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Beta-adrenoceptor agonists and hypoxia in sheep fetuses.

https://arctichealth.org/en/permalink/ahliterature12285
Source
Acta Physiol Scand. 1989 Oct;137(2):291-9
Publication Type
Article
Date
Oct-1989
Author
A. Dagbjartsson
G. Herbertsson
T S Stefansson
M. Kjeld
H. Lagercrantz
K G Rosen
Author Affiliation
Department of Pediatrics, Landspitalinn University Hospital, Reykjavik, Iceland.
Source
Acta Physiol Scand. 1989 Oct;137(2):291-9
Date
Oct-1989
Language
English
Publication Type
Article
Keywords
Animals
Blood Pressure - drug effects
Female
Fetal Hypoxia - blood - drug therapy - physiopathology
Heart Rate - drug effects
Hemodynamic Processes - drug effects
Myocardial Contraction - drug effects
Pregnancy
Prognosis
Research Support, Non-U.S. Gov't
Sheep
Terbutaline - administration & dosage
Tocolysis
Abstract
Sheep fetuses, near term, were studied to test the influence of a tocolytic beta agonist, terbutaline, on fetal responses to hypoxia. After fetal exteriorization the drug was administered intravenously to the mother in three different doses: The max group comprised 11 ewes receiving 67-134 micrograms min-1. Seven ewes were given 30 micrograms min-1 and eight ewes were infused with 10 micrograms min-1. Seventeen fetuses served as controls. Hypoxia was induced by intermittent complete occlusions of the maternal abdominal aorta. Maternal terbutaline levels were high (range 50-748 nmol l-1) in the max group and the 30-micrograms group, whereas those in the 10-micrograms group were in the clinical range (range 11-58 nmol l-1). Fetuses in the max and 30-micrograms groups reacted to moderate hypoxia with excessive responses of heart rate, blood pressure myocardial contractility and ST waveform changes and a 50% mortality rate during severe hypoxia as compared with 12% in the control animals. Ten micrograms min-1 did not decrease the survival but caused an increase in myocardial workload and a negative energy balance during severe hypoxia.
PubMed ID
2618763 View in PubMed
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European Community multi-Center Trial "Fetal ECG Analysis During Labor": ST plus CTG analysis.

https://arctichealth.org/en/permalink/ahliterature63978
Source
J Perinat Med. 1999;27(6):431-40
Publication Type
Article
Date
1999
Author
R. Luzietti
R. Erkkola
U. Hasbargen
L A Mattsson
J M Thoulon
K G Rosén
Author Affiliation
Department of Obstetrics and Gynecology, University of Parma, Italy.
Source
J Perinat Med. 1999;27(6):431-40
Date
1999
Language
English
Publication Type
Article
Keywords
Acid-Base Equilibrium
Apgar score
Birth weight
Cardiotocography
Delivery, Obstetric
Electrocardiography
Europe
Female
Fetal Hypoxia - diagnosis - physiopathology
Fetal Monitoring
Gestational Age
Heart Rate, Fetal
Humans
Intensive Care, Neonatal
Labor, Obstetric
Pregnancy
Abstract
This report form part of the European Community Multi-Center Trial "Fetal ECG Analysis during Labor". Aim of this prospective trial was to identify changes in the fetal ECG waveform with cases of verified fetal hypoxia. In this paper we also report on the use of a newly developed automatic system for identification of ST waveform changes (ST Log). All ECG were recorded with the STAN recorder (Neoventa Medical AB, Gothenburg, Sweden). The ECG information was not displayed during labor in order not to influence the clinical management. This report includes data from 320 cases and include six cases of fetal intrapartum hypoxia. Twenty seven cases showed changes in ST waveform. All five cases with the most marked ST change (a rise in T/QRS of > 0.10 units and lasting more then 10 minutes) had signs of ongoing intrapartum hypoxia. Six out of six cases with evidence of intrapartum asphyxia, showed ST changes. On the basis of our multi-center trial it appears that the combined analysis of CTG and ST waveform changes provides an accurate way to identify adverse events during labor. The work is continuing with a new STAN recorder developed by Neoventa Medical in Göteborg and currently being tested in a Swedish randomized, controlled multi-center trial.
PubMed ID
10732301 View in PubMed
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STAN, a clinical audit: the outcome of 2 years of regular use in the city of Varberg, Sweden.

https://arctichealth.org/en/permalink/ahliterature162656
Source
Acta Obstet Gynecol Scand. 2007;86(7):827-32
Publication Type
Article
Date
2007
Author
Anna-Karin Welin
Håkan Norén
Anders Odeback
Mona Andersson
Gunnel Andersson
K G Rosén
Author Affiliation
Department of Obstetrics and Gynaecology, Varberg Hospital, Varberg, Sweden. anna-karin.welin@telia.com
Source
Acta Obstet Gynecol Scand. 2007;86(7):827-32
Date
2007
Language
English
Publication Type
Article
Keywords
Apgar score
Female
Fetal Blood - chemistry
Fetal Distress - diagnosis
Fetal Monitoring - instrumentation - methods
Heart Rate, Fetal - physiology
Humans
Infant, Newborn
Medical Audit
Pregnancy
Pregnancy outcome
Retrospective Studies
Sweden
Abstract
To monitor and analyze (audit) the introduction of the STAN methodology in a district hospital.
Retrospective study covering the total population of deliveries at term during 2004 and 2005.
1,875 out of 3,193 term pregnancies (59%) were monitored using the STAN fetal heart monitor (Neoventa Medical, Moelndal, Sweden) and the associated clinical guidelines. Cord metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were recorded.
The overall cesarean section rate was significantly reduced in the STAN group. Emergency (crash) cesarean sections were significantly reduced from 1.51% to 0.27% in the cardiotocography- and STAN-monitored groups, respectively (OR 0.18, 95% CI 0.07-0.49). When cesarean section was performed only because of non-reassuring cardiotocography, cord acid base was significantly higher, 7.26 versus 7.19 (p
PubMed ID
17611828 View in PubMed
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ST analysis of the fetal electrocardiogram during labor: Nordic observational multicenter study.

https://arctichealth.org/en/permalink/ahliterature58434
Source
J Matern Fetal Neonatal Med. 2002 Oct;12(4):260-6
Publication Type
Article
Date
Oct-2002
Author
I. Amer-Wåhlin
P. Bördahl
T. Eikeland
C. Hellsten
H. Norén
T. Sörnes
K G Rosén
Author Affiliation
Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden.
Source
J Matern Fetal Neonatal Med. 2002 Oct;12(4):260-6
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Acidosis - congenital - etiology
Cardiotocography - instrumentation
Diagnosis, Computer-Assisted - instrumentation
Electrocardiography - instrumentation
Female
Fetal Blood - chemistry
Fetal Hypoxia - complications - diagnosis
Fetal Monitoring - instrumentation
Heart Rate, Fetal - physiology
Humans
Hydrogen-Ion Concentration
Infant, Newborn
Labor, Obstetric
Nervous System Diseases - congenital - etiology
Observation
Practice Guidelines
Predictive value of tests
Pregnancy
Pregnancy outcome
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To assess the diagnostic power of cardiotocography (CTG) plus the ST interval of the electrocardiogram (ECG) clinical guidelines with combined fetal heart rate and ST waveform analysis of the fetal ECG recorded during labor, to identify an adverse labor outcome (neonatal neurological symptoms and/or metabolic acidosis). STUDY DESIGN: An observational, multicenter study was undertaken in 12 Nordic labor wards. A total of 573 women in labor were monitored using a prototype of the STAN S 21 recorder with fetal ECG data and computerized ST analysis. RESULTS: Fifteen cases of intrapartum fetal hypoxia identified from neurological neonatal symptoms and/or cord artery pH 12.0 mmol/l were recorded. All these cases were identified by CTG + ST clinical guidelines. Five developed neonatal symptoms and had ECG abnormalities during the first stage of labor and, of the remaining ten, eight showed ST changes during active pushing in the second stage. Another eight cases had acidemia only and normal neonatal outcome. Seven of these displayed CTG + ST abnormalities. The high sensitivity of CTG + ST to predict fetal acidosis was associated with a marked increase in positive predictive values compared with conventional CTG. CONCLUSION: The STAN clinical guidelines identify fetuses at risk of intrapartum asphyxia.
PubMed ID
12572595 View in PubMed
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ST-segment analysis of the fetal electrocardiogram improves fetal heart rate tracing interpretation and clinical decision making.

https://arctichealth.org/en/permalink/ahliterature63353
Source
J Matern Fetal Neonatal Med. 2004 Mar;15(3):181-5
Publication Type
Article
Date
Mar-2004
Author
M G Ross
L D Devoe
K G Rosen
Author Affiliation
Department of Obstetrics and Gynecology, Harbor-UCLA Research and Education Institute, Torrance, California 90501, USA.
Source
J Matern Fetal Neonatal Med. 2004 Mar;15(3):181-5
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Electrocardiography - methods
Female
Fetal Monitoring
Heart Rate, Fetal - physiology
Humans
Monitoring, Physiologic - methods
Pregnancy
Pregnancy Complications - diagnosis
Abstract
INTRODUCTION: Since its introduction into clinical use, the efficacy of electronic fetal heart rate (FHR) monitoring (EFM) has been questionable. This has been due partly to the marked variation in interpretation of the FHR pattern and subsequent decisions for obstetric intervention, (e.g., the need for prompt delivery). Current application of EFM is limited to the assessment of FHR patterns and uterine contractions. Recent development of higher-order FHR analysis has yielded monitoring systems that can add automated fetal electrocardiographic ST segment analysis to the standard FHR and uterine contraction information. Our goal was to evaluate the effect of adding ST segment analysis to standard FHR information on observer agreement for clinical decision making. METHODS: Seven practitioners who were trained and experienced in combined FHR and ST monitoring reviewed 51 fetal monitor tracings, ranging from 2 to 4 h in length. Reviews were conducted in two sessions and at different times. The first session presented only the FHR and uterine contraction information, following which the participants determined the time at which intervention (decision for operative vaginal or Cesarean section delivery) was indicated. In the second session, the participants were provided with a randomized sequence of the same tracings with the addition of ST segment information, as produced by the STAN monitor system (Neoventa Medical, Gothenburg, Sweden). Observer agreement was based on the proportion of participants who agreed on the need for an intervention, and the per cent agreement on the timing of the intervention within 20 min before or after the median time of intervention. RESULTS: Of the 51 cases included in this study there were ten fetuses with umbilical artery (UA) pH between 7.05 and 7.14, and nine with UA pH of
PubMed ID
15280144 View in PubMed
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