Review

Authors: A C Alves, J G Cecatti, R T Souza...

This narrative review addresses resilience and stress during pregnancy, which is part of a broader concept of maternal health. Pregnancy and postpartum are opportune periods for health promotion interventions, especially because the close contact of the women with health professionals. In this way, it can be considered a useful window of opportunity to identify women at higher risk for adverse outcomes. Integrated health is a concept that aims at providing comprehensive care related to the promotion of individuals' physical, mental, and social well-being. In this context, stress during pregnancy has been targeted as a remarkable condition to be addressed whether due to individual issues, social issues, or specific pregnancy issues, since it is directly and indirectly associated with pregnancy complications. Stress is associated with preterm birth, postpartum depression, anxiety, child neurodevelopment, and fetal distress. The way that an individual faces a stressful and adverse situation is called resilience; this reaction is individual, dynamic, and contextual, and it can affect maternal and fetal outcomes. Low resilience has been associated with poorer pregnancy outcomes. The social context of pregnancy can act as a protective or contributory (risk) factor, indicating that environments of high social vulnerability play a negative role in resilience and, consequently, in perceived stress. A given stressor can be enhanced or mitigated depending on the social context that was imposed, as well as it can be interpreted as different degrees of perceived stress and faced with a higher or lower degree of resilience. Understanding these complex mechanisms may be valuable for tackling this matter. Therefore, in the pregnancy-puerperal period, the analysis of the stress-resilience relationship is essential, especially in contexts of greater social vulnerability, and is a health-promoting factor for both the mother and baby.

Topics: Anxiety; Depression, Postpartum; Female; Fetal Distress; Fetus; Humans; Infant, Newborn; Maternal Health; Parturition; Perinatal Care; Pregnancy; Pregnancy Complications; Premature Birth; Resilience, Psychological; Social Vulnerability; Stress, Psychological

PubMed: 34434079
DOI: 10.1155/2021/9512854

Review

Authors: Sofie Hjortø, Lone Skov, Jacob Alexander Lykke...

The specific dermatoses of pregnancy are rare and consist of pemphigoid gestationis (PG), intrahepatic cholestasis of pregnancy (ICP), polymorphic eruption of pregnancy and atopic eruption of pregnancy. The dermatoses are characterized by pruritus, and they are important to recognize since PG and ICP increase the risk of prematurity, fetal distress and stillbirth. Diagnosis is based on medical history, morphology, blood sample and biopsy. The dermatoses are treated with respectively ursodeoxycholic acid (in case of ICP) and steroids. Breast-feeding is recommended and induction of labour is not normally indicated.

Topics: Cholestasis, Intrahepatic; Dermatitis, Atopic; Female; Fetal Death; Fetal Distress; Humans; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Pruritus; Risk Factors

PubMed: 25294508
DOI: No ID Found

Authors: Diana Labastida-García, Guzmán Díaz-Gabriel, Fernando López-Díaz...

BACKGROUND

Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD.

METHODS

We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2.

RESULTS

Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity.

CONCLUSIONS

Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.

Topics: Female; Pregnancy; Infant, Newborn; Humans; Lactic Acid; Cross-Sectional Studies; Fetal Distress; Resuscitation; Hypertension; Hydrogen-Ion Concentration

PubMed: 37703551
DOI: 10.24875/BMHIM.23000033

Authors: S M Yentis

Topics: Anesthesia, Obstetrical; Cesarean Section; Female; Fetal Distress; Humans; Pregnancy; Time Factors

PubMed: 12859462
DOI: 10.1046/j.1365-2044.2003.03349.x

Review

Authors: G Boog

Three different clinical patterns of acute fetal distress may be observed during labor: an ante-partum hypoxia with a persistent nonreactive and "fixed" fetal heart rate (FHR) on admission to the hospital, a progressive intra-partum asphyxia manifested, as the labor continues, by a substantial rise in baseline heart rate, a loss of variability and repetitive severe variable or late decelerations, and finally, as a result of a catastrophic event, a sudden prolonged FHR deceleration to approximately 60 beats per minute lasting until delivery. However the majority of fetuses with nonreassuring tracings of FHR are neurologically intact, as evidenced by the high false-positive rate of electronic fetal monitoring (EFM). Therefore the diagnosis of fetal distress must be corroborated by complementary methods, such as continuous recording of the fetal electrocardiogram or computed-assisted EFM, fetal pulse oximetry or fetal scalp sampling with immediate determination of blood gases or lactates. Defavorable outcome of an acute fetal distress leading to neonatal encephalopathy or death is best predicted by a persisting low Apgar score (<3) for more than 5 minutes and by a severe metabolic acidosis (umbilical artery pH<7,00 and base-excess>-12mmol/l).

Topics: Acute Disease; Apgar Score; Electrocardiography; Extraction, Obstetrical; Female; Fetal Death; Fetal Distress; Fetal Heart; Fetal Monitoring; Humans; Infant, Newborn; Oximetry; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prognosis; Reference Values; Resuscitation; Risk Factors; Severity of Illness Index; Time Factors

PubMed: 11598554
DOI: No ID Found

Review

Authors: E H Morrison

Peripartum emergencies occur in patients with no known risk factors. When the well-being of the fetus is in question, the fetal heart rate pattern may offer etiologic clues. Repetitive late decelerations may signify uteroplacental insufficiency, and a sinusoidal pattern may indicate severe fetal distress. Repetitive variable decelerations suggesting umbilical cord compression may be relieved by amnioinfusion. Regardless of the etiology of the nonreassuring fetal heart pattern, measures to improve fetal oxygenation should be attempted while options for delivery are considered. Massive obstetric hemorrhage requires prompt action. Clinical signs, such as painless bleeding, uterine tenderness and nonreassuring fetal heart patterns, may help to differentiate causes of vaginal bleeding that may or may not require emergency cesarean delivery. The causes of postpartum hemorrhage include uterine atony, vaginal or cervical laceration, and retained placenta. The challenge of managing shoulder dystocia is to effect a rapid delivery while avoiding neonatal and maternal morbidity. The McRoberts maneuver has been shown to be the safest and most successful technique for relieving shoulder dystocia. Eclampsia responds best to magnesium sulfate, supportive care and supplemental hydralazine or labetalol as needed for severe hypertension.

Topics: Algorithms; Decision Trees; Eclampsia; Emergencies; Family Practice; Female; Fetal Distress; Humans; Obstetric Labor Complications; Pregnancy; Risk Factors; Uterine Hemorrhage

PubMed: 9824957
DOI: No ID Found

Authors: Yongli Liu, Jinling Yan, Ruifen Jiao...

The clinical significance and correlation of cord blood NO, activin A levels, and middle cerebral artery (MCA)/umbilical artery (UA) with fetal distress are explored. 120 puerperae who delivered in the obstetrics department of our hospital from January 2021 to January 2022 are selected as the examination subjects. According to the diagnostic criteria of fetal distress, they are divided into 70 cases of fetal distress and 50 cases of normal delivery. The parameters of umbilical cord blood NO, activin A, UA, and MCA are contrast between the two sets, then the diagnostic value of umbilical cord blood NO and activin A combined with UA and MCA in fetal distress is analyzed. The experimental results show cord blood NO and activin A combined with UA and MCA have a high diagnostic value for fetal distress, and there is an extensive correlation with the occurrence of fetal distress, which provides a reliable clinical diagnosis of fetal distress in a timely manner.

Topics: Activins; Female; Fetal Blood; Fetal Distress; Humans; Middle Cerebral Artery; Nitric Oxide; Pregnancy; Ultrasonography, Prenatal; Umbilical Arteries

PubMed: 36034198
DOI: 10.1155/2022/2693776

Authors: Bharathi Muthu, Prabhu Manivannan, Murali Subbaiah...

INTRODUCTION

Different factors affect the quality and viability of cord blood stem cells, and therefore the efficacy of umbilical cord stem cell transplantation. Fetal distress is one factor affecting the quantity of CD34 cells in cord blood. This study was designed to compare the viability and yield of the umbilical cord blood stem cells of women who have undergone emergency lower segment caesarean section for fetal distress or for other causes.

MATERIALS AND METHODS

This cross-sectional analytical study was performed at a tertiary care hospital facility with a total sample size of 68: 34 participants had undergone emergency C-section for fetal distress, and 34 had undergone emergency C-section for other causes. Umbilical cord blood was collected ex-utero in a 350 mL bag with citrate-phosphate-dextrose solution with adenine. Three milliliter of blood were transferred to an ethylenediaminetetraacetic acid (EDTA) tube for cell counts and flow cytometry testing for CD34. The chi-square test was used to compare the total mononuclear cell, CD34, and viability between the groups.

RESULTS

The CD34 count [mean 4.9 versus 1.1 (× 10 cells/unit)] and total nucleated cell count [mean 14.2 versus 7.5 (× 10/unit)] were significantly higher in cord blood units collected from women who delivered by C-section for fetal distress (p-value <0.05). However, the volume of umbilical cord stem cells and viability of stem cells did not vary significantly based on the presence or absence of fetal distress (p-value >0.05).

CONCLUSION

The current study shows that umbilical cord blood collected during fetal distress has a significantly higher content of stem cells and total nucleated cells than the non-fetal distress group.

PubMed: 38763843
DOI: 10.1016/j.htct.2024.03.004

Review

Authors: Asma Khalil, Basky Thilaganathan

Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term. CPR is an independent predictor of intrapartum fetal distress, admission to the neonatal unit at term, stillbirth, perinatal death and neonatal morbidity. Raised uterine artery Doppler resistance in the third trimester is independently associated with significantly lower birthweight and CPR. The combination of the estimated fetal weight, CPR and uterine Doppler in the third trimester can identify the majority of fetuses at risk of stillbirth.

Topics: Female; Fetal Distress; Fetal Growth Retardation; Fetus; Humans; Infant, Newborn; Infant, Small for Gestational Age; Middle Cerebral Artery; Perinatal Death; Placenta; Pregnancy; Pregnancy Trimester, Third; Risk Assessment; Stillbirth; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries; Uterine Artery; Uterus

PubMed: 27720309
DOI: 10.1016/j.bpobgyn.2016.09.003

Review

Authors: A E P Heazell, J F Frøen

Maternal perception of fetal movements is widely used as a marker of fetal viability and well-being. A reduction in fetal movements is associated with fetal hypoxia, increased incidence of stillbirth and fetal growth restriction (FGR). Therefore, a reduction in fetal movements has been proposed as a screening tool for FGR or fetal compromise. The problem of this approach is that there is no widely accepted definition of reduced fetal activity or 'alarm limits', and pregnant women are currently given a wide range of non-evidence-based advice. We have reviewed the background of published definitions and their potential usefulness in screening. A formal meta-analysis of these studies is not possible due to variation in methodology and definitions of reduced fetal movements. Assessment of fetal movements using formal fetal movement counting has shown equivocal results. Importantly, in all studies, there was a decrease in perinatal mortality suggesting a beneficial role for raising maternal awareness of fetal movements. Most studies implemented limits to define reduced fetal movements based on small groups of high risk pregnancies and obsolete counting methodology. A single case-control study developed 'normal limits' in a low risk population, and successfully implemented it prospectively for screening. At present, there is no evidence that any absolute definition of reduced fetal movements is of greater value than maternal subjective perception of reduced fetal movements in the detection of intrauterine fetal death or fetal compromise. Further investigation is required to determine an effective method of identifying patients with reduced fetal movements and to determine the best subsequent management.

Topics: Female; Fetal Distress; Fetal Growth Retardation; Fetal Monitoring; Fetal Movement; Fetal Viability; Humans; Pregnancy

PubMed: 18393008
DOI: 10.1080/01443610801912618