Biomedical subjects

N J Randall

Publications and source records attributed to N J Randall.

10 recordsLinked to original sources

PubMed1993

A method for continuous monitoring of meconium in the amniotic fluid during labour.

In about 10% of pregnancies overall, the fetus discharges meconium (its bowel contents) into the amniotic fluid during labour. In about 10% of cases where meconium is passed, the fetus gasps, inhaling the sticky meconium into the upper respiratory tract. After birth, the meconium blocks the air passages in the lungs, impairing gas exchange--meconium aspiration syndrome (MAS). Up to 20% of infants suffering from MAS die and recently published studies have shown a long-term effect of MAS in causing cough and wheeze. The risk of meconium aspiration is thought to be increased by intrauterine hypoxia. At present, meconium is only noticed at birth or occasionally when amniotic fluid leaks past the presenting part of the fetus. A method has been developed which measures absolute meconium concentration with a 99% prediction interval of +/- 30 g l-1; allows monitoring of the rate of appearance of meconium linearly with a nonlinearity of 5%, and differentiates between meconium and blood. The method uses the ratio of the intensity of back-scattered light from the amniotic fluid at 700 and 415 nm, the latter being near the peak of light absorption by meconium and the former a reference value. The ratio is also affected by the presence of blood. However, blood has specific absorption peaks at 540 and 575 nm from which it can be detected (the presence of blood is also a significant abnormality, and is relatively uncommon). The measurement method could easily be integrated into an optical sensor mounted onto an intrauterine probe.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic Fluid↗

PubMed1993

Detection of atrial activation by intraventricular electrogram morphology analysis: a study to determine the feasibility of P wave synchronous pacing from a standard ventricular lead.

The detection of atrial activation from a standard ventricular pacing lead with standard ventricular electrodes would provide patients with VVI and VVIR pacing systems atrial rate response and atrial synchrony. In addition to potentially increasing cardiac output appropriately in these patients at rest and during moderate exercise, P wave sensing with such a device could help reduce pacemaker syndrome. In this study, unipolar signals from distal and proximal intraventricular electrodes were recorded from the right ventricular apex in 20 patients. Unipolar electrograms from 16 patients were recorded using temporary electrophysiology catheters and in four patients using permanent pacemaker leads. Approximately 3 minutes of data per patient were acquired and analyzed. After selection of a P wave template, the difference in baseline normalized area between the template and signal was calculated on a point-by-point basis. The percent of atrial depolarizations correctly detected was determined for each patient and lead configuration at the optimal threshold. Far-field P wave accuracy was better at the proximal electrode (74 +/- 25%) than at the distal electrode (57 +/- 34%) (P < 0.025). At the proximal electrode, 15/20 (75%) patients had > 70% accuracy and 11/20 (55%) patients had > 80% accuracy. At the distal electrode, 10/21 (48%) patients had > 70% accuracy and 7/21 (33%) patients had > 80% accuracy. In conclusion, far-field detection of atrial activation at the ventricular proximal electrode appears possible with sufficient accuracy to provide periods of atrial rate response and synchrony in patients with a single standard lead.

Atrioventricular Node↗

PubMed1991

Measuring fetal and maternal temperature differentials: a probe for clinical use during labour.

The healthy fetus maintains a higher temperature than that of its mother during gestation and labour. This results from the thermal balance between the heat generated by the fetus and the heat loss to its maternal surroundings. The heat loss can be by heat exchange via blood flowing in the umbilical cord and placenta, and via conduction through the fetal skin and amniotic fluid to the maternal wall. The temperature difference between the fetal and maternal tissue may reflect the metabolic state of the fetus and the magnitude and changing patterns of placental blood flow during labour. Physiological changes, such as those induced by epidural analgesia, and fetal infection have been shown to exhibit an increase in the absolute temperature. An intrauterine probe, previously used for non-invasive ECG detection, has been equipped with temperature sensors that measure fetal and maternal skin temperature in utero. Laboratory tests to characterize the performance of the probe reveal that absolute and differential temperatures can be resolved to around 0.01 degree C with a thermal time constant of approximately 9 s. Ideally the probe body should have infinite thermal insulation or thermal shunting across the probe will occur reducing the measured temperature difference. In this initial probe design, a high thermal isolation between sensors has been achieved but is not perfect, resulting in around 85% of the actual temperature difference across the probe being registered. Average feto-maternal differences of 0.2 degrees C have been measured in a clinical investigation.

Body Temperature↗

PubMed1990

Head-to-cervix forces and their relationship to the outcome of labor.

The force (as distinct from pressure) between the fetal head and the maternal cervix during labor was measured for the first time in an attempt to improve the intrapartum prediction of progress in labor. The 50th percentile of the variables active pressure and active force and the mean uterine activity integral were compared with the cervical dilatation rate and delivery mode in 31 women. The 50th percentile of active force had the highest correlation with the cervical dilatation rate (r = 0.54) (50th percentile of active pressure, r = 0.43; mean uterine activity integral, r = 0.40). The 50th percentile of active force was significantly higher in women who achieved a vaginal delivery (mean +/- SD 45 +/- 21.2 g wt) than in those who underwent cesarean delivery for failure to progress (16.5 +/- 9 g wt). The 50th percentile of active force discriminated among modes of delivery as effectively as did the cervical dilatation rate. These results support the hypothesis that head-to-cervix force measurements may have clinical value in the management of labor.

Biomechanical Phenomena↗

PubMed1988

Validation of thermal techniques for measurement of pelvic organ blood flows in the nonpregnant sheep: comparison with transit-time ultrasonic and microsphere measurements of blood flow.

Data obtained from a thermal system capable of measuring changes in organ temperature as well as tissue thermal clearance in the uterus and vagina have been compared with blood flow measured continuously with a transit-time ultrasound volume-flow sensor placed around the common internal iliac artery and intermittently with radioactive microspheres in the chronically instrumented nonpregnant sheep. Temperature changes in both the uterus and the vagina correlated well with blood flow changes measured by both techniques after intravenous administration of estradiol or norepinephrine. Thermal clearance did not correlate well with blood flow in the vagina or uterus. These methods may have value in the investigation of blood flow patterns in various clinical situations such as the pelvic pain syndrome and early pregnancy.

Animals↗

PubMed1988

Detection of the fetal ECG during labour by an intrauterine probe.

The feasibility of detecting the fetal ECG (FECG) from within the uterus in labour by a technique which is non-invasive to the fetus, has been investigated. The design of a special multi-electrode flexible probe has demonstrated that the FECG can be obtained with signal amplitudes of 20-300 microV and a success rate similar to that of the scalp electrode. Under favourable conditions very large signals can be detected in utero compared to a scalp electrode, but average signal amplitudes are lower. The probe is suitable as a carrier for other sensors such as pressure and temperature transducers. Currently, simultaneous FECG and intrauterine pressure measurement using a commercially available transducer within the same probe has been achieved.

Electrocardiography↗

PubMed1976

The measurement of uterine activity in induced labour.

A simple electronic system for quantifying uterine activity in labour has been developed. The basic construction of the system is described. It has been used to confirm the hypothesis of Steer et al (1975) that oxytocin-induced labour has a stable phase during which uterine activity is largely independent of oxytocin infusion rate.

Adolescent↗

PubMed1976

A transportable sleep recording system.

A system for monitoring sleep, which can be used in th ward without unduly disturbing either the patient or the medical and nursing staff, is described. The system records the electroencephalogram, electro-oculogram, the basal skin resistance and the galvanic skin resistance. In addition, the delta waves of the EEG are automatically counted and a histogram of their frequency plotted. The system allows a whole night's sleep recording to be compressed into just over a metre of paper.

Adult↗

PubMed1976

A method for monitoring uterine activity in induced labour.

A system for the quantitative assessment of uterine activity during an oxytocin-induced labour has been developed. This has been achieved using relatively simple analogue techniques and can easily be used in the labour ward alongside existing monitoring equipment. Initial results indicate that a plateau of uterine activity can be easily recognised from the display and maintained at oxytocin dosage levels below those that might normally be used.

Female↗

PubMed1975

A new uroflowmeter for routine clinical use.

A uroflowmeter has been produced using a simple strain gauge transducer system with a performance that has been optimised to provide various micturition parameters with an accuracy consistent with the known physiological range. The total cost of the uroflowmeter is around L140 including the digital read-out. The results from over 300 patients have been collected and the flow curves of over 100 of these have been obtained. It is hoped that we can define a set of clinically significant parameters from each flow curve and correlate these against their associated urological conditions. Since, with the majority of patients, only one test is carried out, the parameters would also have to be significant for a single result.

Female↗