RESUMO
AIM: To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non-reassuring fetal heart-rate (FHR) pattern using conventional heart rate monitoring. METHODS: This was a prospective and randomized study, conducted between 2001 and 2004 at Pereira Rossell Hospital, Montevideo, Uruguay. The population consisted of 390 fetuses, in which intrauterine distress was diagnosed using electronic FHR monitoring. Of these, 197 were randomly assigned to the emergency delivery group and 193 to the fetal intrauterine resuscitation group. The inclusion criteria were: term singleton pregnancy, in labor, cephalic presentation, and no placental accidents. RESULTS: The time between randomization and birth was 16.9 +/- 7.6 min (mean +/- SD) for the emergency delivery group, and 34.5 +/- 11.7 min (mean +/- SD) for the resuscitation group. The relative risk (RR) of acidosis in the umbilical artery (pH < 7.1) in the emergency delivery group was 1.47 (0.95-2.27). The RR of base deficit < or =12 mEq/L in the emergency delivery group was higher than in the resuscitation group (RR = 1.48 [1.0-2.2], P = 0.04). When considering the need for admission to the neonatal care unit, the relative risk was higher in the emergency delivery group than in the resuscitation group (RR = 2.14 [1.23.3.74], P = 0.005). No maternal adverse effects were reported. CONCLUSION: Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects.
Assuntos
Parto Obstétrico , Fenoterol/uso terapêutico , Sofrimento Fetal/terapia , Tocólise , Tocolíticos/uso terapêutico , Descolamento Prematuro da Placenta/metabolismo , Acidose/metabolismo , Acidose/prevenção & controle , Índice de Apgar , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Feminino , Fenoterol/efeitos adversos , Sofrimento Fetal/metabolismo , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Tocólise/efeitos adversos , Tocólise/estatística & dados numéricos , Tocolíticos/efeitos adversos , Falha de Tratamento , Artérias Umbilicais/metabolismoRESUMO
C-reactive protein rises in blood in an acute-phase response in adults, children, and neonates. In a prospective study of the influence of perinatal asphyxia, premature rupture of membranes, hyperbilirubinemia, and respiratory distress syndrome on levels of C-reactive protein in the neonate, we detected no confounding effect on the rise of C-reactive protein level in infants with these pathologic perinatal conditions, as compared with the results of a control group.
Assuntos
Proteína C-Reativa/análise , Doenças do Recém-Nascido/metabolismo , Hemorragia Cerebral/metabolismo , Feminino , Sofrimento Fetal/metabolismo , Ruptura Prematura de Membranas Fetais/metabolismo , Humanos , Hiperbilirrubinemia/metabolismo , Recém-Nascido , Gravidez , Estudos Prospectivos , Valores de Referência , Síndrome do Desconforto Respiratório do Recém-Nascido/metabolismoRESUMO
Thirty cesarean section-delivered newborn were studied. Fifteen of them scored from 0 to 3 and, 8 and greater on the Apgar scale when measured at one and five minutes, respectively. The other 15 scored 8 or more at one minute and 9 at five minutes. Arterial electrolyte and blood gases were measured in samples obtained from the umbilical cord. The anion gap formula was then applied. The average weight of the depressed newborns was found to be less than for those of the control group. The mean gestational age for both groups was 39 weeks. The average values for electrolyte, bicarbonate and the anion gap were found to be practically the same in both groups. No correlation was found between the pH and the gap nor for the gap and the hydrogen ion concentration [H+]. The correlation between the gap and the bicarbonate was 0.78. No differences were seen between anion gap values for the newborn with lactic acidosis or hyperlactemia when compared to those of the control group. It is therefore concluded that the anion gap is not useful for the detection of newborns suffering from metabolic acidosis. Anion gap; bicarbonate; Apgar score; depressed neonates; metabolic acidosis.