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Critical Care Obstetrics part 63

Critical Care Obstetrics part 63 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Fetal Considerations in the Critically Ill Gravida absent but 5 bpm into one category known as diminished FHRV 6 bpm . Similarly the CIPF approach merges the NICHD criteria of moderate 6-25 bpm and marked 25bpm into their average FHRV classification. Regardless of the approach used the more simplified approach of the CIPF or the more complicated one of the NICHD a uniform approach for the classification of FHR variability should be used in your institution and established by the Department of Obstetrics and Gynecology. Decreased FHRV 6 bpm in and of itself is not an ominous observation. In most cases the diminished FHRV represents normal fetal physiologic adjustments to a number of medications illicit substances or simply behavioral state changes such as 1F to 4F 26 . For example narcotic administration 27 or magnesium sulfate infusion 28 can alter FHRV by inducing a change in the behavioral state of the fetus to one of a sleep state or behavioral state 1F. Clinically diminished FHRV appears to be clinically significant in cases of the Hon pattern of intrapartum asphyxia 11-13 . As observed herein Figures 43.1-43.3 the FHR pattern was first reactive and exhibited a normal baseline rate. Subsequently the FHR pattern changed. Then the diminished FHRV was associated with a loss of FHR reactivity a substantial rise in the baseline FHR a FHR tachycardia and repetitive FHR decelerations. Under these circumstances the potential for fetal asphyxia is increased. Additionally the presence of diminished FHRV 24 in the setting of the Hon pattern of intrapartum asphyxia is associated with significantly higher rates of neonatal cerebral edema. Sinusoidal fetal heart rate pattern A sinusoidal FHR pattern is defined as a persistent regular sine wave variation of the baseline FHR that has a frequency of 3-6 cycles per minute 29 . The degree of oscillation correlates with fetal outcome 30 . For instance infants with oscillations of 25 bpm or more have a significantly greater .