| Intrapartum monitoring and management of the low birth weight fetus. | |
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MedLine Citation:
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PMID: 6749377 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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All physicians responsible for the care of gravidae at high risk for preterm labor and delivery must be expert in the management of these pregnancies. Only a fraction of women who present in labor remote from term are candidates for long-term tocolysis. Whatever treatment regimen is utilized, the clinician must be familiar with their risks as well as their benefits. The majority of women who present with preterm labor will require delivery or will deliver despite efforts to the contrary. If delivery is imminent or indicated, intensive intrapartum monitoring of these fetuses, especially those weighing less than 1500 gm, is mandatory. The mother should be transferred to a facility that contains both expert obstetric care and a neonatal intensive care unit staffed with individuals experienced in the management of these very low birth weight infants. Attempts at pharmacologic induction of lung maturation should be reserved for those situations in which: (1) the fetal membranes are intact, (2) the fetal lungs are likely to be immature, (3) delivery of the infant may be delayed without undue risk for 48 hours following initiation of therapy, and finally, (4) the informed consent of the parents has been obtained. (By the same token, the probable efficacy of glucocorticoids should not serve as license to deliver the preterm infant.) Preterm infants are viable, even at 25 to 26 weeks of gestation, provided that labor and delivery are managed expertly. When vaginal delivery is contemplated, labor, if induced, should not be forceful. Fetal heart rate and uterine contractions should be monitored continuously. Evidence of fetal jeopardy must be dealt with expeditiously. Nontraumatic delivery, including the liberal use of cesarean section, into the hands of an experienced neonatologist will reduce the number of asphyxiated premature infants and, therefore, the risk of hyaline membrane disease. For the very low birth weight infant presenting as a breech, abdominal delivery is recommended. It is important that the uterine incision, regardless of type, be large enough to allow for nontraumatic delivery of the infant. If greater improvements in the survival and outcome of low birth weight infants are to continue, it is mandatory that there be close collaboration not only between obstetrician and pediatrician, but also between all physicians and nursing staff who care for this group of high-risk patients. |
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Authors:
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J G Quirk; W A Bowes |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S.; Review |
Journal Detail:
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Title: Clinics in perinatology Volume: 9 ISSN: 0095-5108 ISO Abbreviation: Clin Perinatol Publication Date: 1982 Jun |
Date Detail:
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Created Date: 1982-12-02 Completed Date: 1982-12-02 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 7501306 Medline TA: Clin Perinatol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 363-80 Citation Subset: IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Analgesia Anesthesia, Obstetrical Betamethasone / therapeutic use Body Weight Cesarean Section Dexamethasone / therapeutic use Female Fetal Blood / analysis Fetal Heart / physiopathology Fetal Monitoring* Fetal Organ Maturity / drug effects Gestational Age Humans Infant, Low Birth Weight Infant, Newborn Labor Presentation Lung / drug effects Obstetric Labor, Premature / etiology, prevention & control, therapy* Pregnancy |
| Grant Support | |
ID/Acronym/Agency:
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1-K01-AM00883-02/AM/NIADDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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378-44-9/Betamethasone; 50-02-2/Dexamethasone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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