The unreactive fetal heart rate.
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Electrocardiography↗
Biomedical subjects
D K James
Publications and source records attributed to D K James.
Intermittent fetal tachycardia and fetal hydrops.
A case is reported where fetal hydrops was noted 10 days after an initial observation of intermittent fetal tachycardia at 31 weeks. A diagnosis of supraventricular tachycardia was made and a successful conversion to sinus rhythm was achieved with maternally administered flecainide, with subsequent resolution of the hydrops. The fetus required no further treatment in pregnancy or at follow up. The mother suffered no side effects of the treatment.
Adult↗
Oxytocin infusion during second stage of labour with epidural analgesia.
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Analgesia, Epidural↗
Two-tier approach to biophysical assessment of the fetus.
The biophysical profile score is widely accepted as a superior predictor of acute-on-chronic fetal asphyxia over the nonstress test. Nevertheless, in the United Kingdom facilities for assessment of high-risk pregnancies by nonstress test are more widely available than with the biophysical profile score. After a retrospective review of 2038 biophysical assessments in 500 high-risk pregnancies, it is suggested that biophysical evaluation of the fetus can be rationalized on the basis of the clinical problem and fetal growth. Terminal acute-on-chronic fetal asphyxia can be excluded by a two-tier method of fetal assessment by initial nonstress test backed up by the biophysical profile score when the nonstress test is suboptimal.
Asphyxia Neonatorum↗
Total perinatal wastage. A clarification of priorities.
The pregnancy outcome of 16,971 women carrying 17,352 living fetuses after 16 weeks gestation was studied. As well as recording perinatal deaths, all losses before 28 weeks and up to one year after delivery were recorded to give a total perinatal wastage rate of 21.6 per 1000 fetuses alive at 16 weeks compared with a perinatal mortality rate (stillbirths plus early neonatal deaths) of 7.8 per 1000 births. All deaths were then classified according to pathological sub-groups. The concept of auditing perinatal care using perinatal mortality was then compared with that using total perinatal wastage.
England↗
Surfactant maturation and preterm premature membrane rupture: a case study.
Preterm premature membrane rupture (PPROM) is known to accelerate fetal lung surfactant maturation. The mechanism for this is unclear. We report a case of prolonged PPROM, where the maturation of fetal surfactant was studied in detail by the serial analysis of surfactant phospholipids in the drained liquor.
Adult↗
Zinc taste test and postnatal depression.
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Depressive Disorder↗
Zinc supplementation during pregnancy: a double blind randomised controlled trial.
OBJECTIVE: To see whether zinc supplementation during pregnancy improves maternal and fetal outcome. DESIGN: Prospective study started at booking and continued till discharge of mother and baby from the maternity hospital. Mothers were randomly assigned to receive zinc supplementation or placebo in a double blind trial. SETTING: Mothers booking at one hospital. PATIENTS: Women booking before 20 weeks of gestation who agreed to take part in the study. 494 Mothers were followed up till the end of pregnancy. There was no difference between the groups given zinc and placebo in their social or medical backgrounds. INTERVENTIONS: Mothers in the active treatment group received one capsule of 20 mg elemental zinc daily and those in the placebo treated group a capsule identical in appearance and taste with the active capsule but which contained inert substances. MAIN OUTCOME MEASURE: Various adverse outcomes were tested, including maternal bleeding, hypertension, complications of labour and delivery, gestational age, Apgar scores, and neonatal abnormalities. The main outcome measure was birth weight. RESULTS: There were no differences whatsoever between mothers given a zinc supplement and those given a placebo. CONCLUSION: Zinc supplementation in pregnancy in the United Kingdom does not seem to offer any benefits to the mother or her fetus.
Adult↗
Maternal leucocyte zinc deficiency at start of third trimester as a predictor of fetal growth retardation.
Leucocyte zinc concentrations were measured in 70 mothers at the beginning of the third trimester of pregnancy and compared with the weight centiles of their subsequently delivered babies. The median maternal leucocyte zinc concentrations rose progressively with weight centile. Thus the median leucocyte zinc concentration of the mothers delivering babies weighing below the 10th centile was 112 nmol/10(9) leucocytes and that of the mothers with babies weighing above the 90th centile was 229.5 nmol/10(9) leucocytes. A maternal leucocyte zinc concentration less than 120 nmol/10(9) leucocytes strongly predicted a baby weighing below the 10th centile (positive predictive value = 71.9%, negative predictive value = 91.5%, sensitivity = 64.3%, specificity = 81.8%). These findings suggest that maternal zinc concentration might have a role in antenatal screening, but larger studies are required.
Birth Weight↗
Monitoring fetal heart rate by telephone.
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Female↗
Non-specificity of surfactant deficiency in neonatal respiratory disorders.
The phospholipid content of lung fluid taken from 77 babies during the first day of life was studied. Babies with hyaline membrane disease had low concentrations of the surfactant phospholipids phosphatidylcholine, phosphatidylinositol, and phosphatidylglycerol. The palmitic acid content in phosphatidylcholine was also lower than normal. Surfactant deficiency was not, however, specific for hyaline membrane disease, as similar phospholipid abnormalities were observed in babies with congenital pneumonia and transient tachypnoea of the newborn. These findings have important clinical implications. They are relevant to research into surfactant substitution and cast doubts on the value of the antenatal phospholipid lung profile of amniotic fluid in predicting the risk of hyaline membrane disease.
Gestational Age↗
Maternal diabetes and neonatal respiratory distress. I. Maturation of fetal surfactant.
The phospholipid composition of amniotic fluid samples from 30 normal patients and 44 diabetic patients over the last 10 weeks of pregnancy was studied. Higher levels of phosphatidylcholine (PC) and phosphatidylinositol (PI) were found in diabetic pregnancies where there was excellent glucose control. These differences were statistically significant at 34-36 weeks. Phosphatidylglycerol (PG) appeared significantly earlier in the well controlled diabetic pregnancies, but even in the poorly controlled diabetics the levels of PC, PI and PG were comparable to those in normal pregnancies. There was no evidence of delayed appearance of fetal surfactant phospholipids in either the well or poorly controlled diabetic pregnancies. The absolute lecithin (PC)/sphingomyelin (SM) ratio in diabetic pregnancies was generally greater for any given gestational age than those in normal pregnancies. Whilst in most cases this was due to a higher PC concentration, in a few poorly controlled diabetics it was the result of a lower concentration of SM.
Amniotic Fluid↗
Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity.
Fifty babies were born at less than or equal to 37 weeks to mothers with diabetes. Delivery was undertaken in all patients with the reassurance that the L/S ratio was greater than or equal to 2.0 within the preceding 72 h. Five babies (10%) developed respiratory distress syndrome (RDS). Prediction of fetal lung maturity was improved dramatically by measuring amniotic fluid concentrations of phosphatidylcholine (PC), phosphatidylinositol (PI) and phosphatidylglycerol (PG). Fourteen babies were predicted as having 'no surfactant' (PC less than 20 mg/l, PI less than 2 mg/l and PG less than 2 mg/l), five developed RDS. None of the remaining 36 babies developed the illness: they were predicted as having either 'early surfactant' (PC greater than or equal to 20 mg/l, PI greater than or equal to 2 mg/l but PG less than 2 mg/l) or 'late surfactant' (PC greater than or equal to 20 mg/l, PI greater than or equal to 2 mg/l and PG greater than or equal to 2 mg/l). Measurement of PC levels alone was the most was the most accurate method of predicting RDS. There was a significant association between low surfactant phospholipid concentrations and the development of transient tachypnoea of the newborn.
Amniotic Fluid↗
Is the lecithin/sphingomyelin ratio outdated?
The lecithin/sphingomyelin (L/S) ratio in amniotic fluid is an excellent predictor of fetal lung maturity in most pregnancies but today its value is limited. A review of the use of the L/S ratio service in Manchester from 1975 to 1981 (inclusive) shows a dramatic and consistent fall in the number of requests made over the last 18 months of this period resulting in inconvenience and inefficiency in the laboratory service. Possible explanations for the declining use of the L/S ratio service are discussed with particular reference to St Mary's Hospital, Manchester and a regional re-organization of laboratory assessment of fetal lung maturity is proposed.
Amniotic Fluid↗
Kielland's forceps: role of antenatal factors in prediction of use.
The association between certain antenatal factors and the use of Kielland's forceps was analysed retrospectively in liveborn singleton births that occurred at this hospital between January and December 1976. Factors significantly associated with the use of Kielland's forceps were primiparity, short maternal stature, induction of labour, late engagement of the fetal head, low ratio of maternal height to fetal occipitofrontal head circumference, slow dilatation of the cervix in labour, and the use of epidural analgesia in labour. The findings support a contribution of cephalopelvic disproportion in the genesis of malposition, and when associated with slow dilatation of the cervix delivery should be expedited. Long-term follow-up studies are needed, however, before the role of caesarean section in reducing morbidity associated with malposition can be properly assessed.
Anesthesia, Epidural↗
Kielland's forceps: association with neonatal morbidity and mortality.
The incidence of certain neonatal complications associated with the use of Kielland's forceps was analyzed retrospectively in liveborn singleton babies delivered at this hospital between January and December 1976. The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications. Babies on whom Kielland's forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit. Neither maternal height nor the infant's birth weight or occipitofrontal head circumference influenced the occurrence of neonatal complications. The results also suggest that neither the speed of cervical dilatation nor the timing of engagement of the fetal head is of help in predicting the occurrence of neonatal complications after the use of Kielland's forceps.
Anesthesia, Obstetrical↗
Foot length--a new and potentially useful measurement in the neonate.
The foot length, occipito-frontal head circumference (OFC), crown-rump, and crown-heel length (CHL) of 123 neonates of gestational ages 26-42 weeks, were measured between 12 hours and 5 days. A gauge, designed and constructed at St Mary's Hospital, Manchester, was used to measure foot length. In term babies (37-42 weeks) who were of weights appropriate for gestational age (AGA) the scatter about the mean of foot length measurements was small (coefficient of variation = 4.5%) compared with birthweight (coefficient of variation = 12.0%). The wide range of foot length measurements in babies of different gestational ages prevented maturity being accurately estimated. The mean birthweight of term light-for-dates (LFD) babies was 30.9% lower than term AGA babies, whereas the mean foot length, OFC, and body length of LFD babies was reduced by only 4.2-8.8%. There was a positive linear correlation between foot length and other indices of body size in LFD and AGA babies of all gestational ages. However, in premature babies (less than 37 weeks) the correlation between foot length and birthweight (r = 0.95) and foot length and CHL (r = 0.96) was pronounced. The 95% confidence limits of the regression lines were +/- 327 g and +/- 2.3 cm respectively. Birthweight and CHL of premature babies can therefore be estimated from a measurement of foot length that is performed simply and rapidly. Measurements of foot length are valuable in premature babies who are too ill at birth for conventional anthropometric measurements to be made, and in whom such measurements cannot be carried out subsequently because of the encumbrance of the incubator and intensive care apparatus. Drug dosages and intravenous fluid requirements based on body weight or surface area can be indirectly calculated from a measurement of foot length.
Anthropometry↗