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Biomedical subjects

R H Philpott

Publications and source records attributed to R H Philpott.

At least 19 recordsLinked to original sources
PubMed1988

Intrauterine pressure studies in multigravid patients in spontaneous labour: effect of oxytocin augmentation in delayed first stage.

Uterine activity was assessed by measuring the uterine activity integral (UAI) in 116 black multigravid patients in spontaneous active labour at term. Although individual patients showed a wide range of mean UAI levels, normal labour (group I, n = 54) was associated with a mean UAI level of 1640 kPas/15 min which was higher than the mean level observed in patients in whom delay in cervical dilatation occurred in active labour. The patients who failed to progress in labour were treated with oxytocin infusion and 32 of them made good progress in labour and achieved vaginal delivery (group IIa: mean UAI pre-oxytocin treatment 1040 (SD 424) kPas/15 min, post-oxytocin 1890 (SD 559) kPas/15 min). The other 23 patients required operative delivery (group IIb) despite correction of uterine activity after oxytocin treatment (pre-oxytocin mean UAI 1230 (SD 570) kPas/15 min, post-oxytocin 1815 (SD 650) kPas/15 min). The rate of oxytocin infusion varied between patients from 2 to 16 mU/min but in 75% uterine activity was corrected to normal levels by a dose of less than or equal to 8 mU/min. It is concluded that delay in progress in labour is associated with lower intrauterine pressures than are present in normal labour, and that management of patients presenting with inefficient uterine action may benefit from the use of uterine activity integral measurements.

Female↗
PubMed1987

Comparison of labetalol and dihydralazine in hypertensive emergencies of pregnancy.

Labetalol (Trandate; Allen & Hanburys), a combined alpha- and beta-adrenergic blocking agent, was compared with the more commonly used peripheral vasodilator, dihydrallazine (Nepresol; Ciba), each administered as an infusion, in the treatment of severe hypertension in 20 primigravidas at greater than or equal to 32 weeks' gestation. With the dosage regimen used in this study there was a tendency towards more effective blood pressure control with dihydrallazine. The pulse rate was unaffected by labetalol therapy and there were no harmful effects on the neonate or fetus directly attributable to either drug.

Blood Pressure↗
PubMed1986

Changes in amniotic fluid prostaglandins with oxytocin-induced labor.

Amniotic fluid prostaglandin levels were measured serially in 15 patients who underwent successful induction of labor and compared with those of patients presenting in spontaneous labor. At comparable cervical dilation the induced group demonstrated significantly lower prostaglandin levels. Four of these patients delivered without any increment in prostaglandins while in the remaining patients increases in prostaglandins followed the attainment of efficient uterine contractions by several hours. These data support the hypothesis that oxytocin acts directly on myometrial cells and not primarily by prior generation of prostaglandin synthesis in the membranes.

Amniotic Fluid↗
PubMed1985

Rupture of the gravid uterus.

A detailed analysis of 129 cases of rupture of the gravid uterus between 1980 and 1983 is presented and compared with two previous reports from King Edward VIII Hospital, Durban, over the last 2 decades. Statistically significant decrease in the occurrence of this condition (from 2,7 to 1,06/1000 deliveries (P less than 0,001; chi 2 = 20,38)) and in the maternal mortality rate (from 12% to 3%) have taken place since the initial study. The most probable reasons for this improvement are the provision of a community-based obstetric service, the early detection of cephalopelvic disproportion, awareness of the condition, immediate and adequate resuscitation once the diagnosis is established, and the performance of a total abdominal hysterectomy as definitive treatment in most cases.

Adult↗
PubMed1984

Abnormal concentrations of prostaglandins in amniotic fluid during delayed labour in multigravid patients.

Concentrations of prostaglandins E (PGE), F2 alpha (PGF), 13,14-dihydro-15-keto prostaglandin F2 alpha (PGFM), 6-keto F1 alpha and thromboxane B2 were measured by specific radioimmunoassay in samples of amniotic fluid from 22 multigravid patients during labour. Normal labour in 10 patients was associated with a significant increase of PGE, PGF and PGFM with close correlation to cervical dilatation (P less than 0.05). In the 12 patients with clinically delayed labour, in the absence of cephalopelvic disproportion, there were significantly lower PGF (P less than 0.002) and PGFM (P less than 0.05) concentrations obtained while no differences were observed in the other prostanoids measured. Administration of oxytocin to the latter group to enhance labour did not have any effect on the concentrations of prostaglandins obtained in spite of an improvement in intrauterine pressures and accelerated progress of labour.

6-Ketoprostaglandin F1 alpha↗
PubMed1979

Pelvic dimensions and the outcome of trial labour in Shona and Zulu primigravidas.

Pelvic contraction is very prevalent in Africa while radiological facilities to assess pelvic size and shape are seldom available. A trial of labour using simple guidelines on a cervicograph can enable the midwife to detect dysfunctional labour and can help medical staff to manage these problems. Radiological checks in 116 Black primigravid patients with dysfunctional labour demonstrated that an active trial of labour is accurate in determining which of these patients have marked disproportion requiring caesarean section, minimal disproportion requiring assisted delivery, or primary uterine inertia responding to oxytocic stimulation. The role of radiological pelvimetry in African obstetrics is discussed, and the radiological features of the Shona and Zulu pelves in this series are described.

Black or African American↗
PubMed1979

The effect of fetal head compression and fetal acidaemia during labour on human fetal cerebral function as measured by the fetal electroencephalogram.

We investigated the effect of head compression and acidaemia during labour in 25 African primigravidae. Evidence that head compression had occurred during labour was confirmed by both clinical and radiological means at the end of a trial of labour. No significant difference could be demonstrated in the quantity of fetal electroencephalogram (EEG) abnormality that occurred in the groups with marked head compression as compared to the groups without marked head compression. Deterioration in the fetal EEG to a flat record known as electrocerebral silence (ECS) was associated with the development of acidaemia. As fetal heart rate (FHR) decelerations appeared the percentage of ECS in the fetal EEG record increased significantly (P less than 0.05), and likewise, as fetal acidaemia developed a highly significant increase in ECS in the fetal EEG was demonstrated (P less than 0.001). We concluded that in the management of trial of labour there was no significant deleterious change in the fetal EEG as a result of head compression, unless fetal acidaemia supervened. However, in the majority of these cases a significant increase in ECS to more than 20 per cent occurred in association with only moderate acidaemia (pH 7.25 to 7.30).

Acidosis↗
PubMed1976

Induction of labour in Black patients.

The results of a prospective study of induction of labour in 175 Black patients are presented. They show that induction of labour in Blacks, even when performed with optimal care, is more hazardous than in other population groups, owing to an increased proportion of patients of high parity and an increased prevalence of cephalopelvic disproportion. The factors affecting the outcome of induction, the safety of induction and the criteria for a safer induction are discussed.

Black or African American↗
PubMed1976

Rupture of the uterus: the preventable factors.

A review of 50 cases of ruptured uterus revealed that important measures to prevent this serious complication are: good antenatal care; careful attention to patients who have had a previous Caesarean section; the correct management of cephalopelvic disproportion in the multigravida; the recognition of the serious hazards of internal version in the management of transverse lie; and careful attention to detail in the use of oxytocin in the multigravida. The factors that were regarded as critical in maintaining a low maternal mortality rate in rupture of the uterus are also reviewed.

Anesthesia, Obstetrical↗