Biomedical subjects
Publications and source records attributed to G Sturbois.
High levels of catecholamines have been found in plasma from the umbilical cord of newborn infants, suggesting a release of catecholamine from the fetus during parturition. Plasma catecholamine levels are also elevated in mothers at delivery.
The application technique of a newly developed tissue pH electrode designed for continuous pH monitoring is described. Some parameters are described as criteria of technically accurate records.
Our experience is based on 139 attempts of tissular pH electrode applications in the fetal scalp during labor and includes 119 records comprising 86 tracings of good quality and 33 tracings of bad quality. Technical progress in the electrode and application material allowed an increase in the good quality tracings rate (from 54.5--66%) and a decrease of the complications, particularly the numbers of broken electrodes (from 18 to 2.4%).
A newly developed tissue pH electrode designed for continuous pH monitoring was evaluated in 61 fetuses during labor. The results obtained in this series confirm the reliability of this method. The correlation coefficient between tissular pH and capillary blood pH is 0.94. The correlation coefficient between the last intrapartum tissue pH and the umbilical arterial blood pH is 0.84.
The subcutaneous pH values of 42 fetuses has been measured continuously during labor with the use of the electrode designed by Stamm and associates. We have obtained 60 per cent good tracings. The results have confirmed the reliability of the subcutaneous pH measurement, if the electrode is correctly inserted, when compared with both capillary and umbilical artery blood pH measurements (r = 0.91, p less than 0.001 and 0.83, p less than 0.001, respectively). Technical improvements appear to be necessary prior to widespread clinical use of continuous pH measurement.
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The authors have studied the action of an intravenous injection of Spasmaverine (Bis gamma phenyl-3-propylethylamine) on the intra-uterine pressure in labour in 20 cases. This study has shown that there is a definite rise in amplitude, in the frequency of contractions, in the uterine activity as expressed in montevideo units and in the basal tone of the uterus in the ten minutes following an injection of 80 mg of Spasmavérine intravenously. The fetal cardiac rhythm was never altered. The authors recommend care in using this substance intravenously when sedation of uterine activity is sought.
Fetal heart rate (FHR) deceleration areas were studied to obtain by objective measurement of the FHR, their prognostic value of the new-born state. 1. There is a reasonably good correlation between FHR deceleration areas and UApH (Tab. II). Such a correlation was found by SHELLEY and TIPTON [6] for the whole deceleration area, and by TOURNAIRE et al. [10] for areas divided in a slightly different way. The correlation coefficients between FHR deceleration areas and Apgar score at 1 minute are within a close range of those of the FHR deceleration area and UApH (Tab. I and II). 2. According to the time relationship between deceleration areas and uterine contractions the best correlation coefficient was obtained surprisingly for total, followed by residual and then simultaneous areas. These results agree with those of SHELLEY and TIPTON [6] suggesting that in practice a simple measurement of the whole deceleration area, regardless of the uterine contractions is a sufficient method in evaluating FHR patterns. 3. The special purpose computer built by the BAUDELOCQUE research group can be used on-line, thus in clinical practice. It was not the case for the manual method [4] or the method using a large programmed computer [10]. 4 The evaluation of deceleration areas appears to have several advantages: 1. It provides objective measurements. 2. The unit used is independant of factors such as display speed or scale of the strip-chart. 3. The data is reduced: A few numbers replace the long descriptions of the usual clinical classifications.
A method for reading the foetal heart rate tracings and a guide of management advise in each case have been established from a review of the literature and the study of 500 records. The tracings are schematically divided into three categories according to the presumed risk of foetal distress: normal or "tolerable" tracings, alarm symptoms and danger symptoms. For each categorie, and according to the duration of the variations, a type of management is proposed. Other diagnostic means, such as capillary blood pH measurement are desirable to improve the foetal state diagnostic and make the treatment more precise.
The authors, after going over in brief the technical details of the physical characteristics of ultra-sounds and in particular the Doppler effect, describe a new cardiotachymeter using ultra-sounds which they have developed at the Baudelocque Maternity Hospital in Paris. In the first month in which they used this apparatus they kept 37 records on women who had not yet started labour and 36 records on women who were in labour. In 9 of the latter group they recored the fetal cardiac rhythm by the external route using ultra-sound pick-up and a recording by internal route using the fetal electrocardiogram. Tracings were comparable. It is interesting to note that even when uterine contractions are very strong indeed or the mother moves a lot the ultra-sound pick-up very rarely loses the fetal signal.
The authors using an electronic calculator have measured 3 parameters, which allowed them to carry out quantitative evaluations of rapid variations in basal fetal cardiac rhythms (fluctuation) of 29 samples of fetal heart rate obtained during labour. The three parameters are: 1. Mean variation by intervals. 2. Values for differences in intervals approaching zero. 3. Zero changes in the derived curve. Each of these parameters was compared with the values of fluctuations which were obtained by visual analysis quantified on the same samples of tracings. The results of these coefficients of correlation show that the chosen parameters enable quantitative values for these fluctuations to be obtained.
We have examined 1,200 placentas in a fresh state and have compared the results of these examinations with maternal pathology on the one hand and the neo-natal pathology on the other hand. It turns out that most abnormalities of pregnancy are associated in a significant way with the pathological findings in the placenta, and that the good or pathological health of the newborn is significantly associated with the normal of pathological character of the placenta. The principal weakness in this method of examination is the absence of information about infection. This is why it seems important to us to carry out smears from the placenta before examining it macroscopically.