Biomedical subjects
Publications and source records attributed to T R Eggers.
A controlled study comparing clinical aspects of birthing unit confinement with orthodox obstetric care in a major obstetric hospital is detailed. The results confirm that this centre provides an acceptable and safe alternative for those who desire such an environment.
Analysis is made of fetal growth in 563 twin pregnancies. The birth-weight of a twin is affected by the duration of pregnancy and zygosity. Intrauterine growth and weight is the same as a singleton pregnancy up to a gestational age of 32 weeks. After this stage fetal growth slows markedly. The growth curves of both twins are similar with an increasing tendency towards growth retardation in twin 2 after 39 weeks' gestation. Intrauterine growth retardation, as represented by the 10th percentile line, for twin 1 joins 1,094g at 31 weeks, 1,836g at 36 weeks and 2,428g at 40 weeks' gestation. The corresponding figures for twin 2 are 1,131g, 1,875g and 2,337g respectively.
This report details the outcome of pregnancy in 469 patients admitted before 34 weeks' gestation with premature labor with intact membranes (253 patients) or premature rupture of the membranes (PROM) but no labor (216 patients). Betamethasone significantly reduced the incidence of severe respiratory distress syndrome (RDS) both in patients with intact membranes and in those with PROM. PROM had a significant beneficial effect on the incidence of RDS in both groups of patients, those who had received betamethasone and those who had not. Fetal sex did not significantly influence the respiratory response to either PROM or betamethasone administration, except that betamethasone treated female fetuses showed a significantly better response to PROM than similarly treated males. Except in patients with PROM associated with a cervical suture, betamethasone administration did not increase the risk of perinatal or maternal infection.
The clinical and pathological features of oligohydramnios associated with severe pulmonary hypoplasia are described in 10 infants without renal anomalies. In 8 patients the condition was associated with prolonged premature rupture of the membranes at 16 and 36 weeks of gestation in a study of 244 patients (3.3%). Seven of the infants died of respiratory failure within 24 hours of delivery; the other infant survived. In the remaining 2 patients with severe oligohydramnios at term, but unassociated with premature rupture of the membranes, both infants succumbed. Problems with resuscitation should be anticipated in pregnancies complicated by prolonged leakage of amniotic fluid or oligohydramnios, and pulmonary hypoplasia should be recognized as a cause of respiratory distress. Apart from the ultrasonic predelivery confirmation of normal kidneys to exclude Potter's syndrome it is recommended that ultrasonic assessment of thoracic cage volume should be made before delivery.
In a consecutive series of 93 patients with premature rupture of the membranes at 20 to 34 weeks of gestation, the perinatal mortality was 23.7%. One-quater of the deaths were due to lethal congenital abnormalities, 18% were due to intrauterine infection, and 36% resulted from severe respiratory distress syndrome (RDS). Corticosteroid therapy increased the risk of incompetence, and did not reduce the incidence or severity of RDS. Almost one-third of the patients were delivered within 48 hours of membrane rupture; however, short-term treatment with salbutamol was able to delay the delivery for at least six days in 5 of the 13 patients to whom it was given. As postponement of delivery for days or weeks after the membranes have ruptured reduces the incidence and severity of Rds, this therapy may well have a place in the treatment of this condition.
Intravenously administered salbutamol inhibited premature labour for at least 48 hours in 49 of 76 patients (64%), but was more effective (89%) when the cervical dilatation was less than 2 cm, and no apparent cause for the premature labour was evident. Even when premature labour complicated multiple pregnancy, hydramnios, or followed a small antepartum haemorrhage, suppression of labour could often be achieved for at least 48 hours, thus following the administration of betamethasone or the transfer of the patient to a hospital with intensive care facilities for both mother and child. Treatment with betamethasone, in addition to salbutamol, was associated with a less severe form of respiratory distress syndrome, and did not increase the risk of maternal or fetal infection, except in patients with cervical incompetence when 46.2% of such patients were infected.
A case of severe water intoxication with convulsion and prolonged coma, following the use of a high dose Syntocinon infusion is described. The pathogenesis and treatment of the condition are discussed.