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1/13. Elevation of the fetal presenting part: A method of intrauterine resuscitation.

    Traditional methods of diagnosing fetal distress have become obsolete. This diagnosis should be suggested by fetal heart rate patterns that demonstrate recurrent late or severe variable decelerations. Based upon our understanding of these patterns, methods of treating fetal distress in utero have evolved. This paper presents several cases in which elevation of the fetal presenting part was employed in an attempt to improve severe variable decelerations. It is suggested that this might be a salutary procedure when other methods of intrauterine resuscitation have failed.
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keywords = deceleration
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2/13. The association of umbilical cord complications and variable decelerations with acid-base findings.

    Variable decelerations during the last 2 hours of labor were associated with an abnormally positioned umbilical cord at delivery in 52% of cases. In cases where an abnormally positioned umbilical cord was seen at delivery, 89% had been preceded by variable decelerations. Cord compression resulted in an A-V difference in pH that was significantly increased when compared to a control group. This was mainly due to a decrease in the pH of the umbilical artery. The pathophysiology of cord compression is discussed.
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keywords = deceleration
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3/13. Termination of supraventricular tachycardia with intravenous adenosine in a pregnant woman with wolff-parkinson-white syndrome.

    BACKGROUND: pregnancy is associated with an increased frequency of arrhythmias in women with wolff-parkinson-white syndrome. We describe the use of intravenous (IV) adenosine for the acute termination of a narrow complex tachycardia in a pregnant patient with this syndrome. CASE: A 26-year-old woman with known wolff-parkinson-white syndrome presented with dizziness, palpitations, and a narrow complex supraventricular tachycardia. We used IV adenosine to convert the arrhythmia to a normal sinus rhythm. During labor, the patient again developed a narrow complex supraventricular tachycardia, and fetal monitoring revealed recurrent deep variable decelerations. Intravenous adenosine resulted in conversion to sinus rhythm and restoration of the fetal heart rate to normal. Cesarean delivery produced a healthy male infant. CONCLUSIONS: adenosine is effective in rapidly terminating maternal narrow complex tachyarrhythmias before and during delivery in women with wolff-parkinson-white syndrome. It can also treat fetal bradycardia resulting from the maternal arrhythmia.
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keywords = deceleration
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4/13. Holy consent--a dilemma for medical staff when maternal consent is withheld for emergency caesarean section.

    A parturient (grand multipara) developed arrested labour complicated by severe fetal heart rate decelerations. Senior physicians explained the need for a caesarean section, but she chose to deliver vaginally since rabbinical blessing could not be obtained. Forcing the mother to have a cesarean section without consent is considered "civil battery." The dilemma faced by medical staff and the implications of her refusal for the treating medical staff are described.
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ranking = 0.5
keywords = deceleration
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5/13. Lumbar epidural anesthesia initiated in the knee-chest position.

    The knee-chest position may become necessary in labor to mitigate fetal heart rate decelerations. This position may also prove advantageous for initiation of lumbar epidural anesthesia. This case report demonstrates a clinical situation in which lumbar epidural anesthesia was initiated in the knee-chest position. A description of the technique is included.
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keywords = deceleration
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6/13. fetal heart rate accelerations in second-stage labour; two case reports.

    Two cases of umbilical cord compression are reported in which variable decelerations in the fetal heart rate in the first stage of labour progressed to marked periodic accelerations in the second stage. A respiratory acidosis was present at birth in both cases.
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ranking = 0.5
keywords = deceleration
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7/13. thrombosis of the right umbilical artery, presumably related to the shortness of the umbilical cord: an unusual cause of fetal distress.

    This case report concerns a late pregnancy complication, clinically apparent as severe variable decelerations in the first stage of labor. Emergency cesarean section delivered a mildly asphyxiated full-term newborn infant. Examination of the umbilical cord revealed a thrombus of the right umbilical artery, near the fetal side, confirmed by histological examination. The total length of the umbilical cord, only 30 cm, was below the limit necessary for uncomplicated delivery of the fetus near term. Transient stretching during fetal descent is thought to be responsible for constriction of the umbilical arteries, blood flow sludging and thrombosis. Although only a few cases have been reported, thrombosis of the umbilical vessels has to be considered whenever the fetal heart rate pattern shows unexplained variable decelerations.
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ranking = 1
keywords = deceleration
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8/13. Saline amnioinfusion for relief of variable or prolonged decelerations. A preliminary report.

    Variable decelerations are of frequent concern to the practicing obstetrician. oligohydramnios resulting in cord and/or placental compression is probably the most common cause of variable decelerations. We performed intrauterine saline amnioinfusion in 42 patients having repetitive variable or prolonged decelerations that did not respond to conventional therapy, such as maternal position changes and oxygen administration. Saline amnioinfusion was effective for relief of repetitive variable decelerations in 19 of 28 patients and prolonged decelerations in 12 of 14 patients. No neonatal or maternal complications occurred. This preliminary study suggests that amnioinfusion therapy may become a useful adjunct in the management of repetitive variable and prolonged decelerations.
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ranking = 5
keywords = deceleration
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9/13. Intrauterine rupture of the umbilical cord during delivery.

    Two cases of bleeding from ruptured umbilical vein during delivery are reported. In one case the rupture was spontaneous, leading to fetal distress. In the second case the rupture was probably iatrogenic, and was caused by forceps delivery. Bleeding from ruptured umbilical vessel should be considered when a combination of variable decelerations during fetal heart rate monitoring, blood-stained amniotic fluid and fetal distress are detected during delivery.
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ranking = 0.5
keywords = deceleration
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10/13. Sudden fetal death in labor. The significance of antecedent monitoring characteristics and clinical circumstances.

    Three patients experienced sudden fetal death in labor. The clinical presentations of the patients and their preceding monitoring patterns are discussed. A typical example of a benign, sustained deceleration in a healthy fetus is given for comparison. The characteristics of the clinical and monitoring behavior of the premorbid patient are discussed, and suggestions for appropriate responses to avoid fetal death are offered.
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keywords = deceleration
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