[FULL] Obstetricia Y Medicina Materno Fetal Cabero UPD
[FULL] Obstetricia Y Medicina Materno Fetal Cabero
as detailed in the treatment of arrhythmias section, the use of midazolam has been successful for second-trimester termination of fetal svt. in cases of severe hydrops, the first-trimester noncervical cerclage procedure may be considered as the initial step in the management of second-trimester tachyarrhythmias. the placement of a cerclage is associated with an increased risk of uterine rupture, resulting in mortality in both the mother and the fetus. this risk is particularly high if the location is close to the placental insertion. although there is little evidence to support the use of preterm deliveries to treat fetal svt, these cases should be monitored closely. the risks and benefits should be discussed with the patient. fetal asphyxia is a common cause of fetal demise. fetal asphyxia can be defined as hypoxia, acidemia, and metabolic acidosis, and it may occur in the absence of maternal hypoxia. when the hypoxia is prolonged and severe, it may result in a prolonged second stage of labor. although various studies have shown that fetal heart rate monitoring is useful to detect fetal asphyxia, obstetricians are often reluctant to perform fetal heart rate auscultation because it is time consuming. fetal asphyxia results in decreased fetal heart rate variability and an absence of fetal heart rate accelerations. fetal asphyxia should be considered in cases of fetal bradycardia and asystole. fetal asphyxia can be treated by maternal resuscitation or a planned delivery, depending on the severity of the hypoxia and the fetal status. there are various anesthetic options for spontaneous vaginal delivery of the second twin, including a general anesthetic, spinal block, or neuraxial block. with the exception of cases where the cephalic presentation was the result of maternal forceps delivery, the second twin can be delivered vaginally when the first twin is in cephalic presentation and the second twin is in breech presentation. labor induction with prostaglandin is appropriate for preterm premature rupture of membranes. with induction of labor, the membranes can be opened before rupture using a mechanical instrument, amniotomy, or oxytocin infusion. the second twin can be delivered vaginally within the first hour of induction. if there are no contraindications, it is recommended that induction of labor be performed to facilitate the delivery of the second twin. in some cases, induction of labor with prostaglandin may be the safest alternative. if the second twin is in cephalic presentation, it can be delivered vaginally, as discussed in the breech extraction section. in cases of preterm premature rupture of membranes, the second twin can be delivered vaginally with a planned cesarean section at term. vaginal delivery is contraindicated in preterm premature rupture of membranes and prolongation of pregnancy. if the membrane ruptures more than 12 hours after rupture, it is recommended that the second twin be delivered by cesarean section.
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