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Direct fetal creatine supplementation increased plasma and cerebral creatine concentrations but did not alter fetal body weight, basal cardiovascular output, or blood chemistry. Creatine-treated fetuses displayed changes to arterial oxygenation 24–72 h after acute global hypoxia. An increase in striatum total creatine levels following UCO was also noted and suggests that increasing creatine tissue availability may be an adaptive response against the effects of hypoxia.

Over 50 years ago, visionary researchers began work on an extracorporeal artificial placenta to support premature infants. Despite rudimentary technology and incomplete understanding of fetal physiology, these pioneering scientists laid the foundation for future work. The research was episodic, as medical advances improved outcomes of premature infants and extracorporeal life support (ECLS) was introduced for the treatment of term and near-term infants with respiratory or cardiac failure. Despite ongoing medical advances, extremely premature infants continue to suffer a disproportionate burden of mortality and morbidity due to organ immaturity and unintended iatrogenic consequences of medical treatment. With advancing technology and innovative approaches, there has been a resurgence of interest in developing an artificial placenta to further diminish the mortality and morbidity of prematurity. Two related but distinct platforms have emerged to support premature infants by recreating fetal physiology: a system based on arteriovenous (AV) ECLS and one based on veno-venous (VV) ECLS. The AV-ECLS approach utilizes only the umbilical vessels for cannulation. It requires immediate transition of the infant at the time of birth to a fluid-filled artificial womb to prevent umbilical vessel spasm and avoid gas ventilation. In contradistinction, the VV-ECLS approach utilizes the umbilical vein and the internal jugular vein. It would be applied after birth to infants failing maximal medical therapy or preemptively if risk stratified for high mortality and morbidity. Animal studies are promising, demonstrating prolonged support and ongoing organ development in both systems. The milestones for clinical translation are currently being evaluated.

Water and electrolytes are major constituents of the body in the preterm infant and undergo rapid changes in content and distribution within the body compartments during the first few days of postnatal adaptation. The changes can be amplified by the severity of the functional immaturity of organs and adverse environmental factors. A clear understanding of fetal physiology and postnatal adaptation, along with frequent and structured clinical assessment, is necessary to guide optimal fluid and electrolyte supplementation. An accurate fluid and electrolyte prescription is critical to delivery of optimum early nutrition. While survival of premature infants has leapt forward with widespread use of antenatal corticosteroids, postnatal surfactant and advances in respiratory support modalities, further improvement is dependent on multiple marginal gains. Meticulous attention to maintain a physiological milieu in the ex utero environment and providing high quality early nutrition to prevent catabolism and promote early growth have been shown to have a positive impact in reducing neonatal morbidities and improving long-term outcomes. This review offers a simple overview of the physiological changes during postnatal adaptation in the preterm infant. It provides practical guidance on fluid, electrolyte and nutritional management in the first few days following birth including advice about clinical assessment and preventative measures. A self-assessment exercise is also included.

Despite improvements in survival over the past few decades, pulmonary immaturity and the use of mechanical ventilation have stunted reduction in short- and long-term morbidities for infants at the borderline of viability (22-24 weeks of gestation). It has long been suspected that the use of an artificial womb or artificial placenta to preserve native fetal physiology and maintain fluid- rather than air-filled lungs would help to improve outcomes for these infants. As such, several institutions have ongoing efforts to develop this technology, bringing the field of neonatology within sight of clinical trials. Prior to use in humans, several important ethical issues should be considered and discussed, including the moral status of these patients and the term used to describe them, whether neonate, fetus, or another term entirely. These determinations will guide when it is appropriate to use the technology and when it is permissible to withdraw this support, as well as how to ascribe parental rights and the legal status of these patients.

Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia.The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient.Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55-0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO.

Extreme prematurity remains an unsolved problem and is the leading cause of pediatric mortality and morbidity in developed countries. The extreme premature infant is physiologically a fetus, and current supportive measures in our NICUs are for the most part non-physiologic. In order to improve morbidity and mortality in this population, we have developed the Extra-uterine environment for newborn development (EXTEND) system which seeks to mimic as closely as possible the environment of the womb. The primary components of EXTEND include a sterile fluid environment, a pumpless arteriovenous extracorporeal oxygenator circuit, and vascular access via umbilical arterial and venous vessels. While supported on the EXTEND system, premature fetal lambs grow and develop normally for up to 4 weeks. Fetal physiology is maintained, and detailed organ system analysis supports normal development. This article summarizes current progress in the development of EXTEND, the pathway for human translation, ethical considerations related to EXTEND, and anticipated clinical applications of this potentially paradigm changing technology. LEVEL OF EVIDENCE: IV.

Cardiotocography (CTG) has its limits in detecting fetal acidosis and intrapartum asphyxia. Our aim was to evaluate a CTG training programme based on fetal physiology in the Mediterranean perinatal network.Professionals from 41 maternity units of the Mediterranean network were invited to participate in a CTG masterclass based on fetal physiology in March 2019 and October 2019. They were asked to react to three practical cases by a physiological approach before the training course (T0), one month after (T1) and six to seven months after (T2). The mean scores were compared by using a mixed model including lapse of time to evaluation, profession of participants and level of the maternity unit as fixed effects.A total of 248 professionals from 32 maternity units finally participated in the organizational audit. By using a mixed model, we found a significant improvement of the mean score at T1=6.44/10 compared to T0=4.97/10 (p0.0001), and a significant improvement of the mean score obtained at T2=6.17/10 compared to T0 (p0.0001). T2 scores were not significantly different from T1 scores (p=0.143).A CTG training programme based on fetal physiology showed a significant improvement in the professionals' interpretation of CTG at short term and stable results at long term. Continuing medical education could help maintain and improve knowledge to ensure neonatal safety.

Cord blood umbilical artery (Ua) pH, base deficit (BD), and pH eucapnic Blickstein/Green-50 may mislead clinicians to identify newborns at risk for hypoxic-ischemic encephalopathy. Neonatal eucapnic pH (pH euc-n Racinet-54) may be a comprehensive alternative. The goal of the study is to compare the predictive performance of these four biomarkers for the combined primary outcome of hypoxic-ischemic encephalopathy/death.This retrospective cohort study includes newborns ≥35 weeks gestational age. Receiver operating characteristics curves analysis was performed for Ua cord pH, BD, pH euc-n Racinet-54, and pH eucapnic Blickstein/Green-50 for the global cohort and for two subgroups of newborns with Ua cord pH ≤ 7.15. Cutoff values were derived for all four markers.From the original cohort of 61,037 newborns born between 1 January 2007 and 31 December 2016, we excluded cases with major congenital malformations and missing/incomplete data. The global cohort includes 51,286 newborns and 60 newborns afflicted with hypoxic-ischemic encephalopathy (HIE)/death. The area under the curves (AUC) derived from the global cohort were comparable between Ua cord pH (0.95; 95%CI = 0.94-0.95), BD (0.93; 95%CI = 0.93-0.93), pH euc-n Racinet-54 (0.93; 95% CI = 0.93-0.93), and lower for pH Blickstein/Green-50 (0.78; 95% CI = 0.77-0.78) (In this large retrospective study, predictive performance for Ua cord pH, BD, and pH euc-n Racinet-54 are comparable when applied to the global group. For newborns with Ua cord pH ≤ 7.00 and Ua cord 7.00 ≤ pH ≤ 7.15, pH euc-n Racinet-54 appears better to identify those with HIE/death, especially when the target is sensitivity 80%. Prospective studies will confirm if pH euc-n Racinet-54 is a better alternative to Ua cord pH and BD to evaluate newborn acid-base physiology.

To determine the perinatal outcomes in fetuses with baseline fetal heart rate changes with preceding decelerations on the cardiotocography (CTG) trace, and to interpret CTG traces from the aspect of fetal physiology.A retrospective analysis of 500 consecutive CTG traces was carried out. The presence of repetitive variable and late decelerations followed by the changes in the baseline including baseline tachycardia and abnormal baseline variability were determined. Perinatal outcomes including Apgar scores and umbilical arterial pH at birth, NNU admission, and meconium-stained amniotic fluid were analyzed. We interpreted the changes in CTG based on fetal physiology.When repetitive variable and late decelerations were present without tachycardia (There were significant differences in perinatal outcomes when fetuses were exposed to evolving intrapartum hypoxic stress culminating in an abnormal baseline fetal heart rate variability, which was preceded by repetitive decelerations, followed by an increase in the baseline heart rate. However, despite ongoing decelerations, if the baseline variability remained normal, none of the fetuses had a pH of7. Therefore, the knowledge of fetal physiological response to evolving hypoxic stress can be reliably used to determine fetal compensation.

Fetal surveillance is an integral part of prenatal care, especially in the last trimester. In order to understand antepartum fetal surveillance modalities, clinicians must be familiar with fetal physiology. This chapter will describe fetal cardiac physiology, which is primarily monitored. The authors will also describe fetal respiratory physiology and neurologic function to understand the impact of fetal distress, which may result in lifelong sequelae. In the subsequent sections, antepartum fetal surveillance technology is described, including nonstress tests, the biophysical profile, and umbilical artery Doppler velocimetry. The indications and limitations of these studies will be described. The purpose of this chapter is to educate clinicians on the roles of these modalities and the assessment they offer.

The foundation of neonatal anesthesia lies in the understanding of neonatal physiology and the challenges of the neonatal transition from fetal physiology. A thorough preoperative assessment of the neonate is essential prior to any surgery, including a history, physical exam, and any necessary studies. The neonatal airway is notable for being smaller, more anterior, and more cephalad in comparison to adults and should be examined for features of a difficult airway. A comprehensive review of airway management, respiratory physiology, and cardiovascular physiology is imperative to the intraoperative and postoperative management of the neonate. The fundamentals of neonatal physiology establish the basis for successfully guiding a neonate through the perioperative period.

Prematurity is a global health problem representing one of the most significant causes of morbidity and mortality in children. The concept of an artificial womb has been explored as an innovation which could substantially improve clinical outcomes in preterm patients by offering the ability to support growth and development of the neonate in a manner consistent with fetal physiology. This review will address the contemporary literature exploring the development of the artificial womb, with a focus on promising new breakthroughs in the field. Our laboratory has reported the development of an artificial womb incorporating the critical components of intrauterine physiology, namely sterile fluidic incubation of the isolated fetus as well as perfusion and gas exchange using a pumpless extracorporeal circuit. We have demonstrated support of fetal lambs for up to 4 weeks with stable hemodynamics and normal growth and development. The artificial womb represents unprecedented potential for improvement in clinical outcomes in critically preterm infants. Recent studies have demonstrated promising results in preclinical animal models, supporting the translation of this technology to human clinical trials.

In ruminants, prolonged exposure to high ambient temperatures negatively affects placental development and function. The pursuing limitations in placental oxygen and nutrient supply between the mother and fetus slow fetal growth lowering birth weights and postnatal performance. The pregnant ewe is a long-standing animal model for the study of maternal- fetal interactions and is susceptible to naturally occurring heat stress, which causes fetal growth restriction. In the pregnant ewe, studies show that the fetus adapts to hyperthermia-induced placental insufficiency to preserve placental transport capacity of oxygen and nutrients. These adaptive responses are at the expense of normal fetal development and growth. Enlarged transplacental gradient for oxygen and glucose facilitates diffusion across the placenta, but develops by lowering fetal blood oxygen and glucose concentrations. Fetal hypoxemia and hypoglycemia slow growth and alter their metabolic and endocrine profiles. Deficits in amino acids transport across the placenta are present but are overcome by reduced fetal clearance rates, likely due to fetal hypoxemia or endocrine responses to hypoxic stress. Here, we provide an overview of the performance limitations observed in ruminants exposed to heat stress during pregnancy, but we focus our presentation on the sheep fetus in pregnancies complicated by hyperthermia-induced placental insufficiency. We define the characteristics of placental dysfunction observed in the fetus of heat stressed ewes during pregnancy and present developmental adaptations in organogenesis, metabolism, and endocrinology that are proposed to establish maladaptive situations reaching far beyond the perinatal period.

Evaluation of fetal well-being during labor is based on fetal heart rate (FHR) analysis, which requires physiology expertise. The aim of the present study was to assess medical residents' fetal physiology training in terms of theoretical knowledge, FHR interpretation, and use of second-line examinations.This single-center, prospective study of obstetrics and gynecology residents (N = 34) at CHU de Lille Hospital (Lille, France) was conducted from November 2017 to November 2018. Evaluation and training were conducted in three stages. First, residents' pre-training knowledge of FHR interpretation and use of fetal scalp blood sampling (FBS) was assessed using clinical cases. Second, a didactic training session on fetal physiology was delivered. Finally, post-training knowledge was evaluated using the same cases presented during pre-training. I: Pre-training, 3%, 11.8%, and 14.7% of residents considered their training on fetal physiology, FHR analysis, and second-line examinations, respectively, to be sufficient. Training significantly improved their theoretical knowledge, which was assessed using multiple-choice questions (median [interquartile range]: 1.5 [1.0-2.0] vs. 4.0 [3.0-4.5], p0.001), and reduced the number of FBS requested (36.3% vs. 29.5%, p = 0.002). Krippendorff's alpha coefficient for the reproducibility of residents' responses improved significantly, reflecting greater homogenization of clinical practice decisions (alpha [95% confidence interval]: 0.60 [0.55-0.65] vs. 0.72 [0.67-0.76]).Improved fetal physiology knowledge promotes more accurate FHR interpretation, better indications for second-line examinations, and greater homogenization of clinical practice decisions. Future studies should evaluate the impact of fetal physiology training on clinical practice.

Extreme prematurity is a major cause of neonatal mortality and morbidity, and remains an unsolved clinical challenge. The development of an artificial womb, an extrauterine system recreating the intrauterine environment, would support ongoing growth and organ maturation of the extreme preterm fetus and would have the potential to substantially improve survival and reduce morbidity. Previous efforts toward the development of such a system have demonstrated the ability to maintain the isolated fetus for short periods of support, but have failed to achieve the long-term stability required for clinical application. Here we describe our initial experiments demonstrating the stable support of fetal lambs developmentally equivalent to the extreme premature infant for up to four weeks with stable hemodynamics, growth, and development. The achievement of long-term physiologic support of the fetus in an extrauterine system has the potential to fundamentally change the management and clinical outcome of the extreme premature infant.

The developing fetus has some unique physiological properties that differ from properties in extra-uterine life. The fetus exists in a hypoxemic condition as a result of the presence of the placenta, which serves as a limiting interface between maternal and fetal circulation. In addition, the fetus is prone to be exposed to uterine contractions, which place it under a further hypoxic burden. Thus, the fetal response to hypoxic insults is important. There has been marked progression in the understanding of fetal physiology since the introduction of the 'chronic preparation model'. Based upon information from animal research, we now utilize medical technologies in daily medical care, for example, fetal heart rate monitoring and high-resolution ultrasonographic devices. In this review, we discuss the main findings in relation to fetal physiology and their clinical relevance.

Cardiotocography (CTG) is a technique used to monitor intrapartum fetal condition and is one of the most common obstetric procedures. Second line methods of fetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography and to better identify fetuses at risk of intrapartum asphyxia. The acid-base balance of the fetus is evaluated by fetal blood scalp samples, the modification of the myocardial oxygenation by the fetal ECG ST-segment analysis (STAN) and the autonomic nervous system by the power spectral analysis of the fetal heart variability. To correctly interpret the features observed on CTG traces or second line methods, it seems important to understand normal physiology during labor and the compensatory mechanisms of the fetus in case of hypoxemia. Therefore, the aim of this review is first to describe fetal physiology during labor and then to explain the modification of the second line monitoring during labor.

Objective To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks. Methods A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20- minute periods (resting, treadmill walking, and postexercise recovery). Results The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p

The increased commercialisation of intracytoplasmic sperm injection (ICSI) in horses creates more opportunities to incorporate advanced reproductive technologies, such as sex-sorted, refrozen and lyophilised spermatozoa, into a breeding program. This paper reviews the status of these semen-handling technologies in light of their use in equine ICSI programs. Pregnancies have been achieved from each of these advanced technologies when combined with ICSI in horses, but refinements in the semen-handling processes underpinning these technologies are currently being explored to produce more reliable and practical improvements in the results from equine ICSI.

BACKGROUND: Combined spinal epidural labor analgesia has gained popularity, but it is unclear whether this technique is associated with a higher incidence of nonreassuring fetal heart rate (FHR) tracings compared with epidural analgesia. Our meta-analysis aimed at comparing the incidence of nonreassuring FHR tracings between the 2 neuraxial techniques. METHODS: Databases were searched to identify randomized controlled trials that compared the incidence of nonreassuring FHR tracings, as defined in the individual studies, after combined spinal epidural versus epidural analgesia in laboring women. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using the random-effects model. We performed a subgroup analysis for studies using low-dose epidural bupivacaine concentrations (

Reading of fetal heart rate (FHR) tracing during labor remains one of the most controversial and problematic issues in Obstetrics. The incorrect interpretation of CTG can be due to errors and pitfalls. Some common errors are related to the incorrect use of oxytocin, specifically the failure to recognize tachysystole, to correct it and to use oxytocin to accelerate labor when the fetal heart rate tracing is not reassuring. A common error is also the incorrect interpretation of deceleration that leads to unnecessary and often dangerous interventions, despite the clarification of the significance of decelerations, which in themselves are not a sign of impending acidosis, except when they are accompanied by loss of variability. Another potential error that can be identified as a pitfall is the transition from fetal to maternal heart rate (MHR) recording. The misidentification of MHR as FHR can potentially mask pathological FHR traces, appearing as a falsely reassuring trace.

Purpose: We studied natural vanilla permeability through amniotic membranes.Methods: We studied natural vanilla permeability through amniotic membranes obtained from 45 spontaneous normal deliverie...

The Criolla breed is a local genetic resource, distributed in Patagonia, Argentina, whose primary production is meat. In the Criolla goat, efforts were made to locate productively superior males and to conserve their genetic material. Studies were carried on the feasibility of obtaining superior offspring through the implementation of embryo transfer programs. We assessed the fertilization rate and embryo production following AI with frozen semen or natural mating in Criolla goats subjected to a superovulation program. During the breeding season (May, 41° S), 26 Criolla goats were treated for oestrus with sponges (60 mg of medroxyprogesterone acetate, Progespon®, Syntex, Buenos Aires, Argentina) placed for 13 days. Goat donors were superovulated with a total of 80 mg of porcine (p)FSH (Folltropin V®, Bioniche, Ontario, Canada) every 12 h in 6 decreasing doses (18, 18, 14, 14, 8, and 8 mg) during the last 3 days of progestagen treatment. A dose of 125 μg of cloprostenol (Estrumate®, Schering-Plough, Quebec, Canada) was given in conjunction with the first dose of pFSH. Oestrus detection was performed every 12 h, starting at 24 h after sponge removal. Females were considered to be in oestrus if they passively accepted buck mounting. Goats were randomly assigned to the following treatments: (1) natural mating (NM, n = 12): donors detected in oestrus were individually mated with one proven fertile buck at oestrus and 12 h post-oestrus; does were remove from the male in between (Conventionally accepted treatment); (2) AI (n = 14): donors detected in oestrus were inseminated 12 ± 2 h after the onset of oestrus by laparoscopy with frozen-thawed semen (200 × 106 spermatozoa) from the same fertile buck. Embryo recovery was done by surgical prepubic laparotomy at Day 8 after sponge removal. Superovulation response was estimated by counting the number of corpora lutea (CL). Analysis of variance was used to compare fertilization rate (total number of embryos recovered for each animal, expressed as a proportion of the total number of embryos/oocytes recovered) and embryo production between treatments. Results were expressed as mean ± SEM. Statistical significance was accepted at P 0.05). In conclusion, fertilization rates did not differ following laparoscopic insemination with frozen semen compared to natural mating in superovulated Criolla goats. Fil: Cueto, M. I.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; Argentina Fil: Fernández, J.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; Argentina Fil: Bruno Galarraga, María Macarena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; Argentina Fil: Pereyra Bonnet, Federico Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; Argentina Fil: Gibbons, A.. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte; Argentina

The fetal circulation is an entirely transient event, not replicated at any point in later life, and functionally distinct from the pediatric and adult circulations. Understanding of the physiology of the fetal circulation is vital for accurate interpretation of hemodynamic assessments in utero, but also for management of circulatory compromise in premature infants, who begin extrauterine life before the fetal circulation has finished its maturation. This review summarizes the key classical components of circulatory physiology, as well as some of the newer concepts of physiology that have been appreciated in recent years. The immature circulation has significantly altered function in all aspects of circulatory physiology. The mechanisms and significance of these differences are also discussed, as is the impact of these alterations on the circulatory transition of infants born prematurely.

The introduction of intrapartum fetal monitoring has failed to achieve one of its major goals - to reduce perinatal morbidity and mortality secondary to intrapartum hypoxic events. Despite this, it remains at common place in labour wards around the world. Although there is now a much greater understanding of fetal physiology and the fetus' normal adaptation in labour, there continues to be around 500 intrapartum stillbirths in the UK each year, many with avoidable factors that are related to cardiotocograph (CTG) misinterpretation. This review article aims to consider the mechanisms for the control of the fetal heart rate as well as features of a normal CTG. It also discusses the physiology behind abnormal fetal heart rate patterns in labour and by explaining these changes in terms of physiological mechanisms, it is hoped that readers will better understand how the fetus adapts in labour and hence guide appropriately timed intervention rather than intervention based purely upon pattern recognition.

The purpose of placental pathology is to explain adverse clinical outcomes. One of the most tragic of these outcomes is perinatal brain injury with subsequent neurodisability. Findings in the placenta can play an important role in documenting sentinel events, uncovering clinically silent thromboinflammatory disease processes, revealing developmental alterations in functional reserve, and suggesting alterations in related maternal and fetal physiology. These findings, when integrated with clinical data, provide a plausible explanation for an otherwise unexpected outcome and can be helpful for treating physicians and family members.

The physiology of the fetus is fundamentally different from the neonate, with both structural and functional distinctions. The fetus is well-adapted to the relatively hypoxemic intrauterine environment. The transition from intrauterine to extrauterine life requires rapid, complex, and well-orchestrated steps to ensure neonatal survival. This article explains the intrauterine physiology that allows the fetus to survive and then reviews the physiologic changes that occur during the transition to extrauterine life. Asphyxia fundamentally alters the physiology of transition and necessitates a thoughtful approach in the management of affected neonates.

Objective To evaluate whether a subcategory system for category II tracings can improve team communication and perinatal outcomes. Study Design We collected data prospectively for 15 months, first using the NICHD system, followed by the ABC system, which divides category II tracings into subcategories A, B, and C, each representing increased risk for metabolic acidemia. We surveyed providers about communication effectiveness and agreement on tracing interpretation for each system. In cases where the communication system was used to alert an off-site physician about a category II tracing, we compared arrival to LD and NICU admissions. Results The ABC system was preferred (69%, n = 152) and considered a more effective tool for communicating concerning fetal status (80% vs. 43%, p 0.01). Participants also reported greater agreement on tracing interpretation (79% for ABC vs. 64% for NICHD, p = 0.046). When an off-site physician was contacted about a category II tracing (n = 95), they were more likely to arrive to LD (44% vs. 20%, p 0.01) and have fewer NICU admissions (0% vs. 6%, p 0.01) with the ABC system. Conclusion The ABC system resulted in improved team communication, increased physician response, and decreased NICU admissions. Using standardized communication may offer a useful strategy for identifying and expediting care.

There is a direct link between healthy mothers and healthy infants. Exercise and appropriate nutrition are important contributors to maternal physical and psychological health. The benefits and potential risks of exercise during pregnancy have gained even more attention, with a number of studies having been published after the 2002 American College of Obstetrics and Gynecologists guidelines. A review of the literature was conducted by using PubMed, Scopus, and Embase to assess the literature regarding the benefits of exercise during pregnancy. The search revealed 219 publications, which the authors then narrowed to 125 publications. The purpose of this review is to briefly summarize the known benefits of exercise to the mother, fetus, and newborn.

Resume Objectif Determiner la place du dosage des lactates au scalp et a l’artere ombilicale par rapport au pH (Gold standard) devant des anomalies du rythme cardiaque fœtal pendant le travail. Methodes Etude de cohorte prospective du 01/07/2007 au 31/03/2008 regroupant 162 patientes presentant des anomalies du rythme cardiaque fœtal pendant le travail. Resultats La frequence des echecs de prelevements au scalp etait plus faible pour le dosage des lactates par rapport au pH ( Conclusion Le microdosage des lactates se revele etre un bon test diagnostique d’hypoxie fœtale (bonnes specificite et valeur predictive negative). Nous pouvons aussi conclure, que ce test peut se substituer au pH comme predicteur de devenir neonatal. Nous estimons qu’il existe un interet evident a combiner les deux analyses.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 40 - N° 8 - p. 774-784

Doppler velocimetry has recently become an informative procedure for the real-time and noninvasive evaluation in fetal hemodynamics. The analysis of flow velocity waveforms in various kinds of vessels has been made for not only clarifying fetal physiology and pathophysiology of various disorders but also for determining the most appropriate intervention from the viewpoint of the integrated management protocol. The unique change in both the arterial and venous flow in normal and compromised fetuses has been demonstrated. Clinical applications of the Doppler technique in monitoring the fetus are reviewed.

The Apgar score is a useful tool which has been used to assess newborn infants' apparent health within midwifery practice. However, the ‘colour' sign/observation used as part of the Apgar score requires a review because it is not applied appropriately with regard to the physiological changes that occur from fetal to neonatal life. With regards to this, midwives would usually provide a score of 9/10 at 1min, which suggests that the infant is not entirely healthy because of the categories provided within the Apgar tool. Hence, the physiology from fetal to neonatal life is not understood clearly enough, nor appropriately represented in the Apgar, to reflect the health status of a well newborn infant. More accurate information is required to correctly assess the healthy infant and reassure the parents that an Apgar of 10/10 at 1min is indicative of a normal, well neonate. The assessment of ‘colour' must also extend to include accurate assessment of all healthy infants, which include those infants born to black African/Caribbean and Asian parents.

The influence of maternal respiration on the occurrence of short-term fetal--maternal heart-rate coordination was examined using a model, which considers both heart-rate characteristics and effects of maternal respiratory sinus arrhythmia. Epochs of fetal--maternal heart-rate coordination were identified in model data produced at varying respiratory rates and compared with epochs found in real data acquired in mother-fetus pairs. The model results suggest that the low incidence of epochs found in the real data at low-breathing rates may be explained by heart-rate characteristics, but that the higher incidence at fast rates must be due to other factors.

Recent advances of ultrasound technology including 3D/4D sonography have revealed embryonal/fetal morphology, intrauterine vascularity and fetal behavior from early gestation. Modern ‘sonoembryology’ allows the definition of in vivo anatomy including visualization of dynamic features, which cannot be characterized in fixed specimens after embryonic death in embryology. Furthermore, recent highresolutional ultrasound technologies have remarkably approached accurate prenatal diagnoses with vivid and distinct sonographic depiction. Nowadays, the antenatal diagnosis is no longer ‘maybe’ nor ambiguous, owing to progressive 3D/4D ultrasound which have contributed to the field of embryology, fetal physiology and pathology.

In this study, we tried to establish cut-off values for more than one parameters of computerized cardiotocography (c CTG) in the prediction of fetal distress during labor, using a group of pregnant women with low-risk pregnancies.A retrospective study was performed. Data were collected from 167 patients for measurements of fetal heart rate (FHR) variables and perinatal outcome. Computerized CTG was performed with an Oxford Sonicaid monitor with connection to a 8000 system for CTG spontaneous analysis. The following c CTG variables were considered: FHR, number of accelerations, the presence and the number of episodes of high and low variation, the number of decelerations, short-term variation (STV), peaks of contractions (per hour) and fetal movements assessed by maternal perception (per hour). Computerized CTG recordings started not earlier than the beginning of week 38 of gestation. Immediately after delivery, blood sample was collected from umbilical artery for umbilical artery blood gas analysis (UBGA). The main UBGA parameter in cord umbilical artery that was considered for analysis was pH. pH values7.25 were considered as suspicious for acidemia and pH valuesor=7.25 as normal.Women suspicious for fetal distress during labor presented significantly lower fetal movements (P=0.026), accelerations (P=0.018), variability (P0.001), number of high episodes (P0.001), higher values of FHR baseline (P0.001) and low episodes (P0.001). Only the number of decelerations did not differ significantly between the two groups (P=0.545). The cut-off points of 5.00 for STV and 3.00 for high episodes were determined to classify women with fetal distress, which yielded high sensitivities (34 and 52%) and specificities (96.6 and 94.9%), with positive predictive values of 81.0 and 81.3% and negative predictive values of 77.4 and 82.2%, respectively.In conclusion, we believe that not only STV but also other components of the cCTG, mainly the presence and the number of episodes of high variation, are related to pregnancy's outcome as measured by an umbilical artery pH.

The feasibility and accuracy of long-term transabdominal fetal electrocardiogram (fECG) recordings throughout pregnancy were studied using a portable fECG monitor. Fifteen-hour recordings of fetal heart rate (FHR) were performed in 150 pregnant women at 20-40 weeks of gestation and 1-hour recordings were performed in 22 women in labour and compared with simultaneous scalp electrode recordings. When >or=60% of fECG signals was present, the recording was defined as good. Eighty-two percent (123/150) of antenatal recordings were of good quality. This percentage increased to 90.7 (136/150 recordings) when only the night part (11 p.m.-7 a.m.) was considered. Transabdominal measurement of FHR and its variability correlated well with scalp electrode recordings (r=0.99, P

Technological advances in ultrasound have led to a greater ability to monitor the internal life of the fetus. This has led to fascinating discoveries of fetal physiology as well as to the natural progression of some cardiac defects while in utero. Watching this progression has stimulated the medical/research community to find ways to intervene in those cardiac defects with the highest morbidity and mortality. Although still in the early stages, the challenge continues to be explored in an attempt to stop progression to a more significant defect in utero. This article explores the diagnosis, evaluation for intervention, and the role of a multidisciplinary group in educating, preparing, and caring for these families before birth.

Background: Detrended fluctuation analysis (DFA) has recently been validated as an excellent method by which to analyze heart rate variability and distinguish healthy subjects from patients with various types of the cardiac nervous system dysfunction. Methods: One hundred and nineteen fetal heart rate (FHR) recordings obtained from healthy normal fetuses and 68 recordings obtained from small-for-gestational-age (SGA) fetuses were analyzed by DFA to examine gestational and pathologic changes of the scaling exponent, α. Results: In normal fetuses, a significant increase was observed in both the short-term (≤30 s) α1 and long-term (>30 s) α2 scaling exponents according to gestational age. The α1 values of SGA fetuses were not significantly different from those of healthy normal fetuses; however, the α2 values of the former group (0.955 ± 0.152) were significantly higher than those of normal subjects (0.887 ± 0.128; p = 0.001). Conclusion: The α2 exponent appears to be a sensitive probe for detecting subtle, and possibly important, changes that occur in fetuses with intrauterine growth restriction, and may be helpful in the early and noninvasive detection of placental insufficiency or incipient intrauterine growth restriction. The use of DFA techniques offers great promise for understanding FHR behavior.

Background: The inappropriate use or interpretation of intrapartum fetal surveillance (IFS) continues to be a major contributor to adverse obstetric outcomes, suggesting that training in IFS is deficient. What professional education in intrapartum fetal sureveillance currently exists in Victorian public hospitals is unknown. Aims: To map the current formal IFS education and competency assessment practices in Victorian public hospitals. Methods: A structured survey comprising 25 questions was developed and mailed to both a senior obstetric and a midwifery manager in all public maternity hospitals in Victoria. Non-respondents were followed up at 2 months. Results: One hundred and twenty surveys were sent to 60 hospitals, of which 103 replies from 58 hospitals were received, representing a 97% hospital response rate. Only 19 (33%) of respondent hospitals had an existing education program. Hospitals with > 2000 births per annum were more likely to have a program than those with < 1000 births per annum (86% vs 23%, P = 0.004). Of the 19 existing education programs, only nine contained any fetal physiology. All respondents thought that IFS education should be compulsory for relevant staff. Only six (10%) of the hospitals had any assessment of competency but 90% of respondents thought that such an assessment should be compulsory. Conclusions: These data reveal important deficiencies in the provision and quality of current IFS education practices in Victoria, particularly in smaller and rural hospitals. However, these deficiencies seem to reflect a lack of opportunity rather than a lack of interest.