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Fetal Mouse Cardiovascular Imaging Using a High-frequency Ultrasound 30/45MHZ System
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Earlier and improved screening for impending fetal compromise.

Mark I Evans1,2, David W Britt1, Robert D Eden1,3

  • 1Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|September 3, 2020
PubMed
Summary

Fetal acid-base balance declines during labor. The Fetal Reserve Index (FRI) can predict acidosis risk earlier, allowing for timely interventions to improve fetal outcomes.

Keywords:
1st stage of laborACOG Category systemElectronic fetal monitoringbase excesscardiotocographycerebral palsyfetal reserve indexfetal scalp samplingmetabolic acidosismultiples of the median (MOMs)pHscreening test

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Area of Science:

  • Obstetrics and Gynecology
  • Fetal Medicine
  • Neonatal Acidosis

Background:

  • Fetal scalp sampling (FSS) for pH and base excess (FSSPHBE) was previously abandoned with the rise of cardiotocography (CTG).
  • Understanding fetal stress tolerance in labor is crucial for developing better screening methods.
  • Early identification of acidosis risk is essential for timely intervention.

Purpose of the Study:

  • To investigate sequential changes in fetal pH and base excess (BE) during the first stage of labor.
  • To evaluate the utility of multiples of the median (MoM's) for fetal acid-base values.
  • To assess the Fetal Reserve Index (FRI) as a proxy for fetal acid-base status and its predictive capacity for acidosis risk.

Main Methods:

  • Retrospective evaluation of FSSPHBE data from 475 high-risk parturients.
  • Categorization of specimens by cervical dilatation (CxD).
  • Development of non-parametric MoM's assessments and analysis of FRI scores and their change over time as predictors.

Main Results:

  • Fetal acid-base balance (FSSPHBE) deteriorates throughout the first stage of labor.
  • The interpretation of BE values is dependent on CxD, with MoM's logic enhancing understanding.
  • FRI scores and their trajectory effectively screen for acidosis risk in the second stage.

Conclusions:

  • Fetal acid-base reserve deteriorates early in labor, even before critical acidosis develops.
  • MoM's logic aids in appreciating fetal acid-base status.
  • The FRI and its trajectory serve as a suitable screening tool for early detection of fetal deterioration, enabling timely interventions.