Today, we present a case of a patient undergoing induction for mild preeclampsia and receiving treatment with prostaglandins and magnesium sulfate. We will discuss how these drugs can affect the patient and how to assess changes in variability.
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An urgent cesarean section was performed due to FHR abnormalities. A male newborn was delivered, weighing g, with APGAR scores and a pHa of 7.02/PHv 7.06. EBa -9.4, EBv -9.9.
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1st segment of the CTG: Baseline FHR congruent for gestational age. Reduced variability. Cycling. RUPI (we introduce the concept of RUPI). Tachysystole.
Edwin asked us to consider a hypothetical situation in which we were both in a gym and he had a partial lung collapse, while I did not. How would we both adapt to hypoxic stress? We wouldn’t, would we?
–> Preeclampsia is a similar situation in terms of the placenta. Due to the involvement of the villi and deposits of fibrin, thrombosis, and other alterations, placental function is reduced. Babies who suffer from it will show changes earlier with chemoreceptor-type decelerations and RUPI.
2nd segment of the CTG: Stable and sustained baseline FHR. Here we can observe cycling. Frequent uterine dynamics.
It is noteworthy that there is sustained maternal tachycardia.
–> We consider, in a preeclampsia case with maternal tachycardia, what we should be thinking about.
*We discuss the changes in the CTG when there is a placental abruption: If it is a total abruption, we will see bradycardia. But if there is a partial abruption (20-40%), we will see chemoreceptor-type decelerations and absence of cycling. In the antenatal period, 50% of the placenta must have detached for alterations to be seen on Doppler or CTG, but during labor, the addition of contractions causes a sudden limitation of oxygen supply.
3rd segment of the CTG: 1/2 ampoule of Dolantina is administered at the beginning. TV: 1cm dilation. Stable baseline and reduced variability persist. There is an absence of cycling.
Effect of Dolantina (Meperidine, Pethidine) or Magnesium Sulfate: They decrease variability WITHOUT making cycling disappear.
From here, the decrease in variability is maintained, and the progressive appearance of chemoreceptor-type decelerations is observed, with an absence of cycling.
–> At this point, we should still have cycling, despite being under medication. Faced with loss of cycling and chemoreceptor-type decelerations, we should consider pathology. We are not facing a case of decompensated phase of progressive hypoxia. It also does not suggest an infection. What we are left to think about in a patient with preeclampsia is that she has a reduced placental reserve and RUPI, without being able to rule out that there has been a partial placental abruption (we have not been informed that there was suggestive clinical evidence). 30% of babies who have a sustained reduction in variability have metabolic acidosis.
We comment that it is “mild acidosis”. With very close arterial and venous pH. And elevated base excess.
We end up talking about the British TV program “I’m a celebrity get me out of here” –> Edwin says that when there is disappearance of cycling, reduction of variability and chemoreceptor-type decelerations, “get me out of here”. They should be an alarm.
