home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-05 | 375.7 KB |
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MacOS 8.1
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Win98
|
DOS
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Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| a7 11 00 00 30 31 00 00 | 00 01 43 17 00 00 4d 10 |....01..|..C...M.|
|00000030| 00 00 30 32 00 00 00 01 | 90 27 00 00 7b 10 00 00 |..02....|.'..{...|
|00000040| 30 33 00 00 00 01 0b 38 | 00 00 9e 0d 00 00 30 34 |03.....8|......04|
|00000050| 00 00 00 01 a9 45 00 00 | 46 13 00 00 30 35 00 00 |.....E..|F...05..|
|00000060| 00 01 ef 58 00 00 c9 0e | 00 00 30 36 00 00 00 01 |...X....|..06....|
|00000070| b8 67 00 00 e4 0b 00 00 | 30 37 00 00 00 01 9c 73 |.g......|07.....s|
|00000080| 00 00 43 17 00 00 30 38 | 00 00 00 01 df 8a 00 00 |..C...08|........|
|00000090| f2 11 00 00 30 39 00 00 | 00 01 d1 9c 00 00 21 0e |....09..|......!.|
|000000a0| 00 00 31 30 00 00 00 01 | f2 aa 00 00 c4 10 00 00 |..10....|........|
|000000b0| 31 31 00 00 00 01 b6 bb | 00 00 ca 10 00 00 31 32 |11......|......12|
|000000c0| 00 00 00 01 80 cc 00 00 | ee 12 00 00 31 33 00 00 |........|....13..|
|000000d0| 00 01 6e df 00 00 b8 0e | 00 00 31 34 00 00 00 01 |..n.....|..14....|
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|00000110| 00 00 31 38 00 00 00 01 | e8 2a 01 00 ae 11 00 00 |..18....|.*......|
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|000001c0| 01 d9 01 00 92 0d 00 00 | 33 31 00 00 00 01 93 e6 |........|31......|
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|00000220| 00 01 00 3a 02 00 cd 12 | 00 00 33 38 00 00 00 01 |...:....|..38....|
|00000230| cd 4c 02 00 58 0f 00 00 | 33 39 00 00 00 01 25 5c |.L..X...|39....%\|
|00000240| 02 00 d1 0b 00 00 34 30 | 00 00 00 01 f6 67 02 00 |......40|.....g..|
|00000250| 50 0f 00 00 34 31 00 00 | 00 01 46 77 02 00 f1 0f |P...41..|..Fw....|
|00000260| 00 00 34 32 00 00 00 01 | 37 87 02 00 7b 0c 00 00 |..42....|7...{...|
|00000270| 34 33 00 00 00 01 b2 93 | 02 00 b3 0d 00 00 34 34 |43......|......44|
|00000280| 00 00 00 01 65 a1 02 00 | 8e 0d 00 00 34 35 00 00 |....e...|....45..|
|00000290| 00 01 f3 ae 02 00 5b 12 | 00 00 34 36 00 00 00 01 |......[.|..46....|
|000002a0| 4e c1 02 00 d5 0f 00 00 | 34 37 00 00 00 01 23 d1 |N.......|47....#.|
|000002b0| 02 00 5e 15 00 00 34 38 | 00 00 00 01 81 e6 02 00 |..^...48|........|
|000002c0| 0a 10 00 00 34 39 00 00 | 00 01 8b f6 02 00 c6 11 |....49..|........|
|000002d0| 00 00 35 30 00 00 00 01 | 51 08 03 00 ec 11 00 00 |..50....|Q.......|
|000002e0| 35 31 00 00 00 01 3d 1a | 03 00 6b 0f 00 00 35 32 |51....=.|..k...52|
|000002f0| 00 00 00 01 a8 29 03 00 | 6f 10 00 00 35 33 00 00 |.....)..|o...53..|
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|00000310| 6c 4d 03 00 d6 0e 00 00 | 35 35 00 00 00 01 42 5c |lM......|55....B\|
|00000320| 03 00 b0 0f 00 00 35 36 | 00 00 00 01 f2 6b 03 00 |......56|.....k..|
|00000330| 40 0a 00 00 35 37 00 00 | 00 01 32 76 03 00 a6 0e |@...57..|..2v....|
|00000340| 00 00 35 38 00 00 00 01 | d8 84 03 00 4f 0e 00 00 |..58....|....O...|
|00000350| 35 39 00 00 00 01 27 93 | 03 00 e4 0e 00 00 36 30 |59....'.|......60|
|00000360| 00 00 00 01 0b a2 03 00 | 74 0f 00 00 36 31 00 00 |........|t...61..|
|00000370| 00 01 7f b1 03 00 b9 0d | 00 00 36 32 00 00 00 01 |........|..62....|
|00000380| 38 bf 03 00 74 0a 00 00 | 36 33 00 00 00 01 ac c9 |8...t...|63......|
|00000390| 03 00 b9 0e 00 00 36 34 | 00 00 00 01 65 d8 03 00 |......64|....e...|
|000003a0| 11 14 00 00 36 35 00 00 | 00 01 76 ec 03 00 d2 0f |....65..|..v.....|
|000003b0| 00 00 36 36 00 00 00 01 | 48 fc 03 00 13 09 00 00 |..66....|H.......|
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|000003d0| 00 00 00 01 67 14 04 00 | 3f 16 00 00 36 39 00 00 |....g...|?...69..|
|000003e0| 00 01 a6 2a 04 00 ff 0e | 00 00 37 30 00 00 00 01 |...*....|..70....|
|000003f0| a5 39 04 00 23 0d 00 00 | 37 31 00 00 00 01 c8 46 |.9..#...|71.....F|
|00000400| 04 00 66 0a 00 00 37 32 | 00 00 00 01 2e 51 04 00 |..f...72|.....Q..|
|00000410| 14 0d 00 00 37 33 00 00 | 00 01 42 5e 04 00 2c 0e |....73..|..B^..,.|
|00000420| 00 00 37 34 00 00 00 01 | 6e 6c 04 00 cb 0e 00 00 |..74....|nl......|
|00000430| 37 35 00 00 00 01 39 7b | 04 00 c9 0e 00 00 37 36 |75....9{|......76|
|00000440| 00 00 00 01 02 8a 04 00 | 12 0e 00 00 37 37 00 00 |........|....77..|
|00000450| 00 01 14 98 04 00 ab 0e | 00 00 37 38 00 00 00 01 |........|..78....|
|00000460| bf a6 04 00 08 11 00 00 | 37 39 00 00 00 01 c7 b7 |........|79......|
|00000470| 04 00 6c 09 00 00 38 30 | 00 00 00 01 33 c1 04 00 |..l...80|....3...|
|00000480| 52 0b 00 00 38 31 00 00 | 00 01 85 cc 04 00 db 11 |R...81..|........|
|00000490| 00 00 38 32 00 00 00 01 | 60 de 04 00 7f 0f 00 00 |..82....|`.......|
|000004a0| 38 33 00 00 00 01 df ed | 04 00 3c 0a 00 00 38 34 |83......|..<...84|
|000004b0| 00 00 00 01 1b f8 04 00 | 19 11 00 00 38 35 00 00 |........|....85..|
|000004c0| 00 01 34 09 05 00 7d 0c | 00 00 38 36 00 00 00 01 |..4...}.|..86....|
|000004d0| b1 15 05 00 f6 0d 00 00 | 38 37 00 00 00 01 a7 23 |........|87.....#|
|000004e0| 05 00 c6 0e 00 00 38 38 | 00 00 00 01 6d 32 05 00 |......88|....m2..|
|000004f0| 34 0f 00 00 38 39 00 00 | 00 01 a1 41 05 00 7a 0b |4...89..|...A..z.|
|00000500| 00 00 39 30 00 00 00 01 | 1b 4d 05 00 a1 0c 00 00 |..90....|.M......|
|00000510| 39 31 00 00 00 01 bc 59 | 05 00 fe 0d 00 00 39 32 |91.....Y|......92|
|00000520| 00 00 00 01 ba 67 05 00 | c0 0e 00 00 39 33 00 00 |.....g..|....93..|
|00000530| 00 01 7a 76 05 00 98 0d | 00 00 39 34 00 00 00 01 |..zv....|..94....|
|00000540| 12 84 05 00 cf 0a 00 00 | 39 35 00 00 00 01 e1 8e |........|95......|
|00000550| 05 00 8a 0d 00 00 39 36 | 00 00 00 01 6b 9c 05 00 |......96|....k...|
|00000560| 20 13 00 00 39 37 00 00 | 00 01 8b af 05 00 b9 11 | ...97..|........|
|00000570| 00 00 39 38 00 00 00 01 | 44 c1 05 00 17 10 00 00 |..98....|D.......|
|00000580| 39 39 00 00 00 01 5b d1 | 05 00 86 0d 00 00 00 00 |99....[.|........|
|00000590| 00 00 00 00 e1 de 05 00 | 00 00 00 00 24 55 6e 69 |........|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 32 35 30 30 7d |que_ID{Y|RB02500}|
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|000005c0| 6c 61 74 69 6f 6e 73 68 | 69 70 73 20 41 6d 6f 6e |lationsh|ips Amon|
|000005d0| 67 20 41 62 6e 6f 72 6d | 61 6c 20 43 61 72 64 69 |g Abnorm|al Cardi|
|000005e0| 6f 74 6f 63 6f 67 72 61 | 6d 73 20 69 6e 20 4c 61 |otocogra|ms in La|
|000005f0| 62 6f 72 2c 20 4d 65 63 | 6f 6e 69 75 6d 0d 0a 53 |bor, Mec|onium..S|
|00000600| 74 61 69 6e 69 6e 67 20 | 6f 66 20 74 68 65 20 41 |taining |of the A|
|00000610| 6d 6e 69 6f 74 69 63 20 | 46 6c 75 69 64 2c 20 41 |mniotic |Fluid, A|
|00000620| 72 74 65 72 69 61 6c 20 | 43 6f 72 64 20 42 6c 6f |rterial |Cord Blo|
|00000630| 6f 64 20 70 48 2c 20 61 | 6e 64 20 41 70 67 61 72 |od pH, a|nd Apgar|
|00000640| 20 53 63 6f 72 65 73 7d | 0d 0a 24 41 75 74 68 6f | Scores}|..$Autho|
|00000650| 72 7b 0d 0a 53 74 65 65 | 72 2c 20 50 4a 0d 0a 45 |r{..Stee|r, PJ..E|
|00000660| 69 67 62 65 2c 20 46 0d | 0a 4c 69 73 73 61 75 65 |igbe, F.|.Lissaue|
|00000670| 72 2c 20 54 4a 0d 0a 42 | 65 61 72 64 2c 20 52 57 |r, TJ..B|eard, RW|
|00000680| 7d 0d 0a 24 41 66 66 69 | 6c 69 61 74 69 6f 6e 7b |}..$Affi|liation{|
|00000690| 53 74 20 4d 61 72 79 27 | 73 20 48 6f 73 70 2c 20 |St Mary'|s Hosp, |
|000006a0| 4c 6f 6e 64 6f 6e 7d 0d | 0a 24 4a 6f 75 72 6e 61 |London}.|.$Journa|
|000006b0| 6c 7b 4f 62 73 74 65 74 | 20 47 79 6e 65 63 6f 6c |l{Obstet| Gynecol|
|000006c0| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 37 34 7d 0d 0a |}..$Volu|me{74}..|
|000006d0| 24 50 61 67 65 7b 37 31 | 35 2d 37 32 31 7d 0d 0a |$Page{71|5-721}..|
|000006e0| 24 44 61 74 65 7b 31 39 | 38 39 7d 0d 0a 24 59 42 |$Date{19|89}..$YB|
|000006f0| 56 6f 6c 7b 31 39 39 31 | 20 59 65 61 72 20 42 6f |Vol{1991| Year Bo|
|00000700| 6f 6b 20 6f 66 20 4f 62 | 73 74 65 74 72 69 63 73 |ok of Ob|stetrics|
|00000710| 20 61 6e 64 20 47 79 6e | 65 63 6f 6c 6f 67 79 7d | and Gyn|ecology}|
|00000720| 0d 0a 24 43 68 61 70 74 | 65 72 7b 35 2d 31 7d 0d |..$Chapt|er{5-1}.|
|00000730| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|00000740| 4d 69 73 68 65 6c 6c 2c | 20 4b 69 72 73 63 68 62 |Mishell,| Kirschb|
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|000007b0| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|000007c0| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|000007d0| 20 31 39 39 31 0d 0a 0d | 0a 31 39 39 31 20 59 65 | 1991...|.1991 Ye|
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|000007f0| 74 72 69 63 73 20 61 6e | 64 20 47 79 6e 65 63 6f |trics an|d Gyneco|
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|00000810| 63 73 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 35 20 |cs....Ch|apter 5 |
|00000820| 2d 2d 20 41 6e 74 65 70 | 61 72 74 75 6d 20 46 65 |-- Antep|artum Fe|
|00000830| 74 61 6c 20 53 75 72 76 | 65 69 6c 6c 61 6e 63 65 |tal Surv|eillance|
|00000840| 0d 0a 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |....----|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000890| 2d 2d 0d 0a 49 6e 74 65 | 72 72 65 6c 61 74 69 6f |--..Inte|rrelatio|
|000008a0| 6e 73 68 69 70 73 20 41 | 6d 6f 6e 67 20 41 62 6e |nships A|mong Abn|
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|000008d0| 4d 65 63 6f 6e 69 75 6d | 20 53 74 61 69 6e 69 6e |Meconium| Stainin|
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|000008f0| 69 63 20 46 6c 75 69 64 | 2c 20 41 72 74 65 72 69 |ic Fluid|, Arteri|
|00000900| 61 6c 20 43 6f 72 64 20 | 42 6c 6f 6f 64 20 70 48 |al Cord |Blood pH|
|00000910| 2c 20 61 6e 64 20 41 70 | 67 61 72 20 53 63 6f 72 |, and Ap|gar Scor|
|00000920| 65 73 0d 0a 0d 0a 53 74 | 65 65 72 20 50 4a 3b 20 |es....St|eer PJ; |
|00000930| 45 69 67 62 65 20 46 3b | 20 4c 69 73 73 61 75 65 |Eigbe F;| Lissaue|
|00000940| 72 20 54 4a 3b 20 42 65 | 61 72 64 20 52 57 0d 0a |r TJ; Be|ard RW..|
|00000950| 28 53 74 20 4d 61 72 79 | 27 73 20 48 6f 73 70 2c |(St Mary|'s Hosp,|
|00000960| 20 4c 6f 6e 64 6f 6e 29 | 0d 0a 4f 62 73 74 65 74 | London)|..Obstet|
|00000970| 20 47 79 6e 65 63 6f 6c | 20 37 34 3a 37 31 35 2d | Gynecol| 74:715-|
|00000980| 37 32 31 2c 20 31 39 38 | 39 0d 0a 2d 2d 2d 2d 2d |721, 198|9..-----|
|00000990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000009e0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 46 65 |tract...|. Fe|
|000009f0| 74 61 6c 20 64 69 73 74 | 72 65 73 73 20 69 6e 64 |tal dist|ress ind|
|00000a00| 69 63 61 74 6f 72 73 20 | 77 69 64 65 6c 79 20 75 |icators |widely u|
|00000a10| 73 65 64 20 69 6e 20 63 | 6c 69 6e 69 63 61 6c 20 |sed in c|linical |
|00000a20| 70 72 61 63 74 69 63 65 | 20 68 61 76 65 20 61 20 |practice| have a |
|00000a30| 68 69 67 68 0d 0a 72 61 | 74 65 20 6f 66 20 66 61 |high..ra|te of fa|
|00000a40| 6c 73 65 20 70 6f 73 69 | 74 69 76 65 20 72 65 73 |lse posi|tive res|
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|00000a60| 74 69 76 65 20 73 74 75 | 64 79 20 6f 66 20 74 68 |tive stu|dy of th|
|00000a70| 65 20 72 65 6c 61 74 69 | 6f 6e 73 68 69 70 73 0d |e relati|onships.|
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|00000aa0| 20 6d 65 63 6f 6e 69 75 | 6d 20 73 74 61 69 6e 69 | meconiu|m staini|
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|00000ae0| 20 62 6c 6f 6f 64 20 67 | 61 73 20 61 6e 64 20 70 | blood g|as and p|
|00000af0| 48 2c 20 61 6e 64 20 41 | 70 67 61 72 20 73 63 6f |H, and A|pgar sco|
|00000b00| 72 65 20 77 61 73 20 63 | 6f 6e 64 75 63 74 65 64 |re was c|onducted|
|00000b10| 20 69 6e 20 31 2c 32 31 | 39 0d 0a 63 6f 6e 73 65 | in 1,21|9..conse|
|00000b20| 63 75 74 69 76 65 20 62 | 69 72 74 68 73 2e 20 20 |cutive b|irths. |
|00000b30| 49 6e 74 65 72 70 72 65 | 74 61 62 6c 65 20 63 61 |Interpre|table ca|
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|00000b70| 62 6c 6f 6f 64 20 67 61 | 73 20 61 6e 61 6c 79 73 |blood ga|s analys|
|00000b80| 69 73 20 77 65 72 65 20 | 6f 62 74 61 69 6e 65 64 |is were |obtained|
|00000b90| 20 69 6e 20 36 39 38 20 | 70 61 74 69 65 6e 74 73 | in 698 |patients|
|00000ba0| 2e 0d 0a 20 20 20 20 20 | 41 6e 20 61 62 6e 6f 72 |... |An abnor|
|00000bb0| 6d 61 6c 20 63 61 72 64 | 69 6f 74 6f 63 6f 67 72 |mal card|iotocogr|
|00000bc0| 61 6d 20 68 61 64 20 61 | 20 73 65 6e 73 69 74 69 |am had a| sensiti|
|00000bd0| 76 69 74 79 20 6f 66 20 | 38 30 25 20 66 6f 72 20 |vity of |80% for |
|00000be0| 61 63 69 64 6f 73 69 73 | 20 61 6e 64 20 38 33 25 |acidosis| and 83%|
|00000bf0| 0d 0a 66 6f 72 20 73 65 | 76 65 72 65 20 61 63 69 |..for se|vere aci|
|00000c00| 64 6f 73 69 73 2e 20 20 | 48 6f 77 65 76 65 72 2c |dosis. |However,|
|00000c10| 20 74 68 65 20 70 72 65 | 64 69 63 74 69 76 65 20 | the pre|dictive |
|00000c20| 76 61 6c 75 65 20 77 61 | 73 20 6c 6f 77 2c 20 61 |value wa|s low, a|
|00000c30| 6e 64 20 33 32 25 20 6f | 66 20 74 68 65 0d 0a 66 |nd 32% o|f the..f|
|00000c40| 65 74 75 73 65 73 20 68 | 61 64 20 61 6e 20 61 62 |etuses h|ad an ab|
|00000c50| 6e 6f 72 6d 61 6c 20 63 | 61 72 64 69 6f 74 6f 63 |normal c|ardiotoc|
|00000c60| 6f 67 72 61 6d 20 62 75 | 74 20 6e 6f 20 61 63 69 |ogram bu|t no aci|
|00000c70| 64 6f 73 69 73 2e 20 20 | 57 68 65 6e 20 6f 6e 6c |dosis. |When onl|
|00000c80| 79 0d 0a 63 61 72 64 69 | 6f 74 6f 63 6f 67 72 61 |y..cardi|otocogra|
|00000c90| 6d 20 61 6e 6f 6d 61 6c | 79 20 69 6e 20 74 68 65 |m anomal|y in the|
|00000ca0| 20 66 69 72 73 74 20 73 | 74 61 67 65 20 6f 66 20 | first s|tage of |
|00000cb0| 6c 61 62 6f 72 20 77 61 | 73 20 63 6f 6e 73 69 64 |labor wa|s consid|
|00000cc0| 65 72 65 64 2c 20 69 74 | 73 0d 0a 73 65 6e 73 69 |ered, it|s..sensi|
|00000cd0| 74 69 76 69 74 79 20 77 | 61 73 20 34 37 25 20 66 |tivity w|as 47% f|
|00000ce0| 6f 72 20 61 63 69 64 6f | 73 69 73 20 61 6e 64 20 |or acido|sis and |
|00000cf0| 36 37 25 20 66 6f 72 20 | 73 65 76 65 72 65 20 61 |67% for |severe a|
|00000d00| 63 69 64 6f 73 69 73 2c | 20 61 6e 64 20 74 68 65 |cidosis,| and the|
|00000d10| 20 66 61 6c 73 65 0d 0a | 70 6f 73 69 74 69 76 65 | false..|positive|
|00000d20| 20 72 61 74 65 20 77 61 | 73 20 72 65 64 75 63 65 | rate wa|s reduce|
|00000d30| 64 20 74 6f 20 6f 6e 6c | 79 20 31 34 25 2e 20 20 |d to onl|y 14%. |
|00000d40| 57 68 65 6e 20 6d 65 63 | 6f 6e 69 75 6d 20 73 74 |When mec|onium st|
|00000d50| 61 69 6e 69 6e 67 20 6f | 66 20 74 68 65 20 61 6d |aining o|f the am|
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|00004440| 73 69 6e 67 6c 65 20 65 | 78 63 65 70 74 69 6f 6e |single e|xception|
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|00004490| 6c 61 70 73 65 2e 20 20 | 54 68 69 73 20 73 74 75 |lapse. |This stu|
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|000044b0| 73 0d 0a 6d 6f 72 65 20 | 64 61 74 61 20 66 72 6f |s..more |data fro|
|000044c0| 6d 20 6c 61 72 67 65 72 | 20 6e 75 6d 62 65 72 73 |m larger| numbers|
|000044d0| 20 6f 66 20 70 61 74 69 | 65 6e 74 73 20 6d 61 6e | of pati|ents man|
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|000044f0| 6e 65 72 61 6c 20 63 6c | 69 6e 69 63 61 6c 0d 0a |neral cl|inical..|
|00004500| 75 73 65 20 6f 66 20 44 | 6f 70 70 6c 65 72 20 65 |use of D|oppler e|
|00004510| 76 61 6c 75 61 74 69 6f | 6e 20 63 61 6e 20 62 65 |valuatio|n can be|
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|00004550| 20 6f 66 20 70 61 70 65 | 72 73 20 70 75 62 6c 69 | of pape|rs publi|
|00004560| 73 68 65 64 20 65 61 72 | 6c 69 65 72 20 74 68 61 |shed ear|lier tha|
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|00004580| 69 74 65 20 63 6f 6e 63 | 6c 75 73 69 6f 6e 73 2d |ite conc|lusions-|
|00004590| 2d 54 2e 48 2e 0d 0a 4b | 69 72 73 63 68 62 61 75 |-T.H...K|irschbau|
|000045a0| 6d 2c 20 4d 2e 44 2e 0d | 0a 24 55 6e 69 71 75 65 |m, M.D..|.$Unique|
|000045b0| 5f 49 44 7b 59 52 42 30 | 32 35 30 34 7d 0d 0a 24 |_ID{YRB0|2504}..$|
|000045c0| 54 69 74 6c 65 7b 52 6f | 75 74 69 6e 65 20 55 6d |Title{Ro|utine Um|
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|00004620| 69 2c 20 56 4d 0d 0a 43 | 72 65 61 73 79 2c 20 52 |i, VM..C|reasy, R|
|00004630| 4b 7d 0d 0a 24 41 66 66 | 69 6c 69 61 74 69 6f 6e |K}..$Aff|iliation|
|00004640| 7b 55 6e 69 76 20 6f 66 | 20 54 65 78 61 73 2c 20 |{Univ of| Texas, |
|00004650| 48 6f 75 73 74 6f 6e 7d | 0d 0a 24 4a 6f 75 72 6e |Houston}|..$Journ|
|00004660| 61 6c 7b 41 6d 20 4a 20 | 4f 62 73 74 65 74 20 47 |al{Am J |Obstet G|
|00004670| 79 6e 65 63 6f 6c 7d 0d | 0a 24 56 6f 6c 75 6d 65 |ynecol}.|.$Volume|
|00004680| 7b 31 36 31 7d 0d 0a 24 | 50 61 67 65 7b 36 30 30 |{161}..$|Page{600|
|00004690| 2d 36 30 35 7d 0d 0a 24 | 44 61 74 65 7b 31 39 38 |-605}..$|Date{198|
|000046a0| 39 7d 0d 0a 24 59 42 56 | 6f 6c 7b 31 39 39 31 20 |9}..$YBV|ol{1991 |
|000046b0| 59 65 61 72 20 42 6f 6f | 6b 20 6f 66 20 4f 62 73 |Year Boo|k of Obs|
|000046c0| 74 65 74 72 69 63 73 20 | 61 6e 64 20 47 79 6e 65 |tetrics |and Gyne|
|000046d0| 63 6f 6c 6f 67 79 7d 0d | 0a 24 43 68 61 70 74 65 |cology}.|.$Chapte|
|000046e0| 72 7b 35 2d 35 7d 0d 0a | 24 59 42 45 64 69 74 6f |r{5-5}..|$YBEdito|
|000046f0| 72 7b 44 72 73 2e 20 4d | 69 73 68 65 6c 6c 2c 20 |r{Drs. M|ishell, |
|00004700| 4b 69 72 73 63 68 62 61 | 75 6d 2c 20 61 6e 64 20 |Kirschba|um, and |
|00004710| 4d 6f 72 72 6f 77 7d 0d | 0a 24 54 61 62 6c 65 7b |Morrow}.|.$Table{|
|00004720| 7d 0d 0a 24 43 6f 6d 6d | 65 6e 74 61 74 6f 72 7b |}..$Comm|entator{|
|00004730| 54 2e 48 2e 20 4b 69 72 | 73 63 68 62 61 75 6d 2c |T.H. Kir|schbaum,|
|00004740| 20 4d 2e 44 2e 7d 0d 0a | 0d 0a 43 6f 70 79 72 69 | M.D.}..|..Copyri|
|00004750| 67 68 74 20 28 43 29 20 | 59 65 61 72 20 42 6f 6f |ght (C) |Year Boo|
|00004760| 6b 20 4d 65 64 69 63 61 | 6c 20 50 75 62 6c 69 73 |k Medica|l Publis|
|00004770| 68 65 72 73 2c 20 49 6e | 63 2e 20 31 39 39 31 0d |hers, In|c. 1991.|
|00004780| 0a 0d 0a 31 39 39 31 20 | 59 65 61 72 20 42 6f 6f |...1991 |Year Boo|
|00004790| 6b 20 6f 66 20 4f 62 73 | 74 65 74 72 69 63 73 20 |k of Obs|tetrics |
|000047a0| 61 6e 64 20 47 79 6e 65 | 63 6f 6c 6f 67 79 0d 0a |and Gyne|cology..|
|000047b0| 0d 0a 4f 62 73 74 65 74 | 72 69 63 73 0d 0a 0d 0a |..Obstet|rics....|
|000047c0| 43 68 61 70 74 65 72 20 | 35 20 2d 2d 20 41 6e 74 |Chapter |5 -- Ant|
|000047d0| 65 70 61 72 74 75 6d 20 | 46 65 74 61 6c 20 53 75 |epartum |Fetal Su|
|000047e0| 72 76 65 69 6c 6c 61 6e | 63 65 0d 0a 0d 0a 2d 2d |rveillan|ce....--|
|000047f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 52 6f |--------|----..Ro|
|00004840| 75 74 69 6e 65 20 55 6d | 62 69 6c 69 63 61 6c 20 |utine Um|bilical |
|00004850| 43 6f 72 64 20 42 6c 6f | 6f 64 20 47 61 73 20 44 |Cord Blo|od Gas D|
|00004860| 65 74 65 72 6d 69 6e 61 | 74 69 6f 6e 73 3f 0d 0a |etermina|tions?..|
|00004870| 0d 0a 54 68 6f 72 70 20 | 4a 41 3b 20 53 61 6d 70 |..Thorp |JA; Samp|
|00004880| 73 6f 6e 20 4a 45 3b 20 | 50 61 72 69 73 69 20 56 |son JE; |Parisi V|
|00004890| 4d 3b 20 43 72 65 61 73 | 79 20 52 4b 0d 0a 28 55 |M; Creas|y RK..(U|
|000048a0| 6e 69 76 20 6f 66 20 54 | 65 78 61 73 2c 20 48 6f |niv of T|exas, Ho|
|000048b0| 75 73 74 6f 6e 29 0d 0a | 41 6d 20 4a 20 4f 62 73 |uston)..|Am J Obs|
|000048c0| 74 65 74 20 47 79 6e 65 | 63 6f 6c 20 31 36 31 3a |tet Gyne|col 161:|
|000048d0| 36 30 30 2d 36 30 35 2c | 20 31 39 38 39 0d 0a 2d |600-605,| 1989..-|
|000048e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000048f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004930| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004940| 20 20 4e 65 77 62 6f 72 | 6e 20 64 65 70 72 65 73 | Newbor|n depres|
|00004950| 73 69 6f 6e 20 68 61 73 | 20 6d 61 6e 79 20 64 69 |sion has| many di|
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|00004970| 20 69 73 20 6e 6f 74 20 | 61 20 73 70 65 63 69 66 | is not |a specif|
|00004980| 69 63 0d 0a 69 6e 64 69 | 63 61 74 6f 72 20 6f 66 |ic..indi|cator of|
|00004990| 20 70 65 72 69 6e 61 74 | 61 6c 20 66 65 74 61 6c | perinat|al fetal|
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|000058c0| 20 73 61 6d 70 6c 69 6e | 67 0d 0a 61 74 74 72 61 | samplin|g..attra|
|000058d0| 63 74 69 76 65 2e 2d 2d | 54 2e 48 2e 20 4b 69 72 |ctive.--|T.H. Kir|
|000058e0| 73 63 68 62 61 75 6d 2c | 20 4d 2e 44 2e 0d 0a 24 |schbaum,| M.D...$|
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|000059d0| 65 2c 20 4a 57 4b 7d 0d | 0a 24 41 66 66 69 6c 69 |e, JWK}.|.$Affili|
|000059e0| 61 74 69 6f 6e 7b 55 6e | 69 76 20 6f 66 20 54 6f |ation{Un|iv of To|
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|00005a00| 7b 55 6c 74 72 61 73 6f | 75 6e 64 20 4d 65 64 20 |{Ultraso|und Med |
|00005a10| 42 69 6f 6c 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 31 |Biol}..$|Volume{1|
|00005a20| 36 7d 0d 0a 24 50 61 67 | 65 7b 31 39 2d 32 37 7d |6}..$Pag|e{19-27}|
|00005a30| 0d 0a 24 44 61 74 65 7b | 31 39 39 30 7d 0d 0a 24 |..$Date{|1990}..$|
|00005a40| 59 42 56 6f 6c 7b 31 39 | 39 31 20 59 65 61 72 20 |YBVol{19|91 Year |
|00005a50| 42 6f 6f 6b 20 6f 66 20 | 4f 62 73 74 65 74 72 69 |Book of |Obstetri|
|00005a60| 63 73 20 61 6e 64 20 47 | 79 6e 65 63 6f 6c 6f 67 |cs and G|ynecolog|
|00005a70| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 35 2d 36 |y}..$Cha|pter{5-6|
|00005a80| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00005a90| 2e 20 4d 69 73 68 65 6c | 6c 2c 20 4b 69 72 73 63 |. Mishel|l, Kirsc|
|00005aa0| 68 62 61 75 6d 2c 20 61 | 6e 64 20 4d 6f 72 72 6f |hbaum, a|nd Morro|
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|00005ac0| 20 4f 6d 69 74 74 65 64 | 7d 0d 0a 24 43 6f 6d 6d | Omitted|}..$Comm|
|00005ad0| 65 6e 74 61 74 6f 72 7b | 54 2e 48 2e 20 20 4b 69 |entator{|T.H. Ki|
|00005ae0| 72 73 63 68 62 61 75 6d | 2c 20 4d 2e 44 2e 7d 0d |rschbaum|, M.D.}.|
|00005af0| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 43 29 |...Copyr|ight (C)|
|00005b00| 20 59 65 61 72 20 42 6f | 6f 6b 20 4d 65 64 69 63 | Year Bo|ok Medic|
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|00005b30| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4f 62 | Year Bo|ok of Ob|
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|00005b60| 74 72 69 63 73 0d 0a 0d | 0a 43 68 61 70 74 65 72 |trics...|.Chapter|
|00005b70| 20 35 20 2d 2d 20 41 6e | 74 65 70 61 72 74 75 6d | 5 -- An|tepartum|
|00005b80| 20 46 65 74 61 6c 20 53 | 75 72 76 65 69 6c 6c 61 | Fetal S|urveilla|
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|00005bb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bc0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005bd0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005be0| 2d 2d 2d 2d 2d 0d 0a 53 | 69 74 65 2d 44 65 70 65 |-----..S|ite-Depe|
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|00005c20| 20 52 65 73 69 73 74 61 | 6e 63 65 20 6f 6e 20 74 | Resista|nce on t|
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|00005c40| 74 65 72 69 61 6c 20 56 | 65 6c 6f 63 69 74 79 20 |terial V|elocity |
|00005c50| 57 61 76 65 66 6f 72 6d | 20 69 6e 20 46 65 74 61 |Waveform| in Feta|
|00005c60| 6c 20 53 68 65 65 70 0d | 0a 0d 0a 41 64 61 6d 73 |l Sheep.|...Adams|
|00005c70| 6f 6e 20 53 4c 3b 20 4d | 6f 72 72 6f 77 20 52 4a |on SL; M|orrow RJ|
|00005c80| 3b 20 4c 61 6e 67 69 6c | 6c 65 20 42 4c 3b 20 42 |; Langil|le BL; B|
|00005c90| 75 6c 6c 20 53 42 3b 20 | 52 69 74 63 68 69 65 20 |ull SB; |Ritchie |
|00005ca0| 4a 57 4b 0d 0a 28 55 6e | 69 76 20 6f 66 20 54 6f |JWK..(Un|iv of To|
|00005cb0| 72 6f 6e 74 6f 29 0d 0a | 55 6c 74 72 61 73 6f 75 |ronto)..|Ultrasou|
|00005cc0| 6e 64 20 4d 65 64 20 42 | 69 6f 6c 20 31 36 3a 31 |nd Med B|iol 16:1|
|00005cd0| 39 2d 32 37 2c 20 31 39 | 39 30 0d 0a 2d 2d 2d 2d |9-27, 19|90..----|
|00005ce0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005cf0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005d00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005d10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005d20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|00005d30| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 54 |stract..|.. T|
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|00005e20| 67 69 6f 74 65 6e 73 69 | 6e 20 49 49 2e 20 20 53 |giotensi|n II. S|
|00005e30| 69 78 20 66 65 74 61 6c | 20 73 68 65 65 70 20 77 |ix fetal| sheep w|
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|00005e60| 73 74 68 65 73 69 61 20 | 61 66 74 65 72 20 69 6d |sthesia |after im|
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|00006260| 20 20 20 54 68 69 73 20 | 77 6f 72 6b 2c 20 70 65 | This |work, pe|
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|000062b0| 20 6f 66 20 44 6f 70 70 | 6c 65 72 2d 62 61 73 65 | of Dopp|ler-base|
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|000062e0| 63 65 2c 20 62 75 74 20 | 65 78 70 6c 61 69 6e 73 |ce, but |explains|
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|00006310| 66 69 6e 64 69 6e 67 73 | 2e 20 20 46 65 74 61 6c |findings|. Fetal|
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|00006390| 33 2d 66 6f 6c 64 20 61 | 6e 64 20 64 65 63 72 65 |3-fold a|nd decre|
|000063a0| 61 73 65 20 75 6d 62 69 | 6c 69 63 61 6c 20 61 72 |ase umbi|lical ar|
|000063b0| 74 65 72 79 20 66 6c 6f | 77 20 6d 65 61 73 75 72 |tery flo|w measur|
|000063c0| 65 64 20 62 79 20 65 6c | 65 63 74 72 6f 6d 61 67 |ed by el|ectromag|
|000063d0| 6e 65 74 69 63 20 66 6c | 6f 77 0d 0a 6d 65 74 65 |netic fl|ow..mete|
|000063e0| 72 73 20 62 79 20 61 20 | 74 68 69 72 64 2c 20 70 |rs by a |third, p|
|000063f0| 72 6f 64 75 63 65 64 20 | 6e 6f 20 63 68 61 6e 67 |roduced |no chang|
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