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Biomedical subjects

J Forberg

Publications and source records attributed to J Forberg.

16 recordsLinked to original sources
PubMed1991

[Effect of pregnancy and perinatal parameters--including mode of delivery--on survival rate of "low birth weight premature infants" (less than 1,500 g)].

A retrospective analysis of 225 very low birth weight infants (less than 1500 g) was made, to assess the influence of the mode of delivery on the survival rate. In 186 preterm deliveries which could not be prevented by therapeutic measures, we included additionally certain gestational and perinatological parameters. Generally, an average survival rate of 72% was found in this study. In addition to the well-known negative influence of birth weight less than 1000 g and gestational age of less than 28 weeks, such parameters as antenatal pre-pathological CTG findings, haemorrhages at the time of hospitalisation, and ineffectuousness of tocolytic drugs, were associated with a reduced survival rate. In contrast, the presence of anamnestic risk factors of preterm delivery and prolongation of gestation by one day and more improved the survival rate. Additional consideration of foetal presentation showed, that abdominal delivery was fundamentally safer in cases with breech and transverse presentation. Whether a higher survival rate can be achieved by vaginal delivery in cases of breech presentation with premature rupture of membranes or a gestational age greater or equal to 28 weeks, remains to be proved. A gestational age of less than 28 weeks or antenatal prepathological cardiotocographic findings will facilitate in future the decision to perform Cesarean section in cases of inevitable premature deliveries with cephalic presentation.

Cesarean Section↗
PubMed1989

[Relation of uteroplacental hemodynamics and fetal respiratory behavior in pregnancy with threatened premature labor or intrauterine retardation].

The results of uteroplacental hemodynamics obtained by nuclear medicine were correlated with the corresponding antepartal and intrapartal cardiotocographic findings in 52 patients with preterm labor and in 53 patients with intrauterine-growth-retarded fetuses. With the existence of continued disturbance in pregnancy the relationship between primary maternal hemodynamic disorders and decreased fetal respiratory performance is already evident antepartum and unambiguously intrapartum. The dependence of the antepartal cardiotocographic findings on therapeutical improvements in perfusion is of clinical relevance.

Cardiotocography↗
PubMed1989

[Results of treatment of 718 endometrial cancers with reference to clinical and morphologic prognostic factors].

This article deals with a retrospective analysis of therapeutic achievements in 718 endometrial carcinoma patients in relation to important prognostic factors (clinical stage, age, tumour type/degree of differentiation). The unfavourable age structure (64.9 years) and frequent multimorbidity of endometrial cancer patients require a close interdisciplinary cooperation for optimal management planning. With the priority of a graduated operative procedure with differential additional radiation therapy on the basis of essential clinical and morphological factors in contrast to the primary radiation therapy, the unsettled cumulative 5-year-survival rate accounted for in stage Ia 69%, Ib 64%, II 41%, III 33% and also for the whole material 59%. The obvious deterioration of the prognosis already with the involvement of the cervix (stage II) as well as in the presence of unfavourable prognostic factors in stage I (tumour type, undifferentiated, myometrial invasion, suspicion of lymph node involvement) justify a radical operative intervention (lymphadenectomy, Wertheim-Meigs) in these cases despite possible anaesthesiological risk on the basis of an extended pretherapeutic diagnostic procedures (sonography, lymphography, computer tomography). Under these conditions mentioned above we had only 6 per cent late therapeutic consequences requiring treatment.

Adenocarcinoma↗
PubMed1988

[Therapeutic results in uterine sarcoma (1955-1985)].

This is a retrospective analysis of prognostic factors and treatment outcomes in 126 uterine sarcoma cases from the period of 1955 to 1985 inclusively. Up to now there lacks unanimity and extensive scientific based therapeutic concept; and treatment results could not be improved despite better operative and radiation therapy possibilities. From the examined charts and materials, the five year survival rate achieved for all stages is 31%. The mean age of the patients is 57.9 years and significant prognostic differences will be appreciated only in relation to the clinical stages at the commencement of therapy and also after local total operative intervention (stages I and II) in conjunction with postoperative radiation therapy. The difference in course in relation to the histologic tumour type can not be statistically verified.

Adult↗
PubMed1987

[Premature labor in gestosis].

796 pregnancies complicated by preeclampsia and 1,299 pregnancies without toxemia of the years 1981 to 1985 have been compared with regard to prematurity. Prematurity rates were 12.4 respectively 13.8 per cent, hypotrophy rates were 20 resp. 13 per cent, acidosis morbidity was 75 resp. 20 per cent and Apgar values below 8 were 63 resp. 24 per cent. Morbidity rate of respiratory distress syndrome was 8 resp. 12 per cent, of sepsis 2 resp. 7 per cent, intrauterine death rate 5 resp. 2 per cent, but survival rate overall was 93 resp. 90 per cent. Prematurity was influenced by severity of preeclampsia, time of onset and prenatal care. Prolongation of pregnancy by tocolysis is possible principally, but influenced in its effect by maternal and fetal symptoms and the necessity of termination of pregnancy by these factors.

Birth Weight↗
PubMed1987

[Therapy of suspected intrauterine fetal retardation].

In a randomized prospective study, performed on 45 pregnancies with clinical and sonographic suspicion for intrauterine fetal growth retardation, examinations were done to evaluate the therapeutic effect of bed rest and of additional daily administered glucose infusions or oral galactose applications respectively on the fetal growth, the hemodynamic, respiratory and endocrine insufficiency of the materno-feto-placental unit as well as selected biochemical parameters of the umbilical blood. There is no positive therapeutic effect, either on the impaired endocrine partial function nor on the reduced respiratory function of the feto-placental unit. It is obvious, that despite the improvement of the nutritional supply of the fetus and the revival of the regular fetal growth, the previous lack of fetal growth can not be altered. This can be demonstrated in all three therapeutic groups due to the fact of a resulting high hypotrophy-rate of the newborns. The results prove that the additional supply of the fetus with glucose or galactose does not remarkably improve the therapeutic effectivity as opposed by strict bed rest alone.

Bed Rest↗
PubMed1986

[Hemodynamic placental insufficiency and its therapeutic modification in threatened premature labor].

The authors are involved in a study in the field of nuclear medicine aimed at further clarifying the connection between premature delivery and placental insufficiency. They are particularly concerned with uteroplacental perfusion at the time when a trend is emerging toward premature birth, and with ways of treating this by exclusive therapy using betamimetics and/or additional maternal oxygen inhalation/additional maternal transcutaneous dorsal nerve stimulation (TNS). The significantly longer half-life periods of activity increase found at the time of hospitalization similar to pregnancies with intra-uterine fetal retardation, as compared with a normal control group, are interpreted as expressing a hemodynamic placental insufficiency and a risk of premature delivery. In contrast to exclusive betamimetic therapy, additional O2 inhalation/additional TNS significantly shorten the half-life period both in short-time and long-time tests. The better therapeutic effect on uteroplacental perfusion in cases of imminent premature delivery which is thus demonstrated can be seen also in an improved respiratory condition of the fetus as shown in a cardiotocogram. From a clinical point of view, the authors call attention to the clearly prolonged pregnancy periods regardless of the duration of gestation, at the time when a trend is emerging toward premature birth, as compared with exclusive betamimetic therapy, the duration of tocolysis/amount of betamimetic applied being the same.

Combined Modality Therapy↗
PubMed1986

[Clinical experiences with a single layer uterine suture in cesarean section].

In this analysis 536 caesarean sections with a single layer uterine suture were compared to 256 sections with two layer closure. Their relations with regard to indications of operative delivery, complications during the puerperium and their courses in subsequent vaginal deliveries were taken into consideration. - The significant lower rate of pyrexia and shorter hospital stay of the patients may be a result of quicker and better healing of the single layer suture. The increased rate of complications in the puerperium is partially due to changes in the registry of dates. Absent disturbances during the placental period and the occurrence of only one uterine rupture, in the course of vaginal delivery in a patient with a previous single layer caesarean section suture, demonstrates the functional sufficiency of this technic.

Cesarean Section↗
PubMed1986

[Value of cardiotocographic studies in threatened premature labor and intrauterine retardation. A contribution to respiratory placental insufficiency].

The authors evaluated a total of 1,237 cardiotocograms obtained from 138 pregnancies where premature delivery was imminent, 49 pregnancies with intrauterine retardation and 10 pregnancies without pathological findings from a clinical and anamnestic point of view. The cardiotocograms resulted from antepartal screening, and the Fischer score was used for evaluation. Restricted fetal respiration was assumed in all cases where prepathological CTGs were significantly more frequent in the course of pregnancy (24%) and where there was a significant increase in such findings immediately before delivery (41%) in the event of imminent premature birth, compared with normal controls (10%) and pregnancies with intrauterine retardation in the absence of premature uterine contractions (13%). Similar findings were also obtained for individual parameters of the fetal heart frequency such as the oscillation frequency, oscillation amplitude, acceleration and deceleration. By way of comparison with normal controls of the same age it is insured in each case that the disturbance observed expresses a respiratory insufficiency in the feto-placento-maternal unit rather than an immature fetal heart and circulatory system. In this connection, particular hazards exist during early gestation where a premature delivery is imminent, whereas IUR carries only a limited risk. This assumption is reinforced by the greater number of prepathological findings encountered in pregnancies which have successfully been prolonged (beyond the 37th week), compared with normal controls of the same age. The connections shown between a prepathological CTG (particularly in the last week before delivery) and a greater frequency of intra- and postnatal disturbances (hypoxia, acidosis morbidity, impaired adaptation) confirm the value which must be attached to a prepathological cardiotocographic finding. In this connection it is important to include results gained in the course of monitoring and to see if the antepartal CTG is normal at all times, prepathological at all times or, in the case of variations, normal or prepathological in the end.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Fetal systolic time intervals in threatened premature labor and their relation to therapeutic efforts].

In a total of 113 single pregnancies we determined foetal systolic time intervals (pre-ejection period, left ventricular ejection time, a quotient of both) in order to investigate the impact of threatened premature labour and the different therapeutic regimen (betamimetics, maternal O2-inhalation, maternal transcutaneous dorsal nerve stimulation) on the myocardial performance capacity. Prolonged systolic time intervals (significant for pre-ejection period) in threatened premature labour (compared with control) supplement the concept of a chronic respiratory impairment of the foe-to-materno-placental relationships. Therapeutic prolongation of the pregnancy by betamimetics led to further impairment of the myocardial contractility while additional oxygen inhalation brought about a positive effect. As indicated by "no changes" after transcutaneous dorsal nerve stimulation, the decisive effect apparently seems not to be in the improvement of the uteroplacental perfusion but more on the direct influence of the raised O2-provision on the foetal myocardium. Non-demonstrable obvious relations to the cardiotocographic findings, such as to the postnatal evaluation criteria, speak against a serious threat to the foetus as the advantages of a reasonable prolongation of the gestational period by betamimetics preponderate. More than that the foetal myocardial impairments are to be favourably influenced by additional O2-therapy.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Antepartal cardiotocographic studies in threatened premature labor and intravenous tocolysis].

In view of the connection which exists between premature birth and placental insufficiency and the means which are available for determining the respiratory performance of the fetoplacental unit by way of cardiotocography, the authors investigated the incidence of prepathological findings in the fetal heart frequency parameters for 81 cases of imminent premature delivery before, during and after intravenous tocolysis, and for 10 normal pregnancies between the 28th and 36th week. The greater number of prepathological cardiotocograms (oscillation amplitude and frequency, periodic acceleration and deceleration) found at the beginning of a trend toward premature delivery beginning with the 30th week of pregnancy, confirms the assumption of a restricted respiratory function of the fetoplacental unit. This restriction is, however, slight. The increase which is observed in these changes, particularly during up to 7 days of intravenous tocolysis in the 28th/29th week of pregnancy, and which continues after the end of intravenous therapy in the further course of pregnancy, is not seen as a result of the effect of betamimetics. The latter obviously do not succeed in positively influencing respiratory insufficiency in the event of imminent premature delivery. Neither the cardiotocographic findings from the beginning of the therapy nor later results permit conclusions to be drawn with regard to its possible success. On the other hand, a prepathological finding, especially where this occurs immediately before delivery, suggests possible larger disturbances of respiratory performance intrapartum, and problems with neonatal adaptation.

Electrocardiography↗