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Clinical signs of fetal distress during labor

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      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.
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