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Chapter 22 - Fetal Assessment

from Part IV - SPECIAL ISSUES

Published online by Cambridge University Press:  07 May 2010

John Patrick O'Grady ,
Martin L. Gimovsky ,
Lucy A. Bayer-Zwirello  and
Kevin Giordano
By
Barry S. Schifrin  and
Wayne R. Cohen
John Patrick O'Grady
Affiliation:
Tufts University, Massachusetts
Barry S. Schifrin
Affiliation:
Director, Maternal-Fetal Medicine Tarzana Regional Medical Center Tarzana, California
Wayne R. Cohen
Affiliation:
Professor, Department of Obstetrics and Gynecology Weill Cornell Medical Center New York, New York
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Summary

This chapter focuses primarily on surveillance during the intrapartum period using electronic fetal heart rate (FHR) monitoring and ancillary techniques of fetal evaluation, including capillary blood sampling, pulse oximetry, and automated electrocardiographic (ECG) analysis of ST waveform changes in refining the evaluation of moderately abnormal FHR pattern. It is critical to the understanding of FHR patterns that in the presence of uterine contractions, any fetal hypoxia is reflected by the appearance of decelerations before a rise in the baseline rate or decrease in variability. In the evaluation of decelerations, recovery from a deceleration sequence means a return to the previously normal baseline rate and variability. There is universal agreement that the frequency of decelerations increases dramatically in the second stage of labor, probably because of the effects of frequent uterine contractions and maternal expulsive forces on the fetal head and the cord.
Type
Chapter
Information
Operative Obstetrics , pp. 683 - 724
Publisher: Cambridge University Press
Print publication year: 2008

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