Re: CTG anomaly - continued
From: art fougner, md (evsono@pipeline.com)
Sat Apr 27 10:33:26 2002
Joe -
your statement is NOT ridiculous.
Here is a reference to a similar but not identical case to Mats' -
: Am J Obstet Gynecol 1999 Sep;181(3):765-6
Fetal seizures causing increased heart rate variability during terminal
fetal
hypoxia.
Westgate JA, Bennet L, Gunn AJ.
Department of Obstetrics, Research Centre for Developmental Medicine,
University
of Auckland, New Zealand.
Fetal seizures together with both abnormal breathing movements and
fluctuations
in fetal blood pressure and heart rate resulting in increased fetal
heart rate
variability have been observed in brain-damaged fetal sheep shortly
after an
asphyxial insult. We report a clinical example of convulsions and
increased
heart rate variability during terminal fetal hypoxia.
art
At Sat, 27 Apr 2002, Joe Cutchin wrote:
>
>John: now that I am out of OB I can make maybe some redicuilous statements.As far as I am
>concerned there is very little true EBM for FHR.It is probably the worst technical
>advancement we have had thrust upon us.It has caused more harm than good.Everyone is an
>"expert" with their own definition of a particular portocol or abnormality..By far the
>best writing are by Dr Parer and the NIH conference he chaired.I started out with the era
>of Hon and wish in retrospect I had never heard off EFM.As Art would add, just my
>opinion.Joe Cutchin
>
>"Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C." wrote:
>
>> At Fri, 26 Apr 2002, Mats O. Bergstrom wrote:
>> >
>> >Thanks everyone for your input. I havenīt been able
>> >to visit a library yet to check up the references (especially
>> >Ikeda and Murray, respectively) that mention CTG and fetal
>> >seizures.
>> >
>> >Answers to questions:
>> >
>> >(Original findings of LP WBC high, 45, with poly 40 -
>> >if these measures have the same meaning in other lab
>> >techniques around the world - in a newborn with multiple
>> >seizures immediately after delivery.) Spinal fluid and blood cultures,
>> >viral PCRīs and serology all negative (so far). Broad spectrum
>> >antibiotics were given but the theory is still viral meningitis.
>> >The mother had a weak febrile flu-like episode during the week
>> >preceeding delivery.
>> >
>> >No neonatal anemia.
>> >
>> >"PVC's" ruled out as far as it goes by concomitant monitoring
>> >of ("listening to") the fetal heartbeats with an ACSWRD (Analogue
>> >Cochlear Sound Wave Recognition Device), also called Ear - with
>> >the aid of one of those old wooden funnels.
>> >
>> >MRI not done, CT day 1 negative.
>> >
>> >Scalp pH wasnīt measured intrapartum but, as I wrote,
>> >*scalp lactate* was normal. We use more and more
>> >lactate, albeit still mostly on a research basis (a Swedish
>> >multi-center study under way). You need less blood and
>> >can use a disposable kit that needs no calibration and
>> >apparently it's more sensitive - lactate elevation before
>> >matabolic acidosis is manifest.
>> >
>> >"FMP 9% (9%) ... 3% (6%)"
>> >I donīt know! Someone else?
>> >
>> >Suggested experiments:
>> >
>> >To apply a scalp to a delivered baby. I guess the opposite
>> >electrode on the mother's thigh would be hard to simulate
>> >realistically - better leave it for the guys with access to animal
>> >models...
>> >
>> >To strech a strip with a graphic editor. Have to try that! But it'll
>> >take me some time since I haven't used Photoshop for anything
>> >more complicated than removing red retinas from family pictures.
>> >
>> >Synthesis:
>> >Steve and Malcolm (who can read 1 cm/s properly) don't really
>> >believe that the pattern has to be significant. And I have to agree.
>> >But there is still doubt...
>> >
>> >And the good news:
>> >The seizures were cured with phenobarbital and the baby girl
>> >was released from the NICU on day 9, apparently healthy.
>> >The prognosis is very good.
>> >
>> >Mats Bergstrom, MD
>> >Ob Gyn
>> >South Hospital
>> >Stockholm
>>
>> --
>> Sorry if this is slightly off topic, I decieded to do a google search with the
>> topic being seizures and Fetal Heart rate monitoring, ofcourse I got dozens of
>> hits. Here is one sample.
>> http://www.gentlebirth.org/archives/decels.html#Seizures
>> My point is if I could do this so can any patient, I know its always been possible for
>> patients to research medical topics, but its never been this easy to do so from the
>> the comfort of your own home! I am seeing more and more patients who actually
>> present with questions about stuff they have found on the internet. Is this good
>> or bad I don't know but its obviously something physicians did not have to cope
>> with a decade ago.
>> Take care, John
--
art fougner, md
ich bin ein New Yorker
