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Biomedical subjects

R K Freeman

Publications and source records attributed to R K Freeman.

At least 55 records · Page 3Linked to original sources
PubMed1984

Fetal heart rate patterns and fetal distress in patients with preterm premature rupture of membranes.

Two hundred sixty-seven consecutive patients with preterm premature rupture of membranes (PROM) and 130 consecutive patients with idiopathic premature labor and intact membranes between 28 and 35 weeks' gestation were compared. A significantly higher incidence of cesarean section for fetal distress was found in patients with PROM (7.9%) compared with patients with premature labor (1.5%) (P less than .05). Fetal distress occurred with similar frequency in patients with and without chorioamnionitis. Analysis of electronic fetal heart rate patterns in patients with fetal distress revealed that 16 of 21 patients (76%) with PROM had patterns consistent with umbilical cord compression. A significant difference was found in neonatal mortality rates between the PROM group (4.5%) and the premature labor group (0) (P less than .05). The neonatal death rate in patients with fetal distress (three of 12) was significantly higher than in patients without distress (nine of 385) (P less than .01). It is suggested that the increased incidence of fetal distress in patients with preterm PROM may represent the loss of the protection of the umbilical cord that amniotic fluid normally provides.

Female↗
PubMed1983

A new rapid slide agglutination test for amniotic fluid phosphatidylglycerol: laboratory and clinical correlation.

A new rapid slide agglutination test (Amniostat-FLM/AFLM) for amniotic fluid phosphatidylglycerol has been developed. One hundred ninety-three samples of amniotic fluid were tested for lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol by thin-layer chromatography and fluorescence polarization and compared with the AFLM. All four tests agreed in 123/193 cases. Phosphatidylglycerol and AFLM were concordant in 176/193 cases. From these samples, data were available on 105 neonates, of whom 74 were delivered within 72 hours of amniocentesis. All positive AFLM tests were associated with absence of hyaline membrane disease, of 22 negative tests, eight babies had hyaline membrane disease. Thus, preliminarily, it appears that this is a useful, rapid test for assessing fetal lung maturity, which like other tests is reliable when indicating maturity but has a high incidence of falsely immature results.

Agglutination Tests↗
PubMed1983

Short-term variability assessment from abdominal electrocardiogram during the antepartum period.

One hundred eighty-eight patients undergoing antepartum fetal heart rate (FHR) monitoring with abdominal fetal electrocardiogram (ECG) technique were studied with respect to FHR variability derived from fetal R-R intervals. Statistically significant positive correlation existed between various measures of FHR variability and accelerations per minute (p less than 0.01). Insufficient numbers of positive contraction stress tests (CST) were available to establish a relationship with variability, although a trend existed between positive CST and low variability. Postdate pregnancies had significantly higher variability than nonpostdate pregnancies (p less than .05). This mathematical analysis establishes statistical significance between short-term variability and accelerations per minute and application of this technique for assessment of true variability in antepartum testing is possible.

Electrocardiography↗
PubMed1982

Short versus long course of prophylactic antibiotics.

The use of prophylactic antibiotics to reduce post-cesarean section febrile morbidity has been advocated since 1968. Although this approach has theoretical and actual disadvantages, all but one study found a reduction in febrile morbidity when prophylactic antibiotics were used. An unresolved question was the duration of antibiotic therapy. A double-blind randomized study compared a long course of ampicillin (3 days) to a short course of ampicillin (three doses) to placebo. The long course of prophylactic antibiotics reduced febrile morbidity significantly better (p less than 0.025) than the short course, and hospital stay was also significantly reduced when compared to placebo (significance, p less than 0.01). A longer course (3 days) of antibiotics was superior to a short course (three doses) in situations in which prophylactic antibiotics were used.

Administration, Oral↗
PubMed1982

A prospective multi-institutional study of antepartum fetal heart rate monitoring. II. Contraction stress test versus nonstress test for primary surveillance.

This study includes, 1,542 patients who underwent nonstress tests (NSTs) for primary fetal surveillance and 4,626 patients who underwent contraction stress tests (CSTs) for primary fetal surveillance. All pregnancies were at increased risk for uteroplacental insufficiency. The results showed that the two groups were comparable according to maternal diagnostic criteria for testing. Those patients who underwent NSTs as primary surveillance had a 2.9% incidence of intervention because of abnormal test results while the CST group had a 4.5% incidence of intervention because of abnormal test results ( p less than 0.05). The NST group had significantly more respiratory distress syndrome, intrauterine growth retardation, birth weight less than 2,500 gm, and 5-minute Apgar scores less than 7. The antenatal death rate was nearly eight times higher in the NST group (7.8/1,000 versus 1.1/1,000 in the CST group) (p less than 0.05). After correction for congenital anomalies and unrelated causes, the NST group had an antenatal death rate of 3.2/1,000 versus 0.4/1,000 in the CST group (p less than 0.05); there was still an antenatal death ratio of 8:1.

Apgar Score↗
PubMed1982

Helicopter transportation of patients with obstetric emergencies in an urban area.

Regionalization of perinatal care has contributed to a decline in perinatal morbidity and mortality in neonates delivered at tertiary centers when compared to neonates delivered and transported to the intensive care nurseries. Transportation of the mother to the perinatal center in an emergency situation must be evaluated critically for neonatal outcome, response time, and cost. In a large metropolitan area in Southern California, a helicopter transport service has been used successfully to move emergency patients from referring hospitals to a perinatal center. This experience was examined with respect to response time, cost, obstetric problems, and newborn outcome in our first 100 patients. The results are indicative that when patient and neonates would benefit from delivery at a perinatal center, helicopter transport, even in an urban area, is highly successful and cost effective.

Aircraft↗
PubMed1982

Sinusoidal fetal heart rate pattern: its definition and clinical significance.

A review was made of the available literature on the sinusoidal heart rate (SHR) pattern. A specific definition of SHR was made in order to elucidate its clinical significance. According to this definition 41 tracings from 23 publications were classified as being either true SHR, equivocal, or a heart rate pattern other than SHR. On the basis of this definition, 27 tracings were classified as true SHR patterns and all were associated with significant fetal or neonatal morbidity or mortality, except in two cases after administration of alphaprodine. Three tracings were judged to be equivocal. In two other cases the fetal heart rate tracings were classified as nonsinusoidal premortem patterns associated with poor perinatal outcome. As for the other nine tracings that did not meet the proposed definition, the perinatal outcome was normal. Therefore, because of a stricter definition of jeopardy, except when the SHR pattern appears after induction of analgesia with alphaprodine.

Alphaprodine↗
PubMed1982

Chorioamnionitis in the preterm gestation.

Two hundred fifty-one patients with premature rupture of membranes between 28 and 34 weeks' gestation were followed prospectively to evaluate the maternal and neonatal effects of chorioamnionitis. Forty-seven (19%) developed intrauterine infection prior to delivery. Fetal tachycardia, maternal leukocytosis, and uterine contractions were not predictive of intrauterine infection in afebrile patients. In afebrile patients, however, amniocenteses positive for bacteria on Gram stains and/or with subsequent positive culture correlated with subsequent development of antenatal maternal fever. Other than an increased rate of postpartum endometritis no serious maternal complications were seen in patients with chorioamnionitis. Neonatal outcome, however, was significantly adversely affected with respect to increase in perinatal mortality, overall neonatal infection rate, and respiratory distress syndrome (RDS) in patients with maternal infection. Neither trial of labor nor duration of labor in patients with chorioamnionitis correlated with adverse neonatal outcome. However, the appearance of maternal fever prior to the onset of labor correlated more significantly with neonatal death and RDS in the newborn that did the development of maternal fever in the intrapartum period.

Amniotic Fluid↗
PubMed1982

Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia.

From 1960 to 1980 at Memorial Hospital Medical Center--Miller Children's Hospital, the mean birth weight for term-size neonates increased from 3381 to 3458 g inspite of increases in ethnic groups known to have smaller neonates. More significantly, the incidence of macrosomic neonates (birth weight greater than 4000 g) increased from 7.0 to 10.7%. Because of this marked increase in the incidence of neonatal macrosomia, prospective study was designed to characterize the macrosomic neonate anthropometrically. The results of this study revealed that neonates experiencing shoulder dystocia had significantly greater shoulder-to-head and chest-to-head disproportions than did macrosomic neonates delivered by cesarean section for failed progress in labor or macrosomic neonates delivered without shoulder dystocia. In addition, neonates of diabetic mothers also showed significantly greater shoulder-head and chest-head size differences than did neonates of nondiabetic mothers of comparable weight. These data suggest that antenatal ultrasonic measurements to compare chest-head size difference in fetuses suspected to be macrosomic and in diabetic pregnancies could be of value in selecting patients for the appropriate route of delivery.

Adult↗
PubMed1982

Ultrasonic prediction of fetal macrosomia in diabetic patients.

Traumatic morbidity in the newborn of a diabetic mother occurs in 3 to 9% of vaginal deliveries in diabetic pregnancies. Prediction of diabetic macrosomia by ultrasound measurement of chest diameter and biparietal diameter is evaluated in this study. A macrosomia index was calculated for 70 diabetic pregnancies by subtracting the biparietal diameter from the chest diameter (chest - biparietal diameter). Twenty-three macrosomic infants (weight greater than 4000 g) were delivered. In this study 20/23 (87%) of the infants weighing greater than 4000 g had a chest - biparietal diameter of 1.4 cm or greater. There were 4 cases of shoulder dystocia in 15 patients delivered vaginally. In this study, cesarean section for all fetuses with a chest - biparietal diameter of 1.4 cm or greater would reduce the incidence of traumatic morbidity from 27% to 9%.

Body Weight↗
PubMed1981

Prospective randomized study of corticosteroids in the management of premature rupture of the membranes and the premature gestation.

A prospective randomized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted. Patients with chorioamnionitis, advanced labor, and fetal distress, as well as those with mature lecithin/sphingomyelin ratios and/or Gram stains positive for bacteria, were delivered immediately. The remaining patients were randomized. One group received betamethasone. Tocolytic agents were used in this group when necessary. After 48 hours all patients given corticosteroids (CS group) were delivered). The second group was managed expectantly (EM group) and were delivered only when spontaneous labor or infection occurred. A total of 160 patients were randomized, 80 in each group. Maternal outcome, including chorioamnionitis and cesarean section rates, was not different; however, the endometritis rate was significantly higher in the CS group (p less than 0.05). Neonatal outcome did not differ in mean birth weights, perinatal death rates, neonatal infections, or incidences of respiratory distress. The frequency of prolonged hospital stay (greater than 4 weeks) was higher in the neonates in the CS group (p less than 0.01). The conclusion is that corticosteroids and active management in patients with premature rupture of the membranes and premature gestations do not decrease the incidence of respiratory distress syndrome or perinatal mortality and may aggravate certain infectious complications.

Adolescent↗
PubMed1981

Incidence of premature delivery following the oxytocin challenge test.

The oxytocin challenge test (OCT) has been used to identify and follow the fetus at risk for uteroplacental insufficiency. Of 389 patients who had at least one OCT prior to 38 weeks' gestation, 26 (6.7%) underwent delivery after spontaneous onset of premature labor within 5 days of an OCT. This compares to a 7.5% incidence of spontaneous delivery prior to 38 wk at the University of California Irvine Hospital, and to a 7.6% rate of premature delivery after spontaneous onset of labor in those patients followed with nonstress tests only.

Delivery, Obstetric↗
PubMed1981

Postdate pregnancy: utilization of contraction stress testing for primary fetal surveillance.

Six hundred seventy-nine postdate study patients surveyed with a contraction stress test (CST) protocol had no perinatal deaths and no greater morbidity than that found in a 500-patient normal term control population. However, the postdate study did have a significantly increased risk of intrapartum fetal distress, meconium-stained amniotic fluid, macrosomia, and cesarean section for both failed progress of labor and fetal distress. Among the postdate study group there was a high incidence of patients with abnormal CST results (39%); these patients with abnormal CST results were at increased risk for subsequent intrapartum fetal distress. Seventy-five percent of the postdate study patients entered labor spontaneously and delivery was elected because of abnormal CST results in only 5.4%. The data presented here support the use of contraction stress testing for primary surveillance of the prolonged pregnancy and they suggest that only one in 20 patients past 42 weeks' gestation will require intervention for fetal indications with this approach.

Cesarean Section↗
PubMed1980

Perinatal transport to a regional perinatal center in a metropolitan area: Maternal versus neonatal transport.

A prospective study was undertaken to evaluate antenatal maternal referral, acute maternal transport, and neonatal transport to a regional perinatal center in a metropolitan area. During an 18-month period, there were 143 antenatal maternal referrals, 254 antenatal maternal transports, and 506 neonatal transports. Indications for the antenatal referrals were maternal diseases of a chronic nature. This group had a 28.7% incidence of delivery by primary cesarean section, a 15.8% incidence of low-birth weight infants, and a 30.8% incidence of neonatal admissions to the Neonatal Intensive Care Unit (NICU). The perinatal mortality rate was 13.7 per thousand which compares favorably with that of low-risk obstetric patients. Indications for the antenatal maternal transports were mainly premature labor and/or premature rupture of the membranes and third-trimester bleeding. There was a 37% incidence of delivery by primary cesarean section and a 71.5% incidence of low-birth weight infants, and 77.4% of the newborn infants were admitted to the NICU. The perinatal mortality rate was 137.4 per thousand live births. Compared to postnatal neonatal transports, the neonates transported antenatally had a slightly higher mortality rate which was not statistically significant. One hundred thirty-one neonates transported antenatally could be matched in sequential order of admission with 131 neonates transported postnatally of comparable birth weights and gestational ages. Although there was a significant increase in the incidence of delivery by cesarean section among the mothers transported antenatally, the neonates in this group had a significantly lower incidence of respiratory distress syndrome and other morbidity and a shorter hospitalization. This study suggests that antenatal referral and transport of high-risk parturient patients to a regional perinatal center may significantly decrease neonatal morbidity and length of hospitalization.

California↗