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Biomedical subjects

I Ingemarsson

Publications and source records attributed to I Ingemarsson.

At least 73 records · Page 4Linked to original sources
PubMed1988

Breech delivery and mental handicap.

Recent studies with strict management protocols for selection of cases for trial of vaginal delivery for full-term breech presentations show no significant differences in outcome brought about by the birth route. This is in clear contrast to some of the older studies which indicated considerable risk for the vaginally born breech infant. Prospective follow-up studies and carefully matched controlled studies with sophisticated neurological evaluations indicate that breech infants, regardless of mode of delivery, will score slightly less favourably than infants born in vertex presentation. This difference seems to reflect prenatal factors rather than birth injuries.

Breech Presentation↗
PubMed1988

Uterine activity in spontaneous labour with breech presentation.

Uterine activity was quantified for patients who had a breech presentation, spontaneous labour and a vaginal delivery. Results were studied according to parity and in relation to cervical dilatation. The multiparas with breech presentation overall had lower uterine activity compared to nulliparas when the whole labour was considered. These values were compared with control patients with vertex presentation who had spontaneous normal labour and vaginal delivery. The median uterine activity values in breech presentation were not significantly different from control nulliparous or multiparous patients. Among the breech deliveries, irrespective of parity, mean Apgar scores at 1 and 5 minutes were over 6 and cord arterial blood pH values were above 7.15, but these results were significantly lower than the control cases with vertex presentation. The uterus performs similar uterine activity in spontaneous normal labour whether the fetus presents as a vertex or breech, when controlled for parity.

Breech Presentation↗
PubMed1988

Effects of D2343, a new beta-mimetic drug, and terbutaline on spontaneous term labor.

The effects of an intravenous bolus injection of D2343 (0.75 or 1 mg) or terbutaline (0.25 mg) on spontaneous term labor were studied. The uterine activity was recorded by a transducer-tipped intrauterine catheter and calculated electronically by an uterine activity integrator module built in a conventional fetal monitor. After drug administration the uterine activity was reduced to a similar extent with D2343 and terbutaline but the contractions were abolished for a longer time with terbutaline injection (mean of 9.3-9.8 min compared with 17.0 min). Maternal blood pressure was unaffected in both groups but the increase in pulse rate was slightly higher in the D2343 groups. D2343 seems to have an effect ratio between uterine inhibitory capacity and cardiovascular side effects similar to terbutaline.

Adult↗
PubMed1987

Obstetric outcome of patients with a previous episode of spurious labor.

The obstetric performance of patients admitted with spurious labor was evaluated. The incidence of fetal distress in labor was significantly higher in those who had spurious labor (16.7%) than in those who were established in labor within 24 hours of admission (3.8%). An equivocal or ominous fetal heart rate trace on admission was related to the occurrence of fetal distress in labor in both the spurious labor group and the normal labor group. Positive predictive value of a normal test was low in the spurious labor group. Obstetric interventions such as augmentation (35.7%) and operative deliveries (41.0%) were significantly higher in the spurious labor group than in the normal labor group (19.7% and 18.8%, respectively). The induction rate in the spurious labor group was 15.5%. The use of oxytocin for augmentation and induction of labor seems to contribute to the increased incidence of fetal distress and operative deliveries in the spurious labor group. The spurious labor group also had a higher incidence of fetal distress than the control group even among the patients who did not receive oxytocin. The results suggest that patients with an episode of spurious labor constitute a high-risk group with a considerable risk of fetal distress and obstetric interventions in subsequent labor.

Delivery, Obstetric↗
PubMed1987

Oxytocin titration to achieve preset active contraction area values does not improve the outcome of induced labour.

The value of controlling oxytocin titration in induction of labour by a present uterine activity, assessed as active contraction area, was examined in a randomized study in 60 nulliparae and 54 multiparae. Each parity group was divided into two groups according to the cervical score (less than or equal to 5 and greater than 5) and within those four groups the women were randomly allocated to oxytocin titration against a present frequency of 6-7 uterine contractions every 15 min, or to a preset uterine activity equivalent to the 75th centile for spontaneous labour. The length of labour was slightly, but not significantly, longer in the frequency group. The mode of delivery, Apgar scores at 1 and 5 min and cord artery blood pH values were similar with the two modes of oxytocin titration. The mean maximum dose rate of oxytocin infusion was not significantly different except in the nulliparous group with a poor cervical score. The given mean total dose of oxytocin was similar in the different groups when controlled for parity and cervical score. The results suggest that oxytocin titration to achieve uterine activity values equivalent to the 75th centile of those observed in spontaneous labour does not confer any advantage compared with the traditional practice of titrating the oxytocin infusion to achieve a preset frequency of uterine contractions.

Apgar Score↗
PubMed1987

Augmentation of labour--mode of delivery related to cervimetric progress.

This study was designed to investigate the possible benefits, in terms of obstetric and neonatal outcome, of a prolonged augmentation period with oxytocin in patients with dysfunctional first stage of labour. The majority of patients (65.5% of nulliparas and 83.8% of multiparas) responded with satisfactory progress within the first 4 hours of augmentation and the Caesarean section rate was low in this group (1.3%). In those with unsatisfactory progress during the first 4 hours of augmentation a further 4 hour period of augmentation resulted in vaginal delivery for 50.7% of nulliparas with primary dysfunctional labour and 33.3% of those with secondary arrest in labour. Corresponding figures for multiparas were 41.7% and 25.0%, respectively. The neonatal outcome was uniformly good. It is concluded that the management protocol presented for augmentation of labour seems to be a safe procedure and might reduce the rising Caesarean section rate for dystocia.

Female↗
PubMed1987

Effect of a beta-adrenoceptor antagonist, pindolol, on human uterine smooth muscle.

The effect of a beta-adrenoceptor antagonist, pindolol, on uterine smooth muscle in term pregnant women was studied in vitro and in vivo (in hypertensive women). In most preparations in vitro and in most patients in vivo, the drug induced an inhibitory effect on spontaneous uterine activity. The fetal heart rate was not affected by the drug. These actions of pindolol would make it an appropriate drug in the therapy of hypertension in pregnancy.

Adult↗
PubMed1986

Fetal acid-base balance in low-risk patients in labor.

The fetal acid-base balance from scalp blood in the early and late first stage of labor and from cord arterial blood was assessed in 120 low-risk patients only monitored electronically for 15 minutes at admission. The mean scalp blood pH values were 7.332 at a cervical dilatation of 5 cm and 7.335 at 10 cm cervical dilatation. A low pH value (less than 7.25) was found in 14 patients; five (4.2%) of them had fetal distress. Stethoscopic auscultation failed to identify these cases. Another nine patients had transient abnormal acid-base balance (a check value within 30 minutes was normal), and the fetal heart rate trace (obtained immediately after the sampling) showed no ominous changes in these cases. It is concluded that an abnormal fetal acid-base balance is not uncommon in a low-risk population in labor. However, a critical evaluation of the acid-base balance is necessary, since in most cases the abnormal acid-base balance is transient and of a respiratory, innocuous type without concomitant fetal distress.

Acid-Base Equilibrium↗
PubMed1986

Fetal distress during labour in diabetic pregnancy.

The frequency of fetal distress in labour was studied in 46 diabetic women and in 46 non-diabetic matched controls. Fetal distress was assessed by electronic fetal heart rate (FHR) monitoring and fetal scalp blood pH determinations in late first stage of labour. Ominous FHR and/or low pH (less than 7.26) was more common in the diabetic group than in the control group (17.4% and 10.9%, respectively) but the difference was not statistically significant. The frequency of caesarean section and low Apgar score at 1 min was significantly higher in the diabetic group (P less than 0.05). There was no correlation between maternal blood glucose regulation and the occurrence of fetal distress in the diabetic group. The results suggest that fetal distress may be slightly more common in labour in diabetic women compared with controls managed in a similar way. Careful FHR monitoring and liberal use of fetal scalp blood pH determinations is recommended.

Adult↗
PubMed1986

Medical treatment of placenta accreta with methotrexate.

Placenta accreta is a rare condition and is associated with considerable maternal morbidity and mortality. Though the surgical approach of hysterectomy is a definitive therapy, there are occasions when conservation of the uterus is desired by the patient. We report a case of placenta accreta successfully treated with intravenous methotrexate. After 2 weeks of treatment no signs of placenta could be visualized on ultrasound examination of the uterus. The patient was discharged after 15 days and has since been well. Such therapy may be useful in exceptional cases in institutions with adequate facilities for careful monitoring and management of the patient.

Adult↗
PubMed1986

Placental grading with ultrasound in hypertensive and normotensive pregnancies. A prospective, consecutive study.

Placental grading was studied prospectively with real-time ultrasound in 654 consecutive pregnancies. The placental maturation was clearly demonstrated in both unselected and hypertensive pregnancies. No differences in placental grading were found between normotensive and hypertensive pregnancies. Fetal outcome was not associated with different placental grades and a grade III placenta was not predictive of an adverse outcome. The value of antenatal placental grading in unselective and hypertensive pregnancies could not be demonstrated.

Female↗
PubMed1986

Premature rupture of the membranes at term. Obstetric outcome with oxytocin stimulation in relation to parity and cervical dilatation at admission.

The obstetric outcome in women with premature rupture of the membranes (PROM) at term (greater than 36 weeks gestation) without spontaneous onset of labor (within 2 h after admission) was evaluated prospectively in a joint study at the University Hospital of Lund, Sweden and Kandang Kerbau Hospital, National University of Singapore. After 2 h of observation without uterine contractions, labor was stimulated with oxytocin infusion. 303 patients participated and were classified according to parity (nulliparae-multiparae) and cervical dilatation at admission (less than 2 cm dilated; greater than or equal to 2 cm dilated). No significant race-related differences could be found, except for birthweight. Nulliparae with unfavorable cervix at admission had a high rate of ominous fetal heart rate findings in labor and a high cesarean section rate (19.4%), particularly for failed stimulation of labor. The high cesarean section rate after routine stimulation of labor in nulliparae with unfavorable cervix suggests that a non-intervention approach may be justified in this group. In contrast, the cesarean section rate after stimulation of labor was 3.6% in nulliparae with the cervix dilated 2 cm or more at admission and 4.2% in multiparae and ominous fetal heart rate changes were much less common.

Adult↗
PubMed1986

Intra-uterine growth retardation and gestational age.

This is a 5-year material of all singleton SGA (small for gestational age) infants born at the University Hospital in Lund, 1977-81, with a long-term follow-up. After the introduction of routine ultrasound scanning for all pregnancies in weeks 17 and 32 (1980-81), the rate of SGA-diagnosis before birth increased from 54.6% to 74.5% and the long-term outcome improved for term SGA infants. All women were treated according to a uniform policy regarding the termination of pregnancy--even in the early preterm period, if signs of fetal jeopardy appeared. More than half of all infants born before gestational week 34 died (40.0%) or showed major neurological handicap (16.0%) in spite of all being delivered by cesarean section. The corresponding figures for infants born in weeks 34-36 were 8.3% (deaths) and 8.3% (major handicaps); the cesarean section rate in this group was 83.3%. Term SGA-infants had an excellent outcome, with a low rate both for postnatal death (0.5%) and for major handicaps (2.0%). The results suggest that despite a high rate of antenatal diagnosis of intra-uterine growth retardation, and a uniform management of the pregnancy and the newborn, the high rate of cesarean delivery, and also intensive neonatal care, preterm SGA-infants are exposed to a greater risk of death or severe handicap.

Child Development↗