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Biomedical subjects

J R Fliegner

Publications and source records attributed to J R Fliegner.

At least 37 records · Page 2Linked to original sources
PubMed1987

Occult fetomaternal haemorrhage as a cause of fetal mortality and morbidity.

Spontaneous fetomaternal haemorrhage is an important, but usually overlooked, cause of perinatal mortality and morbidity. Although fetomaternal bleeding in the third trimester of pregnancy is common it is normally less than 0.1 ml. A fetal macrotransfusion (greater than 5 ml) is uncommon, but is important because it is insidious, unexpected and usually occurs in completely normal pregnancies. This paper analyses the perinatal mortality and morbidity associated with occult fetomaternal haemorrhage at the Royal Women's Hospital, Melbourne. It may lead to fetal distress before and during labour, unexplained stillbirth, or nonhaemolytic neonatal anaemia. A Kleihauer test on maternal blood will readily detect fetomaternal bleeding, and we describe a simple way of calculating the absolute volume of fetal red cells present. Greater awareness of the problem may eventually lead to diagnosis sufficiently early to permit effective treatment.

Adult↗
PubMed1987

Can anything be done about mid-trimester fetal wastage?

In Victoria in the triennium 1982-1984, perinatal losses between 22 and 28 weeks' gestation accounted for 32% of the overall perinatal wastage of 12.7 per 1,000 births. Over the same period only 1.2% of babies were delivered weighing less than 1,500g, but this group made up 40% of the total stillbirths and 50% of the neonatal deaths. By contrast the perinatal wastage was only 7 per 1,000 births in babies born weighing more than 1,500g and this included lethal congenital malformations. The major antenatal risk factors contributing to the high mid-trimester fetal wastage were premature labour (17.7%), multiple pregnancy (13.9%), cervical incompetence (12.9%), antepartum haemorrhage (12.9%), premature rupture of the membranes (11.5%), lethal congenital malformations (10.6%) and hypertensive disorders (7.4%). Cognizant of the frequency of preventable factors, the Consultative Council on Maternal and Perinatal Mortality and Morbidity in Victoria recommends that, where feasible, the mother of these high-risk pregnancies be transferred to a centre where facilities are available to monitor the pregnancy and labour, and which offers intensive care facilities for the baby.

Female↗
PubMed1987

Congenital atresia of the vagina.

The correction of an absent vagina requires the creation of a canal either by surgical means or by the intermittent pressure technique of Frank. Both methods have drawbacks and, in our experience, it is difficult to persuade a patient to use a vaginal dilator alone, accurately and conscientiously for long enough to give a good result. A simple surgical alternative is described which gives good anatomic and functional results with minimal morbidity. It combines the positive features of the traditional McIndoe approach and the Frank method of vaginal development. The results of a study of 24 patients with vaginal agenesis confirmed that the condition is usually part of the Rokitansky-Kuester-Hauser syndrome with an absent or rudimentary uterus and tubes but normally functional ovaries (21 patients). There were three instances of testicular feminization with an XY karyotype, and the results of orchidectomy performed upon these patients after puberty showed the classical histologic findings. The uterus and tubes were absent. Since 1976, the new isograft technique has been performed upon 11 patients with excellent results and no complications.

Adolescent↗
PubMed1986

Uncommon problems of the double uterus.

Although often asymptomatic, congenital anomalies of the uterus may be associated with many gynaecological and obstetrical problems. The double uterus should always be considered in cases of severe dysmenorrhoea and chronic pelvic pain; in cases of the failure of intrauterine contraceptive devices; in cases of a symptomatic or asymptomatic pelvic mass that is inseparable from the uterus; in cases where termination of pregnancy has been unsuccessful; and in cases of cervical incompetence. Where uterine malformations are overlooked patients may not be treated properly before excessive fetal wastage occurs and may undergo extensive surgical procedures that may terminate fertility. Clinical suspicion, accurate documentation of curettage findings and the increased use of hysterography and, especially, ultrasound enable earlier diagnoses and the application of the correct treatment.

Abnormalities, Multiple↗
PubMed1986

A simple surgical cure for congenital absence of the vagina.

The correction of an absent vagina requires the creation of a canal either by surgery or by the intermittent pressure technique of Frank. Both methods have their drawbacks and it is difficult to persuade a patient to use a vaginal dilator alone, accurately and conscientiously for long enough to give a good result. A simple surgical alternative is described which gives good anatomical and functional results with minimal morbidity. It combines the positive features of the traditional McIndoe approach and the Frank method of vaginal development. Since 1976 the new isograft technique has been performed on 11 patients with excellent results and no complications.

Dilatation↗
PubMed1984

The relationship between gestational age and birth-weight in twin pregnancy.

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.

Birth Weight↗
PubMed1981

Premature rupture of the membranes, oligohydramnios and pulmonary hypoplasia.

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.

Adult↗
PubMed1979

The relation between maternal serum alpha-fetoprotein levels and fetomaternal haemorrhage.

Spontaneous fetomaternal haemorrhage at 14 to 20 weeks gestation resulted in raised serum alpha-fetoprotein (AFP) levels in 13 of 150 patients attending a genetic counselling clinic. In all 13 patients, the placenta was anterior or fundal in position. By allowing for a rise in serum AFP levels of 4 microgram/l for each fetal cell seen in 30 high power fields (Kleihauer test), a 62.5 per cent reduction in the number of patients selected for amniocentesis because of raised serum AFP levels would have been achieved. The occurrence of fetomaternal haemorrhages at the time of amniocentesis can be detected by either the Kleihauer technique or the measurement of maternal serum AFP levels.

Adult↗
PubMed1979

Seven years experience in the evaluation and management of patients with urge incontinence of urine.

In 1970 the authors established a specific clinic at the Royal Women's Hospital in an attempt to evaluate the causes of urinary incontinence, to improve the follow-up of patients treated for this complaint, and to determine areas where treatment was deficient. Of 258 patients seen in the clinic so far 80 (31%) were considered to have had stress incontinence, 84 (33%) urgency, and 82 (32%) both symptoms. Incontinence of urine with exertion was common in patients with urgency and furthermore, the Bonney test of urethral elevation was of no value in distinguishing stress from urge incontinence. Therapy with Probanthine 15 mg t.d.s. and Tofranil 25 mg t.d.s. was effective in 127 patients (90%) in whom urgency was the sole or dominant complaint.

Female↗
PubMed1979

Water intoxication and Syntocinon infusion.

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.

Adult↗
PubMed1978

Third stage management: how important is it?

The normal physiology of the third stage of labour and the effect of oxytocics at the end of the second stage have been discussed. An assessment of the results of different policies of third stage management has been made, including a comparison of the advantages and disadvantages of the traditional method versus the use of controlled cord traction. It is recommended that ergometrine (0.25 mg) be administered intravenously after delivery of the baby, and the exclusion of a second twin. Once the uterus has contracted the placenta should then be delivered by the technique of controlled cord traction.

Delivery, Obstetric↗
PubMed1977

Significance of red-cell irregular antibodies in the obstetric patient.

Irregular antibodies were identified in 1.3% of obstetric patients who were delivered at the Royal women's Hospital, Melbourne. The most common antibodies found were anti-P1 and anti-Lewis, but, although these antibodies may cause difficulty in obtaining compatible blood if transfusion is required, they were not associated with haemolytic disease of the newborn. Immunization with other irregular antibodies, especially Rhesus subtype and Kell, may occur due to pregnancy alone or follow the combination of pregnancy and incompatible blood transfusion. Irrespective of the initial cause of immunization, these antibodies are often associated with haemolytic disease of the newborn which may be severe enough to result in perinatal death. As most irregular antibodies are found in patients with Rh-positive blood, the need for screening of all antenatal patients in each pregnancy must be recognized.

Blood Transfusion↗
PubMed1976

Placental function and renal tract studies in pre-eclampsia with proteinuria and long-term maternal consequences.

A total of 99 patients with pre-eclampsia and proteinuria were managed conservatively between 30 and 37 weeks of gestation, based on serial urinary estriol, liquor amnii, and renal function studies. The over-all perinatal wastage was 14 per cent, but was 35 per cent in association with subnormal estriol excretion and oligohydramnios (less than 250 ml.). In severe pre-eclampsia (blood pressure greater than 170/110 mm. Hg with proteinuria greater than 5 Gm. per liter) the incidence of subnormal estriol was 73 per cent and, becuase of this and the associated maternal hazards, conservative treatment had little place. However, in less severe pre-eclampsia with proteinuria early in the third trimester, this prospective study, based on serial placental and renal function tests, showed that frequently the pregnancy could be prolonged and fetal losses due to prematurity avoided. It should be stressed that such conservative treatment should not be continued when there are strong clinical contraindications. Irrespective of the severity of the prior pre-eclampsia, it was unusual for patients to show residual hypertension, proteinuria, or abnormal pyelography at their postnatal examination. Postpartum renal biopsy showed either normal histology or regression of the classical glomerular lesion in 77 per cent of cases.

Amniotic Fluid↗