Best neonatal outcome following emergency cesarean delivery in nonreassuring fetal heart rate: General or a low-dose spinal anesthesia

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.

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Correlation of prolonged fetal heart rate decelerations and perinatal outcome among patients undergoing emergency cesarean section: Implication to standardizing management and notification guidelines

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.08.155 ◽

2019 ◽

Vol 234 ◽

pp. e3

Author(s):

Rendy Pratama ◽

Maria Constancia Ferraris

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Fetal Heart Rate ◽

Perinatal Outcome ◽

Fetal Heart ◽

Emergency Cesarean Section ◽

Emergency Cesarean

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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 ◽

10.3390/medicina57050478 ◽

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.

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Cesarean delivery at term for non-reassuring fetal heart rate tracing: risk factors and predictability

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1920914 ◽

2021 ◽

pp. 1-7

Author(s):

Emma J. Qureshey ◽

Hector Mendez-Figueroa ◽

Rachel L. Wiley ◽

Asha B. Bhalwal ◽

Suneet P. Chauhan

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Cesarean Delivery ◽

Fetal Heart Rate ◽

Fetal Heart

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Fetal Growth Restriction and Cesarean Delivery for Nonreassuring Fetal Heart Rate Tracing in the Late Preterm Period [15K]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000664456.24820.ba ◽

2020 ◽

Vol 135 ◽

pp. 117s

Author(s):

Ghamar Bitar ◽

Vanita Jain ◽

Kelly Ruhstaller ◽

Alexandra Mapp ◽

Anthony Sciscione

Keyword(s):

Heart Rate ◽

Cesarean Delivery ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Growth Restriction ◽

Late Preterm

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Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

Anesthesiology ◽

10.1097/aln.0000000000000601 ◽

2015 ◽

Vol 122 (4) ◽

pp. 736-745 ◽

Cited By ~ 103

Author(s):

Warwick D. Ngan Kee ◽

Shara W. Y. Lee ◽

Floria F. Ng ◽

Perpetua E. Tan ◽

Kim S. Khaw

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cardiac Output ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Adrenergic Receptor ◽

Neonatal Outcome ◽

Computer Controlled ◽

Double Blinded

Abstract Background: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. Methods: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. Results: Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. Conclusions: When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.

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Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0077 ◽

2015 ◽

Vol 43 (4) ◽

Cited By ~ 1

Author(s):

Nele Everaert ◽

Marc Coppens ◽

Peter Vlerick ◽

Geert Braems ◽

Patrick Wouters ◽

...

Keyword(s):

Heart Rate ◽

Retrospective Study ◽

Epidural Analgesia ◽

Fetal Heart Rate ◽

Neonatal Outcome ◽

Fetal Heart ◽

Uterine Activity ◽

Combined Spinal Epidural ◽

Spinal Epidural ◽

Intrathecal Space

AbstractWe retrospectively compared a protocol using sufentanil and ropivacaine intrathecally with a protocol in which only ropivacaine was administered intrathecally and sufentanil was used epidurally to evaluate whether banning sufentanil from the intrathecal space results in a decreased incidence of adverse fetal heart rate changes.Some 520 cardiotocographic tracings were examined for changes in fetal heart rate and uterine activity following two different protocols of combined spinal epidural analgesia. Charts were consulted for neonatal and labor outcome.When sufentanil was used epidurally instead of intrathecally, the incidence of adverse changes in fetal heart trace was less, demonstrated by a higher percentage of normal reassuring tracings (74.5% vs. 60.4% when sufentanil was used intrathecally; P=0.007), less tracings showing bradycardia (7.5% vs. 14.1%; P=0.035), and more tracings displaying 3 or more accelerations in fetal heart rate in 45 min (93.5% vs. 83.9%; P=0.003) together with less episodes of tachycardia (3.5% vs. 11.4%; P=0.005). There were no differences in labor and neonatal outcome.Based on fetal heart tracing, it seems favorable to ban sufentanil from the intrathecal compartment.

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Correlation of reduced amniotic fluid index with neonatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172320 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2401 ◽

Cited By ~ 1

Author(s):

Rachna Chaudhary ◽

Vandana Dhama ◽

Shakun Singh ◽

Madhumita Singh

Keyword(s):

Heart Rate ◽

Birth Weight ◽

Low Birth Weight ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Neonatal Death ◽

Neonatal Outcome ◽

Fetal Heart ◽

Birth Asphyxia ◽

Apgar Scores

Background: Amniotic fluid assessment is an essential part of evaluation of fetus health in terms of fetal distress, meconium aspiration, IUGR, Non-reassuring fetal heart rate patterns, birth asphyxia, low birth weight, low Apgar-scores and NICU Admissions.Methods: This prospective observational study included 200 antenatal patients of term gestation of which 100 cases with AFI<8 and 100 controls with AFI ≥8 but ≤ 15 were included in study. Ultrasonography and NST were done and results of both groups compared for the presence of meconium passage, non-reactive NST, birth asphyxia, low Apgar-scores, low birth weight, NICU admissions and neonatal deaths.Results: There was increased incidence of non-reactive NST (40% vs 12%), meconium stained (33% vs 10%) in oligohydramnios group. In cases 49% of patients had vaginal delivery while in controls 78%. 51% underwent LSCS in cases while in controls 22%. Apgar score <7 was found in 7% vs 4%. Birth weight was <2.5 kg in 35% vs 13%. NICU admissions in study group was 15% vs 11%. The neonatal death was similar in both cases groups.Conclusions: Oligohydramnios affect the neonatal outcome in terms of meconium stained liquor, non-reassuring fetal heart rate, low birth weight, birth asphyxia, low Apgar-scores and NICU Admissions and neonatal death but the difference was not statistically significant. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and decreased caesarean deliveries.

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