Biomedical subjects
Publications and source records attributed to J R Doig.
A patient with the Bernard Soulier Syndrome was successfully delivered of twins. The pregnancy was complicated by slight bleeding from the uterus during the first 8 weeks, by cord prolapse necessitating emergency caesarean section, and by moderate post partum haemorrhage. The management of pregnancy in the Bernard Soulier Syndrome is discussed.
Cardiac electromechanical intervals were measured during labour in 103 unselected human fetuses. Mean values (+/- SD) for the three intervals measured were 76.01 +/- 9.93 ms for the pre-ejection period, 41.56 +/- 8.51 ms for the isovolumetric contraction time and 156.23 +/- 16.58 ms for the left ventricular ejection time. These are consistent with previously reported data from our own and other centres. the intervals studied did not alter significantly as labour proceeded or during uterine contractions. There was no consistent correlation between them and fetal scalp blood PO2, PCO2 or pH, although the pre-ejection period was shortened considerably in three very acidaemic or hypoxic fetuses, and it was prolonged in association with tight nuchal cord entanglement and variable decelerations in fetal heart rate. These findings raise the possibility of using recorded cardiac electromechanical intervals to determine the clinical significance of different fetal heart-rate patterns that suggest the possibility of fetal distress.
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Six patients with severe pre-eclampsia were found to have low central venous pressures. This was considered to be an indication that hypovolaemia was present, depsite concurrent generalized oedema. Treatment with sufficient intravenous saline and albumin, to restore the central venous pressure to normal, resulted in improved renal function and avoidance of permanent renal impairment in all cases. These observations support the view that diuretics should not be administered to patients with pre-eclampsia.
A case of thoracopagus conjoined twins is described in which ultrasonography was helpful in achieving an antenatal diagnosis and in allowing consultative decision on management.
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A survey of 23443 live births in the North Canterbury area has shown that the incidence of uncomplicated congenital dislocation of the hip was 2.65 per 1000 live births. That a positive family history and breech delivery are important factors in identifying the infant at risk was confirmed. In spite of the fact that routine neonatal examination of 5158 of the infants detected dislocation or instability of the hip in the neonatal period four times as frequently as in the remainder of the group, no evidence can be found to suggest that this achieved a reduction in the frequency of late diagnosed or missed cases.