Monitor fetal heart rate/intraoperative uterine activity if gestational age is >24 weeks. Keep in mind that pregnancy is a vasodilated state and there may be natural alterations in vital signs. Treat hypotension aggressively to maintain uteroplacental blood flow. Place a wedge under the patient's right hip for left uterine displacement to relieve the weight of the uterus on the aorta and inferior vena cava. Use pentothal for induction and narcotics and inhalational agents for maintenance a decreased minimum alveolar concentration for inhalational agents is needed in pregnant patients. Though often not possible, surgery should be delayed until the second trimester. Figure 2 presents examples of traditional two-dimensional (2D) and 3D images.
#HEART DOPPLER PLUS#
The most recent technological advance is the development of three-dimensional (3D) and so-called four-dimensional ultrasound (i.e., 3D image plus addition of a fourth dimension of real time motion) that allows visualization of details, such as fetal facial expressions and hand movements, which were not previously possible. Doppler has also generated techniques to detect fetal motor activity without ultrasound visualization and makes it possible to measure the amount of blood flow and resistance in maternal and fetal vessels, including umbilical, cerebral, and uterine arteries. In addition, refinement of techniques to monitor fetal heart rate and its patterning, using Doppler ultrasound, has provided another important source of information regarding prenatal neural development. Visualization can reveal specific behaviors (e.g., thumb-sucking), qualitative aspects of movement (e.g., fluidity of flexion and extension), structural features of the fetus (e.g., size), and characteristics of the uterine milieu (e.g., volume of amniotic fluid). Protocols must be established regarding critical care, perinatal support, lactation consultation, and nursing monitoring should the fetus be viable and delivered anesthetic consultation and support should surgical intervention be indicated nutrition optimization clinical pharmacist consultation regarding recommendations for optimal medications DVT prophylaxis initiated and aggressive screening established to monitor the hypercoagulable state native to pregnant women and physical therapy regimens.Īlthough speculation about the nature of fetal behavior has existed since antiquity, the advent of real-time ultrasound in the early 1970s enabled modern scientific investigation of prenatal development. In contrast with the treatment of the severely burned pregnant population, early wound excision can be balanced between the risk and benefit to both patients of surgical intervention versus topical treatments. Utilize the multidisciplinary team to maximize management of the burned pregnant patient.
Optimize fluid resuscitation and perfusion, beginning with the Parkland formula. Perform an ultrasound to determine fetal viability and gestational age, as well as acquire patient history regarding last menstrual cycle. Obtain a high-risk obstetric consult upon admission of the pregnant burn patient. The approach to the nonseverely burned pregnant victim is much the same ( Fig. The text of this chapter has dealt with the care of the severely burned obstetric patient. Mullins, in Total Burn Care (Fifth Edition), 2018 Nonsevere Burns The normal rate is between 120 and 160 beats per minute.īeretta Craft-Coffman. The fetal heart rate is usually measured every 15–30 min in early labour and every 5 min in active labour. These can be used in the pool and the woman can remain more mobile than with the CTG. Hand-held monitors, also called fetal Dopplers or sonicaids, which are not attached to a graphic record can be used. It cannot be used if the woman is in water. Some care providers prefer the woman to be semi-recumbent or side-lying. It need not necessarily interfere with maternal position as the woman may still be able to utilise forward leaning or upright positions, although if she moves much the printout will be inaccurate. It measures the fetal heart rate and gives a readout. This can be hand held and intermittent or continuous.Īn electronic fetal heart monitor or cardiotocograph (CTG), ultrasound, is placed over the woman's abdomen near the fetus's heart. Suzanne Yates BA(Hons) DipHSEC MRSS(T) APNT PGCE(PCET), in Pregnancy and Childbirth, 2010 Electronic fetal monitoring
0 kommentar(er)
