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Biomedical subjects

R Deckardt

Publications and source records attributed to R Deckardt.

28 records · Page 2Linked to original sources
PubMed1991

The implication of upright posture on pregnancy.

Pregnant women spend more than half of the day in an upright position. The physiological effects of this posture on the mother and the fetus are evaluated. Changes in vascular autoregulation and anatomy lead to maternal fainting in about 8% of women during early pregnancy. The immediate effects of such episodes on the fetus are unknown. There is a positive correlation of orthostatic dysregulations and abortions. In late pregnancy we found a significant increase in functional residual capacity in the upright posture. Minute volume and oxygen consumption were also significantly increase (p less than 0.001). Regarding the cardiovascular changes we detected a rhythmic change of the maternal heart rate with the change to upright position, which had not been published before. Change from the left lateral position to unsupported standing increased maternal heart rate by a mean of 27 beats per minute and a mean duration of 105 seconds in two thirds of the women. This was accompanied by a decreased cardiac output, systolic blood pressure and an increased oxygen consumption. The gravid uterus is responsible for these changes. During the upright position, the venous flow to the right ventricle is inhibited by the relaxed uterus. Contractions, leaning forward and the muscle pump improve the venous return. The phenomenon reached its maximum during the 38th week, where 71% of pregnant women displayed a cyclic change in heart rate. The fetal heart rate baseline is significantly increased in the upright position with a significantly reduced acceleration frequency (p less than 0.001). Combined with the data from epidemiologic studies, prolonged standing during late pregnancy may signal potential risks for the fetus such as low birth weight, prematurity and stillbirths because of an 'uterovascular syndrome'. Maternal standing possibly may be used as a physiological fetal stress test.

Adult↗
PubMed1990

[Laparoscopic treatment of tubal pregnancy with prostaglandins].

Fifteen patients with laparoscopically diagnosed tubal pregnancy and constant or rising plasma beta-hCG levels were treated with prostaglandin F2 alpha and prostaglandin E2. Prostaglandin F2 alpha (5 mgms diluted in 10 cc of isotonic sodium solution) was injected transabdominally with a 22 gauge spinal needle during laparoscopy into the Fallopian tube. Prostaglandin E2 (500 micrograms ms) was given intramuscularly during three consecutive postoperative days. The treatment was defined as successful if plasma beta-hCG levels declined below the lower limit of detection and no further intervention other than prostaglandin application was required. The treatment was successful in eight patients. Six patients underwent laparotomy and salpingotomy because of rising beta-hCG levels. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. One patient underwent explorative laparotomy during the second postoperative day because of lower abdominal pain. During operation, no pathological change could be found. This patient was excluded from the study. In the group treated successfully (n = 8) seven out of eight patients had beta-hCG levels below 2500 mlU/ml preoperatively. In the unsuccessfully treated group (n = 6), four out of six patients had beta-hCG levels above 2500 mlU/ml preoperatively. Mean duration of beta-hCG decline to 10 percent of the maximum preoperative value was 15.8 +/- 8.64 days (mean +/- S.D.). Postoperatively, hysterosalpingography was performed in six out of eight successfully treated patients after three menstrual cycles (one patient had an intrauterine pregnancy, one patient refused written consent). The Fallopian tubes were patent bilaterally in all six patients.

Abortifacient Agents↗
PubMed1989

[Hemorrhage, shock and infection].

Hemorrhage and sepsis may lead to multiple organ system failure caused by a redistribution of cardiac output and a reduction of tissue perfusion. The pathophysiologic changes caused by hemorrhage are frequently prevented by rapid diagnosis of the cause of the bleeding (e.g., vessel injury or coagulation disorder) and its therapy. The pathophysiologic changes in sepsis are mediated by toxins which affect almost every organ system. Knowledge of the predisposing factors, rapid recognition of signs and symptoms, and understanding of the underlying pathobiochemical and pathophysiologic changes are mandatory in the successful therapy of septic shock. The main therapeutic principle remains removal of the focus.

Female↗
PubMed1987

[Advantages of early artificial respiration of the newborn infant using a modified T-piece].

Onset of sufficient respiration in the newborn may be delayed and require respiratory assistance. Its early institution is mandatory and its mode guided by the respiratory requirements of the newborn at risk. In our Department we use a simple respiratory equipment consisting of a modified mask elbow and a pigtail bag. We have applied this system in over thousand newborns without any complications. Sufficient respiratory care is easily accomplished. The system offers advantages because of its simplicity. It is lightweight, transparent, without valves and enables the user to applicate assisted or controlled ventilation with or without CPAP or PEEP. Tidal volume and frequency of spontaneous respiration can be gauged by watching the inflated bag's movements. If sufficient fresh gas flow is provided, there is no hazardous rebreathing. An elevated orifice maintains a safe system pressure, while still permitting high inspiratory pressures for resuscitation. Pressures applied are checked by an attached manometer.

Humans↗
PubMed1987

Monitoring arterial oxygen saturation in the neonate.

Term neonates (N = 35) with an one minute Apgar score of greater than or equal to 8 and mean umbilical artery pH values within normal were monitored by pulse oximetry. SaO2 monitoring started one minute after delivery. The initial SaO2 ranged from 40 to 75%. Neonates with a SaO2 above 80% five minutes after delivery remained untreated, neonates with a SaO2 below 80% received mask CPAP (figure 1). The initial difference in SaO2 between the groups was statistically significant (p less than 0.05). Mean umbilical artery pH and one, five and ten minutes Apgar score values were statistically not significant between the groups (p greater than 0.05). CPAP had been terminated as soon as SaO2 had reached 90%. This had been the lowest value monitored in spontaneously breathing neonates one day after delivery. Our findings indicate that neonates may sustain prolonged periods of decreased SaO2 which had not been detected by umbilical artery pH nor by the Apgar score. SaO2 monitoring by pulse oximetry served as a valuable method in the immediate newborn evaluation.

Apgar Score↗
PubMed1987

Maternal arterial oxygen saturation during labor and delivery: pain-dependent alterations and effects on the newborn.

This study evaluated the effects of labor pain on maternal arterial hemoglobin oxygen saturation and neonatal acid-base status. Arterial oxygen saturation was monitored noninvasively by pulse oximetry during labor and delivery. The patients studied (N = 46) were divided into four groups according to obstetric history (primiparas and multiparas) and pain management during labor (lumbar peridural anesthesia versus meperidine and nitrous oxide). Nine patients at term but not in labor served as controls. Decreases of arterial oxygen saturation were related to both subjective pain, reported by visual pain analog scales, and to neonatal acid-base status at delivery. All values are reported as mean +/- standard deviation (SD). Primiparas with peridural anesthesia showed significantly less decrease in arterial oxygen saturation (1.7 +/- 1.4%; P less than .001; N = 15), superior scores on the visual pain analog scale (3.5 +/- 2.0), and a significantly better neonatal acid-base status (pH 7.29 +/- 0.06; P = .01; base excess -6.4 +/- 2.2; P less than .05) as compared with primiparas treated with meperidine and nitrous oxide (SaO2 7.2 +/- 3.9%; visual pain analog scale 7.1 +/- 1.2; pH 7.21 +/- 0.1; base excess -9.5 +/- 4.5; N = 16). In multiparas there was no statistically significant difference in decrease of arterial oxygen saturation, visual pain analog scale, and neonatal acid-base status.

Acid-Base Equilibrium↗
PubMed1984

Noninvasive arterial hemoglobin oxygen saturation versus transcutaneous oxygen tension monitoring in the preterm infant.

We found that results from a transcutaneous arterial hemoglobin oxygen-saturation monitor correlated well with those from a co-oximeter. The monitor was not disturbed by differing hematocrit levels, the presence of fetal hemoglobin, or hypotension. We also found that the results of simultaneous transcutaneous arterial hemoglobin oxygen saturation (StcaO2) and transcutaneous oxygen tension (PtcO2) monitoring were predictably correlated over a wide range of hemoglobin saturations in preterm infants. When StcaO2 was between 80% and 95%, PtcO2 was at a safe level of 40 to 80 torr in 94% of the patients studied. StcaO2 monitoring as an index of arterial oxygenation has several advantages for the preterm infant.

Arteries↗
PubMedDate not supplied

Grief and depression after miscarriage: their separation, antecedents, and course.

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Abortion, Spontaneous↗