Complications of fetal blood sampling.
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During a six-month period, 929 newborn infants had continuous, direct fetal heart rate monitoring during labor. Of these, 481 were monitored with the Berkeley Bio-Electronics spiral electrode and 448 were monitored with the Corometrics spiral electrode. The over-all incidence of scalp abscess complicating fetal monitoring was 4.5 per cent. In the group monitored with the Berkeley electrode, 25 newborn infants (5.2 per cent) developed a scalp abscess; in the group with the Corometrics electrode, 17 newborn infants (3.8 per cent) developed scalp abscess. The incidence of scalp abscess was not significantly different in the two groups.
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Scalp abscess is an infrequent and usually benign complication of the implantation of fetal heart rate electrodes that becomes noticeable from 2 to 10 days after birth. The lesions are usually single and localized. Most exudates will produce aerobic and/or anaerobic bacteria similar to the cervical flora of the late trimester of pregnancy. Scalp abscesses are more likely to occur subsequent to prolonged rupture of the membranes and an extended period of fetal heart rate monitoring. Local treatment may be adequate in most cases, but parenteral antibiotic therapy may be needed in others. Since herpes simplex virus infection has been reported to start as vesicles around the site of electrode implantation, careful attention to the maternal history must be given. The parents of infants who undergo internal fetal heart rate monitoring should be given careful and concise follow-up instructions when the infant is discharged from the hospital. It is apparent after a decade of experience that the benefits of electronic fetal heart rate monitoring, even when invasive, far outweigh the risks of this still infrequent complication.
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The lay term "wen" has been applied to a wide range of scalp swellings. To help clarify the correct use of the term, we describe three patients recently treated in Leicester, who presented with macroscopically similar but histologically very dissimilar large scalp swellings.
We report the reconstruction of scalp defects by subcutaneous pedicle flaps with transverse pedicles. These flaps are supplied by vascular networks in the upper and lower parts of the epicranial aponeurosis. We have used this technique in 12 cases and have found it to be a useful alternative to other methods of scalp reconstruction.
Two cases of coup de sabre, a linear form of scleroderma, treated by means of tissue expansion, are discussed. Expanded skin flaps on the scalp and forehead provided sufficient skin and tissue for closure of the defect after resection of the defect, and good results were obtained.
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A syndrome consisting of a hypocalcified-hypoplastic enamel, onycholysis with subungual hyperkeratosis, seborrheic dermatitis of the scalp, and hypofunction of the sweat glands with rough dry skin is inherited as an autosomal dominant trait in a kindred of Caucasian ancestry.
Mycetoma of the scalp in a 10-year-old boy is reported. This is the first report of this infection in the Eastern Province of Saudi Arabia. The causative agent, Actinomadura madurae, has already been described in the Kingdom and shown by other workers to affect other parts of the body. The probable pathogenesis is discussed and the need to increase clinical awareness of the condition stressed.
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Subcutaneous granuloma annulare is a rare scalp lesion that occurs in infants and children. Occurrence in the occipital region, absence of bone involvement, slow growth, and foci of necrosis of collagen surrounded by palisading granulomatous inflammation are characteristic of this lesion. Although the cause remains unknown, it is not infectious and is more likely due to a defect in cell-mediated immunity. The prognosis after excision is excellent. Increased awareness that this peculiar granulomatous lesion can rarely occur in the soft tissue of the occipital region will help prevent confusion with neoplastic or infectious processes.
Fifty-one patients with clinical history of dog allergy were skin prick tested with eight individual standardized dog breed-allergen preparations, one mixed breed-allergen preparation (Poodle/Alsatian), dog-serum albumin, and histamine hydrochloride, 1 mg/ml. All extracts were characterized by crossed immunoelectrophoresis and crossed radioimmunoelectrophoresis with a pool of sera from patients clinically sensitive to dog. The dog-breed extracts contained common antigens/allergens, as well as components represented only in one or two dog-breed extracts. The concentration corresponding 1000 BU/ml varied from 16 to 100 micrograms of protein per milliliter. The sensitivity of skin prick test was 67% to 88% for the various dog breed-allergen preparations, but only 18% for dog-serum albumin. Significant difference between the skin test response to different dog breed-allergen preparations indicating dog breed-specific allergens was obtained in 15% of the patients. There was no significant correlation between skin prick test results and symptoms related to a specific dog breed.
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This 2-week, randomized, multicenter, investigator-blinded, parallel-group study was conducted to compare the efficacy and safety of augmented betamethasone dipropionate 0.05% lotion and clobetasol propionate 0.05% solution in the treatment of moderate-to-severe scalp psoriasis among 197 (193 assessable) healthy adult patients with at least 20% scalp-surface involvement. The patients received one of two treatments applied twice a day for 2 weeks. Signs and symptoms were evaluated at baseline, after 3 days (day 4), and after weeks 1 (day 8) and 2 (day 15) of treatment. As early as 3 days after treatment, scaling and induration were improved significantly faster by betamethasone dipropionate than by clobetasol propionate. Both treatments also reduced erythema and pruritus. Patients receiving betamethasone dipropionate had a significantly greater mean percent improvement in total sign/symptom scores (P < or = 0.015) at all visits and better mean global clinical response scores at the early visits (days 4 and 8) (P < or = 0.017). At the end of the study, only mild disease was present in both groups. Adverse events were reported by 34.0% and 36.4% of patients receiving betamethasone dipropionate and clobetasol propionate, respectively. All events were transient, most were mild and local, and no discontinuations resulted. The effects of treatment on the hypothalamic-pituitary-adrenal axis were not measured. In conclusion, augmented betamethasone dipropionate lotion and clobetasol propionate solution were equally effective, but betamethasone dipropionate lotion provided a faster onset of relief for scaling and induration, which may enhance patient compliance and patient satisfaction with treatment.