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Showing papers by "John Radcliffe Hospital published in 1977"


Journal ArticleDOI
TL;DR: Postmortem brain weight and head circumference were measured in 485 fetuses and newborn infants and a cubic relationship was demonstrated between these two variables in normal infants.

190 citations


Journal ArticleDOI
TL;DR: A method of extra‐amniotic prostaglandin administration to achieve ripening of the cervix as a preliminary to induction of labour achieved a 25 per cent reduction in the length of the induced labour, a fall in the incidence of maternal pyrexia and fetal distress, an improvement in neonatal condition of the infants and a Reduction in the need to resort to Caesarean section.

188 citations


Journal ArticleDOI
TL;DR: There was a reduction in menstrual blood loss in the first period following uterine curettage but no effect thereafter, compared to women with normal menstrual loss.

150 citations



Journal ArticleDOI
TL;DR: The concept of pre-eclampsia may need to be widened to include a non-hypertensive syndrome characterised by these changes in clotting and renal function, particularly when measured by increases in plasma-urate.

130 citations


Journal ArticleDOI
TL;DR: The hypotensive effect of methyldopa was similar to its action in non‐pregnant individuals and greatly reduced the frequency of severe hypertension occurring antenatally and in labour.

123 citations


Journal ArticleDOI
TL;DR: The results suggest that some pregnant women who will deliver low-birth-weight infants at high risk of perinatal death may be identified by means of serum-A.F.P. measurement early in pregnancy.

119 citations


Journal ArticleDOI
TL;DR: The ratio of factor VIII-related antigen/factor VIII biological activity may be a useful indicator of hypercoagulability or intravascular coagulation, and a measure of the efficacy of steady state anticoagulation.

88 citations


Journal ArticleDOI
TL;DR: Levels of prostaglandin F and its major circulating metabolite 13,14‐dihydro‐15‐keto‐PGF (PGFM) have been measured in amniotic fluid during spontaneous labour at term and they were significantly higher during early spontaneous labour than before the onset of labour.

80 citations


Journal ArticleDOI
TL;DR: Heat treatment of pooled drip milk with a semi-automated holder pasteurizer caused a 21% reduction in IgA concentration and a 36% reduced in lysozyme activity, as well as a decrease in the ability of the milk to inhibit the growth of E. coli.

73 citations


Journal ArticleDOI
TL;DR: Comparison of the numbers of F-cells with the percentage haemoglobin F determined chemically indicated that the increase in maternal ha Hemoglobin F synthesis results from an increased production of F -cells rather than from anincreased synthesis of haenoglobin F by the F- cells.

Journal ArticleDOI
TL;DR: The growth and development of three groups of infants were prospectively assessed from birth to 12 mth, and the dangers of assessing the effects of different pregnancy conditions in terms of neonatal mortality and morbidity alone are drawn attention.

Journal ArticleDOI
TL;DR: In both hypertensive groups there was a higher incidence of clinical signs of possible fetal distress and instrumental delivery, and the treated hypertensive group had an excess of infants with relatively smaller head circumferences for their gestational age compared with both the untreated hypertensive Group and the hospital sample.

Journal ArticleDOI
TL;DR: With correct use of CPAP, and improvement in oxygenation generally occurs without obvious adverse cardiorespiratory effects, CPAP must nevertheless be used cautiously and in conjunction with close monitoring; because when the appropriate pressures are exceeded, it is possible that both circulatory and ventilatory function might be severely compromised.
Abstract: A method of investigating the cardiorespiratory responses to continuous positive airway presslre (CPAP) in infants with respiratory distress syndrome is described. All measurements were made immediately before and within five minutes of application or any change in level of CPAP. Ventilation was derived from a pneumotachograph and dynamic compliance calculated. We have also measured arterial pH, oxygen and carbon dioxide tensions, arterial blood pressure and central venous pressure. Arterial oxygen tension increased in association with a decrease in the alveolar-arterial oxygen gradient. No consistent changes occurred in pH or carbon dioxide tension. Heart rate and mean arterial blood pressure remained the same but the arterial pulse pressure narrowed and the increase in central venous pressure averaged 17% of the applied airway pressure. There were less variations in both tidal volumes and instantaneous respiratory rates with CPAP compared with spontaneous breathing without CPAP. The respiratory rate decreased, but there were no consistent changes in tidal volume, resulting in a lesser reduction of minute ventilation. Dynamic compliance decreased on CPAP. With correct use of CPAP, and improvement in oxygenation generally occurs without obvious adverse cardiorespiratory effects. CPAP must nevertheless be used cautiously and in conjunction with close monitoring; because when the appropriate pressures are exceeded, it is possible that both circulatory and ventilatory function might be severely compromised.

Journal ArticleDOI
TL;DR: Concentrations of free arachidonic acid have been measured by gas liquid chromatography in amniotic fluid obtained during spontaneous labour at term and showed no significant relation to concentrations of either prostaglandin F or 13,14‐dihydro‐15‐keto‐prostagland in F.

Journal ArticleDOI
TL;DR: Cortisol may function as a tuner that synchronizes and coordinates those maturational processes needed for extrauterine life in the absence of a prepartum glucocorticoid surge.
Abstract: Some of the mechansims by which fetal adrenal growth and steroidogenesis are stimulated during late pregnancy are discussed and some of the functions of the increase in cortisol production particularly in relation to the initiation of parturition and to the maturation of organ systems necessary for extrauterine life are considered. In sheep there is a gradual rise in the concentration of cortisol in fetal plasma beginning 10-15 days prepartum with a more rapid increase during the last 2 or 3 days of gestation. This increase in cortisol is abolished by fetal hypophysectomy. The fetal adrenal can be stimulated to secrete cortisol by the continuous infusion of ACTH into the fetus for 2-5 days; this leads to premature parturition. In humans a decrease in the concentration of ACTH in cord plasma during late pregnancy has been reported. A good correlation has also been demonstrated between the concentration of prolactin in fetal plasma and growth of the fetal adrenal glands. In sheep the increase in fetal cortisol production during the last 7-10 days of pregnancy is closely followed by a decrease in progesterone during the last 1-4 days and by an increase in unconjugated estrogen during the last 24 hours of gestation. The increase is estrogen is associated with an increase in prostaglandin production and with the onset of active labor. In primates there is a greater degree of permeability to cortisol than in domestic animals and there is no evidence for placental enzyme induction or activation. Cytosol and nuclear binding sites for glucocorticoids appear in fetal lung tissue before the appearance of surfactant in alveolar speces. In human fetal lung glucocorticoid receptors have been demonstrated by 9 weeks of gestation. Glucocorticoids are known to be involved in the maturation and biochemical differentiation of other tissues in the fetus. Many of the changes attributed to cortisol will proceed although at a slower rate in the absence of a prepartum glucocorticoid surge. Cortisol may function as a tuner that synchronizes and coordinates those maturational processes needed for extrauterine life.

Journal ArticleDOI
TL;DR: The rate of clearance of the heightened plasma activity could not be shown to differ from that of ‘ordinary’factor VIII infused into haemophiliacs, and among the biochemical responses, the only significant difference between the drugs was that lactate rose after adrenaline and salbutamol but did not change after isoprenaline.
Abstract: Adrenaline, isoprenaline and salbutamol were administered by intravenous infusion to human subjects. Isoprenaline was covered with practolol in an attempt to reduce the unpleasantness of the circulatory effects. Changes were recorded in pulse rate and blood pressure, and in blood levels of factors V, VIII, X, XI, and XII, platelet count, lactate, pyruvate, potassium and free fatty acids. Factor VIII was studied by clotting assays, by reactions with two rabbit antisera and two human antibodies, and by desulphated agarose chromatography. At the rate at which they were adiminstered, all three drugs increased the pulse rate by 20-40 beats/min. Factor VIII rose c. 2.5 X with adrenaline but only c. 1.5 X with isoprenaline and salbutamol; but other clotting factors did not alter. Chromatography provided no evidence of a change in the size of the molecule carrying factor-VIII clotting activity. The rate of clearance of the heightened plasma activity could not be shown to differ from that of "ordinary" factor VIII infused into haemophiliacs. The platelet count rose after adrenaline, fell after salbutamol and did not change significantly after isoprenaline. Among the biochemical responses, the only significant difference between the drugs was that lactate rose after adrenaline and salbutamol but did not change after isoprenaline. The rise in factor-VIII clotting activity after adrenaline is considered to represent a real increase in blood concentration, presumably by release of additional factor VIII from stores. The evidence suggests that this could be classified as a beta2 effect; and that the quantity which can be released is unrelated to the current plasma level. The rise in platelet count produced by adrenaline may be the resultant of an alpha-mediated rise due to contraction of the exchangeable splenic pool and a beta2-mediated fall, the alpha effect predominating.

Journal ArticleDOI
TL;DR: It is suggested that high levels do not predict the development of abortion in women who have not already threatened to abort, and when maternal serum AFP levels are used to screen for fetal neural tube defects, women referred for a diagnostic amniocentesis on account of a high level are unlikely to have been selected on the basis of a tendency to abort.

Journal ArticleDOI
TL;DR: The value of measuring plasma urate and serum deoxycytidylate deaminase for the early diagnosis of pre-eclampsia has been investigated in 45 patients as discussed by the authors.

Journal ArticleDOI
TL;DR: The apparently rapid change in prostaglandin concentrations in amniotic fluid in response to amniotomy strongly supports a local control of these compounds within the pregnant uterus.


Book
01 Aug 1977

Journal ArticleDOI
TL;DR: The maternal cotyledon contained the highest concentrations of PGF, but the fetal cotYledon was the only tissue exhibiting a statistically significant rise in the concentration of P GF following labour.

Journal ArticleDOI
TL;DR: The levels of prostaglandins in these fluids were similar in ewes bearing hypophysectomized fetuses, and there was no correlation between the level of prostglandins found in each fluid.

Journal ArticleDOI
TL;DR: This is the 1st time delivery was induced by progesterone withdrawal without affecting estrogen in ewes inducing a chronic elevation in plasma PFGs.

Journal ArticleDOI
TL;DR: There is high-affinity, limited-capacity binding of cortisol in human amniotic fluid; the protein-binding characteristics resemble those of corticosteroid binding globulin (CBG) and are distinct from the testosterone-binding globulin.


Journal ArticleDOI
TL;DR: Triploidy, 69,XXY, was found in a newborn with multiple abnormalities; the infant carried a pair of 21s with giant satellites; of the parents, only the father carried a giant-satellited 21.
Abstract: Triploidy, 69,XXY, was found in a newborn with multiple abnormalities. Conception had occurred shortly after the mother ceased taking an oral contraceptive. The infant carried a pair of 21s with giant satellites; of the parents, only the father carried a giant-satellited 21. This, together with the XXY constitution, suggested a dispermic origin of the triploidy.

Journal ArticleDOI
TL;DR: The volume of gas in this embolus would have increased more than threefold due to the nitrous oxide content of the blood, so it would seem to be logical to discontinueNitrous oxide in the anaesthetic mixture at least ten minutes before any such injection is made.
Abstract: in a threefold increase in the volume of any air injected into the circulation. This effect was predicted by Nunn’ and confirmed by Munsen et aL2 in relation to venous air embolism and, more recently, it has been postulated that changes in cerebral and renal blood flow at the start of cardio-pulmonary bypass could be related to the effect of nitrous oxide causing expansion of microbubbles from the priming f l ~ i d . ~ As the accidental intravenous injection of air can occur whenever it is used as a contrast medium it would seem to be logical to discontinue nitrous oxide in the anaesthetic mixture at least ten minutes before any such injection is made. A further example of this interaction occurs in the excellent paper on the detection of venous air embolism during neurosurgery by Dr Buckland and Dr Manners (Anaesthesia, 1976, 31, 633), where it is surprising to find that nitrous oxide is recommended as being advantageous in detecting small emboli. In fact in one of the cases described in this paper a very small embolus proved fatal as it impacted in the coronary arteries. As the volume of gas in this embolus would have increased more than threefold due to the nitrous oxide content of the blood there must be very good reasons, which are not stated in the article, for continuing the use of nitrous oxide in such cases.