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Biomedical subjects

F A Manning

Publications and source records attributed to F A Manning.

At least 55 records · Page 3Linked to original sources
PubMed1989

Severe fetal brain injury without evident intrapartum asphyxia or trauma.

Two appropriate-for-dates term infants were born after uncomplicated labors and atraumatic deliveries. They were depressed at birth, developed seizures on the first day of life, and followed clinical courses compatible with hypoxic-ischemic encephalopathy. However, the umbilical cord vessel pH and blood gases were normal. The children are now severely retarded and have cerebral palsy. These cases prove that the events of labor and delivery may not be responsible for all cases of brain damage in surviving children.

Adolescent↗
PubMed1989

Reflections on future directions of perinatal medicine.

Up to the immediate past, and perhaps even to the present, a major difference between care of the fetus and of the neonate was the ability to examine directly the physical and biochemical traits of the unborn patient. In a span of time as short as perhaps 10 years it has become progressively possible to institute almost all neonatal investigative maneuvers to the fetus. In the last 5 years, the concept of treating the decreased fetus in utero has developed from a multitude of sources. The psychological, physical, and therapeutic barriers between the fetus and newborn are sharply eroded now, and may soon disappear. The impact on the advances discussed is likely to be very significant, since the near elimination of all late gestation (greater than 20 weeks) perinatal death is not unrealistic, and a major thrust in either preventing or ameliorating disease of genetic origin is at least worthy of serious contemplation. With each advance, either concrete or speculative, comes a need to reassign training priorities, professional self-definition, societal resources, and societal priorities. The distinct possibility of achieving near excellence in perinatal care exists. The possibility that society and its physicians would wish to ensure that such events are entirely desirable despite the cost is less certain. It is likely that the definitive confrontation will occur on this field.

Asphyxia Neonatorum↗
PubMed1988

Biophysical profile scoring in the management of the diabetic pregnancy.

Biophysical profile scoring was the principal technique of antepartum fetal surveillance in 238 well-controlled diabetic pregnancies. Fifty insulin-dependent diabetics had twice-weekly testing, and 188 gestational diabetics had weekly testing. Intervention was not pursued unless there were maternal or fetal complications. There were no stillbirths and three neonatal deaths, all resulting from congenital anomalies, giving a corrected perinatal mortality rate of 0. The incidence of abnormal biophysical profile scores, eight of 238 (3.3%) overall, was low, with no significant difference between types of diabetics. In those with an abnormal score, intervention was mandated; the cesarean section rate was 50% and the rate of intensive care nursery admissions was high. Of the 230 fetuses with a normal biophysical profile score, 200 (87%) were delivered at term with minimal maternal or neonatal morbidity. Amniocentesis for phospholipid profile was performed in only 33 cases (13.9%). Hyaline membrane disease was confined to five premature neonates (incidence 2.1%). We conclude that antepartum fetal surveillance using the biophysical profile score permits safe expectant management in the diabetic pregnancy, yielding significant clinical advantages to both mother and fetus.

Amniotic Fluid↗
PubMed1987

Fetal biophysical profile scoring: selective use of the nonstress test.

The fetal biophysical profile score was modified by selective use of the nonstress test. In 2712 study patients (7851 tests) the incidence of nonstress test was reduced to 2.7% with no measurable effect or test accuracy. The nonstress test was most useful in evaluation of abnormal ultrasound monitored variables.

Female↗
PubMed1987

Fetal assessment based on fetal biophysical profile scoring: experience in 19,221 referred high-risk pregnancies. II. An analysis of false-negative fetal deaths.

The incidence of false-negative fetal death, which is defined as stillbirth unrelated to major anomaly or alloimmunization occurring after a last normal fetal biophysical score, was determined in 19,221 referred high-risk pregnancies. The calculated rate of fetal death after a last normal test was 0.726/1000 (14 deaths), which remained relatively constant despite a progressive increase in tests and patients studied. We conclude that a normal fetal biophysical profile score confers a high probability of perinatal survival.

Amniotic Fluid↗
PubMed1987

Fetal surgery for obstructive uropathy: rational considerations.

The widespread use of high resolution dynamic ultrasound imaging methods in obstetrics now permits recognition of structural and/or functional developmental anomalies of fetal genitourinary tract with some considerable accuracy. Detection of congenital obstructive uropathy in the human fetus may occur as early as 16 weeks gestation. In the fetal lamb model, experimental occlusion of the outflow tract results in progressive hydronephrosis, pulmonary hypoplasia, and oligohydramnios. The renal parenchymal changes vary with the fetal age at obstruction ranging from simple hydronephrosis with later obstruction to dysgenesis with earlier obstruction. The pulmonary damage, and to some extent the renal damage, may be halted or even reversed with release of obstruction. These advances in diagnosis and an understanding of the pathophysiology have prompted attempts at chronic in utero diversion therapy in the human fetus with obstructive uropathy yielding encouraging, but as of yet, unproven success. In this report, the methods for such therapy, the rationale for the therapy, and the results of the therapy is reviewed.

Amniotic Fluid↗
PubMed1987

Antepartum fetal risk assessment: the role of the fetal biophysical profile score.

In the art of medicine we have always known that establishing an accurate diagnosis of health or disease is essential. An active search for the physical signs, both the time honoured and newly discovered, are a crucial step in achieving diagnostic accuracy, in monitoring disease progression, and in assigning prognosis. In extrauterine medicine it is common practice to gather together sets of biophysical data in order to determine immediate health, to monitor condition, and to estimate prognosis: witness the use of vital signs, and, in the newborn, the Apgar score. The providers of perinatal care have known since biblical days that fetal biophysical activities were a reflection of fetal condition (Luke: Chapter 1, Verses 44-45), yet lacked the ability to categorize these activities in an objective and complete manner. The introduction of dynamic ultrasound imaging methods to perinatal medicine at last create the window through which the principles of extrauterine medicine may now be applied to the intrauterine patient--the fetus. Fetal biophysical profile scoring is a method that utilizes this new wealth of information to differentiate the normal fetus from the fetus at risk for death or damage in utero. The method is based on the concept that the discrimination of fetal health and disease improves as more variables are considered. The now extensive clinical experience with the method, in which both overall (gross) and selected (corrected) perinatal death are reduced, while maintaining a remarkably low false negative predictive error, indicate the validity of the concept. Comparative studies lead us to believe that reliance upon single biophysical variables, such as fetal movement counts, or antepartum fetal heart rate monitoring, is no longer of sufficient accuracy to support its use as a sole measure of fetal condition. Looking forward, we anticipate that while the concept on which fetal biophysical profile scoring is based will remain unchanged, inclusion of additional variables is likely to occur. It seems likely that addition of new variables, as may be now measured using high-resolution dynamic ultrasound methods, both B-mode and Doppler, will improve diagnostic accuracy even more. We believe that the application of the current and future modified methods of composite fetal risk assessment will render the occurrence of the tragedy of perinatal loss even more infrequent. While the goal of complete elimination of perinatal deaths remain elusive, this method may be one step towards this goal.

Biophysical Phenomena↗
PubMed1987

Fetal blood sampling in Rh hemolytic disease.

Fetal blood sampling under ultrasound guidance has added a new dimension to the management of Rh hemolytic disease. Combined with the established parameters of history, antibody measurement and amniotic fluid delta OD450 readings, direct testing of the blood of the fetus completes the picture. As well as giving information that may be applied to decisions regarding management, an opportunity is provided to observe the mechanism of anti-D IgG-induced red cell destruction in vivo.

Blood Cells↗
PubMed1987

Intraperitoneal fetal transfusion: paralysis inhibits red cell absorption.

This study was undertaken to determine whether differences in fetal activity could account for the unpredictability of absorption of red blood cells from the peritoneal cavity of fetuses with alloimmune hydrops. The absorption of red cells from the peritoneal cavity of fetal lambs was studied in 7 pregnant ewes. In 3 nonparalyzed fetuses, uptake of donor red cells was complete by 80 h. In 4 fetuses given pancuronium for 4 days to abolish breathing and body movements, the absorption of red cells was markedly diminished at 92 h, but was complete 3-4 days after fetal movement resumed. This study demonstrates that fetal movements are essential in ensuring the normal absorption of red cells from the peritoneal cavity. Variability in fetal movements, particularly fetal breathing movements, may explain the unpredictability of absorption of red cells from the peritoneal cavity in fetuses with hydrops fetalis.

Absorption↗
PubMed1986

Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry.

In the period 1982 to 1985, 73 placements of catheter shunts for fetal obstructive uropathy and 44 drainage procedures for obstructive hydrocephalus were reported to a voluntary international registry. The attempts to decompress the obstructed fetal urinary tracts resulted in the survival of 30 fetuses (41 percent), with a procedure-related death rate of 4.6 percent. Pulmonary hypoplasia was the major cause of death in both untreated and treated fetuses. Although the natural history of fetal obstructive uropathy has not been well studied, the outcome of intervention for selected fetuses with posterior urethral valve syndrome was encouraging. The results of shunt procedures for obstructive hydrocephalus were less encouraging. Although 34 of 44 fetuses (83 percent) survived, the procedure-related death rate was 10.25 percent, 18 of the 34 survivors (52.9 percent) have serious neurologic handicaps, 4 (11.8 percent) have less severe handicaps, and only 12 (35.3 percent) are developing normally. Analysis of data from this registry has guided the early development of fetal surgery, but it cannot establish the efficacy of the procedures because of selection bias. A controlled trial is needed.

Catheterization↗
PubMed1986

Identification of the small for gestational age fetus with the use of gestational age-independent indices of fetal growth.

This study reviews the roles of sonographic assessment of the rate of growth of the fetal abdominal circumference, the femur length/abdominal circumference ratio, and qualitative determination of amniotic fluid volume as gestational age-independent indices for identification of the small for gestational age fetus. The sensitivity and specificity for single and combinations of test results were evaluated in 50 appropriate for gestational age and 40 small for gestational age fetuses. Positive and negative predictive values were derived for the general population. Our results indicate that either a rate of growth of the fetal abdominal circumference less than or equal to 10 mm/14 days or a femur length/abdominal circumference ratio greater than or equal to 23.5 correctly identifies most small for gestational age fetuses. When the general population is screened, only 15% of small for gestational age fetuses will be missed by this combination of criteria. The presence of a pocket of amniotic fluid less than or equal to 2.0 cm is highly suggestive of a small for gestational age fetus. However, the presence of a pocket of amniotic fluid greater than 2.0 cm does not guarantee an appropriate for gestational age fetus. We conclude that these gestational age-independent indices of fetal growth offer useful tools for differentiating between the small for gestational age and appropriate for gestational age fetus.

Amniotic Fluid↗
PubMed1986

Biophysical profile scoring in the management of the postterm pregnancy: an analysis of 307 patients.

Management and outcome were reviewed in 307 consecutive postterm pregnancies assessed by biophysical profile scoring. Twice-weekly scores accurately differentiated normal fetuses from those at risk for intrauterine hypoxia. When the profile score is normal, waiting for spontaneous labor results in healthy neonates and a much lower cesarean section rate (15% versus 42% for "prophylactic" induction). Confident conservative management of postterm pregnancy is possible.

Cesarean Section↗
PubMed1986

Fetal assessment by biophysical profile scoring: 1985 update.

In extrauterine medicine, physicians have come to rely upon sampling of multiple biophysical variables as a means of differentiating states of well-being and compromise. This basic tenet of medicine is expressed by obtaining an Apgar score or some variant in the newborn and as a measure of vital signs in later life. Few, if any, decisions regarding well-being are ever based on a single-variable assessment and, conversely, definition of compromise is rarely based upon a single variable. Through the use of dynamic ultrasound imaging it now becomes possible to visualize the fetus and its biophysical responses in health and disease. Through such visualization it becomes possible to bring to bear some of the basic principles that sustain extrauterine medicine on the intrauterine patient, the fetus. Fetal biophysical profile scoring describes a method that encompasses this concept. The results obtained by application of this method are promising. We would argue that consideration of multiple fetal biophysical variables will, in most instances, yield superior results to single-variable monitoring alone. Hence we have abandoned antepartum fetal heart rate testing as the sole method of fetal risk assessment and used the tool only in conjunction with others of the many variables that may be monitored by dynamic ultrasound methods. This concept of multiple-variable analysis as the superior method for fetal assessment seems clear and well-justified. It is our opinion, however, that the concept of fetal bioprofile scoring may be more important than the method itself in its original description.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗
PubMed1986

Monoamniotic twins: antenatal diagnosis and management.

Confident prenatal diagnosis of monoamniotic twins permits timed elective delivery, thereby reducing the risk of perinatal loss. In this report serial dynamic ultrasound fetal assessment and amniography were used to confirm this diagnosis and guide management to a successful outcome.

Amnion↗
PubMed1985

Cord prolapse: is antenatal diagnosis possible?

Cord presentation was diagnosed antenatally in nine patients at term referred for fetal ultrasound assessment (incidence of 0.61%). Seven patients were delivered by cesarean section; cord position was confirmed in four and suspected in three patients. There were two vaginal deliveries, one following spontaneous version and the other a stillbirth associated with cord prolapse.

Breech Presentation↗