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PubMed1975

Ethrane anaesthesia for caesarean section.

Fifty patients scheduled for elective Caesarean section were anaesthetised with nitrous oxide, oxygen, relaxant, and 0,5 - 1,5% Ethrane. The mothers were tilted laterally throughout the operation. Analysis of the maternal blood gas status before induction and at delivery revealed a mild respiratory alkalosis with an associated metabolic acidosis. The mean modified Apgar score (Apgar minus colour) of the infants 1 minute after delivery, was 7/8. All infants achieved the maximum score at 5 minutes. Blood gas studies on umbilical cord blood indicated a relative lack of fetal acidaemia. The results suggest that Ethrane does not cause significant perinatal depression, and that fetoplacental exchange is well maintaned during anaesthesia. The anaesthetic was well tolerated by the mothers and there were no instances of factual recall, no cardiac arrhythmias were observed, no significant hypotension was encountered and blood loss was average.

Acidosis↗
PubMed1985

Meconium aspiration and fetal acidosis.

Meconium in labor is associated with increased perinatal morbidity and mortality. To identify the infants at risk, 53 women with moderate-to-thick meconium were followed in labor after obtaining baseline fetal scalp blood pH levels. Although 28 of the newborns (53%) exhibited an arterial cord pH of less than 7.25 at delivery, there were no significant predictive variables found in the electronic fetal monitoring score, Apgar score, or mode of delivery. Nine of the infants with a pH value of less than 7.25 had meconium below the vocal cords at delivery, but none in the infants with pH levels greater than or equal to 7.25. The P50 value for cumulative acidosis is 55 minutes, indicating a more rapid deterioration than an average-for-gestational-age fetus without meconium. Therefore, the presence of thick meconium implies that fetal stress must be avoided during labor, and early intervention is warranted when there is deviation from normal labor progress or fetal heart rate pattern.

Acidosis↗
PubMed1993

Family factors affecting the outcome of tuberculosis treatment in Taiwan.

Despite the progress of tuberculosis (TB) control, the failure of treatment mainly due to non-adherence to medical recommendations remains a major obstacle to the eradication of this disease in both industrialized and developing countries. We interviewed 397 active pulmonary TB cases (274 males and 123 females) in Taiwan and followed up their treatment outcomes. No significant differences were found between any of the groups of either sex on TB cognition scores. Positive correlations between cognition scores and compliance scores, between cognition scores and family apgar scores, and between compliance scores and family apgar scores were noted in this study. In males, the complete treatment group had a higher compliance score (mean +/- standard deviation = 13.45 +/- 2.80) and family apgar score (22.44 +/- 2.29) than the incomplete treatment group (11.61 +/- 3.21 and 14.77 +/- 3.92, respectively). In females, the complete treatment group had a higher cognition score (65.99 +/- 6.75), compliance score (13.65 +/- 2.55) and family Apgar score (22.78 +/- 2.30) than the incomplete treatment group (62.05 +/- 6.91, 11.70 +/- 3.04 and 14.84 +/- 3.80, respectively). In the logistic regression analysis, both the family Apgar score and compliance score were significantly related to the TB treatment outcomes. The subjects with a family Apgar score higher than 20 had a chance to complete treatment as high as 72-fold (95% confidence interval = 31.7-164.0) that of those with a score less than 20.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Systematic antepartum fetal evaluation ("Safe"). A concept for diagnosis of fetal function in threatened hypoxia].

TARGET: The significant aim of the study was to prove whether it makes sense to apply the classical approach of diagnostic procedures to the fetus. PATIENTS AND METHODS: In a group of a total of 534 singleton pregnancies we examined the value of various biochemical and biophysical tests for detecting the risk of perinatal hypoxia. The sequence and combination of the most decisive tests was considered as well as the different approach within the observation period. RESULTS: Maternal laboratory findings like HPL and E3 were significantly less predictive of growth disturbance and compromise than any biophysical test. A small fetal abdomen detected by ultrasound ("observation") is up to now the earliest and most reliable predictor of foetal growth disturbance, followed by Doppler measurements of the uteroplacental circulation ("examination of the chronic respiratory function"). Examination of the foetal heart-circulatory function with pulsed Doppler and the foetal cardiac frequency (CTG) are the procedures of choice to determine the risk of perinatal hypoxia following pre-selection of foetuses, which are too old or too thin. In these patients, additional stress tests have neither medical nor a diagnostic advantage compared to the published function tests. Amongst the variety of biophysical tests, the Apgar score ("fetal Apgar score") was superior to all other tests in predicting prenatal or perinatal hypoxia and might even prevent invasive procedures. CONCLUSION: The sequence from non-invasive biophysical tests, including the fetal Apgar score, to invasive procedures is recommended for screening and follow-up of preselected pregnancies at risk for perinatal hypoxia. This approach might be applied to other risk groups and will hopefully be supplemented by new noninvasive diagnostic tools allowing early prognosis and prevention of fetal and neonatal disease.

Asphyxia Neonatorum↗
PubMed2002

A weighted risk index for antenatal prediction of perinatal outcome.

OBJECTIVE: The hypothesis is that a risk score derived from the risk index (RI) is correlated with perinatal outcomes. STUDY DESIGN: The RI is a weighted numerical score based on gestational risk factors applied to 782 gravidas antepartum. Management was independent of the score. Birth weight, Apgar scores, and cesarean birth were correlated with risk score. RESULTS: The break point score in this non-Gaussian cohort was 6. Using 6, 80.2% were low and 19.8% high risk. Birth weight < 2500 gm was inversely correlated (p < .001) and occurred in 13% of the high risk ((3)6) and 4.9% of the low risk (< 6) group, relative risk (RR) 2.7. C-section correlated (p < .001), and occurred in 51% of the high and 23% of the low risk group, RR 2.4. risk score inversely correlated with 5 minute Apgar (RR 4.7 p < .002) but not the 1 minute Apgar score. CONCLUSION: The RI identified gravidas at risk for low birth weight, low 5 minute Apgar score, and cesarean birth.

Adolescent↗
PubMed1980

Fetal activity determination and neosynephrine test for evaluation of fetal well-being in high risk pregnancies.

At the special outpatient clinic for high risk pregnancies, a total of 197 patients were evaluated with fetal activity acceleration determination (FAD) as a non stress test. FAD was done on 197 patients, of these there were 8 fetal distress (4.7%) and 3 low Apgar scores (1 minute Apgar score less than 6) (1.8%) of 169 positive FAD, on the other hand, 14 fetal distress (50%) and 10 low Apgar scores (35.7%) of 28 negative FAD. Neosynephrine Test was performed in 62 cases as a stress test and the correlation between these two tests was evaluated. In 51 instances FAD was positive and the simultaneous Neosynephrine Test was normal. In 2 cases of negative FAD with positive Neosynephrine Test, there were 2 fetal distress (100%) and 2 low Apgar scores (100%). All the two tests are reliable for fetal evaluation in high risk pregnancies, because FAD and Neosynephrine Test are less time consuming and have fewer contraindications. It is concluded that the combination of these two tests are the most useful screening methods for fetal evaluation in high risk pregnancies.

Evaluation Studies as Topic↗
PubMed1997

[The family function of patients on home oxygen therapy and their main caregivers].

We examined family APGAR scores in patients on home oxygen therapy (n = 101) and their main caregivers (n = 91), and compared them with those obtained from members of a seniors' club who were not on home oxygen therapy themselves, nor had any family members on home oxygen therapy. Furthermore, the relationship between the main caregivers recognition of the patients' mental state and the patients' CESD score was examined. Family APGAR scores for the main caregivers were significantly lower than those of the patients (p < 0.002), or the seniors' club members (p < 0.004). Since most the main caregivers were women, we compared family APGAR scores of the female main caregivers and the age-matched female members of the seniors' club, revealing that the satisfaction of the female main caregivers with the "adaptation" component of the APGAR score (the component dealing with support given when something troublesome happens), was significantly lower than that of the members of the seniors' club (p < 0.0001). The CESD of the patients whom the main caregivers recognized as depressed was significantly higher. Thus, we concluded that satisfaction of the main caregivers with family function who were family members was low, and that the role of the main caregivers is important in alleviating the depression of patients on home oxygen therapy.

Aged↗
PubMed2002

Correlating head-to-body delivery intervals with neonatal depression in vaginal births that result in permanent brachial plexus injury.

OBJECTIVE: The purpose of this study was to evaluate which variables predict neonatal depression in vaginal deliveries that result in permanent brachial plexus injury. STUDY DESIGN: With the use of a data set of litigated vaginal deliveries (n = 103 deliveries) from 1978 through 1999 that resulted in permanent brachial plexus injury, detailed delivery and neonatal and pediatric information was obtained by chart review. Neonatal depression was defined as a 5-minute Apgar score of <7. Data that were extrapolated from neonates with low Apgar scores at 5 minutes were compared with neonates with Apgar scores of > or =7 with the use of the Fisher exact test, chi(2) test, or one-way analysis of variance; a two-tailed probability value of <.05 was considered significant. RESULTS: Nine of 89 neonates (10%) had low 5-minute Apgar scores. Head-to-body delivery intervals (available for 36 deliveries) were significantly longer in neonates with 5-minute Apgar scores of <7 vs > or =7 (294 +/- 68 seconds vs 147 +/- 82 seconds, P <.001). Differences in other clinical variables (ie, maternal weight, gestational age, diabetes mellitus, parity, birth weight, and sex) were not significant. None of the infants in this data set, which includes those infants with neonatal depression) died or had long-term asphyxia-related sequelae in the form of speech impediments, seizures, cerebral palsy, coma, or organ dysfunction. CONCLUSION: The head-to-body delivery interval was the only significant factor in the prediction of 5-minute Apgar score of <7 in a data set of deliveries that resulted in permanent brachial plexus injury. Despite extended times (< or =6 minutes) on the perineum that resulted in a higher reduced Apgar score rate, there was no asphyxia-related morbidity.

Apgar Score↗
PubMedDate not supplied

[The value of the cardiotocographic index in the 2d stage of labor].

In the analysis of sixty five (65) cardiotocographic patterns performed at least half an hour before delivery of the child, the authors have used Kuvacić's CTG score in the second stage of labour as well as Hammacher's CTG score. The cardiotocographic patterns were evaluated on the basis of Kuvacić's CTG score for the second stage of labour and the fetal blood acid-base condition was observed. The authors obtained some statistically important correlation coefficients between CTG score and the values of the pH, pCO2 and BE in the blood of fetal umbilical artery and between CTG score and Apgar score after one and five minutes. Out of obtained results the authors have concluded that Kuvacić's CTG score for the second stage of labour is as precise as Hammacher's score, but is more simple.

Adult↗
PubMed1979

[Intrapartum fetal heart rate patterns and fetal outcome: prediction of newborn depression (author's transl)].

A statistically significant correlation exists between patterns of fetal heart rate (FHR) and neonatal state. However, the prognostic value of alterations of FHR for the individual has not been established. In 812 deliveries, we analyzed FHR tracings of the 30 minutes preceding delivery and correlated 6 characteristics of baseline, 10 of floating line and 6 of oscillation type with the incidence of severe acidosis (pH of umbilical cord artery less than or equal to 7.10) and low Apgar scores (one minute Apgar score less than or equal to 6). The exact risk for neonatal depression was calculated for each pattern of FHR. A high rate of depressed infants could be expected when the following alterations of FHR were seen during the last 30 minutes before delivery:--mild tachycardia, severe bradycardia,--severe variable decelerations, uniform late decelerations,--oscillation frequency less than 2 per minute independent of oscillation amplitude.

Acidosis↗
PubMed1999

Is paracervical block safe and effective? A prospective study of its association with neonatal umbilical artery pH values.

BACKGROUND: Paracervical blocks (PCBs) relieve labor pain, but reports of associated complications have caused many physicians to question their safety. METHODS: We designed a prospective observational study to examine the association between PCBs and umbilical artery hydrogen ion concentration (pH) values. A total of 261 healthy women in labor were recruited from a community hospital. Physicians used 1% lidocaine for the PCBs. We used multivariate linear regression to model predictors of umbilical artery pH at birth. RESULTS: Of the women studied, 238 (91%) received analgesia during labor (nalbuphine, PCB, pudendal, caudal, or epidural). Of these, 126 (48%) received at least one PCB (191 were given), and 197 (76%) received at least one dose of nalbuphine (237 were given). Univariate analyses showed no significant differences in mean 1-minute Apgar scores, 5-minute Apgar scores, umbilical artery pH, resuscitation with oxygen by mask, or length of newborn stay according to either PCB or nalbuphine exposure. Factors significantly associated with lower umbilical artery pH in a linear regression analysis included longer second stage of labor (-0.032 pH units for each 1-hour increase; 95% confidence interval [CI], -.046 to -.018), pudendal block (-0.022; 95% CI, -.040 to -.004), intrauterine pressure catheter use (-0.029; 95% CI, -0.053 to -.006), nuchal cord (-0.027; 95% CI, -.051 to -.004), and midforceps delivery (-0.080; 95% CI, -.159 to .000). Increasing maternal age and induction with either artificial rupture of membranes or gel were associated with higher umbilical artery pH values. CONCLUSIONS: After adjusting for other variables, neither PCB nor nalbuphine use were associated with umbilical artery pH at birth. PCBs using 1% lidocaine injected superficially should be considered a safe and effective form of obstetric analgesia. PCBs may be especially useful for women giving birth in hospitals where other obstetric anesthesia services are not readily available.

Acid-Base Equilibrium↗
PubMed1996

Breech infants: vaginal or cesarean delivery?

BACKGROUND: This study was undertaken to determine whether planned vaginal or elective cesarean delivery is better for singleton term breech infants and their mothers. METHODS: We studied deliveries of 388 singleton term breech infants that were born in our teaching hospital in Vienna. We follow well defined criteria for vaginal delivery versus cesarean section of term breech fetuses. We thus compared 280 (72%) cases scheduled for vaginal delivery with 108 (28%) scheduled cesarean sections with regard to neonatal mortality and morbidity, including Apgar score, umbilical artery pH, and postpartum maternal morbidity. RESULTS: Vaginally delivered fetuses of primiparas had lower five-minute Apgar scores (5% < Apgar 7) and a lower umbilical artery pH (39% below 7.2). This is significantly different from the abdominally delivered primiparas (no Apgar below 7, only 11% with an artery pH below 7.2). Multiparas did not show significantly different results with regard to Apgar scores and umbilical artery pH between the different modes of delivery. Postpartum maternal morbidity was not different between the two groups. CONCLUSION: The results suggest that planned vaginal delivery of singleton breech infants of primiparas result in newborns with lower Apgar-scores, a lower umbilical artery pH and a poorer fetal outcome. On the other hand, it seems that singleton term infants of multiparas do not profit from cesarean delivery.

Adolescent↗
PubMed1979

HCS, estriol and oxytocinase in maternal serum and neonatal condition in high risk pregnancies.

In order to find a reliable index of fetal wellbeing, maternal estriol, hCS and oxytocinase levels were related with condition of the neonate. Fifty six high risk pregnancies were studied. Estriol and hCS were determined by specific radioimmunoassay and oxytocinase with a colorimetric method. The condition of the newborn was evaluated by the APGAR score. Neonates were divided into two groups, depressed (APGAR score 0-6) and vigorous (APGAR score 7-10). When the mean birthweights of both groups were statistically different, maternal estriol levels were corrected to avoid the influencing factor of newborn weight. Mean maternal estriol level corresponding to vigorous newborns was 46.73 ng/ml. This value was statistically higher than that corresponding to the group of depressed newborns, which was 26.25 ng/ml (Fig. 1). The mean birthweight of depressed infants (2,382.75 g) was statistically lower than that of the vigorous group (3,044.75 g). The corrected mean maternal estriol values of vigorous neonates (45.44 ng/ml) was different from that of depressed ones (25.14 ng/ml) (Fig. 2). When patients were divided according to maternal diseases (diabetes, vascular pathology, Rh sensitization) serum estriol levels of the mother were statistically different according to the Apgar score of the newborns. There was no significant difference between serum hCS and oxytocinase levels of mothers with depressed and vigorous newborns. Discarding fetal weight as an influencing factor in maternal hormone level, our results indicate the suitability of maternal serum estriol determinations to predict condition of the newborns in high risk pregnancies.

Aminopeptidases↗
PubMed1993

Evaluation of the fetal assessment score in pregnancies at risk for intrauterine hypoxia.

OBJECTIVE: Our purpose was to define the diagnostic value of a new fetal assessment score that is based on each of the components of the Apgar score. STUDY DESIGN: A fetal assessment score was established to study the main fetal vital functions: (1) cardiovascular (heart rate, color of the skin in the Apgar score), now based on fetal heart rate patterns and Doppler assessment of fetal blood flow redistribution, (2) fetal respiratory (quality of breathing in the Apgar score), now based on Doppler assessment of uteroplacental perfusion, and (3) neuromuscular function (tone and reflexes in the Apgar score), now based on fetal tone and response to external stimuli. The fetal assessment score was used in the study of 110 postdate pregnancies and 103 small-for-gestational-age infants and was compared with the traditional biophysical profile score in the prediction of perinatal outcome. RESULTS: There were significant associations between both the fetal assessment score and the biophysical profile score with fetal distress that necessitated operative delivery, low Apgar scores, and low umbilical cord arterial blood pH. However, receiver-operator characteristic plots demonstrated that the fetal assessment score was superior to the biophysical profile score in predicting fetal distress and low Apgar values particularly in the small-for-gestational-age infants. The best single parameters in predicting fetal distress were the amniotic fluid volume in the biophysical profile score and fetal heart rate patterns and pulsed Doppler measurements in the new score. CONCLUSION: A fetal Apgar score in which respiration is assessed by placental perfusion rather than chest movements and in which skin color is assessed by centralization of fetal blood flow may be better than the traditional biophysical profile score in predicting fetal hypoxic compromise.

Apgar Score↗
PubMed1993

[The intensity of fetal movements vs. amnioscopy and cardiotocography in assessing fetal well-being].

In 1989 at the Hospital Civil of Guadalajara we make a study with 100 patients with a term pregnancy, initial labor and alive fetus. At all women we practiced interrogatory about subjective intensity of fetal movements, amnioscopy and cardiotocographic registry and we compare results with Apgar score of the newborns at minute and five minutes. The fetal movements were normal in 91% of which 95.7% had Apgar score > or = 7 at minute and 98.9% Apgar score > or = 8 at five minutes; clear amniotic fluid in 75% of which 94.6% had Apgar score > or = 7 at minute and 100% had Apgar > or = 8 at five minutes and 94% with normal cardiotocographic registry of which 95.7% had Apgar score > or = 7 at minute and 100% had Apgar score > or = 8 at five minutes. In the distress fetal prediction, the best method was the cardiotocography and the worse was the meconial amniotic fluid. We conclude that the subjective intensity of fetal movements are similar in the well-being fetal prediction to the amnioscopy and cardiotocography and the physicians must use it in the obstetric care.

Adolescent↗
PubMed2006

[Clinical study on improving the diagnostic criteria for neonatal asphyxia].

OBJECTIVE: Diagnosing neonatal asphyxia solely according to Apgar score may lead to misdiagnosis. The aim of this study was to explore new and more accurate diagnostic criteria for neonatal asphyxia. METHODS: Totally 10 376 live born neonates in our hospital were consecutively enrolled into the study. The following five items related to birth asphyxia, i.e., antepartum high-risk factors, Apgar scores, umbilical artery blood pH, organ injury, differential diagnosis on the causes of low Apgar score cases were examined and registered. The relationship among the first 4 items were analyzed. By differential diagnosis, the sensitivity and specificity of each index on diagnosing asphyxia and their complementary value on each other were investigated. RESULTS: The items correlated well with each other (P < 0.01 or < 0.05) but were not entirely parallel and consistent; they could complement but could not substitute for each other. The sensitivity of antepartum high-risk factors, low Apgar scores, umbilical artery blood pH < 7.00 and organ injury was 100%, 100%, 44.44% and 100%, while the specificity was 17.99%, 98.90%, 96.05% and 96.62%, respectively. Of the 230 low Apgar score cases in this series only 50.9% coincided with asphyxia. For the 230 cases, when low Apgar score was combined with umbilical artery blood pH < 7.00, the sensitivity and specificity were 41% and 99.1% and when low Apgar score was combined with umbilical artery blood pH < 7.20, the sensitivity and specificity were 100% and 29.20%, respectively. After organ injury was added, the specificity was increased to 65.49%. When differential diagnosis was further added to exclude the other causes of low Apgar score cases, the misdiagnosis rate was minimized. CONCLUSION: Up to now, no single accurate index for diagnosing neonatal asphyxia is available. In order to increase diagnostic bases and reduce misdiagnosis, the criteria of sole Apgar score should be replaced by multi-index diagnostic criteria. Based on the present study, a set of integrated diagnostic criteria for neonatal asphyxia is proposed: (1) prenatal high-risk factors, (2) low Apgar scores (respiratory depression must present), (3) umbilical artery blood pH < 7.00, if only pH < 7.20, the items (2) (4) (5) must be present, (4) hypoxic-ischemic organ injury (at least one organ dysfunction), (5) the other causes of low Apgar scores should be excluded. The last 4 indexes should all be met and the first one serves as reference. If multi-organ (three or more organs) dysfunction and (or) hypoxic-ischemic encephalopathy are present, severe asphyxia can be diagnosed.

Apgar Score↗
PubMed2006

A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neonatal effects.

PURPOSE: Analgesia and sedation, routinely used as adjunct medications for regional anesthesia, are rarely used in the pregnant patient because of concerns about adverse neonatal effects. In an effort to obtain more information about maternal analgesia and sedation we studied neonatal and maternal effects of iv fentanyl and midazolam prior to spinal anesthesia for elective Cesarean section. METHODS: In this double-blinded, randomized, placebo-controlled trial, 60 healthy women received either a combination of 1 microg x kg(-1) fentanyl and 0.02 mg x kg(-1) midazolam intravenously or an equal volume of iv saline at the time of their skin preparation for a bupivacaine spinal anesthetic. Sample size was based on a non-parametric power analysis (power > 0.80 and alpha = 0.05) for clinically important differences in Apgar scores. Fetal outcome measures included Apgar scores, continuous pulse oximetry for three hours, and neurobehavioural scores. Maternal outcomes included catecholamine levels, and recall of anesthesia and delivery. RESULTS: There were no between-group differences of neonatal outcome variables (Apgar score, neurobehavioural scores, continuous oxygen saturation). Mothers in both groups showed no difference in their ability to recall the birth of their babies. CONCLUSIONS: Maternal analgesia and sedation with fentanyl (1 microg x kg(-1)) and midazolam (0.02 mg x kg(-1)) immediately prior to spinal anesthesia is not associated with adverse neonatal effects.

Adult↗