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Biomedical subjects

G Breart

Publications and source records attributed to G Breart.

At least 73 records · Page 4Linked to original sources
PubMed1981

Antepartum fetal heart rate monitoring. A semi-quantitative evaluation of the 'non-stressed' fetal heart rate.

1964 recordings (from 246 patients were analysed on the basis of a semi-quantitative evaluation of base-line heart rate variability. All the tracings were obtained in the antepartum period, between the 20th wk of pregnancy and prior to the onset of labour. None of the recordings were made during labour or after induction of uterine activity so that a 'non-stressed' fetal heart rate test was obtained in every case. The percentage of flat tracing in each recording and the presence of sinusoidal patterns were compared with the neonatal outcome. When the tracings included a more than 50% flat pattern, 81.8% of the babies were distressed at birth. When a less than 50% flat recording was present only 11.4% of the neonates were distressed. Sinusoidal patterns were more frequently associated with abnormal tracings including those with more than 50% flat recordings. The presence of sinusoidal features did not significantly influence the neonatal outcome for tracings with a less than 50% anomaly: conversely sinusoidal patterns superimposed on a more than 50% flat tracing were predictive of fetal compromise and neonatal distress in 100% of the cases. These results allow to advocate the use of 'non-stressed' antepartum fetal heart rate monitoring, as a reliable test in the management of high risk pregnancies.

Female↗
PubMed1981

Antepartum fetal heart rate monitoring. II. Deceleration patterns.

Fetal heart rate was studied during the antepartum period in 246 patients, yielding a total of 1964 recordings. The following parameters were evaluated and correlated: --the semi-quantitative assessment of fetal heart rate instability (as expressed by the percentage of duration of flat traces); --the presence of decelerations and their relationship to the presence or absence of uterine contractions; --the neonatal condition. Overall, 50% of the patients exhibited uterine contractions while 30% contained decelerations patterns either occurring spontaneously or in association with uterine contractions. A definite relationship was observed between the presence of severe decelerations (irrespective of the time relationship with any uterine contraction) and poor neonatal outcome. A relationship does exist between the presence of severe decelerations and flattening in the recording, which, as demonstrated in the previous part of the paper also exhibited a strong positive relationship with the neonatal outcome. When one considers the different degrees of flattening, it appears that a further correlation between decelerations and neonatal state is demonstrable only in the case of a 10--50% flat recording. Here the probability of a distressed baby is 20% in the absence of decelerations, but 43.4% in the presence of decelerations. In other cases (i.e., less than a 10% or more than a 50% flat recording) the pronostic significance of the instability of the record is not significantly modified by he presence or absence of decelerations. These results indicate that consideration of decelerations is only advisable in these cases where instability is moderately affected (flattening in 10-50% of the record) and that the use of the oxytocin challenge test OCT may be reserved for such cases, when these are neither spontaneous contractions nor decelerations and not contraindications present.

Apgar Score↗
PubMed1981

Antepartum fetal heart rate monitoring. III. Fetal movements and accelerations in fetal heart rate.

This third part of the paper deals with the study of the relationships between fetal movements, fetal heart rate accelerations associated with such movements, fetal heart rate instability and neonatal outcome. No correlations has been found between absence of fetal movements and neonatal distress. A correlation has been found between the lack of fetal heart rate accelerations, the flatness of the record and poor neonatal outcome. In extreme situations (i.e. flatness in less than 10% of the record or in more than 80%) the presence or absence of accelerations does not add further useful information. Such information, however, is gained in the intermediary situations (the 'combined' recordings) and particularly when the record is between 51 and 80% flat where there appears to be an 85.6% risk to the fetus. Consequently, when trying to analyse an antenatal record it seems advisable to take primarily into account the percentage of flat recordings (providing the records are numerous enough and of sufficient length). Then, in records between 10 and 50% flat, the presence or the lack of spontaneous decelerations requires consideration whereas, when the record is between 51 and 80% flat, it is the presence or absence of fetal heart rate accelerations which is important.

Apgar Score↗
PubMed1980

Antenatal care and maternal demographic and social characteristics. Evolution in France between 1972 and 1976.

A study was carried out on representative samples of 11 254 births in France in 1972 and 4685 births in 1976. Women were interviewed after delivery to obtain information about the medical care they had received during pregnancy. Inadequate antenatal care was defined as: first antenatal visit after the first trimester of pregnancy, or total number of visits fewer than the required minimum, or no visit to an obstetrician or the hospital maternity team. In 1972, the problem of inadequate care occurred mainly in very young women, or in those of high parity or with short birth intervals when the father's social class had been taken into account. Social status was also an important factor independently of a woman's demographic characteristics. These inequalities persisted in 1976 despite the policy adopted in 1972 to improve antenatal care for high-risk women.

Adult↗
PubMed1980

[Perinatal pathology after normal pregnancies (author's transl)].

We have analysed, using the score of Hobel, 326 case notes of pregnancies that were considered normal out of 500 consecutive deliveries in order to try to find out whether there was any way in which women could be selected for delivery at home without risk. We have studied among these cases complications or accidents that happened in the neonatal period and the time when the first abnormal signs appeared. These signs were discovered at the consultation which took place at the beginning of the 9th month (for example, breech presentation) in 4.6 per cent of cases of normal pregnancy, at the examination carried out on admission to the unit (for example, post-term) in 16 per cent of cases and during labour in 9.8 per cent of cases. These showed up in half the cases by clinical signs (for example, the appearance of meconium), and in the other half of the cases they were totally unpredictable (for example, compression of the cord) which was diagnosed early thanks to continual monitoring of the fetal heart rate. The figure for complications or accidents in the perinatal period (fetal death, an Apgar score less than 7 at 5 minutes, intensive resuscitation of the baby, a birth weight of less than 2000 g) was found tobe in 5.4 per cent of normal pregnancies and 15 per cent of pathological pregnancies. The presence of these complications after normal pregnancy made us look more carefully for diagnostic features which could be singled out during the pregnancy (for example, mild urinary tract infection, a little bleeding at the beginning of the pregnancy). These "small signs" could not help to make a prognosis. These findings suggest, without definite proof because a controlled study has not been possible, that the prevention of serious complications in labour is only possible when all labours are supervised intensively routinely: and delivery at home means that a real risk is run by the infant even after the pregnancy has been normal.

Adult↗
PubMed1978

Improvements in the results with the continuous pH electrode due to technical progress: a comparison between two series of cases.

Our experience is based on 139 attempts of tissular pH electrode applications in the fetal scalp during labor and includes 119 records comprising 86 tracings of good quality and 33 tracings of bad quality. Technical progress in the electrode and application material allowed an increase in the good quality tracings rate (from 54.5--66%) and a decrease of the complications, particularly the numbers of broken electrodes (from 18 to 2.4%).

Electrodes↗
PubMed1978

[Outcome of pregnancy and prenatal care among immigrant women (author's transl)].

A retrospective survey on a representative sample of births in France in 1972 relating to more than 11000 women showed the amount of perinatal pathology among immigrants as compared with French women: a higher rate of foetal or neonatal distress, a three to four times higher stillbirth rate among Portuguese and North African women, a prematurity rate more than twice as higher among North African women. When differences in parity and socio-cultural level between immigrant and French women were allowed for, there remained a higher rate of perinatal pathology among immigrants. Prenatal care was also more often inadequate among immigrants, even when taking into account their low socio-cultural standard. Attitude towards prenatal care was highly influenced by the level of adaptation in France. But, even with equal prenatal care, perinatal pathology was higher among immigrant women: being an immigrant is a risk factor in itself.

Acculturation↗
PubMed1977

Continuous subcutaneous pH measurement in human fetuses: correlations with scalp and umbilical blood pH.

The subcutaneous pH values of 42 fetuses has been measured continuously during labor with the use of the electrode designed by Stamm and associates. We have obtained 60 per cent good tracings. The results have confirmed the reliability of the subcutaneous pH measurement, if the electrode is correctly inserted, when compared with both capillary and umbilical artery blood pH measurements (r = 0.91, p less than 0.001 and 0.83, p less than 0.001, respectively). Technical improvements appear to be necessary prior to widespread clinical use of continuous pH measurement.

Electrodes↗
PubMed1977

[Effect of intravenous administration of spasmaverine on uterine activity during labor].

The authors have studied the action of an intravenous injection of Spasmaverine (Bis gamma phenyl-3-propylethylamine) on the intra-uterine pressure in labour in 20 cases. This study has shown that there is a definite rise in amplitude, in the frequency of contractions, in the uterine activity as expressed in montevideo units and in the basal tone of the uterus in the ten minutes following an injection of 80 mg of Spasmavérine intravenously. The fetal cardiac rhythm was never altered. The authors recommend care in using this substance intravenously when sedation of uterine activity is sought.

Ethylamines↗
PubMed1976

[The induction of labor by prostaglandin F2alpha Clinical, tocographic and electrohysterographic study].

Induction of labor was performed in 65 patients by intravenous infusion of PgF2alpha. 55 patients were near term and induction made electively. 5 cases failed. No correlation was found between the stade of the cervix and the probability of success nor the length of the induction time. PgF2alpha induced labor needs to be closely monitored (electronical pumps and monitoring) because of the risk of hypertonus. With such a technique the side effects are minimal and no undesirable consequences were observed concerning either the mother or the child. During the course of this investigation a study was performed for the first time of the electrical activity of the human myometrium subjected to PgF2alpha stimulation. (26 recordings through the extra-amniotic intrauterine technique). The pattern of this activity is quite similar to spontaneously occuring alectrical activity.

Apgar Score↗
PubMed1976

Evaluation of the fetal state by automatic analysis of the heart rate. 2. Deceleration areas and umbilical artery blood pH.

Fetal heart rate (FHR) deceleration areas were studied to obtain by objective measurement of the FHR, their prognostic value of the new-born state. 1. There is a reasonably good correlation between FHR deceleration areas and UApH (Tab. II). Such a correlation was found by SHELLEY and TIPTON [6] for the whole deceleration area, and by TOURNAIRE et al. [10] for areas divided in a slightly different way. The correlation coefficients between FHR deceleration areas and Apgar score at 1 minute are within a close range of those of the FHR deceleration area and UApH (Tab. I and II). 2. According to the time relationship between deceleration areas and uterine contractions the best correlation coefficient was obtained surprisingly for total, followed by residual and then simultaneous areas. These results agree with those of SHELLEY and TIPTON [6] suggesting that in practice a simple measurement of the whole deceleration area, regardless of the uterine contractions is a sufficient method in evaluating FHR patterns. 3. The special purpose computer built by the BAUDELOCQUE research group can be used on-line, thus in clinical practice. It was not the case for the manual method [4] or the method using a large programmed computer [10]. 4 The evaluation of deceleration areas appears to have several advantages: 1. It provides objective measurements. 2. The unit used is independant of factors such as display speed or scale of the strip-chart. 3. The data is reduced: A few numbers replace the long descriptions of the usual clinical classifications.

Apgar Score↗
PubMedDate not supplied

Cesarean section odds ratios.

Cesarean section (CS) rates for primiparas, multiparas with and without previous CS were investigated in seven obstetrical settings. Despite the great diversity of global CS rates (5.3 to 17.4%), common CS odds ratios of 3.0 and 37 have been found for primiparas and multiparas with previous CS, respectively. Internal links between CS odds ratios have also been investigated for some anomalies associated with CS (fetal distress, non-vertex presentation, hypertension, dystocia, small for dates new born and prematurity), suggesting that perinatal services may be evaluated on CS aspects according to a single general interventionist/conservative clinical attitude. Data from two additional obstetrical settings were used to verify the findings in terms of perinatal evaluation.

Cesarean Section↗