scholarly journals RETROSPECTIVE REVIEW OF PATIENTS WITH REPEATED PRESENTATIONS FOR MATERNAL REDUCED FETAL MOVEMENTS (RFMS) AND VARYING NUMBERS OF PSANZ STILLBIRTH RISK FACTORS (SRFS) WITH NEONATAL BIRTH OUTCOMES IN A HIGH‐RISK AUSTRALIAN QUATERNARY MATERNAL FETAL ASSESSMENT UNIT (MFAU)

2019 ◽  
Vol 55 (S1) ◽  
pp. 105-105
2021 ◽  
Vol 8 (3) ◽  
pp. 356-362
Author(s):  
P Pallavee ◽  
Prudvi Rani Podili ◽  
Rupal Samal ◽  
Seetesh Ghose

Fetal movement counting may assist clinicians to intervene at the right time and improve perinatal outcomes, but may sometimes cause unnecessary interventions. A recent Cochrane review in 2015 concludes that there is insufficient evidence to influence practice. This prospective observational study was conducted to evaluate pregnancy outcomes of 103 pregnant women presenting with primary complaints of reduced fetal movements to our Institute. All patients underwent ultrasonography (USG) and non-stress testing (NST) as preliminary investigations and were followed up till delivery. Labor outcomes like onset of labor, mode of delivery, neonatal outcomes like APGAR scores, admission to NICU for > 24 hours, birth weight, neonatal complications and maternal complications were noted. One hundred and three pregnant women presented with reduced fetal movements, of whom, 65% were term primigravida between the ages of 18-26 years. 47.5% belonged to the high risk pregnancy group. The rates of admission (62.1%), induction (77.7%) and cesarean section (43.7%) were high in this group. Pregnancy outcomes did not differ between single and multiple episodes of reduced fetal movements. Based on risk categorization we found that a single episode of reduced fetal movement was associated with approximately 70% good neonatal outcomes, whereas there was 50% risk of adverse neonatal outcomes with multiple episodes. Though this was clinically significant we could not establish statistical significance for this result. Reduced fetal movement can occur in both low and high risk pregnant population. Pregnancy outcomes between single and multiple episodes of RFM were not significantly different.


Author(s):  
Vidyashree G. Poojari ◽  
Sahan S. Kumar ◽  
Akhila Vasudeva

Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM).Methods: Prospective observational study, recruiting all women with singleton pregnancy at or beyond 28 weeks of gestation presenting with a subjective perception of RFM from April 2015 to December 2016. Maternal characteristics, antenatal risk factors, management pathways and perinatal outcome studied.Results: 47% belonged to high risk pregnancy. Among high risk women, although only 39% showed poor BPP at the first presentation, 58% were delivered irrespective of their gestational age, out of which 32.75% had poor neonatal outcome. Among low risk who had >2 episodes of RFM, 50% had poor neonatal outcome. 7% among high risk pregnancies and 18% among low risk, presented with RFM within 48 hours following steroid prophylaxis.24% of high risk women showed liquor volume abnormalities as compared to low risk (6.3%).Conclusions: Significant proportion of those with RFM belonged to high risk pregnancy. Among high risk group, there were high rates of stillbirth and poor BPP at the time of admission when compared to low risk group. Due to early approach to the hospital and timely intervention, significant women with abnormal BPP had good perinatal outcome. All those fetuses who were delivered on first episode of RFM in low risk group did not show evidence of compromise at birth, probably indicating unnecessary delivery. More than 2 episodes of RFM even among low risk group seems significant as good number of fetuses were compromised at birth. Steroids prophylaxis for the fetal lung maturity causes transient changes in BPP, hence unnecessary delivery should be avoided especially those among low risk pregnancy.


2018 ◽  
Vol 11 (2) ◽  
pp. 95-104
Author(s):  
Ivan D. Ivanov ◽  
Stefan A. Buzalov ◽  
Nadezhda H. Hinkova

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.


Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.


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