DRFM - e-Medicinafetal

Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage

Tue, 03 Apr 2012 16:38:20 GMT

Título : Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage

Autor : LEDUC MD, DEAN; LALONDE, ANDRÉ B. MD; SENIKAS, VYTA MD

Resumen : Objective: To review the clinical aspects of postpartum hemorrhage(PPH) and provide guidelines to assist clinicians in the preventionand management of PPH. These guidelines are an update fromthe previous Society of Obstetricians and Gynaecologists ofCanada (SOGC) clinical practice guideline on PPH, published inApril 2000.

Descripción : SOGC CLINICAL PRACTICE GUIDELINE. No. 235 October 2009 (Replaces No. 88, April 2000

Classification of urgency of caesarean section – A continuum of risk

Tue, 03 Apr 2012 16:24:56 GMT

Título : Classification of urgency of caesarean section – A continuum of risk

Autor : Royal College of Obstetricians and Gynaecologists

Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction

Tue, 03 Apr 2012 16:12:29 GMT

Título : Neurodevelopment following fetal growth restriction and its relationship with antepartum parameters of placental dysfunction

Autor : A. A. BASCHAT

Resumen : Placental dysfunction leading to fetal growth restriction(FGR) is an important risk factor for neurodevelopmentaldelay. Recent observations clarify that FGR evolvesprenatally from a preclinical phase of abnormal nutrientand endocrine milieu to a clinical phase that differsin characteristics in preterm and term pregnancies.Relating childhood neurodevelopment to these prenatalcharacteristics offers potential advantages in identifyingmechanisms and timing of critical insults. Based onavailable studies, lagging head circumference, overalldegree of FGR, gestational age, and umbilical artery(UA), aortic and cerebral Doppler parameters arethe independent prenatal determinants of infant andchildhood neurodevelopment. While head circumferenceis important independent of gestational age, overallgrowth delay has the greatest impact in early onsetFGR. Gestational age has an overriding negative effecton neurodevelopment until 32–34 weeks’ gestation.Accordingly, the importance of Doppler status isdemonstrated from 27 weeks onward and is greatest whenthere is reversed end-diastolic velocity in the UA or aorta.While these findings predominate in early-onset FGR,cerebral vascular impedance changes become importantin late onset FGR. Abnormal motor and neurologicaldelay occur in preterm FGR, while cognitive effects andabnormalities that can be related to specific brain areasincrease in frequency as gestation advances, suggestingdifferent pathophysiology and evolving vulnerability ofthe fetal brain. Observational and management studiesdo not suggest that fetal deterioration has an independentimpact on neurodevelopment in early-onset FGR. In lateonsetFGR further research needs to establish benefits ofperinatal intervention, as the pattern of vulnerability andeffects of fetal deterioration appear to differ in the thirdtrimester. Copyright  2011 ISUOG. Published by JohnWiley & Sons, Ltd

Descripción : Ultrasound Obstet Gynecol 2011; 37: 501–514Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.9008

Palabras Claves : biophysical profile; Doppler ultrasound; fetal growth restriction; neurodevelopment

Functional Assessment of the fetal heart - Review

Tue, 03 Apr 2012 16:08:39 GMT

Título : Functional Assessment of the fetal heart - Review

Autor : M. E. GODFREY, B. MESSING; S. M. COHEN, D. V. VALSKY; S. YAGEL

Resumen : The purpose of this review is to evaluate the currentmodalities available for the assessment of fetal cardiacfunction. The unique anatomy and physiology of thefetal circulation are described, with reference to thedifference between in-utero and ex-utero life. M-mode,early/atrial ratio, myocardial performance index, threedimensionaland four-dimensional ultrasound, tissueDoppler including strain and strain rate, speckle tracking,magnetic resonance imaging and venous flow assessmentare described. The modalities are analyzed from theperspective of the clinician and certain questions areposed.Does the modality assess systolic function, diastolicfunction or both? Is it applicable to both ventricles?Does it require extensive post-processing or additionalhardware, or does it make use of technology alreadyavailable to the average practitioner? The reproducibilityand reliability of the techniques are evaluated, withreference to their utility in clinical decision-making.Finally, directions for future research are proposed.Copyright  2012 ISUOG. Published by John Wiley& Sons, Ltd.

Palabras Claves : fetal heart; four-dimensional ultrasound; magnetic resonance imaging; M-mode; MPI; myocardial performance index; MRI; prenatal diagnosis; speckle tracking; strain rate; three-dimensional ultrasound; tissue