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Biomedical subjects

R Jouppila

Publications and source records attributed to R Jouppila.

At least 73 records · Page 4Linked to original sources
PubMed1979

Segmental epidural analgesia in labour: related to the progress of labour, fetal malposition and instrumental delivery.

The effect of low-dose continuous segmental epidural analgesia given during the first stage of labour on the progress of labour, the frequency of fetal malpositions and the rate of vacuum extractions was studied prospectively in 100 parturients (epidural group). The results were compared with 100 parturients given none or conventional analgesia (control group). The results showed that in the primiparous epidural group the progress of labour before analgesia was induced was significantly slower than in the control group. After the block, however, the subsequent course of the labour was of equal duration in both groups. The durations of the second stages of labour did not differ significantly between the groups. The differences in fetal malpositions at delivery were statistically insignificant. Nor did the rate of vacuum extractions, 8% in the primiparous and 0% in the multiparous epidural group, differ statistically from the corresponding rate in the control groups. The results signify a normal progress and outcome of labour after low-dose segmental epidural analgesia.

Adolescent↗
PubMed1978

Placental blood flow during caesarean section under lumbar extradural analgesia.

The effect on intervillous blood flow of lumbar extradural analgesia for Caesarean section was studied in nine healthy women using xenon-133. Extradural anaesthesia was performed with lignocaine 1 1/2% 16--20 ml with adrenaline 5 microgram ml-1. Impairment of placental blood flow during the block was observed in seven patients, but the mean decrease (13% from the control value) was not statistically significant. The most notable decrease in intervillous blood flow occurred in two patients with simulateous arterial hypotension.

Anesthesia, Epidural↗
PubMed1978

Effect of segmental extradural analgesia on placental blood flow during normal labour.

Placental blood flow was measured during the first stage of normal labour using a xenon-133 clearance technique before and after segmental extradural analgesia. Analgesia was produced with 0.5% plain bupivacaine in eight patients and with 0.5% bupivacaine--adrenaline in 10 patients. Segmental extradural analgesia with a small dose (20 mg) of bupivacaine did not change placental blood flow significantly. The addition of adrenaline 20 microgram produced no effect.

Adolescent↗
PubMed1978

Neurologic activity of infants following anesthesia for cesarean section.

Elective cesarean section was performed in a consecutive series of 30 patients with full-term pregnancies who were not in labor. Epidural (lidocaine, 1.5 per cent, with epinephrine, 1:200,000) and general anesthesia (thiopental, nitrous oxide-oxygen, succinylcholine infusion) was used alternately. Neonatal acid-base values and Apgar scores showed no significant difference between the two anesthetic groups, and most infants were vigorous at birth. The neurologic recoveries of the infants showed no significant difference between the two groups. In the group receiving epidural anesthesia, there was a significant correlation between maternal hypotension and weak rooting and sucking reflexes of the infants during the first two days. All infants of high-risk obstetric patients in the series, independent of anesthetic technique used, had abnormal neurologic activity, as evidenced by either depression of muscle tone and the reflexes or all the tested variables. Neurologic assessment as followed in this series is a sensitive indicator of the effects of fetal stress factors acting during cesarean section.

Adult↗
PubMed1978

Maternal, foetal and neonatal blood creatine-phosphokinase-activities and creatine-phosphokinase-isoenzymes after labour with and without epidural analgesia and after caesarean section.

Maternal, cord and neonatal blood creatine-phosphokinase (CK) activities and CK-isoenzymes were determined in connection with 24 labours after normal pregnancies. In eight cases there was a normal vaginal delivery; in another eight cases there was a normal vaginal delivery with segmental epidural analgesia; and in the remaining eight cases there was an elective caesarean section under general anaesthesia. The lowest maternal blood CK-activities were seen in connection with caesarean section. There was a statistically significant difference in the maternal CK levels after delivery between cases with caesarean section and normal labour (P less than 0.05) and between cases with caesarean section and labour with segmental epidural analgesia (P less than 0.001). Most of the maternal CK-activity was of muscular type, and there were no statistically significant differences in isoenzyme fractions between the different groups. The neonatal blood CK-activities were at their peak at the age of 1 day in all groups. Between the groups there were no statistically significant differences in cord or neonatal blood CK-activities at any time. Most of the cord and neonatal blood CK-activity was also of muscular type, and there were no significant differences in the CK-isoenzyme fractions between the groups.

Adult↗
PubMed1978

Segmental epidural analgesia and postpartum sequelae.

The incidence of the postpartum sequelae of headache, backache, pain in the legs and difficulties in micturiton, was studied in 219 normal vaginal deliveries. 135 of the parturients received continuous segmental epidural analgesia at the level of Th 10--12 for pain relief during the first stage of labour. The remaining 84 parturients served as controls. The results showed that segmental epidural analgesia did not increase the occurrence of postpartum sequelae either in primiparous or in multiparous parturients.

Adolescent↗
PubMed1978

Maternal and foetal plasma bupivacaine concentrations in labour with segmental epidural analgesia.

Maternal and foetal plasma bupivacaine concentrations were assayed following segmental epidural analgesia during the first stage of 14 normal labours. Analgesia was accomplished with 20 mg of 0.5% bupivacaine. 10 mothers received only one dose and four mothers two doses. The maternal and foetal plasma bupivacaine levels remained very low and the foetomaternal ratios were about 1:4 during the labour. At delivery, the foeto-maternal ratio increased, showing that the decline of bupivacaine concentrations is slower in foetal than in maternal plasma.

Adult↗
PubMed1977

Segmental epidural analgesia and urinary excretion of catecholamines during labour.

Urinary excretion of catecholamines was determined separately during the first stage of labour and during the period from the beginning of the second stage until 1/2 h after delivery in 16 healthy mothers, whose labours were induced at term. Seven mothers were given segmental epidural analgesia, at the height of TH10-12, to achieve complete pain relief during the first stages of labour. The remaining parturients served as controls. During the first stage of labour the urinary excretion rate of catecholamines was at the normal nongravid rest level in both groups. During the second stage, and 1/2 h after the delivery, the amount of urinary catecholamines increased significantly in both groups. The latter values corresponded to the amounts of catecholamines excreted during heavy physicial work.

Adult↗
PubMed1977

Cyclic AMP and segmental epidural analgesia during labour.

The blood cyclic AMP level was determined just before, during and after induced labour in 27 healthy women. To achieve complete pain relief during the first stage of labour, 14 of them were given segmental epidural analgesia at the height of Th 10-12. The remaining parturients served as controls. Cyclic AMP was above the normal non-gravid level before induction in both groups. In the control group the cyclic AMP content decreased during the first stage of labour, then it increased and reached a peak at the moment of delivery. These changes were, however, not significant. In the epidural group the cyclic AMP level rose significantly during the first stage, and also reached its peak at the moment of delivery. There was a statistically significant difference between the groups at a cervical dilatation of 6-8 cm. After delivery the cyclic AMP rapidly declined to its initial value in both groups. The possible role of the decreased uterine contractions after the block in the increase of the cyclic AMP is discussed.

Adolescent↗
PubMed1977

Selective lumbar epidural block in labour. A clinical analysis.

Segmental epidural analgesia (T10-T12) was performed in 418 parturients, using a 4-6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3-5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.

Anesthesia, Epidural↗
PubMed1977

Fetal heart rate patterns and uterine activity after segmental epidural analgesia.

The effects of low-dose segmental epidural analgesia on fetal heart rate (FHR) patterns, uterine activity, and some clinical features were examined in a series of 105 normal parturients. The aim of the analgesic technique was to relieve pain during the first stage of labour by blocking the sensory nerve fibres at the spinal level of T 10 to T12, with either 0-5 per cent bupivacaine or bupivacaine with adrenaline 1 : 200 000, the dose varying from 10 to 25 mg. Obvious pathological changes (late decelerations, prolonged fetal bradycardia, variable deceleration, or loss of beat to beat variation) in FHR patterns within the first 30 minutes after the beginning of analgesia were noted in 9 per cent of the patients. Addition of adrenaline to the analgesic agent seemed to reduce uterine activity for 60 minutes after the analgesia and this was reflected in a longer interval between the block and delivery. A 25 per cent fall in systolic blood pressure was recorded in 11 per cent of the patients. Nine patients required vacuum extractions. Our results show that the epidural technique employed has distinct advantages over the previous methods, which require larger doses of the analgesic, agent, and is therefore safer for the fetus; the addition of adrenaline to the analgesic agent is contraindicated.

Anesthesia, Epidural↗
PubMed1976

The effect of segmental epidural analgesia on maternal and foetal acid-base balance, lactate, serum potassium and creatine phosphokinase during labour.

Maternal and foetal acid-base balance, PaO2, lactate, potassium and creatine phosphokinase (CPK) were studied during the course of 28 induced labours. Every second mother received segmental epidural analgesia during the first stage of labour (epidural group), while the remaining mothers (who were given pethidine for pain relief, if necessary) acted as a control group. In the epidural group the patients had only minimal changes in acid-base balance and lactate concentration during the first stage. During the second stage lactate concentration increased. In the control group, on the other hand, the acid-base balance showed signs of hyperventilation and lactic acid accumulation during the first stage. The potassium changes were quite minimal and were not significantly different between the groups. The CPK level did not change during labour, but 2 and 4 h after delivery it was significantly elevated in both groups. The foetal acid-base balance, potassium, lactate and PaO2 values revealed no differences between the groups at any time. The CPK level in umbilical venous blood was significantly higher in the epidural group.

Acid-Base Equilibrium↗
PubMed1976

The effect of labour on ACTH and cortisol levels in amniotic fluid and maternal blood.

Levels of adrenocorticotrophic hormone (ACTH) and cortisol were measured in amniotic fluid during labour and in maternal blood during and after labour. There was a significant rise of maternal ACTH and cortisol levels during labour and a significant decrease after delivery in all 14 patients studied. There were no significant changes in amniotic fluid ACTH and cortisol levels during labour. The initial level of ACTH in amniotic fluid (162-7 pg/ml) was higher than that in maternal circulation (120-2 pg/ml). The correlation between maternal and amniotic fluid ACTH was not significant while the corresponding correlation for cortisol values was.

Adrenocorticotropic Hormone↗
PubMed1976

The effect of segmental epidural analgesia on maternal growth hormone, insulin, glucose and free fatty acids during labour.

The maternal plasma HGH, insulin, glucose and FFA levels were determined during the course of induced labours in 28 healthy mothers. Every second patient was given segmental epidural analgesia for pain relief during the first stage of labour (epidural) group). The others acted as a control group. HGH did not change significantly during the labour in either group. Insulin decreased during the first stage of labour in both groups. This decrease was more pronounced and statistically almost significant in the control group. Thereafter the insulin increased in both groups. Glucose levels did not change during the first stage, but at the moment of delivery they were significantly higher than the initial levels in both groups. FFA levels became raised in both groups during labour, reaching a peak at the moment of delivery. The results are discussed in relation to stress and effectiveness of pain relief during the first stage of labour.

Anesthesia, Epidural↗
PubMed1976

The effect of segmental epidural analgesia on maternal ACTH, cortisol and TSH during labour.

Maternal plasma ACTH, cortisol and TSH concentrations were determined during the course of the induced labours of 20 normal parturients. Alternate mothers were given segmental epidural analgesia for pain relief during the first stage of labour. The remaining parturients served as controls. The ACTH level rose in same way in both groups, reaching its peak at the moment of delivery and decreasing rapidly thereafter. Cortisol secretion reached its maximum during the first stage of labour in the moment of delivery. After delivery the cortisol level decreased more rapidly in the epidural group tha. in the control gro,p. Umbilical venous cortisol concentration was the same in both groups. The maternal TSH level did not change significantly during labour in either group.

Adolescent↗