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Biomedical subjects

M Westgren

Publications and source records attributed to M Westgren.

At least 19 recordsLinked to original sources
PubMed1992

Fetal scalp and umbilical artery blood lactate measured with a new test strip method.

OBJECTIVE: To compare the measurement of lactate in fetal scalp and umbilical artery blood by a new dry reagent strip method with a commercially available enzymatic method using plasma (Monotest). DESIGN: Comparative study. SUBJECTS: Fetal scalp blood samples were obtained during labour from 24 fetuses and umbilical artery blood samples were obtained at birth in a further 51 deliveries. RESULTS: The concentration of lactate in scalp and umbilical artery blood measured by the reagent strip method correlated well (r = 0.94, P less than 0.001 and 0.95, P less than 0.001 respectively) with the enzymatic plasma method. The paper strip method tended to give lower readings than the enzymatic method when the fetal haematocrit was greater than or equal to 50%. CONCLUSIONS: The new dry reagent strip method which takes only 1 min to carry out and requires only 20 microliters of blood seems to be handy and reliable. This system provides a convenient and rapid test for measuring fetal blood lactate.

Evaluation Studies as Topic↗
PubMed1992

A four-year follow-up of hearing and development in children exposed in utero to vibro-acoustic stimulation.

OBJECTIVE: To obtain information of hearing and neuro-development in children exposed to vibro-acoustic stimulation in utero. DESIGN: Information collected from Swedish child care programmes. SETTING: Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd University Hospital, Sweden. SUBJECTS: Children of 460 mothers exposed to vibro-acoustic stimulation for the assessment of fetal well-being during high- and low-risk pregnancies during 1985-1987. MAIN OUTCOME MEASURES: Auditory test (20-25 dB at eight frequencies between 500 and 8000 Hz) and general neurological examination at four years of age. RESULTS: No hearing damage or neuro-developmental abnormalities that could be connected to the vibro-acoustic stimulation were found. CONCLUSIONS: Vibro-acoustic stimulation, as applied in clinical practice, did not endanger either neurological development or hearing in children exposed in utero.

Acoustic Stimulation↗
PubMed1992

Vibro-acoustic stimulation in high-risk pregnancies; maternal perception of fetal movements, fetal heart rate and fetal outcome.

Maternal perception of fetal movement in response to vibro-acoustic stimulation was compared with antenatal fetal heart rate monitoring as a test of fetal well-being in a population of gravidae with high-risk pregnancies (n = 517), admitted to the high-risk ward at Danderyd Hospital, Karolinska Institutet; a total of 2,015 tests were performed. The sensitivity and the specificity of the test compared to the fetal heart rate tracing was 81% and 89% respectively. If the test was performed within 24 hours of delivery, its predictive value for fetal asphyxia (i.e. a 5-minute Apgar score < 7) was 14% (7/49). Ten per cent of the patients felt no fetal movement in response to stimulation (irrespective of gestational age). In five cases where fetal heart rate tracings were pathological, stimulation nonetheless produced fetal movement and fetal outcome was good. Pathological heart rate tracings and no fetal movement in response to stimulation were present in 30 cases (out of 251 with no fetal movements at stimulation), in seven of which the infants had 5-minute Apgar scores < 7. Although many patients underwent repeated vibro-acoustic stimulation, there was no evidence of fetal habituation to the test. On 24 occasions (i.e. 1.2%), the patient denied vibro-acoustic stimulation, mostly because of previous discomfort due to vigorous fetal response. Where resources are limited, maternal perception of fetal movements in response to vibro-acoustic stimulation might be a useful alternative for preliminary screening of high-risk pregnancies.

Acoustic Stimulation↗
PubMed1991

Iontophoresis of vasoactive drugs. Effect on peripheral blood flow during pregnancy.

The aim of this study was to evaluate whether iontophoretic administration of the vasoactive agents noradrenaline (NA) and angiotensin (AII) combined with measurement of skin blood flow with a laser Doppler technique could serve as a predictive method for pre-eclampsia. Nine healthy non-pregnant women, 9 healthy pregnant women and 9 pre-eclamptic patients were investigated. A significant reduction of skin blood flow was induced by NA in all three groups and by AII in the non-pregnant group. There was no significant difference between healthy pregnant and pre-eclamptic patients in the degree of reduction of blood flow with respect to NA and AII administration.

Angiotensin II↗
PubMed1991

Vibroacoustic stimulation and intrauterine sound pressure levels.

The sound pressure level in amniotic fluid generated by vibroacoustic stimulation, assessed with a hydrophone placed close to the fetal head, was studied in 16 subjects. The mean recorded sound pressure level was 115 dB and the highest level was 129 dB. The range of the background noise was 63.5-80.5 dB. There was no obvious relationship between the distance from the stimulator to the hydrophone and the intrauterine sound pressure level. Although sound pressure levels are high, they are probably reduced before reaching the cochlea of the fetus because of the surrounding amniotic fluid and the fluid in the middle ear.

Acoustic Stimulation↗
PubMed1990

Discomfort after outpatient abortion using paracervical block: a comparison between two opioids and one non-opioid drug for premedication.

One hundred and one patients undergoing outpatient abortion using local anesthesia were randomly allocated to one of three different premedications: morphine-scopolamine, pethidine or midazolam. The incidence of pain, anxiety, emetic (nausea-vomiting) and patient cooperation was analyzed. Discomfort was frequently noticed, 79 patients reported pain, 57 nausea and 26 vomited at least once during the postoperative period which lasted 2.6 h (mean value). There were no major differences in complaints among the different premedication groups. Nausea, though, was correlated to pain. Symptoms of pain, nausea and vomiting were frequent after abortion under paracervical block. These complaints were not found to be related to the type of premedication or other circumstances in the perioperative period.

Abortion, Induced↗
PubMed1990

Fetal heart rate responses to anemia in Rh isoimmunization.

On 52 occasions 24 Rh immunized women were monitored with a nonstress test (NST) prior to fetal blood sampling. Cardiotocographic characteristics were recorded for each NST. Fetal blood was analysed for hemoglobin and hematocrit. Fetal hemoglobin and hematocrit were positively correlated to long-term variability, acceleration amplitude and negatively correlated to deceleration amplitude (linear regression analysis; p less than 0.05). Decelerations were almost without exception associated with low concentrations of hemoglobin and hematocrit. In fetuses of 32 weeks' gestation or more, a loss of variability (less than or equal to 5 bpm) was associated with severe anemia. Hemoglobin and hematocrit were significantly lower in the group with a pathological NST (n = 15) compared with the group with a normal NST (n = 37) (Mann-Whitney U test; p less than 0.05). The predictive value of a pathological test was 13/15 concerning hemoglobin and hematocrit; whereas, the predictive value of a normal test was poor. A pathological NST, especially when decelerative, is a good predictor of fetal anemia, but a normal NST is no guarantee for a normal blood status.

Anemia↗
PubMed1990

Fetal responses to different intensity levels of vibroacoustic stimulation.

The fetal responses to three different intensity levels of vibroacoustic stimulation (mean 92, 103, and 109 dB) were investigated in 275 pregnant women between 32-42 weeks of gestation. A 103-dB and a 109-dB stimulation aroused fetal movements, perceived by the mother, significantly more often than did a 92-dB stimulation (P less than .05 and P less than .01, respectively). Fetal heart rate (FHR) accelerations occurred slightly more often at a 109-dB stimulation than at a 92-dB level, but the difference was not significant. In the second part of the study, the three modes of stimulation were compared under standardized conditions in ten normal patients. The immediate reaction concerning fetal body movements as measured by the mother or the observer and FHR accelerations were the same as described earlier. There was a significant delayed increase of fetal gross body movements after 8 minutes at the 103- and 109-dB stimulation levels. Thus, the fetal response to vibroacoustic stimulation changes with different intensity levels.

Acoustic Stimulation↗
PubMed1989

Acid-base status in fetal heart blood in erythroblastotic fetuses: a study with special reference to the effect of transfusions with adult blood.

Blood gas levels, pH, and lactate concentration were studied in fetal heart blood on 70 occasions in 26 fetuses with erythroblastosis. A decreasing hemoglobin concentration correlated to a fall in pH (p = 0.006) and bicarbonate (p = 0.015) and to a rise in base deficit (p = 0.002) and lactate concentration (p = 0.05). Twenty of the fetuses underwent 63 intracardiac transfusions. A multivariance analysis for hemoglobin concentration, percentage of fetal to adult blood, and different acid-base parameters revealed a significant correlation between the presence of adult blood and a rise in PO2 (p = 0.047), but failed to demonstrate any correlation to the other studied acid-base variables. Thus the present study suggests that the fetus can compensate for the physiologic properties of adult hemoglobin that are disadvantageous to itself by increasing PO2 and thereby maintaining oxygen supply. The physiologic background and the clinical implication are discussed.

Acid-Base Equilibrium↗
PubMed1989

Maternal perception of sound-provoked fetal movements in low-risk pregnancies during the third trimester.

Maternal perception of fetal movements after vibroacoustic stimulation (Servox) was studied longitudinally on 456 occasions in 90 low-risk pregnancies after 28 weeks gestation until delivery. A positive response to sound stimulation, recorded as a fetal movement by the mother, occurred on 444 (97%) occasions. Of the 12 negative responses eight occurred before 33 weeks showing a positive correlation with decreasing maturity. All the pregnancies had good outcomes. The low rate of false-positive tests (3%) adds support to the suggestion that this rapid test could play a role in the assessment of fetal well-being.

Acoustic Stimulation↗
PubMed1989

Feto-placental blood volume in severely anemic erythroblastotic fetuses.

The feto-placental blood volume was studied using a hemoglobin hemodilution technique in 15 erythroblastotic fetuses at 43 intravascular transfusions. Four severely anemic fetuses (Hb 30 g/l) had significantly larger blood volumes than 11 moderately anemic fetuses (Hb 30-79 g/l), 169 +/- 37 versus 105 +/- 32 ml/kg fetal body weight (p less than 0.001). We speculate that hypovolemia might be an adaptive change to maintain an adequate hemoglobin concentration. An escape of fluid from the intra- to the extra-vascular space will probably compensate for the reduction in total red cell mass and thus slightly increase the hemoglobin concentration. Theoretically, interstitial fluid accumulation will continue until the hydrostatic pressure of the extravascular tissue balances that of the capillary. This compensatory mechanism seems to function until the hemoglobin concentration drops below, 30 g/l, at which point the blood volume will increase, suggesting a change from a hypo- to a hyper-volemic state.

Anemia↗
PubMed1989

Fetal growth and fetal glucose and C-peptide levels in relation to the degree of anemia in fetuses affected by rhesus iso-immunization.

Fetal growth rate was determined by measuring the fetal biparietal diameter at 63 two-week time points during the second trimester in 14 patients with severe Rhesus isoimmunization. Growth rate was found to be related to the fetal hemoglobin concentration which was determined at the end of each 2-week period. Fetuses with a hemoglobin concentration of less than 30% of the normal value had a significantly decreased growth rate (p less than 0.01). These fetuses had also reduced C-peptide (p less than 0.05) and increased glucose levels (p less than 0.1) compared with less anemic fetuses. The physiological background to impaired fetal growth in cases of severe fetal anamia at Rhesus iso-immunization is discussed.

Anemia↗
PubMed1988

Fetal intracardiac transfusions in patients with severe rhesus isoimmunisation.

Six patients with pregnancies of 19-31 weeks' duration showing evidence of erythroblastosis fetalis were treated with 25 fetal intracardiac blood transfusions. Complications related to the procedure occurred on five occasions in three patients. In two of the six patients the fetus died, but it was unlikely that death was related to the intracardiac transfusions. Fetal intracardiac blood transfusion may result in potentially severe complications but offers an alternative when transfusion cannot be performed into the umbilical cord.

Blood Transfusion, Intrauterine↗