An approach to controlled parturition.
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Biomedical subjects
Publications and source records attributed to J M Beazley.
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In 50 women who had five successive pregnancies the difference was studied between the mean maternal weight at the 20th week of gestation and six weeks post partum. The difference changed from a weight loss to a weight gain in the fourth and fifth pregnancies. The maximum weight increment occurred between the end of the first pregnancy and the 20th week of the second, especially in obese multiparae.
Three patients, aged 14, 16, and 32 years respectively, with congenital adrenal hyperplasia (21-hydroxylase deficiency) are described. Excessive adrenal activity and ACTH secretion could not be suppressed with doses of corticosteroids sufficient to cause iatrogenic Cushing's syndrome, even though part of the steroid dosage was administered in the late evening. The resistance to feed-back suppression was of the same order as that seen in Cushing's syndrome. Adrenalectomy was performed in the 16-year-old girl, and was followed by a menarche. Adrenalectomy was considered inadvisable in the other two patients.
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Oral glucose tolerance and insulin response to glucose were analysed in 124 pregnant women during the fourth quartile of pregnancy. Employing different criteria for the detection of glucose intolerance, 9% to 21% of women were abnormal, and using the H index 43% would have been declared "diabetic". There was no evidence of a progressive change in the glucose curve detectable by the H index within the fourth quartile of pregnancy. There was no association between actual or potential fetal morbidity and any of the interpretative criteria employed. It is concluded that the oral glucose tolerance test should be interpreted with caution if non-pregnant criteria of abnormality are employed.
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A prospective study of 447 labours and the resulting newborn failed to reveal any significant difference between the incidence of neonatal hyperbilirubinaemia, defined as a level of at least 205 mumol/l (12 mg/100 ml), following spontaneous labour and after labour induced or accelerated with prostaglandin E2 (PGE2). The incidence of unexplained neonatal hyperbilirubinaemia after spontaneous labour was 4-5 per cent. There was no significant association between the incidence of neonatal hyperbilirubinaemia and the total dose of PGE2 used for induction. None of the babies of the six mothers who required more than 1-5 mg of PGE2 to induce labour developed hyperbilirubinaemia. No association was demonstrated between neonatal hyperbilirubinaemia and birth weight or the duration of labour. The implications of these findings are discussed.
The construction of an 'inductograph' is described which defines the rates of progress of the latent phase of labour in 80 per cent of a group of patients selected from a 'low risk' category. A standard induction regime was used, and changes in the uterine cervix were assessed quantitatively by a modified form of the Bishop scoring system.
In planned delivery it is often advantageous to be able to monitor the early course of stimulated labour. This paper describes the construction of a graph which defines the rate of progress of the latent phase of augmented labour in 307 women, which represented 80% of a group of patients in a "low risk" category obstetrically.
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In 160 women large but variable amounts of intravenous oxytocin were needed to induce labour within a reasonable time interval to 5 cm cervical dilatation. Thereafter 7 mU of oxytocin/min would maintain progress. Since large maintenance doses may cause obstetric problems it is recommended that a maintenance regimen should be used once labour has progressed to this stage.
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