Frank Manning | New York University (original) (raw)

Papers by Frank Manning

Research paper thumbnail of Maternal and foetal effects of methoxyflurane anaesthesia in the pregnant ewe

Canadian Journal of Anesthesia/ …, 1975

METHOXYFLURANE is widely used as an analgesic during the first and second stages of labour. Low i... more METHOXYFLURANE is widely used as an analgesic during the first and second stages of labour. Low inspired concentrations provide excellent maternal pain relief without causing foetal or neonatal depression. 1-5 More recently, the addi-tion of methoxyflurane in higher ...

Research paper thumbnail of Human fetal breathing: relationship to fetal condition

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Fetal breathing

Current practice in obstetric and gynecologic nursing

Research paper thumbnail of Real-time B-scan-directed amniocentesis

American Journal of Obstetrics and Gynecology

Utilizing real-time B scan, 150 amniocenteses, 14 in the second trimester and 136 in the third tr... more Utilizing real-time B scan, 150 amniocenteses, 14 in the second trimester and 136 in the third trimester, were carried out in 143 patients. In 146 procedures, amniotic fluid was obtained with a single attempt. In four other procedures, two attempts were required, and oligohydramnios was present in two. In one, both taps were dry, while in the other a second tap yielded a slight amount of meconium fluid. One patient was tapped in a site other than that suggested by real-time scanning, and a bloody tap (Apt negative) was obtained. Clear fluid was obtained when the real-time-indicated site was used. The remaining patient had premature rupture of membranes, and two attempts yielded bloody fluid (Apt negative) and the procedure was abandoned. Amniocenteses in eight patients had failed previously (one to three attempts). With the subsequent aid of real-time B scan, fluid was obtained in a single attempt. These data suggest that real-time B scanning prior to and/or during amniocentesis is ...

Research paper thumbnail of Control of parturition in subhuman primates

Research paper thumbnail of Fatal meconium aspiration "in utero": a case report

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Breathing movements before death in the primate fetus (Macaca mulatta)

American Journal of Obstetrics and Gynecology

The incidence and character of fetal breathing movements (FBMs) were determined by analysis of co... more The incidence and character of fetal breathing movements (FBMs) were determined by analysis of continuous tracheal pressure recordings in a 48 hour period preceeding fetal death in utero in 7 chronic pregnant monkey preparations (Macaca mulatta). All fetuses were judged normal by blood gas tensions, pH, and fetal heart rate within 48 hours of death. In the normal fetus breathing movements were periodic and a circadian distribution in the incidence of FBMs was observed. Four distinct patterns of FBMs were observed in the normal fetuses. In five fetuses death occurred in the intrapartum period; all five fetuses were breathing at the onset of labor. A progressive fall in the incidence of FBMs was observed in labor coincident with the development of fetal acidemia. In the remaining two fetuses death occurred before labor. Apnea and gasping were observed in all fetuses before death. The duration of apnea and gasping appeared dependent upon the nature of the lethal insult.

Research paper thumbnail of Fetal breathing movements and the nonstress test in high-risk pregnancies

American Journal of Obstetrics and Gynecology

Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test... more Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test (NST) were made in 223 patients. The presence of FBM was noted in a significantly higher proportion of tests with a reactive NST (88%) than a nonreactive NST (67%). Conversely, a significantly higher proportion of tests were reactive when FBM were present (82.6%) than when FBM were absent (49%). A significant relationship existed betweeen either test and the outcome of pregnancy as judged by the five minute Apgar score or the incidence of fetal distress in labor. Combining two normal tests did not improve the accuracy in predicting outcome; but the combination of both tests, when abnormal, produced a significant improvement in predicting fetuses likely to have an abnormal outcome. The combination of the normal with the abnormal test had a predictive accuracy similar to a single normal test in predicting a normal five-minute Apgar. This combination was associated with an incidence of fet...

Research paper thumbnail of Fetal breathing movements: antepartum monitoring of fetal condition

Clinics in obstetrics and gynaecology

Until recently, the relative inaccessibility of the human fetus to physical assessment has made a... more Until recently, the relative inaccessibility of the human fetus to physical assessment has made antepartum assessment of its condition difficult. The development of methods for accurate antepartum fetal heart rate monitoring and the subsequent study of heart rate responses to various stimuli have resulted in a significant improvement in accuracy of antepartum fetal surveillance. The development of real time B-mode ultrasound enables the clinician to assess many additional fetal biophysical variables including fetal breathing movements. In our observations, the combination of heart rate and fetal breathing assessment has produced a significant improvement in differentiating the normal from the compromised fetus. The addition of other biophysical variables (tone, movements and amniotic fluid volume) have further refined the ability to identify the fetus at risk. At this point, we have evaluated only a few of many possible variables. It seems probable that, as other fetal biophysical v...

Research paper thumbnail of Amniotic fluid phosphatidylglycerol and real-time ultrasonic cephalometry

American Journal of Obstetrics and Gynecology

The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amn... more The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amniocentesis in 159 cases and a phospholipid profile was obtained from the amniotic fluid. BPD measurements of 9.0, 8.7, and 9.2 cm were then compared with a lecithin/sphingomyelin (L/S) ratio greater than or equal to 2.0 for the ability to predict the presence of phosphatidylglycerol (PG) in the profile. The data from the diabetic and nondiabetic patients were analyzed separately. The results demonstrated that in the presence of a L/S ratio greater than or equal to 2.0 the BPD does not aid in the identification of amniotic fluid samples which contain PG in either the diabetic or nondiabetic groups. The data also confirmed previous findings that the BPD is not a reliable predictor of the L/S ratio. It is concluded that for the detection of PG in amniotic fluid, the use of real-time ultrasonic cephalometry cannot substitute for the performance of the phospholipid profile.

Research paper thumbnail of Fetal movements in human pregnancies in the third trimester

Obstetrics and Gynecology

Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trime... more Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trimester. One hundred ninety-five observations were made. The number of FM per 20-minute observation period was similar in normal, diabetic, and hypertensive pregnancies and in patients with placenta previa, but was significantly lower in patients with Rh isoimmunization and an affected fetus. The number of FM did not vary with gestational age, mode of delivery, or birth weight and was significantly increased in patients either with a reactive nonstress test (NST) or in the presence of fetal breathing movements (FBM). Fetal movements were absent before delivery in 4 patients: In 3, the fetus died in utero and in the other a positive contraction stress test (CST) was observed. Conversely, in 2 other fetuses who died in utero, FM were observed during the last examination before death. In both, the cause of fetal death was related to an acute change. No relationship between FM and neonatal deat...

Research paper thumbnail of Immediate effect of amniocentesis on fetal breathing and gross body movements

American Journal of Obstetrics and Gynecology

The incidence of fetal breathing movements (FBMs) has been observed to be significantly reduced a... more The incidence of fetal breathing movements (FBMs) has been observed to be significantly reduced at 24 and 48 hours after amniocentesis. The cause is unknown. We studied the immediate effects of amniocentesis on two fetal variables, FBMs and gross body movements (FMs). No effect was observed in the incidence of FBMs but an immediate increase in FMs occurred.

Research paper thumbnail of Fetal biophysical profile scoring: a prospective study in 1,184 high-risk patients

American Journal of Obstetrics and Gynecology

The results of a prospective clinical management based on fetal biophysical profile scoring metho... more The results of a prospective clinical management based on fetal biophysical profile scoring method was evaluated in 1,184 referred high-risk patients. Six perinatal deaths occurred in the study group (perinatal mortality of 5.06 per 1,000); only one fetus suffered unpredictable and unpreventable death (true false negative rate 0.8 per 1,000). In addition, 13 fetuses with major congenital anomalies were detected as a result of ultrasound scanning for fetal biophysical activities. These data suggest that this method can be used effectively to screen and manage a high-risk population.

Research paper thumbnail of Antenatal diagnosis of congenital pleural effusions

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Intrauterine transfusion in an Rh-immunized twin pregnancy: a case report of successful outcome and a review of the literature

Obstetrics and Gynecology

Fifteen sets of twins have been reported among 2331 pregnancies complicated by Rh alloimmunizatio... more Fifteen sets of twins have been reported among 2331 pregnancies complicated by Rh alloimmunization of sufficient severity to warrant intrauterine transfusions. Four of the 15 sets were managed in Winnipeg, Canada. One of the four is described in detail in the present report. Serial amniocenteses (N = 15) and intrauterine transfusions (N = 8) were used in the management of the dizygous affected twin fetuses with a favorable outcome. Factors contributing to the survival of the twins are described.

Research paper thumbnail of Alloimmunization and intravenous drug abuse

Canadian Medical Association Journal

Research paper thumbnail of Maternal serum alpha-fetoprotein in twin pregnancy

American Journal of Obstetrics and Gynecology

Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 1... more Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum alpha-fetoprotein value in the remaining 136 twin pregnancies paralleled a curve 2.5 times the median curve for singleton pregnancies over the gestational range studied. Higher serum alpha-fetoprotein values correlated significantly with increasing incidence of fetal and neonatal death, premature delivery (less than 35 weeks' gestation), and twin-to-twin birth discordance (greater than 20%), most pronounced at greater than 4 multiples of the singleton median level. A significant negative correlation between alpha-fetoprotein and birth weight was observed (p less than 0.001), but was related more to prematurity than to poor fetal growth. Theoretically, serum al...

Research paper thumbnail of Die intrauterine Transfusion – intraperitoneal versus intravaskulär – im fallkontrollierten Vergleich

Gynäkologisch-geburtshilfliche Rundschau

Research paper thumbnail of Hemolytic disease of the fetus: a plea for restraint

Obstetrics and Gynecology

The recent addition of fetal blood sampling and transfusion techniques to the management schemes ... more The recent addition of fetal blood sampling and transfusion techniques to the management schemes for hemolytic disease of the fetus has expanded clinical options for patient care. Coincident with these techniques is a new aggressiveness toward sensitized pregnancies that, upon review of available data, selects more patients for early and invasive testing than appears necessary. This paper explores the issues of invasive testing and offers guidelines that are more conservative than those recommended in recent reports.

Research paper thumbnail of Fetomaternal hemorrhage following funipuncture: increase in severity of maternal red-cell alloimmunization

Obstetrics and Gynecology

To determine the prevalence of fetomaternal transplacental hemorrhage after funipuncture and its ... more To determine the prevalence of fetomaternal transplacental hemorrhage after funipuncture and its effect on maternal red-cell alloantibody levels. The prevalence and size of transplacental hemorrhages at the Health Sciences Centre were studied in two groups of patients: 174 women who were not alloimmunized or were carrying fetuses whose red cells were negative for the antigen to which they were immunized, and 122 women who were alloimmunized and carrying fetuses whose red cells were positive for the antigen to which they were immunized. In the alloimmunized group with affected fetuses, we surveyed the incidence of maternal antibody increase in titer by two or more doubling dilutions and the Rh(D) antibody increase (in microgram/mL of serum) of more than 50% after funipuncture. One hundred of the 174 women (57.5%) in the nonimmunized group and 69 of the 122 women (56.6%) in the immunized group had evidence of transplacental hemorrhages ranging in volume from 0.03 mL to greater than 5 ...

Research paper thumbnail of Maternal and foetal effects of methoxyflurane anaesthesia in the pregnant ewe

Canadian Journal of Anesthesia/ …, 1975

METHOXYFLURANE is widely used as an analgesic during the first and second stages of labour. Low i... more METHOXYFLURANE is widely used as an analgesic during the first and second stages of labour. Low inspired concentrations provide excellent maternal pain relief without causing foetal or neonatal depression. 1-5 More recently, the addi-tion of methoxyflurane in higher ...

Research paper thumbnail of Human fetal breathing: relationship to fetal condition

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Fetal breathing

Current practice in obstetric and gynecologic nursing

Research paper thumbnail of Real-time B-scan-directed amniocentesis

American Journal of Obstetrics and Gynecology

Utilizing real-time B scan, 150 amniocenteses, 14 in the second trimester and 136 in the third tr... more Utilizing real-time B scan, 150 amniocenteses, 14 in the second trimester and 136 in the third trimester, were carried out in 143 patients. In 146 procedures, amniotic fluid was obtained with a single attempt. In four other procedures, two attempts were required, and oligohydramnios was present in two. In one, both taps were dry, while in the other a second tap yielded a slight amount of meconium fluid. One patient was tapped in a site other than that suggested by real-time scanning, and a bloody tap (Apt negative) was obtained. Clear fluid was obtained when the real-time-indicated site was used. The remaining patient had premature rupture of membranes, and two attempts yielded bloody fluid (Apt negative) and the procedure was abandoned. Amniocenteses in eight patients had failed previously (one to three attempts). With the subsequent aid of real-time B scan, fluid was obtained in a single attempt. These data suggest that real-time B scanning prior to and/or during amniocentesis is ...

Research paper thumbnail of Control of parturition in subhuman primates

Research paper thumbnail of Fatal meconium aspiration "in utero": a case report

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Breathing movements before death in the primate fetus (Macaca mulatta)

American Journal of Obstetrics and Gynecology

The incidence and character of fetal breathing movements (FBMs) were determined by analysis of co... more The incidence and character of fetal breathing movements (FBMs) were determined by analysis of continuous tracheal pressure recordings in a 48 hour period preceeding fetal death in utero in 7 chronic pregnant monkey preparations (Macaca mulatta). All fetuses were judged normal by blood gas tensions, pH, and fetal heart rate within 48 hours of death. In the normal fetus breathing movements were periodic and a circadian distribution in the incidence of FBMs was observed. Four distinct patterns of FBMs were observed in the normal fetuses. In five fetuses death occurred in the intrapartum period; all five fetuses were breathing at the onset of labor. A progressive fall in the incidence of FBMs was observed in labor coincident with the development of fetal acidemia. In the remaining two fetuses death occurred before labor. Apnea and gasping were observed in all fetuses before death. The duration of apnea and gasping appeared dependent upon the nature of the lethal insult.

Research paper thumbnail of Fetal breathing movements and the nonstress test in high-risk pregnancies

American Journal of Obstetrics and Gynecology

Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test... more Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test (NST) were made in 223 patients. The presence of FBM was noted in a significantly higher proportion of tests with a reactive NST (88%) than a nonreactive NST (67%). Conversely, a significantly higher proportion of tests were reactive when FBM were present (82.6%) than when FBM were absent (49%). A significant relationship existed betweeen either test and the outcome of pregnancy as judged by the five minute Apgar score or the incidence of fetal distress in labor. Combining two normal tests did not improve the accuracy in predicting outcome; but the combination of both tests, when abnormal, produced a significant improvement in predicting fetuses likely to have an abnormal outcome. The combination of the normal with the abnormal test had a predictive accuracy similar to a single normal test in predicting a normal five-minute Apgar. This combination was associated with an incidence of fet...

Research paper thumbnail of Fetal breathing movements: antepartum monitoring of fetal condition

Clinics in obstetrics and gynaecology

Until recently, the relative inaccessibility of the human fetus to physical assessment has made a... more Until recently, the relative inaccessibility of the human fetus to physical assessment has made antepartum assessment of its condition difficult. The development of methods for accurate antepartum fetal heart rate monitoring and the subsequent study of heart rate responses to various stimuli have resulted in a significant improvement in accuracy of antepartum fetal surveillance. The development of real time B-mode ultrasound enables the clinician to assess many additional fetal biophysical variables including fetal breathing movements. In our observations, the combination of heart rate and fetal breathing assessment has produced a significant improvement in differentiating the normal from the compromised fetus. The addition of other biophysical variables (tone, movements and amniotic fluid volume) have further refined the ability to identify the fetus at risk. At this point, we have evaluated only a few of many possible variables. It seems probable that, as other fetal biophysical v...

Research paper thumbnail of Amniotic fluid phosphatidylglycerol and real-time ultrasonic cephalometry

American Journal of Obstetrics and Gynecology

The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amn... more The fetal biparietal diameter (BPD) was measured at the time of real-time ultrasound-directed amniocentesis in 159 cases and a phospholipid profile was obtained from the amniotic fluid. BPD measurements of 9.0, 8.7, and 9.2 cm were then compared with a lecithin/sphingomyelin (L/S) ratio greater than or equal to 2.0 for the ability to predict the presence of phosphatidylglycerol (PG) in the profile. The data from the diabetic and nondiabetic patients were analyzed separately. The results demonstrated that in the presence of a L/S ratio greater than or equal to 2.0 the BPD does not aid in the identification of amniotic fluid samples which contain PG in either the diabetic or nondiabetic groups. The data also confirmed previous findings that the BPD is not a reliable predictor of the L/S ratio. It is concluded that for the detection of PG in amniotic fluid, the use of real-time ultrasonic cephalometry cannot substitute for the performance of the phospholipid profile.

Research paper thumbnail of Fetal movements in human pregnancies in the third trimester

Obstetrics and Gynecology

Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trime... more Fetal movements (FM) were measured using a real-time B-scan method in 50 women in the third trimester. One hundred ninety-five observations were made. The number of FM per 20-minute observation period was similar in normal, diabetic, and hypertensive pregnancies and in patients with placenta previa, but was significantly lower in patients with Rh isoimmunization and an affected fetus. The number of FM did not vary with gestational age, mode of delivery, or birth weight and was significantly increased in patients either with a reactive nonstress test (NST) or in the presence of fetal breathing movements (FBM). Fetal movements were absent before delivery in 4 patients: In 3, the fetus died in utero and in the other a positive contraction stress test (CST) was observed. Conversely, in 2 other fetuses who died in utero, FM were observed during the last examination before death. In both, the cause of fetal death was related to an acute change. No relationship between FM and neonatal deat...

Research paper thumbnail of Immediate effect of amniocentesis on fetal breathing and gross body movements

American Journal of Obstetrics and Gynecology

The incidence of fetal breathing movements (FBMs) has been observed to be significantly reduced a... more The incidence of fetal breathing movements (FBMs) has been observed to be significantly reduced at 24 and 48 hours after amniocentesis. The cause is unknown. We studied the immediate effects of amniocentesis on two fetal variables, FBMs and gross body movements (FMs). No effect was observed in the incidence of FBMs but an immediate increase in FMs occurred.

Research paper thumbnail of Fetal biophysical profile scoring: a prospective study in 1,184 high-risk patients

American Journal of Obstetrics and Gynecology

The results of a prospective clinical management based on fetal biophysical profile scoring metho... more The results of a prospective clinical management based on fetal biophysical profile scoring method was evaluated in 1,184 referred high-risk patients. Six perinatal deaths occurred in the study group (perinatal mortality of 5.06 per 1,000); only one fetus suffered unpredictable and unpreventable death (true false negative rate 0.8 per 1,000). In addition, 13 fetuses with major congenital anomalies were detected as a result of ultrasound scanning for fetal biophysical activities. These data suggest that this method can be used effectively to screen and manage a high-risk population.

Research paper thumbnail of Antenatal diagnosis of congenital pleural effusions

American Journal of Obstetrics and Gynecology

Research paper thumbnail of Intrauterine transfusion in an Rh-immunized twin pregnancy: a case report of successful outcome and a review of the literature

Obstetrics and Gynecology

Fifteen sets of twins have been reported among 2331 pregnancies complicated by Rh alloimmunizatio... more Fifteen sets of twins have been reported among 2331 pregnancies complicated by Rh alloimmunization of sufficient severity to warrant intrauterine transfusions. Four of the 15 sets were managed in Winnipeg, Canada. One of the four is described in detail in the present report. Serial amniocenteses (N = 15) and intrauterine transfusions (N = 8) were used in the management of the dizygous affected twin fetuses with a favorable outcome. Factors contributing to the survival of the twins are described.

Research paper thumbnail of Alloimmunization and intravenous drug abuse

Canadian Medical Association Journal

Research paper thumbnail of Maternal serum alpha-fetoprotein in twin pregnancy

American Journal of Obstetrics and Gynecology

Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 1... more Maternal serum alpha-fetoprotein concentration was measured at 14 to 20 weeks' gestation in 138 twin pregnancies. All patients had at least one ultrasonographic examination (86% before 20 weeks' gestation). Two pregnancies were discordant for open fetal defects (one anencephaly, one gastroschisis). The median serum alpha-fetoprotein value in the remaining 136 twin pregnancies paralleled a curve 2.5 times the median curve for singleton pregnancies over the gestational range studied. Higher serum alpha-fetoprotein values correlated significantly with increasing incidence of fetal and neonatal death, premature delivery (less than 35 weeks' gestation), and twin-to-twin birth discordance (greater than 20%), most pronounced at greater than 4 multiples of the singleton median level. A significant negative correlation between alpha-fetoprotein and birth weight was observed (p less than 0.001), but was related more to prematurity than to poor fetal growth. Theoretically, serum al...

Research paper thumbnail of Die intrauterine Transfusion – intraperitoneal versus intravaskulär – im fallkontrollierten Vergleich

Gynäkologisch-geburtshilfliche Rundschau

Research paper thumbnail of Hemolytic disease of the fetus: a plea for restraint

Obstetrics and Gynecology

The recent addition of fetal blood sampling and transfusion techniques to the management schemes ... more The recent addition of fetal blood sampling and transfusion techniques to the management schemes for hemolytic disease of the fetus has expanded clinical options for patient care. Coincident with these techniques is a new aggressiveness toward sensitized pregnancies that, upon review of available data, selects more patients for early and invasive testing than appears necessary. This paper explores the issues of invasive testing and offers guidelines that are more conservative than those recommended in recent reports.

Research paper thumbnail of Fetomaternal hemorrhage following funipuncture: increase in severity of maternal red-cell alloimmunization

Obstetrics and Gynecology

To determine the prevalence of fetomaternal transplacental hemorrhage after funipuncture and its ... more To determine the prevalence of fetomaternal transplacental hemorrhage after funipuncture and its effect on maternal red-cell alloantibody levels. The prevalence and size of transplacental hemorrhages at the Health Sciences Centre were studied in two groups of patients: 174 women who were not alloimmunized or were carrying fetuses whose red cells were negative for the antigen to which they were immunized, and 122 women who were alloimmunized and carrying fetuses whose red cells were positive for the antigen to which they were immunized. In the alloimmunized group with affected fetuses, we surveyed the incidence of maternal antibody increase in titer by two or more doubling dilutions and the Rh(D) antibody increase (in microgram/mL of serum) of more than 50% after funipuncture. One hundred of the 174 women (57.5%) in the nonimmunized group and 69 of the 122 women (56.6%) in the immunized group had evidence of transplacental hemorrhages ranging in volume from 0.03 mL to greater than 5 ...