 beat per minute. There were zero cases above the 180 beat per minute.Conclusion: The result of this study will help to evaluate abnormal and normal fetal heart rate so that early clinical decision whether to continue the pregnancy or terminate it can be taken, as Ultrasonography is only the method used in screening fetal well being in most of the region of our country.Med Phoenix Vol.2(1) July 2017, 34-37

738 Sex-specific differences in electronic fetal monitoring patterns

2021 ◽  
Vol 224 (2) ◽  
pp. S462-S463
Author(s):  
Erin Bailey ◽  
Nandini Raghuraman ◽  
Fan Zhang ◽  
Jeny Ghartey ◽  
George A. Macones ◽  
...  
Keyword(s):  
Fetal Monitoring ◽  
Electronic Fetal Monitoring

scholarly journals Laying ghosts to rest

2021 ◽  
Author(s):  
Donnchadh O’Conaill
Keyword(s):  
New York ◽  
Philosophy Of Mind ◽  
A Priori ◽  
A Posteriori ◽  
Rule Out

AbstractOne of the most widely-discussed arguments against physcialism appeals to the conceivability of zombies, being which are physically or functionally identical to humans but which have no conscious experiences. Philip Goff (Philos Phenomenol Res 81(1): 119–139, 2010; Consci Cognit 21(2): 742–746, 2012a; in Sprevak M, Kallestrup J (eds) New waves in philosophy of mind. Palgrave, 2014) has recently presented a number of different anti-physicalist arguments appealing to the conceivability of ghosts, entities whose nature is exhausted by their being conscious. If ghosts are conceivable, this would rule out a priori physicalism. If the conceivability of ghosts entails that they are metaphysically possible, then this forms the basis for arguments against a posteriori physicalism. Drawing on work on conceivability by Peter Kung (Philos Phenomenol Res 81(3):620–663, 2010, Noûs 50(1): 90–120, 2016) and my own discussion of arguments which appeal to the conceivability of zombies (O’Conaill in Mihretu P Guta (ed) Consciousness and the ontology of properties. Routledge, New York, 2019), I shall argue that ghosts are conceivable, but that what allows us to conceive of them (our ability to make certain stipulations about the scenarios we conceive) undermines the belief that conceivability is a reliable guide to possibility. While this does not undermine Goff’s argument against a priori phyiscalism, it suggests that a posteriori physicalists need not be haunted by ghosts.

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