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Acceleration: A visually apparent abrupt increase (onset to peak in <30 seconds) in the FHR.
These are mediated by the
sympathetic nervous system in response to fetal movements or scalp stimulation. • At ≥32 weeks gestation, an acceleration has a peak of >15 beats/min above baseline, with a duration of >15 seconds but < 2 min from onset to return. • At <32 weeks gestation, an acceleration has a peak of >10 beats/min above baseline, with a duration of >10 sec but <2 min from onset to return. Early deceleration: A visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction. These are mediated by parasympathetic stimu- lation and occur in response to head compression. • A gradual FHR decrease is defined as from the onset to the FHR nadir of >30 seconds. • The decrease in FHR is calculated from the onset to the nadir of the deceleration. • The nadir of the deceleration occurs at the same time as the peak of the contraction. Late deceleration: A visually apparent usually symmetrical gradual decrease and return of the FHR associated with a uterine contraction. These are mediated by either vagal stimulation or myocardial depression and occur in response to placental insufficiency. • A gradual FHR decrease is defined as from the onset to the FHR nadir of >30 seconds. • The decrease in FHR is calculated from the onset to the nadir of the deceleration. • The deceleration is delayed in timing, with the nadir of the deceleration occurring after the peak of the contraction. Variable deceleration: A visually apparent abrupt decrease in FHR. These are mediated by umbilical cord compression. • An abrupt FHR decrease is defined as from the onset of the deceleration to the begin- ning of the FHR nadir of <30 seconds. • The decrease in FHR is calculated from the onset to the nadir of the deceleration. • The decrease in FHR is >15 beats per minute, lasting >15 seconds, and<2 minutes in duration. Sinusoidal pattern: • A visually apparent, smooth, sine wave-like undulating pattern in FHR baseline with a cycle frequency of 3–5/min which persists for ≥20 min. Category I: FHR tracings are normal Criteria include all of the following: • Baseline rate: 110-160 beats/min • Baseline FHR variability: moderate • Late or variable decelerations: absent • Early decelerations: present or absent • Accelerations: present or absent Interpretation: strongly predictive of normal fetal acid-base status at time of observation Action: monitoring in a routine manner, with no specific action required Category II: FHR tracings are indeterminate These include all FHR tracings not categorized as category I or III, and may represent an appreciable fraction of those encountered in clinical care. Interpretation: not predictive of abnormal fetal acid-base status Action: evaluation and continued surveillance and reevaluation, taking into account the entire associated clinical circumstances Category III: FHR tracings are abnormal Criteria include absent baseline FHR variability and any of the following: • Recurrent late decelerations • Recurrent variable decelerations • Bradycardia • Sinusoidal pattern Interpretation: associated with abnormal fetal acid-base status at time of observation; requires prompt evaluation Action: expeditious intrauterine resuscitation to resolve the abnormal FHR pattern; if tracing does not resolve with these measures, prompt delivery should take place. AMNIOTIC FLUID INDEX The 4-quadrant amniotic fluid index test assesses in centimeters the deepest single vertical amniotic fluid pocket in each of the 4 quadrants of the uterus. The sum of the pockets is known as the amniotic fluid index, or AFI. Interpretation is as follows: <5 cm—oligohydramnios/ 5–8 cm—borderline/ 9–25 cm—normal/ >25 cm—polyhydramnios BIOPHYSICAL PROFILE (BPP): A complete BPP measures 5 components of fetal well-being: NST, amniotic fluid volume, fetal gross body movements, fetal extremity tone, and fetal breathing movements. The last 4 components are assessed using obstetric ultrasound. Scores given for each component are 0 or 2, with maximum possible score of 10 and minimum score of 0. • Score of 8 or 10—highly reassuring of fetal well-being. Management is to repeat the test weekly or as indicated. Fetal death rate is only 1 per 1,000 in the next week. • Score of 4 or 6—worrisome. Management is delivery if the fetus is >36 weeks or repeat the biophysical profile in 12–24 h if <36 weeks. An alternative is to perform a CST. • Score of 0 or 2—highly predictive of fetal hypoxia with low probability of false posi- tive. Management is prompt delivery regardless of gestational age. CONTRACTION STRESS TEST (CST):This test assesses the ability of the fetus to tolerate transitory decreases in intervillous blood flow that occur with uterine contractions. It uses both external FHR and contraction moni- toring devices and is based on the presence or absence of late decelerations. These are grad- ual decreases in FHR below the baseline with onset to nadir of ≥30 s. The deceleration onset and end is delayed in relation to contractions. If 3 contractions in 10 min are not spontane- ously present, they may be induced with either IV oxytocin infusion or nipple stimulation. This test is rarely performed because of the cost and personnel time required. The most com- mon indication is a BPP of 4 or 6. • Negative CST requires absence of any late decelerations with contractions. This is reassuring and highly reassuring for fetal well-being. Management is to repeat the CST weekly. Fetal death rate is only 1 per 1,000 in the next week. • Positive CST is worrisome. This requires the presence of late decelerations associ- ated with at least 50% of contractions. Fifty percent of positive CSTs are false positive (meaning the fetus is not hypoxemic). They are associated with good FHR variability. The 50% of true positives are associated with poor or absent variability. Management is prompt delivery. • Contraindications—CST should not be performed whenever contractions would be hazardous to the mother or fetus. Examples include previous classical uterine incision, previous myomectomy, placenta previa, incompetent cervix, preterm membrane rup- 1. Have a written breastfeeding policy that is regularly communicated to all health-care staff 2. Train all staff in skills necessary to implement this policy 3. Inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within an hour of birth 5. Show mothers how to breastfeed and how to sustain lactation, even if they should be separated from their infants 6. Feed newborns nothing but breast milk, unless medically indicated, and prioritize donor breast milk when supplementation is needed 7. Practice rooming-in, which allows mothers and newborns to remain together 24 hours a day 8. Encourage breastfeeding on demand 9. Give no artificial pacifiers to breastfeeding newborns 10. Help start breastfeeding support groups and refer mothers to them Advantage BF: Nutritional/ Immunological /Developmental /Psychological /Social /Economic /Environmental /Optimal growth and development Decrease risks for acute and chronic diseases First trimester care: Care team/Postpartum visits/Lactation support/Infant feeding plan/Reproductive life plan /Contraception/ Pregnancy complications /Cardiovascular risk assessment/ Mental health/ Postpartum problems /Chronic conditions CONDUCTION OF DELIVERY: Delivery of the head: The principles to be followed are to maintain flexion of the head, to prevent its early extension and to regulate its slow escape out of the vulval outlet. The patient is encouraged for the bearing-down efforts during uterine contractions. This facilitates descent of the head. Delivery of the shoulders: Not to be hasty in delivery of the shoulders. Wait for the uterine contractions to come and for the movements of restitution and external rotation of the head to occur Delivery of the trunk: After the delivery of the shoulders, the fore finger of each hand are inserted under the axillae and the trunk is delivered gently by lateral flexion.
Trends in Computer Science, Engineering and Information Technology First International Conference on Computer Science, Engineering and Information Technology, CCSEIT 2011, Tirunelveli, Tamil Nadu, India, September 23-25, 2