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Biomedical subjects

R B Johanson

Publications and source records attributed to R B Johanson.

28 records · Page 2Linked to original sources
PubMed1996

Role of magnesium sulfate in seizure prevention in patients with eclampsia and pre-eclampsia.

Eclampsia is a leading cause of maternal mortality. The prevention of seizure activity in pre-eclampsia and recurrent seizures in eclamptic patients is an essential aspect of management. Many drugs with anticonvulsant properties have been used to treat patients with pre-eclampsia and eclampsia. Magnesium sulfate is a significantly better drug than either diazepam or phenytoin for preventing recurrent seizures in eclamptic patients. Magnesium sulfate has diverse cardiovascular and neurological effects and also alters calcium metabolism. Although the drug crosses the placenta and may affect the fetus, these effects are clinically small and fetal morbidity has been shown to be reduced in randomised studies comparing magnesium sulfate to either phenytoin or benzodiazepines. Dosage regimens of magnesium sulfate are empirical. Because adverse effects of this agent are related to toxicity, the establishment of greater efficacy by using higher dosage regimens needs to be tested against a greater risk of adverse effects. The most serious toxicity related to magnesium sulfate use is magnesium sulfate use is neuromuscular blockade that may result in respiratory arrest. Magnesium sulfate is now the drug choice for treating eclamptic patients. However, further studies are required to establish the role of this agent as a prophylactic agent in the prevention of eclampsia.

Anticonvulsants↗
PubMed1995

A multicentre study of perinatal mortality in Nepal.

A prospective survey was carried out in two Kathmandu hospitals and two rural districts to establish urban and rural perinatal mortality rates (PNMRs) for these four centres in Nepal and to ascertain the causes of perinatal mortality. All perinatal deaths occurring over a 1-year period in the four centres were included (during which time there was a total of 14,967 births). Cause of death was established by contemporary review of hospital case records or by structured questionnaire ('verbal autopsy') in the rural areas. The PNMRs in the hospitals were 48.0 and 23.7 per thousand total births respectively, whilst those of the rural settings were 96.2 and 42.5 per thousand births. Perinatal asphyxia, low birthweight and infection were the most common causes but many of the deaths were unexplained. The high mortality rates were felt to reflect the difficult circumstances of childbirth in Nepal. It was concluded that a number of interventions would appear appropriate, but that these should be introduced in a scientific manner.

Adult↗
PubMed1994

Worldwide survey of assisted vaginal delivery.

OBJECTIVES: To ascertain which instruments are most commonly used for assisted vaginal delivery. METHODS: A postal survey in which 1411 questionnaires were sent to major obstetric centers worldwide. RESULTS: Over 60% (305/508) of the respondents indicated willingness to participate in a multicenter randomized controlled trial between the two instruments. CONCLUSIONS: The forceps remained popular in most of the 'English-speaking' countries, as well as in Eastern Europe and South America. The ventouse was most popular in Africa, Asia and Northern Europe.

Data Collection↗
PubMed1993

A survey of technology and temperature control on a neonatal unit in Kathmandu, Nepal.

An assessment of the incubators in use at the Kathmandu Maternity Hospital neonatal unit was undertaken; this was followed by a prospective survey of neonatal temperatures on the unit. In the incubator assessment 11 studies were carried out in five incubators. Three of the thermostats in the five incubators did not work at all and those in the other two incubators were more than 3 degrees C inaccurate. All the incubator thermometers gave recordings less than the actual temperature (with a range of error: 1.3-4.4 degrees C). Six out of the 11 babies studied were hypothermic (defined as rectal temperature < 36 degrees C). In the prospective survey of temperatures a high incidence of hypothermia was found on the neonatal unit at the time of first temperature measurement (64 per cent had a rectal temperature of < 36 degrees C). A significant association between admission hypothermia and mortality was noted. Sixteen per cent (10/64) of babies admitted with temperatures < 36 degrees C died within the first week, compared to 0 (0/36) of those admitted with temperatures > or = 36 degrees C.

Body Temperature↗
PubMed1993

A randomised prospective study comparing the new vacuum extractor policy with forceps delivery.

OBJECTIVE: To compare assisted vaginal delivery by forceps with delivery by vacuum extractor, where a new vacuum extractor policy was employed which dictated the cup to be used in specific situations. DESIGN: Multicentre randomised controlled trial. SETTING: Four district general hospitals in the West Midlands. SUBJECTS: Six hundred-seven women requiring assisted vaginal delivery, of whom 296 were allocated to vacuum extractor delivery and 311 to forceps. MAIN OUTCOME MEASURES: Delivery success rate, maternal perineal and vaginal injuries, maternal anaesthetic requirements, neonatal scalp and facial injuries. RESULTS: Of the vacuum extractor group, 85% were delivered by the allocated instrument compared to 90% in the forceps group (odds ratio (OR) 0.64; 95% confidence intervals (CI) 0.4-1.04). However, more women in the vacuum extractor group were delivered vaginally (98%) than in the forceps group (96%). There were significantly fewer women with anal sphincter damage or upper vaginal extensions in the vacuum extractor group (11% vs 17%, OR 0.6; 95% CI, 0.38-0.97). There were significantly fewer women in the vacuum extractor group requiring epidural or spinal anaesthetics (25.4% vs 32.7%, OR 0.69; 95% CI 0.49-0.99) or general anaesthetics (1% vs 4%, OR 0.17; 95% CI 0.04-0.76). Although there were significantly more babies in the vacuum extractor group with cephalhaematomata (9% vs 3%, OR 3.3; 95% CI 1.4-7.4) there were fewer babies in the vacuum extractor group with other facial injuries. There were three babies in the forceps group with unexplained neonatal convulsions. CONCLUSIONS: Assisted vaginal delivery using the new vacuum extractor policy is associated with significantly less maternal trauma than with forceps. Further studies are required to assess neonatal morbidity adequately.

Adult↗
PubMed1992

Effect of post-delivery care on neonatal body temperature.

A prospective observational study of post-delivery care and neonatal body temperature, carried out at Kathmandu Maternity Hospital, was followed by a randomized controlled intervention study using three simple methods for maintaining body temperature. There were 500 infants in the initial observation study and 300 in the intervention study. In the observation study, 85% (420/495) of infants had temperatures < 36 degrees C at 2 h and nearly 50% (198/405) had temperatures < 36 degrees C at 24 h (14% were < 35 degrees C). Most of the infants who were cold at 24 h had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the "kangaroo" method, the traditional "oil massage" or a "plastic swaddler". All three were found to be equally effective. Overall, 38% (114/298) of the infants had temperatures < 36 degrees C at 2 h and 18% (41/231) at 24 h (when none was < 35 degrees C).

Body Temperature↗