Intravenous isotonic fluid challenge, and L-arginine infusion for oligoamnios and diminished fetal movements: a preliminary study

Background: Utero-placental insufficiency is one of the major causes of oligoamnios and diminished fetal movements (FM). Rapid intravenous isotonic fluid infusion within the cardiovascular reserve improves tissue perfusion in all systems. We tested the hypothesis that isotonic fluid challenge may improve uteroplacental perfusion, which may, in turn improve fetal oxygenation, liquor formation, and FM.Methods: In this descriptive study, twenty-three antenatal mothers with gestational age >26 weeks, and with amniotic fluid index (AFI) <8 cm were included. Intravenous isotonic fluid challenge with 2 or 3 pints of ringer’s lactate, at the rate of 180-200 drops/minute, twice daily for 2-3days and, L-arginine infusion, 300 ml/day alternate days for 2-3 doses were given. Women were advised to take more than 3 litres of water a day. AFI was recorded once daily for 5 days, and then biweekly. The fluid challenge was repeated whenever AFI diminished <8.00 cm. AFI and perceived FM were graded. Pregnancies were terminated when there was no response to fluid challenge. The trend of changes in AFI and FM grades, number of days pregnancies continued, and perinatal outcomes were recorded.Results: We noted recurrent fall in AFI after an initial arise in 20 women, which required recurrent fluid challenges. Pregnancies could be continued for 18±8.5 days (median±SD). Three women, with case of absent FM, reported FM within 1 hour after initiation of the fluid challenge. There were no perinatal deaths.Conclusions: Intravenous isotonic fluid challenge and L-arginine infusion, improves AFI and FM, and helps to prolong pregnancies towards viability.

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Cardiotocography monitoration in antepartum care: analysis of controls

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.897 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Napolitani ◽

L Kundisova ◽

B Giannini ◽

F Moirano ◽

L Alaimo ◽

...

Keyword(s):

Diabetes Mellitus ◽

Best Practice ◽

Medical Condition ◽

Perinatal Outcomes ◽

Obstetric Care ◽

Clinical Practices ◽

Amniotic Fluid Index ◽

Fetal Movements ◽

Italian Women ◽

The Moment

Abstract Introduction WHO does not recommend the routine prenatal cardiotocography (CTG) during pregnancy to improve maternal and perinatal outcomes. Instead, Italian guidelines consider CTG after the 41st week of pregnancy to be useful. The aim of this work was to identify the variables associated with CTG performed before the 40th week. Materials and Methods A retrospective study was conducted at the Hospital of Siena (Italy), all females that accessed to CTG from 2016 to 2018 was included. The variables were: nationality, pregnancy associated pathology(PAP), gestational age(GA), parity, type of access (urgent/programmed), n° of accesses, active fetal movements (AFM), amniotic fluid index (AFI) and necessity of recovery. The statistical analysis was carried out using Stata 12. Results The women included were 4010, mean age was 32.8±5.6 years (75% Italian; 62.4% primiparous). A mean GA was 38 ± 3 weeks; 47.5% had one access, 27% two accesses, 14% three accesses. The 22% were urgent accesses, 11.5% had PAP (70% diabetes mellitus). The 58% showed up before the 40th week, the probability was higher for non-Italian women (OR 1.3), multiparous (OR 1.32), women with urgent access (OR 7.9) and women with PAP (OR 3.4). In 5.4% the CTG was altered, 23% had absent AFM and 2% had alterated AFI. Females that came before 40th week were more likely to have absent AFM (OR 4.5) and AFI (OR 2). The 3% needed an immediate hospitalization, mainly in non-Italian (OR 1.7), urgent accesses (OR 4.4), those that came before 40th week (OR 2.44), absent AFM (OR 21.8), and altered AFI (OR 15.8), Conclusions Our analysis shows the association between precocious access to CTG and urgent medical condition and PAP as expected, but also with other variable as parity and nationality. The low GA without an indication of high risk at the moment of the access suggests the possible overmedicalization of pregnancy. It seems useful to review clinical practices to ensure obstetric care close to best practice. Key messages As literature reports, to avoid overmedication of pregnancy cardiotocography should not be performed before the 41st week of pregnancy. In some situations the CTG is anticipated and for this reason it seems useful to review the clinical practices implemented in order to ensure obstetric care close to best practice.

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Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

Scientific Reports ◽

10.1038/s41598-021-90240-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shigeki Koshida ◽

Shinsuke Tokoro ◽

Daisuke Katsura ◽

Shunichiro Tsuji ◽

Takashi Murakami ◽

...

Keyword(s):

Pregnant Women ◽

Maternal Behavior ◽

Multivariable Analysis ◽

Perinatal Outcomes ◽

Fetal Movement ◽

Post Intervention ◽

Fetal Movements ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

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Intraoperative Assessment of Fluid Responsiveness in Normotensive Dogs under Isoflurane Anaesthesia

Veterinary Sciences ◽

10.3390/vetsci8020026 ◽

2021 ◽

Vol 8 (2) ◽

pp. 26

Author(s):

Despoina Skouropoulou ◽

Luca Lacitignola ◽

Caterina Di Bella ◽

Marzia Stabile ◽

Claudia Acquafredda ◽

...

Keyword(s):

Fluid Responsiveness ◽

Systolic Pressure ◽

Fluid Challenge ◽

Pressure Variation ◽

Before And After ◽

Ringer’S Lactate ◽

Controlled Mechanical Ventilation ◽

Variability Index ◽

Plethysmographic Variability Index ◽

Volume Controlled

The aim of this study was to evaluate the incidence of fluid responsiveness (FR) to a fluid challenge (FC) in normotensive dogs under anaesthesia. The accuracy of pulse pressure variation (PPV), systolic pressure variation (SPV), stroke volume variation (SVV), and plethysmographic variability index (PVI) for predicting FR was also evaluated. Dogs were anaesthetised with methadone, propofol, and inhaled isoflurane in oxygen, under volume-controlled mechanical ventilation. FC was performed by the administration of 5 mL/kg of Ringer’s lactate within 5 min. Cardiac index (CI; L/min/m2), PPV, (%), SVV (%), SPV (%), and PVI (%) were registered before and after FC. Data were analysed with ANOVA and ROC tests (p < 0.05). Fluid responsiveness was defined as 15% increase in CI. Eighty dogs completed the study. Fifty (62.5%) were responders and 30 (37.5%) were nonresponders. The PPV, PVI, SPV, and SVV cut-off values (AUC, p) for discriminating responders from nonresponders were PPV >13.8% (0.979, <0.001), PVI >14% (0.956, <0.001), SPV >4.1% (0.793, <0.001), and SVV >14.7% (0.729, <0.001), respectively. Up to 62.5% of normotensive dogs under inhalant anaesthesia may be fluid responders. PPV and PVI have better diagnostic accuracy to predict FR, compared to SPV and SVV.

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THIS STUDY ASSESSES THE ROLE OF NST IN DETECTING FETAL COMPROMISE IN CASES OF REDUCED MATERNAL PERCEPTION OF FETAL MOVEMENT

10.36106/9025472 ◽

2021 ◽

pp. 62-65

Author(s):

Archana Kiran ◽

Umapada Mondal ◽

Debarshi jana

Keyword(s):

Pregnant Women ◽

Stress Test ◽

Perinatal Outcomes ◽

Fetal Monitoring ◽

Well Being ◽

Fetal Movement ◽

Obstetrics And Gynaecology ◽

Fetal Movements ◽

Modern Era

Introduction:In modern era of medicine, antenatal fetal monitoring is an essential way that assess the fetal well being. Aims and objectives: This study was performed to test the association between non-stress test ( NST) results and fetal and perinatal outcomes in pregnant women with perceived decrease in fetal movements attending our hospital. To determine the role of Non stress test on fetal and prenatal outcome of pregnant women with perceived decrease in fetal movements attending labor room. Materials and methods: Study is carried out at 'Imambara District Hospital', at the Dept. Of obstetrics and gynaecology, Hooghly, WB. All the pregnant mother with decreased fetal movement perception in the 3rdtrimester, attending OBG (OPD) and ANC or getting admitted in Dept. OF OBSTETRICS AND GYNAECOLOGY, at IMAMBARADIST. HOSPITAL, Chinsurah, Hooghly, WB. 1st May 2018 – April 30, 2019. Conclusion: The antenatal surveillance of cases with reduced perception of fetal movement by mother with NST can effectively screen for identication of high risk foetuses and segregate the cases that are at risk for poor perinatal outcome.

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Comparison of Amniotic Fluid Index and Single Deepest Vertical Pocket

Current Women s Health Reviews ◽

10.2174/1573404817666210223162752 ◽

2021 ◽

Vol 17 ◽

Author(s):

Roopa Padavagodu Shivananda ◽

Rekha Anbu ◽

Shubha Rao ◽

Nivedita Hegde ◽

Anjali Suneel Mundkur ◽

...

Keyword(s):

Birth Weight ◽

Amniotic Fluid ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fluid Volume ◽

Maternal Outcomes ◽

Amniotic Fluid Index ◽

Amniotic Fluid Volume ◽

Vaginal Deliveries ◽

Nicu Admission

Background: The best method of estimation of amniotic fluid volume is a matter of ongoing debate. Objectives: To determine the perinatal & maternal outcomes in pregnant patients when the amniotic fluid volume was assessed by the amniotic fluid index (AFI) in comparison to the single deepest vertical pocket (SDVP). Methods: We studied abnormal Cardiotocograph, meconium stained amniotic fluid, birth weight <2.5kg, Apgar score at 5 min <7, cord blood pH <7.2 & necessity for NICU admission as perinatal outcomes. Rate of diagnosis of oligohydramnios, induction of labor for oligohydramnios & mode of delivery were observed in maternal outcomes. Results: Of the 697 pregnant patients recruited, 353 were in the AFI and 344 in the SDVP group. Perinatal outcomes were similar in both. In the AFI group, the number of women diagnosed with oligohydramnios was higher (p = 0.0333) & the rate of induction was also higher (p = 0.003378). Vaginal deliveries were more in the SDVP group. The Receiver Operating Characteristic curves showed statistically significant correlation with NICU stay, birth-weight, and mode of delivery. While an AFI of >5cm and SDVP of >1.9cm had good sensitivity in predicting babies with a birth weight of ≥ 2.5kg and avoiding NICU admissions, an AFI of > 5.8cm and an SDVP of > 1.9 cm had a sensitivity of around 80% in predicting successful vaginal deliveries. Conclusion: The SDVP method has a slight edge over the AFI in terms of lower inductions and higher vaginal deliveries with comparable perinatal outcomes.

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Comparison between AFI and DVP in predicting adverse neonatal respiratory outcomes in women with prolonged pregnancy undergoing induction of labour

QJM ◽

10.1093/qjmed/hcab115.015 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Ahmed Elkady ◽

Dina Yahia Mansour ◽

Hamada Farag Abu zaid

Keyword(s):

Perinatal Outcomes ◽

Fetal Distress ◽

Neonatal Outcomes ◽

Induction Of Labour ◽

University Hospitals ◽

Amniotic Fluid Index ◽

Assessment Tests ◽

Prolonged Pregnancy ◽

Heart Rate Pattern ◽

Respiratory Outcomes

Abstract Background The intrapartum management of prolonged pregnancies is aunique challenge to the obstetricians, as the perinatal outcomes areadverse after completed 40 weeks. In such cases, intrapartumasphyxia and meconium aspiration are associated with almost. Objective To comparison between MVP and AFI in predicting neonatal respiratory outcomes in induction of labour in prolonged pregnancies. Patients and Methods The study was a prospective comparative study that was conducted on 266 women with prolonged pregnancy undergoing induction of labour. The patients were recruited from Ain Shams university hospitals during the period from February 2019 to August 2019. Results Amniotic fluid index and MVP were evaluated in 269 women with pregnancies of 40 or more weeks and intact membranes using a 3.5-MHz linear transducer. Both measurements were obtained for each participant by the same obstetrician in one sitting. Oligohydramnios was defined as an AFI of 5 cm or less or an DVP of 1 cm or less. External cardiotocography was performed during intrapartum period in all cases. Fetal distress was diagnosed when any one of the nonreassuring fetal heart rate pattern occurred or when the Apgar score at birth was 6 or less. The results were analyzed by the chi(2) and the t tests. Conclusion The use of the AFI and SDVP is useful in predicting neonatal outcomes in the induction of labor in prolonged pregnancies. The SDVP measurement appears to be the more appropriate method for predicting neonatal outcomes. The same observation was found when AFI and SDVP were combined. It is also logical to recommend that only one method should be used for fetal assessment tests.

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Perinatal outcome in uncomplicated pregnancies with oligohydramnios

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185426 ◽

2018 ◽

Vol 8 (1) ◽

pp. 215

Author(s):

Snehal Gaware ◽

V. B. Bangal

Keyword(s):

Birth Weight ◽

Amniotic Fluid ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Induction Of Labor ◽

P Value ◽

Amniotic Fluid Index ◽

Medical College ◽

Time Of Admission ◽

Singleton Pregnancies

Background: Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. We aimed to assess the perinatal outcomes in pregnancies with oligohydramnios.Methods: The prospective study was conducted in the Department of Obstetrics and Gynecology, Pravara Medical College, Loni in which 200 consecutive singleton pregnancies delivered vaginally, with intact membranes were included. Amniotic fluid index was determined using the Phelan’s technique at the time of admission and women were diagnosed with oligohydramnios if AFI was five or less, which formed the first group and the rest of mother formed the second group. Perinatal outcomes were noted in the proforma as well.Results: Of the 200 mothers included in the study, 38 had AFI ≤ 5. Baseline characteristics was similar in both the groups. Most common antenatal risk factors studies were pregnancy induced hypertension (29% vs 12%; p value <0.05), intrauterine growth restriction (34% vs 10%; p value <0.001) and severe anemia (21% vs 9%; p value <0.05). Proportion of pregnancies needing induction of labor and birth weight less than 2.5 kgs were significantly higher among mothers with oligohydramnios.Conclusions: Authors observed that induction of labor and low birth weight were significantly associated with oligohydramnios. Prospective randomized trials are needed to establish whether early induction of labor in the presence of a oligohydramnios improves perinatal outcome.

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Fetal Vibroacoustic Stimulation in Computerized Cardiotocographic Analysis: The Role of Short-Term Variability and Approximate Entropy

Journal of Pregnancy ◽

10.1155/2012/814987 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Maria Laura Annunziata ◽

Mariamaddalena Scala ◽

Natascia Giuliano ◽

Salvatore Tagliaferri ◽

Olga Carmela Maria Imperato ◽

...

Keyword(s):

High Risk ◽

Perinatal Outcomes ◽

Approximate Entropy ◽

Computer Assisted ◽

Short Term ◽

Fetal Movements ◽

The Impact ◽

Short Term Variability

The aim of this study was to evaluate the impact of vibroacoustic stimulation (VAS) on computerized cardiotocography short-term variability (STV) and approximate entropy (ApEn) in both low- and high-risk pregnancies. VAS was performed on 121 high- and 95 low-risk pregnancies after 10 minutes of continuous quiet, while their FHR parameters were monitored and recorded by cCTG analysis. Fetal heart rate was recorded using a computer-assisted equipment. Baseline FHR, accelerations, decelerations, STV, long-term irregularity (LTI), ApEn, and fetal movements (FMs) were calculated for defined observational periods before VAS and after 10 minutes. Data were also investigated in relationship with the perinatal outcome. In each group of patients, FHR after VAS remained almost unmodified. Fetal movements significantly increased after VAS in both groups. Results show that only in the high-risk pregnancies, the increase of STV and the decrease of ApEn after VAS were significantly associated with favorable perinatal outcomes.

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