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Biomedical subjects

R K Freeman

Publications and source records attributed to R K Freeman.

At least 73 records · Page 4Linked to original sources
PubMed1980

Use of corticosteroids in pregnancy-induced hypertension.

The first study on the use of corticosteroids to accelerate fetal pulmonary maturity reported an increased risk of fetal death in pregnancies complicated by hypertension-edema-proteinuria syndromes. Since that publication the use of corticosteroids to acclerate fetal lung maturity in women who are preeclamptic has been of great concern. This study provides evidence that when continuous fetal heart rate (FHR) monitoring is used, the use of corticosteroids to accelerate fetal lung maturity can be considered even in the presence of severe preeclampsia.

Adrenal Cortex Hormones↗
PubMed1980

Macrosomia--maternal, fetal, and neonatal implications.

Perinatal morbidity and mortality are known to be higher for the macrosomic neonate whose birth weight is 4500 g or more, compared with that of appropriate-weight term-size neonates. In a retrospective study comparing 287 macrosomic neonates with 284 appropriate-weight term-size neonates, we found that macrosomia occurred in 1.3% of our annual deliveries, with a male-to-female ratio of 2.3:1. Factors that occurred significantly more frequently in the mothers of macrosomic infants were maternal obesity, multiparity, diabetes mellitus, and previous delivery of an infant heavier than 4000 g. During the intrapartum period the incidence of labor augmentation by oxytocin, shoulder dystocia, and cesarean section was significantly greater in fetal macrosomia. Most significantly, this study revealed that macrosomia. Most significantly, this study revealed that macrosomic fetuses do not experience greater fetal distress in biophysically monitored labor than appropriate-weight term-size fetuses. Twenty-nine (10%) of the macrosomic infants required admission to the neonatal intensive care unit (NICU) compared to 9 (3%) of the control patients (P less than 0.01). This excess neonatal morbidity in the macrosomic neonates was predominantly caused by the delivery process.

Adult↗
PubMed1979

Fetal heart rate patterns and fetal distress in fetuses with congenital anomalies.

Over a 3-year period at the Long Beach Women's Hospital, where electronic FHR (fetal heart rate) monitoring was routine, there were 8622 live births, including 41 infants born with major congenital malformations. The neonatal death rate in these malformed infants was 44%; 17 were delivered by cesarean section, 11 of which were performed because of fetal distress. There were no characteristic FHR patterns that would specifically identify major congenital malformations. There was a significantly increased incidence of prematurity, breech presentation, and cesarean section delivery in the congenital malformation group as compared to the overall population delivering at the Women's Hospital. The clinical implications of these observations are discussed.

Adult↗
PubMed1979

Antenatal versus neonatal transport to a regional perinatal center: a comparison between matched pairs.

Fifty randomly selected newborn infants of maternal transports admitted to the neonatal intensive care unit (NICU) at Long Beach Memorial Hospital in 1976 and 1977 were matched by birth weight, gestational age, and outcome with 50 transported neonates. The factors compared included type of delivery, 5-minute Apgar score, length of hospital stay, distance of transport, admitting diagnosis, need for assisted ventilation, and length of time on assisted ventilation. Only 2 factors were found to be statistically different between the 2 groups. There was an increased cesarean section rate in transport mothers but a lower morbidity among preterm neonates born to maternal transports.

Birth Weight↗
PubMed1979

The use of amniocentesis in patients with premature rupture of membranes.

A prospective study was conducted to evaluate the usefulness of amniocentesis in patients with premature rupture of membranes (PROM) for the prediction of occult or impending intrauterine infection and the assessment of fetal maturity. Fifty-nine patients with PROM between 28 and 35 weeks' gestation, without apparent infection, were evaluated sonographically for possible amniocentesis. Thirty patients had successful amniocenteses for a success rate of 51%. Fifteen patients had a mature lecithin/sphingomyelin (L/S) ratio and were delivered immediately without respiratory distress syndrome (RDS) or other neonatal complications. All amniotic fluids were evaluated by Gram stains and cultures. Nine of the 30 patients had positive cultures, with a high incidence of subsequent development of amnionitis and other infectious morbidity. In the 21 patients with negative cultures, there were 19 without any infectious morbidity. Amniocentesis appears in this study to be a useful method for selecting the patients who have mature fetuses and/or who are more likely to develop amnionitis.

Amniocentesis↗
PubMed1978

Oxytocin challenge test: achieving the desired goals.

The desired goals of the oxytocin challenge test (OCT) are preventing stillbirth and avoiding unnecessary premature intervention. To effectively reduce stillbirth the test should be done on a significant proportion of those fetuses who would subsequently succumb in utero. To analyze whether or not the OCT is achieving these goals. 5351 deliveries over a 2-year period at the University of California, Irvine, Medical Center were studied retrospectively. Four hundred and thirty of these patients had 823 OCTs performed. There were ten positive and 19 suspicious tests, and five neonatal deaths in these two groups. In patients who were studied with OCTs only one stillbirth occurred (in a patient who was noncompliant). During the same period, all stillbirths were reviewed. In the group in which stillbirth occurred, it was determined that 11 or 35% of the patients had indications for antepartum testing but were not tested. All 11 of these patients were transferred to the University hospital or had no prenatal care. It is suggested that these stillbirths may have been prevented had appropriate prenatal care allowed identification of patients for antepartum testing.

False Positive Reactions↗
PubMed1978

Comparison of quinestrol and Tace for relief of postpartum breast discomfort.

A single 2-mg dose of quinestrol was demonstrated safe and effective for controlling postpartum lactation and for alleviating breast discomfort. A double-blind comparison to Tace 72 mg every 12 hours for 2 days, and to placebo, was made in 134 patients. The single oral dose of quinestrol showed efficacy equal to the 2-day regimen of Tace. Both were superior to placebo.

Adolescent↗
PubMed1977

Management and outcome of pregnancy in diabetes mellitus, classes B to R.

During the period 1971 to 1975, 260 women with diabetes mellitus, Classes B through R, were delivered of their infants at Los Angeles County Women's Hospital. The plan of patient management included frequent clinic visits and hospitalization to assure good control. A program of intensive antepartum fetal surveillance was begun at 34 weeks' gestation, with the use of daily 24 hour urinary estriol determinations and a weekly contraction stress test (CST). A lecithin/sphingomyelin ratio was evaluated for all patients before elective delivery. The perinatal mortality rate in these diabetic pregnant women was 46 per 1,000 as compared to 24 per 1,000 in the general population. Only three stillbirths occurred in the diabetic group, none within one week of a negative CST. Congenital malformations were responsible for almost half of the neonatal deaths. There were no deaths due to iatrogenic prematurity or trauma. Mean gestational age at delivery was 37.9 weeks and vaginal delivery was the mode for approximately half of the women. Two thirds of the infants did experience some morbidity.

Delivery, Obstetric↗
PubMed1977

Lecithin/sphingomyelin ratio in pregnancies complicated by diabetes mellitus.

The amniotic fluid lecithin/sphingomyelin (L/S) ratio was determined in 182 pregnancies complicated by Classes B and C diabetes and in 28 patients with Classes D, F, and R diabetes. These data were retrospectively correlated with the occurrence of the respiratory distress syndrome (RDS) or hyaline membrane disease (HMD). Only four cases of RDS and two cases of HMD were observed in 200 patients with an L/S ratio of 2.0 or greater prior to delivery. This 3 per cent incidence of complications is no higher than that of the nondiabetic population in our institution. Seven of 10 neonates with an antenatal L/S ratio of 1.5 to 1.9 developed RDS. An L/S ratio of 2.0 or more appears to be reliable predictor of fetal pulmonary maturity even in pregnancies complicated by diabetes mellitus.

Amniotic Fluid↗
PubMed1977

A simple method of fetal and neonatal heart rate beat-to-beat variability quantitation: preliminary report.

Good base-line fetal and neonatal heart rate beat-to-beat variability appears to be a reassuring sign of well-being. Conversely, decreased base-line heart rate beat-to-beat variability during the latter part of the intrapartum period is often associated with neonatal acidosis and/or depression. A simple method of quantitation of the beat-to-beat neonatal heart rate is reported here. This method of variability quantitation (VQ) consists of a continuous integration and display of the baseline heart rate beat-to-beat variability on a scale of zero to four, expressed in beats per minute averaged over a one-minute period. Serial variability quantitation in 35 neonates with different clinical conditions appeared to demonstrate a good correlation between the variability quantitation and the outcome of the neonates. Further studies are planned for evaluating the method in the intrapartum period.

Female↗
PubMed1977

Management and outcome of class A diabetes mellitus.

Patients who have a normal fasting serum glucose (FSG) and an abnormal glucose tolerance test, and who require little dietary regulation, have been designated as Class A diabetics by White. During the period 1970 through 1972, 261 Class A women were delivered at Los Angeles County (LAC) Women's Hospital. These patients were managed by a uniform protocol which included dietary supervision and continued surveillance for the onset of overt diabetes. Elective intervention prior to 40 weeks' gestation was to be avoided. Twenty-five per cent of the Class A patients--those who had had a previous stillbirth or who developed pre-clampsia--were considered at greater risk for perinatal death and were managed as if they had overt diabetes. The perinatal death rate for the entire Class A group was 19/1,000 as compared to 32/1,000 in the general population. Five perinatal deaths occurred, three associated with congenital malformations. There were no unexplained stillbirths or deaths due to trauma or iatrogenic prematurity. Our data thus indicate that as long as the FSG remains normal, an unexplained intrauterine death is a rare event. Twenty-five per cent of the infants did experience some morbidity.

Adult↗
PubMed1977

The diagnosis of fetal hydrocephalus before viability.

A diagnosis of fetal hydrocephalus was made before viability. The diagnosis was indicated by a discrepancy between the sonographic fetal head size, the uterine size by both clinical and sonographic examination, and x-ray films. An abortion was performed by hysterotomy.

Adolescent↗
PubMed1977

Sinusoidal fetal heart rate pattern and severe fetal anemia.

This report describes a case of a sinusoidal fetal heart rate (FHR) pattern encountered in a fetus at 34 weeks' gestation during antepartum fetal stress testing because of maternal hypertension. Delivery of the fetus was accomplished, and the newborn was found to be severely anemic and hypotensive due to a massive fetomaternal transfusion. Some pathophysiologic mechanisms are suggested, and the clinical significance of this finding is discussed.

Adult↗