PubMed · 9017541
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C Hodgins. Apgar score.. https://doi.org/10.1111/j.1552-6909.1997.tb01500.x
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OBJECTIVE: To examine the possible maternal and fetal variables associated with meconium aspiration syndrome in labors with thick meconium. STUDY DESIGN: The fetal heart rate tracings, cord pH, Apgar scores and maternal risk factors were evaluated in singleton pregnancies with vertex presentation and thick meconium in labor. The study included 33 consecutive fetuses which developed a moderate or severe meconium aspiration syndrome and 104 consecutive fetuses which had a favorable outcome. RESULTS: Significant differences between fetuses with meconium aspiration syndrome and healthy fetuses were found in the following parameters: baseline FHR (154+/-17 vs. 136+/-10, P<0.0001), small accelerations/30 min (1.47+/-1.52 vs. 3.04+/-1.2, P<0.0001), large accelerations/30 min (1.46+/-1.96 vs. 3.5+/-2.31, P<0.0003), decelerations/30 min (4.9+/-3.9 vs. 2.4+/-2.1, P<0.0034), number of fetuses with reduced beat-to-beat variability (9/33 vs. 0/104, P<0.0001), cord pH (7.21+/-0.09 vs. 7.33+/-0.08, P<0.0013) and Apgar scores at 1 min (5+/-2 vs. 8+/-1, P<0.0001) and Apgar scores at 5 min (8+/-2 vs. 9.7+/-0.6, P<0.0001). Maternal risk factors were found in two of 33 sick infants and in 13 of 104 healthy infants. CONCLUSION: Thick meconium by itself is not associated with adverse fetal outcome. However, the incidence of meconium aspiration syndrome increases in cases of a non-reassuring FHR.
BACKGROUND: Subgaleal hemorrhage results from a pericranial effusion of blood subsequent to neonatal trauma. This exceptional situation compared with other pericranial effusion conditions in the neonate may be life-threatening. CASE REPORTS: We report the obstetrical and neonatal data in 5 cases of subgaleal hemorrhage observed in our unit over an 8-year 8-month period. We detail one particularly demonstrative case which illustrates the potentially serious course of certain clinical presentations. DISCUSSION: Subgaleal hemorrhage is a clinical diagnosis. Signs of hemorrhagic shock are associated with hemostasis disorders in the more severe forms of the condition. The main risk factor is instrumental delivery with suction. Careful monitoring is required.
Intrapartum death has become a rare event since the introduction of electronic fetal monitoring (EFM). Randomized studies of EFM versus intermittent auscultation show that EFM reduces the risk of low Apgar score at birth and of neonatal seizures, although it may be possible to ensure low perinatal mortality even with intermittent auscultation alone. The rate of operative deliveries may increase with EFM, at least if scalp blood sampling is not used. Since scalp blood sampling is an invasive procedure providing only temporary information, the search goes on for new methods as complements to EFM. Fetal pulse oximetry and ST-analysis of fetal ECG (STAN) are two methods currently being tested in clinical studies. Regardless of the efficiency of monitoring methods that we may develop, there will always be a need for competent staff at our labor wards. Ongoing training of staff is necessary if asphyxia is to be avoided as far as possible.