[Medial and mediolateral perineotomy with intracutaneous sutures - a pilot study].
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Episiotomy↗
Biomedical subjects
I Ingemarsson
Publications and source records attributed to I Ingemarsson.
Cardiovascular complications of terbutaline for preterm labor.
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Cardiovascular Diseases↗
Transplacental passage and breast milk concentrations of hydralazine.
The concentration of "real" and "apparent" (= "real" hydralazine + acid-labile hydrazones) hydralazine in maternal and umbilical plasma obtained at delivery of 6 women treated with hydralazine and atenolol for pregnancy hypertension were measured by gas chromatography. In one of the patients, the concentrations of the same substances were subsequently measured in breast milk. "Apparent" hydralazine reached higher levels in umbilical than in maternal blood. The concentration of "real" hydralazine seemed to be at least as high in the fetus as in the mother. On the other hand, even though the fraction of "real" (i.e. presumably active) hydralazine was greater in milk than in plasma, the total concentration was smaller, and the estimated dose per milk feed of 75 ml would not exceed 0.013 mg. Thus, hydralazine treatment of the pregnant woman would expose her fetus to effective concentrations of the drug, but breast feeding would not result in a clinically relevant concentration in the infant.
Adult↗
Prevalence of stress incontinence among women delivered by elective cesarian section.
A retrospective investigation into the prevalence of stress incontinence in women delivered by elective cesarian section (without experience of labor) in Lund from 1974 to 1979, was carried out in 1980. Of 264 women whose replies were solicited, 204 responded. The others had moved about and could not be reached. Permanent stress incontinence was reported by a significant number of patients without experience of labor. This supports our earlier findings which indicated that pregnancy and hereditary factors are more decisive in bringing about stress incontinence than the delivery itself.
Adult↗
Use of beta-receptor agonists in obstetrics.
Modern beta-receptor agonists are potent inhibitors of uterine activity, both spontaneous and induced, and there are several indications for therapy, such as preterm labor, abnormal uterine activity during labor (with or without concomitant fetal distress), complicated cesarean sections, and others. In recent years the widespread use of beta-receptor agonists for preterm labor has been criticized and the efficacy of these drugs has been questioned, since the rate of preterm deliveries (before week 37) has remained unchanged. However, an analysis of preterm births in Sweden from 1973 to 1979 shows that the number of both preterm births before week 32 and of infants with birthweight below 1 500 g is declining, which is more interesting in terms of fetal outcome than is the crude preterm figure (before week 37). The introduction of routine use of beta-receptor agonists for preterm labor coincides with this decrease. It is concluded that these drugs can be of great value in many obstetrical situations.
Adrenergic beta-Agonists↗
Continuous maternal glucose measurements and fetal glucose and insulin levels after administration of terbutaline in term labor.
Maternal blood glucose and fetal blood glucose and insulin levels were studied in 16 women at full-term labor after administration of terbutaline 250 microgram i.v. The maternal blood glucose level was registered by a continuous blood glucose monitoring unit. In all patients studied, the terbutaline injection was followed by a rise in maternal blood glucose within 15 min, lasting for at least one hour. The fetal glucose levels paralleled those of the mothers, but on a lower level. None of the infants demonstrated hypoglycemia during the first 90 min after birth. We conclude that terbutaline administrated in this way has a direct effect on the maternal blood glucose release, and report that no harmful effects on fetal carbohydrate metabolism could be demonstrated.
Blood Glucose↗
Delivery and long-term outcome of very low birth weight infants.
The obstetric and the neonatal management of 72 infants weighing less than 1 500 g at birth were evaluated. Sixty per cent of the mothers were delivered by cesarean section. The neonatal mortality (27%) was equal in the cesarean section and the vaginally delivered groups, but intraventricular hemorrhage was a more frequent autopsy finding in the latter group. At follow-up, 88% of all surviving infants are neurologically normal at two years of age. Of the vaginally delivered infants, three suffered from cerebral palsy, but none in the cesarean section group. The present results reveal that an active management including cesarean section in the delivery of very low birth weight infants is justified and leads to a favorable prognosis.
Cesarean Section↗
Intrapartum fetal monitoring in preterm deliveries: prospective study.
Fetal heart rate (FHR) and fetal acid-base status were prospectively studied in 61 patients in preterm labor of unknown etiology. Tachycardia (43%), decreased variability (39%), and variable decelerations (61%) were often recorded. Fetal acidosis (pH less than 7.25 in scalp blood) occurred in 52% of patients delivered in weeks 28 to 33 and in 8% of patients delivered in weeks 34 to 36 of gestation. Ominous FHR changes considered classic for fetal distress were very frequently associated with fetal acidosis, but among the most immature infants with fetal acidosis several had tachycardia and decreased variability combined with variable decelerations of innocent appearance. Patients treated with a beta-receptor agonist (terbutaline) for inhibition of preterm labor had fetal tachycardia and decreased variability more often than nontreated patients. No positive correlation with fetal acidosis for these FHR changes could be demonstrated in the terbutaline-treated patients. The results indicate that fetal acidosis can appear rapidly and frequently among the most immature infants during labor, and emphasize the value of considering the gestational age and the administration of beta-receptor stimulators in the assessment of the FHR pattern in preterm labor.
Acid-Base Equilibrium↗
Impact of routine fetal monitoring during labor on fetal outcome with long-term follow-up.
A computerized system for the storage of antenatal, intrapartal, and neonatal data has been used since 1973. The present study evaluated the influence of changed neonatal and obstetric practices, with special regard to routine fetal monitoring. Three periods were studied: 1973-1974 (6,542 deliveries, only selected high-risk patients monitored); 1975-1976 (6,857 deliveries, high-risk patients monitored); 1977-1979 (9,638 deliveries, 90% monitored). The numbers of infants with an Apgar score less than 7 at 1 and 5 min were similar in 1973-1974 and 1975-1976, but the number was significantly reduced in 1977-1979. During the years studied, all but eight infants with an Apgar score less than 7 at 5 min participated in a scheduled long-term follow-up (at least 14 mo). In 1973-1974, 25 infants (35.2%) demonstrated neurological handicaps. In 1975-1976, 14 infants (19.2%) had sequelae; in 1977-1979, only three infants (4.6%) were damaged. Trend analysis showed a significant reduction in the number of infants with neurological sequelae through the years; the reduction was significant for premature and low-risk infants but not for mature high-risk infants. The improved short-term and long-term fetal outcomes seem to be largely a result of routine fetal monitoring with all its implications for obstetric and neonatal management; the significant reduction in neurological sequelae, even after correction for other changes in obstetric routines, supports this suggestion.
Apgar Score↗
Single injection of terbutaline in term labor: placental transfer and effects on maternal and fetal carbohydrate metabolism.
Maternal and fetal blood glucose and insulin levels were studied in 10 women in the second stage of labor after administration of terbutaline, 250 micrograms intravenously. The transport of the drug across the placenta was also studied. Saline solution was administered to four other women who served as controls. A rise in maternal plasma insulin levels occurred in all patients but was more pronounced in patients treated with terbutaline less than 25 minutes before delivery than in those treated more than 45 minutes prior to delivery. No difference was found in maternal blood glucose levels between terbutaline-treated patients and controls. Blood glucose increased in the fetuses during the second stage of labor and paralleled that of the mothers, but on a lower level. None of the newborn infants demonstrated hypoglycemia during the first 90 minutes after birth. Terbutaline crossed the placenta rapidly, and fetal plasma levels up to 55% of the maternal plasma levels were found. The conclusion is that this form of administration of terbutaline does not seem to have any negative short-term influences on the fetal carbohydrate metabolism.
Blood Glucose↗
Maternal and fetal concentrations of morphine after epidural administration during labor.
In this study of 20 healthy women in labor we attempted to determine the efficacy of epidural morphine as an obstetric analgesic. Four patients experienced some relief of pain while 16 patients reported no effect on pain. One newborn infant demonstrated possible morphine-induced respiratory depression. It was concluded that morphine is ineffective as an obstetric analgesic.
Anesthesia, Epidural↗
Hyperextension of the fetal head in breech presentation. A study with long-term follow-up.
The attitude of the fetal head was determined in 445 women with breech presentations. Thirty-three women (7.4 per cent) were found to have a fetus with the head in various degrees of hyperextension. Of these 26 were born vaginally and seven by Caesarean section. At follow-up (2 to 4 years) five of the vaginally born infants (22 per cent) had neurological sequelae referable to spinal, supraspinal and cerebellar injuries but all infants born by Caesarean section were normal. The results emphasise the value of an abdominal X-ray examination of all women with breech presentations. Caesarean section is recommended if the fetal head is hyperextended.
Breech Presentation↗
The accuracy of ultrasonic fetal cardiography.
The present work investigated the accuracy of ultrasound cardiography (uFCG) in registering the fetal heart rate variability. Five patients in early labour were studied. Two cardiotocographs (HP 8030A) were simultaneously recording uFCG and direct fetal electrocardiography (dFECG). The information was stored in an analogue FM tape recorder for further data processing. The number of beats registered by the two methods were counted, and the time intervals between the beats were calculated. The short term variability (STV) and the long term variability (LTV) were investigated according to the definitions of DE HAAN [3]. To get an acceptable correlation coefficient in STV of 0.78, a difference as high as 5 beats per minute (bpm) between the two registrations had to be allowed. For LTV, a correlation coefficient of 0.70 was reached at a difference of 2 bpm. The results of the study show that the uFCG can hardly be used in interpretation of the STV. As the visual examination of the cardiotocograms reflects the LTV rather than the STV [7, 9], the uFCG can be used for interpretation of LTV provided that "jitter" is absent on the tracing.
Electrocardiography↗
Combined decelerations--clinical significance and relation to uterine activity.
A combined fetal heart rate deceleration consists of a first (either early or variable) component and a second (late) component. All patients with combined decelerations during a 2-year period of routine fetal monitoring were studied. The incidence was 1.1% (70 patients). Most patient were at low risk, and the combined decelerations appeared predominantly late in the first stage of labor. In all but 5, labor was stimulated by oxytocin infusion. In two thirds of patients, intrauterine pressure was recorded; uterine hyperactivity was found in 78.7%. Combined decelerations with a total loss of at least 90 beats and lasting for at least 60 seconds were associated with low fetal scalp pH. Ten percent of infants were born in the occiput posterior position. The results indicate a relation between abnormal uterine activity and combined fetal heart decelerations. This type of deceleration could serve as a warning signal of excessive oxytocin administration.
Electrodes↗
[Epidural anesthesia in vaginal delivery].
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Anesthesia, Epidural↗
Urodynamic studies in normal pregnancy and in puerperium.
Fourteen primiparas (11 pregnant for the first time, and three with a history of one abortion) were examined during pregnancy to elucidate changes in parameters of importance of maintenance of urinary continence. Urethral pressure profile measurements and simultaneous urethrocystometry were carried out in the beginning of pregnancy (weeks 12 to 16), in the thirty-eighth week, and 5 to 7 days after delivery. Both the absolute and functional lengths of the urethra were found to increase throughout pregnancy by median values of 6.7 and 4.8 mm, respectively. Also, the maximum urethral pressure increased gradually during pregnancy, returning within 1 week after delivery to almost the same value as at the beginning of pregnancy. The urethral closure pressure also increased throughout pregnancy. Thus, the results of the investigation revealed that the physiologic changes which took place within the urethra during pregnancy were to advantage from standpoint of maintaining continence.
Female↗
Extradural block in patients who have previously undergone caesarean section.
The 119 patients who had undergone previous Caesarean section lumbar extradural block was administered to 77 (65%); the other 42 (35%) received analgesia with ketobemidone 0.8-1.0 ml i.m. or nitrous oxide in oxygen intermittently, or both. Controlled i.v. infusion of oxytocin for induction or acceleration of labour was given to 77% in the extradural group and to 40% in the other group. In both groups 88% were delivered per vaginam. In two patients the uterine scar ruptured; both had received oxytocin during extradural block.
Adult↗
Influence of occiput posterior position on the fetal heart rate pattern.
Fetal heart rate (FHR) recordings of 138 deliveries with the fetus in the occiput posterior position (OPP) are compared with recordings of 138 control fetuses in the occiput anterior position (OAP). The 2 groups are comparable in maternal age, parity, duration of first stage of labor, frequency of nerve blocks for analgesia, and incidence of cord complications. Variable decelerations were significantly more frequent and more pronounced in the OPP group than in the controls. The number of newborns with low Apgar scores was similar in both groups, despite a large number of pronounced decelerations in the OPP group. Possible mechanisms for the origin of variable decelerations in the occiput posterior position are discussed.
Female↗