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Biomedical subjects

M Selinger

Publications and source records attributed to M Selinger.

At least 19 recordsLinked to original sources
PubMed2005

Evaluation of the role of day assessment unit in the management of pregnancy induced hypertension.

This study is based on an audit designed to investigate observance of the guideline on pregnancy induced hypertension (PIH) and referral to the day assessment unit (DAU) at the Royal Berkshire Hospital. The audit included 60 patients; all were first time referrals, over a period of 4 months in 2003. The main sources of cases were the community (50%), followed by the antenatal clinic (ANC) 47%. The majority (67%) were referred with hypertension. A total of 28% had suspected symptomatic pre-eclampsia. About 94% of the patients were at >or= 32 weeks' gestation. After assessment in the unit, it was found that about 47% had a diastolic blood pressure of <90 mmHg and 77% had no proteinuria. Nearly all the cases referred with symptoms were found to be asymptomatic on review. The laboratory investigations were normal in over 92% of cases. In spite of these findings, 65% of patients were followed-up in ANC and DAU. The audit showed the need for the local guideline.

Ambulatory Care↗
PubMed2002

Episiotomy closure comparing enbucrilate tissue adhesive with conventional sutures.

OBJECTIVES: The purpose of the study was to evaluate the use of enbucrilate tissue adhesive compared with subcuticular polyglycolic acid sutures in episiotomy wound closure. METHODS: In a prospective controlled trial, two groups were studied after undergoing an episiotomy skin wound repair using either enbucrilate tissue adhesive (n=32) or a subcuticular polyglycolic acid suture (n=30). The variables measured included pain scores during selected activities in the first 5 postnatal days, the time taken to become pain free after childbirth and the time taken to resume pain free sexual intercourse. Suitable patients were invited by the midwives to participate in the trial. If they gave consent to the trial, the gynecologist was contacted. If available, he would perform a repair using enbucrilate tissue adhesive. If he was not available, one of the midwives would perform a repair using subcuticular polyglycolic acid sutures. In this group, 90% of the women were recruited and sutured by one midwife. RESULTS: Patients treated with enbucrilate were found to have significantly less postnatal pain while walking, became pain free in a shorter period (mean=25 days vs. 18 days; P<0.01) and were able to resume pain-free intercourse sooner (mean=34 days vs. 52 days; P<0.001). CONCLUSIONS: Tissue adhesives incorporate the qualities of an ideal skin-closure material. The results demonstrate their advantage over the current standard suture-based methods of repair in the perineum. The use of adhesives merits further evaluation.

Adolescent↗
PubMed1997

Characteristics and outcome of deliveries by forceps after failed ventouse.

With the increasing use of the ventouse, it is becoming common for deliveries to be completed by the application of forceps. We present 48 cases delivered by forceps after a failed ventouse and compare these with 63 cases delivered by forceps only. There was significantly higher incidence of caesarean sections and cephalhaematoma in the group where forceps delivery was attempted after a failed ventouse compared to those delivered with forceps only.

Journal Article↗
PubMed1994

Prenatal determination of fetal rhesus D status by DNA amplification of peripheral blood of rhesus-negative mothers.

We have developed a sensitive PCR-based assay for the RhD gene and used it to detect circulating fetal cells from RhD-positive fetuses from peripheral blood of RhD-negative mothers. With further improvement in diagnostic accuracy, this assay may have implications in the management of RhD-sensitized pregnancies in women whose partners are heterozygous for the RhD gene. Further studies are required to determine the relationship between maternal anti-D levels and circulating fetal cell numbers.

Amniotic Fluid↗
PubMed1994

Temperature acceleration in cold oral stimulation.

This study measured the temperature acceleration of a cold probe as it contacts human tissue. Both the effects of touching a cold probe to the oral cavity were investigated. The results indicated a rapid warming pattern. This warming is effected first by temperature changes resulting from the probe being moved from ice into room temperature and second by the contact to oral mucosa. In fact, in some cases, the probe had reached minimal cold sensation levels by the time it reached the oral cavity. Results also indicated that 6 sec after the probe is lifted from the ice, the temperature closely approximates temperatures perceived as warm or at least neutral, but not cold.

Body Temperature↗
PubMed1993

Anti-D concentrations in fetal and maternal serum and amniotic fluid in rhesus allo-immunised pregnancies.

OBJECTIVE: To investigate the relation between anti-D concentrations in maternal serum, fetal serum and amniotic fluid, and the development of fetal anaemia. DESIGN: Observational cross sectional and longitudinal study. SETTING: Regional referral centre. SUBJECTS: Sixty-one women undergoing fetal blood sampling at 19 to 36 weeks' gestation for fetal blood and haematocrit estimation for the management of Rh (D) allo-immunisation. Thirty-eight pregnancies (7 with an Rh (D) negative fetus) were tested only once but the rest had two to five fetal blood samplings. INTERVENTIONS: Ultrasound guided fetal blood sampling and amniocentesis, and automated analysis of anti-D antibody quantitation. RESULTS: There were strong correlations between maternal serum, fetal serum and amniotic fluid anti-D concentrations. Analyses of both longitudinal and cross sectional data demonstrated a decrease of the maternal/fetal serum anti-D ratio with gestation. In pregnancies with Rh (D) negative fetuses the maternal/fetal anti-D ratio was significantly lower (P < 0.0001) than in those with Rh (D) positive fetuses. The degree of fetal anaemia (delta haematocrit) was correlated with maternal serum and amniotic fluid anti-D concentrations (r = -0.55, n = 54, P < 0.0001; r = -0.57, n = 44, P < 0.0001, respectively) but there was a weaker correlation with fetal serum anti-D (r = 0.37, n = 54, P < 0.01). CONCLUSION: Anti-D concentrations in maternal serum, fetal serum and amniotic fluid are correlated with fetal anaemia. The decrease in maternal/fetal anti-D ratio with gestation suggests an increase in placental permeability for anti-D with advancing pregnancy.

Amniotic Fluid↗
PubMed1992

Computerized measurement of heart rate variation in fetal anemia caused by rhesus alloimmunization.

OBJECTIVE: The purpose of this study was to examine the relationship between fetal heart rate variation and fetal hematocrit. STUDY DESIGN: In 36 red-cell alloimmunized pregnancies (mean gestational age 30, range 25 to 36 weeks) 65 computerized fetal heart rate recordings were obtained before ultrasonographically guided fetal blood sampling for the measurement of fetal hematocrit. The recordings were captured and analyzed by a microcomputer on-line. Fetal heart rate variation in anemic fetuses was accurately measured. RESULTS: Significant positive correlations between short-term or long-term heart rate variation and fetal hematocrit have been demonstrated even after adjusting for the effect of gestation (r = 0.60, n = 65, p less than 0.01, y = 19.264 + 0.913x - 0.003x2; r = 0.52, n = 65, p less than 0.01, y = 21.13 + 0.858x - 0.003x2, respectively). The relationship was best described by a quadratic model. When short-term variation was less than 5 milliseconds or long-term variation was less than 30 milliseconds, the positive predictive values for fetal hematocrit of less than 30 were 85% and 90%, and the negative predictive values 56% and 57%, respectively. CONCLUSION: Computerized recording and analysis of fetal heart rate variation may prove to be a useful noninvasive tool for assessing fetal anemia in red-cell alloimmunization.

Anemia↗
PubMed1991

Mid-trimester termination of pregnancy with 16,16-dimethyl-trans-delta 2 PGE1 vaginal pessaries: a comparison with intra- and extra-amniotic prostaglandin E2 administration.

PGE1 analogue (gemeprost) vaginal pessaries administered three hourly for three doses has been compared with a single extra- or intra-amniotic injection of PGE2 for mid-trimester termination of pregnancy in 450 women between 13 and 20 weeks gestation. The mean (SD) induction-abortion interval (IAI) in the vaginal pessary group of 19.5 (8.4) h was significantly longer than the respective intervals of 14.4 (9.3) and 16.1 (6.8) h in the patients treated extra- or intra-amniotically (P less than 0.001). Seventy-three percent treated with gemeprost aborted within 24 h of initial treatment compared with 84% and 87%, respectively in the extra- and intra-amniotic groups (P less than 0.05). Patients treated with gemeprost were more likely to need further prostaglandin treatment and had an increased incidence of gastrointestinal side effects. Despite these differences vaginal gemeprost pessaries provide a safe, effective, easy to administer method for midtrimester termination of pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1991

Transplacental passage of mifepristone and its influence on maternal and fetal steroid concentrations in the second trimester of pregnancy.

The maternal and fetal endocrine effects of the maternal administration of the anti-progestin mifepristone in mid-pregnancy have been investigated. Mifepristone and the metabolite RU 42,633 were detected in the fetal circulation and in the amniotic fluid 4, 24 and 48 h after oral ingestion. Maximum fetal plasma concentrations of mifepristone occurred 4 h after treatment indicating rapid placental transfer of the drug. No significant changes in progesterone, cortisol, oestradiol or aldosterone concentrations were detected in the maternal circulation after mifepristone treatment. No significant changes occurred in the fetal progesterone, oestradiol or cortisol concentrations, but a significant increase in fetal aldosterone occurred 4 and 24 h after treatment. The significance of these results is discussed in relation to the possible therapeutic uses of mifepristone for inducing labour.

Abortion, Induced↗
PubMed1990

Limb reduction and chorion villus sampling.

Upper limb reduction was diagnosed by ultrasound scan at 17 weeks after chorion villus sampling at 9 weeks' gestation. Pregnancy was terminated and necropsy confirmed limb reduction in an otherwise normal fetus. The relationship of limb reduction to amniotic band syndrome is discussed.

Adult↗
PubMed1990

The placental transfer of mifepristone (RU 486) during the second trimester and its influence upon maternal and fetal steroid concentrations.

A double-blind, placebo-controlled study has assessed the maternal and fetal endocrine effects of the maternal administration of the anti-progestin mifepristone in mid-pregnancy. There were six women in each group. Four hours after oral administration of 600 mg mifepristone, the drug was detected in both maternal and fetal circulations and in the amniotic fluid. No significant changes in progesterone, cortisol, oestradiol, or aldosterone concentrations were detected in the maternal circulation after treatment with mifepristone or placebo. In women treated with mifepristone, the mean fetal aldosterone level was 1699 (SD 217) pmol/l which was significantly higher than the mean level of 999 (SD 84) pmol/l in the control group but no significant changes occurred in the fetal progesterone, oestradiol or cortisol concentrations. The significance of these results is discussed in relation to the possible therapeutic uses of mifepristone for inducing labour.

Aldosterone↗
PubMed1990

The physiological and clinical effects of progesterone inhibition with mifepristone (RU 486) in the second trimester.

A double-blind placebo-controlled trial was performed in 20 primigravidae to assess the physiological and clinical effects of oral mifepristone on myometrial contractility and sensitivity in the second trimester. Ten women received 600 mg of oral mifepristone and 10 women a placebo 24 h before abortion was induced in both groups, with extra-amniotic PGE2 instillation. Intrauterine pressure recordings demonstrated increased spontaneous uterine activity and increased sensitivity to PGE2 and ergometrine, but no change in oxytocin sensitivity after mifepristone treatment. There were no significant differences in PGE or PGF metabolite concentrations in peripheral maternal plasma over the 24-h study period after treatment between the mifepristone and placebo groups. The mean induction abortion interval in the mifepristone group was 512 (SD 321) min compared with 1128 (SD 606) min in the placebo group (P less than or equal to 0.02). The mechanism whereby mifepristone provokes enhanced uterine contractility and sensitivity to prostaglandins, with a reduction in abortion times, does not appear to be through endogenous production of PGE or PGF.

Abortion, Induced↗
PubMed1989

Auditory event-related potential probes and behavioral measures of aphasia.

This study examined the relationship between an auditory event-related potential probe technique measure of differential hemispheric processing and traditional tests of aphasia in aphasic patients. Subjects were 10 aphasic and 10 normal adult males. The results of the electrophysiological measures indicated that the aphasic subjects responded differently from the normal group particularly when the task required processing of verbal information. During the verbal task the aphasic group showed higher amplitude right hemisphere responses as compared to left. The normal group showed little hemispheric task related asymmetries. The pattern of electrical asymmetry in the aphasic group seems to be an indicator of severity as measured by traditional aphasia examinations.

Adult↗