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Biomedical subjects

M Osler

Publications and source records attributed to M Osler.

At least 127 records · Page 7Linked to original sources
PubMed1989

Maternal heart disease. A survey of a decade in a Danish university hospital.

Among 87 pregnancies complicated by heart disease, delivered during the decade 1977-86, 70 (81%) had a congenital heart malformation, 7 (8%) an acquired heart disease and 10 (11%) arrhythmias or conduction disturbances. The incidence was 0.3%. The corresponding data from a report from Rigshospitalet during the 1950s were: 42%, 49%, and 9%, respectively, and an incidence of 0.9%. Ventricular septal defect (VSD) and atrial septal defect (ASD) were the most frequent malformations. The women were classified according to the NYHA before, during and after the pregnancy. All women except 4 re-entered their original functional class. In 51 cases, ECG showed completely normal sinus rhythm, while in 36, various degrees of arrhythmia or conduction disturbance were found as well as left or right ventricular hypertrophy and/or strains. Nine infants had congenital defects, 4 of which were a heart malformation (4.6%). One infant died. Gestational duration, weight and perinatal mortality did not differ significantly from that of the general population. Two women died, one of primary pulmonary hypertension and one with a rupture of the thoracic aorta. Rheumatic heart disease is no longer a significant factor in relation to pregnancy in Denmark, but congenital heart disease is still of great importance, because more survive and reach the age of fertility. Today most women can be brought safely through pregnancy, but obstetric, cardiologic and anesthesiologic expertise is still mandatory for a successful course and outcome of pregnancies complicated by heart disease.

Adult↗
PubMed1988

Eisenmenger's syndrome and pregnancy.

Two cases of successfully managed Eisenmenger's syndrome during pregnancy are reported. A women suffering from Eisenmenger's syndrome who becomes pregnant should be advised to have her pregnancy terminated. On the basis of the available literature and our own experiences we suggest the following plan, if a woman, despite medical advice, chooses to continue her pregnancy: admission to hospital at approximately 25 weeks of gestation; bed rest during the remaining period of pregnancy; oxygen face-mask during episodes of dyspnoea; determination of serial blood gases to detect changes in the shunt flow. At the onset of labour, arterial and epidural catheters should be inserted, a fall in blood pressure should immediately be counteracted by the administration of norepinephrine and loss of blood by transfusion. The patient should remain in hospital for 7-14 days after delivery.

Adult↗
PubMed1987

A double-blind study comparing meptazinol and pethidine for pain relief in labour.

A double-blind comparison of meptazinol 100 mg and pethidine 75 mg as analgesics during the first stage of labour was undertaken in 199 patients. Injections were allowed to be repeated at intervals of 2 h to a maximum of three doses. There were only minor differences between the two drugs with regard to pain relief and no differences in the need for supplementary epidural and pudendal blocks and neonatal status and behaviour. It is concluded that meptazinol and pethidine are of equal clinical value as analgesic injections during the first stage of labour.

Adult↗
PubMed1987

Obesity and cancer. A review of epidemiological studies on the relationship of obesity to cancer of the colon, rectum, prostate, breast, ovaries, and endometrium.

Cancer of the colon, rectum, prostate, breast, ovaries and endometrium may be associated with obesity. The present paper reviews both prospective and retrospective studies of the potential associations between obesity and these cancers. This research is especially difficult because of the complex interrelations between weight and diet, physical activity, cigarette smoking, and other conditions. Epidemiological studies of body weight are subject not only to biases of sampling, selection, and confounding but also to marked difficulties in definition and measurement. Bearing in mind the methodological shortcomings, there is a distinct and reproducible association between obesity and cancer of the endometrium and postmenopausal breast cancer. The studies of cancer of the colon, rectum, prostate, and ovaries are too inconclusive to elucidate whether obesity implies an increased risk. It is recommended that future studies in this field include a standardised assessment of the distribution of fat tissue, the onset and duration of the condition, and the associated confounding factors. It is concluded that obesity, especially in females, should be avoided as a part of the general cancer preventive effort.

Breast Neoplasms↗
PubMed1986

Intrapartum fetal heart rate monitoring in a combined low- and high-risk population: a controlled clinical trial.

In a prospective clinical randomized investigation 487 women had the condition of the fetus during labour supervised by means of stethoscope (AUS), while 482 women went through labour under surveillance of electronic fetal monitoring, cardiotocography (EFM). 349 women refused to participate in the investigation (NAI) and had delivery conducted according to the normal procedures of the department (70% AUS, 30% EFM). Significantly more pathological fetal heart rate patterns (FHR) were found in the EFM group compared to the AUS group in both the first and the second stage of labour. As a result significantly more vacuum extractions were performed in the EFM group than in the AUS group, while no statistical difference was found between the groups in the incidence of acute cesarean sections carried out for asphyxia. One case of intrapartum death occurred in the AUS group. No differences were found in Apgar scores after 1 and 5 min or in neonatal morbidity at examination on the 2nd and 5th days after delivery. A tendency towards more biochemically compromised children was found in the AUS group. The specificity for both methods was found to be acceptably high (80%), while the predictive value for both methods was low (50%). More research is therefore urgently needed to evaluate supplementary investigations and parameters for the evaluation of the intrapartum fetal condition.

Acid-Base Equilibrium↗
PubMed1986

Ritodrine in the treatment of preterm labor: second Danish Multicenter Study.

In a randomized trial intramuscular ritodrine followed by oral ritodrine treatment and bed rest was compared with placebo and bed rest in the treatment of 99 cases of preterm labor. The ritodrine treatment did not have a statistically significant effect on birth weight, gestational age, or the incidence of low birth weight. However, it did inhibit preterm labor in the initial stage, resulting in a gain of a few days to a few weeks in length of gestation. This gain may be valuable. Where necessary, advantage can be taken of it to transfer the mother before delivery to a more specialized hospital with a neonatal intensive care unit or to administer steroid treatment to promote fetal lung maturation. No serious side effects were recorded. The intramuscular route is recommended because large fluid infusions are avoided and treatment can easily be started before the patient is transported from home to hospital.

Clinical Trials as Topic↗
PubMed1985

Maternal attitudes to fetal monitoring.

During a randomized clinical trial concerning alternative methods of intrapartum fetal surveillance (electronic fetal monitoring (EFM) and auscultation (AUS)) an investigatory interview was carried out. Out of 655 expecting mothers the antepartum preference of EFM was 39.5%, of AUS 32.3% and 28.1% were undecided (UD). EFM was especially preferred by obstetrical high-risk patients. Reasons for preference of AUS were a natural childbirth, a non-technological milieu, and the lack of supposed discomfort from sensors and belts. The pregnant women found as major advantages of EFM continuous observation and the possibility of quick intervention. Postpartum 385 patients were again interviewed. The majority upheld the original preference if that method was used. If the non-preferred method had been applied many would stick to the primary preference although a tendency to prefer the experienced method was seen. The patients who antepartum preferred AUS, but had EFM, became more positive toward the method, and a significantly increased number were positively influenced by the EFM signal/trace and found the method promoting their partner's involvement in labor. Enforced immobility, however, was a major disadvantage as well as the technical milieu. If EFM is to be accepted by a majority of women giving birth it is necessary to increase the pregnant women's knowledge of the method and to take milieu factors into consideration in order to reduce the intrinsic depersonalization of EFM.

Adult↗
PubMed1985

15(S)-15-methyl-prostaglandin F2 alpha used for induction of delivery in the case of intra-uterine fetal death.

102 pregnant women with intra-uterine fetal death after the 12th week of gestation were treated with 15(S)-15-methyl-prostaglandin F2 alpha intramuscularly with doses of 125-250 micrograms at 2-3 hourly intervals. In all cases abortion or delivery was completed within 30 hours. The average time in primigravidae was 9 hours 43 minutes, and in multigravidae 9 hours and 59 minutes. In approximately two-thirds of the patients, mild or moderate gastrointestinal side effects were recorded in spite of prophylactic treatment with Retardin or Loperamide + Diphenoxylate. The therapy was found to be effective, easy to administer and the side effects acceptable. No serious side effects were recorded.

Abortion, Induced↗
PubMed1983

Premature rupture of the membranes and Ritodrine treatment.

The treatment with Ritodrine of 38 women with preterm rupture of the membranes (PROM) and 109 with intact membranes (ITM) was compared. Before the 36th gestational week, parturition could be postponed significantly longer in the ITM group than in the PROM group (p less than 0.01), whereas there was no difference between the two groups after the 36th week. Parturition could be postponed significantly longer in the PROM group, when Bishop's score was below or equal to 6, than when it was above, while the same was true for ITM, when the score was even 9 or below (p less than 0.001). Therefore, it seems like that PROM adds 3 points to the Bishop score, when the score is used as a prognostic index for the ability to postpone parturition. There was no significant difference in the occurrence of RDS between the PROM group and the ITM group, although birth weight was significantly higher in the ITM group (mean 2799.5 g) than in the PROM group (mean 1985.5 g) (p less than 0.001). No serious side effects of the treatment given were seen, either in the mothers or in the infants. It is concluded that all women with preterm labor should be treated with ritodrine and bedrest, if betamethasone treatment of the mothers is indicated, as parturition could be postponed for at least 24 h in all pregnancies in both groups.

Apgar Score↗