Objectives This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum and intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing and intrapartum electronic fetal surveillance to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum and intrapartum care in Canada. Options Consideration has been given to all methods of fetal surveillance currently available in Canada. Outcomes Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. Evidence A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance both antepartum and intrapartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). Sponsor This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program.

https://www.glowm.com/pdf/Fetal%20health%20surveillance%20antepartum%20and%20intrapartum%20Consensus%20Guideline.pdf

Fetal health surveillance: antepartum and intrapartum consensus guideline.

OBJECTIVE
This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum and intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing and intrapartum electronic fetal surveillance to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum and intrapartum care in Canada.


OPTIONS
Consideration has been given to all methods of fetal surveillance currently available in Canada.


OUTCOMES
Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered.


EVIDENCE
A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance both antepartum and intrapartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care.


SPONSOR
This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program.

http://www.acmgo.com/archivos/sogc-2007-control-fetal.pdf

Fetal Health Surveillance: Antepartum and Intrapartum Consensus Guideline Abstract

Monitoring in Anesthesia and Perioperative Care: Fetal heart rate monitoring

Adult respiratory distress syndrome (ARDS) is rarely encountered in association with pregnancy, but with the decline in other causes of maternal death, is an increasingly important cause of mortality in obstetric patients. ARDS may result from a variety of different types of pulmonary injury; uniquely obstetric causes include preeclampsia, amnionitis-endometritis, obstetric hemorrhage, and tocolytic therapy. Crucial management issues include support of maternal oxygenation and cardiac output, myriad interactions between the pulmonary process and its treatment, with maternal and fetal physiology, and decision making regarding delivery. Our review of the literature suggests that, for the patient requiring antepartum intubation for ARDS, except at a very early gestational age or when pyelonephritis or varicella pneumonia is a cause of respiratory compromise, delivery will likely be required for maternal and/or fetal indications, and an early decision for delivery may be beneficial. Postpartum management is similar to treatment of the nonpregnant patient with ARDS, with aggressive attention to potential surgically correctable causes for infection. Maternal mortality rates are affected little by duration of intubation, and therefore prolonged mechanical ventilation is justified and appropriate for mothers with ARDS.

Adult Respiratory Distress Syndrome in Pregnancy: Report of Three Cases and Review of the Literature

Background and objective To investigate whether the administration of ketamine before induction with propofol produces a smaller decrease in arterial pressure.Methods Twenty-two patients were assigned to one of two groups to receive either propofol with ketamine (n = 11) or propofol alone (n = 11, control). Anaesthesia was induced with 2 mg kg−1 propofol and 0.5 mg kg−1 ketamine or 2 mg kg−1 propofol alone. Ketamine was administered 1 min prior to induction with propofol. Immediately after induction with propofol, vecuronium (0.15 mg kg−1) was administered. Four minutes after administration of vecuronium, tracheal intubation was performed. Anaesthesia was maintained using sevoflurane (0.5%) in 66% nitrous oxide until 3 min after intubation. Systolic, diastolic and mean arterial pressure and heart rate were recorded on arrival, directly before induction with propofol, prior to tracheal intubation, immediately after intubation and at 3 min after intubation.Results and conclusions Administration of ketamine before induction with propofol preserved haemodynamic stability compared with induction with propofol alone.

Intravenous ketamine attenuates arterial pressure changes during the induction of anaesthesia with propofol

The CST is one of the first forms of fetal surveillance; it is still the only form that tries to use the principle of induced stress to reveal marginal placental insufficiency. With the expansion of biophysical evaluation, there are many choices in antenatal testing. Clearly the CST should not be the only form of testing to follow high-risk pregnancies. However, its proved efficacy and close correlation with intrapartum monitoring make it an essential tool. With nipple stimulation techniques, it is an easy and quick method for evaluating the fetus. Clinicians who follow high-risk pregnancies need to understand fully the administration and proper interpretation of the CST.

The contraction stress test.

Fetal evaluation in early gestational ages.

Unexplained fetal baseline bradycardia in congenital panhypopituitarism

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The contraction stress test.

Fetal evaluation in early gestational ages.

Unexplained fetal baseline bradycardia in congenital panhypopituitarism