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Biomedical subjects

C A Crowther

Publications and source records attributed to C A Crowther.

At least 55 records · Page 3Linked to original sources
PubMed2000

A randomised controlled trial comparing birthing centre care with delivery suite care in Adelaide, Australia.

Birthing centre care offers women with a low risk of complication in pregnancy an alternative to conventional care for the birthing of their baby. It is important these two forms of care are appropriately assessed. A randomised controlled trial comparing the newly opened birthing centre with the established conventional delivery suite was conducted at the then Queen Victoria Hospital, Adelaide, South Australia. The outcomes measured included maternal satisfaction, costs and clinical outcomes both for mother and baby which related to the need for Caesarean section, episiotomy or tear rate and method of feeding. Two hundred and one women attending the hospital's antenatal clinic were randomly allocated to either birthing centre or delivery suite care. One hundred women were allocated to the birthing centre. No differences were found in either group related to clinical outcomes or costs. The only difference in maternal satisfaction was the choice women made for their next birth. More women in the birthing centre group felt they were encouraged to breastfeed immediately after birth. While the numbers in this study were too small to detect any but large differences in outcome, birthing centre care should remain an option for women and further studies undertaken with larger numbers.

Adult↗
PubMed1999

Is an ultrasound assessment of gestational age at the first antenatal visit of value? A randomised clinical trial.

OBJECTIVES: To assess the efficacy of an ultrasound scan at the first antenatal visit. DESIGN: Randomised clinical trial. SETTING: Women's and Children's tertiary level hospital, Adelaide, Australia. POPULATION: Six hundred and forty-eight women attending for their first antenatal visit at less than 17 weeks of gestation who had no previous ultrasound scan in the pregnancy, who were expected to give birth at the hospital, and for whom there was no indication for an ultrasound at their first visit. METHODS: Eligible consenting women were enrolled by telephone randomisation into either the ultrasound at first visit group, who had an ultrasound at the time of their first antenatal visit, or the control group in whom no ultrasound assessment was done at their first antenatal visit. Both groups of women completed a questionnaire at the end of the first visit on their feelings towards the pregnancy and anxiety levels. Data were collected on details of any ultrasound assessments, including the 18 to 20 weeks morphology scan, and pregnancy outcome. All primary analyses were on an intention-to-treat basis. MAIN OUTCOME MEASURES: The number of women who needed adjustment in dates of 10 days or more on the basis of their 18 to 20 weeks ultrasound morphology scan, who were booked for their morphology scan at sub-optimal gestations, who had a repeat of their maternal serum screening test, or who felt worried about their pregnancy at the end of the first antenatal visit. RESULTS: Fewer women (9%) in the ultrasound at first visit group needed adjustment of their expected date of delivery as a result of the 18 to 20 week ultrasound, compared with 18% of women in the control group (RR 0.52, 95% CI 0.34-0.79; P = 0.002). The number of women who had the 18 to 20 week ultrasound assessment timed suboptimally was similar to that in the control group (16% vs. 21%), as was the number of women who had a repeat blood sample taken for maternal serum screening (6% vs. 6%). Fewer women in the ultrasound at first visit group reported feeling worried about their pregnancy (RR 0.80, 95% CI 0.65-0.99; P = 0.04) or not feeling relaxed about their pregnancy (RR 0.73, 95% CI 0.56-0.96; P = 0.02), compared with women in the control group. CONCLUSIONS: A routine ultrasound assessment for dating offered to women at the first antenatal visit provides more precise estimates of gestational age and reduces the need to adjust the estimate of the date of delivery in mid-gestation. Women who had an ultrasound at the first visit reported more positive feelings about their pregnancy, compared with women in the control group at that time.

Adult↗
PubMed1999

Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT Study Group.

A multicentre, randomized controlled double-blind trial in 5 maternity hospitals in Australia assessed the effect of a daily supplement of calcium (1.8g oral calcium or an oral placebo) taken daily until delivery, from less than 24 weeks' gestation, on the frequency of pregnancy-induced hypertension, preeclampsia and preterm birth (< 37 weeks' gestation) in 456 nulliparas with a singleton pregnancy. Treatment with calcium reduced the risk of preeclampsia (relative risk 0.44 [95% CI, 0.21-0.90], p = 0.02) and the risk of preterm birth (relative risk 0.44 [95% CI, 0.21-0.90], p = 0.02). No significant differences were seen between the 2 groups in the frequency of pregnancy-induced hypertension, although the study only had statistical power to detect large differences in this outcome. An updated systematic review of the 9 randomized trials of calcium supplementation in pregnancy shows a significant reduction in the risk of hypertension and preeclampsia although no effect on preterm birth. Calcium supplementation during pregnancy reduced the risk of preeclampsia and preterm birth in this nulliparous population. The available evidence for systematic review of all the randomized trials of calcium supplementation shows benefit in reducing the risk of hypertension and preeclampsia.

Adult↗
PubMed1998

Prevention of preterm birth in multiple pregnancy.

Preterm birth is the greatest threat to the infants in a multiple pregnancy. This chapter focuses on strategies that aim to prevent preterm birth and concentrates on the evidence derived from randomized clinical trials and systematic review of randomized clinical trials. The options to avoid a multiple pregnancy are briefly considered. Interventions that aim to prolong pregnancy, including prophylactic cervical cerclage, prophylactic tocolysis, home uterine activity monitoring and hospitalization for bed rest, are critically appraised, as are interventions that aim to improve the outcome of preterm birth. Interventions that require additional evaluation are highlighted.

Female↗
PubMed1997

Lag times between blood sampling, spinning and plasma glucose estimation.

This study investigated the effect of lag times between blood sampling and glucose analysis on plasma glucose results from 6 volunteers. Our aim was to determine whether glucose tolerance test protocols should include instructions on the handling of blood between sampling and analysis. Plasma glucose levels remained stable for all lag times between spinning and analysis. With a lag time between blood sampling and spinning, plasma glucose levels did not remain stable, and a significant lowering of plasma glucose was found in the first 2 hours of lag. With increased lag time there was no further decrease in plasma glucose levels. Glucose tolerance test protocols should include clear guidelines on the handling of the blood samples between collection and analysis, and the spinning down of samples needs to be prioritized.

Adult↗
PubMed1997

Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone: adverse effects at 12-month follow-up. ACTOBAT Study Group.

OBJECTIVE: The Australian Collaborative Trial of Antenatal Thyrotropin-Releasing Hormone (ACTOBAT) assessed the efficacy of 200 microg of thyrotropin-releasing hormone (TRH) in combination with glucocorticoids in the prevention of neonatal lung disease. This paper reports the 12-month follow-up of the infants from the trial completed in 1994. DESIGN: This was a double-blinded randomized controlled trial. SETTING: Women were recruited from level 3 perinatal centers throughout Australia. PARTICIPANTS: Mothers who had not withdrawn from treatment and whose infants were discharged alive (1262 infants). Extensive efforts were made to trace this entire cohort. OUTCOME MEASURES: A questionnaire was mailed to parents for self-completion immediately before their baby's/babies' first birthday. The questionnaire included a checklist to assess sensory, motor, language, and social development, and use of health services. RESULTS: Milestone scores were developed from items on the follow-up form. Treatment with TRH was associated with an increased risk of motor delay, social delay, fine motor delay, sensory impairment, and early language impairment. No differences were seen between treatment and placebo groups for motor impairment. Multivariate analyses were performed, adjusting for chronological age, duration of gestation at randomization, time from randomization to delivery, parity, history of perinatal death, history of preterm rupture of the membranes, infant sex, singleton or twin status, maternal age, and maternal blood pressure (systolic and diastolic) at randomization. For the total cohort (N = 1022), treatment with TRH was associated with motor delay (odds ratio [OR], 1.51; 95% confidence interval [CI] 1.11 to 2.05); social delay (OR 1.40; 95% CI 1.01 to 1.95); sensory impairment (OR, 2.00; 95% CI 1.06 to 3.74); severe impairment (OR, 1.75; 95% CI 1.07 to 2.87); and a trend toward motor impairment (OR, 1.50; 95% CI .97 to 2.33), early language impairment (OR, 1.27, 95% CI .90 to 1.79), and fine motor delay (OR, 1.15; 95% CI .83 to 1.60). There were no differences between the treatment groups in hospital admissions (OR, 1.08; 95% CI .83 to 1.42), doctors' visits (general practitioner OR adj, 1.09; 95% CI .79 to 1.50 or specialist OR adj 1.15; 95% CI .87 to 1.49), respiratory symptoms (OR adj, 1.16; 95% CI .88 to 1.53), or behavioral disturbances (OR adj, .93; 95% CI .71 to 1.21). CONCLUSIONS: Because antenatal administration of TRH is associated with small, consistent deficits in major milestone achievements at 12 months of age, it is essential that additional planned trials make provision for long-term follow-up. Antenatal TRH should only be used in the context of a clinical trial.

Adult↗
PubMed1996

Predicting postnatal depression among pregnant women.

BACKGROUND: Depression after the birth of a baby is a common cause of maternal morbidity, and its prevalence in Australia is 10 to 15 percent at 6 to 9 months postpartum. This study assesses the prediction of postnatal depression at 6 weeks postpartum. METHOD: Women at 24 weeks' gestation or less were invited to complete a Modified Antenatal Screening Questionnaire (MASQ) that identified women more vulnerable to becoming depressed after childbirth. Of these 249 women, 144 (58%) screened more vulnerable, and were randomly allocated to receive either a supportive intervention to reduce postnatal depression or to receive no intervention. At 6 weeks postpartum the women completed the Edinburgh Postnatal Depression Scale (EPDS) to assess their mood after the birth. RESULTS: No difference occurred at 6 weeks postpartum between the MASQ vulnerable group (return rate 64/68) and the MASQ less vulnerable group (return rate 44/51) in the frequency of those who screened as potential candidates for major depression using the EPDS. For major depression the MASQ's sensitivity was 73 percent, specificity 43 percent, positive predictive value 17 percent, and negative predictive value 91 percent; for minor depression its sensitivity was 81, 48, 34, and 89 percent, respectively. The MASQ was able to predict minor depression. More women in the vulnerable group scored at increased risk of minor depression on the EPDS at 6 weeks postpartum. CONCLUSION: Further studies are needed to extend this work and develop a screening test with higher specificity and greater positive predictive value.

Adult↗
PubMed1995

Candida tropicalis chorioamnionitis.

A case of Candida tropicalis chorioamnionitis at 25 weeks' gestation is presented, and the literature is reviewed. This is the first report, to our knowledge, of C. tropicalis diagnosed antenatally with confirmed congenital infection.

Adult↗
PubMed1995

Aspirin and prevention of preeclampsia. Position statement of the use of low-dose aspirin in pregnancy by the Australasian Society for the Study of Hypertension in Pregnancy.

1. A heterogeneous group of randomized trials have been conducted using low-dose aspirin to prevent preeclampsia. The results do not support widespread use of low-dose aspirin to prevent preeclampsia. 2. On the basis of existing literature, it is reasonable to use prophylactic low-dose aspirin from early pregnancy in the following groups: (i) Women with prior fetal loss after the first trimester, with placental insufficiency (ii) Women with severe fetal growth retardation in a preceding pregnancy either due to preeclampsia or unexplained (iii) Women with severe early-onset preeclampsia in a previous pregnancy necessitating delivery at or before 32 weeks' gestation. 3. On the basis of existing literature, it is recommended that aspirin not be used in the following groups: (i) Healthy nulliparous women (ii) Women with mild chronic hypertension (iii) Women with established preeclampsia. 4. The data are sufficient to support further trials in more homogeneous select subgroups of women considered at risk of developing preeclampsia.

Aspirin↗
PubMed1995

Evaluation of antenatal and postnatal support to overcome postnatal depression: a randomized, controlled trial.

This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (> 12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.

Adult↗
PubMed1994

Women's views of their postnatal care by midwives at an Adelaide Women's Hospital.

OBJECTIVE: to determine the characteristics of a sample of women giving birth in one hospital in South Australia and these women's perceptions of the usefulness of the advice and care that they were given during the puerperium DESIGN: survey using questionnaires, incorporating Lipsett's (1984) questions, administered before the women left hospital and at six weeks postdelivery. SETTING: one hospital in South Australia. PARTICIPANTS: a sample of convenience of 235 women completed the hospital questionnaire and 222 (95%) returned the six weeks postpartum questionnaire. FINDINGS: the women's ages ranged from 17-44 years, 86% were living in a stable relationship and 42% were primiparous. Most women (74%) made comments on the helpfulness of midwives. The midwife provided emotional support (57%), answered questions (32%) and gave information (30%). However, midwives' attitudes were perceived as insensitive (18%) and judgemental (9%). Midwives gave conflicting advice (10%) and 40% of the women made one or more comments about midwife unhelpfulness. Sixteen per cent of the women made no comment on the helpfulness of the midwife. IMPLICATIONS FOR PRACTICE: contact with midwives in the early postnatal period is an ideal time for helpful advice and support to be given but midwives are not always perceived as fulfilling this part of their role. There is a need to address the issue of conflicting advice.

Adolescent↗
PubMed1994

Postnatal depression: a South Australian prospective survey.

The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self-esteem in the early postnatal period and at 6 weeks postpartum and PND at 6 months postpartum. Women giving birth to term babies over a 6-month period, completed an Edinburgh postnatal depression scale (EPDS) and a Rosenberg self-esteem scale in hospital, at 6 weeks postpartum and an EPDS only at 6 months postpartum. A total of 235 women participated in the study of which 222 (95%) returned their questionnaire at 6 weeks postpartum and 192 (82%) at 6 months postpartum. Characteristics of the women and their pregnancy outcome are presented. The EPDS identified a depressed mood in 9% of women in hospital and at 6 weeks postpartum (95% CI 5.3%-12.8%). At 6 months this had increased to 10% (95% CI 7.8%-12.2%).

Adolescent↗
PubMed1993

Suction v. conventional curettage in incomplete abortion. A randomised controlled trial.

This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0.0001) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage. Suction curettage was a faster procedure and less painful. No difference was found between the two groups with regard to the incidence of post-abortal sepsis, or the re-evacuation rate. No problems were encountered with the use of suction curettage in the presence of uterine sepsis. In an era where blood transfusions should be kept to an absolute minimum, suction curettage will help to save blood in several ways.

Abortion, Incomplete↗
PubMed1992

Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension?

OBJECTIVE: To test whether a policy of admission to hospital for rest is of value in the management of women with non-proteinuric hypertension during pregnancy. DESIGN: A randomized controlled trial. SETTING: Harare Maternity Hospital, Zimbabwe. SUBJECTS: 218 (28 first pregnancies) women with non-proteinuric hypertension and a singleton pregnancy at between 28 and 38 weeks gestation allocated to rest in hospital or routine outpatient care. INTERVENTION: Admission to hospital for rest. Encouraged to rest in bed although voluntary ambulation around the ward was allowed. The women in the control group were encouraged to continue normal activity at home, to check urine each day for proteinuria. All the women were reviewed weekly. MAIN OUTCOME MEASURES: Disease progression was assessed by the development of severe hypertension (greater than or equal to 160/110 mmHg), development of proteinuria, need for induction of labour and number of infants born preterm (less than 37 weeks). Fetal outcome was assessed by birthweight, number of infants small-for-gestational age (SGA), and the number of infants requiring admission to the neonatal unit and their length of stay. RESULTS: The hospital rest group had a decreased risk of developing severe hypertension (blood pressure greater than or equal to 160/110 mmHg [odds ratio 0.47, 95% CI 0.26-0.83]). No differences were found in fetal growth or neonatal morbidity. The mean antenatal stay in hospital was 22.2 (SD 16.5), and 6.5 (SD 7.9) days in the rest and control groups, respectively. CONCLUSIONS: Hospital admission for bed rest decreased the risk of developing severe hypertension but no improvement in fetal growth or neonatal morbidity was observed. Fetal monitoring at home and continued outpatient antenatal care provided a safe, alternative policy to hospital admission.

Adult↗
PubMed1992

Booked and unbooked mothers delivering at Harare Maternity Hospital, Zimbabwe: a comparison of maternal characteristics and foetal outcome.

This study was prompted by the poor maternal and foetal outcome at Harare Maternity Hospital, Zimbabwe, in unbooked mothers compared to women who had booked for antenatal care. Comparison was made of 195 recently delivered unbooked mothers with 196 booked mothers. Unbooked mothers were significantly more likely to be younger, of lower parity, be single, have lower socio-economic status, live in or migrate from rural areas, be uneducated and have an unwanted pregnancy. Their infants were significantly more likely to preterm and/or of low birth weight and had a higher perinatal mortality. The major reasons cited by the women for not booking were lack of money and delivery occurring before the intended time of booking. Discussion focuses on how to improve outcome in unbooked mothers.

Adult↗