Roger K. Freeman's research while affiliated with Long Beach Memorial Medical Center and other places

Publications (61)

Article
There is currently no standard national approach to the management of category II fetal heart rate patterns, yet such patterns occur in the majority of fetuses in labor. Under such circumstances, it would be difficult to demonstrate the clinical efficacy of fetal heart rate monitoring even if this technique had immense intrinsic value, since there...
Chapter
Intrapartum fetal heart rate monitoring was developed in the mid 1960s after patterns of heart rate change in relation to uterine contractions had been described by Hon, Caldero-Barcia and Hammacher. When the method was first developed, there were numerous non-randomized studies comparing electronically monitored patients to either historical contr...
Article
A prospective study on 231 consecutive patients who underwent transabdominal genetic amniocentesis was performed to determine the incidence of intraamniotic bleeding associated with needle removal and to determine if this increased future pregnancy complications. Eleven procedures traversed the placenta and intraamniotic bleeding was seen in every...
Chapter
Rationale for Intrapartum Fetal Heart Rate MonitoringPattern InterpretationManagement of Patients with Non-Reassuring FHR PatternsFetal Inflammatory Response to Maternal ChorioamnionitisMedicolegal Implications Of Intrapartum FHR MonitoringReferences
Article
In August 2007, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health Office of Rare Diseases, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics cosponsored a 2-day workshop to reassess the body of evidence supporting antepartum assessment...
Article
Intrapartum hypoxia leading to neonatal hypoxic-ischemic encephalopathy (HIE) is the leading cause of cerebral palsy targeted in malpractice law suits, because it is believed that the health care providers may avert the neurologic damage by intervention for fetal heart rate patterns that are believed to indicate hypoxia. Unfortunately, because of t...
Article
Antepartum fetal testing in pregnant patients with hypertensive disorders may be beneficial in preventing stillbirth and hypoxic sequelae in the fetus. The highest risk patients in this category are those with intrauterine growth restriction, superimposed preeclampsia, associated medical complications such as diabetes, systemic lupus erythematosis,...
Article
We report cases of unexpected adverse fetal outcome from monitored labors in which the fetal heart rate tracing was interpreted as reassuring. In these cases, portions from another signal source, usually maternal, were imperceptibly substituted into the fetal tracing in a way that masked the evidence of fetal compromise.
Article
Fetal heart rate (FHR) monitoring was introduced over 3 decades ago into clinical use and patient management. It continues to be the predominant method for intrapartum fetal surveillance despite questions about its efficacy and outcomes associated with its use. Currently, there appears to be a consensus regarding the reassuring value of a normal re...
Article
Although a few studies have evaluated the effect of meconium on the lecithin/sphingomyelin ratio for testing of fetal lung maturity, to date these studies have assessed only the lecithin-sphingomyelin ratio of amniotic fluid contaminated with meconium. The purpose of this study was (1) to determine whether meconium by itself has a lecithin/sphingom...
Article
Our purpose was to evaluate whether inserting prostaglandin E2 gel at the time of scheduled nonstress tests in patients with postdate pregnancies can decrease rates of intervention. A multicenter pilot study enrolled women with postdate pregnancies with Bishop score < or = 6 who were undergoing antepartum fetal heart rate testing. Patients were ran...
Article
A history of stillbirth is universally accepted as an indication for antepartum fetal heart rate testing. Our goal was to examine when fetal testing should begin in an otherwise healthy patient with a history of stillbirth. This is a nonconcurrent cohort study of patients who were seen for antepartum surveillance from January 1979 to December 1991...
Article
Our purpose was to evaluate perinatal outcomes in high-risk pregnancies monitored with a modified biophysical profile. All non-insulin-dependent patients referred for antepartum fetal surveillance received a modified biophysical profile biweekly. A modified biophysical profile is a combination of a nonstress test and an amniotic fluid index. Patien...
Article
The presence of phosphatidylglycerol in amniotic fluid from the vaginal pool has been established as a reliable marker of pulmonary maturity in pregnancies complicated by preterm premature rupture of membranes because its presence is not affected by contaminants. This study was undertaken to determine the distribution of positive phosphatidylglycer...
Article
Although antepartum fetal well-being testing is an accepted practice in the management of diabetic patients, there are few data suggesting when to start. Our goal was to examine when testing should be started in the pregnant diabetic woman. Antepartum test results and patient histories were prospectively collected on all diabetic pregnancies from J...
Article
Our objective was to determine the most appropriate interval for assessing amniotic fluid volume with amniotic fluid index. In a retrospective analysis amniotic fluid indexes performed every 3 to 4 days in antepartum testing patients were compared with their follow-up values. Of 10,742 amniotic fluid indexes there were 7393 with follow-up values wi...
Article
Previous randomized controlled studies of corticosteroids for the reduction of respiratory distress syndrome have failed to demonstrate benefit in very early premature gestational age groups. A randomized, double-blind, placebo-controlled clinical trial of betamethasone given to mothers with intact membranes and threatened premature delivery betwee...
Article
Antepartum testing has been recommended for patients whose pregnancies are complicated by hypertension. Although this is considered accepted practice, there are little data available to help the clinician know when to start testing. To help answer this question in patients with chronic hypertension and nonproteinuric pregnancy-induced hypertension,...
Article
The contraction stress test has long been used to assess fetal wellbeing in the antepartum period. The CST continues to be a valuable tool for practicing obstetricians when interpreted and managed according to previously published guidelines. More recent data have further defined the level of compromise at which the CST becomes abnormal. When compa...
Article
To assess uterine activity before labor in patients delivering preterm, at term, and postterm, the maximum spontaneous contraction frequency per 10-minute window during the initial portion of antepartum fetal heart rate monitoring was analyzed. Patients with multiple gestation, third trimester bleeding, polyhydramnios, or premature rupture of membr...
Article
The use of various antepartum testing schemes may be limited by the ability to integrate the test result into the clinical situation. Certainly clinical decisions differ greatly at 42 weeks' and at 26 weeks' gestation, even given the same test result. Understanding the significance of the result as well as the underlying cause for an abnormal resul...
Article
Expectant management was compared with similar management plus ritodrine tocolysis in a randomized controlled trial in patients with premature rupture of membranes at 25 to 30 weeks of gestation. In the tocolysis group intravenously administered ritodrine was instituted at the onset of labor and then changed to the oral form if successful. Tocolysi...
Article
This retrospective analysis of the use of serum estriol levels for antenatal assessment was performed in an effort to determine if routine, late third-trimester, daily serum estriol monitoring of insulin-dependent pregnant diabetic women can still be justified. Estriol profiles of 170 diabetic pregnancies, managed under a consistent protocol of wee...
Article
One hundred ninety-three amniotic fluid samples were tested for fetal lung maturity using a maturity cascade scheme involving the sequential use of, in order, the shake test, fluorescence polarimetry, and lecithin: sphingomyelin (L:S) ratio. If any of these tests indicated maturity, the sequence was terminated and no further test was performed, and...
Article
Management of the problems associated with pregnancies that extend beyond 294 days of amenorrhea has become increasingly important in obstetrics. This article outlines some of the methods that minimize the risks to the mother, fetus, and neonate in postdate pregnancy. A brief description of the definitions, incidence, and impact of postdate pregnan...
Article
Patients with preterm premature rupture of the membranes are at increased risk to develop intrapartum variable decelerations and fetal distress. Short-term saline solution amnioinfusion may be of benefit in the treatment of variable or prolonged decelerations once they appear. In an effort to assess the benefit of prophylactic amnioinfusion, patien...
Article
A 3-year study of women ages 35 years and older who were delivered at Women's Hospital of Long Beach from January 1, 1981, to December 31, 1983, was performed to study the risks involved with advanced maternal age. The study group included 1023 women who were 35 years and older, and they were divided into parous and nulliparous groups. A control gr...
Article
One hundred nineteen very low-birth weight infants were studied to see whether intrapartum fetal distress with or without acidosis correlated with the development of intraventricular and subependymal hemorrhage. Of 112 infants studied prospectively, 24% (27/112) had intraventricular/subependymal hemorrhage documented by real-time ultrasound studies...
Article
Among 7052 patients studied between 1976 and 1982 in a collaborative project on antepartum fetal heart rate monitoring, 337 patients had a previous stillbirth as a reason for testing. Overall a previous stillbirth history significantly increased the risk of having a positive result on a contraction stress test, primarily among hypertensive patients...
Article
A new rapid slide agglutination test (Amniostat-FLM/AFLM) for amniotic fluid phosphatidylglycerol has been developed. One hundred ninety-three samples of amniotic fluid were tested for lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol by thin-layer chromatography and fluorescence polarization and compared with the AFLM. All four tests agr...
Article
One hundred eighty-eight patients undergoing antepartum fetal heart rate (FHR) monitoring with abdominal fetal electrocardiogram (ECG) technique were studied with respect to FHR variability derived from fetal R-R intervals. Statistically significant positive correlation existed between various measures of FHR variability and accelerations per minut...
Article
The use of prophylactic antibiotics to reduce post-cesarean section febrile morbidity has been advocated since 1968. Although this approach has theoretical and actual disadvantages, all but one study found a reduction in febrile morbidity when prophylactic antibiotics were used. An unresolved question was the duration of antibiotic therapy. A doubl...
Article
A total of 18,517 antepartum fetal heart rate (AFHR) monitoring studies were conducted on 7,448 high-risk patients in 18 institutions in the United States between 1976 and 1980. Data were gathered prospectively. A perinatal mortality rate of 12.9/1,000 (5.5/1,000 corrected) with a fetal death rate of 3.2/1,000 (1.9/1,000 corrected) was found. Nonre...
Article
This study includes 1,542 patients who underwent nonstress tests (NSTs) for primary fetal surveillance and 4,626 patients who underwent contraction stress tests (CSTs) for primary fetal surveillance. All pregnancies were at increased risk for uteroplacental insufficiency. The results showed that the two groups were comparable according to maternal...
Article
With the development of the nipple stimulation test, the contraction stress test becomes much simpler, less time-consuming, and less expensive. Since the risk of antepartum fetal death in high-risk patients followed with nonstress test surveillance is 8 times higher (3.2 vs. 0.4 per 1000), it would appear that contraction stress test would be the c...
Article
Regionalization of perinatal care has contributed to a decline in perinatal morbidity and mortality in neonates delivered at tertiary centers when compared to neonates delivered and transported to the intensive care nurseries. Transportation of the mother to the perinatal center in an emergency situation must be evaluated critically for neonatal ou...
Article
Full-text available
A review was made of the available literature on the sinusoidal heart rate (SHR) pattern. A specific definition of SHR was made in order to elucidate its clinical significance. According to this definition 41 tracings from 23 publications were classified as being either true SHR, equivocal, or a heart rate pattern other than SHR. On the basis of th...
Article
A prospective randomized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted. Patients with chorioamnionitis, advanced labor, and fetal distress, as well as those with mature lecithin/sphingomyelin ratios and/or Gram stains positive for bacteria, were...
Article
The oxytocin challenge test (OCT) has been used to identify and follow the fetus at risk for uteroplacental insufficiency. Of 389 patients who had at least one OCT prior to 38 weeks' gestation, 26 (6.7%) underwent delivery after spontaneous onset of premature labor within 5 days of an OCT. This compares to a 7.5% incidence of spontaneous delivery p...
Article
Six hundred seventy-nine postdate study patients surveyed with a contraction stress test (CST) protocol had no perinatal deaths and no greater morbidity than that found in a 500-patient normal term control population. However, the postdate study did have a significantly increased risk of intrapartum fetal distress, meconium-stained amniotic fluid,...
Article
In the term gestation prolonged rupture of membranes (ROM) is associated with substantial increases in neonatal infections and perinatal mortality. Previous studies have not generally separated the effect of duration of ROM into term and preterm gestations. In a prospectively randomized study all patients were divided into expectantly managed (EM)...
Article
A prospective study was undertaken to evaluate antenatal maternal referral, acute maternal transport, and neonatal transport to a regional perinatal center in a metropolitan area. During an 18-month period, there were 143 antenatal maternal referrals, 254 antenatal maternal transports, and 506 neonatal transports. Indications for the antenatal refe...
Article
Sinusoidal fetal heart rate (FHR) patterns have been observed in a number of different clinical situations. This pattern has been observed in cases of Rh isoimmunization with severe fetal compromise and fetal anemia secondary to massive fetomaternal transfusion. Sinusoidal FHR patterns have also been observed in severely asphyxiated fetuses as a pr...
Article
The OCT is a well tested method of antepartum surveillance with no demonstrable risk involved. It effectively allows the clinician to avoid fetal death and avoid inappropriate intervention. While it is a somewhat cumbersome method with some difficulties, it probably gives an early warning of the fetus in jeopardy. No one test should be the basis fo...
Article
This report of pulmonary edema associated with magnesium sulfate and corticosteroid administration, used to improve fetal outcome where premature delivery is imminent, should point to the possibility that some maternal risk may be involved. When using beta-mimetic amines or magnesium sulfate in association with corticosteroids (or perhaps alone) th...
Article
The desired goals of the oxytocin challenge test (OCT) are preventing stillbirth and avoiding unnecessary premature intervention. To effectively reduce stillbirth the test should be done on a significant proportion of those fetuses who would subsequently succumb in utero. To analyze whether or not the OCT is achieving these goals. 5351 deliveries o...
Article
Good base-line fetal and neonatal heart rate beat-to-beat variability appears to be a reassuring sign of well-being. Conversely, decreased base-line heart rate beat-to-beat variability during the latter part of the intrapartum period is often associated with neonatal acidosis and/or depression. A simple method of quantitation of the beat-to-beat ne...

Citations

... Evidence about medicines and over the counter drugs used in pregnancy are also widespread (Yaffe, 2002). Ever since the thalidomide period, there has been a high level of consciousness regarding the dangerous effects of drugs on the growing fetus (Kacew, 1994;Melton, 1999). ...
... Prolonged fetal heart rate deceleration, defined as a visually apparent decrease in the fetal heart rate below baseline by 15 bpm for longer than 2 min but less than 10 min, is an example of a non-reassuring fetal heart rate characteristic, which often occurs in response to physiologic and reversible changes to maternal or fetal status [8]. Some examples of causes include rapid cervical change, uterine tachysystole, cervical examination, maternal hypotension from regional anesthesia placement, and artificial rupture of membranes [8]. ...
... Podatkov, ki bi govorili v prid UZpreiskavi pri vsaki nosečnici z zmanjšanim gibanjem ploda, ni zadosti, vsekakor pa lahko z UZ ugotovimo nekatere vzroke zmanjšanega gibanja ploda. V veliki Norveški raziskavi (29,40,82) so ugotavljali, da so s spremljanjem plodovih gibov in z ustreznim protokolom pri nosečnici z zmanjšanim številom plodovih gibov (CTG in UZ) pomembno Tabela 1: Vrednotenje priporočil (84). ...
... There are several methods of antepartum testing, including non-stress test (NST), ultrasonography, and OCT [5]. As stated by Freeman et al. in a multi-institutional study which included 1542 NSTs and 4626 OCTs, a negative result of OCT is considered to lead to a low rate of 0.04% of stillbirth within a week after the test, compared to 0.32% in pregnancies monitored with NST only [6]. In our study we did not observe any stillbirths. ...
... Процедура амниоцентеза приводит к попаданию материнской крови в полость матки, так как игла проходит через брюшную стенку и стенку матки. В самом деле, видимые признаки внутриутробного кровотечения, которые не связаны с плацентой, можно увидеть в 38% случаев амниоцентеза [13]. Однако случаи передачи ГВ во время амниоцентеза встречаются редко. ...
... Porém, outros autores consideram que os testes para avaliação da maturidade pulmonar não devem ser abando-nados. Deve-se considerá-los em casos de parto pré-termo tardio e termo recente, nos quais não está clara a decisão entre realizar o parto imediatamente ou aguardar um tempo a mais 16 (D). ...
... Non reassuring fetal status was defined as category III [26] or persistent category II fetal heart rate pattern with abnormal labor progress [27], non-reactive non stress test (NST) associated with recurrent decelerations among non-laboring women [28], absent or reverse umbilical artery end diastolic flow in the setting of fetal growth restriction (FGR) [29]. Clinical chorioamnionitis was defined as Triple I [30] with the presence of fever without a clear source plus any of the following: 1) baseline fetal tachycardia (greater than 160 beats per min for 10 min or longer, excluding accelerations, decelerations, and periods of marked variability), 2) maternal white blood cell count greater than 15,000 per mm 3 in the absence of corticosteroids and 3) definite purulent fluid from the cervical os. ...
... According to the available evidence, penicillins and cephalosporins are considered safe to use in pregnancy (these antibiotics are the first-line options for many infections in pregnancy), while the use of fluoroquinolones should be avoided unless the benefits outweigh the risks [25,30,31]. More uncertainty remains for the use of macrolides during pregnancy [25,32]. ...
... Though the first observation of foetal heart sound was reported during the 17th, it was Lejumeau Kergaradec who reported the usefulness of the auscultation in diagnosis of twins, foetal lie and presentation during the pregnancy [1]. Foetal heart rate is an important parameter in the assessment of foetal wellbeing both intrapartum and antepartum, Kilian was the first to propose that changes in heart rate can be used to diagnose foetal distress and to indicate the time for clinical intervention [1]. ...
... PE is a disease specific to pregnancy with a prevalence of about 5% -10% [8]. ...