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Biomedical subjects

P Boylan

Publications and source records attributed to P Boylan.

At least 37 records · Page 2Linked to original sources
PubMed1985

The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring.

In a randomized controlled trial involving 12,964 women, a policy of continuous electronic intrapartum fetal heart monitoring was compared with an alternative policy of intermittent auscultation, both policies including an option to measure fetal scalp blood pH. Women allocated to electronic fetal heart monitoring had shorter labors and received less analgesia. The caesarean delivery rates were 2.4% for electronic fetal heart monitoring and 2.2% for intermittent auscultation but this small difference arose from the identification of nearly twice as many fetuses with low scalp pH (less than 7.20) in the electronic fetal heart monitoring group. The forceps delivery rate was 8.2% in the electronic fetal heart monitoring group compared with 6.3% in the intermittent auscultation group, and this excess was explained by more instrumental deliveries prompted by fetal heart rate abnormalities. There were 14 stillbirths and neonatal deaths in each group, with a similar distribution of causes. There were no apparent differences in the rates of low Apgar scores, need for resuscitation, or transfer to the special care nursery. Cases of neonatal seizures and persistent abnormal neurological signs followed by survival were twice as frequent in the intermittent auscultation group, and this differential effect was related to duration of labor. Follow-up at 1 year of babies who survived neonatal seizures revealed three clearly abnormal infants in each group. The implications of these findings for both theory and practice are discussed.

Adult↗
PubMed1985

Fetal breathing movements and the diagnosis of labor: a prospective analysis of 100 cases.

One hundred patients self-admitted to the hospital with a diagnosis of labor, were observed for up to 45 minutes with real-time ultrasonography to determine if the presence or absence of fetal breathing movements was helpful in separating false labor from true labor. Fetal breathing movements were not detected in 31 patients, and 30 of these delivered spontaneously within 48 hours; fetal breathing movements were present in 69 cases, and pregnancy continued for at least 48 hours in 56; of the remaining 13, labor occurred spontaneously within 48 hours in eight, whereas five had labor induced. Assessment of the cervix by Bishop score after ultrasound further improved diagnostic precision; none of 13 patients with a score greater than 9 exhibited fetal breathing movements, and all delivered within 48 hours. Gestational age did not influence outcome; 25 patients were preterm, and all 22 in whom fetal breathing movements were present continued for more than 48 hours. The results suggest that the absence of fetal breathing movements differentiates true labor from false labor.

Cervix Uteri↗
PubMed1984

The value of ultrasound measurement of amniotic fluid volume in the management of prolonged pregnancies.

Ultrasound assessment of amniotic fluid volume was used to monitor 335 patients with prolonged pregnancy. Reduced amniotic fluid was diagnosed when no single vertical pool of amniotic fluid measured greater than 30 mm. Sixty-five patients with reduced amniotic fluid had labour induced while 270 patients with normal amniotic fluid were managed expectantly unless the cervix was favourable. Patients with reduced amniotic fluid had a statistically significant increase in meconium-stained amniotic fluid and growth-retarded babies and were more likely to require delivery by caesarean section for fetal distress. There were no perinatal deaths in the series and the perinatal outcome was satisfactory in both groups. Ultrasound measurement of amniotic fluid represents an effective discriminatory test in post-term pregnancy.

Amniotic Fluid↗
PubMed1983

Improvement in perinatal mortality rate attributed to spontaneous preterm labor without use of tocolytic agents.

A retrospective study of the influence of spontaneous preterm labor on perinatal mortality rate over a period of 15 years was conducted at the National Maternity Hospital, Dublin. As the perinatal mortality rate from all causes declined from 48 to 16 per 1,000 births, the rate attributed to spontaneous preterm labor declined in the same proportion, from 10 to three per 1,000 births. Review of the circumstances of death attributed to spontaneous preterm labor in each case indicates that improvement in this area was due mainly to a natural reduction in incidence and, to a lesser degree, to better care of the neonate. Pharmacologic agents recommended for the purpose of averting spontaneous preterm labor made no contribution, because none was used. Natural improvement in the evolution of a disease may lead to exaggerated claims for the benefits of treatment; experience with perinatal death attributed to spontaneous preterm labor in this large unit suggests that current enthusiasm for tocolytic agents may well be misplaced.

Female↗
PubMed1980

An audit of prescribing in an obstetric service.

An audit of drug prescribing was carried out in an obstetric service. Sixty-five different drugs were prescribed in 976 separate prescriptions. Nitrazepam and paracetamol accounted for 75 per cent of all prescriptions. Many of the prescriptions were incomplete. In 83 per cent of cases the drugs prescribed were not referred to in the patients' case notes, suggesting that their prescription did not form part of a therapeutic plan for the patient.

Drug Prescriptions↗
PubMed1980

How obstetricians in the United Kingdom manage preterm labour.

A questionnaire survey was conducted in order to establish how obstetricians in this country manage preterm labour. The results indicate that the majority of obstetricians would use beta sympathomimetic agents to inhibit premature labour; most would use corticosteroids in some circumstances to accelerate pulmonary surfactant production, while the use of prophylactic antibiotics seemed variable. The findings and implications of the survey are discussed.

Adrenergic beta-Agonists↗
PubMed1980

Antepartum fetal heart rate monitoring: value of sound stimulation.

The fetal heart rate (FHR) response to sound stimulation has been studied. The normal fetus exhibits an acceleration of at least 15 beats/min sustained for at least 2 minutes. This response was studied in 116 pregnancies in which the fetus was considered to be at high risk. The response was impaired in the 3 cases of perinatal death, in 14 of 19 cases of perinatal morbidity, and in 17 of 27 fetuses whose subsequent birth weight was below the fifth percentile. An impaired response was of greater predictive value than the nonreactive pattern of nonstressed FHR monitoring.

Female↗
PubMed1980

Fetal breathing in labor.

Fetal breathing during labor was investigated in a 3-part study of 42 normal singleton pregnancies. In the first part fetal breathing movements (FBM) were compared antenatally and during labor in 22 patients to determine whether FBM persisted during labor in fetuses in whom these movements had been demonstrated antenatally. In the second part a double-blind trial was conducted on the responsiveness of fetal breathing in labor to maternal glucose infusion in 12 patients. In the third part the influence of artificial rupture of the membranes (ARM) to induce labor was examined in 8 patients. Fetuses spent 36% of their time making breathing movements antenatally but this decreased to less than 1% during labor. Fetal trunk movements also decreased during labor but not significantly. Fetal breathing and trunk movements were not stimulated by maternal glucose infusion. Fetal breathing but not trunk movements were significantly inhibited by ARM prior to the onset of labor. Cessation of fetal breathing in labor is normal, but the cause of this change in behavior has not been positively identified.

Blood Glucose↗
PubMed1979

Fetal breathing: a review.

The history, physiology, pharmacology, and clinical application of fetal breathing are reviewed. Early optimism that measurements of fetal breathing would aid in perinatal management decisions has remained unfulfilled. Problems to be overcome include standardization of technique and measurement parameters and allowance for physiologic variations. Recent research developments indicate that the likely role of fetal breathing in perinatal medicine will be in conjunction with other established tests of fetal health.

Amniocentesis↗
PubMed1977

Down's syndrome.

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Adult↗