MODERN METHODS IN THE PREVENTION AND MANAGEMENT OF COMPLICATIONS IN LABOR, ACTA UNIVERSITATIS OULUENSIS D Medica 1051

Although in Finland the incidence of maternal and neonatal mortality in labor is very low, labor\ncarries some risks. This study focused on two major complications in labor: fetal asphyxia and\nmaternal hemorrhage. The roles of fetal electrocardiographic ST-analysis (STAN) and pelvic\nartery embolization in the prevention and management of these complications were investigated.\nIntrapartum fetal monitoring aims at a timely detection of fetal hypoxemia. When non-selected\nparturients were randomly assigned to be monitored during labor either by STAN or conventional\ncardiotocography, no differences between the groups were detected in terms of neonatal outcome\nand operative delivery rates. Only the incidence of fetal blood sampling was lower in the STAN\ngroup. In the interpretation of the STAN tracings according to the guideline matrix provided by\nthe STAN manufacturer, the interobserver agreement was moderate; in terms of clinical decision\n-making as to whether to intervene in the labor, this agreement varied from moderate to good\namong STAN-trained obstetricians.\nThe aim of prophylactic pelvic artery occlusion balloon catheterization, with or without\nembolization, is to reduce hemorrhage in elective cesarean operations in patients with placenta\naccreta. Furthermore, pelvic arterial embolization may be performed post partum if bleeding\ncontinues after cesarean hysterectomy, or may serve as an alternative to hysterectomy. In the\npresent study, pelvic artery catheterization and embolization did not reduce blood loss during\ncesarean delivery, nor did it decrease the need to perform hysterectomy in patients with placenta\naccreta. In the management of massive postpartum hemorrhage, pelvic artery embolization was\nmost successful in patients with uterine atony, with a success rate of 75% in achieving hemostasis.\nHowever, the angiographic method included risk of complications, the most hazardous being\nthromboembolic complications.\nTo conclude, STAN does not provide improvement in intrapartum fetal monitoring when\ncompared to cardiotocography, but the need for fetal blood sampling is reduced. This may relate\nto the fact that subjective interpretation of STAN data is moderate at best. Prophylactic\ncatheterization and embolization of pelvic arteries does not improve the surgical outcome of\npatients with placenta accreta. In the management of postpartum hemorrhage, pelvic artery\nembolization should be considered, especially in cases with uterine atony.

ISBN-10:
978-951-42-6163-3
Kieli:
eng.
Sivumäärä:
140 s.
Tekijät:
Ojala Kati
Tuotekoodi 013963
21,00 €