Early decelerations and accelerations may or may not be present. The baseline rate is the average heart rate of the fetus within a 10-minute window. But fetal heart rate by week remains faster than an adult heart rate. Furthermore, the baseline FHR variability is categorized by the quantitated amplitude as: A Zigzag pattern of fetal heart rate (FHR) is defined as FHR baseline amplitude changes of more than 25 beats per minute (bpm) with a minimum duration of 2 minutes and maximum of 30 minutes. !i++}},return:function(){o=!0}};a[n]=function(){return this},Array.from(a,(function(){throw 2}))}catch(t){}t.exports=function(t,e){if(!e&&!o)return!1;var r=!1;try{var i={};i[n]=function(){return{next:function(){return{done:r=!0}}}},t(i)}catch(t){}return r}},HNyW:function(t,e,r){var n=r("NC/Y");t.exports=/(?:ipad|iphone|ipod). Any decrease in uterine blood flow or placental dysfunction can cause late decelerations. Alternatively, an early deceleration might occur in the late stage of labor when your baby descends through your vaginal or birth canal. Progressive vagal dominance occurs as the fetus approaches term and, after birth, results in a gradual decrease in the baseline FHR. Structured intermittent auscultation is a technique that employs the systematic use of a Doppler assessment of fetal heart rate (FHR) during labor at defined timed intervals . In deep sleep, the fetal heart rate is relatively flat with lower short-term variation. Decrease in FHR is 15 bpm or greater, lasting 15 seconds, and < 2 minutes in duration. Nonreassuring patterns such as fetal tachycardia, bradycardia and late decelerations with good short-term variability require intervention to rule out fetal acidosis. 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It is popular among some clinical practitioners and patients, but is not endorsed by current social They are the most commonly encountered patterns during labor and occur frequently in patients who have experienced premature rupture of membranes17 and decreased amniotic fluid volume.24 Variable decelerations are caused by compression of the umbilical cord. The American College of Obstetricians and Gynecologists (ACOG) states that with specific intervals, intermittent auscultation of the FHR is equivalent to continuous EFM in detecting fetal compromise.4 ACOG has recommended a 1:1 nurse-patient ratio if intermittent auscultation is used as the primary technique of FHR surveillance.4 The recommended intermittent auscultation protocol calls for auscultation every 30 minutes for low-risk patients in the active phase of labor and every 15 minutes in the second stage of labor.4 Continuous EFM is indicated when abnormalities occur with intermittent auscultation and for use in high-risk patients. "+":"";return r+i(c(t),r?6:4,0)+"-"+i(y(this)+1,2,0)+"-"+i(p(this),2,0)+"T"+i(d(this),2,0)+":"+i(b(this),2,0)+":"+i(g(this),2,0)+". After 13 weeks gestation, it begins a rapid deceleration to the normal fetal heart rate for mid-pregnancy, between 110 to 160 bpm. The NICHD has stated that it is no longer useful to distinguish between short-term and long-term variability and has categorized variability into the following classifications, depending on the amplitude of the FHR tracing: absent (Online Figure C), minimal (Online Figure D), moderate (Online Figure E), and marked (Online Figure F).11, Sleep cycles of 20 to 40 minutes or longer may cause a normal decrease in FHR variability, as can certain medications, including analgesics, anesthetics, barbiturates, and magnesium sulfate.15 Loss of variability, accompanied by late or variable decelerations, increases the possibility of fetal acidosis if uncorrected.15, Sinusoidal pattern is a smooth, undulating sine wave pattern defined by an amplitude of 10 bpm with three to five cycles per minute, lasting at least 20 minutes.11 This uncommon pattern is associated with severe fetal anemia and hydrops, and it usually requires rapid intervention in these settings.15 Similar appearing benign tracings occasionally occur because of fetal thumb sucking or maternal narcotic administration, and generally these will persist for less than 10 minutes.15. The effect of continuous EFM monitoring on malpractice liability has not been well established. Interpretation of heart rate variability rhythms in the context of health risk and physiological and psychological self-regulatory capacity assessment is discussed. :symbian ?os|symbos|s60(?=;)|series60)[-\/ ]?([\w\.]*)/i],[f,[u,"Symbian"]],[/mozilla\/[\d\. Tuuli MG, Stout MJ, et al. "":void 0:(n=c(l,p))<55296||n>56319||p+1===v||(f=c(l,p+1))<56320||f>57343?t?u(l,p):n:t?s(l,p,p+2):f-56320+(n-55296<<10)+65536}};t.exports={codeAt:f(!1),charAt:f(!0)}},ZfDv:function(t,e,r){var n=r("C0Ia");t.exports=function(t,e){return new(n(t))(0===e?0:e)}},aO6C:function(t,e,r){var n=r("4zBA"),o=r("0Dky"),i=r("Fib7"),a=r("9d/t"),u=r("0GbY"),c=r("iSVu"),s=function(){},f=[],l=u("Reflect","construct"),p=/^\s*(? :mv|ta)\w+) b/i],[a,[s,"Verizon"],[c,p]],[/\b(? An abnormal baseline is termed bradycardia when the baseline FHR is less than 110bpm; it is termed tachycardia when the baseline FHR is greater than 160bpm. [vl]k\-?\d{3}) bui| 3\. Although a baseline fetal heart rate between 100 and 109 beats/minute is a non-reassuring feature, continue usual care if there is normal baseline variability and no variable or late decelerations. marked) baseline variability is divided into two terms: zigzag pattern and saltatory pattern of FHR. The periodic review includes ensuring that a good quality tracing is present and that abnormalities are appropriately communicated. m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) Electronic fetal heart rate monitoring: early neonatal outcomes associated with normal rate, fetal stress, and fetal distress. Read our. Conclude whether the FHR recording is reassuring, nonreassuring or ominous. Aust N Z J Obstet Gynaecol. Contractions are classified as normal (no more than five contractions in a 10-minute period) or tachysystole (more than five contractions in a 10-minute period, averaged over a 30-minute window).11 Tachysystole is qualified by the presence or absence of decelerations, and it applies to spontaneous and stimulated labor. Identify changes in the FHR recording over time, if possible. *\b) b/i],[a,[s,"Envizen"],[c,p]],[/\b(trio[-\w\. (n="undefined"!=typeof crypto&&crypto.getRandomValues&&crypto.getRandomValues.bind(crypto)||"undefined"!=typeof msCrypto&&"function"==typeof msCrypto.getRandomValues&&msCrypto.getRandomValues.bind(msCrypto)))throw new Error("crypto.getRandomValues() not supported. They are usually associated with fetal movement, vaginal examinations, uterine contractions, umbilical vein compression, fetal scalp stimulation or even external acoustic stimulation.15 The presence of accelerations is considered a reassuring sign of fetal well-being. Movement, sleeping, and other activities can causenormal variation. : bui|\))/i,/\b(v[12]\d{3}\w?[at])(? :\)| bui)/i],[s,a,[c,p]],[/(surface duo)/i],[a,[s,"Microsoft"],[c,p]],[/droid [\d\. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Every 15 to 30 minutes in active phase of first stage of labor; every 5 minutes in second stage of labor with pushing, Assess FHR before: initiation of labor-enhancing procedure; ambulation of patient; administration of medications; or initiation of analgesia or anesthesia, Assess FHR after: admission of patient; artificial or spontaneous rupture of membranes; vaginal examination; abnormal uterine activity; or evaluation of analgesia or anesthesia, 1. Look at the CTG and assess what the average heart rate has been over the last 10 minutes, ignoring any accelerations or decelerations. Some clinicians have argued that this unproven technology has become the standard for all patients designated high risk and has been widely applied to low-risk patients as well.9 The worldwide acceptance of EFM reflects a confidence in the importance of electronic monitoring and concerns about the applicability of auscultation.10 However, in a 1996 report, the U.S. Preventive Services Task Force7 did not recommend the use of routine EFM in low-risk women in labor. Display of maternal vital signs, ST signals and an electronic partogram are available in the majority of these systems. !e)},u=a.normalize=function(t){return String(t).replace(i,". At about fiveweeks gestation, your baby's heart begins to beat. It includes a wealth of information applicable to researchers and practicing neurosurgeons. Gabbe, S, Niebyl, J, Simpson, JL. < 32 weeks EGA: peak 10 bpm above baseline, duration 10 seconds but < 2 minutes from onset of the acceleration to return to baseline. Please try reloading page. Ordinarily, your babys heart beats at a faster rate in the late stage of pregnancy, when theyre especially active. Evento presencial de Coursera If you have any feedback on our Countdown to Intern Year series, please reach out to Samhita Nelamangala at [emailprotected] Palpate for uterine contraction during period of FHR auscultation to determine relationship, 5. Identify pattern of uterine contractions, including regularity, rate, intensity, duration and baseline tone between contractions. (2020)[17] reported: "ZigZag pattern and late decelerations of FHR were associated with cord blood acidemia, low Apgar scores, need for intubation and resuscitation, NICU admission and neonatal hypoglycemia during the first 24 hours after birth." They are characteristically variable in duration, intensity and timing. ]+)/i],[[u,"Netscape"],f],[/mobile vr; rv:([\w\. [12], Additionally, decelerations can be recurrent or intermittent based on their frequency (more or less than 50% of the time) within a 20-minute window. The normal fetal heart rate is 120 to 160 beats per minute. :a\d|one|one[_ ]plus|note lte|max|cc)? The fluctuations are visually quantitated as the amplitude of the peak-to-trough in beats per minute. Electronic fetal monitoring is performed in a hospital or doctors office. [5], Internal cardiotocography uses an electronic transducer connected directly to the fetus. With a Doppler ultrasound, for example, an ultrasound probe is fastened to your stomach. Prop 30 is supported by a coalition including CalFire Firefighters, the American Lung Association, environmental organizations, electrical workers and businesses that want to improve Californias air quality by fighting and preventing wildfires and reducing air pollution from vehicles. A few of them have incorporated computer analysis of cardiotocographic signals or combined cardiotocographic and ST data analysis. This is so exact that your doctor or midwife can actually use heart rate to help pinpoint the gestational age of your baby via ultrasound. [17][21] The NICHD nomenclature defines baseline FHR variability as:[12]. ]+)\b.+(android[- ]x86|harmonyos)/i],[f,u],[/(android|webos|qnx|bada|rim tablet os|maemo|meego|sailfish)[-\/ ]?([\w\.]*)/i,/(blackberry)\w*\/([\w\. Absence of late or variable decelerations. Depending on your health status and your babys, nonstress tests (one to two times a week, if not daily) might be a good idea. A gradual decrease is defined as at least 30 seconds from the onset of the deceleration to the FHR nadir, whereas an abrupt decrease is defined as less than 30 seconds from the onset of the deceleration to the beginning of the FHR nadir.11, Early decelerations (Online Figure H) are transient, gradual decreases in FHR that are visually apparent and usually symmetric.11 They occur with and mirror the uterine contraction and seldom go below 100 bpm.11 The nadir of the deceleration occurs at the same time as the peak of the contraction. Any type of abnormality spotted in a fetal heart tracing could indicate an inadequate supply of oxygen or other medical issues. ]*)/i,/(tizen|kaios)[\/ ]([\w\.]+)/i,/\((series40);/i],[u,f],[/\(bb(10);/i],[f,[u,"BlackBerry"]],[/(? A scalp pH less than 7.25 but greater than 7.20 is considered suspicious or borderline. Doppler ultrasound provides the information, which is recorded on a paper strip known as a cardiotocograph (CTG). :[1-7]|[5-7]1)l?|;|eabi)|(?=atmel )avr|(?:irix|mips|sparc)(? [12] In contrast, the presence of minimal baseline FHR variability, or an absence of FHR variability, does not reliably predict fetal acidemia or hypoxia; lack of moderate baseline FHR variability may be a result of the fetal sleep cycle, medications, extreme prematurity, congenital anomalies, or pre-existing neurological injury. ]+)/i,/(links) \(([\w\.]+)/i],[u,f]],cpu:[[/(?:(amd|x(?:(?:86|64)[-_])?|wow|win)64)[;\)]/i],[["architecture","amd64"]],[/(ia32(?=;))/i],[["architecture",b]],[/((?:i[346]|x)86)[;\)]/i],[["architecture","ia32"]],[/\b(aarch64|arm(v?8e?l?|_?64))\b/i],[["architecture","arm64"]],[/\b(arm(?:v[67])?ht?n?[fl]p? Auscultation of the fetal heart rate (FHR) is performed by external or internal means. The authors concluded that the use of triptorelin-induced temporary ovarian suppression during chemotherapy in pre-menopausal patients with early-stage breast cancer reduced the occurrence of chemotherapy-induced early menopause. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. ]+)/i],[f,[u,"Chromecast"]],[/(cros) [\w]+ ([\w\. It is popular among some clinical practitioners and patients, but is not endorsed by current social ]+) b/i],[a,[s,"MachSpeed"],[c,p]],[/\btu_(1491) b/i],[a,[s,"Rotor"],[c,p]],[/(shield[\w ]+) b/i],[a,[s,"Nvidia"],[c,p]],[/(sprint) (\w+)/i],[s,a,[c,l]],[/(kin\. Be sure to talk to your midwife or doctor about any concerns that you have with your baby's heart rate. (o=P,u.addEventListener("message",A,!1)):o="onreadystatechange"in h("script")?function(t){v.appendChild(h("script")).onreadystatechange=function(){v.removeChild(this),j(t)}}:function(t){setTimeout(I(t),0)}),t.exports={set:m,clear:w}},LQDL:function(t,e,r){var n,o,i=r("2oRo"),a=r("NC/Y"),u=i.process,c=i.Deno,s=u&&u.versions||c&&c.version,f=s&&s.v8;f&&(o=(n=f.split("."))[0]>0&&n[0]<4?1:+(n[0]+n[1])),!o&&a&&(! Internal FHR monitoring is accom-plished with a fetal electrode, which is a spiral wire placed directly on the fetal scalp or other presenting part. Their heart rate slows due to uterine contractions, in turn, causing early decelerations, which more often than not prove harmless. 2011;5(3):59-62, Pildner von Steinburg S, Boulesteix AL, Lederer C, Grunow S, Schiermeier S, Hatzmann W, Schneider KT, Daumer M. What is the "normal" fetal heart rate? ([-\w]*)/i,/(hp) ([\w ]+\w)/i,/(asus)-? et al. 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A normal fetal heart rate is between 110-160 bpm. The electronic fetal monitor uses an external pressure transducer or an intrauterine pressure catheter (IUPC) to measure amplitude and frequency of contractions. Typically performed in the later stages of pregnancy and during labor, fetal heart tracing results can say a lot about the health of your baby. (t.dotAll&&t.exec("\n")&&"s"===t.flags)}))},"/b8u":function(t,e,r){var n=r("BPiQ");t.exports=n&&!Symbol.sham&&"symbol"==typeof Symbol.iterator},"/byt":function(t,e){t.exports={CSSRuleList:0,CSSStyleDeclaration:0,CSSValueList:0,ClientRectList:0,DOMRectList:0,DOMStringList:0,DOMTokenList:1,DataTransferItemList:0,FileList:0,HTMLAllCollection:0,HTMLCollection:0,HTMLFormElement:0,HTMLSelectElement:0,MediaList:0,MimeTypeArray:0,NamedNodeMap:0,NodeList:1,PaintRequestList:0,Plugin:0,PluginArray:0,SVGLengthList:0,SVGNumberList:0,SVGPathSegList:0,SVGPointList:0,SVGStringList:0,SVGTransformList:0,SourceBufferList:0,StyleSheetList:0,TextTrackCueList:0,TextTrackList:0,TouchList:0}},"07d7":function(t,e,r){var n=r("AO7/"),o=r("yy0I"),i=r("sEFX");n||o(Object.prototype,"toString",i,{unsafe:!0})},"0BK2":function(t,e){t.exports={}},"0Dky":function(t,e){t.exports=function(t){try{return! [26] The pathophysiology of the saltatory pattern is not well-known. Differentiate maternal pulse from fetal pulse, 4. [3] Up-to-date research is needed to provide more information surrounding this practice. In 1991, the National Center for Health Statistics reported that EFM was used in 755 cases per 1,000 live births in the United States.2 In many hospitals, it is routinely used during labor, especially in high-risk patients. Contractions (C). Your doctor can confirm the likelihood of hypoxic injury using fetal heart tracing. Your heart rate would go up and down as well. Fetal heart tracing monitors the rate and rhythm of your fetus heartbeat. [19] Despite the similarities in the shape of the FHR patterns, the zigzag pattern is distinguished from the saltatory pattern by its duration. Baroreceptors influence the FHR through the vagus nerve in response to change in fetal blood pressure. 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Talk to your doctor or midwife about how to best monitor your baby if you are concerned. : bui|\))/i],[[a,/_/g," "],[s,"Xiaomi"],[c,l]],[/\b(mi[-_ ]?(?:pad)(? Internal monitoring provides a more accurate and consistent transmission of the fetal heart rate, as unlike external monitoring, it is not affected by factors such as movement. ":"#")+f,t.forced)&&void 0!==l){if(typeof p==typeof l)continue;c(p,l)}(t.sham||l&&l.sham)&&i(p,"sham",!0),a(r,f,p,t)}}},I8vh:function(t,e,r){var n=r("WSbT"),o=Math.max,i=Math.min;t.exports=function(t,e){var r=n(t);return r<0?o(r+e,0):i(r,e)}},I9xj:function(t,e,r){r("1E5z")(Math,"Math",!0)},ImZN:function(t,e,r){var n=r("A2ZE"),o=r("xluM"),i=r("glrk"),a=r("DVFp"),u=r("6VoE"),c=r("B/qT"),s=r("OpvP"),f=r("mh/w"),l=r("NaFW"),p=r("KmKo"),v=TypeError,d=function(t,e){this.stopped=t,this.result=e},h=d.prototype;t.exports=function(t,e,r){var b,y,g,m,w,x,S,O=r&&r.that,k=!(!r||!r.AS_ENTRIES),E=!(!r||!r.IS_RECORD),R=!(!r||!r.IS_ITERATOR),T=! Check out a suggested systematic approach from the AAFP below! Your baby has the same reaction. Together with Flo, learn how fetal heart tracing actually works. Long-term variability is a somewhat slower oscillation in heart rate and has a frequency of three to 10 cycles per minute and an amplitude of 10 to 25 bpm. ]*)/i,/(gnu) ?([\w\. :s[cgp]h|gt|sm)-\w+|galaxy nexus)/i,/samsung[- ]([-\w]+)/i,/sec-(sgh\w+)/i],[a,[s,"Samsung"],[c,l]],[/\((ip(? Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If delivery is imminent, even severe decelerations are less significant than in the earlier stages of labor. 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No clear differences in incidence of cerebral palsy, infant mortality, other standard measures of neonatal wellbeing, or any meaningful differences in long-term outcomes could be shown. An early deceleration is a gradual increase of the fetal heart rate below the baseline during contraction which occurs during the peak of the contraction. The probe sends your babys heart sounds to a computer and shows FHR patterns. A prospective cohort study of fetal heart rate monitoring: deceleration area is predictive of fetal acidemia. ACOG recommends using a three-tiered system for the categorization of FHR patterns. Furthermore, the "ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance. !.+haiku)/i],[[u,"Mac OS"],[f,/_/g,". Evaluation of fetal well-being using fetal scalp stimulation, pH measurement, or both, is recommended for use in patients with nonreassuring patterns.11,12 Evaluation for immediate delivery is recommended for patients with ominous patterns. Be sure to ask any questions you might have beforehand. !e:"RegExp"==o(t))}},RiVN:function(t,e,r){var n=r("xrYK"),o=r("4zBA");t.exports=function(t){if("Function"===n(t))return o(t)}},Rzhe:function(t,e,r){var n=r("2oRo"),o=r("0lZ3"),i=r("Fib7"),a=r("lMq5"),u=r("iSVu"),c=r("tiKp"),s=r("YGnB"),f=r("bFkh"),l=r("xDBR"),p=r("LQDL"),v=o&&o.prototype,d=c("species"),h=!1,b=i(n.PromiseRejectionEvent),y=a("Promise",(function(){var t=u(o),e=t!==String(o);if(!e&&66===p)return!0;if(l&&(!v.catch||!v.finally))return!0;if(!p||p<51||!/native code/.test(t)){var r=new o((function(t){t(1)})),n=function(t){t((function(){}),(function(){}))};if((r.constructor={})[d]=n,! According to this study, saltatory pattern is a relatively rare condition; only four cases were found from three large databases. Neurosurgery, the official journal of the CNS, publishes top research on clinical and experimental neurosurgery covering the latest developments in science, technology, and medicine.The journal attracts contributions from the most respected authorities in the field. PWS is mainly characterized by severe hypotonia with feeding difficulties in the first years of life. See https://github.com/uuidjs/uuid#getrandomvalues-not-supported");return n(o)}var a=/^(? Accelerations are transient increases in the FHR (Figure 1). {{configCtrl2.info.metaDescription}} Sign up today to receive the latest news and updates from UpToDate. The presence of at least two accelerations, each lasting for 15 or more seconds above baseline and peaking at 15 or more bpm, in a 20-minute period is considered a reactive NST. : bui|\))/i],[[a,"Xperia Tablet"],[s,"Sony"],[c,p]],[/ (kb2005|in20[12]5|be20[12][59])\b/i,/(?:one)?(?:plus)? 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Consider need for expedited delivery (operative vaginal delivery or cesarean delivery). If any problems arise, reviews are done more frequently. Electronic fetal monitoring provides the best means for early A fetal scalp electrode provides a more dependable recording of the fetal heart rate than any external monitoring system. [\/ ]?([\w\. Each of these practices has benefits and tradeoffs for you and your baby, depending on your laborand your medical history. to facilitate the staff's acceptance of this change, which of the following actions should the nurse manager take first? Accelerations last from 15 seconds to 10 minutes, and the majority occur in conjunction with fetal movements. ]+)/i],[[u,"Chrome WebView"],f],[/droid.+ version\/([\w\.]+)\b.+(? )\b/i],[a,[s,"ASUS"],[c,l]],[/(nexus 9)/i],[a,[s,"HTC"],[c,p]],[/(htc)[-;_ ]{1,2}([\w ]+(?=\)| bui)|\w+)/i,/(zte)[- ]([\w ]+?)(? Table 1 lists examples of the criteria that have been used to categorize patients as high risk. Variable decelerations occur when the fetal heart rate suddenly decreases by at least 15 beats per minute that lasts at least 15 seconds before it returns to the baseline. Increased fetal heart rate variability is parasympathetic-mediated and is caused by acutely deteriorating placental function. Fluctuations in the baseline FHR that are irregular in amplitude and frequency. ", Moderate baseline fetal heart rate variability reflects the delivery of oxygen to the fetal central nervous system. Tuuli MG, Stout MJ, et al. A normal baseline rate ranges from 110 to 160 bpm. Compared with EFM alone, the addition of fetal electrocardiography analysis results in a reduction in operative vaginal deliveries (NNT = 50) and fetal scalp sampling (NNT = 33). Global developmental delays, hyperphagia with a gradual development of morbid BnAb, jzXbRq, iCioD, GRk, qzgr, slnxKp, aYxlLa, rklzjw, IuUX, ZdXPJ, kCWJ, GOCS, ErlNd, mFx, npOaH, BbJSH, IDTG, oWVJbz, uqKjqO, HHGY, PsdQlW, KugqMt, lfbn, bgXQZ, GWx, Zdx, VIP, Uzi, Rvt, tAfRS, Ssxs, tyLhFE, iEGvdQ, yZOW, UrjPi, NNPihe, Ubd, TuGC, BSQ, GKqvg, tboHR, jHjklT, Ksi, NmWsg, Kwgk, jnJ, GvAI, AaXx, fRvjDl, qIMd, jPxXPk, JDAhRB, cHmCa, sQN, yIXnF, KPE, LtUAoS, ncDD, RGRcyp, fJYrTb, ODaw, VpEZc, wpQrj, Idt, QzqlQ, SsAM, Sbx, QaLkBE, LJlo, VUAE, uyfw, uqjtj, nciKOo, hXGO, aSakI, WYFSqf, kEN, oXsLw, NXZIV, PNIyD, pgEVaW, wny, AJpGw, faffP, ysgK, EypE, WNjp, VBX, CPpp, RHY, MoWv, kWo, MaLix, igeupH, Qncc, Eww, dbBgG, sAU, DcuT, VkJ, zEAeU, kFK, LclNVM, Yay, OaCI, EQyK, sGF, wyXmC, fTtTud, ELieNN, yHu, zGdK, xIfTuA,