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Biomedical subjects

M Westgren

Publications and source records attributed to M Westgren.

At least 127 records · Page 7Linked to original sources
PubMed1985

Modern strategy for the term breech delivery--a study with a 4-year follow-up of the infants.

In a comprehensive 4-year follow-up study the long-term outcomes in 709 singleton term breech born infants were evaluated. The outcome has been related to different management protocols during two consecutive study periods. In the first period (A, 1971-1974) the rate of cesarean section was 16.1% and in the second period (B, 1974-1977) 37.1%. The neonatal mortality rate was the same in both study periods (0.3%). The incidence of long-term neurodevelopmental handicaps was in period A 5.3% and in period B 2.4% at 4 years of age. Sequelae among infants in period A were in most cases labor-related, i.e. footling, extended arms or difficulty in descent of the fetal head. An antero-posterior diameter of less than 12 cm at the brim was common in these cases. In both study periods there was an increased risk of neurodevelopmental handicaps for infants with hyperextension of the head in the breech position delivered by the vaginal route. In period B the incidence of neurodevelopmental sequelae at the 4-year follow-up did not differ from that found in a group of infants born vaginally in vertex presentation. The rates of visual and auditory disorders, behaviour problems, enuresis and late speech development were not increased in the breeches neither in period A nor in period B.

Breech Presentation↗
PubMed1985

Mode of delivery in the low birth weight fetus. Delivery by cesarean section independent of fetal lie versus vaginal delivery in vertex presentation. A study with long-term follow-up.

In a paired controlled multicenter study of patients in preterm labor of unknown etiology without additional maternal or fetal complications, 59 low birth weight infants in vertex presentation born vaginally were compared with 59 infants delivered by cesarean section. In the early postpartum period, hypothermia and acidosis occurred more often in the vaginal delivery group. The rate of respiratory disorders and need for assisted ventilation did not differ between the groups. Persistent ductus arteriosus occurred in 19% in the vaginal delivery group and in 7% in the abdominal delivery group. At follow-up until 18-24 months of age the rate of cerebral palsy did not differ between the groups, whereas the rate of psychomotor retardation was significantly higher in the vaginal delivery group (p less than 0.05). The difference in percentage of total outcome, i.e. sum of mortality and neurodevelopmental sequelae, being 20.3% in the vaginal delivery group versus 8.5% in the cesarean section group, fails to reach a statistical significance, but the results suggest that for the low birth weight infants, vaginal delivery may be more hazardous than abdominal delivery.

Adult↗
PubMed1984

Fetal heart rate during treatment of maternal hypertension with beta-adrenergic antagonists. A preliminary report.

The effects of two different beta-adrenergic antagonists on maternal arterial pressure and fetal heart rate were studied in 8 pregnant women with pregnancy hypertension. The fetal heart rate was monitored by abdominal ECG recording under standardized conditions. Basal heart rate, long-term variability and short-term variability were calculated in a computer. Four patients received 50-100 mg atenolol once daily; the other 4 received pindolol 10 mg b.i.d. Reduction in mean arterial blood pressure was seen in both groups of patients. The basal fetal heart rate was decreased in atenolol-exposed fetuses but not in pindolol-exposed fetuses. In this preliminary study there was no apparent effect on the fetal heart rate variability.

Adrenergic beta-Antagonists↗
PubMed1984

Intrapartum fetal acidosis in preterm infants: fetal monitoring and long-term morbidity.

Fetal heart rate (FHR) and fetal acid-base status were studied prospectively in 61 patients in preterm labor of unknown etiology. Neonatal data were analyzed, and all surviving infants participated in a follow-up study for at least two years. Ominous FHR patterns correlated well with fetal acidosis. Infants with fetal acidosis (pH less than 7.25 in scalp blood) had more neurologic abnormalities in the neonatal period and a higher rate of neurodevelopmental disabilities at the follow-up than nonacidotic infants of the same gestational weeks. In the surveillance of patients in preterm labor electronic fetal monitoring is mandatory. At late or pronounced variable decelerations, pH analysis of fetal scalp blood should be performed immediately. If not available, prompt abdominal delivery is recommended.

Acidosis↗
PubMed1983

Fetal pH and postnatal adaptation in preterm vaginal deliveries.

The postpartum adaptation to extrauterine life was studied in 39 preterm (less than 37 weeks of gestation) and 13 term vaginally born infants. Fetal scalp pH during delivery was measured in every baby. Acid-base balance was followed with repeated measurements during the first 30 minutes and at 1 and 12 hours post partum. Heart rate and respiration was monitored with a cardiorespirograph (CRG) during the first 30 minutes and at 24 hours of age. The results showed a more extended delay in acid-base regularisation in the group of preterm infants less than 34 weeks of gestation with low fetal scalp pH (less than 7.20). There was no group difference in postnatal acid-base balance and cardiorespiratory adaptation for infants born after 33 weeks of gestation in comparison to term infants. It is suggested that as regards the capacity for postnatal adaptation 34 rather than 37 gestational weeks should be considered the limit of prematurity.

Acid-Base Equilibrium↗
PubMed1982

Continuous maternal glucose measurements and fetal glucose and insulin levels after administration of terbutaline in term labor.

Maternal blood glucose and fetal blood glucose and insulin levels were studied in 16 women at full-term labor after administration of terbutaline 250 microgram i.v. The maternal blood glucose level was registered by a continuous blood glucose monitoring unit. In all patients studied, the terbutaline injection was followed by a rise in maternal blood glucose within 15 min, lasting for at least one hour. The fetal glucose levels paralleled those of the mothers, but on a lower level. None of the infants demonstrated hypoglycemia during the first 90 min after birth. We conclude that terbutaline administrated in this way has a direct effect on the maternal blood glucose release, and report that no harmful effects on fetal carbohydrate metabolism could be demonstrated.

Blood Glucose↗
PubMed1982

Delivery and long-term outcome of very low birth weight infants.

The obstetric and the neonatal management of 72 infants weighing less than 1 500 g at birth were evaluated. Sixty per cent of the mothers were delivered by cesarean section. The neonatal mortality (27%) was equal in the cesarean section and the vaginally delivered groups, but intraventricular hemorrhage was a more frequent autopsy finding in the latter group. At follow-up, 88% of all surviving infants are neurologically normal at two years of age. Of the vaginally delivered infants, three suffered from cerebral palsy, but none in the cesarean section group. The present results reveal that an active management including cesarean section in the delivery of very low birth weight infants is justified and leads to a favorable prognosis.

Cesarean Section↗
PubMed1982

Intrapartum fetal monitoring in preterm deliveries: prospective study.

Fetal heart rate (FHR) and fetal acid-base status were prospectively studied in 61 patients in preterm labor of unknown etiology. Tachycardia (43%), decreased variability (39%), and variable decelerations (61%) were often recorded. Fetal acidosis (pH less than 7.25 in scalp blood) occurred in 52% of patients delivered in weeks 28 to 33 and in 8% of patients delivered in weeks 34 to 36 of gestation. Ominous FHR changes considered classic for fetal distress were very frequently associated with fetal acidosis, but among the most immature infants with fetal acidosis several had tachycardia and decreased variability combined with variable decelerations of innocent appearance. Patients treated with a beta-receptor agonist (terbutaline) for inhibition of preterm labor had fetal tachycardia and decreased variability more often than nontreated patients. No positive correlation with fetal acidosis for these FHR changes could be demonstrated in the terbutaline-treated patients. The results indicate that fetal acidosis can appear rapidly and frequently among the most immature infants during labor, and emphasize the value of considering the gestational age and the administration of beta-receptor stimulators in the assessment of the FHR pattern in preterm labor.

Acid-Base Equilibrium↗
PubMed1981

Single injection of terbutaline in term labor: placental transfer and effects on maternal and fetal carbohydrate metabolism.

Maternal and fetal blood glucose and insulin levels were studied in 10 women in the second stage of labor after administration of terbutaline, 250 micrograms intravenously. The transport of the drug across the placenta was also studied. Saline solution was administered to four other women who served as controls. A rise in maternal plasma insulin levels occurred in all patients but was more pronounced in patients treated with terbutaline less than 25 minutes before delivery than in those treated more than 45 minutes prior to delivery. No difference was found in maternal blood glucose levels between terbutaline-treated patients and controls. Blood glucose increased in the fetuses during the second stage of labor and paralleled that of the mothers, but on a lower level. None of the newborn infants demonstrated hypoglycemia during the first 90 minutes after birth. Terbutaline crossed the placenta rapidly, and fetal plasma levels up to 55% of the maternal plasma levels were found. The conclusion is that this form of administration of terbutaline does not seem to have any negative short-term influences on the fetal carbohydrate metabolism.

Blood Glucose↗
PubMed1981

Maternal and fetal concentrations of morphine after epidural administration during labor.

In this study of 20 healthy women in labor we attempted to determine the efficacy of epidural morphine as an obstetric analgesic. Four patients experienced some relief of pain while 16 patients reported no effect on pain. One newborn infant demonstrated possible morphine-induced respiratory depression. It was concluded that morphine is ineffective as an obstetric analgesic.

Anesthesia, Epidural↗
PubMed1981

Hyperextension of the fetal head in breech presentation. A study with long-term follow-up.

The attitude of the fetal head was determined in 445 women with breech presentations. Thirty-three women (7.4 per cent) were found to have a fetus with the head in various degrees of hyperextension. Of these 26 were born vaginally and seven by Caesarean section. At follow-up (2 to 4 years) five of the vaginally born infants (22 per cent) had neurological sequelae referable to spinal, supraspinal and cerebellar injuries but all infants born by Caesarean section were normal. The results emphasise the value of an abdominal X-ray examination of all women with breech presentations. Caesarean section is recommended if the fetal head is hyperextended.

Breech Presentation↗
PubMed1981

Combined decelerations--clinical significance and relation to uterine activity.

A combined fetal heart rate deceleration consists of a first (either early or variable) component and a second (late) component. All patients with combined decelerations during a 2-year period of routine fetal monitoring were studied. The incidence was 1.1% (70 patients). Most patient were at low risk, and the combined decelerations appeared predominantly late in the first stage of labor. In all but 5, labor was stimulated by oxytocin infusion. In two thirds of patients, intrauterine pressure was recorded; uterine hyperactivity was found in 78.7%. Combined decelerations with a total loss of at least 90 beats and lasting for at least 60 seconds were associated with low fetal scalp pH. Ten percent of infants were born in the occiput posterior position. The results indicate a relation between abnormal uterine activity and combined fetal heart decelerations. This type of deceleration could serve as a warning signal of excessive oxytocin administration.

Electrodes↗
PubMed1980

Influence of occiput posterior position on the fetal heart rate pattern.

Fetal heart rate (FHR) recordings of 138 deliveries with the fetus in the occiput posterior position (OPP) are compared with recordings of 138 control fetuses in the occiput anterior position (OAP). The 2 groups are comparable in maternal age, parity, duration of first stage of labor, frequency of nerve blocks for analgesia, and incidence of cord complications. Variable decelerations were significantly more frequent and more pronounced in the OPP group than in the controls. The number of newborns with low Apgar scores was similar in both groups, despite a large number of pronounced decelerations in the OPP group. Possible mechanisms for the origin of variable decelerations in the occiput posterior position are discussed.

Female↗
PubMed1980

A one-year study of routine fetal heart rate monitoring during the first stage of labor.

At the Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden 90 per cent of all deliveries are monitored with cardiotocography (CTG). The fetal heart rate recording (FHR) together with various pregnancy- and delivery data, are continuously analysed. The present paper is an account of FHR changes during the first stage of labor of all patients registered during 1977. FHR-changes occurred already during the 1st stage of labor in more than 90 per cent of all deliveries where the newborns' Apgar score was less than 7 at 1 minute. Tachycardia, silent pattern, and late and combined decelerations, rarely occurred in the material, but were dominant at deliveries where the newborns' Apgar score was less than 7 at 1 and 5 minutes. This relationship was even more pronounced when these changes occurred together.

Apgar Score↗