Biomedical subjects

M Luterkort

Publications and source records attributed to M Luterkort.

8 recordsLinked to original sources

PubMed1999

Activated protein C resistance (FV:Q506) and pregnancy.

Activated protein C (APC) resistance, due to a point mutation in the factor V gene (FV:Q506), is a major risk factor for venous thromboembolism. To determine the prevalence of APC resistance in a large series of pregnant women, and to elucidate its obstetric consequences, we performed a prospective study in Malmo, Sweden, comprising 2,480 women enrolled in early pregnancy. The presence of APC resistance (the FV:Q506 allele) was determined. The women were interviewed about their medical histories including venous thromboembolic events (VTE) in relatives. The outcome variables were the VTE rate, intrapartum blood loss, and the prevalence of selected pregnancy complications such as fetal loss, pre-eclampsia. and intrauterine growth retardation. The overall prevalence of APC resistance was 11% (270/2480). The APC-resistant subgroup did not differ significantly from the non-APC-resistant subgroup in terms of pregnancy complications, but was characterized by an 8-fold higher risk of VTE (3/270 vs. 3/2210), a lower rate of profuse intrapartum haemorrhage (3.7% vs. 7.9%) (p = 0.02), and less intrapartum blood loss (340 ml vs. 361 ml) (p = 0.04). Despite the high prevalence of APC resistance in this series of gravidae (11%), its presence was unrelated to adverse pregnancy outcome apart from an 8-fold increased risk of VTE.

Activated Protein C Resistance↗

PubMed1987

Cardiovascular dynamics in relation to presentation and postural changes in normal fetuses.

The role of fetal cardiovascular function in the reduced intrauterine growth rate of breech pregnancy was studied in fetuses with different presentations. Hemodynamic responses to postural changes were also investigated in fetuses in horizontal and vertical positions. Thirty-one normal pregnancies, with 15 fetuses presenting by the breech and 16 fetuses by the vertex, were included in the study. Diameter pulse waves from the fetal descending aorta were measured using equipment combining real-time ultrasound imaging with phase-locked echo-tracking. No differences in basal pulse wave parameters were demonstrated between breech and vertex fetuses nor did any differences appear when maternal posture was changed from horizontal to upright or vice versa. The present observations suggest that fetal circulatory factors are less likely to be a primary cause of the reduced intrauterine growth in breech presentation. Tilting of the fetus in late gestation seems to produce neither a redistribution of its blood volume nor secondary adaptations to an orthostatic challenge. The hydrostatic effect of amniotic fluid presumably precludes the requirement of fetal circulatory adaptation to postural changes.

Adult↗

PubMed1987

Umbilical cord acid-base state and Apgar score in term breech neonates.

Umbilical cord acid-base state and Apgar score were compared in neonates after breech and vertex term birth. The breech group comprised 149 consecutive newborns, 91 born vaginally and 58 by cesarean section. The control group consisted of a random sample of 150 newborns in vertex presentation: 100 born vaginally and 50 by cesarean section. Among vaginally born babies, the 1-min Apgar score was more often depressed in the breech presentation group than in the vertex group; after 5 min the Apgar scores were comparable in both groups. No difference was found in umbilical cord values of pH and base excess between the breech and the vertex groups when comparison was made within each delivery mode. In both groups, umbilical cord values were lower after vaginal than after abdominal delivery. It is concluded that in selected cases, uneventful vaginal breech labor and delivery at term is not associated with an increased risk of asphyxia.

Acid-Base Equilibrium↗

PubMed1986

Role of asphyxia and slow intrauterine growth in morbidity among breech delivered infants.

The outcome of breech delivery was evaluated by a neonatal neurological score and a follow-up examination at 18 months of age. The subjects were 132 children identified by ultrasound to be in breech presentation in the 33rd gestational week. 62 were born in breech presentation, while 70 turned to vertex presentation. During the early neonatal period, a neurological score was obtained based on the results of 29 items concerning posture, muscle tone, reflexes and reactions. Although there was no difference, in neurological score or in general development when the entire breech and vertex groups were compared, the SGA (small-for-gestational age) infants and the infants with low Apgar scores of the breech group had the poorest neurological scores. The contribution of certain maternal and fetal factors to postnatal condition was evaluated by a multiple linear regression analysis. Within the breech group, relationships were found between the neurological score and the variables intrauterine growth, fetal sex, and low Apgar score. A major part (66%) of the variation in neurological score was explained by the combination of these variables. These factors should therefore be taken into consideration when deciding on the mode of delivery in breech presentation.

Apgar Score↗

PubMed1986

Hip joint instability in breech pregnancy.

222 consecutive fetuses found by ultrasound to be in breech presentation in the 33rd gestational week were followed with repeated examinations in weeks 35 and 38. Ninety-one of these fetuses persisted in breech presentation until delivery, while cephalic version occurred in 131. The frequency of hip joint instability was 21% in the breech delivered group and 1.5% in the vertex delivered group. The position of the fetal legs was established at each ultrasound examination. The intrauterine fetal attitude was classified as extended when the fetuses had extended knees and maximally flexed hips at all ultrasound examinations. This occurred in 30 breech delivered fetuses, 47% of which developed hip joint instability. Only 8% of the breech born infants with flexed legs in utero developed hip joint instability. It is concluded that instability of the hip joint is a consequence of the intrauterine attitude, rather than of the breech delivery per se.

Breech Presentation↗

PubMed1986

Growth in breech presentation. Ultrasound and post-partal assessment of growth in 225 fetuses presenting by the breech in the 33rd gestational week.

225 fetuses with ultrasonically determined gestational age were shown by ultrasound to be in breech presentation in the 33rd gestational week. The biparietal diameter (BPD) and the mean of two perpendicular abdominal diameters (AD) were measured ultrasonically in gestational weeks 33, 35, and 38. Based on these measurements, fetal weight was estimated and compared with weight, length, and head circumference at birth and at 18 months of age. 42% of the fetuses were born in breech presentation (breech group) and 58% in vertex presentation (vertex group). The mean birth weight corrected for gestational age was 4.9% lower in the breech group than in the vertex group, which corresponds to the lower intra-uterine values of BPD and AD found in the breech group. The weight differences at birth still persisted at 18 months of age. There were no differences between the groups regarding head circumference or length, either at birth or at 18 months of age.

Birth Weight↗

PubMed1985

Fetal motor activity in breech presentation.

Intrauterine motor activity was studied in breech presenting but otherwise normal fetuses. In the first part of the study, 48 fetuses were examined in the 33rd gestational week with an objective method using four piezo-electric crystals attached to the maternal abdomen for recording fetal movements. Of the 48 fetuses, 25 remained in breech presentation until delivery, while 23 assumed the vertex presentation before birth. In the second part of the study, 63 pregnant women with breech-presenting fetuses in the 33rd gestational week subjectively recorded perceptible movements every evening. Spontaneous cephalic version occurred in 40 cases, and 23 fetuses persisted in the breech presentation until delivery. Neither in the objective nor in the subjective study were any quantitative differences in motor activity found between fetuses subsequently born in breech presentation and these born in vertex presentation.

Birth Weight↗

PubMed1984

Maternal and fetal factors in breech presentation.

The authors used ultrasound examination in an attempt to identify fetal and environmental differences between breech and vertex presentations. During a period of 13 months, 228 pregnancies with the fetus in breech position were found by routine ultrasound screening in the 33rd gestational week. Before delivery, 132 fetuses (58%) turned to vertex presentation and 96 (42%) remained in breech presentation. Fetal growth, posture, position, placental site, and amniotic fluid volume in the 33rd, 35th, and 38th gestational weeks were studied. In contrast to earlier proposed theories, no difference between the two groups (breech and vertex) was found regarding the frequency of extended fetal legs and cornual-fundal placental implantation. However, the neonates born in breech presentation had a shorter gestational age by ten days at delivery, and preterm delivery was more common. At birth, the breech neonates weighed 4.9% less than their vertex controls in relation to gestational age. In the breech group, there was an increased frequency of oligohydramnios, contracted pelvis, and uterine and fetal malformations. These conditions occurred only in 15% of the breech pregnancies; in the remaining 85%, no single cause of the breech presentation could be identified.

Adult↗