scholarly journals Cesarean Audit for fetal distress- A indispensable tool to reduce Obstetrician Distress

2021 ◽  
Vol 5 (1) ◽  
pp. 01-04
Author(s):  
Anuradha Singh
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
Emergency Cesarean ◽  
Audit Period ◽  
Nicu Admission ◽  
Operative Findings

Background and Objectives: Overuse of cesarean section and its implications are of growing concern. Suspected fetal distress has been the commonest indication for cesarean in last few decades heart rate changes shown by fetus without being adversely affected and CTG has been criticized to create unnecessary higher rate of operative deliveries. There is need to know which fetal heart rate abnormality is important and leading to two adverse neonatal outcome to decrease unnecessary operative deliveries. Therefore Caesarean Audit was planned. Material and methods: A total of hundred women were included who underwent emergency cesarean section for suspected fetal distress in labour or without labour detected by cardiotocography or intermittent auscultation were included for analysis. Details were noted in pre designated proforma. Results: During the audit period, total number of caesarean done due to fetal distress analysed during the period were 100.The most common fetal heart rate abnormality was nonspecific in form of single or transient deceleration seen in 63% of cases where records were also incomplete, it was followed by persistent deceleration on cardiotocography which was present in 16% of the cases. In 57 women who were primigravida 14 (24%) patients had nonspecific fetal heart rate patterns and intra operative findings were normal in this group. These were avoidable cesareans. Various Intraoperative findings, observed ,maximum no. of cases had meconium stained liquor seen in 63% of the cases followed by abruption in 9 cases followed by other findings like loop of cord around the neck of foetus, thin scar or scar dehiscence . Maternal resuscitation was carried out only in 53% of cases. Detection delivery interval of less than 30 minutes was present in 4% of cases. In fetal outcomes 16% of babies diagnosed with fetal distress, had poor outcome where Apgar score < 7 and 12 babies had asphyxia related NICU admission. 82% of babies had absolutely normal fetal outcome among which majority (78%) did not require any form resuscitation. which were thus avoidable cases. Conclusions: Correct Knowledge about Standardized fetal heart rate interpretations on CTG and there standardized management protocols like Maternal resuscitative measures ,follow up to ensure fast detection delivery interval should be practiced strictly in all cases of non reassuring Fetal Heart rate patterns. There should be consistent efforts in reducing the rate of cesarean sections particularly primary cesarean deliveries and in order to understand the degree to which cesarean delivery is preventable it is important to know no why cesareans are being performed. Therefore caesarean audit is need of the hour

A Case of Emergency Cesarean Section on Client with Pseudopregnancy

2020 ◽  
pp. 1-6
Keyword(s):  
Heart Rate ◽  
Cesarean Section ◽  
Fetal Heart Rate ◽  
Medical Service ◽  
Fetal Heart ◽  
Placenta Previa ◽  
Urban Hospital ◽  
Emergency Cesarean Section ◽  
Emergency Cesarean ◽  
Rural Health Center

Pseudopregnancy detection is significant while as the false pregnancy may show all symptoms. It is important to differentiate it. This is a case report of a pseudopregnancy which led to an emergency cesarean section. A 28-year-old woman who claimed to 7-month pregnancy was brought to the rural health center by husband families complaining of vaginal bleeding. The woman refers to an urban hospital by Emergency Medical Service with the diagnosis of placenta previa. In the hospital, she underwent an emergency cesarean section due to a severe deceleration of fetal heart rate, prior to assessing by sonography. No fetus or signs of uterine or abdominal pregnancy were found. Wrong auscultation of the mother's heart rate instead of fetal heart rate seems to be the main error. It is required to pay more attention to the methods of differentiation of fetal heart rate from the mother's heart rate. This report enlightens false pregnancy and early differentiation.

scholarly journals The excessive use of cesarean section and its contribution factors in Shanghai, China

2019 ◽  
Author(s):  
Yuyin Xiao ◽  
Chenshu Shi ◽  
Wu Zeng ◽  
Minye Dong ◽  
Chunling Lu ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Heart Rate ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Fetal Distress ◽  
Bayes Estimation ◽  
World Health ◽  
Medical Indications

Abstract Objectives: This study proposes a mathematical analysis framework to estimate the proportion of cesarean section (CS) with non-medical indications and of CS cases correctly diagnosed, examine the excessive use of CS, and investigate its contributing factors in Shanghai. Design and Settings A mathematical model (C-model), developed by the World Health Organization, was employed to estimate the expected proportion of women having CS based on clinical indicators. Cases in which CS occurred but vaginal delivery (VD) was recommended instead by the C-model were regarded as "Suspicious CS". Cases that are “CS of suspected non-medical indications” were identified and used for categorical principal component analysis to explore causes of "Suspicious CS". A Bayesian model was used to calculate the proportion of correctly diagnosed CS. The use of CS and medical conditions were collected from 5,686 pregnant women delivered in twenty public hospitals with obstetrics departments in 2016, which were randomly selected in Shanghai. The excessive use of CS in Shanghai and the cost of "CS suspected non-medical indications" were estimated. Results 43.96% of pregnant women performed CS in Shanghai in 2016, much higher than the expected CS rate of 30.13% according to the C-model. A total of 1271 CS cases were classified as “Suspicious CS”, representing 22.35% of the sample. There were 784 cases classified as “CS of suspected non-medical indications”, including CS caused by fetal heart rate abnormality/fetal distress and cesarean delivery on maternal request (CDMR), accounting for 13.79% of the sample. Based on Bayes estimation, only 42.5% of pregnant women who had CS were medically necessary. If the CS with non-medical indications were appropriately controlled, the hospitalization costs in the whole year in Shanghai would drop by about US$ 60 million (408 million RMB). Conclusion The study provides empirical evidence on non-medical indications of CS in Shanghai, and uses a mathematical model to estimate the excessive use of CS. The high rate of CS in Shanghai was associated with non-medical indications. Establishing clinical standards of CS, especially in relations to abnormal fetal heart rate/fetal distress, would help reduce CS without medical indications, which would significantly lower medical expenses of hospitalization.

scholarly journals The Successful Use of Nitroglycerin for Uterine Hyperstimulation with Fetal Heart Rate Abnormality Caused by a Controlled-Release Dinoprostone Vaginal Delivery System (PROPESS): A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 478
Author(s):  
Sho Takakura ◽  
Hiroaki Tanaka ◽  
Naosuke Enomoto ◽  
Shintaro Maki ◽  
Tomoaki Ikeda
Keyword(s):  
Heart Rate ◽  
Controlled Release ◽  
Vaginal Delivery ◽  
Delivery System ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Cervical Ripening ◽  
Emergency Cesarean ◽  
Uterine Hyperstimulation ◽  
Uterine Relaxation

The PROPESS, a controlled-release dinoprostone vaginal delivery system, is a pharmacological cervical ripening intervention and promotes cervical change causing uterine contraction. During insertion of the PROPESS, uterine hyperstimulation could occur and result in fetal heart rate (FHR) abnormality. We report a case of uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS in a pregnant woman. Postural change, oxygenation, fluid infusion, and the immediate PROPESS removal were ineffective to address the adverse event, so we administered nitroglycerin for acute uterine relaxation. The nitroglycerin resulted in uterine relaxation, and the FHR abnormality was resolved immediately, thereby preventing an emergency cesarean section. Therefore, nitroglycerin could be considered an effective option for uterine hyperstimulation accompanied with FHR abnormality caused by the PROPESS.

Thrombolytic Treatment During Pregnancy

1981 ◽  
Author(s):  
H Ludwig ◽  
H J Genz
Keyword(s):  
Heart Rate ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Oral Anticoagulants ◽  
Initial Dosage ◽  
Clinical Signs ◽  
Fetal Outcome ◽  
Vein Thrombosis ◽  
Complete Restoration ◽  
Fetal Malformations

The treatment of occlusive deep vein thrombosis during pregnancy with fibrinolytic agents as streptokinase and urokinase is still controversial. The main points of controversy are retroplacental bleeding, fetal heart rate acceleration and malformations of the fetus. The main author conducted 122 therapeutic fibrinolytic treatments during pregnancy since 1961. The earliest beginning of treatment was the 14th week, the latest the 38th week of pregnancy. The indications to all treatments in these cases was an acute thrombotic occlusion of one or both ileofemoral veins in pregnant women. The diagnosis was established by clinical signs and, since 1975 by ultrasonography (n = 63). The treatment regimen was previously designed with the use of medium large doses of streptokinase in prolongation of an initially high dosage (1000,000 IU), later on 63 cases were treated by the following scheme: Initial dosage 1.5 - 1000,000 IU streptokinase within 30 minutes i.v. by monitored infusion, followed by an hourly dosage of not more than 250,000 IU streptokinase for 24 to 48 hours. An initial raise of body temperature occured in 28% of all cases. The fetal heart rate was watched by cardiotocography so far the pregnancy was beyond the 28th week. The success rate of all cases was 72%, indicating the complete restoration of the vessel's patency, 18% responded partially, 10% did not respond at all. 55% of all cases were examined by phlebography some days after delivery, the others were checked by clinical examination only or by ultrasonography respectively. The postfibrinolytic treatment in all cases consisted in the application of heparin in the dosage of 20,000 to 40,000 IU/24 hours for at least two weeks, approximately 60 percent of the cases received oral anticoagulants for further five weeks. Complications: One premature rupture of the membranes with healthy child, one premature separation of the well situated placenta with fatal fetal outcome, two severe bleedings during the treatment which made ar. emergency delivery by cesarean section necessary. Streptokinase was then neutralized by AM- CA. No fetal malformations were observed.

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