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Biomedical subjects

M Westgren

Publications and source records attributed to M Westgren.

At least 109 records · Page 6Linked to original sources
PubMed1990

Fetal responses to different intensity levels of vibroacoustic stimulation.

The fetal responses to three different intensity levels of vibroacoustic stimulation (mean 92, 103, and 109 dB) were investigated in 275 pregnant women between 32-42 weeks of gestation. A 103-dB and a 109-dB stimulation aroused fetal movements, perceived by the mother, significantly more often than did a 92-dB stimulation (P less than .05 and P less than .01, respectively). Fetal heart rate (FHR) accelerations occurred slightly more often at a 109-dB stimulation than at a 92-dB level, but the difference was not significant. In the second part of the study, the three modes of stimulation were compared under standardized conditions in ten normal patients. The immediate reaction concerning fetal body movements as measured by the mother or the observer and FHR accelerations were the same as described earlier. There was a significant delayed increase of fetal gross body movements after 8 minutes at the 103- and 109-dB stimulation levels. Thus, the fetal response to vibroacoustic stimulation changes with different intensity levels.

Acoustic Stimulation↗
PubMed1989

Acid-base status in fetal heart blood in erythroblastotic fetuses: a study with special reference to the effect of transfusions with adult blood.

Blood gas levels, pH, and lactate concentration were studied in fetal heart blood on 70 occasions in 26 fetuses with erythroblastosis. A decreasing hemoglobin concentration correlated to a fall in pH (p = 0.006) and bicarbonate (p = 0.015) and to a rise in base deficit (p = 0.002) and lactate concentration (p = 0.05). Twenty of the fetuses underwent 63 intracardiac transfusions. A multivariance analysis for hemoglobin concentration, percentage of fetal to adult blood, and different acid-base parameters revealed a significant correlation between the presence of adult blood and a rise in PO2 (p = 0.047), but failed to demonstrate any correlation to the other studied acid-base variables. Thus the present study suggests that the fetus can compensate for the physiologic properties of adult hemoglobin that are disadvantageous to itself by increasing PO2 and thereby maintaining oxygen supply. The physiologic background and the clinical implication are discussed.

Acid-Base Equilibrium↗
PubMed1989

Maternal perception of sound-provoked fetal movements in low-risk pregnancies during the third trimester.

Maternal perception of fetal movements after vibroacoustic stimulation (Servox) was studied longitudinally on 456 occasions in 90 low-risk pregnancies after 28 weeks gestation until delivery. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 444 (97%) occasions. Of the 12 negative responses eight occurred before 33 weeks showing a positive correlation with decreasing maturity. All the pregnancies had good outcomes. The low rate of false-positive tests (3%) adds support to the suggestion that this rapid test could play a role in the assessment of fetal well-being.

Acoustic Stimulation↗
PubMed1989

Feto-placental blood volume in severely anemic erythroblastotic fetuses.

The feto-placental blood volume was studied using a hemoglobin hemodilution technique in 15 erythroblastotic fetuses at 43 intravascular transfusions. Four severely anemic fetuses (Hb 30 g/l) had significantly larger blood volumes than 11 moderately anemic fetuses (Hb 30-79 g/l), 169 +/- 37 versus 105 +/- 32 ml/kg fetal body weight (p less than 0.001). We speculate that hypovolemia might be an adaptive change to maintain an adequate hemoglobin concentration. An escape of fluid from the intra- to the extra-vascular space will probably compensate for the reduction in total red cell mass and thus slightly increase the hemoglobin concentration. Theoretically, interstitial fluid accumulation will continue until the hydrostatic pressure of the extravascular tissue balances that of the capillary. This compensatory mechanism seems to function until the hemoglobin concentration drops below, 30 g/l, at which point the blood volume will increase, suggesting a change from a hypo- to a hyper-volemic state.

Anemia↗
PubMed1989

Fetal growth and fetal glucose and C-peptide levels in relation to the degree of anemia in fetuses affected by rhesus iso-immunization.

Fetal growth rate was determined by measuring the fetal biparietal diameter at 63 two-week time points during the second trimester in 14 patients with severe Rhesus isoimmunization. Growth rate was found to be related to the fetal hemoglobin concentration which was determined at the end of each 2-week period. Fetuses with a hemoglobin concentration of less than 30% of the normal value had a significantly decreased growth rate (p less than 0.01). These fetuses had also reduced C-peptide (p less than 0.05) and increased glucose levels (p less than 0.1) compared with less anemic fetuses. The physiological background to impaired fetal growth in cases of severe fetal anamia at Rhesus iso-immunization is discussed.

Anemia↗
PubMed1988

Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation.

Six patients with pregnancies of 19-31 weeks' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions. Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord.

Blood Transfusion, Intrauterine↗
PubMed1988

Intrauterine hypercalcaemia and non-immune hydrops fetalis--relationship to the Williams syndrome.

We describe a 28-week-old fetus with severe non-immune hydrops. Intrauterine cord blood sampling revealed hypercalcaemia of 3.4 mmol/l (n = 2.6 +/- 0.1). Subsequently, a postmortem examination revealed supravalvular aortic and pulmonary artery stenosis together with extensive arterial calcification. The maternal calcium, 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and parathyroid hormone levels were normal at delivery. This is the first time that hypercalcaemia has been diagnosed in utero. We speculate on the fact that the disorder resulted as a consequence of abnormal vitamin D metabolism in the fetoplacental unit, and that it might be related to the Williams syndrome.

Adult↗
PubMed1988

Introduction of a programme for intravascular transfusions at severe rhesus isoimmunization.

Thirty-seven fetuses with severe rhesus isoimmunization with a gestational age of less than 30 week underwent 92 intravascular transfusions. Of these, 77 were intracardiac, 13 umbilical vein and two umbilical artery transfusions. Procedure related complications occurred at eight (10%) intracardiac and at two (14%) umbilical cord transfusions. Reversal of hydrops was observed in 10 of 16 fetuses. The perinatal mortality among transfusion treated fetuses was 8/37 (21%). It is concluded that intravascular, intrauterine transfusion leads to improved results among fetuses with early onset of hydrops. Problems concerning indications and technique are discussed.

Blood Transfusion, Intrauterine↗
PubMed1988

Intravascular fetal blood transfusion under ultrasonic guidance in a case of severe Rh isoimmunization.

A severely Rh-affected fetus with an initial hematocrit value of 7% and a hemoglobin value of 2.3 g/dl was transfused three times by the intravascular route into the umbilical cord under ultrasonic guidance. After the second transfusion, fetal movements recurred and the non-stress test became reactive. Neonatal outcome was favorable. The implications of this procedure are discussed.

Adult↗
PubMed1987

Maternal perception of sound-provoked fetal movements as a measure of fetal well-being.

Maternal perception of sound-provoked fetal movements was studied on 613 occasions in 259 risk pregnancies. The response was compared with a non-stress (N-S) test performed immediately after the sound stimulation. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 534 occasions (87%) and was always accompanied by a normal N-S test; sensitivity 100%. An inconclusive (3%) or negative response to sound (10%) had a specificity of 89% and a predictive value for a pathological N-S test of 19%. There was a positive correlation between inconclusive or negative test results and fetal growth retardation (P less than 0.01), fetal hypoxia (P less than 0.05) and neonatal mortality (P less than 0.05). This rapid test may have a place as a simple first-line screening test.

Acoustic Stimulation↗
PubMed1987

Postpartum anuria caused by silent bilateral nephrolithiasis.

A case of remarkable silent anuria caused by bilateral nephrolithiasis in the post-partum period is reported. The anuria was not associated with any kind of pain and the diagnosis was not revealed until three days postpartum when an intravenous pyelography was carried out. Differential diagnosis and management of nephrolithiasis are discussed. Ultrasound scanning is recommended as a routine procedure for all patients with signs and symptoms of renal dysfunction during pregnancy.

Adult↗
PubMed1986

Missing hospital records: a confounding variable in retrospective studies.

In retrospective chart reviews there are often a certain number of missing hospital records. To elucidate this variable we compared the outcomes of very low birth weight breech infants with respect to the method of collecting data. A prospective sampling, during the hospital stay, of data was performed in 1979 to 1980 and in 1983 to 1984, and the frequencies of very low birth weight were 1.89 and 1.90, respectively, per 1000 live births. For 1981 to 1982 a retrospective record search was performed with the use of the ordinary medical record search system at this institution. For this period 39 of 52 (75%) hospital records were recovered, giving an apparent frequency of 1.32/1000 live births, which differed significantly from either period studied prospectively. An analysis of demographic data of the three groups revealed that the mean gestational age and the mean birth weights were higher in the period studied retrospectively compared with both periods studied prospectively and that the neonatal mortality rates were higher in the periods studied prospectively (74.1% and 57.1%, respectively) than in the period studied retrospectively (28.2%). It is concluded that the more complicated a clinical case is, the more likely the record will not be found for retrospective chart review. This problem should be kept in mind, and it ought to be a requirement that the number of missing charts be stated in retrospective observational studies.

Adult↗
PubMed1986

Maternal and fetal endocrine stress response at vaginal delivery with and without an epidural block.

Maternal and fetal stress response at vaginal delivery were studied in 19 normal parturients at term. Ten patients to whom an epidural block (group EA) had been administered were compared with 9 patients (group NEA) who used only nitrous oxide for pain relief. Plasma concentrations of ACTH, cortisol, 17-alpha-hydroxyprogesterone, blood glucose and catecholamines were measured in maternal and umbilical vein blood at delivery and in maternal vein blood 30 minutes after delivery. At delivery maternal plasma concentrations of ACTH, cortisol and catecholamines were lower in the EA group compared with in the NEA group. There were no differences in umbilical plasma concentrations of the studied stress variables between the two groups. A linear relation was demonstrated between maternal and umbilical vein cortisol concentration. In both the EA and NEA group a significant fall in ACTH, 17-alpha-hydroxyprogesterone and catecholamine concentrations were demonstrated 30 minutes after delivery, whereas cortisol and blood glucose were virtually unchanged. It was found that epidural anesthesia reduced the maternal stress hormones at delivery but seemed to have little or no effect on the fetal endocrine stress hormones.

17-alpha-Hydroxyprogesterone↗
PubMed1986

Reactivity of non-stress tests and its relationship to outcome in infants born prior to the 33rd week of gestation.

In order to evaluate the significance of the non-stress test (NST) in the immature fetus, 60 patients who gave birth between the 26th and 33rd week of gestation were studied. They were grouped according to reactivity of the last non-stress test performed 24 hours prior to delivery. Twenty-eight (47%) of the patients were reactive, 10 (17%) non-reactive, and 22 (37%) non-reactive with decelerations on the last NST. The one-year mortality rates were significantly higher in those non-reactive with decelerations (41%) and in those non-reactive (30%), than in the reactive group (7%) (p less than 0.001, p less than 0.05). The results suggest that reactive non-stress tests and those that are non-reactive with decelerations predicted the fetal outcome similarly to the same findings in term pregnancies. Non-reactive non-stress tests without decelerations were associated with poor outcome in fetuses with a gestational age of more than 29 weeks. Conversely, in more immature fetuses, nonreactive patterns occurred in patients with favorable outcome. The clinical implications of these findings are discussed.

Female↗
PubMed1986

Fetal femur length/abdominal circumference ratio in preterm labor patients with and without successful tocolytic therapy.

A correlation has been suggested between impaired fetal growth and preterm delivery. To further investigate this possibility, the femur length/abdominal circumference ratio (FL/AC) was used as a gestational-age independent index of fetal growth in 82 patients admitted because of preterm labor. Of these patients, 43 delivered at term; tocolysis was unsuccessful in 39 patients who delivered preterm. The FL/AC was significant larger in the group with unsuccessful tocolytic therapy compared with the successfully treated group, 23.6 +/- 2.6 vs. 21.3 +/- 1.3 (mean + SD), respectively (P less than 0.001). These results indicate that preterm delivery may be associated with suboptimal fetal growth.

Abdomen↗
PubMed1985

Spontaneous cephalic version of breech presentation in the last trimester.

A prospective longitudinal investigation of spontaneous cephalic version from breech presentation in the last trimester is reported. All pregnancies were assessed with ultrasound in the 32nd week of gestation, and were thereafter checked weekly. Of the 310 singleton breech presentations identified at 32 weeks, spontaneous cephalic version occurred in 177 (57%) while breech presentation persisted in 133 patients (43%). Of 140 patients with a breech presentation at delivery 95% were already presenting by the breech in the 32nd week. Spontaneous cephalic version was less likely in pregnancies with extended fetal legs, low birth-weight, short umbilical cord and primiparity.

Adult↗