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Biomedical subjects

I Ingemarsson

Publications and source records attributed to I Ingemarsson.

At least 91 records · Page 5Linked to original sources
PubMed1986

Admission test: a screening test for fetal distress in labor.

The usefulness of a short electronic fetal heart rate recording at admission of patients in labor (admission test) was investigated in low-risk patients in two prospective studies. The admission test was done in a concealed manner, and the result of the test was evaluated after delivery so as not to influence the clinical management. In part I of the investigation, the test was performed in 130 patients monitored during labor with pH determinations in scalp blood and in cord blood at birth. Patients with reactive admission tests had a low rate of intrauterine asphyxia in labor (0.9%), whereas half of the patients with ominous traces had intrauterine fetal asphyxia with a low scalp blood pH and neonatal depression. Similar results were obtained in part II, when the admission test was used as a screening procedure involving 1041 patients. The test was reactive in 94.3%, and in this group fetal distress (cesarean section, or forceps on that indication, or an Apgar score less than 7 at five minutes) occurred in 1.3%. Ten patients (1.0%) had ominous tests; four of these had fetal distress, and one of these fetuses died in utero three hours after admission, during which time stethoscopic auscultation failed to detect the fetal compromise. It is concluded that the admission test can detect fetal distress already present at admission and unnecessary delay in intervention can be avoided in such a case. The test seems also to have some predictive value for the fetal well-being for the next few hours of labor. The test is simple and convenient for screening purposes.

Delivery, Obstetric↗
PubMed1986

Chorioamnionitis and the isolation of microorganisms from the placenta.

Specimens for the isolation of microorganisms were obtained from the cervical canal in 83 and from the placenta in 86 of 90 women delivered by cesarean section. In addition, the placentas from 87 of these women were examined histopathologically. No correlation was found between the isolation of a given microorganism from the cervical canal and infectious disease in mothers and/or neonates. Isolation of microorganisms from the placenta was correlated with rupture of the membranes occurring six or more hours before surgery and, in women with intact fetal membranes, was correlated with uterine activity. Chorioamnionitis histopathologically was associated with maternal and/or neonatal infections and prematurity. Microorganisms were not isolated significantly more often from the placenta in cases with chorioamnionitis than without. The value of cervical and placental cultures in predicting intrauterine infection is questionable.

Bacteria↗
PubMed1985

Single injection of terbutaline in term labor. I. Effect on fetal pH in cases with prolonged bradycardia.

Thirty-three patients with prolonged fetal bradycardia (fetal heart rate baseline less than 100 bpm for a minimum of 3 minutes or less than 80 bpm for at least 2 minutes) in labor were studied. They were treated with a bolus injection of terbutaline if the bradycardia persisted at less than 80 bpm for 2 minutes and other efforts to improve the fetal heart rate (oxygen, positional changes) had failed. After the bolus injection a scalp blood pH (or a cord arterial pH in abdominal deliveries) was obtained within 30 minutes. Fetal acidosis was common if the bradycardia lasted 10 minutes or more, particularly if the rate was less than 80 bpm with a flat baseline for 4 minutes or more. The fetal heart rate improved after injection in 30 cases; 23 patients had vaginal delivery of infants in good condition. Ten underwent cesarean section: three for no improvement in fetal heart rate, two for cord prolapse, four for later ominous fetal heart rate, and one for failure to progress. These results suggest that tocolysis in selected cases can be of benefit for the fetus with prolonged bradycardia. In cases with an ominous fetal heart rate pattern preceding the bradycardia and in abruptio placentae immediate operative intervention without delay is probably better. Administration of terbutaline should be regarded as a temporary measure until it is apparent that the fetal heart rate has recovered. Preparation for emergency delivery should be made while a recovery is awaited.

Female↗
PubMed1985

Single injection of terbutaline in term labor. II. Effect on uterine activity.

The effect of terbutaline, 250 micrograms given as an intravenous bolus injection in term labor, was investigated with use of a transducer-tipped catheter placed in the uterine cavity. Maternal side effects were common but well tolerated. No fetal side effects were recorded. The results suggest that 250 micrograms of terbutaline as a bolus injection gives a safe and effective inhibition of uterine activity in term labor. Possible indications and benefits of transient inhibition of uterine activity in term labor, particularly when fetal distress is associated with abnormal uterine activity, are discussed.

Adult↗
PubMed1985

Complications of beta-mimetic therapy in preterm labour.

Selective beta-mimetic drugs are the most frequently used agents for arresting preterm labour. For this purpose these drugs have to be given in high doses for several hours and since they act on several organ systems, side-effects, some of which are potentially dangerous, appear. These hazards, which involve chiefly the cardiovascular and metabolic areas, have been examined in the light of available experience with these drugs. This review considers the possible mechanisms for the side-effects and offers suggestions on how the dangers in the use of beta-mimetic drugs in preterm labour might be avoided.

Adrenergic beta-Agonists↗
PubMed1985

Modern strategy for the term breech delivery--a study with a 4-year follow-up of the infants.

In a comprehensive 4-year follow-up study the long-term outcomes in 709 singleton term breech born infants were evaluated. The outcome has been related to different management protocols during two consecutive study periods. In the first period (A, 1971-1974) the rate of cesarean section was 16.1% and in the second period (B, 1974-1977) 37.1%. The neonatal mortality rate was the same in both study periods (0.3%). The incidence of long-term neurodevelopmental handicaps was in period A 5.3% and in period B 2.4% at 4 years of age. Sequelae among infants in period A were in most cases labor-related, i.e. footling, extended arms or difficulty in descent of the fetal head. An antero-posterior diameter of less than 12 cm at the brim was common in these cases. In both study periods there was an increased risk of neurodevelopmental handicaps for infants with hyperextension of the head in the breech position delivered by the vaginal route. In period B the incidence of neurodevelopmental sequelae at the 4-year follow-up did not differ from that found in a group of infants born vaginally in vertex presentation. The rates of visual and auditory disorders, behaviour problems, enuresis and late speech development were not increased in the breeches neither in period A nor in period B.

Breech Presentation↗
PubMed1985

Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up.

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.

Adult↗
PubMed1985

A five-year experience with terbutaline for preterm labor: low rate of severe side effects.

The medical records of 330 patients treated with terbutaline infusion for the inhibition of preterm labor were reviewed over a five-year period. In patients with intact membranes the results were uniformly good, particularly when treatment was instituted before the 30th week. Half these patients had a prolonged labor of six weeks or more; in most cases of treatment failure complications already existed on admission. In only nine patients (2.7%) terbutaline treatment was stopped due to side effects: predominantly maternal tachycardia or vomiting. Two patients had chest symptoms, but in no case was pulmonary edema diagnosed. The results suggested that a low incidence of severe side effects can be obtained if the following precautions are taken: glucose is used as the infusion medium, instead of sodium chloride; concentrated solutions are given to avoid fluid overload; the patients are carefully controlled; and the infusion is immediately reduced or stopped if signs of severe side effects appear.

Dose-Response Relationship, Drug↗
PubMed1984

Neurodevelopmental outcome and electronic fetal heart rate monitoring in a neonatal intensive care population.

In a one-year population, 1977, of newborn infants admitted to the Neonatal Intensive Care Unit (NICU) the incidence of persistent neurodevelopmental handicaps was 3%, i.e. 13 of 427 survivors at 2 years of age. Transient abnormalities during the first 6 months of life were found in 63 infants, but after 6 months of age they were all normal at follow-up examinations. Most mothers with infants showing transient abnormalities or persistent handicaps had a high-risk pregnancy but one-third (35.5%) had a low-risk pregnancy and in this group 4 out of 7 cases with persistent major neurodevelopmental handicaps were found. In the total one-year population, 6% showed ominous fetal heart rate patterns (FHR) in labor compared with 31% of infants with later abnormalities and handicaps. Furthermore, all 13 infants with persistent handicaps had a normal Apgar score at 5 min, indicating that Apgar scoring was less predictive than FHR for neurodevelopmental outcome. Altogether 54 infants born in 1977 were small for gestational age (SGA): 33 NICU-treated and 21 not NICU-treated. Seven (6 NICU-treated, 1 not NICU-treated) had transient abnormalities (12.9%). No SGA infant developed persistent handicaps. The results suggest an improved obstetric and neonatal care of these infants.

Child, Preschool↗
PubMed1984

Fetal heart rate during treatment of maternal hypertension with beta-adrenergic antagonists. A preliminary report.

The effects of two different beta-adrenergic antagonists on maternal arterial pressure and fetal heart rate were studied in 8 pregnant women with pregnancy hypertension. The fetal heart rate was monitored by abdominal ECG recording under standardized conditions. Basal heart rate, long-term variability and short-term variability were calculated in a computer. Four patients received 50-100 mg atenolol once daily; the other 4 received pindolol 10 mg b.i.d. Reduction in mean arterial blood pressure was seen in both groups of patients. The basal fetal heart rate was decreased in atenolol-exposed fetuses but not in pindolol-exposed fetuses. In this preliminary study there was no apparent effect on the fetal heart rate variability.

Adrenergic beta-Antagonists↗
PubMed1984

Pharmacology of tocolytic agents.

Various drugs have been used to inhibit preterm labour. Selective beta-receptor agonists are the drugs of choice and have been extensively studied for more than ten years. Several controlled studies have demonstrated a significant prolongation of the pregnancy after treatment with beta-receptor agonists and some have demonstrated improved fetal outcome. There is apparently sufficient evidence to conclude that in selected patients, treated with these drugs for inhibition of preterm labour, there is a beneficial effect on the fetal outcome. These drugs are often given in high doses and therefore there is a potential risk of severe side effects. Careful monitoring of mother and infant is essential. There has been doubt as to the efficacy of beta-receptor agonist therapy since the rate of preterm deliveries (less than 37 weeks) is unchanged in most countries despite frequent use of these drugs. However, only 15 to 17 per cent of the preterm population constitutes deliveries before week 32, which is of greater interest than the overall preterm rate. Since the introduction in Sweden of beta-receptor agonist therapy there has been a significant decrease of deliveries prior to week 32 and of infants with a birthweight of less than 1500 g. In the same population the perinatal mortality rate has decreased from 60 per cent in 1973 to 40 per cent in 1980. Among the various factors influencing these figures the inhibition of preterm labour with beta-receptor agonists may have contributed to the successful results.

Adrenergic beta-Agonists↗
PubMed1984

Intrapartum fetal acidosis in preterm infants: fetal monitoring and long-term morbidity.

Fetal heart rate (FHR) and fetal acid-base status were studied prospectively in 61 patients in preterm labor of unknown etiology. Neonatal data were analyzed, and all surviving infants participated in a follow-up study for at least two years. Ominous FHR patterns correlated well with fetal acidosis. Infants with fetal acidosis (pH less than 7.25 in scalp blood) had more neurologic abnormalities in the neonatal period and a higher rate of neurodevelopmental disabilities at the follow-up than nonacidotic infants of the same gestational weeks. In the surveillance of patients in preterm labor electronic fetal monitoring is mandatory. At late or pronounced variable decelerations, pH analysis of fetal scalp blood should be performed immediately. If not available, prompt abdominal delivery is recommended.

Acidosis↗
PubMed1983

Prenatal diagnosis of fetal brain ventricle dilatation.

In a 13 month prospective screening programme 3120 pregnant women were examined with diagnostic ultrasound at 17 and 32 weeks gestation; five fetuses (0.16%) were found with dilatation of brain ventricles. Early diagnosis was made in one patient resulting in legal termination of the pregnancy. The four other patients were diagnosed at the second ultrasound examination.

Adult↗
PubMed1983

Fetal pH and postnatal adaptation in preterm vaginal deliveries.

The postpartum adaptation to extrauterine life was studied in 39 preterm (less than 37 weeks of gestation) and 13 term vaginally born infants. Fetal scalp pH during delivery was measured in every baby. Acid-base balance was followed with repeated measurements during the first 30 minutes and at 1 and 12 hours post partum. Heart rate and respiration was monitored with a cardiorespirograph (CRG) during the first 30 minutes and at 24 hours of age. The results showed a more extended delay in acid-base regularisation in the group of preterm infants less than 34 weeks of gestation with low fetal scalp pH (less than 7.20). There was no group difference in postnatal acid-base balance and cardiorespiratory adaptation for infants born after 33 weeks of gestation in comparison to term infants. It is suggested that as regards the capacity for postnatal adaptation 34 rather than 37 gestational weeks should be considered the limit of prematurity.

Acid-Base Equilibrium↗
PubMed1983

The role of estradiol and progesterone in the regulation of myometrial activity for the onset of labor.

The concentrations of estradiol (E2) and progesterone (P) were measured in peripheral plasma and myometrium from women in the 35th to 42nd week of pregnancy. On the basis of the subjective symptoms and objective signs of labor, judged by tocography and cervical status, the women were divided into two groups, one in labor and the other not. There were no significant inter-group differences in the concentrations of E2 or P in either plasma or the myometrium. The plasma P/E2 ratio, however, differed significantly, being lower in the women in labor. A similar tendency was found in the P/E2 ratio in the myometrium but due to a wide variation, the inter-group difference did not attain statistical significance. The results suggest that a lower P/E2 ratio at term would facilitate the action of an, as yet unknown, physiological stimulus to the onset of labor.

Adult↗