Search PubMed⌕ Search

Biomedical subjects

I Ingemarsson

Publications and source records attributed to I Ingemarsson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Continuous maternal glucose infusion during labor: effects on maternal and fetal glucose and lactate levels.

Fetal and neonatal glucose and lactate levels and acid-base balance after continuous maternal infusion of 5% dextrose at 180 mL/h (9 g/h) was compared with 0.9% saline solution in a prospective, randomized study from selected monitored labors. An infusion of 5% dextrose produced significantly increased glucose levels in maternal (p < 0.01), cord artery (p < 0.01), and cord vein (p < 0.001) blood. An increased maternal insulin level was also present (p < 0.05), but no differences in cord insulin levels were observed. beta-Hydroxybutyrate was lower in maternal (p < 0.05) and cord vein (p < 0.01), but not in cord artery blood, after maternal dextrose infusion. No significant changes occurred in blood lactate levels between the two groups in either mother, fetus, cord, or neonate. Acid-base balance in cord blood did not differ between the two groups. Maternal infusion of 5% dextrose at 180 mL/h (9 g/h), compared with saline solution, produces higher glucose levels in both mother and fetus, but increased insulin concentrations only in the mother. Dextrose infusion also lowers beta-hydroxybutyrate in maternal and cord vein blood. No differences were seen in lactate levels or cord acid-base balance. Both regimens seem safe according to risks for lactacidosis and neonatal hypoglycemia in the normoxemic, normal size fetus.

3-Hydroxybutyric Acid↗
PubMed1995

Scalp blood lactate: a new test strip method for monitoring fetal wellbeing in labour.

OBJECTIVE: To determine fetal scalp blood lactate with a new test strip method in parturients with normal and abnormal cardiotocograms during labour and to describe the relation to maternal lactate, fetal scalp blood pH, cord artery lactate and acid-base balance. SETTING: Labour wards at the University Hospitals of Huddinge and Lund and at the County Hospital of Ostersund, Sweden. MATERIALS AND METHOD: Fetal scalp blood was sampled for lactate (n = 269) and pH (n = 285) determination in 177 parturients with abnormal intrapartum CTG. Lactate and pH were also analysed in a group of 64 women with normal pregnancies and with a reactive fetal heart rate tracing prior to sampling of fetal scalp blood. At fetal blood sampling lactate was also determined in maternal capillary blood, while at birth lactate and acid-base balance in cord artery blood was performed in almost all cases. MAIN OUTCOME MEASUREMENTS: Medians and percentiles (lactate and acid-base balance). Correlation between fetal scalp blood lactate (dependent) and scalp blood pH, cord artery blood lactate and acid-base parameters and labour time prior to fetal blood sampling. RESULTS: In the group with abnormal cardiotocograms, fetal scalp and umbilical artery blood lactate and acid-base parameters differed significantly from the same parameters in the normal group. The fetal-maternal lactate gradient changed from negative in the normal group to positive in the fetal distress group. Multiple regression analysis, with scalp lactate as the dependent parameter, revealed a significant correlation with fetal scalp blood pH (P < 0.001) and umbilical artery lactate (P < 0.01). CONCLUSIONS: Intrapartum scalp blood lactate was significantly correlated with pH and cord artery lactate. The results indicate that increased lactate levels in fetal blood sampling describes fetal lactacidosis. The new disposable test strip requiring only 5 microliters of blood for lactate determination may be better than traditional methods for monitoring fetal wellbeing in labour.

Acid-Base Equilibrium↗
PubMed1995

Umbilical artery velocimetry may influence clinical interpretation of intrapartum cardiotocograms.

BACKGROUND: In a previous prospective randomised trial on pregnancies complicated by small-for-gestational-age fetuses fewer operative deliveries for fetal distress were found after antenatal surveillance with umbilical artery Doppler velocimetry (Doppler group) than after surveillance with cardiotocography (CTG group). Despite that, the neonatal outcome was similar in both groups. This raised the question whether the knowledge of the antenatal Doppler results had influenced the obstetric management of labor. METHODS: In this retrospective study 242 intrapartum cardiotocogram tracings, obtained from the above mentioned prospective trial, were re-interpreted by an expert without knowledge of the results in the original study. The re-interpretation was then compared to the original interpretation. RESULTS: The expert interpreted 18 intrapartum tracings in the Doppler group and 18 in the CTG group as abnormal, whereas the clinicians interpreted only 8 tracings as abnormal in the Doppler group and 18 tracings in the CTG group. CONCLUSIONS: The results of this retrospective study lend support to our hypothesis that the obstetricians in clinical practice are influenced by the knowledge of a normal umbilical Doppler velocimetry when interpreting an intrapartum CTG. This finding may partly explain why there were fewer emergency cesarean sections for fetal distress in the Doppler group than in the CTG group in the original prospective study.

Blood Flow Velocity↗
PubMed1994

Intermittent versus continuous electronic monitoring in labour: a randomised study.

OBJECTIVE: To compare the efficacy in detecting signs of fetal hypoxia in labour of intermittent (I-group) versus continuous (C-group) electronic fetal monitoring in women with low or moderate risk factors for fetal distress. DESIGN: A prospective, randomised study. SETTING: A tertiary referral centre. SUBJECTS: Four thousand and forty-four parturients at low risk for obstetric complications with a reactive fetal heart rate admission test at arrival in labour. During the study period (October 5 1989 to May 31 1991), 5647 women were delivered in the labour ward. Of these, 1178 women (20.9%) were excluded because of high risk factors in pregnancy or at admission for labour, including women undergoing elective caesarean section. Of the remaining 4469 women 4044 (90.5%) were randomised to either intermittent (n = 2015) or continuous monitoring (n = 2029) during the first stage of labour. METHODS: In the C-group the fetal heart rate was recorded continuously with electronic fetal monitoring during the first stage of labour. In the I-group the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2.5 h during the first stage of labour, and the fetal heart rate was auscultated every 15 to 30 min in between recording periods. If complications occurred, recording was changed to continuous. In the second stage of labour all the women were monitored continuously. Umbilical cord artery acid-base status was assessed at birth. MAIN OUTCOME MEASURES: Duration of electronic fetal monitoring, rates of abnormal fetal heart rate patterns, caesarean section for fetal distress, acidosis in umbilical cord arterial blood at birth, Apgar scores of less than 7 at 1 or 5 min, and referrals to the neonatal intensive care unit. RESULTS: There were no significant differences between the study groups in the incidence of ominous fetal heart rate recordings: 6.3% (I-group) versus 6.6% (C-group), or the interval from arrival to first detected abnormal fetal heart rate, although the number of suspicious fetal heart rate patterns was higher in the C-group (28.6%) than in the I-group (24.6%). In the I-group electronic fetal monitoring was performed for (median monitoring time) 38.8% of the first stage of labour as compared with 78.6% in the C-group. The incidence of caesarean section for fetal distress was similarly low in both groups: 1.2% versus 1.0%. There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit. CONCLUSIONS: Intermittent use of electronic fetal monitoring at regular intervals (with stethoscopic auscultation in between) appears to be as safe as continuous electronic fetal monitoring in low risk labours.

Apgar Score↗
PubMed1994

The cesarean section rate in Sweden: the end of the rise.

This nationwide study examined the annual changes in cesarean section rates in relation to perinatal mortality, the condition of the newborn at birth, and different indications for the procedure in Sweden. Since 1973 all obstetric units have sent copies of medical birth registration forms for newborns to the National Board of Health and Welfare. Information about the cesarean section rate, indications for the surgery, Apgar scores, and perinatal mortality between 1973 and 1990 was obtained from this data base. The cesarean section rate increased from 5 percent in 1973 to 12.3 percent in 1983, and thereafter declined steadily to 10.84 percent in 1990. Perinatal mortality was halved from 14.2 to 6.3 per 1000 live births, and the number of newborns with low Apgar scores (< 4 at 1 min and/or < 7 at 5 min) decreased from 20 to 14 per 1000 live births. We conclude that it is possible to lower the cesarean section rate on a nationwide basis without increasing risks to newborn infants.

Adult↗
PubMed1994

How Swedish obstetricians manage hypertensive disorders in pregnancy. A questionnaire study.

OBJECTIVE: To study treatment of hypertension in pregnancy in Sweden and compare our results with a similar study published in 1981. METHODS: A multiple choice questionnaire was sent to 92 obstetricians throughout Sweden and 88% responded. RESULTS: Most Swedish obstetricians would treat a woman in the second trimester with blood pressure 140/95 mmHg without antihypertensive medication (83%) in the out-patient clinic (81%). The corresponding figures according to a similar study published in 1981 were 33% and 71% of obstetricians, respectively. Almost all obstetricians (95%) would give antihypertensive treatment if the blood pressure was 170/110 mmHg or more. Betablockers and hydralazine were the most commonly used drugs. Sixteen per cent of obstetricians would use calcium antagonists, drugs not available in the previous study. Treatment with diuretics, methyldopa or diazepam in hypertension was rarely used. Eight per cent of obstetricians would give low-dose aspirin to patients with mild hypertension and 20% to patients with severe hypertension. Fourteen per cent of obstetricians would stop all kind of antihypertensive medication and frequently observe patients with essential hypertension. CONCLUSION: Antihypertensive therapy and management of hypertensive disorders of pregnancy show a great disparity among Swedish obstetricians. National strategies might improve the morbidity and mortality associated with hypertensive disorders in pregnancy.

Adult↗
PubMed1994

Lactate in fetal scalp blood and umbilical artery blood measured during normal labor with a test strip method.

A new test strip method was used to determine the lactate concentration in fetal scalp blood during normal labor. Sixty-six fetal scalp blood samples were collected at cervical dilatations between 4 cm and 10 cm. The mean lactate value was 1.7 +/- 0.8 mmol/l simultaneously (IS.D.) and the mean pH sampled simultaneously was 7.36 +/- 0.04 (IS.D.). The corresponding values for base deficit was 2.1 (+/- 1.9) and for pCO2 5.8 (+/- 0.8). No difference was seen in lactate concentrations or pH values in early compared to late first stage of labor. The mean lactate concentration in the umbilical artery immediately after delivery was 3.7 mmol/l +/- 1.2 (IS.D.). The method was easy to handle and gave the result within 60 seconds.

Female↗
PubMed1993

Effect of methyldopa and isradipine on fetal heart rate pattern assessed by computerized cardiotocography in human pregnancy.

OBJECTIVE: The effects of two antihypertensive drugs, methyldopa and isradipine, on fetal heart rate pattern were analyzed by computerized cardiotocography. STUDY DESIGN: The first part of the study was a prospective, randomized, controlled trial of 19 women with preeclampsia in the third trimester given 2.5 mg of oral slow-release isradipine twice a day or 250 mg of methyldopa three times a day. In a second part of the study 23 women with preeclampsia in the third trimester given 5 mg of oral slow-release isradipine twice a day were compared with 23 matched controls without medication. Main outcome measures were maternal blood pressure and mean baseline fetal heart rate, fetal movements, number of accelerations, periods of high and low baseline variability, and mean baseline heart rate variability. RESULTS: Compared with the pretreatment value, the mean arterial blood pressure decreased significantly in all drug treatment groups. Fetal heart rate characteristics were not significantly changed during drug treatment or bed rest. CONCLUSION: The various features of the fetal heart rate pattern evaluated by computerized methods were not influenced by treatment with methyldopa or isradipine.

Adolescent↗
PubMed1993

Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension.

OBJECTIVE: Our purpose was to study the effect of methyldopa on uteroplacental and fetal hemodynamics in women with pregnancy-induced hypertension. STUDY DESIGN: A prospective study of Doppler ultrasonographic blood flow data before and after 1 week of methyldopa treatment was conducted at the Department of Obstetrics and Gynecology, National University Hospital, Singapore, in 20 women (mean 35 weeks' gestation) with pregnancy-induced hypertension. The main outcome measures were maternal blood pressure, maternal and fetal heart rate, and blood velocity waveforms characterized by the pulsatility index in the fetal ascending aorta, middle cerebral artery, umbilical artery, and maternal uterine and arcuate arteries. Statistical evaluation was performed with t tests for paired observations. RESULTS: Maternal mean arterial blood pressure was reduced 9.7 mm Hg (95% confidence interval -13.8 to -5.6), and mean heart rate decreased 6.3 beats/min (95% confidence interval -11.1 to -1.4). Mean pulsatility index in the uterine (0.93 to 0.92) and arcuate arteries (0.61 to 0.73) were unchanged after treatment. Fetal hemodynamic changes before and after treatment were not significant. Fetal and neonatal outcome was uneventful. CONCLUSION: Short-term treatment with methyldopa in the last trimester in women with pregnancy-induced hypertension reduced maternal blood pressure and heart rate but had no adverse effects on uteroplacental and fetal hemodynamics.

Adult↗
PubMed1993

Transplacental passage of isradipine in the treatment of pregnancy-induced hypertension.

The aim of this study was to assess the concentration of isradipine in maternal and fetal plasma, and in amniotic fluid under steady-state conditions. Eight women were treated with 5-mg isradipine tablets twice daily and eight women were given slow-release isradipine capsules (SRO) twice daily for hypertension in pregnancy. Blood and amniotic fluid sampling for analysis of drug concentration was performed at delivery. In the isradipine tablet group, maternal and fetal plasma levels were 788 +/- 701 pg/mL (mean +/- SD) and 270 +/- 90 pg/mL, respectively. The corresponding levels in the SRO-treated group were 463 +/- 217 pg/mL and 185 +/- 95 pg/mL, respectively. In the amniotic fluid, the concentration was 74 +/- 42 pg/mL in the tablet group and 45 +/- 14 pg/mL in the SRO group. Therefore, isradipine passes the placental barrier, but its concentration is considerably lower in the fetal compartments.

Amniotic Fluid↗
PubMed1993

Prognosis and long-term follow-up of a twin after antenatal death of the co-twin.

It is generally believed that among twin pregnancies with one fetal loss prior to delivery, the surviving twin has an increased rate of perinatal mortality and childhood morbidity (cerebral palsy and mental retardation). By using data from the National Medical Birth Registry of Sweden between 1973 and 1983, we identified 206 gestations with the death of at least one twin (in 36 pregnancies both twins died) prior to delivery. The original medical records were retrieved for study. The presence of childhood morbidity for 65 of 129 surviving (8 years of age or older) twins born between 1973 and 1980 was evaluated by a questionnaire sent to rehabilitation centers for disabled children, as well as to offices for the Provision of Care for the Mentally Retarded. Perinatal mortality for a twin after the antenatal death of the co-twin was considerable. Fifty percent of survivors died before 34 weeks' gestation, and 18.7% thereafter. At follow-up, 8 years or more after birth, three twins (4.6%) were handicapped. Our results indicate the need for careful monitoring of the surviving twin fetus after one twin has succumbed prenatally.

Cerebral Palsy↗
PubMed1992

Randomised controlled trial of atenolol and pindolol in human pregnancy: effects on fetal haemodynamics.

OBJECTIVE: To compare the effects of uteroplacental circulation of two beta adrenoceptor blockers, atenolol (cardioselective) and pindolol (non-selective with intrinsic sympathomimetic activity). DESIGN: Controlled double blind double dummy study. SETTING: Departments of obstetrics and gynaecology in two Swedish university hospitals. SUBJECTS: 29 women with pregnancy induced hypertension in the third trimester, 13 randomised to atenolol and 16 to pindolol. MAIN OUTCOME MEASURES: Pulsatility index in fetal aorta, umbilical artery, and maternal arcuate artery. Volumetric blood flow in fetal aorta and umbilical vein. RESULTS: Mean arterial blood pressure decreased by 9.0 (95% confidence interval -13.0 to -5.0) mm Hg in the atenolol group and by 7.8 (-11.4 to -4.2) mm Hg in the pindolol group. During atenolol treatment the pulsatility index increased significantly from 1.82 (SD 0.20) to 2.07 (0.32) in the fetal thoracic descending aorta, from 1.44 (0.28) to 1.79 (0.27) in the abdominal aorta, and from 0.93 (0.17) to 1.05 (0.19) in the umbilical artery; the volumetric blood flow in the umbilical vein decreased from 106 (28.8) to 84 (22.6) ml/min/kg. No such changes were seen after treatment with pindolol. Birth weight was similar in the two groups but placental weight was significantly different (529 (122) g in atenolol group v 653 (136) g in pindolol group; p = 0.03). CONCLUSION: The hypotensive effect was similar with both drugs, but only the beta 1 blocker atenolol had significant effects on fetal haemodynamics, although within normal ranges. The implications of these findings can be only speculative, but negative fetal consequences of beta 1 adrenoceptor blockade cannot be excluded.

Atenolol↗
PubMed1991

A case-control study of the effects of birth by caesarean section on intrapartum and neonatal mortality among twins weighing 1500-2499 g.

The aim of this nationally-based, matched case-control study was to assess the impact of birth by caesarean section on intrapartum, and neonatal mortality among twins weighing 1500-2499 g, born in Sweden between 1973 and 1983. By using data held at the National Medical Birth Registry, Stockholm, 91 such pregnancies (study cases) where one or both twins died were identified. For each case, two controls (in all 182 pregnancies) were allotted at random from the rest of the twin pregnancies, with similar birthweight (+/- 100 g) and year of delivery (+/- 1 year). The number of twins that died was reduced from 73 during the first four years to 22 between 1977 and 1980, and to 6 during the last 3 years of the study period. Almost a quarter (23.1%) had a lethal malformation. The caesarean section rate increased during the study period, but did not differ between cases and controls (chi 2 = 1.0; P greater than 0.05). The analysis could not confirm a significant difference between cases and controls regarding the number of infants born vaginally in non-vertex presentation (chi 2 = 0.1; P greater than 0.05). The results of this study appear to indicate that birth by caesarean section was not a major factor related to the improved fetal outcome.

Birth Weight↗
PubMed1991

Can terbutaline be used as a nebuliser instead of intravenous injection for inhibition of uterine activity?

Terbutaline, a betamimetic drug, is used as bolus of 0.25 mg intravenously to inhibit uterine activity when encountered with uterine hyperstimulation and associated fetal heart rate changes. The effect of terbutaline used as a nebuliser in 1- and 2-mg doses on uterine activity in labor was investigated. It did not show any significant inhibition of the uterine activity in spontaneous term labor. Although convenient and easy to administer especially in an emergency, 1 or 2 mg terbutaline used in the form of nebuliser did not give the desired effect like 0.25 mg of terbutaline given intravenously for inhibition of uterine activity in term labor.

Administration, Intranasal↗
PubMed1991

Fetal and infant outcome of pregnancies with very early rupture of membranes.

Fetal and infant outcome was studied in 38 singleton pregnancies complicated by very early rupture of membranes (PROM), in gestational weeks 19-29, over a 4-year period, in a Swedish population. The pregnancies were managed according to a specified protocol, including postponement of delivery until 34 weeks of gestation if possible. Stillbirth occurred in 10 cases (26.3%), all with PROM before 26 completed weeks, while 6 other infants died in the neonatal period. Respiratory distress syndrome was evident in half (50.0%) of the 28 liveborn infants. The surviving 22 infants (57.9%) were followed up to 2 years of age. The rate of neurological sequelae at follow-up was 22.7% (5/22). The fetal outcome of the 20 pregnancies with rupture of membranes before 26 completed weeks was poor; only 7 infants of the 10 born alive survived the neonatal period. The short-term fetal outcome in the group with rupture of membranes in 26-29 completed weeks was better: 15 of the 18 infants survived, but 4 had neurological sequelae. PROM before 29 completed weeks of gestation is associated with severe short-term and long-term fetal complications, in cases where the pregnancy is prolonged for several weeks.

Adult↗
PubMed1991

No benefit from conservative management in nulliparous women with premature rupture of the membranes (PROM) at term. A randomized study.

OBJECTIVE: To compare maternal and fetal outcome in pregnancies with premature rupture of the membranes (PROM) at term with either early induction of labor or conservative management awaiting spontaneous labor. DESIGN: A prospective randomized trial. SETTING: The University Hospital of Lund, Sweden. SUBJECTS: Altogether 369 women with singleton pregnancy, cephalic presentation, gestational duration 36-41 weeks, were randomized either to induction of labor (n = 139) or conservative management up to 3 days (n = 138). Those eligible but not participating in the study totalled 92. MAIN OBSTETRIC MEASURES: Obstetric intervention rate (cesarean section or instrumental delivery) and short-term neonatal morbidity. RESULTS: No difference was found in the rate of obstetric intervention between the induction of labor group and the group with conservative management (12.2 vs. 18.8%; chi 2 = 2.3, p greater than 0.05). A slightly increased rate of neonatal infections was seen in the latter group (0.7 vs. 4.3%; chi 2 = 3.2, p less than 0.05). CONCLUSIONS: We found no benefit from conservative management for up to 3 days in women with PROM at term, compared with immediate induction of labor. There was no difference in the number of obstetric interventions during labor. The neonatal infectious morbidity was slightly higher in conservatively managed cases.

Adult↗