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Biomedical subjects

S Arulkumaran

Publications and source records attributed to S Arulkumaran.

At least 163 records · Page 9Linked to original sources
PubMed1989

An alternative approach to assisted vaginal breech delivery.

The immediate neonatal outcome by 2 different methods of assisted vaginal breech delivery was studied. In group A, spontaneous expulsion only up to the hip was allowed with one contraction and bearing down efforts; the rest of the baby was delivered with assistance with the next contraction and bearing down efforts. In group B the mother was allowed to expel the fetus up to the shoulders (with assistance) during one contraction and bearing down efforts, followed by assisted delivery of the head with the next uterine contraction and bearing down efforts. A decline in fetal blood pH (greater than 0.10) from the onset of delivery to cord arterial blood pH was more common in group B compared to group A; the difference being almost statistically significant (p = 0.54). Newborns with 1 min Apgar score less than 4 and with a need for assisted ventilation were significantly more common in group B (p less than 0.05). Exposure, stretching and compression of the umbilical cord for a longer time and possible separation of the placenta in group B may be the reason for such an outcome. Further studies are needed to establish the possible advantage of the method of delivery adapted in group A.

Adult↗
PubMed1989

Augmentation of labour: does oxytocin titration to achieve preset active contraction area values produce better obstetric outcome?

The value of quantifying active contraction area to guide oxytocin titration in augmentation of labour was investigated by a randomised trial. Sixty-eight nulliparae with slow progress of labour had oxytocin titrated to achieve preset "optimal" active contraction area or "optimal" frequency of contractions in a randomised manner. There was no difference in maternal characteristics of age and height, pre-augmentation period of observed labour or cervical dilatation at the onset of augmentation between the 2 groups. The maximum dose of oxytocin, post-augmentation period and the number of operative deliveries were similar. There was no difference in the mean birth weight of neonates, or in the number of neonates who had low Apgar score or acidotic cord arterial blood pH. Our results suggest that there may be no advantage in oxytocin titration to achieve preset "optimal" active contraction area compared with "optimal" frequency of uterine contractions in nulliparae with slow progress of labour.

Female↗
PubMed1989

Ethnic influence on uterine activity in spontaneous normal labour.

Uterine activity in spontaneous normal labour was studied in Singaporean Malay women at term with a singleton vertex presentation. Nulliparae had significantly higher uterine activity compared with their multiparous counterparts. Uterine activity in the Malay population was compared with that of a similar Chinese population. When controlled for parity, maternal height and birthweight of babies, there was no difference in uterine activity between the two groups.

Adult↗
PubMed1989

Reactive fetal heart rate response to vibroacoustic stimulation in fetuses with low scalp blood pH.

Fetal vibroacoustic stimulation in fetuses with suspicious or ominous fetal heart rate traces in labour was followed by acid-base balance determination on fetal scalp blood within 30 min of the test. The mean fetal scalp blood pH values were significantly higher in fetuses that showed reactive responses with fetal heart rate acceleration compared with those who had no response or responded with a deceleration to the vibroacoustic stimulation (pH 7.30 and 7.22 respectively). However, acidotic scalp blood pH values (7.16 and 7.18) were found in two fetuses which had shown reactive responses both to vibroacoustic stimulation and pain stimuli with scalp blood sampling.

Acid-Base Equilibrium↗
PubMed1989

Uterine activity during spontaneous labour after previous lower-segment caesarean section.

Uterine activity was measured in three groups of labouring women who previously had a caesarean section (CS): group A included women with a previous elective CS before labour or in the early latent phase of labour and no previous vaginal delivery; group B included women with a CS in the active phase of labour and no previous vaginal delivery; group C included women with a CS and a vaginal delivery either before or after the abdominal delivery. The active contraction area profiles in the three groups were compared with those of matched control groups of nulliparae and multiparae without a uterine scar. Group A had a uterine activity profile similar to that in control nulliparae and significantly higher than that in control multiparae. The uterine activity in group B was less than that in matched nulliparae but was similar to that in matched multiparae. Group C had significantly less uterine activity than matched nulliparae but a similar profile to that in the matched multiparae. Progress of labour into the active phase in the previous pregnancy reduces the uterine activity profile in subsequent labour. Women who had had a vaginal delivery either before or after the CS (group C) exhibited uterine activity profiles similar to multiparae, suggesting that an intact scar did not affect the uterine function.

Adult↗
PubMed1989

Oxytocin augmentation in dysfunctional labour after previous caesarean section.

Uterine activity was quantified in women with a previous caesarean scar and a slow progress of labour who needed oxytocin augmentation. Of the 63 women 49 (78%) progressed well (mean cervical dilatation rate of 1.5 cm/h) and were delivered vaginally. Fourteen women had slow progress of labour (0.3 cm/h) and were delivered by caesarean section despite adequate and similar augmented uterine activity to that in the women who were delivered vaginally. Those who were delivered by caesarean section had a significantly higher mean maximum dose of oxytocin and a longer period of augmentation. All caesarean sections were for cephalopelvic disproportion and the mean birthweight of babies born by caesarean section (3598 g) was significantly higher than that of babies born vaginally (3230 g). Satisfactory rate of cervical dilatation in the presence of optimal uterine activity is predictive of favourable outcome when oxytocin is used for dysfunctional labour after previous caesarean section.

Adult↗
PubMed1989

Trial of labour after previous caesarean section: obstetric outcome.

Of 305 patients with a previous lower segment Caesarean section scar admitted over a 28-month period, 207 were allowed a trial of labour. A successful trial of labour was achieved in 63.3% of patients with a recurrent indication and 73.4% with a nonrecurrent indication. Of 75 patients who received oxytocin for augmentation and 22 for induction of labour, 70.5% achieved vaginal delivery. This was similar to the vaginal delivery rate in patients who did not require augmentation in induction. Three cases of scar dehiscence occurred in patients who had oxytocin, but in whom the recommended management protocol was ignored. The events that led to these 3 dehiscences is described. Analysis of birth-weights revealed a trend towards more repeat Caesareans with increasing birth-weight beyond 2,500 g. This was especially reflected by the higher emergency Caesarean section rate in those who had a trial of labour. A trial of labour in patients with a previous Caesarean scar is safe, and can be allowed even in patients who had the previous Caesarean for cephalopelvic disproportion, although malpresentation and obvious disproportion must be excluded. Judicious use of oxytocin for a limited period of time should help in reducing the number of repeat Caesarean sections.

Birth Weight↗
PubMed1989

Effects of isradipine, a new calcium antagonist, on postpartum uterine activity.

The effects of a new calcium antagonist, isradipine (PN 200-110) on postpartum uterine activity and the maternal cardiovascular system were investigated. Uterine activity was recorded by a microtip transducer catheter inserted transcervically within 45 min of normal vaginal delivery. 0.5 mg of isradipine was given as a bolus injection during 5 min to 7 women with spontaneous uterine activity and 1 mg was given during a 15-min period to another 8 women with oxytocin-stimulated uterine activity. Matched controls with similar pre-injection activity (+/- 5%) but not given the drug were selected for comparison. The effects of the drug in 3 women (given 1 mg of isradipine) were compared with those in matched controls and in women given 0.25 mg of terbutalin i.v. as a bolus injection. Isradipine had a marked inhibitory effect on both spontaneous and oxytocin-stimulated uterine activity. The inhibitory effect of 1 mg of isradipine seemed comparable to that of 0.25 mg of terbutalin. The inhibition occurred within 1-2 min after the injection and was sustained throughout the study period (2 h). A transient reduction of the systolic (mean maximum decrease 10-15%) and diastolic blood pressure (mean maximum decrease 15-20%) was seen, particularly during the injection period. Hypotension (systolic blood pressure less than 80 mmHg) was not recorded. A moderate increase in pulse rate (mean maximum increase 22-27%) was seen in all cases. The results show that isradipine given as a bolus injection can inhibit early postpartum uterine activity, with minimal side effects.

Adult↗
PubMed1989

Antenatal monitoring of the high risk fetus.

Fetus may be at high risk of perinatal mortality or morbidity or childhood morbidity either due to congenital malformations, genetically inherited disorders, chromosomal aberrations or due to antenatal and/or intrapartum hypoxia. Environmental hazards of infection, radiation and drug ingestion or maternal medical disorders are associated with some risk to the fetus. So it is important to identify those at risk by obtaining a detailed medical and family history. Maternal age and past obstetric history would also suggest the high risk nature of the pregnancy. A detailed clinical examination of the mother and the pregnancy will add further information. It is equally known that patients with no risk factors prior to pregnancy become at risk if they develop obstetric disorders of antepartum haemorrhage, pregnancy induced hypertension or diabetes. Therefore not only initial surveillance but continued care is important to identify those at risk. It is good practice to rule out congenital malformations, recognise multiple pregnancy and determine the gestational age in the early second trimester (18-21 weeks) by an ultrasound scan. This is of value in giving optimal care when a pregnancy turns from low to high risk. Aspects of monitoring the high risk fetus by simple clinical means and by appropriate technology is discussed.

Female↗
PubMed1989

Importance of antenatal karyotyping in the management of a case with vestigial radii.

An uncommon presentation of vestigial radii in a Trisomy E fetus was detected prenatally with ultrasound scanning. Appropriate counselling and obstetric management were thus carried out avoiding an unnecessary caesarean section. The importance of identifying high risk pregnancy and prenatal diagnosis by a qualified personnel cannot be overstressed.

Abnormalities, Multiple↗
PubMed1989

Evaluation of maternal perception of sound-provoked fetal movement as a test of antenatal fetal health.

Maternal perception of sound-provoked fetal movement was correlated with the results of nonstress cardiotocography in 1097 women with obstetric or medical antenatal risk factors. Ninety-two percent of the mothers felt fetal movements with the stimulus; all but three had a reactive non-stress test (NST). These three women were taking multiple antihypertensive drugs and were less than 33 weeks' gestation. Of 88 patients with no maternal perception of sound-provoked fetal movement, ten had nonreactive NSTs. Ultrasound confirmed the absence of fetal movement to the stimulus. The outcome in nine of these ten cases suggested some evidence of fetal compromise. Maternal perception of sound-provoked fetal movement correlated well with the results of the NST; the sensitivity (76.9%), specificity (92.8%), and negative predictive value (99.7%) were all high, although the positive predictive value was only 11.4%. Maternal perception of sound-provoked fetal movement may suffice as an inexpensive and simple method of evaluating antenatal fetal well-being in risk situations. When the mother is doubtful or does not feel the sound-provoked fetal movement, NST is indicated to evaluate the fetal health.

Acoustic Stimulation↗
PubMed1988

Fetal acoustic stimulation in early labor in patients screened with the admission test.

Fetal heart rate reactions to the fetal acoustic stimulation test were investigated in 952 women in early labor. All had cephalic presentations (greater than 33 weeks of gestation) and were screened with a 15-minute fetal heart rate recording (admission test) before the sound stimulation was applied. Three different types of responses were observed: type I, an accelerative response; type II, a biphasic response with acceleration(s) followed by a deceleration; type III, no response or a prolonged deceleration (greater than 60 beats/min and greater than 60 seconds). A type I response was recorded in 98.0% of the women after a reactive admission test result, in 90.2% after an equivocal admission test result, and in 42.9% after an ominous admission test result. Fetal distress in labor occurred in these three groups in 2.0%, 22.2%, and 35.7% of cases, respectively. The risk for fetal distress was high after an ominous admission test and a type III response on the fetal acoustic stimulation test (75.0%). The fetal acoustic stimulation test might be of value in labor and give additional information about fetal well-being in patients previously screened by the admission test. Testing time can be shortened after an equivocal admission test.

Acoustic Stimulation↗
PubMed1988

Fetal ECG during labour: a presentation of a microprocessor system.

Changes in the ST waveform of the fetal ECG have been detected in 47 term deliveries with vertex presentations using a specially developed microprocessor-based system for on-line recording of T wave amplitude. The T wave was quantified by the T/QRS ratio. The recording included one scalp electrode for exploration and a maternal skin electrode as reference. Signal quality allowed optimal ST waveform assessment in 89% of the cases. The degree of perinatal asphyxia was judged from cord artery acid-base status and the neonatal outcome. In completely normal fetuses at term the mean T/QRS ratio was 0.148 with a standard deviation of 0.048. With this basic information we can proceed in the investigation of the T/QRS ratio as a means for fetal surveillance.

Electrocardiography↗
PubMed1988

Uterine activity in spontaneous labour with breech presentation.

Uterine activity was quantified for patients who had a breech presentation, spontaneous labour and a vaginal delivery. Results were studied according to parity and in relation to cervical dilatation. The multiparas with breech presentation overall had lower uterine activity compared to nulliparas when the whole labour was considered. These values were compared with control patients with vertex presentation who had spontaneous normal labour and vaginal delivery. The median uterine activity values in breech presentation were not significantly different from control nulliparous or multiparous patients. Among the breech deliveries, irrespective of parity, mean Apgar scores at 1 and 5 minutes were over 6 and cord arterial blood pH values were above 7.15, but these results were significantly lower than the control cases with vertex presentation. The uterus performs similar uterine activity in spontaneous normal labour whether the fetus presents as a vertex or breech, when controlled for parity.

Breech Presentation↗
PubMed1988

Effects of D2343, a new beta-mimetic drug, and terbutaline on spontaneous term labor.

The effects of an intravenous bolus injection of D2343 (0.75 or 1 mg) or terbutaline (0.25 mg) on spontaneous term labor were studied. The uterine activity was recorded by a transducer-tipped intrauterine catheter and calculated electronically by an uterine activity integrator module built in a conventional fetal monitor. After drug administration the uterine activity was reduced to a similar extent with D2343 and terbutaline but the contractions were abolished for a longer time with terbutaline injection (mean of 9.3-9.8 min compared with 17.0 min). Maternal blood pressure was unaffected in both groups but the increase in pulse rate was slightly higher in the D2343 groups. D2343 seems to have an effect ratio between uterine inhibitory capacity and cardiovascular side effects similar to terbutaline.

Adult↗
PubMed1987

Obstetric outcome of patients with a previous episode of spurious labor.

The obstetric performance of patients admitted with spurious labor was evaluated. The incidence of fetal distress in labor was significantly higher in those who had spurious labor (16.7%) than in those who were established in labor within 24 hours of admission (3.8%). An equivocal or ominous fetal heart rate trace on admission was related to the occurrence of fetal distress in labor in both the spurious labor group and the normal labor group. Positive predictive value of a normal test was low in the spurious labor group. Obstetric interventions such as augmentation (35.7%) and operative deliveries (41.0%) were significantly higher in the spurious labor group than in the normal labor group (19.7% and 18.8%, respectively). The induction rate in the spurious labor group was 15.5%. The use of oxytocin for augmentation and induction of labor seems to contribute to the increased incidence of fetal distress and operative deliveries in the spurious labor group. The spurious labor group also had a higher incidence of fetal distress than the control group even among the patients who did not receive oxytocin. The results suggest that patients with an episode of spurious labor constitute a high-risk group with a considerable risk of fetal distress and obstetric interventions in subsequent labor.

Delivery, Obstetric↗