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Fetal Head (fetal + head)
Selected AbstractsFetal size in mid- and late pregnancy is related to infant alertness: The generation R studyDEVELOPMENTAL PSYCHOBIOLOGY, Issue 2 2009Jens Henrichs Abstract The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z -standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 51: 119,130, 2009 [source] Original Article: Predicting the outcome of induction of labourAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Ralph NADER Objective:, To test whether prediction of delivery outcome is feasible in post-term nulliparous pregnant women, using a published model and a locally produced model combining clinical and ultrasound assessment. Methods:, This is a prospective pilot study of 53 nulliparous women seen in a postdates clinic between 40 weeks four days and 41 weeks three days of gestation. They underwent a routine assessment including transabdominal ultrasound to determine amniotic fluid index, a Bishop score, and translabial ultrasound to determine the station of the fetal head at rest and bladder neck descent at rest and on valsalva. Additional information such as body weight at booking and current weight, height and a family history of caesarean section was obtained. Delivery outcome and labour details were obtained from the local obstetric database. Two models for prediction of delivery outcome were tested. Results:, Forty-nine complete datasets were analysed. Fourteen women had a normal vaginal delivery, 17 instrumental deliveries and 18 caesarean sections. A published model predicted the induction outcome in 62%. A local model using maternal age, body mass index, family history of caesarean section, station of the fetal head and bladder neck descent predicted vaginal delivery in 70% in our study. Conclusion:, Prediction of delivery outcome is of limited feasibility in post-term nulliparous pregnant women. Our locally produced model was successful in predicting vaginal delivery in 70% of women. Prediction of delivery outcome may not be sufficiently powerful to allow modification of current obstetric practice. [source] Role of a second stage partogram in predicting the outcome of normal labourAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Jayati K. BASU Background: Management of the second stage of labour is dictated by arbitrary time limits rather than true measures of progress. No partogram is available for second stage of labour. Objectives: To evaluate a partogram designed for use for the second stage of labour. Methods: This prospective cross-sectional analytical study included low-risk pregnant women with singleton fetuses with vertex presentations at term. From onset of the second stage, vaginal examinations were performed every 30 min until delivery. A scoring system developed by Sizer et al. was used based on station and position of fetal head. Scores were plotted on a second stage partogram and used to predict labour outcomes, such as duration of second stage and mode of delivery. Results: Of 79 women examined, 73 had spontaneous vaginal delivery. Of the remaining six, four required oxytocin infusion and other two required vacuum extraction. The median durations of the second stage of labour for primigravidas (n = 34) and multigravidas (n = 45) were 35 and 25 min, respectively. The median Sizer's partogram score at the onset of second stage was 4. Multiple regression analysis showed that the partogram score (r2 = 0.27) and gravidity (r2 = 0.10) were independent predictors of duration of the second stage. There was a significant association between second stage progress plotted to the right of the partogram line and non-spontaneous delivery (P = 0.01). Conclusion: The second stage partogram score at onset can predict the duration of second stage. Poor progress plotted on the partogram is associated with non-spontaneous delivery. [source] External cephalic version induced fetal cerebral and umbilical blood flow changes are related to the amount of pressure exertedBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2004Tak Yeung Leung Objective To correlate the applied pressure during external cephalic version with the changes in fetal middle cerebral arterial and umbilical arterial flow before and after the procedure. Design A prospective observational study over a two-year period. Setting External cephalic version was performed in a university hospital. Population Sixty-nine women with singleton breech-presenting pregnancy at or above 36 weeks of gestation undergoing external cephalic version. Methods During external cephalic version, the operator wore a pair of pressure-sensing gloves which had thin piezo-resistive sensors positioned on the palmar surface. During each version procedure, real-time pressure readings were recorded from all sensors, and then analysed with a computer program. The amount of pressure applied over time was presented by pressure,time integral. The pulsatility indices of both fetal middle cerebral artery and umbilical artery before and after external cephalic version were measured. The changes of pulsatility indices of both middle cerebral artery and umbilical artery were presented as a ratio of the post-external cephalic version pulsatility indices to pre-external cephalic version pulsatility indices, denoted by middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio, respectively. The statistical correlation between pressure,time integral and middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio are analysed using Pearson's correlation test. Main outcome measures Changes in pulsatility indices of fetal middle cerebral and umbilical arteries and fetal heart rate after external cephalic version. Results The overall success rate of external cephalic version was 77%. There was a significant negative correlation between pressure,time integral and both middle cerebral artery pulsatility index ratio (P= 0.001) and umbilical artery pulsatility index ratio (P= 0.012). When women were categorised according to placental site, pressure,time integral was negatively correlated with middle cerebral artery pulsatility index ratio only when the placenta was posteriorly located (P= 0.003), and with umbilical artery pulsatility index ratio only when the placenta was laterally located (P= 0.03). Conclusions The greater the force applied during external cephalic version, the greater the reduction in pulsatility indices of middle cerebral artery and umbilical artery, indicating an increase in blood flow through these arteries. The increase in cerebral blood flow after external cephalic version is more prominent when the placenta is lying posteriorly, while the increase in umbilical flow is more prominent when the placenta is lying laterally. These findings suggest that the vascular changes probably represent a direct effect of force exerted on the fetal head and the placenta. [source] A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2002Myra Fitzpatrick Objective To assess the effects of delayed vs immediate pushing in second stage of labour with epidural analgesia on delivery outcome, postpartum faecal continence and postpartum anal sphincter and pudendal nerve function. Design Prospective, randomised, controlled trial. Setting Tertiary referral maternity teaching hospital. Population One hundred and seventy nulliparous women randomised at full dilatation to immediate or delayed pushing. Methods A total of 178 nulliparous women, all with continuous epidural analgesia, were randomised at full cervical dilatation, but before the fetal head had reached the pelvic floor, to either immediate pushing or 1 hour delayed pushing. Labour outcome was analysed and all women underwent postpartum assessment of anal sphincter function, including anal manometry. Those women who had a normal delivery underwent neurophysiology studies, while those women who had an instrumental delivery underwent endoanal ultrasound. Main outcome measures Mode of delivery; altered faecal continence. Results Ninety women were randomised to immediate pushing and 88 to delayed pushing. The spontaneous delivery rate was 56% (50/90) in the immediate pushing group and 52% (46/88) in the delayed pushing group. Mean duration of labour for the immediate pushing group was 427 minutes compared with 480 minutes for the delayed pushing group (P= 0.005). Eighty-four percent (76/90) of women in the immediate pushing group received oxytocin to augment labour, 21/76 (28%) in the second stage only. Eighty-one percent (71/88) of women in the delayed pushing group received oxytocin to augment labour, 22/71 (31%) in the second stage only. Fetal outcome did not differ between the two groups. Episiotomy rates were 73% and 69% in the immediate pushing and delayed pushing groups, respectively. 26% (23/90) of the immediate pushing group and 38% (33/88) of the delayed pushing group complained of altered faecal continence after delivery (NS). Manometry, ultrasound and neurophysiology studies did not differ significantly between the two groups. Overall, 55% of women after instrumental delivery had endosonographic evidence of damage to the external anal sphincter, while 36% of women after spontaneous delivery had abnormal neurophysiology studies. Conclusions Rates of instrumental delivery were similar following immediate and delayed pushing, in association with epidural analgesia. Delayed pushing prolonged labour by 1 hour but did not result in significantly higher rates of altered continence or anal sphincter injury, when compared with immediate pushing. [source] The ,sacral hand wedge': a cause of arrest of descent of the fetal head during vacuum assisted deliveryBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2002Aldo Vacca During a study of 108 vacuum assisted deliveries, a fetal hand was detected in the pelvic space between the head and maternal sacrum in seven of the procedures. The larger presenting diameters resulting from the compound fetal presentations were reflected in a greater number of pulls and higher traction forces recorded during the deliveries. In all cases, extraction of the hand facilitated the completion of birth without causing serious injury to the fetus or maternal perineum. It is recommended that a digital examination to detect the presence of a fetal hand in the sacral space should become a part of standard vacuum delivery practice. [source] Factors affecting outcomes of prenatally-diagnosed tumoursPRENATAL DIAGNOSIS, Issue 5 2002K. L. Chan Abstract Objective The outcomes of prenatally-diagnosed tumours affect obstetrical management and parental decisions. The present study reviews the factors affecting outcomes for fetuses with prenatally-diagnosed tumours. Methods Medical records of all fetuses referred to our institutions with antenatally-diagnosed tumours were reviewed for the type and location of the tumours, results of treatment and/or causes of death. Results From January 1994 to May 2001, there were 15 fetuses with antenatally- diagnosed tumours: mesoblastic nephroma (MN) (n=2); neuroblastoma (NB) (n=2); cystic hygroma (CH) (n=3); intracranial germ cell tumour (IGCT) (n=2); sacrococcygeal teratoma (SCT) (n=3) and haemangioma (liver, n=2; limb, n=1). One mother had termination of pregnancy for her fetal SCT. Three mothers had Caesarean section for large fetal heads (CH, n=2; IGCT, n=1). Three fetuses died; two with IGCT and one with SCT, who died of heart failure. Two newborns with CH needed emergency intubation and, later, one of them had tracheostomy. One baby had cardiac failure resulting from a lower limb haemangioma and needed drug therapy. All solid tumours (MN, NB, SCT) of the live births had no recurrence after surgery with or without adjuvant chemotherapy. Conclusion Prenatally-diagnosed tumours without any other associated abnormality cause morbidity and mortality because of their location and vascularity. Solid tumours are relatively benign. Copyright © 2002 John Wiley & Sons, Ltd. [source] | ||||||||||