This paper is only available as a PDF. To read, Please Download here.
Résumé
Fetal heart sounds, being the direct transmission of the sounds from the heart of
the fetus, will usually give first hand information of the condition of the fetus,
and indicate whether or not the child in utero is broadcasting signals of distress.
Careful "listening in" is obligatory to the conscientious obstetrician, and should
be done from early in labor until the child is born. This is especially necessary
in elderly primiparae, in cases of a "questionable" pelvis, and in cases having frequent
strong contractions, or where fetal membranes have ruptured prematurely, and in cases
of breech presentation.
A fetal heart remaining below 100 between pains is a very real sign of distress, and
either calls for extremely careful observation and investigation, or the termination
of labor if this can be done with safety to the mother.
A funic souflle persistently heard, usually indicates a cord around the neck, or pressure
on the cord, and is an extremely valuable sign to the observant obstetrician as indicating
possible danger to the fetus.
The appearance of meconium is not per se of the vital importance that some suppose,
but the presence of meconium with a slowed fetal heart is an added indication for
interference.
A rapid fetal heart is usually not of serious import, nor is a fetal heart that fluctuates
or varies, provided it is within the usual normal range.
Occasionally, however, a child may be born dead, and the fetal heart show no indication
of the impending asphyxia even when carefully observed all during labor. Such deaths
are usually due to some form of cerebral injury, involving the respiratory center.
Syphilis has not been found to be a factor in influencing the rate of the fetal heart
during labor.
A small pelvis, early rupture of the membranes, or frequent strong uterine contractions
have a marked effect in slowing the fetal heart, especially if any of these conditions
are combined.
Prolongation of labor during the first stage influences the heart rate of the fetus
very little, but during the second stage the effect is much more marked and frequent.
Changes in the rate of the fetal heart occur more commonly in the second stage of
labor, therefore, more frequent observations during this period are essential.
The administration of chloroform in the manner suggested, while making ready for the
delivery, may help save some of these babies.
At birth, the heart rate of the baby becomes quite slow and quickly rises after a
few inspirations to gradually return to the usual quickened rate of the newborn child.
Forceps deliveries per se, in competent hands, do not add to the hazard of the baby.
On the contrary, in many instances when a changed rate of the fetal heart has warned
of danger, a timely and judicious delivery by forceps will enable us to reduce our
present persisting ratio of stillborn babies.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Memoirs sur L 'auscultation, etc.1822
- Observations on Obstetric Auscultation. 1843
- Die Geburtshülfliche Auskultation. 1838
- Monatschr. f. Geburtsh. u. Frauenkrankh. 1860; xv: 354
- An Exposition of the Signs and Symptoms of Pregnancy. 1837
- Die Geburtshiilfliehe Auskultation. 1833
- Edinb., Oliver and Boyd. 1875
- Handb. der Geburtshülfe. 1903; i: 634-643
- Arch. f. Gynäk. 1917; cvii: 353-366
- Monatschr. f. Geburtsh. u. Gynäk. 1925; lxix: 308-319
- Ztsekr. f. Geburtsh. u. Gynäk. 1920; lxxxii: 284
- Ztschr. f. Geburtsh. u. Gynäk. 1924; lxxxviii: 261-303
- Zeutralbl. f. Gynäk. 1926; l: 972-976
- Brit. Med. Jour. 1920; ii: 819
- Am. Heart Jour. 1926; : p. 717
- München. Med. Wchnschr. 1925; : 2188
- Am. Jour. Obst. And Gynec. 1925; x: 89-93
Article Info
Footnotes
Read (by invitation) at a meeting of the New York Obstetrical Society. February 8, 1924.
Identification
Copyright
© 1927 C. V. Mosby Company. Published by Elsevier Inc. All rights reserved.
