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Biomedical subjects

N J Saunders

Publications and source records attributed to N J Saunders.

At least 37 records · Page 2Linked to original sources
PubMed1992

Outcome of breech delivery at term.

OBJECTIVE: To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. DESIGN: Population based comparison of outcomes. Data derived from the St Mary's maternity information system. SETTING: North West Thames Regional Health Authority, 1988-90. SUBJECTS: 3447 singleton fetuses presenting by the breech at term. MAIN OUTCOME MEASURES: Intrapartum and neonatal mortality, low Apgar scores, intubation at birth, and admission to special care baby units. RESULTS: After the exclusion of babies with congenital anomalies the incidence of intrapartum and neonatal death associated with vaginal birth was 8/961 (0.83%) compared with 1/2486 (0.03%) in babies born by caesarean section (relative risk 20, 95% confidence interval 2.5 to 163). The numbers of low Apgar scores and neonatal intubation were doubled in babies born vaginally or by emergency caesarean section compared with those delivered by elective operation. CONCLUSIONS: The good neonatal outcome associated with elective caesarean delivery of the term breech fetus may influence the decision of women and their obstetricians about mode of delivery.

Apgar Score↗
PubMed1992

Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy.

Amniocentesis and drainage were performed in 19 twin pregnancies initially seen at less than 28 weeks' gestation with acute polyhydramnios caused by the twin-twin transfusion syndrome. The procedure was performed an average of three times for each patient (range one to six), with the removal of a mean volume of amniotic fluid of 2600 ml on each occasion (range 500 to 6700 ml). The interval between initial examination and delivery averaged 7 weeks (range 1 day to 18 weeks); 14 (37%) of the 38 babies survived the neonatal period. In the pregnancies with poor outcomes, the intertwin disparity in fetal size and the mean volume of amniotic fluid drained at each amniocentesis were greater than in the pregnancies in which one or both twins survived.

Abortion, Spontaneous↗
PubMed1991

Mode of delivery after one caesarean section: audit of current practice in a health region.

OBJECTIVE: To audit the subsequent obstetric management of women who had had one previous baby delivered by caesarean section. DESIGN: Retrospective analysis of a regional obstetric database. SETTING: Data derived from the 17 obstetric units in North West Thames region. SUBJECTS: 1059 women who delivered a singleton fetus of at least 37 weeks' gestation with a cephalic presentation in 1988 who had a history of one previous caesarean section and no other deliveries. MAIN OUTCOME MEASURES: Mode of delivery, postnatal morbidity, and duration of hospital stay. RESULTS: 395 (37%) women were delivered by elective repeat caesarean section and 664 (63%) were allowed a trial of labour. Maternal height and birth weight of the previous infant differed significantly between those who were and those who were not allowed to labour. 471 (71%) of those allowed to labour achieved a vaginal delivery. In individual units there was no significant correlation between the proportion of patients allowed to labour and the rate of the successful trial of labour. There was a trend towards greater success rates in units that allowed a longer duration of labour (p less than 0.05) and units with greater use of oxytocin for augmentation of labour (not significant). Both elective and intrapartum caesarean section was associated with a significantly higher rate of postnatal infection than vaginal delivery (14.7% and 16.0% v 3.4%). CONCLUSIONS: In patients with a history of caesarean section there is no evidence that the likelihood of successful vaginal delivery after trial of labour is modified by the proportion of such patients allowed the option of attempted vaginal delivery. Until selection criteria of adequate prognostic value can be identified a more liberal approach to allowing women a trial of labour seems justified.

Adult↗
PubMed1990

Maternal haematocrit in labour is related to fetal cord pH at delivery.

OBJECTIVE: To determine whether a correlation exists between maternal haematocrit in labour and umbilical cord pH values at delivery. DESIGN: An observational study. SETTING: The delivery suite. SUBJECTS: 200 pregnant women in labour. MAIN OUTCOME MEASURES: Umbilical artery and vein blood pH values. RESULTS: A statistically significant inverse correlation was observed between maternal haematocrit levels during labour and umbilical vein pH (r = -0.22; P = 0.001) and umbilical artery pH (r = -0.18; P = 0.008) at delivery. CONCLUSIONS: Although an inverse correlation does appear to exist between maternal haematocrit and cord pH values, it is unlikely that this weak association will prove to be of clinical value in the management of labour.

Female↗
PubMed1990

The effects of cyclosporin A on glucose homeostasis and the kidney in the normal rat.

The effects of administering cyclosporin A (CsA), for periods of up to 84 days, on glucose homeostasis and renal function were studied in adult male Sprague-Dawley rats. Marked glucose intolerance was demonstrated at a variety of drug doses, accompanied in the longer term by hyperglycaemia. Early on and at high CsA dose, the abnormal islet cell function was accompanied by islet cell vacuolation; in the long-term dose groups, more chronic structural islet changes were present. Although abnormalities in renal function and structure were noted during this study, they were not directly related to the pancreatic changes observed.

Animals↗
PubMed1989

Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial.

OBJECTIVE: To determine whether the high rate of forceps delivery associated with the use of epidural analgesia could be reduced through giving an intravenous infusion of oxytocin during the second stage of labour. DESIGN: A randomised, double blind, placebo controlled trial. SETTING: Delivery suites in three hospitals. SUBJECTS: 226 Primiparous women with adequate epidural analgesia in whom full dilatation of the cervix had been achieved without prior stimulation with oxytocin. INTERVENTION: An infusion of oxytocin or placebo starting at the diagnosis of full cervical dilatation at an initial dose rate of 2 mU/min increasing to a maximum of 16 mU/min. MAIN OUTCOME MEASURES: The outcome of labour was assessed in terms of the duration of the second stage, mode of delivery, fetal condition at birth, postpartum blood loss, and the incidence of perineal trauma. RESULTS: Treatment with oxytocin was associated with a shorter second stage (p = 0.01), a reduction in the number of non-rotational forceps deliveries (p = 0.03), and less perineal trauma (p = 0.03) but was not associated with any reduction in the number of rotational forceps deliveries performed for malposition of the occiput. No adverse effects on fetal condition at birth or in the early puerperium were seen in association with the use of oxytocin. CONCLUSIONS: The use of an oxytocin infusion may reduce the high rate of operative delivery associated with epidural analgesia provided that the fetal occiput is in an anterior position at the onset of the second stage of labour but within the dose range studied does not seem to correct malposition of the fetal occiput.

Adolescent↗
PubMed1989

Hemostasis and cold knife cone biopsy: a prospective randomized trial comparing a suture versus non-suture technique.

Two methods of obtaining hemostasis after cold knife cone biopsy were compared in a prospective randomized trial involving 200 patients. One method relied primarily on hemostatic sutures, and the other involved the use of a styptic solution (Monsel's solution) and vaginal pack, thus avoiding the use of sutures altogether. The short- and long-term morbidity in these two groups were compared and 12-month follow-up was completed. The use of sutures did not reduce the incidence of primary hemorrhage. Secondary hemorrhage was twice as frequent in the suture group, although this trend did not quite reach statistical significance. During long-term follow-up, significantly more patients in the suture group developed menstrual symptoms, cervical stenosis, and unsatisfactory colposcopy, requiring further operative intervention as a result.

Adult↗
PubMed1989

Renal structure and function in streptozotocin-diabetic rats treated with cyclosporin A.

The effect of cyclosporin A (CsA), administered daily by gavage at 20 mg/kg body weight, on renal structure and function was investigated in normal and streptozotocin-diabetic male adult Sprague-Dawley rats over 12 weeks. In the non-diabetic animals CsA caused a progressive decrease in glomerular filtration rate and increased enzymuria. In contrast, the diabetic state was associated with massive increases in both enzymuria and urine flow rates, but a trend towards increased urea and creatinine clearance rates. CsA treatment of diabetic animals did not significantly alter the above parameters, nor affect circulating glucose levels, and trough serum CsA concentrations were similar in both diabetic and non-diabetic animals. The kidneys from CsA-treated non-diabetic animals showed chronic tubular damage. In the streptozotocin groups, the only morphological abnormality which could be related to diabetes was excess glycogen deposition in distal renal tubules. CsA-treatment of these groups was not associated with structural enhancement of either the drug's nephrotoxicity or the diabetes-related changes. Indeed the results indicate that the diabetic state affords some protection against the functional aspects of CsA-nephrotoxicity.

Animals↗
PubMed1988

Closed suction wound drainage and lower-segment caesarean section.

In a randomized controlled study of wound suction drainage after transverse suprapubic incision for lower-segment caesarean section no significant advantages could be demonstrated for routine drainage in terms of wound infection, haematoma formation, duration of hospital stay or analgesic requirements.

Cesarean Section↗
PubMedDate not supplied

Why monitor peak vancomycin concentrations?

Peak and trough serum concentrations are routinely measured to monitor vancomycin therapy. Optimal therapy depends upon maintaining a concentration above that necessary for antibacterial activity and is therefore determined by the trough concentration. I determined the post dose increases in serum drug concentrations in routine clinical practice in adult patients without renal failure. Mean increases of 16.6 mg/L (SD 6.1) (peak samples collected 1 h post infusion) were measured from 165 paired samples. The results suggest that as long as trough concentrations do not exceed 15 mg/L, peak levels will not exceed normally accepted safe concentrations, and therefore do not need to be measured.

Adult↗