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Clinical findings of the latent fetal distress were studied employing the antepartum FHR monitoring, urinary estriol, and the neonatal outcomes.Twelve cases with the latent fetal distress were examined by urinary estriol and the antepartum FHR monitoring. All cases had antepartum FHR decelerations and/or continuous very low levels of urinary estriol.Ten cases with a positive CST/OCT at 36 weeks of gestation or less had severe latent fatal distress. Other 2 cases with a negative CST/OCT, a reactive NST, and a antepartum FHR decleration at 38 weeks of gestation or more had mild latent fetal distress.Of 10 cases with severe latent fetal distress, 8 survived newborn infants were delivered by the cesarean section. Five of these 8 newborn infants had congenital abnormalities, and 1 newborn infant died at early neonatal period. Other 2 cases resulted in the intrauterine fetal death on 2 or 3 days after a positive CST/OCT was present at 30 and 34 weeks of gestation.In 2 cases with mild latent fetal distress, the intrapartum FHR monitoring showed a recurr ent FHR deceleration. These survived newborn infants were delivered by spontaneous vertex with 1/5min. Apgar score: 6/9. These infants had no congenital abnormality.In conclusion of this study, the following suggestions are offered.(1) The antepartum FHR monitoring detected severe latent fetal distress 3 or 4 days before sudden drop of conti nuous very low levels of urinary estriol.(2) For the early detection of the latent fetal distress, an appearance of the anteparum FHR deceleration was more valuable than a disappearance of the FHR acceleration in a NST.(3) A CST/OCT had a great advantage on the decision of the period of the delivery.(4) When the antepartum FHR monitoring showed a negative CST/OCT, a reactive NST, but a FHR deceleration, the intrapartum FHR monitoring showed a recurrent FHR deceleration. In this case, the fetal and neonatal asphyxia was present.(5) When the antepartum FHR monitoring showed a FHR deceleration, there is a greatneed for a CST/OCT. This study suggests that the course of the fetal death from the fetal wellbeingis as follows:areactive NST and a negative CST/OCT a reactive NST and a intermediate CST/OCT areactive NST and a positive CST/OCT non-reactive NST and a positiveCST/OCT. When a positive CST/OCT with non-reactive NST is present, the fetal death approches.(6) If the antepartum FHR monitoring shows a positive CST/OCT, the cesarean section is warranted for the survived newborn infant. If the antepartum FHR monitoring shows a negative CST/OCT and a FHR deceleration, the cesarean section is not necessitated for the survived newborn infant.(7) When the antepartum FHR monitoring shows a recurrent FHR deceleration at 36 weeks of gestation or less, a congenital abnormality was observed in high freaquency.(8) The case of severe latent fetal distress should be treated and delivered in a hospital with the neonatal intensive care unit. The care of high risk fetus should be necessiated for the fetoneonatal intensive care unit.
- 近畿産科婦人科学会の論文
近畿産科婦人科学会 | 論文
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