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Biomedical subjects

I Ingemarsson

Publications and source records attributed to I Ingemarsson.

At least 19 recordsLinked to original sources
PubMed1992

Randomised controlled trial of atenolol and pindolol in human pregnancy: effects on fetal haemodynamics.

OBJECTIVE: To compare the effects of uteroplacental circulation of two beta adrenoceptor blockers, atenolol (cardioselective) and pindolol (non-selective with intrinsic sympathomimetic activity). DESIGN: Controlled double blind double dummy study. SETTING: Departments of obstetrics and gynaecology in two Swedish university hospitals. SUBJECTS: 29 women with pregnancy induced hypertension in the third trimester, 13 randomised to atenolol and 16 to pindolol. MAIN OUTCOME MEASURES: Pulsatility index in fetal aorta, umbilical artery, and maternal arcuate artery. Volumetric blood flow in fetal aorta and umbilical vein. RESULTS: Mean arterial blood pressure decreased by 9.0 (95% confidence interval -13.0 to -5.0) mm Hg in the atenolol group and by 7.8 (-11.4 to -4.2) mm Hg in the pindolol group. During atenolol treatment the pulsatility index increased significantly from 1.82 (SD 0.20) to 2.07 (0.32) in the fetal thoracic descending aorta, from 1.44 (0.28) to 1.79 (0.27) in the abdominal aorta, and from 0.93 (0.17) to 1.05 (0.19) in the umbilical artery; the volumetric blood flow in the umbilical vein decreased from 106 (28.8) to 84 (22.6) ml/min/kg. No such changes were seen after treatment with pindolol. Birth weight was similar in the two groups but placental weight was significantly different (529 (122) g in atenolol group v 653 (136) g in pindolol group; p = 0.03). CONCLUSION: The hypotensive effect was similar with both drugs, but only the beta 1 blocker atenolol had significant effects on fetal haemodynamics, although within normal ranges. The implications of these findings can be only speculative, but negative fetal consequences of beta 1 adrenoceptor blockade cannot be excluded.

Atenolol↗
PubMed1991

A case-control study of the effects of birth by caesarean section on intrapartum and neonatal mortality among twins weighing 1500-2499 g.

The aim of this nationally-based, matched case-control study was to assess the impact of birth by caesarean section on intrapartum, and neonatal mortality among twins weighing 1500-2499 g, born in Sweden between 1973 and 1983. By using data held at the National Medical Birth Registry, Stockholm, 91 such pregnancies (study cases) where one or both twins died were identified. For each case, two controls (in all 182 pregnancies) were allotted at random from the rest of the twin pregnancies, with similar birthweight (+/- 100 g) and year of delivery (+/- 1 year). The number of twins that died was reduced from 73 during the first four years to 22 between 1977 and 1980, and to 6 during the last 3 years of the study period. Almost a quarter (23.1%) had a lethal malformation. The caesarean section rate increased during the study period, but did not differ between cases and controls (chi 2 = 1.0; P greater than 0.05). The analysis could not confirm a significant difference between cases and controls regarding the number of infants born vaginally in non-vertex presentation (chi 2 = 0.1; P greater than 0.05). The results of this study appear to indicate that birth by caesarean section was not a major factor related to the improved fetal outcome.

Birth Weight↗
PubMed1991

Can terbutaline be used as a nebuliser instead of intravenous injection for inhibition of uterine activity?

Terbutaline, a betamimetic drug, is used as bolus of 0.25 mg intravenously to inhibit uterine activity when encountered with uterine hyperstimulation and associated fetal heart rate changes. The effect of terbutaline used as a nebuliser in 1- and 2-mg doses on uterine activity in labor was investigated. It did not show any significant inhibition of the uterine activity in spontaneous term labor. Although convenient and easy to administer especially in an emergency, 1 or 2 mg terbutaline used in the form of nebuliser did not give the desired effect like 0.25 mg of terbutaline given intravenously for inhibition of uterine activity in term labor.

Administration, Intranasal↗
PubMed1991

Fetal and infant outcome of pregnancies with very early rupture of membranes.

Fetal and infant outcome was studied in 38 singleton pregnancies complicated by very early rupture of membranes (PROM), in gestational weeks 19-29, over a 4-year period, in a Swedish population. The pregnancies were managed according to a specified protocol, including postponement of delivery until 34 weeks of gestation if possible. Stillbirth occurred in 10 cases (26.3%), all with PROM before 26 completed weeks, while 6 other infants died in the neonatal period. Respiratory distress syndrome was evident in half (50.0%) of the 28 liveborn infants. The surviving 22 infants (57.9%) were followed up to 2 years of age. The rate of neurological sequelae at follow-up was 22.7% (5/22). The fetal outcome of the 20 pregnancies with rupture of membranes before 26 completed weeks was poor; only 7 infants of the 10 born alive survived the neonatal period. The short-term fetal outcome in the group with rupture of membranes in 26-29 completed weeks was better: 15 of the 18 infants survived, but 4 had neurological sequelae. PROM before 29 completed weeks of gestation is associated with severe short-term and long-term fetal complications, in cases where the pregnancy is prolonged for several weeks.

Adult↗
PubMed1991

No benefit from conservative management in nulliparous women with premature rupture of the membranes (PROM) at term. A randomized study.

OBJECTIVE: To compare maternal and fetal outcome in pregnancies with premature rupture of the membranes (PROM) at term with either early induction of labor or conservative management awaiting spontaneous labor. DESIGN: A prospective randomized trial. SETTING: The University Hospital of Lund, Sweden. SUBJECTS: Altogether 369 women with singleton pregnancy, cephalic presentation, gestational duration 36-41 weeks, were randomized either to induction of labor (n = 139) or conservative management up to 3 days (n = 138). Those eligible but not participating in the study totalled 92. MAIN OBSTETRIC MEASURES: Obstetric intervention rate (cesarean section or instrumental delivery) and short-term neonatal morbidity. RESULTS: No difference was found in the rate of obstetric intervention between the induction of labor group and the group with conservative management (12.2 vs. 18.8%; chi 2 = 2.3, p greater than 0.05). A slightly increased rate of neonatal infections was seen in the latter group (0.7 vs. 4.3%; chi 2 = 3.2, p less than 0.05). CONCLUSIONS: We found no benefit from conservative management for up to 3 days in women with PROM at term, compared with immediate induction of labor. There was no difference in the number of obstetric interventions during labor. The neonatal infectious morbidity was slightly higher in conservatively managed cases.

Adult↗
PubMed1990

Lack of correlation between a high caesarean section rate and improved prognosis for low-birthweight twins (less than 2500 g).

The impact of birth by caesarean section on perinatal mortality was estimated for 9368 low-birthweight twins (less than 2500 g) born in Sweden between 1973 and 1985, by using national data from the Medical Birth Registry, National Board of Health and Welfare, Stockholm. During this period the caesarean section rate increased from 7-10% to 45-50% while concomitantly a sharp decrease in the perinatal mortality rate occurred. A causal relation between the increased rate of abdominal delivery and the improved prognosis for low birthweight twins might be expected. However, analysis of the results failed to show any correlation between these two variables. Factors other than route of delivery seem to have a greater impact on fetal outcome.

Cesarean Section↗
PubMed1990

Effects of isradipine, a new calcium antagonist, on maternal cardiovascular system and uterine activity in labour.

The effects of isradipine (a new calcium antagonist of the dihydropyridine type) on maternal blood pressure and heart rate, fetal heart rate, and uterine activity in labour were measured. Uterine activity was recorded by an intrauterine microtip transducer catheter connected to a fetal monitor. Isradipine was given as a slow injection in doses of 0.5 mg (10 women), 1 mg (11 women), and 1.5 mg (6 women). A reduction of systolic (6-16%) and diastolic (19-22%) blood pressure was seen, and concomitantly there was an increase in maternal (29-34%) and fetal (3-10%) heart rates. Reduction in uterine activity was not dose-related (maximum reduction 17%). Side effects (headache, palpitations) were minor and well tolerated. One women in the high-dose group had a shortlasting episode of hypotension. The results suggest that isradipine given as a bolus dose decreases blood pressure in pregnant women with little effects on uterine activity and fetal heart rate.

Adult↗
PubMed1990

Interval between birth of the first and the second twin and its impact on second twin perinatal mortality.

We investigated the impact of a long interval between the birth of the first and the second twin on second twin perinatal mortality (PNM). National data in the Swedish Medical Birth Registry were used on 7533 second twins born in Sweden between 1973 and 1985. PNM as a function of the time interval between the births of the twins was studied in data from two time periods: during 1973-78 (n = 4008) and 1979-85 (n = 3525). During the first period, PNM was significantly higher at intervals of 30 min or more between the births of the twins than at shorter intervals (chi 2 = 11.1, p less than 0.001). When studied within broad birth weight classes, a significant trend was seen for twins weighing 1500-2499 g with an increasing interval (chi 2 = 8.1: p less than 0.01). A non-significant trend was also found for twins weighing less than 1500 g but none for twins weighing greater than or equal to 2500 g. During the second period, abdominal delivery of the second twin after vaginal delivery of the first twin was significantly more common than during the first period (2.0% vs 0.3%, chi 2 = 52.7, p less than 0.001). During the second period, the interdelivery interval had little impact on second twin PNM. The results of this study seem to indicate that with modern management of labor and delivery, as seen in Sweden since 1979, the interdelivery interval has little impact on second twin PNM.

Cesarean Section↗
PubMed1989

Intrapartum fetal heart rate patterns in pregnancies complicated by hypertension. A cohort study.

Intrapartum fetal heart rate patterns were investigated in pregnancies complicated by hypertension in a cohort study. The total number of live births was 2400 and the frequency of hypertension was 8.8%. The study group comprised 2023 normotensive and 200 hypertensive deliveries. Dates of all pregnancies were established at an ultrasound examination in week 17. Ominous intrapartum fetal heart rate patterns were significantly more common in hypertensive deliveries than in normotensive deliveries (20.5% versus 7.6%). The women with hypertension were compared with a group of control women matched for age, parity, induction of labor, and gestational week (20.5% versus 6.5%). In hypertensive women ominous fetal heart rate tracings were frequently associated with primiparity, induced labor, epidural block, delivery of a growth-retarded fetus, and beta 1-adrenergic receptor blockers. Ominous fetal heart rate patterns were less common in hypertensive women without these risk factors; still the significant differences in comparison with normotensive women remained. The hypertensive pregnancies accounted for no less than 21.0% of all ominous intrapartum fetal heart rate patterns, whereas 13% of all cases of ominous intrapartum fetal heart rate patterns could be attributed to the excess frequency in hypertensive pregnancies.

Adolescent↗
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

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↗