Fetal monitoring and predictions by clinicians: observations during a randomized clinical trial in very low birth weight infants

Article Abstract:

Electronic fetal monitoring, a device used to continuously monitor the fetal heart rate (FHR), is standard practice in obstetrical care; it contributes information that helps practitioners predict fetal well-being. FHR patterns can detect fetal distress and impending complications of labor and delivery. Abnormal FHR patterns can be used to determine effective medical interventions. However, the beneficial effect of electronic fetal monitoring on fetal mortality rate has been questioned. To study the effect electronic fetal monitoring has on predicting fetal well-being, predictions of infants with very-low-birth weights, 2.4-3.9 pounds (750-1,750 grams), were assessed. Practitioners were asked to predict the APGAR score, which evaluates fetal well-being at one and five minutes after birth, the pH of the fetal blood (a way to assess respiratory status of the infant), and the survival status of the infant at hospital discharge. Predictions were made before and after electronic fetal heart monitoring, fetal scalp sampling for pH and periodic fetal auscultation (using a stethoscope to hear the fetal heart). The only consistently correct assessment the physicians made before fetal heart monitoring was infant survival at discharge. The 5-minute APGAR score and blood pH predictions were correct in 92 percent of the very-low-birth-weight infants after electronic monitoring; predictions were correct in 61 percent after auscultation. These results reveal that more accurate predictions of APGAR and pH were made after electronic fetal heart monitoring, which provided useful information and helped practitioners make treatment decisions during labor and delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Birth weight, Low, Low birth weight, Fetal heart rate monitoring, Electronic fetal monitoring

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Once a cesarean?

Article Abstract:

Cesarean sections are used to delivery babies who, for various reasons, cannot be delivered vaginally. The procedure involves making an incision or cut in the abdomen and the uterus, so that the baby can be removed from the uterus through this opening. In the past, women who had cesarean sections and became pregnant again were usually delivered by cesarean section again (repeat cesarean). However, in recent years the attitude of obstetricians toward performing repeat cesarean sections has been changing. Today, women are being encouraged to attempt a normal labor with vaginal delivery even if they have had a cesarean delivery in the past. The idea of vaginal birth after cesarean section (VBAC) is not new, and it is common outside of the United States. VBAC is gaining popularity in the United States and it is hoped that it will reduce the number of cesarean sections that are performed. It is estimated that more than 25 percent of the babies born in the United States are now delivered by cesarean section, and the most common reason is previous cesarean delivery. Several studies of VBAC have been performed and concluded that two thirds or more of the women who have had cesarean sections can have normal labor with vaginal delivery. VBAC has several advantages over repeat cesarean, including reduced medical risk and reduced medical cost. However, in some cases, VBAC can cause the uterus to rupture and can cause damage or death to the fetus. Although VBAC is considered safe for most women, the potential complications should be considered before electing VBAC. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vaginal birth after cesarean, editorial

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Meconium aspiration syndrome without evidence of fetal distress in early labor before elective cesarean delivery

Article Abstract:

Meconium aspiration is the inhaling of the meconium, the mucous material in the intestines, by the fetus or newborn, which may result in lung disease. Seventy-seven cases were noted among 14,527 births. Four cases had normal heart readings and occurred in early labor. Three cases occurred at birth following a cesarean section delivery, and one followed an elective cesarean section that was done because the infant was presenting its buttock or feet first, an abnormal position called a breech presentation. Meconium aspiration may occur without evidence of breathing difficulties and before labor begins.

Care and treatment, Meconium aspiration syndrome

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