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Biomedical subjects

M Westgren

Publications and source records attributed to M Westgren.

At least 37 records · Page 2Linked to original sources
PubMed1999

24-hour ECG frequency-domain measures in preeclamptic and healthy pregnant women during and after pregnancy.

OBJECTIVE: The aim of the present study was to evaluate the autonomic balance in women with preeclampsia and in healthy women during and after pregnancy by means of a 24-h ECG Holter recording combined with power spectral analysis. METHODS: Fifteen preeclamptic and 15 healthy women underwent 24-h Holter monitoring in the 32nd-36th week of gestation and 3-6 months postpartum. The power spectrum of the maternal electrocardiogram was analyzed with an autoregressive algorithm. MAIN OUTCOME MEASURES: The power spectrum contains two major components: a low-frequency peak, primarily attributed to sympathetic tone, and a high-frequency peak, reflecting vagal tone. RESULTS: The power spectrum of maternal heart rate variability did not differ between preeclamptic and normal women during pregnancy. After delivery, the amplitude of all components became significantly higher than those during pregnancy, with one exception: the high-frequency component in the patients who had been preeclamptic. In a comparison of the two groups, the high-frequency component after delivery was significantly lower in women who had preeclampsia than in normal healthy women (p = 0.03). CONCLUSIONS: During pregnancy, the power spectrum is reduced and cannot be used to distinguish between patients with preeclampsia and normal healthy women. Three to 6 months after delivery, the high-frequency component is still reduced in the preeclamptic group of women. This indicates an impaired vagal modulation even in the nonpregnant state in this group of women, unlike those who had a normotensive pregnancy.

Analysis of Variance↗
PubMed1999

Intrapartum amnioinfusion in women with oligohydramniosis. A prospective randomized trial.

BACKGROUND: To evaluate the effects of amnioinfusion in oligohydramniosis. METHODS: During a 20-month period, patients at term with oligohydramniosis (amniotic fluid index less than 5 cm) at Huddinge University and Norrköping Hospitals were recruited for a prospective randomized study to evaluate amnioinfusion. Informed consent was obtained from 112 patients who met the entry criteria. Sixty subjects were randomized to amnioinfusion and 52 to the control group. Outcome parameters included fetal heart rate abnormalities, mode of delivery, Apgar score, pH in umbilical artery blood and need for neonatal intensive care. RESULTS: The cesarean section rate was significantly reduced in the amnio-infusion group (29% versus 13%, p=0.043). No difference in time from randomization to delivery was detected between the two groups. The frequency of ominous fetal heart rate tracings with a cervical dilatation of 0-3 cm was the same in the two groups. The frequency of such heart rate patterns after amnioinfusion was significantly lower than in the control group. Neonatal outcome, pH in the umbilical artery blood and need for neonatal intensive care did not differ between the two groups. CONCLUSIONS: The present study confirms the findings of other authors that amnioinfusion effectively reduces the number of cesarean sections in cases of oligohydramniosis.

Adult↗
PubMed1998

[Minimally invasive techniques make fetal surgery possible. Disabling abnormalities can be corrected].

Increases in our knowledge of the fetus and improved skill in early prenatal diagnosis inevitably result in attempts to treat some of the abnormalities detected. Although most fetal malformations diagnosed prenatally in continuing pregnancies are best managed by medical and surgical intervention after planned delivery, some structural defects may require in utero-treatment to forestall subsequent sequelae. The article consists in a review of the current status of ultrasound-guided invasive fetal therapy, including multifetal pregnancy reduction, manipulation of amniotic fluid, drainage and shunting procedures, fetal transfusion therapy, operative fetoscopy, and in utero stem cell transplantation. Future prospects and developments in this rapidly expanding field are also outlined.

Amniocentesis↗
PubMed1998

[Insufficient knowledge about pain in the unborn child].

There has been debate recently as to whether the fetus can feel pain, a subject not readily amenable to research--not only are ethical issues involved, but the evaluation of pain felt by the fetus is also problematic, as it is unable to communicate intelligibly. A philosophical problem also arise concerning the definition of pain, as it is a phenomenon complicated by the presence of both emotional and experiential components. Moreover, there is the question of which anatomical structures are necessary for pain perception. However, some studies have been done, the most controversial of which having been performed during blood transfusion to anaemic fetuses, where the fetal blood cortisol concentration was shown to be higher in conjunction with hepatic vein needling than in conjunction with umbilical vein needling. Opinion differs in the research community as to the interpretation of these results, and whether stress response is equatable with pain. Most research in this field has been done on premature newborns in neonatal intensive care units, and some of the results can possibly be extrapolated to fetuses. Nervous system function in infants differs from that in adults, reflexes being more easily triggered in infants, for example, and thus it is difficult to distinguish pain response from reflexes. The effect of pain on the health status of the newborn is an important issue. Follow-up studies of premature infants have shown low birthweight and the need of neonatal intensive care to be correlates of divergent pain behaviour and acute pain is known to be associated with such untoward effects as tachycardia. It is important to bear in mind the possibility of fetal pain and provide appropriate pain relief, for example when surgery is performed in utero.

Ethics, Medical↗
PubMed1998

[Successively improved prognosis in erythrocyte immunization].

Prognosis in cases of erythrocyte immunisation has improved continuously over the past decades. Morbidity and mortality have been reduced by improvements in management, including screening programmes, non-invasive ultrasound evaluation and invasive procedures. The article provides an outline of the latest developments in the management of erythrocyte immunisation, and several controversial issues are discussed, such as antibody screening, strategies for the reduction of antibody titres, and the organisation of care.

Anemia, Neonatal↗
PubMed1998

Fetal and neonatal mortality in the postterm pregnancy: the impact of gestational age and fetal growth restriction.

OBJECTIVE: Our purpose was to examine the impact of gestational age and fetal growth restriction on fetal and neonatal mortality rates in the postterm pregnancy. STUDY DESIGN: All deliveries occurring in Sweden between Jan. 1, 1987, and Dec. 31, 1992, were evaluated for participation in this study. Data were derived from the National Swedish Medical Birth Registry. Pregnancies were selected for inclusion in the study on the basis of the following criteria: (1) singleton pregnancy, (2) reliable dates, (3) gestational age > or = 40 weeks, and (4) maternal age 15 to 44 years. Fetal growth restriction was defined as birth weight <2 SD below the mean for gestational age. A total of 181,524 pregnancies met the inclusion criteria and formed the study population. Fetal and neonatal mortalities at 40 weeks' gestation were used as reference levels. Logistic regression analysis was used to estimate the independent effects of gestational age and fetal growth restriction on fetal and neonatal mortality rates. RESULTS: A significant rise in the odds ratio for fetal death was detected from 41 weeks' gestation and on (odds ratios 1.5, 1.8, and 2.9 at 41, 42, and 43 weeks, respectively). Odds ratios for neonatal mortality did not demonstrate a significant gestational age dependency. Fetal growth restriction was associated with significantly higher odds ratios for both fetal and neonatal mortality rates at every gestational age examined (with odds ratios ranging from 7.1 to 10.0 for fetal death and from 3.4 to 9.4 for neonatal death). CONCLUSIONS: Postterm pregnancies have long been considered to be at high risk for adverse perinatal outcome. This study documents a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.

Adolescent↗
PubMed1998

Lactate in scalp and cord blood from fetuses with ominous fetal heart rate patterns.

OBJECTIVE: We investigated lactate concentrations in fetal scalp and cord blood to determine the sources of fetal lactacidosis in fetuses with ominous heart rate patterns. METHODS: Cord blood was collected from newly delivered infants who had been monitored by fetal scalp blood sampling during labor. In 250 cases umbilical arterial and venous cord blood lactate levels were measured. We assessed the umbilical arterial lactate concentrations in relation to the venous lactate levels, the arterial pH level, base excess, and arteriovenous lactate differences in cord blood. In 103 cases the levels of lactate in fetal scalp blood, sampled within 60 minutes of delivery, were compared with those in the umbilical artery and vein and the pH level and base excess immediately after birth. RESULTS: Lactate level in the umbilical artery showed a significant correlation to that in umbilical venous blood (r = .84, P < .001), to arteriovenous lactate differences (r = .52, P < .001), as well as to pH (r = -.55, P < .001) and base excess (r = -.63, P < .001) in arterial cord blood. Lactate concentrations in fetal scalp blood shortly before delivery showed a significant correlation to lactate levels in the umbilical arterial (r = .65, P < .001) and venous blood (r = .62, P < .001). CONCLUSION: The study indicates a close correlation between lactate levels in arterial and venous cord blood, as well as between the lactate levels and pH and base excess in cord arterial blood in patients with ominous fetal heart rate patterns. We also found an increased fetal contribution with increasing lactacidemia. Lactate concentrations in fetal scalp blood correlated well with those in cord arterial and venous blood.

Female↗
PubMed1998

Hormonal counterregulation and subjective symptoms during induced hypoglycemia in insulin-dependent diabetes mellitus patients during and after pregnancy.

BACKGROUND: The objective was to elicit whether hormonal responses to and subjective symptoms of hypoglycemia are modified during pregnancy in patients with insulin-dependent diabetes mellitus. METHODS: In ten type I diabetic women, hyperinsulinemic hypoglycemic clamps, with target arterial blood glucose content of 2.2 mmol/l, were performed during the third trimester of pregnancy and 5-13 months after delivery. The levels of arterial glucose and venous catecholamines, pituitary growth hormone, cortisol, glucagon, dehydroepiandrosterone and free insulin were assessed repeatedly. Subjective symptoms of hypoglycemia were recorded on a visual analog scale. The paired t-test and Wilcoxon signed rank test were used for statistical comparisons. RESULTS: Adrenaline and dehydroepiandrosterone increased during hypoglycemia on both occasions, but dehydroepiandrosterone disclosed a significantly different pattern of response during pregnancy (p=0.016). The cortisol increase was augmented during pregnancy (420+/-50 vs. 310+/-30 nmol/l non-pregnant, p=0.039), while the increase in pituitary growth hormone (hGH) was diminished (5.4+/-1.2 vs. 27.9+/-5.4 microg/l non-pregnant, p=0.001), but nevertheless the increase during pregnancy was significant (p=0.002). Three of the eight subjective symptoms of hypoglycemia recorded were less prominent during pregnancy, namely 'inability to concentrate' (p=0.03), 'headache' (p=0.01) and 'pounding heart' (p=0.03). CONCLUSIONS: Albeit some subjective symptoms were diminished during pregnancy, the study gives no evidence that, in diabetic patients, pregnancy per se impairs the counterregulatory response to hypoglycemia, with the exception of growth hormone. However, despite the suppressed basal growth hormone secretion in late pregnancy, the study disclosed a secretory response of this hormone at hypoglycemia.

Adult↗
PubMed1998

Lactate compared with pH analysis at fetal scalp blood sampling: a prospective randomised study.

OBJECTIVE: Fetal scalp blood sampling is a widely used method for assessing fetal condition in the event of ominous fetal heart rate patterns. The purpose of this randomised trial was to compare the value of fetal scalp blood lactate and pH management in cases of abnormal intrapartum fetal heart rate tracings. METHODS: Of 341 cases of ominous fetal heart rate patterns, 169 were randomly assigned to pH analysis, and 172 to lactate measurements. Lactate was measured using a lactate card requiring 5 microL of blood and yielding the result within 60 seconds. pH analysis was performed with an ABL 510 acid-base analyser requiring 35 microL of blood and yielding the results within 47 seconds. RESULTS: Unsuccessful fetal blood sampling procedures (no result or an unreliable result) occurred significantly more often in the pH subgroup than in the lactate subgroup (OR 16.1 with 95% CI 5.8-44.7). In the pH subgroup the failure rate was inversely related to the degree of cervical dilatation. Compared with the pH subgroup, the lactate subgroup was characterised by fewer fetal scalp incisions per blood sampling attempt (median 1.0 [interquartile range (IQR) 1-1] vs 2.0 [IQR 1-2]), and significantly less time required for the sampling procedure (median 120 s [IQR 90-147] vs 230 s [IQR 180-300]). The groups did not differ in mode of delivery, neonatal outcome and umbilical artery acid-base balance and lactate levels. CONCLUSION: This trial showed the levels of lactate and pH in fetal scalp blood to be comparable in predicting perinatal outcome, but the procedure to measuring lactate was more successful than that for pH. Owing to its simplicity of performance, lactate analysis is an attractive alternative for intrapartum fetal monitoring.

Female↗
PubMed1998

Balloon catheter for induction of labor in nulliparous women with prelabor rupture of the membranes at term. A preliminary report.

The balloon catheter method has been described as an effective method for cervical ripening hitherto used exclusively before rupture of the membranes. We found it of interest to perform a pilot study of the balloon catheter method after rupture of the membranes. In 18 nulliparous women, with an unripe cervix (Bishop score < or = 5) 48 h after prelabor rupture of the membranes at term, cervical ripening was performed using a 26-gauge balloon catheter. Seventy six percent of these women delivered vaginally. Clinical and neonatal outcome data did not differ as compared with term pregnant women who entered labor spontaneously or had a ripe cervix (Bishop score >5) and labor induced with oxytocin within 48 h after prelabor rupture of the membranes. Despite visualization of a pool of amniotic fluid in the vagina on speculum examination on admission, there was a high proportion of patients with an intact forebag observed during the birth process. This preliminary report indicates that the balloon catheter method might be a well-tolerated, safe, and effective method for induction of labor after rupture of the membranes at term.

Adult↗
PubMed1997

Tissue distribution of transplanted fetal liver cells in the human fetal recipient.

OBJECTIVE: Our purpose was to study the tissue distribution and concentrations of transplanted fetal liver cells in the human fetus. STUDY DESIGN: Radiolabeled indium 111 fetal liver cells were injected in vivo under ultrasonographic guidance into 10 normal fetuses (13 to 17 weeks of gestation) before a prostaglandin abortion. Six fetuses were injected intraperitoneally and four intracardially. Another two fetuses serving as controls were injected with indium-labeled maternal plasma. The fetuses were all alive, at least until 6 hours before expulsion. After expulsion the fetuses were dissected, and radioactivity was measured in various fetal tissues. Results for each tissue were expressed as percentages of the total injected dose. RESULTS: Significantly greater uptake of fetal liver cells in the liver, spleen, thymus, kidney, lung, and placenta was obtained with intracardiac than with intraperitoneal injection. Skeletal uptake did not differ in relation to mode of administration. With intracardiac injection uptake was greater in such parenchymal organs as the liver, spleen, and thymus (4.9%, 4.0%, and 3.9%, respectively). Uptake in the rib, clavicle, humerus, and sternum was 2.7%, 1.8%, 2.1%, and 1.1%, respectively. Placental uptake was 0.1%. The intracardiac route yielded a higher concentration of cells in different fetal organs than did injection of only radiolabeled maternal plasma, suggesting an active uptake of cells in different fetal hematopoietic organs. CONCLUSION: The mode of administration of fetal liver cells seems to be a major determinant of donor cell concentration in the transplanted human fetus and may be a significant determinant of the rate of successful engraftment.

Cell Movement↗
PubMed1997

Insulin sensitivity and insulin response in women with gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is associated with much increased risk of developing diabetes later on in life. Using the frequently sampled intravenous glucose tolerance test and the minimal model analyses we have therefore determined the early insulin response to glucose (EIR) and insulin sensitivity (Si), in women with GDM of different severity (n = 14) and in normal women (n = 10). During the last trimester of pregnancy. GDMs compared to controls had significantly lower EIR (p < 0.001) and Si (p < 0.01). The reduction in EIR was less marked in GDM patients treated with diet alone (n = 6) as compared to GMD patients (n = 8) who subsequently during pregnancy needed treatment also with insulin. The insulin treated GDM group only had higher fasting glucose level than controls (5.2 vs 4.2 mmol/l, p < 0.001). Both GDM subgroups had slightly elevated basal levels of FFA and 3-hydroxybutyrate. Si and EIR were inversely correlated in control women and their fasting glucose correlated both to EIR (r = 0.63, p < 0.05) and to Si (r = 0.59, p < 0.05). In the GDM subgroups Si and EIR were unrelated and there were no correlations between fasting glucose and Si or EIR. These results suggest that glucose intolerance in GDM patients in the last trimester of pregnancy is characterized by both an impaired insulin secretion and an increased resistance to insulin. The impairment of insulin secretion and action increases with the severity of hyperglycemia, and the relative insulin deficiency characterizing GDM patients is associated with a selected defect in insulin action mainly affecting gluco-regulation.

3-Hydroxybutyric Acid↗
PubMed1997

Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts: first clinical attempt.

Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.

Fetal Tissue Transplantation↗