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Biomedical subjects

S Arulkumaran

Publications and source records attributed to S Arulkumaran.

At least 199 records · Page 11Linked to original sources
PubMed1986

Premature rupture of the membranes at term. Obstetric outcome with oxytocin stimulation in relation to parity and cervical dilatation at admission.

The obstetric outcome in women with premature rupture of the membranes (PROM) at term (greater than 36 weeks gestation) without spontaneous onset of labor (within 2 h after admission) was evaluated prospectively in a joint study at the University Hospital of Lund, Sweden and Kandang Kerbau Hospital, National University of Singapore. After 2 h of observation without uterine contractions, labor was stimulated with oxytocin infusion. 303 patients participated and were classified according to parity (nulliparae-multiparae) and cervical dilatation at admission (less than 2 cm dilated; greater than or equal to 2 cm dilated). No significant race-related differences could be found, except for birthweight. Nulliparae with unfavorable cervix at admission had a high rate of ominous fetal heart rate findings in labor and a high cesarean section rate (19.4%), particularly for failed stimulation of labor. The high cesarean section rate after routine stimulation of labor in nulliparae with unfavorable cervix suggests that a non-intervention approach may be justified in this group. In contrast, the cesarean section rate after stimulation of labor was 3.6% in nulliparae with the cervix dilated 2 cm or more at admission and 4.2% in multiparae and ominous fetal heart rate changes were much less common.

Adult↗
PubMed1986

Admission test: a screening test for fetal distress in labor.

The usefulness of a short electronic fetal heart rate recording at admission of patients in labor (admission test) was investigated in low-risk patients in two prospective studies. The admission test was done in a concealed manner, and the result of the test was evaluated after delivery so as not to influence the clinical management. In part I of the investigation, the test was performed in 130 patients monitored during labor with pH determinations in scalp blood and in cord blood at birth. Patients with reactive admission tests had a low rate of intrauterine asphyxia in labor (0.9%), whereas half of the patients with ominous traces had intrauterine fetal asphyxia with a low scalp blood pH and neonatal depression. Similar results were obtained in part II, when the admission test was used as a screening procedure involving 1041 patients. The test was reactive in 94.3%, and in this group fetal distress (cesarean section, or forceps on that indication, or an Apgar score less than 7 at five minutes) occurred in 1.3%. Ten patients (1.0%) had ominous tests; four of these had fetal distress, and one of these fetuses died in utero three hours after admission, during which time stethoscopic auscultation failed to detect the fetal compromise. It is concluded that the admission test can detect fetal distress already present at admission and unnecessary delay in intervention can be avoided in such a case. The test seems also to have some predictive value for the fetal well-being for the next few hours of labor. The test is simple and convenient for screening purposes.

Delivery, Obstetric↗
PubMed1985

Single injection of terbutaline in term labor. I. Effect on fetal pH in cases with prolonged bradycardia.

Thirty-three patients with prolonged fetal bradycardia (fetal heart rate baseline less than 100 bpm for a minimum of 3 minutes or less than 80 bpm for at least 2 minutes) in labor were studied. They were treated with a bolus injection of terbutaline if the bradycardia persisted at less than 80 bpm for 2 minutes and other efforts to improve the fetal heart rate (oxygen, positional changes) had failed. After the bolus injection a scalp blood pH (or a cord arterial pH in abdominal deliveries) was obtained within 30 minutes. Fetal acidosis was common if the bradycardia lasted 10 minutes or more, particularly if the rate was less than 80 bpm with a flat baseline for 4 minutes or more. The fetal heart rate improved after injection in 30 cases; 23 patients had vaginal delivery of infants in good condition. Ten underwent cesarean section: three for no improvement in fetal heart rate, two for cord prolapse, four for later ominous fetal heart rate, and one for failure to progress. These results suggest that tocolysis in selected cases can be of benefit for the fetus with prolonged bradycardia. In cases with an ominous fetal heart rate pattern preceding the bradycardia and in abruptio placentae immediate operative intervention without delay is probably better. Administration of terbutaline should be regarded as a temporary measure until it is apparent that the fetal heart rate has recovered. Preparation for emergency delivery should be made while a recovery is awaited.

Female↗
PubMed1985

Single injection of terbutaline in term labor. II. Effect on uterine activity.

The effect of terbutaline, 250 micrograms given as an intravenous bolus injection in term labor, was investigated with use of a transducer-tipped catheter placed in the uterine cavity. Maternal side effects were common but well tolerated. No fetal side effects were recorded. The results suggest that 250 micrograms of terbutaline as a bolus injection gives a safe and effective inhibition of uterine activity in term labor. Possible indications and benefits of transient inhibition of uterine activity in term labor, particularly when fetal distress is associated with abnormal uterine activity, are discussed.

Adult↗
PubMed1985

A comparative study of methods of oxytocin administration for induction of labour.

Equipment has become available for the automatic infusion of oxytocin in a closed loop system for the induction of labour. This system was compared with manual administration of oxytocin by peristaltic infusion pump, the dosage being based on data derived from an intrauterine catheter or by clinical assessment of uterine activity. A total of 121 patients classified according to parity and cervical score were allocated to an automatic infusion system (AIS) or a peristaltic infusion pump system. Patient characteristics were similar in both groups. Labour was significantly longer in those induced by automatic infusion system particularly in nulliparae and patients with poor cervical scores. In 53.3% of the nulliparae with poor cervical scores the automatic infusion system proved inadequate to effect vaginal delivery. Neonatal outcome was similar in both groups. Automatic infusion of oxytocin by the present system increased the length of induced labour and had no statistically significant effect on neonatal outcome, conferring no advantage over a more traditional method of oxytocin administration.

Adult↗
PubMed1985

Total uterine activity in induced labour--an index of cervical and pelvic tissue resistance.

Uterine activity was studied during labour induced using an automatic infusion system (AIS) or a peristaltic infusion pump (IVAC) to administer oxytocin. In the 110 patients who achieved vaginal delivery the total uterine activity required to effect full dilatation of the uterine cervix was found to vary according to parity and cervical score but not according to mode of oxytocin infusion. Irrespective of whether the uterine activity level per 15 min was maintained at between 700 and 1500 kPas or at between 1500 and 2000 kPas, the total uterine activity was similar the lower levels being compensated for by a longer duration. Fetal outcome, in terms of 1- and 5-min Apgar scores and umbilical vein blood pH, was unaffected by the level of uterine activity. The cervical and pelvic tissue resistance varies according to parity and cervical score and the uterus has to achieve a certain total uterine activity in induced labour which is best achieved by maintaining optimal uterine activity levels of 1500-2000 kPas/15 min to effect vaginal delivery of the baby in good condition in optimal time.

Cervix Uteri↗
PubMed1985

Complications of beta-mimetic therapy in preterm labour.

Selective beta-mimetic drugs are the most frequently used agents for arresting preterm labour. For this purpose these drugs have to be given in high doses for several hours and since they act on several organ systems, side-effects, some of which are potentially dangerous, appear. These hazards, which involve chiefly the cardiovascular and metabolic areas, have been examined in the light of available experience with these drugs. This review considers the possible mechanisms for the side-effects and offers suggestions on how the dangers in the use of beta-mimetic drugs in preterm labour might be avoided.

Adrenergic beta-Agonists↗
PubMed1985

Failed induction of labour.

Over a 15-month period 1,057 consecutive inductions of labour were performed representing a 10% induction rate; 174 (16.5%) of these patients were delivered by Caesarean section of which 74 (7.0%) were for failed induction of labour, 58 (5.5%) for fetal distress, 19 (1.8%) for cephalopelvic disproportion, 6 for malposition and 17 for other reasons. The mean cervical score at induction of labour was 5.7 and 5.5 for cephalopelvic disproportion (CPD) and malposition respectively but was 4.0 for failed induction. The mean cervical dilatation at the time of Caesarean section was 5.7 cm and 6.6 cm for CPD and malposition respectively whereas it was 3.5 cm for failed induction. Mean maximum dose of oxytocin was 19.2 milliunits per minute (mu/min) and 22.5 mu/min for CPD and malposition respectively whereas it was 24.7 mu/min for cases of failed induction. Nulliparas with a cervical score of 3 or less had a 65.4% Caesarean section rate of which more than two-thirds were for failed induction of labour. Analysis of indications for induction of labour revealed that a fair number of inductions had debatable obstetric indications. Tailoring induction of labour to the cervical score and indication might reduce the Caesarean section rate for failed induction of labour. Rational management to ensure an adequate dose of oxytocin and sufficient time in the first stage of labour is important. Failed induction of labour may be differentiated from failure of labour progress due to CPD or malposition.

Adult↗
PubMed1984

The effect of parity on uterine activity in labour.

Uterine activity was studied in 40 multiparous Singapore women of Chinese origin who were in normal labour and had a normal delivery. A catheter tip pressure transducer coupled with a uterine activity integrator was used to quantify uterine activity. Normal labour progress was defined as labour progressing within 2 h to the right of a line drawn on the partogram at 1 cm/h in the active phase of labour. A wide range of activity was observed. The median level of uterine activity rose from 815 kPas/15 min at 3 cm dilatation to 1731 kPas/15 min at 9 cm dilatation with an overall median level of 1130 kPas/15 min. The 10th centile value rose from 430 kPas/15 min at 3 cm dilatation to 923 kPas/15 min at 9 cm dilatation. Profiles of dilatation-specific activity values were constructed. These values were significantly lower than in a comparative group of nulliparous patients. The parous uterus requires to expend significantly less effort to effect normal vaginal delivery than its nulliparous counterpart.

Adult↗
PubMed1984

Characteristics of uterine activity in nulliparous labour.

Uterine activity was studied in 40 nulliparous Chinese women who were in normal labour and had a normal delivery. A catheter-tip pressure transducer coupled with a uterine activity integrator was used to observe and quantify uterine activity. Normal labour progress was defined as labour progressing within 2 h to the right of a line drawn at 1 cm/h in the active phase. A wide range of uterine activity was recorded with varying degrees of co-ordination. The minimum level of uterine activity likely to be associated with labour progress was 650 kPas/15 min at 3 cm cervical dilatation. The median level in the active phase of normal labour was 1440 kPas/15 min. There was a strong correlation between measurements in kPas/15 min and Montevideo units/15 min (r = 0.71, P less than 0.001). No significant increase was found in basal tone.

Adult↗