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Biomedical subjects

B A Work

Publications and source records attributed to B A Work.

At least 19 recordsLinked to original sources
PubMed1995

The antepartum patient. Sudden changes in central nervous system status and sensorium.

An approach to the pregnant patient with altered consciousness is presented. The unconscious pregnant patient often represents a straightforward simple problem if the event is a minor syncope secondary to physiologic changes of pregnancy. Most loss of consciousness is postictal in nature after either an epileptic or eclamptic seizure. If these are ruled out, other more serious causes must be considered, and the patient must be fully evaluated by appropriate neurologic consultants.

Consciousness Disorders↗
PubMed1994

Screening general obstetric populations for risk assessment. Who will need testing?

In spite of increasing emphasis on high-technology aids for antepartum screening, diagnosis, and care, the first steps to secure better outcomes for most pregnancies begin with basic preconception and early prenatal risk assessment. Although many well-studied tools are available for prospective care of the high-risk fetus, the impact of many maternal risk factors occurs prior to the time such approaches can be invoked. It is becoming more evident that preventive care may reduce or eliminate the toll exacted by some of the more frequent problems, such as poor nutrition, substance abuse, or failure to comply with effective regimens for treating common medical disorders. Schemes for reducing perinatal mortality place a premium on engaging the patient in her own risk management and early identification of problems. The role of patient education cannot be overemphasized. Making the pregnant woman an active member of her caretaking team is a good investment in time and effort.

Female↗
PubMed1989

The effect of maternal bladder volume on fundal height measurements.

The effect of maternal bladder volume on fundal height measurements was studied in 200 non-obese Black women between 16 and 42 weeks gestation. Fundal height measurements were obtained by the same examiner immediately before and immediately after each subject voided. Examiners were blinded to fundal height measurements and the amount of urine voided. Prevoid fundal height measurements were significantly larger than postvoid fundal height measurements. The differences between pre- and postvoid fundal height measurements varied from -2.8 to 4.6 cm (mean 0.63 cm, SD 1.26). Postvoid fundal height measurements were smaller than the prevoid measurements in 69.5% of the women, and 34.5% of the differences were greater than 1.0 cm. Women who had voided within 30 min before measurement had significantly smaller differences between pre- and postvoid fundal height measurements (n = 20, mean 0.16, SD 1.22) than women who voided more than 30 min before measurement (n = 179, mean 0.68, SD 1.27). These findings indicate that women should be instructed to void within 30 min before fundal height measurements are obtained.

Female↗
PubMed1988

Pulsatile oxytocin for induction of labor: a randomized prospective controlled study.

In a prospective randomized study, 20 patients with term pregnancies underwent induction of labor with either continuous or pulsed (every 8 minutes) intravenous oxytocin infusion. There were no significant differences with respect to induction-labor interval, induction-delivery interval, cesarean section rates, need for pain relief and Apgar scores. Sixty percent of patients receiving continuous oxytocin infusion developed uterine hyperstimulation but only 10% receiving pulsed oxytocin did so. However, the difference was not significant. The mean +/- SEM total amount of oxytocin given by continuous infusion was 4237 +/- 1066 mU which was 70% more than by pulsatile infusion (2454 +/- 808 mU). The highest rate of oxytocin infused was significantly lower by pulsatile administration (5.2 +/- 0.8 mU/min) than by continuous infusion (9.2 +/- 1.8 mU/min, p = less than 0.05). Our study demonstrates that pulsed administration of oxytocin every 8 minutes is as effective and safe as continuous intravenous infusion of oxytocin for induction of labor, requires less oxytocin with therefore, a wider margin of safety and is consistent with the pulsatile release of oxytocin during normal labor.

Adolescent↗
PubMed1986

Hormones and cervical ripening: dehydroepiandrosterone sulfate, estradiol, estriol, and progesterone.

Fetal adrenal steroids have been shown to be important in the timing of parturition. Since dehydroepiandrosterone sulfate is converted to estrogen, which is important in cervical softening, levels of dehydroepiandrosterone sulfate together with those of estradiol, estriol, and progesterone were measured and compared in pregnant women undergoing induction of labor with ripe and unripe uterine cervices. While there were no differences between the levels of estradiol, estriol and progesterone in the two groups of women, dehydroepiandrosterone sulfate was significantly elevated in the group of women with ripe cervices. These findings suggest that cervical changes preceding the onset of labor are associated with a significant elevation of maternal dehydroepiandrosterone sulfate levels. Changes in maternal plasma estradiol, estriol, and progesterone levels do not appear to be clinically related to cervical ripeness.

Cervix Uteri↗
PubMed1985

Operative ultrasonography in the biliary tract during pregnancy.

Operative roentgenographic cholangiography entails problems during pregnancy because of the hazard of radiation to the fetus and mother. In 450 biliary tract operations in which real-time B-mode operative ultrasonography was performed, five were for diseases of the biliary tract during pregnancy. Operative ultrasound correctly revealed non-palpable stones in the gallbladder in one patient and in the common bile duct in three patients. Furthermore, operative ultrasound provided anatomic information, such as dilation or stenosis of the common bile duct. Of seven possible occasions in which roentgenography would customarily be expected to be performed, operative cholangiography was used only once. Thus, ultrasound significantly reduced the number of operative roentgenographic studies. Operative ultrasonography was not associated with any complications and significant time delays. It is concluded that operative ultrasonography can replace operative roentgenographic cholangiography as a screening procedure for gallbladder and common duct calculi at biliary tract operations during pregnancy.

Adult↗
PubMed1985

Single ultrasonic estimation of fetal weight in utero compared with birth weight.

A single ultrasonic determination of fetal weight in utero was made in 270 singleton pregnancies. Infants were divided by birth weights into two groups, less than and greater than the 50th percentile. Ultrasonically determined fetal weight correlated with birth weight (R2 greater than or equal to 0.52) beyond 33 weeks' gestation. Mean fetal weights measured by ultrasound at various stages of gestation correlated well with published values.

Birth Weight↗
PubMed1985

Configuration of the fetal electrocardiogram in ambulatory women in labor monitored with wideband telemetry.

The fetal electrocardiogram (ECG) in 23 ambulatory women in labor was monitored successfully with a single-channel FM telemetry unit with a 0.5-100-Hz wideband receiver to improve the quality of the ECG complex. An inverted QRS complex was seen in a patient with a deceleration and an inverted T wave during a deceleration in a patient confined to bed. A maternal artifact was transmitted in a third. The ECG complex was identical when wired patients were switched to telemetry. Thus, fetal heart rate and ECG configuration can be monitored accurately in ambulatory pregnant women.

Ambulatory Care↗
PubMed1984

Tocolysis with terbutaline sulfate in patients with placenta previa complicated by premature labor.

Six patients with placenta previa complicated by premature labor underwent tocolysis with terbutaline sulfate. The average prolongation of pregnancy was 3.5 weeks. Five patients were at 31 weeks' gestation or more at the initiation of tocolytic therapy and had infants who survived and were greater than 2,000 gm at birth. All patients received an average blood transfusion of 6.7 units of packed cells each.

Blood Transfusion↗
PubMed1983

Mechanical behavior of fetal dura mater under large axisymmetric inflation.

The nonlinear mechanical behavior of fetal dura mater was tested experimentally and compared to two published nonlinear material strain energy functions, the Mooney-Rivlin and the Skalak, Tozeren, Zarda, and Chien (STZC). The STZC constitutive relations best fit the behavior of the dura mater and were used to describe quantitatively its stiffness. Runge-Kutta numerical procedures were used to fit the theoretical data to the experimental results. The material's stiffness was positively correlated with fetal weight (r = 0.67, p less than 0.05). These results are discussed and directions for future research indicated.

Biomechanical Phenomena↗
PubMed1981

Maternal psychological and physiologic correlates of fetal-newborn health status.

Data were obtained from 32 primigravid women in pregnancy and in labor. Anxiety in labor, measured by a self-report inventory, and plasma epinephrine were significantly correlated with the fetal heart rate pattern in active-phase labor (3 to 10 cm of cervical dilatation). The fetal heart rate pattern was significantly correlated with Apgar scores at 1 and 5 minutes. Conflict in the acceptance of pregnancy, measured in prenatal interviews, predicted anxiety and epinephrine levels in labor and the 5-minute Apgar score.

Adult↗
PubMed1981

Significance of the sinusoidal fetal heart rate pattern.

The sinusoidal fetal heart rate pattern has been reported to be an indication of fetal compromise. In this review of 31 cases, drawn from a total of 559 monitored cases of normal and at-risk women, only one resulted in poor outcome, and this was attributable to a difficult breech delivery. An association with administration of analgesics is confirmed. The sinusoidal fetal heart rate pattern does not appear to be uniformly associated with fetal distress. Its presence should be an indication for meticulous assessment of other electrocardiographic, biochemical, or clinical evidence of fetal status.

Analgesics↗
PubMed1981

The relationship of maternal prenatal development to progress in labor and fetal-newborn health.

A study of 32 normal married primigravidas was conducted to determine the relationships among maternal psychological and physiological variables, subsequent progress in labor, and the health status of the fetus and neonate. At the onset of phase 2 of labor (3 cm of cervical dilatation), self-reported anxiety and endogenous plasma epinephrine were significantly correlated. With the deletion of subjects to control for the effect of medications, higher epinephrine levels were significantly associated with lower uterine contractile activity at the onset of phase 2 and with longer labor in phase 2 (3-10 cm of cervical dilatation). Psychological variables measured in pregnancy correlated significantly with the variables measured at the onset of phase 2 labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase 2 labor variables, with correlations of 0.39 for anxiety, 0.59 for plasma epinephrine, -0.70 and -0.52 for the two adjacent Montevideo units, and 0.58 for duration of labor in phase 2. Conflict regarding the acceptance of pregnancy also correlated significantly with the newborns' 5 minute Apgar scores. Anxiety in labor and plasma epinephrine were significantly correlated with the fetal heart rate pattern during phase 2 of active labor. The fetal heart rate pattern was significantly correlated with newborns' Apgar scores at 1 and 5 minutes. The results of this study support the following hypotheses: conflicts in pregnancy are predictive of maternal anxiety and stress-related biochemical factors, and these variables are related to prolonged labor and to fetal-newborn depression.

Adult↗