Examinando por Materia "Electronic fetal monitoring"

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Acceso abierto
Importance of cardiotocography and its interpretation in gestational diabetes"
(Universidad Privada Norbert Wiener, 2019-06-28) Villanueva Arequipeño, Liz Soledad; Fernández Ledesma, Scarlett Estela
To present the clinical case of a 39-year-old pregnant woman, multigravida at 37.3 weeks according to second-trimester ultrasound, with no prior history of diabetes or family history of diabetes. However, her obstetric history included fetal death, spontaneous abortion, and hospitalization one month earlier for uncontrolled gestational diabetes. The patient presented to the emergency department of a healthcare institution on August 26, 2017, at 10:24 a.m. due to decreased fetal movements for two days. Two fetal well-being tests were performed: a non-stress test (NST) with a non-reassuring pattern and a biophysical profile (BPP) indicating 37 weeks of gestation with a score of 6/8, nuchal cord, and an estimated fetal weight of 3329 grams. Blood glucose was 63 mg/dL. An endocrinology consultation recommended continuous glucose monitoring, dietary adjustments, and insulin treatment. With these clinical findings, the patient was transferred to the delivery room, where a stress test (CST) yielded unsatisfactory results. At 10:44 p.m., due to the absence of an indication for delivery and a glucose level of 62 mg/dL, the on-duty physician recommended hospitalization. Fetal heart rates were monitored every three hours during the night and found to be normal. However, at 8:00 a.m., fetal heart sounds were absent, confirmed by ultrasound, leading to an abdominal delivery. Operative findings: fetal death, female fetus, APGAR 0/0, Capurro: 37 weeks, weight: 3280 grams, placenta: 500 grams with complete cotyledons, intact membranes, thick meconium-stained amniotic fluid in small quantities, and a slightly tightened single nuchal cord. Conclusion: Proper recording and interpretation of cardiotocographic parameters in electronic fetal monitoring in diabetic pregnant women are crucial to identifying fetal risks, ensuring timely management, and preventing maternal and perinatal complications.