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Biomedical subjects

R W Beard

Publications and source records attributed to R W Beard.

At least 127 records · Page 7Linked to original sources
PubMed1983

Delayed pushing with lumbar epidural analgesia in labour.

Seventy-six primigravidae with epidural analgesia were randomly assigned to one of two groups for management in the second stage. In one group the women delayed pushing and in the other they were managed conventionally. The two groups were well matched for maternal and infant characteristics, including position and level of the presenting part at full dilatation and fetal scalp blood pH. The mean waiting time in the second stage before pushing was increased from 27 min in the conventional group to 123 min in the delayed group. This delay was not associated with an increase in abnormal fetal heart rate abnormalities or any decrease in umbilical cord pH or Apgar scores. In contrast, the delay was associated with an increase in spontaneous deliveries and a decrease in forceps deliveries (P = 0.06). These findings suggest a need for redefining the management of the second stage of labour with epidural analgesia.

Adult↗
PubMed1982

Reliability of endometrial aspiration cytology in the assessment of endometrial status.

One hundred twenty women attending routine gynecologic clinics were investigated by endometrial aspiration cytology to determine whether outpatient assessment of endometrial status could be used to determine subsequent patient management. The results show that this technique allows recognition and distinction between cystic hyperplasia, adenomatous hyperplasia, and carcinoma, and the time of the menstrual cycle can be assessed when the endometrium is normal. Endometrial aspiration cytology is valuable in gynecologic practice for determining which women with abnormal bleeding, both premenopausal and postmenopausal, require further investigation. Furthermore, the technique has a role to play in monitoring the status of the endometrium in women at high risk of endometrial malignancy, particularly those receiving hormone replacement therapy.

Adult↗
PubMed1981

An evaluation of the tissue pH electrode for fetal monitoring using the fetal sheep as an experimental model.

The performance of the Roche tissue pH electrode has been assessed by comparison of values recorded by the the electrode with the pH of arterial blood, in fetal sheep. Observations were made under controlled conditions when the fetal pH was steady, during hypoxia, and after hypoxia. The results showed a highly significant correlation of the values recorded by the electrodes with the pH of arterial blood (r = 0.89, p less than 0.001 during control; and r = 0.86, p less than 0.001 during hypoxia and recovery). However, in about 10% of cases the insertion proved to be unsatisfactory, and in one half of the successful insertions there was a rapid initial drift which lasted up to 45 min. After stabilization, tissue pH values were symmetrically distributed about the atrial pH, with a SD of 0.07 unit. Multiple electrodes in the same fetus gave the same scatter. Movements of the electrode caused significant artefacts. During hypoxia (produced by compression of the cord or administration of gas mixtures low in O2), the electrodes lagged behind the changes in arterial pH by up to 10 min. The conclusion is that the inherent variability of the tissue pH electrode makes it unsuitable as an absolute indicator of fetal well-being, and that it cannot be used alone as an indication for operative intervention. Nevertheless, because of the limitations of conventional techniques, it should be valuable as an adjunct and, in particular, it should help in the interpretation of equivocal fetal heart rate tracings, thereby reducing the risk of fetal death.

Animals↗
PubMed1981

The influence of maternal analgesia on neonatal behaviour: I. Pethidine.

Neonatal behaviour in a group of infants whose mothers received pethidine during labour was assessed at delivery and during the first six weeks of life by means of the Brazelton Neonatal Behavioural Assessment Scale. The influence of the total maternal dose of pethidine and umbilical cord blood concentration of the drug on such behaviour has been examined with the confounding effects of all other variables controlled. Higher cord blood levels of pethidine were associated with babies who were more prone to respiratory difficulties, drowsy and unresponsive immediately after delivery. Throughout the six weeks in which the assessments were made, depressed attention and social responsiveness were found in infants with high drug levels. At three and six weeks, the infant whose exposure ao pethidine had been high tended to change state more frequently, to cry during the test and to be less capable of quieting himself. These findings suggest that the newborn infant responds to pethidine in the same way as the adult, but the changes observed were relatively subtle, and comparison of these infants with a control groups whose mothers had received no drugs revealed no between-group differences in behaviour.

Anesthesia, Obstetrical↗
PubMed1981

The influence of maternal analgesia on neonatal behaviour: II. Epidural bupivacaine.

Four areas of neonatal behaviour have been assessed at delivery and during the following six weeks in a group of infants whose mothers were given epidural bupivacaine during labour. The influence on such a behaviour of the total maternal dose of bupivacaine and umbilical cord blood concentration of the drug has been examined with the confounding effects of other maternal and obstetric variables controlled. Significant and consistent effects of bupivacaine throughout the assessment period can be demonstrated. Immediately after delivery, infants with greater exposure to bupivacaine in utero were more likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly with increases in the cord blood concentration of bupivacaine, particularly on the first day of life by also throughout the next six weeks. Adverse effects of bupivacaine levels on the infant's motor organisation, his ability to control his own state of consciousness and his physiological response to stress were also observed. Muscle tone alone appeared to improve with increases in the values of the drug variables. These results show that the neonate differs from the adult in respect of both the nature of effects of the drug and sensitivity to it.

Anesthesia, Epidural↗
PubMed1980

Screening for diabetes during pregnancy.

Blood was taken for plasma glucose estimation one hour after oral ingestion of 50 g of glucose in 948 of 970 women booking at an antenatal clinic during one year. An abnormal result (greater than or equal to 7.7 mmol/l) was obtained in 74 subjects of whom 68 subsequently had an oral glucose tolerance test. Fourteen of these women (1.5 per cent of the study population) were found to have chemical diabetes.

Adult↗
PubMed1980

Evaluation of plasma glucose control in pregnancy complicated by chemical diabetes.

Two-hourly plasma glucose measurements were made over a 24-hour period in 24 pregnant women with chemical diabetes treated by dietary carbohydrate restriction alone. The values obtained between midnight and 0600 hours displayed the best correlation with the mean of the diurnal values, the strongest individual correlation being at 0200 hours. During the daytime, the mean of the plasma glucose values before breakfast (0600 hours) and lunch (1200 hours) and two hours after supper (2000 hours) provided the strongest correlation with the mean diurnal value and these are recommended as the routine sampling times for assessment of diabetic control in pregnant women with dietary treatment for chemical diabetes.

Adult↗
PubMed1980

Fetal heart rate monitoring using the abdominal fetal electrocardiogram.

An evaluation of a prototype abdominal fetal electrocardiogram (ECG) module for use in a Sonicaid FM3R monitor is described; 103 antenatal recordings of fetal heart rate (FHR) were attempted in 56 patients between 21 and 43 weeks gestation. The overall success rate was 54 per cent but the proportion of successful recordings was reduced between 24 and 36 weeks gestation. Most successful recordings were obtained with the first electrode placings and the quality of the recordings was generally higher than those obtained by simultaneously recorded FHR from ultrasound. Monitoring using the abdominal ECG during parturition was found to be unreliable. The advantages of the method are that it is non-invasive, the patient is not restricted by belts and the technique is easy to apply. However the uncertainty of obtaining a FHR trace between 24 and 36 weeks gestation is a major disadvantage.

Electrocardiography↗
PubMed1979

The effects of maternally administered pethidine or epidural bupivacaine on the fetus and newborn.

The continuous fetal heart rate rate pattern, condition of the baby at birth and its subsequent behaviour were compared in three groups of infants whose mothers received during labour either no drugs, intramuscular pethidine or epidural bupivacaine. The blood levels of pethidine and bupivacaine were measured at delivery in a maternal vein, and umbilical artery and vein, and in the newborn during the first 48 hours of life. The only significant changes in the fetal heart rate pattern occurred in association with maternal hypotension or uterine hyperstimulation. The Apgar scores at one minutes were 7 or less in more infants in the intramuscular pethidine and epidural bupivacaine groups as compared with the controls. There were no differences in the Apgar scores at five minutes. Neonatal behaviour during the first six weeks of life was not significantly affected by pethidine or epidural bupivacaine when compared with the control group. Pethidine and bupivacaine were shown to cross the placenta freely. The half-life of these drugs in the newborn was longer than in the adult.

Anesthesia, Epidural↗
PubMed1978

Fluid loading to reduce abnormalities of fetal heart rate and maternal hypotension during epidural analgesia in labour.

Fetal heart rate (FHR) was recorded and maternal blood pressure measured in 104 patients in whom lumbar epidural analgesia was induced in labour. Fifty-one patients received an intravenous load of 11 of Hartmann's solution immediately before the epidural injection. This infusion significantly reduced the incidence of abnormalities of FHR from 34% to 12% and of maternal hypotension from 28% to 2%. We did not study mothers with pre-eclampsia and hypertension, but we conclude that there is a strong case for preloading all other mothers in whom lumbar epidural analgesia is induced in labour.

Anesthesia, Epidural↗