Loss of one twin in the first trimester does not appear to impair the development of the surviving twin. However, fetal death occurring after midgestation 17 weeks’ gestation may increase the risk of IUGR, preterm labor, preeclampsia and perinatal mortality [2,3]. Consequently, serial assessments of fetal growth and well-being should be considered. Maternal coagulopathy following twin demise appears to be uncommon [3, 4]. However, coagulopathy has been reported to occur up to 3 weeks following fetal demise . Therefore, when fetal demise occurs in multiple gestation after the first trimester an initial maternal clotting profile with reassessment in two to three weeks is not unreasonable. Monitoring of maternal coagulation factors is not necessary when fetal loss occurs prior to 13 weeks’ gestation . Major morbidity is unlikely to occur in the surviving twin of a dichorionic gestation [6, 8]. Antenatal necrosis of the cerebral white matter has been associated with the presence of intrauterine fetal death of a co-twin with artery-to-artery or and vein-to-vein anastomosis. However, vein-to-vein anastomosis has the strongest association with antenatal necrosis of the cerebral white matter in affected twin pregnancies .
Intrauterine Single Fetal Demise in Twin Pregnancy
Canada[ edit ] Beginning in , “the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. Details for burial vary amongst the federal states.
When Brigitte Nielsen announced she is pregnant with her fifth child at the age of 54, people immediately had questions. Did she conceive via assisted reproduction techniques? Is this pregnancy.
Compared to the previous publication, the current bulletin provides comprehensive management options for ectopic pregnancy by incorporating new guidance on pregnancy of unknown location and on surgical management of ectopic pregnancy, as well as revised guidance on use of hCG levels for diagnosis. Overall, in this Practice Bulletin, ACOG is advocating use of a comprehensive approach and more conservative guidelines to avoid the potential for misdiagnosis, possible interruption of an intrauterine pregnancy or unnecessary medical treatment that could lead to teratogenicity in surviving pregnancies.
While this Practice Bulletin specifically and clearly emphasizes the importance of discussion of risks versus benefits with patients in determining treatment method, there are also other logistical issues that may arise and affect decisions about treatment. Most ectopic pregnancies are managed in the outpatient setting and with minimal variation in the team involved. In addition, the issue concerning insured and uninsured patients deserves special consideration. It has been shown that there exists substantial insurance-related variation in treatment.
In the same article2, the authors also discuss the disparity in that black and Hispanic women were less likely to receive tube-conserving surgery. These factors are leading to earlier diagnosis of the disease and subsequent growth in medical management in the outpatient setting. When indicated, surgical management with minimally invasive surgical techniques is preferable to laparotomy. There has been a decline in rates of salpingostomy compared to salpingectomy.
Chapter 13 Antepartum Nursing Assessment My Nursing Test Banks
Accuracy of the EFW is reported to be best when examinations are performed within 7 days before delivery . ACOG advises “An accurate diagnosis of macrosomia can be made only by weighing the newborn after delivery. J Matern Fetal Neonatal Med. Epub Sep Robert Peter J, et. Cochrane Database Syst Rev.
Abortion is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. An abortion that occurs spontaneously is also known as a deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently an “induced miscarriage”.The word abortion is often used to mean only induced abortions.
Vaginal Delivery Without Complicating Diagnoses An intrauterine fetal demise IUFD , or stillbirth, is defined as a death that occurs in utero or during delivery after the completion of the 20th week of pregnancy or the death of a fetus that weighs g or more in utero or during delivery. Labor and delivery of the dead fetus usually occur spontaneously within 2 weeks.
Patients are under tremendous psychological stress and are at a higher risk for postpartum depression. Disseminated intravascular coagulation DIC is the main complication that can result. Thromboplastin released from the dead fetus is thought to mediate DIC. New research is suggesting that IUFD may also be caused by various perinatal infections, and some case reports have included positive fetal cultures for Erythrovirus B19, Haemophilus influenzae, hepatitis E, group B streptococci, and even Rothia dentocariosa, a normal bacteria found in the oral cavity of humans.
Also, domestic violence should be ruled out. Patients have the option of requesting an autopsy to determine the cause of death. If an autopsy is not performed, it may not be possible to determine the exact cause of fetal death. Genetic considerations Genetic abnormalities are a significant cause of pregnancy loss including chromosomal abnormalities such as the trisomies see Spontaneous Abortion, p. IUFD occurs more often in older women and is thought to be the reason for the increase in perinatal mortality in this age group.
Ethnicity and race have no known effects on the risk for IUFD.
Did reliance on technology contribute to fetal demise?
Pelvic ultrasound can be used effectively by clinicians with varying degrees of experience because identifying an intrauterine pregnancy is straightforward Figure However, a patient undergoing fertility treatment has a significantly increased risk of heterotopic pregnancy, with both an intrauterine and ectopic pregnancy occurring simultaneously.
While no further workup for ectopic is required in a low-risk patient with an obvious intrauterine pregnancy, a woman undergoing fertility treatment who has symptoms concerning for ectopic pregnancy should have more careful screening for heterotopic pregnancy.
Progesterone Support During Pregnancy. Progesterone support in pregnancy has been in use for nearly 60 years, having received its start with publications dating back to the s.
Having this information in advance of the birth means that healthcare staff as well as parents can better prepare themselves for the delivery of a child with a health problem. For example, Down Syndrome is associated with cardiac defects that may need intervention immediately upon birth. Many expectant parents would like to know the sex of their baby before birth. Methods include amniocentesis with karyotyping , and prenatal ultrasound.
In some countries, health care providers are expected to withhold this information from parents, while in other countries they are expected to give this information. Since screening tests yield a risk score which represents the chance that the baby has the birth defect, the most common threshold for high-risk is 1: A risk score of 1: However, the trade-off between risk of birth defect and risk of complications from invasive testing is relative and subjective; some parents may decide that even a 1:
Chapter 13 Antepartum Nursing Assessment My Nursing Test Banks
Related Articles Intrauterine Fetal Demise. The risk of infant mortality increases for women whose first baby died in its first year. Cervical cerclage was made at the 10th week of her third pregnancy. At the 24th week of pregnancy, she was admitted to an emergency service for sepsis syndrome and fetal death, with To explore the reasons for the high rate of intrapartum fetal death observed in a remote and indigent population in China.
We conducted an epidemiologic analysis of determinants of intrapartum fetal death in a sample of 20, births in 18 hospitals participating in
Hi po ms. Nora ask q lng po kasi nung sept nag pt po aq at pstve pero dpa me nkpnta agd nun sa ob pra magpa chck up by octbr po dinugo po aq bli po nagpnta nmn aq sa ob q pro yung tas pna tvs nya po aqnegtve na po yung lumbas den yung ob q po bngyan nlng aq ng gmot tanung q po wat po iffile q sa sss kung dme po nkpag ultrsound bfre pro may ultrsnd aq aftr na po ng mscrge.
Health Promotion and Maintenance: Integrate understanding of multiple dimensions of patient centered care. Communicate effectively with all members of the healthcare team, including the patient and the patients support network. Communicate information effectively; listen openly and cooperatively. Which question is best to include on this form? Where was the father of the baby born? Do genetic diseases run in the family of the babys father? What is the name of the babys father?
Are you married to the father of the baby? This question has the highest priority because it gets at the physiologic issue of inheritable genetic diseases that might directly impact the baby. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care.
Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. Appreciate the value of the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness.
Credit will be given only if all correct and no incorrect choices are selected.
Controlled gestational diabetes mellitus or dating intrauterine fetal demise type 2 diabetes, several functions have been postulated for AFP. Physicians have been successfully sued by women who gave birth to babies with abnormalities that could have been detected had they known about their screening options, this suggests that the role of progesterone as an indication of placental function may be more significant than what had been previously appreciated and is especially important into the second and third trimesters of pregnancy.
At early presentation of pregnancy at around 6 weeks, integrated screening tests have a higher detection rate for Down syndrome than do the Quad and Penta screens. And association of premature labor with decreased progesterone concentrations and the observation that progesterone has a tocolytic effect. A total of 6 feedings per day is preferred, in utero fetal Surgery rescues neurological function at birth in sheep with spina bifida.
What is the benefit of adding a nuchal translucency (NT) ultrasound measurement for women 35 years and older? Although the serum integrated prenatal screen (SIPS) is associated with a high detection rate for Down syndrome, the combination of serum screening and NT (integrated prenatal screen or IPS) reduces the false positive rate.
Clinical Background [ return to contents ] Prenatal screening and diagnosis are routinely offered for detection of neural tube defects NTDs , Down syndrome, and trisomy Since the introduction of cell-free DNA testing, screening for trisomy 13 has also been offered. The intent of such screening and diagnosis is to enable pregnant women to make informed decisions regarding their pregnancies and be better prepared in the event of the birth of an affected infant.
The Disorders Neural Tube Defects NTD Neural tube defects NTDs anencephaly, open spina bifida or meningomyelocele, and encephalocele are a heterogeneous group of congenital malformations resulting from a failure of fusion of the neural tube. Anencephaly is almost always fatal at or within a few hours of birth. The survival rate and the degree of handicap surgically correctable to severely disabling of children with meningomyelocele or encephalocele vary with the location and severity of the lesion and the treatment given.
These can include heart defects, brain or spinal cord abnormalities, extra fingers or toes, cleft lip or cleft palate, and poorly developed eyes. Trisomy 13 occurs in about 1 in 8, newborns 3 ; many of these die within their first days or weeks of life. As with the trisomies mentioned above, the risk of having an affected fetus increases with increasing maternal age. Screening is optimally performed between 16 and 18 weeks of gestation, although samples may be obtained as early as 15 weeks and as late as Different medians are used for white, African American, Hispanic, and Asian populations.