Search PubMed⌕ Search

Biomedical subjects

S Arulkumaran

Publications and source records attributed to S Arulkumaran.

At least 109 records · Page 6Linked to original sources
PubMed1995

A randomized controlled study of prostaglandin 15-methyl F2 alpha compared with syntometrine for prophylactic use in the third stage of labour.

A randomized controlled study of 112 women with singleton pregnancies at term, and no antenatal complications, admitted in spontaneous labour were randomized to receive either an intramuscular injection of 0.5 mg of Syntometrine or an intramuscular injection of 125 ug of prostaglandin 15-methyl F2 alpha at delivery of the anterior shoulder of the baby. Blood lost in the first 2 hours, and subsequent 22 hours postdelivery were collected separately and measured by colourimetric measurement of haemoglobin content. Other parameters in the third stage were measured, including need for transfusion of blood or blood products, length of the third stage, and change in haemoglobin concentration before and 24 hours after delivery. The incidence of side-effects with administration of either prostaglandin 15-methyl F2 alpha or Syntometrine were documented. The prophylactic use of intramuscular prostaglandin 15-methyl F2 alpha (Carboprost) in the active management of the third stage of labour gave similar results to prophylactic intramuscular Syntometrine in terms of length of the third stage of labour, incidence of postpartum haemorrhage and total blood loss in the first 2 hours and subsequent 22 hours after delivery. However it has the disadvantage of higher cost, as well as statistically significant increase in the incidence of profuse and frequent diarrhoea. Based on these results intramuscular injection of prostaglandin 15-methyl F2 alpha offers no advantage over intramuscular Syntometrine for routine prophylactic use to reduce blood loss in the third stage of labour.

Carboprost↗
PubMed1995

Automated 24-hour ambulatory blood pressure monitoring in preeclampsia.

A prospective controlled study was designed to compare automated 24-hour ambulatory blood pressure monitoring with intermittent blood pressure recordings obtained using a sphymomanometer. Blood pressure was measured in 20 hospitalized preeclamptic women in the third trimester. Data obtained using the Spacelabs automated blood pressure monitor was recorded over a period of 24 hours, and thereafter stored and processed in a computer. During the same 24 hour period, blood pressure and heart rate were measured by experienced staff at 07.00, 10.00, 13.00, 15.00, 18.00 and 21.00 hours, with the patient in a semi-recumbent position using a conventional mercury sphygmomanometer with a cuff of appropriate size. Korotkoff phase 5 was used as the indicator of diastolic blood pressure in all recordings by the staff. The main outcome measures were systolic and diastolic blood pressure, mean arterial blood pressure and maternal heart rate. Automated ambulatory monitoring was well tolerated and gave 91.6% successful readings. The mean differences between the blood pressure readings recorded by the monitor and of intermittent mercury sphygmomanometry during daytime were 0.7 (95% confidence interval -2.6 to 4.0) mmHg for the mean arterial blood pressure, -1.7 (95% confidence interval -6.8 to 3.5) mmHg for the systolic blood pressure, and 1.9 (95% confidence interval -2.2 to 6.0) mmHg for the diastolic blood pressure. The mean differences between day-time and night-time monitored blood pressures were 4.3 (95% confidence interval 0.8 to 7.8) mmHg, 4.6 (95% confidence interval 2.0 to 7.2) mmHg, and 4.4 (95% confidence interval 1.5 to 7.2) mmHg, respectively. The number of patients diagnosed as being hypertensive was similar whether automated blood pressure monitor or mercury sphymomanometry was used. Mean maternal heart rate recorded by the monitor or by the staff did not differ. Automated ambulatory blood pressure monitoring is reliable and might improve our understanding of the dynamic changes in blood pressure in pre-eclamptic women and may be a more suitable method to assess the blood pressure control achieved by different drugs.

Autoanalysis↗
PubMed1995

Evaluation of new catheter systems for intrauterine pressure measurement.

To verify the reliability of intrauterine pressure recordings by a newly available intrauterine catheter. In five women in labor the tips of the two newly available catheters (Hewlett Packard HP 13975 A) were tied together and placed in the same amniotic fluid pocket. In three other women the tip of the new catheter (HP) and tip of an established catheter system (Intran II) were tied and placed in the uterine cavity above the fetal head. The difference in active pressure recorded by the two catheters for each contraction in all 8 women was calculated. The total active pressure recorded for each patient for the whole labor by the two catheter was calculated. The active pressure difference for individual contractions was less than 5 mm Hg in 95% of contractions (n = 222) with the two new catheters (HP versus HP) and 99% when the new catheter was compared with the established catheter system (HP versus Intran II) (n = 222). The total active pressure in each labor differed by 0.4% to 5.4% (n = 5) and 1.4% to 4.1% (n = 3) respectively when similar (new HP versus new HP) and different catheter systems (new HP versus established Intran II) were used. The new transducer tip catheter gives reliable pressure readings in-vivo. (n = 3) respectively when similar (new HP versus new HP) and different catheter systems (new HP versus established Intran II) were used. The new transducer tip catheter gives reliable pressure readings in-vivo.

Catheterization↗
PubMed1995

Towards improved perinatal care--perinatal audit.

Perinatal audit is a measure of quality of care given in pregnancy and it gives an idea as to how the resources need to be allocated for better outcome. The perinatal mortality data in the National University Hospital over a 7-year period (1986-1992) were compiled and compared with that of the year 1982. The perinatal mortality rate (PNMR) of 14.6/1000 in 1982 declined to 8.9/1000 for the period 1986 to 1992 and the reduction was noticeable in all ethnic groups, particularly in the Malays. When lethal congenital malformations (LCMs) were excluded, the PNMR decreased to 5.7/1000. Such reduction is due to easy availability and acceptance of antenatal care, improvement in antenatal and intrapartum fetal surveillance and advances in neonatal care. Neonatal audit was extended beyond the first 7 days of birth which showed that the majority (65%) of deaths occurred in the first week and 15% occurred after the first month. The fear that intensive neonatal care serves to postpone death is not entirely substantiated. There was nearly a ten-fold rise in PNMR between the non-low birthweight and low birthweight groups. The important causes of perinatal mortality during the review period were LCMs (35.7%), complications of prematurity (17.9%) and asphyxia (15.3%). No cause was identifiable in 28.5%. Detailed analysis revealed that the standard of care could have been improved in a third of the cases (83/235) which could have led to further reduction of perinatal mortality rate.

Asphyxia Neonatorum↗
PubMed1995

Genital Group B Streptococcus carriage in the antenatal period: its role in prom and preterm labour.

Of 326 high vaginal swabs taken during the antenatal period, Group B Streptococcus (GBS) was isolated from the birth canal in 46 women, giving a carrier rate of 14.1%, which is within the often quoted range of between 5% - 25% in different parts of the world. Carriage rates were similar at different gestations. In a subgroup of 34 women, 2 swabs taken at least 5 weeks apart yielded results which were discordant in over one fifth of the time. This knowledge of the natural history of GBS carriage questions the practice of treating asymptomatic carriers of GBS in the antenatal period to prevent transmission of GBS to the neonate. The group of women with positive swabs in the antenatal period did not have a significantly higher incidence of preterm labour and/or prelabour rupture of membranes (PROM) compared with the group of women with negative swabs. Routine screening of the antenatal population for GBS carrier status prior to 32 weeks gestation may not identify women at high risk of PROM or preterm labour.

Adult↗
PubMed1994

Disorders of platelets in pregnancy.

No significant change in platelet number, function or life-span occurs during pregnancy. However, pregnancy may be complicated by various platelet abnormalities or platelets may be involved in pregnancy pathologies. Thrombocytopenia is the most common platelet disorder to affect pregnancy. It may occur in a number of clinical conditions and both immune and nonimmune mechanisms may be involved. Apart from the risks to the mother, the fetus may be secondarily affected, especially in cases of immunogenic thrombocytopenia. Management of the mother may not necessarily improve fetal prognosis. Improvement in diagnostic techniques like percutaneous umbilical blood sampling (PUBS) has greatly improved in utero diagnosis and management of the affected fetus. The diagnosis and management of the various platelet disorders affecting the pregnant woman and the fetus are discussed in this overview.

Blood Platelet Disorders↗
PubMed1994

Intrauterine pressure: comparison of extra vs intra amniotic methods using a transducer tipped catheter.

Fourteen women admitted in early labor, with intact membranes, were studied. In each woman, two catheters were inserted transcervically; one catheter was inserted into the extraamniotic space before rupture of membranes, and the second catheter was inserted, after artificial rupture of membranes into the intraamniotic cavity. The contraction to contraction difference in active pressure (pressure above the baseline) recorded by the two catheters, as well as the cumulative total active pressure generated (calculated by adding the active pressure of all contractions) throughout labor by the two catheters were compared. Of the 606 contractions analysed, 43.2% showed pressure difference of 0-5 mmHg between the intra amniotic and extraamniotic catheter; 21.3% showed 6-10 mmHg difference, 12.2% showed a difference of 11-15 mmHg, and 23.3% showed a difference greater than 15 mmHg. When total active pressure generated by each catheter for individual patients was calculated, the percentage difference varied from 2.3% to 53.7%. Intrauterine pressure measurements in labour using transducer-tipped catheters inserted in the extraamniotic space may not provide comparable information to a similar catheter inserted intraamniotically when membranes are ruptured.

Amnion↗
PubMed1994

Maternal mortality: evolving trends.

Despite improvement in socioeconomic standards, good and accessible health care facilities the maternal mortality rate in Singapore is not declining. The maternal mortality rate in National University Hospital, Singapore, over a 7 year period 1986-1992 was 22.9 per 100,000 when direct and indirect causes were considered (34.4 per 100,000 when incidental deaths were included). However closer scrutiny reveals that most deaths were not due to the traditional direct causes of haemorrhage, sepsis, embolism or hypertensive disease. Most were due to medical disorders which in their own right carries a high risk to life even without a pregnancy.

Cause of Death↗
PubMed1994

Evaluation of a simple method to assess fetal well-being in antenatal clinic.

To study the feasibility of assessing fetal heart rate (FHR) acceleration by a fetal doptone and fetal movements (FM) as perceived by the mother and observed by the attendant in response to a vibroacoustic stimulus. Baseline FHR and it's response during the first minute after vibroacoustic stimulation was observed by a fetal doptone with a digital display on 317 occasions in 201 pregnancies (81.4% of whom were high risk) during antenatal visits in the third trimester. Fetal movements in response to the stimulus were recorded by the mother and the examiner. FHR increased 15 beats greater than the baseline rate for > 15 secs in 269 of the tests (83.4%), and fetal movements were observed by the mother in 301 (94.9%) of the tests. A FHR increase in > or = 15 bpm together with maternal and examiner perceived fetal movements were observed in 250 tests (81.7%). Good correlation was seen between the mother and the examiner (97.8%) of the observation of presence or absence of fetal movements to the vibroacoustic stimulus. One of the three parameters i.e. increase in FHR > or = 15 beats > or = 15 secs or perception of fetal movement either by the mother or the observer were present in 98.1% of the tests. If it could be considered that one of these three signs are indicative of good fetal health further investigations of fetal well-being would be needed in only 1.9%. The fetal outcome was uneventful in all pregnancies studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation Studies as Topic↗
PubMed1993

Effect of methyldopa and isradipine on fetal heart rate pattern assessed by computerized cardiotocography in human pregnancy.

OBJECTIVE: The effects of two antihypertensive drugs, methyldopa and isradipine, on fetal heart rate pattern were analyzed by computerized cardiotocography. STUDY DESIGN: The first part of the study was a prospective, randomized, controlled trial of 19 women with preeclampsia in the third trimester given 2.5 mg of oral slow-release isradipine twice a day or 250 mg of methyldopa three times a day. In a second part of the study 23 women with preeclampsia in the third trimester given 5 mg of oral slow-release isradipine twice a day were compared with 23 matched controls without medication. Main outcome measures were maternal blood pressure and mean baseline fetal heart rate, fetal movements, number of accelerations, periods of high and low baseline variability, and mean baseline heart rate variability. RESULTS: Compared with the pretreatment value, the mean arterial blood pressure decreased significantly in all drug treatment groups. Fetal heart rate characteristics were not significantly changed during drug treatment or bed rest. CONCLUSION: The various features of the fetal heart rate pattern evaluated by computerized methods were not influenced by treatment with methyldopa or isradipine.

Adolescent↗
PubMed1993

Effects of methyldopa on uteroplacental and fetal hemodynamics in pregnancy-induced hypertension.

OBJECTIVE: Our purpose was to study the effect of methyldopa on uteroplacental and fetal hemodynamics in women with pregnancy-induced hypertension. STUDY DESIGN: A prospective study of Doppler ultrasonographic blood flow data before and after 1 week of methyldopa treatment was conducted at the Department of Obstetrics and Gynecology, National University Hospital, Singapore, in 20 women (mean 35 weeks' gestation) with pregnancy-induced hypertension. The main outcome measures were maternal blood pressure, maternal and fetal heart rate, and blood velocity waveforms characterized by the pulsatility index in the fetal ascending aorta, middle cerebral artery, umbilical artery, and maternal uterine and arcuate arteries. Statistical evaluation was performed with t tests for paired observations. RESULTS: Maternal mean arterial blood pressure was reduced 9.7 mm Hg (95% confidence interval -13.8 to -5.6), and mean heart rate decreased 6.3 beats/min (95% confidence interval -11.1 to -1.4). Mean pulsatility index in the uterine (0.93 to 0.92) and arcuate arteries (0.61 to 0.73) were unchanged after treatment. Fetal hemodynamic changes before and after treatment were not significant. Fetal and neonatal outcome was uneventful. CONCLUSION: Short-term treatment with methyldopa in the last trimester in women with pregnancy-induced hypertension reduced maternal blood pressure and heart rate but had no adverse effects on uteroplacental and fetal hemodynamics.

Adult↗
PubMed1993

ECG waveform analysis in intrapartum fetal monitoring.

Intrapartum cardiotocography (CTG) has a high false positive rate and, in the absence of facilities for fetal scalp blood sampling, is associated with increased operative deliveries for 'fetal distress'. It is presently possible to obtain a representative fetal ECG signal using the fetal scalp electrode. There is renewed interest in fetal ECG waveform analysis in the hope that it will improve the specificity of detecting intrapartum fetal hypoxia when there is an abnormal fetal heart rate pattern. Two portions of the fetal ECG are potentially useful: the ST waveform (T/QRS ratio) and the PR interval correlated with the RR interval. Animal experiments suggest that changes in the ST waveform, increase in the T wave amplitude in particular, reflect myocardial anaerobic metabolism. Clinical studies have shown poor correlation between the T wave changes and fetal heart rate changes. There is also concern that the sensitivity of the ST waveform changes for fetal acidaemia may be poor. More information is required before its use is incorporated into routine clinical practice.

Animals↗
PubMed1993

Should assessment of amniotic fluid volume form an integral part of antenatal fetal surveillance of high risk pregnancy?

This study was conducted to evaluate the role of the Amniotic Fluid Index (AFI), used along with nonstress cardiotocography (NST) and fetal acoustic stimulation test (FAST), when required, in prediction of adverse pregnancy outcome. Over a 3-year period 565 pregnant women had antepartum fetal surveillance due to various high risk pregnancy factors and delivered within 7 days of the test. Antepartum fetal surveillance included nonstress cardiotocography together with estimation of AFI. Need for induction of labour, presence of meconium at rupture of membranes, Caesarean section for fetal distress, Apgar score at 5 minutes, need for neonatal endotracheal intubation, admission to neonatal special care unit and perinatal death were the main outcome measures. Nonreactive nonstress tests and Caesarean sections for fetal distress were more common and neonatal outcome was significantly poorer in patients with AFI < 5 cm than in those with higher AFI values. Of the 4 perinatal deaths in the group with AFI < 5 cm, 3 had a reactive NST within 7 days of fetal death. It is concluded that pregnancy outcome is often poor in the presence of very low AFI and in these cases a reactive NST loses its usual reassuring value. It is suggested that AFI estimation should be included as an integral part of antepartum fetal surveillance of high risk pregnancies.

Acoustic Stimulation↗