Care of the high-risk neonate by M. Klaus, et al.,

By M. Klaus, et al.,

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The nadir heart rate of less than 60 bpm approximates the atrioventricular nodal rate and thereby implies maximal vagal stimulation. Severe cord compression leads to metabolic acidosis. Severe variable decelerations are encountered with PROM, severe oligohydramnios, nuchal cord, true knot in the cord, and cord prolapse. Standard therapy for severe variable decelerations includes changing the maternal position, discontinuation of oxytocics, ruling Antenatal, and Intrapartum Care of the High-Risk Infant 33 perinatal team is confronted by the imminent delivery of a patient with uncertain dates following a pregnancy with no prenatal care.

No Vasculopathy Insulin-Dependent. : NI Preconceptual/initial visit (repeat monthly until normal) Preconceptual/initial visit (if abnormal, each trimester) Preconceptual/initial visit (repeat monthly until normal) Preconceptual/initial visit (if abnormal, each trimester) Prenatal screen panel and bacteriuria screen Glycosylated protelnst Thyroid panel screen Preconceptual/ initial visit Creatinine clearance NI Urine protein Dipstick 24 h Lipid profile Serially NI NI Serially ;~1 + by dipstick Preconceptual/initial visit Serially 2:1 + by dipstick Preconceptual/initial visit 16-18 16-18 16-18 18-22 18-23 18-22 NI 37-39§ 20-24 30-32; 37-39 20-24 30-32; 37-39 36 to intervention§ NI 34 to intervention§ 32-34 to intervention§ 30 to intervention§ 32-34 to intervention§ If intervention <38 wk If intervention <39 wk If intervention <39 wk Fetal (weeks' gestation) Alpha-fetoprotein (maternal serum) Ultrasonography Dating/anomaly screen Echocardiography Fetal growth/ development Fetal movement§ CST/NST (biophysical profile: backup)§ Lung maturity documentation NI, Not routinely indicated.

Caritis S, Sibai B, Hauth J, et al: Low dose aspirin to prevent preeclampsia in women at high risk. N Eng] J Med 338:701-705, 1998. Diabetic Pregnancy188 Major advances in the knowledge of carbohydrate metabolism provide the opportunity 22 Antenatal and Intrapartum Care of the High-Risk Infant for improved screening and identification of the gestational diabetic woman. Physiologic studies currently offer a better rationale for management of both the chemical and the overt diabetic pregnant woman and her fetus.

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