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Biomedical subjects

A N Trivedi

Publications and source records attributed to A N Trivedi.

13 recordsLinked to original sources
PubMed2000

Early teenage obstetrics at Waikato Hospital.

New Zealand has the second highest published teenage pregnancy rate in the world. Different papers have shown adverse obstetric outcome for teenage mothers. The aim of this study was to compare the obstetric parameters, such as birth weight, gestation at birth, Apgar scores, breech delivery, caesarean sections, instrumental deliveries, incidences of birth defects, twins, and gestational hypertension/pre-eclampsia of early teenage mothers with the rest of the population. The data were obtained from the perinatal information management system (PIMS) at Waikato Hospital for the period 1994 to 1996. The data were statistically analysed. There were 306 women in the early teenage group (17 years and younger) and 206 randomly selected women in the control group who were 18 years or older. In the early teen group more than 92% of women were primiparous, whereas in the control group most women were multiparous. The analyses detected no differences in the two groups in the parameters studied except increased incidence of ventouse delivery in the early teenage group (P = 0.004). This was surprising because, older and parous women are supposed to have better outcomes. Hence there was no evidence from this study of any of obstetric risk factors associated with early teenage pregnancy. Also, race did not affect the means of birth weights, gestational age at birth and Apgar scores. Adjustment for race and parity differences did not change the conclusions apart from making the difference in incidence of ventouse delivery less significant (P = 0.067 when adjusted for parity differences).

Journal Article↗
PubMed1999

Implementation of an outpatient hysteroscopy clinic at Waikato Women's Hospital report of the first 60 cases.

AIMS: To study the implementation of an outpatient hysteroscopy clinic at Waikato Women's Hospital and to assess the procedures carried out without the use of local anaesthesia. METHOD: This was a prospective observational study. RESULTS: The main indication for the procedure was menorrhagia in 32 patients (53.34%). Fifteen per cent patients were post-menopausal. The commonest pathology found was fibroids in 14 patients (23.34%). The procedure was considered completed when a detailed examination of the uterine cavity had been done. This was possible in 54 cases (90%). The main reasons for an incomplete/abandoned procedure (10% patients) were troublesome bleeding, blurred camera lens, post-menopausal stenosis and a possible false passage. Only six patients (10%) needed a paracervical block and therefore 90% underwent the procedure without the use of local anaesthesia. An endometrial biopsy was performed selectively in 47 patients and an adequate specimen was obtained in 43 cases (91.49%). Only five patients later underwent a hysteroscopy and D & C in the main theatre and therefore general anaesthesia was avoided in 55 patients (91.67%). Conclusions. Performance of outpatient hysteroscopy in an adequately selected group of patients is successful in a considerable number of patients. This office procedure may be done without local anaesthesia in 90% of cases.

Adult↗
PubMed1999

Maternal height as a risk factor for Caesarean section due to failure to progress in labour.

We examined for a regional sample of the New Zealand population, the relationship between maternal height and an increased risk of emergency Caesarean section due to arrested labour, to identify a height below which the risk of Caesarean section increases markedly and to quantify the risk of a Caesarean section for a range of maternal heights. The data of nulliparous singleton pregnancies over the period 1994-1998 was sorted into 2 study groups, one resulting in emergency Caesarean section for arrested labour and the other a group of women who had normal vaginal delivery requiring no intervention. The means and standard deviations of these 2 groups were found and 99% confidence intervals calculated. They were analysed for statistical difference and then a logistical regression calculation tried to identify a height at which the risk of a Caesarean section increased suddenly. There were 81 women in the Caesarean section group and 997 in the normal vaginal delivery group. Mean heights and confidence intervals were 161.0 cm (158.9-163.1) and 164.6 cm (164.0-165.2) respectively. There was a statistically significant difference between these means (p<0.001) but logistic regression analysis showed that risk of Caesarean section increased gradually with decreasing height, and even then did not reach more than 30% risk until a height of less than 140 cm. Low maternal height was associated with increased risk of Caesarean section due to labour arrest. Because the likelihood of having a normal vaginal delivery was still very good (>80 %) at modest degrees of short stature, this risk factor alone is unlikely to affect management. However the combination of other risk factors with maternal height may be of clinical use.

Body Height↗
PubMed1999

Catheterization prior to evacuation of uterus and diagnostic curettage.

Dilatation and curettage and evacuation of the uterus are the 2 most common minor gynaecological procedures that trainees perform. Some trainees are taught to catheterize the patient before these procedures. This study was carried out with 2 aims, firstly to establish the prevalence of significant residual urine volume prior to these procedures and secondly to gain information on the practices among members and fellows of the RNZCOG residing in New Zealand with regard to catheterization prior to these operations. The measured residual urine volume was greater than 50 mL in 37.5% of patients and greater than 100 mL in 12.1%. About 92% of those surveyed did not catheterize prior to either procedure. The risk of infection does not appear to be a valid argument for not catheterizing. Routine urinary catheterization before these procedures is unnecessary.

Abortion, Spontaneous↗
PubMed1998

The retained twin/triplet following a preterm delivery--an analysis of the literature.

We summarized the overall experience of the management and outcome of the retained twin/triplet and statistically analyzed the effects of the different variables such as cervical cerclage, tocolysis, use of antibiotics etc. on the retained fetal survival; 45 case reports in English were analyzed. The survival rate of the first born was very poor in contrast to the second and third-born infants. Spontaneous rupture of the membranes was the most common cause of the loss of the first born, whereas for the second born, premature labour was the commonest cause. Despite substantial obstetric events leading to delivery of the first-born infant, interval problems were uncommon. The mean period of retention of the surviving retained twin/triplet was 48.9 +/- 37.9 days compared to 25.7 +/- 31.6 days for the dead retained twins/triplets (p=0.08). The female retained twins/triplets were retained much longer than the males (p=0.008). The pregnancies lasted 45.9 days in the tocolytic group and 37 days in the nontocolytic group (p=0.51). The delivery interval of the second born in the cerclage group was 52 +/- 42 days compared to 34 +/- 30 days in the noncerclage group (p=0.1). The longer the twins/triplets were retained the better was their survival. Tocolysis, cervical cerclage and prophylactic use of antibiotics failed to make a statistically significant difference in the fetal outcome. The birth-weights, gestations and sex of the retained twins/triplets affected their survival significantly.

Adult↗
PubMed1987

Arterialization of reversed autogenous vein grafts: quantitative light and electron microscopy of canine jugular vein grafts harvested and implanted by standard or improved techniques.

To provide sequential, quantitative analysis of the cellular events occurring in reversed autogenous vein grafts after implantation and potential modifications of these events, two groups of veins were evaluated. Veins prepared by standard techniques of unmonitored pressure distension with cold heparinized saline solution, tributary ligation adjacent to the wall, and storage at 4 degrees C were morphometrically compared with veins harvested by means of a modified protocol of papaverine irrigation, tributary ligation away from the graft wall, pressure distension to 100 mm Hg with heparinized blood containing papaverine at body temperature, storage in identical solution at 4 degrees C, and implantation while distended. Unilateral jugular veins harvested from dogs with the modified technique (IRJV,N = 9) or standard technique (SRJV,N = 9) were implanted into carotid arteries, retrieved at 30 minutes, 2 days, and 10 days postoperatively along with the contralateral control vein after perfusion fixation in situ, and examined microscopically to quantitate intimal-medial thickness and endothelial damage (denudation and ultrastructural alterations). All IRJVs remained endothelialized, whereas SRJVs had 19% and 40% endothelial denudation at 30 minutes and 2 days, respectively, as well as massive neutrophil, platelet, and monocyte involvement. In contrast, IRJVs had only a modest infiltration of monocytes beginning early after implantation and culminating in their localization beneath endothelial cells; these endothelial cells increased in number during the 10-day period. Although SRJVs exhibited nearly complete reendothelialization over the luminal surface of macrophages by 10 days, endothelial damage was consistently higher than that of IRJVs at all periods and intimal-medial thickness was significantly greater at 10 days (65 +/- 0 vs. 57 +/- 0 micron, respectively; p less than 0.001). These findings suggest that endothelial preservation with improved harvesting techniques inhibits thrombosis and limits wall thickening and also that macrophages may play a protective role by promoting endothelial proliferation.

Animals↗