American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 1991
Case Reports Comparative StudyNeonatal complications at term as related to the degree of umbilical artery acidemia.
The degree of umbilical arterial acidemia associated with immediate newborn morbidity has not been determined. Therefore we compared 358 term infants with umbilical artery acidemia (pH less than 7.20) with 358 term, nonacidotic matched control infants, to evaluate immediate neonatal complications in both groups. Nonacidotic was defined as an umbilical artery pH greater than or equal to 7.20. ⋯ None of the 693 newborns with an umbilical artery pH greater than or equal to 7.00 had such complications. Two of 23 infants with an umbilical artery pH less than 7.00 had sequelae related to intrapartum asphyxia. In these two infants the umbilical artery pH was less than 7.00, the 1-minute and 5-minute Apgar scores were less than or equal to 3 and the acidemia was metabolic in nature.
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Am. J. Obstet. Gynecol. · Feb 1991
The hemodynamic effects of intubation during nitroglycerin infusion in severe preeclampsia.
The effectiveness of intravenous nitroglycerin infusion in lowering maternal blood pressure and in blunting the hemodynamic responses to endotracheal intubation was evaluated in six primigravid women with severe preeclampsia. Monitoring consisted of continuous electrocardiogram monitoring, arterial cannulation, and flow-directed pulmonary arterial catheterization in each patient. ⋯ Intravenous nitroglycerin was administered before induction of general anesthesia. The hemodynamic effects associated with endotracheal intubation revealed a change in the heart rate from 104 +/- 10 to 133 +/- 17 beats/min, an increase in mean arterial pressure from 134 +/- 12 to 164 +/- 32 mm Hg, and an increase in systemic vascular resistance from 1262 +/- 342 to 1351 +/- 259 dynes-sec-cm-5 that was accompanied by a small change in the cardiac index from 4.5 +/- 1.2 to 4.5 +/- 0.9 L.min-1.m-2.
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Am. J. Obstet. Gynecol. · Dec 1990
Randomized Controlled Trial Comparative Study Clinical TrialInduction of labor with pulsatile oxytocin.
In a prospective, randomized study, 106 patients underwent induction of labor with either pulsed (every 8 minutes) (n = 50) or continuous (n = 56) intravenous infusion of oxytocin. Maternal characteristics, gestational age at induction, induction-delivery interval, analgesia for labor, cesarean section rates, and newborn characteristics were similar in both groups. The mean +/- SEM total oxytocin administered was significantly less in the pulsed group (3564 +/- 487 mU) than in the continuous group (7684 +/- 844 mU; p less than 0.0001); the average dose of oxytocin administered per minute was significantly lower in the pulsed group (3.9 +/- 0.3 mU/min) than in the continuous group (7.8 +/- 0.4 mU/min; p less than 0.0001); the peak or highest administered dose of oxytocin expressed per minute was also signficantly lower in the pulsed group (9.6 +/- 0.8 mU/min) than in the continuous group (14.1 +/- 0.7 mU/min; p less than 0.0001). ⋯ Uterine hyperstimulation occurred infrequently in both groups (3.6% to 4.0%). The pulsed group required a significantly smaller infusion volume (25 +/- 14 ml) than the continuous group (780 +/- 84 ml; p less than 0.0001). Thus pulsatile administration uses significantly less oxytocin and infusion fluid but is as effective and safe as continuous infusion.