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A saltatory pattern of fetal heart rate is defined in cardiotocography (CTG) guidelines by FIGO as fetal heart rate (FHR) baseline amplitude changes of more than 25 beats per minute (bpm) with a duration of >30 minutes. [25] [27]
[2] [3] The diagnosis should be suspected if there is a sudden decrease in the baby's heart rate during labor. [4] [2] Seeing or feeling the cord confirms the diagnosis. [4] Management focuses on quick delivery, usually by cesarean section. [4] Filling the bladder or pushing up the baby by hand is recommended until this can take place. [4]
The diagnosis may be suspected if there is a decrease in the baby's heart rate during delivery. [1] Nuchal cords are typically checked for by running the finger over the baby's neck once the head has delivered. [4] Ultrasound may pick up the condition before labor. [1]
Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. [1] Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetrics. [2] [1] [3] The term "non-reassuring fetal status" has largely replaced it. [4]
The heart rate increases, but generally not above 100 beats/ minute. Total systematic vascular resistance decreases by 20% secondary to the vasodilatory effect of progesterone. Overall, the systolic and diastolic blood pressure drops 10–15 mm Hg in the first trimester and then returns to baseline in the second half of pregnancy. [6]
During uterine contractions, fetal oxygenation is worsened. Late decelerations in fetal heart rate occurring during uterine contractions are associated with increased fetal death rate, growth retardation and neonatal depression. [1] [2] This test assesses fetal heart rate in response to uterine contractions via electronic fetal monitoring.
The use of fetal scalp blood testing originated in Germany in 1961 and required 0.25 mL of blood drawn from the fetus. [1] As one of the first methods of monitoring fetal wellbeing during labor, there were many disadvantages including the need for at least 3 cm dilation of the mother and extreme precision from the physician performing the procedure. [9]
Abnormal fetal heart tracing suggests that the fetus's heart rate has slowed during labor due to head compression, cord compression, hypoxemia or anemia. [3] Uterine tachysystole , the most common adverse effect of oxytocin (usually as a result of a problematic dosage), can result in nonreassuring fetal heart tracing.