morphine and Tachycardia

Nonsteroidal anti-inflammatory drugs, such as selective phosphodiesterase type 4 (PDE4) inhibitors have potential anti-inflammatory and respiratory smooth muscle relaxation effects. This study aimed to investigate the pathophysiological effects of an intravenous PDE4 inhibitor (rolipram) and surfactant lavage (SL) in a newborn piglet model of meconium aspiration syndrome (MAS).. MAS was induced in 25 newborn piglets, which were randomly divided into control and four SL treatment groups administered with different doses of intravenous rolipram (0, 0.1, 0.5, and 1 mg/kg). Cardiopulmonary variables were monitored and recorded. The experimental time was 4 hours. Serial blood was drawn for blood gas and biomarker analyses. Lung tissue was examined for histological analysis.. All SL-treated groups revealed improved oxygenation during the 4-hour experiments and had significantly lower peak inspiratory pressure levels than the control group at the end of experiments. All SL plus rolipram-treated groups exhibited significantly higher lung compliance than the control group. However, the animals receiving high-dose (0.5 and 1.0 mg/kg) rolipram demonstrated significantly elevated heart rates. Lung histology of the nondependent sites revealed significantly lower lung injury scores in all SL-treated groups compared with that in the control group, but there were no differences among the rolipram-treated groups.. In addition to SL, intravenous PDE4 inhibitors may further improve lung compliance in treating MAS; however, it is necessary to consider cardiovascular adverse effects, primarily tachycardia. Further investigations are required before the clinical application of intravenous PDE4 inhibitor as an anti-inflammatory agent to treat severe MAS.

Topics: Administration, Intravenous; Animals; Animals, Newborn; Bronchoalveolar Lavage; Combined Modality Therapy; Humans; Lung; Lung Compliance; Meconium; Meconium Aspiration Syndrome; Phosphodiesterase 4 Inhibitors; Rolipram; Surface-Active Agents; Swine; Tachycardia

To investigate the determinants of Group B streptococcus (GBS) maternal colonization, as well as factors associated with its vertical transmission.. Case-control study on all singletons pregnancies delivered beyond at least 24 weeks of amenorrhoea in Southern Reunion maternities for which GBS screening was known. Multiple logistic regression analysis using 2004-2007 dataset of South Reunion birth registers.. Out of 17,430 women delivered between 1st January 2004 and 31st December 2007, 2911 (16.7%) carried GBS. In a model adjusted on antenatal care, risk groups for GBS carriage were the women indigenous from another island of the Indian Ocean than Reunion (OR: 1.29, CI95%: 1.05-1.57) and obese women (body mass index ≥ 30, OR: 1.19, CI95%: 1.03-1.18). Protective factors included birthplace in mainland France (OR: 0.82, CI95%: 0.69-0.97) and underweight (OR: 0.81; CI95%: 0.69-0. 95). In a model controlling for a composite obstetrical variable delineating the protective roles of C-section and antibioprophylaxis as well as the putative role of meconium-stained fluids (thin, thick or fetid), all previously found in our setting, three key factors were independently associated with GBS vertical mother-to-child transmission: obesity (OR: 1.48, CI95%: 1.05-2.09), fetal tachycardia (OR: 4.92, CI95%: 2.79-8.68) and late preterm birth (35 to 36 wks, OR: 2.14, CI95%: 1.32-3.45).. These findings strengthen the putative roles of corpulence and ethnicity in GBS acquisition previously found in the United States, while confirming an authentic role of obesity in its vertical transmission, independently of other classical cofactors lighted by our study.

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Case-Control Studies; Female; Fetal Diseases; France; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Meconium; Obesity; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; Prenatal Care; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae; Tachycardia; Young Adult

The objective of the study was to evaluate, in labors complicated by thick meconium-stained amniotic fluid, the association between specific fetal heart rate (FHR) patterns and adverse perinatal outcomes.. A retrospective cohort study of patients with FHR tracing data (n = 1638) from a previously reported randomized controlled trial of amnioinfusion for the prevention of meconium aspiration syndrome.. The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and/or neonatal morbidity (moderately abnormal: adjusted odds ratio [OR], 1.67; 95% confidence interval [CI], 1.18-2.37; markedly abnormal: adjusted OR, 2.97; 95% CI, 1.88-4.67). Specific abnormalities that were associated with the risk of perinatal mortality and/or neonatal morbidity included prolonged decelerations (OR, 1.22; 95% CI, 1.02-1.48), severe variable decelerations (OR, 1.08; 95% CI, 1.00-1.16), bradycardia (OR, 2.49; 95% CI, 1.02-6.11), and tachycardia (OR, 2.43; 95% CI, 1.49-3.94).. The presence of abnormal FHR tracing patterns in meconium-stained amniotic fluid patients is associated with an increased risk of adverse perinatal outcomes.

Topics: Adult; Amniotic Fluid; Bradycardia; Cohort Studies; Female; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Morbidity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Tachycardia; Young Adult

To determine whether women who receive continuous epidural analgesia for labor and delivery are more likely to receive antibiotic therapy compared to those parturients who do not use epidural analgesia, a chart review was performed for 300 women 100 in each group using narcotics alone epidural alone, or parenteral narcotics followed by epidural analgesia. While only 2% of women with narcotics alone developed an intrapartum temperature > or = 37.8 degrees C, 16% and 24% of women with epidural use alone or in addition to narcotics did so, respectively. Antibiotic administration was increased among women utilizing epidural analgesia, exclusively or following parenteral narcotics. No parturient with culture or pathological evidence of chorioamnionitis had maternal temperature elevation as an isolated finding. A probable causal relationship between maternal temperature elevation and epidural use in labor is supported. Rather than treating all women with temperature elevations and epidurals for presumed chorioamnionitis, it is reasonable to target treatment to those with fetal tachycardia, meconium stained fluid, or abnormal amniotic fluid studies.

Topics: Adult; Amniotic Fluid; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Anti-Bacterial Agents; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Diseases; Fever; Humans; Injections, Intravenous; Labor, Obstetric; Meconium; Placenta; Pregnancy; Probability; Retrospective Studies; Tachycardia

Fifty-six postterm fetuses with intrapartum meconium passage underwent routine scalp stimulation and scalp blood sampling. Fetal heart rate (FHR) patterns were compared with blood pH. Nine fetuses (16%) had a scalp pH less than 7.20. Twenty-nine fetuses (54%) demonstrated spontaneous or induced FHR accelerations; none were acidemic. Acidemia with normal variability was found only in conjunction with severe variable decelerations, and may represent respiratory acidosis. In this group, two of nine acidemic fetuses demonstrated no decelerations (pH 7.04) or mild variable decelerations only (pH 7.19). The absence of late decelerations was not as reliable as the presence of accelerations in the prediction of fetal well-being. Thirty-three percent of the fetuses who failed to exhibit spontaneous or provoked FHR accelerations were acidemic. These findings suggest that in this high-risk group of fetuses, the absence of spontaneous FHR accelerations should be followed by an attempt to induce accelerations, scalp pH assessment, or cesarean section.

Topics: Acidosis; Female; Fetal Diseases; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Pregnancy; Pregnancy, Prolonged; Tachycardia

A retrospective study was carried out on 72 liveborn babies in whom perinatal infection was suspected. Twenty-nine of the 72 neonates were effectively infected. Analysis of intrapartum FHR recordings showed that tachycardia (base line FHR above 160 beats/min) during labor, occurred more often among infected babies (P less than 0.001). When fetal tachycardia is associated with meconium stained amniotic fluid (MSAF), the relative risk of fetal infection is 51 times as great as in babies without MSAF. Fetal tachycardia is not related to maternal fever nor to prematurity. It is not a sign of limited placental or amniotic fluid infection, but implies infection of the fetus itself. Since most infected babies displayed infectious diarrhea immediately at birth, it is suggested that MSAF may eventually be due to antenatal intestinal infection and intrauterine emission of infected stools. Although great caution is advocated for the management of labor in the presence of fetal tachycardia, MSAF should not be always regarded as a sign of acute fetal distress when antenatal infection of the fetus is suspected.

Topics: Bacterial Infections; Female; Fetal Diseases; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Streptococcal Infections; Tachycardia

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Fetal Hypoxia; Heart Function Tests; Humans; Inhalation; Meconium; Monitoring, Physiologic; Pregnancy; Respiration; Tachycardia

Topics: Acid-Base Equilibrium; Acidosis; Female; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy; Tachycardia; Uterine Inertia

Topics: Acidosis; Apgar Score; Blood Specimen Collection; Bradycardia; Carbon Dioxide; Delivery, Obstetric; Female; Fetal Diseases; Gestational Age; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant, Newborn; Inhalation; Meconium; Methods; Monitoring, Physiologic; Oxygen; Pregnancy; Prognosis; Prospective Studies; Scalp; Tachycardia

Topics: Acceleration; Amniotic Fluid; Electrocardiography; Female; Fetal Heart; Heart Rate; Humans; Hypoxia; Labor, Obstetric; Meconium; Monitoring, Physiologic; Muscle Contraction; Oscillometry; Phonocardiography; Placenta Diseases; Pregnancy; Pregnancy Complications; Tachycardia; Umbilical Cord; Uterus

Topics: Apgar Score; Blood; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Gestational Age; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy; Prognosis; Tachycardia; Umbilical Veins

Topics: Atropine; Bradycardia; Electrocardiography; Female; Fetal Diseases; Fetal Heart; Heart Auscultation; Heart Rate, Fetal; Humans; Hypoxia; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Oxygen Inhalation Therapy; Pregnancy; Tachycardia