The normal FHR range is between 120 and 160 beats per minute (bpm). The baseline rate is interpreted as changed if the alteration persists for more than 15 minutes. Prematurity, maternal anxiety and maternal fever may increase the baseline rate, while fetal maturity decreases the baseline rate.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
* These are Dr Gebresilassie's Amazing Notes.
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Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
blockage or problem in the urinary tract can mean urine is unable to drain from the kidneys or is able to flow the wrong way up into the kidneys. This can lead to a build-up of urine in the kidneys, causing them to become stretched and swollen.
An injury higher on the spinal cord can cause paralysis in most of your body and affect all limbs (tetraplegia or quadriplegia). A lower injury to the spinal cord may cause paralysis affecting your legs and lower body (paraplegia)
Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine. one shoulder being higher than the other.
Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.
With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.
About 4 out of 5 cases of acute pancreatitis improve quickly and don't cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure. In severe cases where complications develop, there's a high risk of the condition being fatal.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Background
• Monitoring the FHR intends to determine if a fetus is well
oxygenated because the brain modulates the heart rate.
• FHR monitoring = fetal brain monitoring
• 1980: 45 % of laboring women
• 1988: 74 % of laboring women
• 2002: 85 % of laboring women
06/05/2020
2
3. • Low risk EFM
• review every 30 min. in first stage of labor
• review every 15 min. in second stage of labor
• High risk EFM
• review every 15 minutes in first stage of labor
• review every 5 minutes in second stage of labor
• Long-term variability and short-term variability are
visually determined and considered one entity.
06/05/2020
3
4. Baseline Fetal Heart Rate
• Definition
– Average FHR rounded to 5 bpm
during a 10 minute period, but
excludes
• Periods of marked increased
FHR variability
• Segments of baseline that
differs by more than 25 bpm
– Must compromise at least 2
minutes out of 10 minute segment
– Normal range is 110 – 160 bpm
(NICHD)
– Always documented as a range
06/05/2020
4
5. Fetal Heart Rate Baseline
– Set by atrial pacemaker
– Balanced interplay of sympathetic and
parasympathetic autonomic nervous system
– Developing parasympathetic nervous system
slows baseline during advancing gestational
age
– Ideally assess baseline when: fetus not moving,
fetus not stimulated, between contractions
06/05/2020
5
6. Fetal Tachycardia
• Definition
– Baseline FHR of 160 bpm or greater > 10 minutes (NICHD)
• Description
– Increase in sympathetic and / or decrease in parasympathetic tone,
sometimes associated with decrease in FHR variability
• Etiology
– Fetal hypoxia
– Maternal fever
– Drugs
– Amnionitis
– hyperthyroidism
– Fetal anemia
06/05/2020
6
7. Fetal
tachycardia
• Significance
– Usually hypoxemia is not the reason, especially
in a term fetus and a identifiable cause such as
maternal fever or drugs
– Can be a non reassuring sign if associated with
late decelerations or absent variability
– If > 220 bpm consider SVT
• Intervention
– Maternal fever : can be reduced by antipyretics
and IV hydration
– Maternal oxygenation : supersaturation with O2
by facemask
– NRFS : expeditiously deliver
06/05/2020
7
8. Fetal
Bradycardia
• Definition
– FHR of 110 bpm or less for > 10 minutes
• Etiology
– Late (profound) fetal hypoxemia
– Beta blocker
– Anesthetics
– Maternal hypotension
– Prolonged umbillical cord compression
06/05/2020
8
9. Fetal
bradycardia
• Clinical significance
– Associated with loss of variability or late
decellerations : NRFS
– Substantial bradycardia (< 90 bpm)
especially if prolonged and
uncorrectable is a sign of impending
fetal acedemia
– Mild bradycardia 90-110 bpm with
moderate variability and absence of late
decelerations is generally reassuring
• Intervention: correction of underlying
etiology, if not correctable usually
emergent C/S
06/05/2020
9
10. Variability
• Definition
– Fluctuation in the
baseline FHR of 2 or more
cycles per minute
– Quantify amplitude as
follow:
– Absent : undetectable
– Minimal: 5 or less bpm
– Moderate: 6 to 25 bpm
– Marked: > 25 bpm
06/05/2020
10
11. Variability
• Description
– Normal irregularity of cardiac
rhythm
– Balancing interaction of the
sympathetic and parasympathetic
nervous system
– Results from sporadic impulses of
the cerebral cortex
– Moderate variability reflects an
intact neurological pathway,
optimal fetal oxygenation and
adequate tissue oxygenation
06/05/2020
11
12. Variability
• Short term variability
– Beat to beat change in
FHR from one heart beat
to the next
– Described as absent or
present
– Only measurable by FSE
– Controlled by
parasympathetic nervous
system
– Present STV: reassuring
for fetal oxygentation
06/05/2020
12
13. Variability • Long term variability
– Influenced by sympathetic nervous
system
– Visually examined of rise and fall of FHR
by counting of cycles within 1 minute
and determining amplitude
– Presence of LTV gives indication of fetal
oxygenation
• Generally LTV and STV increase or
decrease together, exceptions can be:
– Fetal sleep : minimal LTV, present STV
– Fetal anemia: moderate LTV, absent
STV
06/05/2020
13
14. Variability
• Marked variability
– Mild hypoxemia
– Fetal stimulation
(contractions, SVE, FSE…)
– Meds :Terbutalin, Albuterol
– Drugs: Cocaine,
methamphetamine, nicotine
Significance: unknown, not in itself a
sign of NRFS
Intervention: observe FHT for non
reassuring signs,
changes in baseline, consider FSE
06/05/2020
14
16. Variability • Significance and Intervention for
decreasedVariability
– Depends on cause
– No intervention if transient secondary to
fetal sleep cycle or CNS depressants
– If hypoxemia suspected : try to improve
fetal blood oxygenation:
• maternal positioning,
• hydration,
• correcting maternal hypotension,
• maternal oxygenation,
• elimination of uterine hyperstimulation
06/05/2020
16
17. Sinusoidal
Pattern
• Sine wave with undulating baseline
– Regular oscillation with an amplitude of 5-15
bpm
– 2 – 5 cycles per minute
– Minimal or absent short term variability
– Absence of accelerations
– Extreme regularity and smoothness
• Etiology: fetal hypoxemia from fetal anemia,
often secondary to Rh isoimunization
• Pseudosinusoidal pattern: sine wave is less
uniform and STV present (narcotics,
amnionitis, thumb sucking)
06/05/2020
17
18. Accelerations• Definition
– Abrupt increase in FHR above
baseline
– Onset to peak:< 30 seconds
– Peak : 15 bpm above most recent
baseline (32 weeks and more)
– Peak : 10 bpm above most recent
baseline (< 32 weeks)
– Duration (from increase to return
to baseline) : 15 seconds, but < 2
minutes
– Prolonged acceleration : 2- 10
minutes
– Acceleration > 10 minutes: new
baseline
06/05/2020
18
19. Acceleration • Description
– Episodic (spontaneous) accelerations
– Periodic accelerations (with contractions)
• Etiology
– Stimulation of sympathetic autonomous
nervous system
– Spontaneous fetal movement
– Vaginal examination
– Abdominal palpation
– Environmental stimuli (noise)
– Scalp or vibroacustic stimuli
– Uterine contraction
– Insertion of IUPC or FSE
06/05/2020
19
20. Acceleration • Clinical significance
– Sign of intact fetal nervous system and
reassuring FWB
– Some fetal monitors have movement
sensors
– Repetitive accelerations: contractions
compress umbilical cord and cause
transient fetal hypotension ->
baroreceptor-induced increase in FHR
06/05/2020
20
21. Decelerations • Early deceleration
• Late deceleration
• Variable deceleration
• Prolonged deceleration
06/05/2020
21
22. Early deceleration• Definition
– Gradual decrease (onset to nadir > 30sec) of FHR and return to baseline
– Nadir at time of uterine contraction peak
• Description
– shape: uniform, mirror image of contraction phase
– Onset: early in contraction
– Recovery: with return of contraction to baseline
– Deceleration: rarely < 110 bpm or 30 bpm below baseline
– Variability: usually moderate
– Occurrence: repetitious with each contraction, usually in active phase of labor or
passive 2nd stage
06/05/2020
22
23. Early deceleration
• Etiology
– Uterine contraction: Fetal head compression leads to
altered cerebral blood flow, leads to vagal stimulation
– CPD (especially when occurs early in labor)
– Persistent occiput posterior position
• Significance
– No pathologic significance
– Do not occur in all labors
06/05/2020
23
24. Late decelerations
• Definition
– Onset: late in contraction
phase, onset to nadir > 30 sec,
nadir after peak of contraction
– Recovery: returns to baseline
afterend of contraction
– Deceleration:rarely < 100
bpm, may be subtle (3-5 bpm)
– Variability: often associated
with decreased variability,
rising baseline or tachycardia
– Occurrence: repetitive with
each contraction
06/05/2020
24
25. Late Deceleration
• Physiology
– Uterine hyperacitivity or maternal hypotension
– Decreases intervillous space blood flow during
contraction
– Decreases maternal /fetal oxygen transfer
– Fetal hypoxia and myocardial depression
– Vagal response -> cardio deceleration
06/05/2020
25
27. Late
Deceleration
• Clinical Significance
– Non reassuring sign when persistent and
uncorrectable
– When associated with decreased
variability and /or tachycardia: sign of
fetal acidemia
– As myocardial depression increases,
depth of late deceleration decreases,
becoming more subtle
– Single deceleration is not clinical
significant if rest of tracing is reassuring
06/05/2020
27
28. Intervention for late
deceleration• Change maternal position to lateral
• Correct maternal hypotension
– Legs up, head down
– IV fluid bolus
– Vasopressors
• Correct uterine hyperstimulation
– Stop pitocin
– RemoveCervidil
– Consider tocolytic (0.2 – 0.5 mgTerbutalin iv)
• Hyperoxygentate maternal blood withO2
• Cervical exam
– Labor status
– Fetal scalp stimulation (only when FHR at baseline)
– Consider FSE
• If repetitive and uncorrectable : expeditious delivery
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29. Variable deceleration
• Characteristics
– Shape: variable, (V, U, W),
may not be consistent
– Onset: onset to beginning
of nadir (< 30 seconds)
– Recovery: rapid return to
baseline
– Deceleration: > 15 bpm,
often > 100 bpm
– Duration : > 15 seconds, <
2 minutes
– Ocurrence: typically late in
labor with descent of head,
and in 2nd stage of labor
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31. Variable deceleration
• Etiology
– Maternal position (cord
between fetus and
pelvis)
– Cord around fetal neck or
other body part
– Short cord
– True knots
– Prolapsed cord
– Oligohydramnios
– After ROM
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32. Variable
deceleration
• Interpretation
– Progression is more important than absolute
parameters
• Grading
– mild
• < 30 seconds or
• > 70 bpm + 30-60 seconds or
• > 80 bpm for any duration
– moderate
• <70 bpm + 30-60 seconds
• 70-80 bpm for > 60 seconds
– severe
• < 70 bpm for > 60 seconds
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33. Variable
decleration
• Reassuring features
– Mild to moderate variable deceleration
– Rapid return to baseline
– Normal, not increasing baseline
– Moderate variability
• Non-reassuring features
– Severe variable deceleration
– Prolonged return to baseline
– Increasing baseline
– Absent or minimal variability
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34. Prolonged deceleration
• Definition
– >15 bpm for > 2 minutes, < 10
minutes
• Characteristics
– Shape: variable
– Deceleration: almost always
below normal FHR range, exept
in fetus with tachycardia
– Variability: often lost
– Recovery: often followed by
period of late deceleration and
or rebound tachycardia
– Some fetuses don’t recover->
terminal bradycardia
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35. Prolonged deceleration
• Etiology
– Cord prolapse
– Maternal hypotension (supine or regional anesthesia)
– Tetanic uterine contractions
• Pitocin
• Abruption
• cocaine
– Maternal hypoxemia
• Seizures
• Narcotic overdose
• Magnesium sulfate toxicity
• High spinal anesthetic
– Fetal head compression or stimulation can produce strong vagal response
• FSE, pelvic exam, sustained maternal Valsalva, rapid fetal descent
• Significance : Depending on recovery and post deceleration FHR tracing
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36. Meta-analysis of 9 RCT
comparing EFM to
auscultation
• EFM increased the overall C/S rate (OR 1.5) and C/S rate for
suspected fetal distress (OR 2.5)
• EFM increased the use of vacuum assisted (OR 1.2) and
forceps assisted (2.4) operative vaginal delivery
• EFM use did not reduce overall perinatal mortality (OR 0.8,
CI 0.57-1.33), but perinatal mortality caused by fetal
hypoxia appeared to be reduced (OR 0.4)
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37. Does EFM reduce cerebral palsy ?
• The positive predictive value of a nonreassuring pattern to
predict cerebral palsy among singeltons with birth weights >
2500 g is 0.14 %
• Out of 1000 fetuses with a nonreassuring FHR pattern only 1-2
will develop CP.
• False positive rate is 99%
• Available data suggests EFM does not reduce CP.
• Occurrence of CP has been stable over time despite widespread
introduction of EFM
• 70 % of CP cases occur before onset of labor
• 4% only can solely attributed to intrapartum events
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38. What medications affect the FHR ?
• Epidural : can lead to sympathetic blockage ->
maternal hypotension -> transient uteroplacental
insufficiency -> alterations in FHR
• Parenteral narcotics : decreased FHR variability, less
accelerations
• Corticosteroids : transiently decreases FHR variability
with return by the 4.-7. day and may reduce rate of
accelerations.
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