Fetal Testing: Nonstress Test, Amniotic Fluid Assessment, and Biophysical Profile
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SUBCHORIONIC HEMATOMA OR SUBCHORIONIC CLOT Val Catanzarite, MD, Phd San Diego Perinatal Center 8010 Frost Street, Suite 300 San Diego, CA 92123 © 2008
SUBCHORIONIC HEMATOMA OR SUBCHORIONIC CLOT Val Catanzarite, MD, PhD San Diego Perinatal Center 8010 Frost Street, Suite 300 San Diego, CA 92123 © 2008 What is a subchorionic hematoma or subchorionic clot? The “bag of waters” within the uterus is composed of two layers, called the chorion and the amnion. The inner layer, closer to the baby, is the amnion. The outer layer, which is normally against the uterine wall, is the chorion. The term “subchorionic clot” or “subchorionic hematoma” describes a blood clot between the bag of waters and the uterus. How does a subchorionic hematoma look on ultrasound? We see subchorionic hematomas or suspect subchorionic clots in perhaps 1% of pregnancies in the between 13 and 22 weeks. Most of these occur in women who have had vaginal bleeding. These must be distinguished from regions of nonfusion of the membranes to the wall of the uterus, which are very common prior to 16 weeks gestation. Findings which suggest a bleed or hematoma rather than membrane separation include irregular texture to the material seen beneath the membranes, a speckled rather than uniform appearance to the amniotic fluid. The image at left shows a crescent shaped subchorionic clot, indicated by the arrows. The image at right shows a larger, rounded subchorionic clot. Both women had experienced bleeding episodes during the prior week, and had passed blood clots. On rare occasions, we will be able to see the source of the bleeding beneath the membranes. Usually, we cannot. This image is of a region of nonfusion of the membranes, also called chorioamniotic separation. -
Prenatal and Preimplantation Genetic Diagnosis for Mps and Related Diseases
PRENATAL AND PREIMPLANTATION GENETIC DIAGNOSIS FOR MPS AND RELATED DISEASES Donna Bernstein, MS Amy Fisher, MS Joyce Fox, MD Families who are concerned about passing on genetic conditions to their children have several options. Two of those options are using prenatal diagnosis and preimplantation genetic diagnosis. Prenatal diagnosis is a method of testing a pregnancy to learn if it is affected with a genetic condition. Preimplantation genetic diagnosis, also called PGD, is a newer technology used to test a fertilized embryo before a pregnancy is established, utilizing in vitro fertilization (IVF). Both methods provide additional reproductive options to parents who are concerned about having a child with a genetic condition. There are two types of prenatal diagnosis; one is called amniocentesis, and the other is called CVS (chorionic villus sampling). Amniocentesis is usually performed between the fifteenth and eighteenth weeks of pregnancy. Amniocentesis involves inserting a fine needle into the uterus through the mother's abdomen and extracting a few tablespoons of amniotic fluid. Skin cells from the fetus are found in the amniotic fluid. These cells contain DNA, which can be tested to see if the fetus carries the same alterations in the genes (called mutations) that cause a genetic condition in an affected family member. If the specific mutation in the affected individual is unknown, it is possible to test the enzyme activity in the cells of the fetus. Although these methods are effective at determining whether a pregnancy is affected or not, they do not generally give information regarding the severity or the course of the condition. -
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion
L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion. Purpose: Replacing the amniotic fluid with normal saline has been found to be a safe, simple, and very effective way to reduce the occurrence of repetitive variable decelerations. Procedure: Initiation of Amnioinfusion will be ordered and performed by a Certified Nurse Midwife (CNM) or physician (MD). 1. Prepare NS or LR 1000ml with IV tubing in the same fashion as for intravenous infusion. Flush the tubing to clear air. 2. An intrauterine pressure catheter (IUPC) will be placed by the MD/CNM. 3. Elevate the IV bag 3-4 feet above the IUPC tip for rapid infusion. Infuse 250-500ml of solution over a 20-30 minute time frame followed by a 60-180ml/hour maintenance infusion. The total volume infused should not exceed 1000ml unless one has access to ultrasound and can titrate to an amniotic fluid index (AFI) of 8-12 cm to prevent polyhydramnios and hypertonus. 4. If variable decelerations recur or other new non-reassuring FHR patterns develop, notify the MD/CNM. The procedure may be repeated as ordered. 5. Resting tone of the uterus will be increased during infusion but should not increase > 15mmHg from previous baseline. If this occurs, infusion should stop until there is a return to the previous baseline then it can be restarted. An elevated baseline prior to infusion is a contraindication. 6. Monitor for an outflow of infusion. If there is a sudden cessation of outflow fetal head engagement may have occurred increasing the risk of polyhydramnios. Complications are rare but can include iatrogenic polyhydramnios, uterine hypertonus, chorioamnionitis, uterine rupture, placental abruption, and maternal pulmonary embolus. -
Massive Subchorionic Haemorrhage: a Rare Case Report Associated with Secondary PPH Due to Uterine Artery Pseudoaneurysm
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Arumaikannu J et al. Int J Reprod Contracept Obstet Gynecol. 2017 Oct;6(10):4723-4726 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174475 Case Report Massive subchorionic haemorrhage: a rare case report associated with secondary PPH due to uterine artery pseudoaneurysm J. Arumaikannu*, S. Usha Rani, T. S. Aarifa Thasleem Institute of Obstetrics and Gynecology, Egmore, Chennai, Tamil Nadu, India Received: 08 August 2017 Accepted: 04 September 2017 *Correspondence: Dr. J. Arumaikannu, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Massive subchorionic hemorrhage is a rare but serious condition in pregnancy in which a large amount of blood, mainly maternal collects between the uterine wall and the chorionic membrane and may leak through the cervical canal. Although many associations have been reported, an underlying etiology has not been elucidated. Association of massive subchorionic hemorrhage with thrombophilias have been reported in few articles. We are reporting a case of massive subchorionic hemorrhage presented at 13 weeks of gestation associated with secondary post-partum hemorrhage due to uterine artery pseudoaneurysm. Keywords: Massive subchorionic haemorrhage, Secondary PPH, Uterine artery pseudoaneurysm INTRODUCTION hemorrhage in the second trimester may also compromise maternal health.2,3 During pregnancy, minor degrees of haemorrhage on the chorionic plate surface of the placenta are commonly A subchorionic hemorrhage can be considered large or identified on ultrasound assessment. -
Management of Prolonged Decelerations ▲
OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others. -
Unfavorable Progression of a Subchorionic Hematoma: a Case Report and Review of the Literature
GSC Biological and Pharmaceutical Sciences, 2020, 12(02), 074-079 Available online at GSC Online Press Directory GSC Biological and Pharmaceutical Sciences e-ISSN: 2581-3250, CODEN (USA): GBPSC2 Journal homepage: https://www.gsconlinepress.com/journals/gscbps (RESEARCH ARTICLE) Unfavorable progression of a subchorionic hematoma: A case report and review of the literature. Sofiane Kouas 1, *, Olfa Zoukar 2, Khouloud Ikridih 1, Sameh Mahdhi 1, Ichrak Belghaieb 1 and Anis Haddad 2 1Department of Gynecology and Obstetrics, Monastir Medical School, Monastir University, Gynecology-Obstetric Service Mahdia-Tunisia. 2 Department of Gynecology and Obstetrics, Monastir Medical School, Monastir University, El Omrane Hospital of Monastir-Monastir-Tunisia. Publication history: Received on 26 July 2020; revised on 06 August 2020; accepted on 09 August 2020 Article DOI: https://doi.org/10.30574/gscbps.2020.12.2.0242 Abstract A hematoma in the uterus or intrauterine hematoma is an effusion of blood that accumulates inside the uterine cavity during gestation. Hematomas, especially subchorionic hematomas, appear most often during the first trimester of pregnancy and can occur with or without vaginal bleeding. They are always a major cause for concern for pregnant women. We will consider pregnancy as a high risk pregnancy. It will then be necessary for the woman to keep rest and benefit from more exhaustive follow-up. This work, carried out from a case observed in our service and from a review of the literature, aims to highlight the existence of this entity and the possible unfavorable development with fetal and maternal risks. Keywords: Subchorionic hematoma; Ultrasound; Bleeding; Possible unfavorable course 1. -
A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction .............................................................................................................. -
Amniotic Fluid Volume: When and How to Take Action
Amniotic fluid volume: When and how to take action http://contemporaryobgyn.modernmedicine.com/pr... Published on Contemporary OB/GYN (http://contemporaryobgyn.modernmedicine.com) Amniotic fluid volume: When and how to take action Alessandro Ghidini, MD and Marta Schilirò, MD and Anna Locatelli, MD Publish Date: JUN 01,2014 Dr. Ghidini is Professor, Georgetown University, Washington, DC, and Director, Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia. Dr. Schilirò is Medical Doctor, Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy. Dr. Locatelli is Associate Professor, University of Milano-Bicocca, Monza, Italy, and Director, Department of Obstetrics and Gynecology, Carate- Giussano Hospital, AO Vimercate-Desio, Italy. None of the authors has a conflict of interest to report with respect to the content of this article. Assessment of amniotic fluid volume (AFV) is an integral part of antenatal ultrasound evaluation during screening exams, targeted anatomy examinations, and in tests assessing fetal well-being. 1 di 17 18/06/2014 11:10 Amniotic fluid volume: When and how to take action http://contemporaryobgyn.modernmedicine.com/pr... Abnormal AFV has been associated with an increased risk of perinatal mortality and several adverse perinatal outcomes, including premature rupture of membranes (PROM), fetal abnormalities, abnormal birth weight, and increased risk of obstetric interventions.1 A recent systematic review demonstrated associations between oligohydramnios, birthweight <10th percentile, and perinatal mortality, as well as between polyhydramnios, birthweight >90th percentile, and perinatal mortality. The predictive ability of AFV alone, however, was generally poor.2 How to assess AFV Ultrasound (U/S) examination is the only practical method of assessing AFV. -
Drug Use and Pregnancy
Rochester Institute of Technology RIT Scholar Works Theses 7-28-1999 Drug use and pregnancy Kimberly Klapmust Follow this and additional works at: https://scholarworks.rit.edu/theses Recommended Citation Klapmust, Kimberly, "Drug use and pregnancy" (1999). Thesis. Rochester Institute of Technology. Accessed from This Thesis is brought to you for free and open access by RIT Scholar Works. It has been accepted for inclusion in Theses by an authorized administrator of RIT Scholar Works. For more information, please contact [email protected]. ROCHESTER INSTITUTE OF TECHNOLOGY A Thesis Submitted to the Faculty of The College of Imaging Arts and Sciences In Candidacy for the Degree of MASTER OF FINE ARTS Drug Use and Pregnancy by Kimberly A. Klapmust July 28, 1999 Approvals Adviser: Robert Wabnitz Date: Associate Adviser. Dr. Nancy Wanek ~)14 Date: \\.\,, c Associate Advisor: Glen Hintz Date ]I-I, zJ Cf9 I 7 Department ChaiIWrson: _ Dale: 1//17._/c; '1 I, , hereby deny permission to the Wallace Memorial library of RIT to reproduce my thesis in whole or in part. Any reproduction will not be for commercial use or profit. INTRODUCTION Human development is a remarkably complex process whereby the union of two small cells can after a period of time give rise to a new human being, complete with vital organs, bones, muscles, nerves, blood vessels, and much more. Considering the intricacy of the developmental process, it is indeed miraculous that most babies are born healthy. Some children, however, are born with abnormalities. Environmental agents, such as drugs, are responsible for some of these abnormalities. -
Fetal Assement Methods
12/3/2020 Fetal Assement Methods 1 up to 9% of exam 5 to 9 questions 13.00 Adjunct Fetal Surveillance Methods 10%) 13.01 Auscultation (Intermittent Auscultation- IA) 13.02 Fetal movement counting 13.03 Nonstress testing 13.04 Fetal acid base interpretation – will be covered in a separate section 13.05 Biophysical profile 13.06 Fetal Acoustic Stimulation 2 1 12/3/2020 HERE IS ONE FOR YOU!! AWW… Skin to Skin in the OR ☺ 3 Auscultation 4 2 12/3/2020 Benefits of Auscultation • Based on Random Control Trials, neonatal outcomes are comparable to those monitored with EFM • Lower CS rates • Technique is non-invasive • Widespread application is possible • Freedom of movement • Lower cost • Hands on Time and one to one support are facilitated 5 Limitation of Auscultation • Use of the Fetoscope may limit the ability to hear FHR ( obesity, amniotic fluid, pt. movement and uterine contractions) • Certain FHR patterns cannot be detected – variability and some decelerations • Some women may think IA is intrusive • Documentation is not automatic • Potential to increase staff for 1:1 monitoring • Education, practice and skill assessment of staff 6 3 12/3/2020 Auscultation • Non-electronic devices such as a Fetoscope or Stethoscope • No longer common practice in the United States though may be increasing due to patient demand • Allows listening to sounds associated with the opening and closing of ventricular valves via bone conduction • Can hear actual heart sounds 7 Auscultation Fetoscope • A Fetoscope can detect: • FHR baseline • FHR Rhythm • Detect accelerations and decelerations from the baseline • Verify an FHR irregular rhythm • Can clarify double or half counting of EFM • AWHONN, (2015), pp. -
Cutoff Point Amniotic Fluid Index and Pregnancy Prognosis in the Third Trimester of Pregnancy in Shariati Hospital of Bandar Abbas in 2013-14
Available online at www.ijmrhs.com International Journal of Medical Research & ISSN No: 2319-5886 Health Sciences, 2016, 5, 12:212-216 Cutoff point amniotic fluid index and pregnancy prognosis in the third trimester of pregnancy in Shariati Hospital of Bandar Abbas in 2013-14 AzinAlavi 1, Najmesadat Mosallanezhad 1,Hosein Hamadiyan 2, Mohammad Amin Sepehri Oskooe 2 and Keivan Dolati 2* 1Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran 2Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran *CorrespondingEmail:[email protected] _____________________________________________________________________________________________ ABSTRACT Background and purpose of study: Amniotic fluid volume varies according to different stages of fetal growth and its different requirements. Disrupted amniotic fluid volume is associated with an increased risk for the fetus. The present research aims to investigate the effect of cutoff point amniotic fluid index on pregnancy prognosis at the third trimester of pregnancy in Shariati hospital of Bandar Abbas. Materials and methods: In the present analytical, cross-sectional research, AFI ≤ 5 cm was considered as oligohydramnios; AFI 5.1-8 was taken as the cut-off point; AFI ˃ 8.1-24 was regarded as normal; AFI ˃ 24 was considered as polyhydramnios. The data were analyzed via SPSS version 16.0 using Chi-squared test, Fisher’s test, Mann-Whitney U-test and Spearman’s correlation coefficient. P-value was set at ≤ .05 for the significance of data. Findings: Subjects with cut-off point AFI (5.1-8) were 38 (40.4%); those with normal AFI (8.1-24) were 56 (59.6%). The mean score of AFI was 8.85±9.54cm. -
Guidelines for Perinatal Care, 8Th Ed., Pp. 48-49, 198-205 ACOG Practice Bulletin, No 145, July 2014, Reaffirmed 2016 JOGNN, No
Guidelines for Perinatal Care, 8th ed., pp. 48-49, 198-205 ACOG Practice Bulletin, No 145, July 2014, Reaffirmed 2016 JOGNN, No. 44, pp. 683-686, 2015 Terminology and interpretation of electronic fetal monitoring tracings as defined by National Institute of Child Health and Development (NICHD) Maternal Health Competencies - Fetal Assessment & Antenatal Fetal Surveillance Fetal Heart Tones (Beginning at 10 Weeks Gestation with hand-held Doppler) 1. Review provider or standing order 2. Explain procedure and obtains patient's verbal consent 3. Perform hand hygiene prior to engaging with patient 4. Assist patient into semi-recumbent position, expose abdomen 5. Locate the point of loudest fetal heart tones and a. Palpate maternal pulse b. Utilize pulse oximetry (placed on maternal index finger) 6. Monitor maternal pulse and count fetal heart rate for 1 full minute 7. Record findings 8. Demonstrate knowledge of fetal heart rate ranges: a. Normal = 110-160 bpm b. Bradycardia = < 110 bpm c. Tachycardia = > 160 bpm 9. Demonstrate knowledge of criteria for notifying provider of concerns/findings before, during, or after assessment (per clinical policies) Fundal Height (Beginning at 12 to 14 Weeks gestation) 1. Review provider or standing order 2. Explain procedure and obtain patient's verbal consent 3. Perform hand hygiene prior to engaging with patient 4. Assist patient to semi-recumbent position, expose abdomen 5. Ensure the abdomen is soft and palpates with 2 hands to locate the uterine fundus 6. Measure from top of fundus to top of symphysis pubis using a pliable, non-elastic tape measure, keeping the tape measure in contact with the skin, and measuring along the longitudinal axis without correcting to the abdominal midline 7.