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Caroline Homer

Publications and source records attributed to Caroline Homer.

5 recordsLinked to original sources
PubMed2005

Microscopic hematuria in pregnancy: relevance to pregnancy outcome.

BACKGROUND: The significance of dipstick or microscopic hematuria in pregnancy is uncertain, with some studies suggesting this is associated with a greater risk for preeclampsia. We sought to determine the prevalence and clinical significance of microscopic hematuria during pregnancy. METHODS: This was a prospective case-control study in the antenatal Clinic of St George Hospital, Kogarah, Australia, a teaching hospital without tertiary referral antenatal care, with approximately 2,600 deliveries per year. One thousand pregnant women attending for routine antenatal care were invited to have a routine urinalysis performed and be referred to a nephrology clinic for further investigation if dipstick microscopic hematuria was detected on more than 1 occasion before 32 weeks' gestation. Main outcome measures were the prevalence of dipstick hematuria, prevalence of hematuria confirmed by urine microscopy, and the development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby. RESULTS: One hundred seventy-eight of 902 women (20%) who entered the study had dipstick hematuria on at least 2 occasions in pregnancy; 66 of 126 women (53%) who had hematuria before 32 weeks attended the nephrology clinic, where microscopic hematuria was confirmed in 40 women (61%). Renal imaging results were normal in all except 1 woman, and all women had a serum creatinine level of 0.90 mg/dL or less (< or =80 micromol/L). The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby were similar in women with and without dipstick hematuria. Microscopic hematuria persisted in half (15 women) of those who attended for follow-up after 3 months postpartum. CONCLUSION: Dipstick hematuria is very common during pregnancy, but rarely signifies a disorder likely to impact on the pregnancy outcome. Postpartum follow-up is recommended to detect women who have persistent hematuria and presumed underlying mild glomerulonephritis.

Adult↗
PubMed2005

The natural history of white coat hypertension during pregnancy.

OBJECTIVE: White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. DESIGN: Prospective observational study. SETTING: St George Hospital, a teaching and University hospital. POPULATION: Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). METHODS: Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. MAIN OUTCOME MEASURE: The development of PE in women with WCH or EH. RESULTS: The overall prevalence of WCH was 32%. Half retained this phenomenon throughout pregnancy and had good pregnancy outcomes. Forty percent developed (benign) gestational hypertension and also had good pregnancy outcomes while 8% developed proteinuric PE, significantly fewer than in women with confirmed EH (22%), P= 0.008. No BP parameter at study entry permitted discrimination between those women with WCH who retained this phenomenon and those who developed GH or PE. CONCLUSION: WCH is a common phenomenon in pregnant women who appear to have EH according to routine BP measurement early in pregnancy. Antihypertensives may be withheld from this group initially and they can be advised they will have better pregnancy outcomes than women with true EH. However, continued monitoring throughout pregnancy remains important to detect the small group of white coat hypertensives who develop PE.

Adult↗
PubMed2003

From student to midwife: the experiences of newly graduated midwives working in an innovative model of midwifery care.

In 2001, a new model of midwifery care was established in the Birth Centre at St George Hospital, a metropolitan hospital in NSW. The new model was designed to encompass the principles and recommendations from numerous government reports and research. The model also build on the previous successful implementation of a team midwifery program (Homer et al 2001b; Homer et al 2001a). Four newly graduated midwives, together with four more experienced midwives were employed to work in the models of midwifery care. This small study evaluates the first 10 months' using qualitative and quantitative data. As this is a small study, no firm conclusion can be reached. The results of the evaluation however demonstrated that with appropriate support and mentoring, newly graduated midwives can work in an innovative model of midwifery care within a birth centre environment.

Attitude of Health Personnel↗