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Biomedical subjects

C W Redman

Publications and source records attributed to C W Redman.

At least 181 records · Page 10Linked to original sources
PubMed1988

Maternal immune responses to the fetus in early pregnancy and recurrent miscarriage.

Direct evidence that maternal immune rejection of the fetus causes some unexplained recurrent spontaneous abortions was sought in 18 women with this condition. Tests of maternal cell-mediated immunity to fetal (paternal) antigens were done before conception, in early pregnancy, and at miscarriage, and were compared with those in 10 controls in their first pregnancies. Maternal cytotoxic alloantibody production and the blocking effect of maternal sera on maternal lymphocyte activation were also evaluated. There was no evidence for maternal cell-mediated reactivity to paternal antigens in normal early pregnancy or in most women who aborted, but circulating cytotoxic cells were found at miscarriage in a third of affected women. There was no correlation between the production of cytotoxic antibodies and serum blocking activity, and the success of the pregnancy. These data provide evidence that cell-mediated immune reactivity may be changed in some women who abort recurrently but show that circulating immunological blocking factors are not relevant to the success of pregnancy. Their induction by maternal immunisation with paternal leucocytes does not explain why this procedure prevents recurrent spontaneous abortions.

Abortion, Habitual↗
PubMed1988

Revised definition of pre-eclampsia.

Different measures of raised blood pressure were analysed in 16,211 singleton pregnancies to determine the most effective way of identifying pre-eclampsia. Increments from baseline in the first half of pregnancy were considered as well as absolute levels. A combination of a high maximum diastolic pressure with a large increase from baseline was better for identifying a group with pre-eclamptic features than either measurement on its own. A first diastolic pressure below 90 mm Hg, a subsequent increase of at least 25 mm Hg, and a maximum reading of at least 90 mm Hg gave appropriate criteria. These were applied to a second set of 15,624 singleton pregnancies and successfully identified a group with pre-eclamptic features. Fewer women were identified as pre-eclamptic than with criteria modified from an existing definition widely used in Britain. The women excluded by the new criteria had the features of mild chronic hypertension rather than pre-eclampsia. The new definition is simple to use but like all other definitions of pre-eclampsia cannot be precise.

Adult↗
PubMed1988

Antenatal fetal heart rate variation in relation to the respiratory and metabolic status of the compromised human fetus.

Three groups of women were delivered by caesarean section before labour: for an abnormal fetal heart rate (FHR) trace (21 cases, group 1), or for maternal deterioration in severe pre-eclampsia without gross fetal heart rate abnormalities (20 cases, group 2), or to avoid mechanical difficulties in labour at term (30 cases, group 3). The mean gestational ages of the first two groups were 32 weeks with a high proportion of infants small-for-gestational-age. In group 1, FHR variation (mean range of pulse intervals) was less than half (20.6 SE 1.2 ms) of the normal value at the same age (44.4 SE 1.5 ms). This was associated with hypoxaemia (mean umbilical artery PO2 of 6 mmHg at delivery), with evidence of compensation shown by an elevated amniotic fluid erythropoietin. The fetuses were hypoglycaemic and had greater umbilical artery blood alanine concentrations, but no large changes in adenine nucleotide or endorphin plasma concentrations. Although there was a minor degree of respiratory acidaemia at birth, there was not significant metabolic acidaemia. The results demonstrate that the reduced variation of 'suboptimal' and 'decelerative' fetal heart rate records is associated with fetal hypoxaemia and evidence of nutritional deprivation, but not with asphyxia.

Cesarean Section↗
PubMed1988

Screening of the fetal heart rate in early labour.

The fetal heart rates (FHR) of 588 women admitted in labour, or in early labour after induction, were screened for up to 60 min (average 17 min) using computerized numerical analysis. Decelerative records with normal FHR variation occurred in eight (1.4%) and were not associated with acidaemia or depression at birth. Forty women (6.8%) had fetuses with a reduced FHR variation. They were more likely to be in spontaneous labour, to be at an earlier gestational age, and to be delivered operatively for fetal distress of babies that were more hypoxaemic and acidaemic. However, none of the fetuses with the least variable FHR patterns required resuscitation at birth or special care. The results of the screening procedure were not fully concealed and could have influenced clinical management. This is unlikely to have caused the associations that were observed, but could have reduced an association between low FHR variation and poor outcome. We conclude that there is a basis for a randomized controlled trial of FHR screening in early labour, but that this would need to be large (more than 10,000 patients) to test the benefit of detecting the most sinister pattern (decelerations with reduced variation) of which only one example was found in this study.

Female↗
PubMed1988

Survival following intestinal obstruction in ovarian cancer.

A retrospective survey of 38 ovarian cancer patients who developed radiologically confirmed intestinal obstruction was performed. Twenty-six patients underwent surgery. In the surgical treatment group, obstruction was not due to recurrent disease in six cases. The median survival for the group as a whole was 56 days. Patients in the operative group survived significantly longer than those in the non-operative group. There was an operative mortality of 15% and major postoperative morbidity was seen in 42%. Neither the site of the obstruction nor the type of operation influenced survival. No postoperative chemotherapy responses were seen in previously treated patients.

Adult↗
PubMed1988

Cell populations in human early pregnancy decidua: characterization and isolation of large granular lymphocytes by flow cytometry.

Cell populations of human pregnancy decidua, obtained by enzymic digestion from first trimester samples, were analysed by flow cytometry after labelling with monoclonal antibodies. The majority of these decidual cells (75%) were of bone marrow origin. The most abundant cell type expressed antigens characteristic of large granular lymphocytes (LGL), although macrophages and small numbers of classical T cells were also present. Three subsets of decidual LGL can be defined by single-and double-antibody labelling. Most decidual LGL are positive for NKH1, a marker of peripheral blood LGL, but negative for CD16, the Fc receptor of NK cells, and for the T-cell markers CD3 and CD5. About half the NKH1-positive cells also express CD2, associated with the E-rosette receptor, and are identical to the CD3-negative/CD2-positive cells reported previously in early pregnancy decidua. The NKH1-positive cells apparently correspond to a minor subset of peripheral blood LGL. The remaining decidual LGL are positive for CD16 and negative or only dimly positive for NKH1, and are similar to the major type of peripheral blood LGL. After purification by flow cytometry, the NKH1-positive cells were demonstrated to be of similar size to, but slightly higher granularity than, lymphocytes, whereas the CD16-positive cells were larger and more granular. The possible role of decidual LGL in modulating placental development is discussed.

Antibodies, Monoclonal↗
PubMed1988

Atypical polypoid adenomyoma--clinical histological and immunocytochemical findings.

The clinico-pathological features of four examples of a distinctive benign uterine neoplasm are presented which has previously been titled atypical adenomyoma. The patients were all nulliparous and premenopausal. All presented with menstrual disturbances. No tumour has recurred after hysterectomy (follow-up between 10 years and 10 months). All tumours arose from the corpus, three were localised lower segment polyps, one a diffuse polypoid involvement of the endometrium. Histologically all of the tumours showed very similar appearances with closely packed, regular, tubular glands lined by low columnar epithelium, resembling most closely basal endometrial glands and surrounded by benign connective tissue which by simple tinctorial methods appeared to be largely smooth muscle. No heterologous components were seen. In two cases squamous metaplasia was extensive, in one microcalcification was present. The histological appearances favour a type of benign mixed Mullerian tumour but the appearances are not typical of Mullerian adenofibroma. Immunocytochemistry performed on 3 cases confirmed that the stroma was in large part smooth muscle, though much of the stroma stained only weakly with monoclonal antidesmin antibody.

Adult↗
PubMed1987

Risk of unexplained stillbirth at different gestational ages.

In 40,635 deliveries in 1978-85, unexplained stillbirths were an important component (nearly a quarter) of all perinatal deaths. The rate of unexplained stillbirth (unexplained stillbirths divided by total births) was highest among preterm deliveries, fell to a minimum at 39-40 weeks' gestation, then rose at 41-42 weeks. Rate is generally accepted as measuring risk, but since it is the population of undelivered, not delivered, infants that is at risk of intrauterine death, stillbirth risk would be better measured as the number of impending stillbirths divided by the total number of undelivered fetuses. With this measure the risk of unexplained stillbirth was least in preterm pregnancies, rising fourfold after 39 weeks to a maximum at 41 weeks. At this time, it was also four times higher than at 33 weeks, in contrast to the rate, which was nineteen times lower.

England↗
PubMed1987

Preeclampsia.

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Delivery, Obstetric↗
PubMed1987

Sodium fluoride in delayed measurement of umbilical blood gases.

In blood samples stored at 5 degrees C with 20 mM sodium fluoride, only small changes in blood gas measurements were observed over 24 h. Most of the changes occurred within the first 2 h after collection. In samples stored at 5 degrees C without fluoride, blood gas measurements showed continuous changes over the 24-h period.

Blood Gas Analysis↗
PubMed1987

Obstetric factors associated with cord blood gas values at birth.

Values of pH, base deficit and Pco2 in 885 unselected samples of umbilical blood collected at birth were related to pregnancy and delivery details. An increase in acidosis in both umbilical vein and artery was associated with placental abruption, maternal pethidine, pre-eclampsia, primigravidity, vaginal operative delivery for fetal distress and a long second stage of labour. Increased acidosis in arterial, but not venous, blood occurred with cord entanglement, vaginal breech delivery, postmaturity, high birthweight and a long first stage of labour. The relationship between obstetric factors and the acid-base state of the neonate suggests a possible role for cord blood gas measurements in assessing the results of obstetric practice.

Abruptio Placentae↗
PubMed1987

Maternal cell-mediated sensitisation to paternal HLA may occur, but is not a regular event in normal human pregnancy.

Maternal cell-mediated sensitisation to paternally-inherited fetal HLA was studied in 10 primigravid and 9 multigravid women. One woman in each group was found to have circulating cytotoxic effector cells specific for paternal lymphocytes, but both had a normal pregnancy outcome. These results show that sensitisation is not a regular event in pregnancy and that there must therefore be a block in the afferent (recognition) phase of the mother's immune response. Where sensitisation does occur there must also be a block on the efferent (effector) arm of the response to prevent rejection of the fetus. The restricted distribution of major histocompatibility complex antigens on trophoblast and the function of the placenta as a barrier between maternal and fetal immune compartments can explain the occurrence of both types of blockade.

Cytotoxicity, Immunologic↗
PubMed1987

New birthweight and head circumference centiles for gestational ages 24 to 42 weeks.

Based on 20,713 singleton livebirths at the John Radcliffe Hospital, Oxford, in 1978-1984, we calculated new birthweight and head circumference values for males and females between 24 and 42 weeks of gestation. Among the 803 babies born at or before 34 weeks of gestation, 28% were delivered electively for fetal problems; they were considerably lighter and had smaller heads than infants born after spontaneous preterm labour. As we and others have recommended elsewhere, the electively delivered preterm infants were excluded from the calculation of the new birthweight and head circumference centiles. In our series males were heavier and had larger head circumferences than females at most gestational ages. There were consistent and statistically significant differences in birthweight at all gestational ages from 37 weeks and in head circumference at all gestational ages from 35 weeks.

Birth Weight↗