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Biomedical subjects

D A Ellwood

Publications and source records attributed to D A Ellwood.

At least 19 recordsLinked to original sources
PubMed2000

Early discharge and postnatal depression: a prospective cohort study.

OBJECTIVES: To determine whether women discharged from hospital < or = 72 hours after childbirth (early discharge) were at greater risk of developing symptoms of postnatal depression during the following six months than those discharged later (late discharge), their reasons for early discharge and their level of postnatal support. DESIGN AND SETTING: Population-based, prospective cohort study with questionnaires at Day 4, and at 8, 16 and 24 weeks postpartum, conducted at all birth sites in the Australian Capital Territory (ACT). PARTICIPANTS: Women resident in the ACT giving birth to a live baby from March to October 1997. MAIN OUTCOME MEASURE: A score > 12 on the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: 1295 (70%) women consented to participate; 1193 (92%) were retained in the study to 24 weeks and, of these, 1182 returned all four questionnaires. Of the 1266 women for whom length-of-stay data were available, 467 (37%) were discharged early and 799 (63%) were discharged late. There were no significant differences between the proportion of women discharged early who ever scored > 12 on the EPDS during the six postpartum months and those discharged late (17% v. 20%), even after controlling for other risk factors (adjusted OR, 0.67; 95% CI, 0.44-1.01). Of women discharged early, 93% had at least one postnatal visit at home from a midwife and 81% were "very satisfied" with the care provided. Most women (96%) reported they had someone to help in practical ways. CONCLUSIONS: Women discharged early after childbirth do not have an increased risk of developing symptoms of postnatal depression during the following six months.

Adult↗
PubMed2000

The cervix as a predictor of preterm delivery in 'at-risk' women.

OBJECTIVE: To examine the relationship between ultrasound-determined cervical status and pregnancy outcome in women 'at-risk' of spontaneous preterm delivery. DESIGN: A prospective cohort study of 120 pregnant women considered to be 'at-risk' of spontaneous preterm delivery by their clinician. Transvaginal ultrasound of the cervix was used to assess overall cervical length, closed endocervical canal length, diameter and internal os dilatation in the second trimester. The main outcome measure was occurrence of spontaneous preterm birth (< 34 and < 37 weeks of gestation). RESULTS: The overall preterm delivery rate (< 37 weeks gestation) in these women was 35% (n = 42) with 20% (n = 24) delivering < 34 weeks gestation. Of the 71 women with a normal cervix, 8 (11%) delivered < 34 weeks, whereas of the 49 women with an abnormal cervix, 16 (33%) delivered < 34 weeks (RR 2.90; 95% CI 1.35-6.24). Using linear regression, closed endocervical canal length of < 21 mm before 20 weeks is associated with delivery < 34 weeks in 95% of women, and with delivery < 37 weeks in 95% of women if the canal length is < 33 mm. Logistic regression showed closed endocervical canal length to be the only significant factor in those women who delivered < 34 weeks after controlling for possible confounders. CONCLUSIONS: A strong relationship is demonstrated between cervical status and pregnancy outcome, particularly the cervical findings before 20 and 24 weeks of gestation. The length of the closed portion of the endocervical canal is the best predictor. A beneficial effect of this approach to 'at-risk' women is the reduction in unnecessary interventions in those with normal cervical findings.

Adult↗
PubMed2000

Ultrasonographic evaluation of the postpartum uterus.

OBJECTIVES: To define the ultrasonographic appearance of the uterus and the uterine cavity, including its contents, in normal women making an uncomplicated postpartum recovery. METHODS: Forty women were scanned on days 7, 14, and 21 postpartum. At each scan the uterine and cavity volumes were estimated, and the appearance of the uterine cavity contents was documented. The amount and duration of postpartum vaginal bleeding, and method of infant feeding were also recorded. RESULTS: The mean duration of postpartum bleeding was 24.5 (range 14-45) days. Fifty-one percent (95% confidence interval 34-68) of the subjects scanned at 7 days postpartum, 21%(8-36) at 14 days, and 6%(0.8-20) at 21 days, had an echogenic mass within the uterine cavity. Statistical analysis revealed no difference, in terms of bleeding duration, between women with a uterine cavity echogenic mass noted at 7, 14, or 21 days postpartum, and those without (unpaired t-test, P = 0.42, 0.39, and 0.06). The presence of an echogenic mass was not associated with heavier bleeding at the time of any of the scans (chi-squared test, P = 0.58, 0.56, and 0.28). Statistical analysis revealed no correlation between the duration or amount of bleeding, and the uterine or cavity volume, at any of the three scans. CONCLUSION: In this study, ultrasound evaluation of the uterine cavity revealed an echogenic mass in 51% of women with normal postpartum bleeding at 7 days, 21% at 14 days, and 6% at 21 days postpartum. This questions the significance of echogenic material within the uterine cavity in the postpartum period.

Adult↗
PubMed2000

Is there a relationship between uterine activity and the length of the cervix in the second trimester?

OBJECTIVE: The purpose of this study was to determine if a relationship could be detected between uterine activity and cervical change in the second trimester. METHODS: Ten women with evidence of cervical change and 10 women with no cervical change (controls) were studied between 20 and 28 weeks gestation. Uterine activity was recorded using home uterine activity monitoring units. Cervical assessment was performed using transvaginal ultrasound. RESULTS: There was no statistically significant difference in the contractions per hour in the cervical change group (1.26 +/- 0.38; mean +/- SEM) compared to the controls (1.13 +/- 0.48) (p 0.48; Mann-Whitney U test). There were significant differences in closed endocervical length (p < 0.001) and internal os dilatation (p 0.004), the cervical change group demonstrating a shorter closed endocervical length and greater internal os dilatation. CONCLUSIONS: This preliminary study shows no evidence of a relationship between uterine activity and endocervical canal length in the second trimester.

Adult↗
PubMed2000

Antenatal transfer of rural women to perinatal centres. High Risk Obstetric and Perinatal Advisory Working Group.

The aim of this study was to describe antenatal transfers of rural women to perinatal centres, and among transferred women, to assess the use of selected evidence-based therapies and determine the predictors of preterm and imminent births. The clinical records of rural women antenatally transferred to perinatal centres in NSW and the ACT during 1997-1998 were reviewed. Of 453 rural antenatal transfers, 408 (90%) were emergency transfers. Increasing remoteness was associated with increased rates of antenatal transfer but not with a lower probability of giving birth. Of all transferred women, 64% delivered; 58% of preterm transfers delivered preterm and of those delivering preterm, 76% delivered within 7 days. Although the main reason for antenatal transfer was the possibility of preterm birth, women presenting with preterm contractions only were less likely to deliver preterm (OR = 0.2, 95% CI 0.1-0.4) or < or = 7 days (OR = 0.3, 95% CI 0.2-0.5) than women with any other presenting symptoms. The overall usage of effective interventions (antenatal steroids, antibiotics for PPROM and beta-mimetic tocolysis to delay birth) among antenatally transferred rural women was high, but there is room for increased uptake prior to transfer.

Adult↗
PubMed1996

A randomized controlled trial of aspirin in patients with abnormal uterine artery blood flow.

OBJECTIVE: To evaluate color Doppler imaging of the uterine arteries as a screening test in nulliparous women, and to examine the role of low-dose aspirin therapy in pregnancies with abnormal uteroplacental resistance. METHODS: At the routine 18-week fetal morphology ultrasound scan, 955 nulliparous women underwent color Doppler imaging of the uterine arteries. Abnormal uteroplacental vascular resistance was defined with respect to both the systolic-diastolic ratio of the flow velocity waveform and the presence of an ipsilateral early diastolic notch. Those with abnormal uterine artery waveforms were asked to participate in a randomized controlled trial of aspirin therapy. Pregnancy outcomes were compared in women with normal or abnormal flow velocity waveforms, as well as in the two arms of the intervention study. RESULTS: Of 186 women with abnormal uteroplacental resistance according to criteria defined previously, 102 agreed to randomization to either low-dose aspirin (100 mg/day) or placebo for the remainder of the pregnancy. Abnormal uterine artery flow velocity waveforms were associated with statistically significant increases in preeclampsia (11 versus 4%), birth weight below the tenth percentile (28 versus 11%), and adverse pregnancy outcome (45 versus 28%). Prophylactic aspirin therapy did not result in a significant reduction in pregnancy complications. CONCLUSION: Abnormal uteroplacental resistance at 18 weeks' gestation was associated with a significant increase in adverse pregnancy outcome. Low-dose aspirin did not reduce pregnancy complications in women with uteroplacental insufficiency.

Adult↗
PubMed1996

A longitudinal study of the cervix in pregnancy using transvaginal ultrasound.

OBJECTIVE: To study longitudinal changes in the cervix during pregnancy using transvaginal ultrasound and secondly, to determine whether the measures used change with gestational age, and whether there are differences between nulliparous and primiparous women. DESIGN: A longitudinal study involving five transvaginal ultrasound examinations of each woman at specified gestational ages from 18 to 30 weeks. PARTICIPANTS: Twenty-one nulliparous and 20 primiparous women completed the study and were delivered at term. Cervical length, diameter and dilation were assessed at each examination. RESULTS: In both nulliparous and primiparous women there is no significant change in either cervical length or diameter over the time period studied. In primiparous women the cervix is significantly longer than in nulliparous women (44.4 (5.1) mm versus 40.6 (4.7) mm [mean (SD)]; P< 0.001). The cervical diameter in primiparous women is also significantly greater (31.8 (4.0) mm versus 29.0 (3.7) mm; P<0.001). CONCLUSIONS: Cervical length and diameter are constant in both nulliparous and primiparous women throughout this gestational period. The cervix in primiparous women is both longer and thicker than in nulliparous women.

Adolescent↗
PubMed1996

Fetal ultrasonography: normal biometric ranges in the baboon (Papio hamadryas).

Normal biometric ranges for fetal growth in a captive breeding baboon (Papio hamadryas) colony are described. Measurements include crownrump length, biparietal diameter, binocular distance, head circumference, abdominal circumference, femur length and amniotic fluid index. The pattern of fetal growth is compared with other baboon subspecies and man. The uses and limitations of such data for breeding colony management and optimum utilisation of experimentally derived data are discussed.

Animals↗
PubMed1995

Computer analysis of the early diastolic notch in Doppler sonograms of the uterine arteries.

This article describes a set of processing and analysis techniques for automated identification and quantification of the early diastolic notch (EDN), a feature of Doppler sonograms from the uterine arteries which has been associated with adverse pregnancy outcomes such as preeclampsia and intrauterine growth retardation. Examples covering different sonogram types are provided to illustrate the effectiveness and reproducibility of the processing/analysis tools. Also, a receiver-operating characteristic-based evaluation of the EDN quantification and pulsatility indexes is presented, which examines the ability to predict hypertension and/or intrauterine growth retardation, using a set of uterine Doppler sonograms from 92 patients acquired at 18 weeks of gestation. In summary, the ROC results confirm the link between the EDN and abnormal pregnancy outcomes, and suggest that EDN quantification has a higher diagnostic accuracy than the pulsatility index, which characterises the flow waveform in a global manner and therefore does not take explicitly into account the localised nature of the EDN. Quantification of the EDN at 18 weeks of gestation appears to best predict the most severely abnormal pregnancy outcomes.

Arteries↗
PubMed1995

Volume imaging: three-dimensional appreciation of the fetal head and face.

Quasi-three-dimensional volume imaging provides an inexpensive means of evaluating the usefulness of three-dimensional imaging. The technique works most efficiently with water-skin interfaces and therefore we investigated its application in obstetrical ultrasonography. Three-dimensional perspectives of the normal and abnormal fetal head and face were spectacular and at times provided more information than the two-dimensional images. The ability of an inexperienced observer to interpret the three-dimensional image more easily may have a role in training sonographers and counseling parents whose fetuses have structural defects. Volume imaging has certain limitations and can only be used as a complementary technique.

Artifacts↗
PubMed1994

Color Doppler imaging of the uteroplacental circulation in the middle trimester: observations on the development of a low-resistance circulation.

We aimed to study the changes in the flow dynamics of the uteroplacental and umbilical circulations in the middle trimester of normal pregnancy, and establish normal ranges for indices of the Doppler flow velocity waveforms (FVWs) from both circulations at 14, 18 and 24 weeks. A longitudinal study was conducted with the use of color Doppler imaging to localize both uterine arteries and umbilical arteries and obtain FVWs from 106 healthy nulliparous women with a singleton pregnancy. Of these, 70 did not have a complicated pregnancy outcome, defined as hypertension, growth retardation, preterm delivery or perinatal death. We measured the resistance index (RI), pulsatility index (PI), systolic/diastolic (S/D) ratio and presence of early diastolic notching in both uterine arteries, and RI, PI and S/D in one umbilical artery. The results showed a fall in all measured indices of blood flow impedance in the uteroplacental and umbilical circulations and a marked reduction in the incidence of the early diastolic notch in the uterine artery FVWs during the mid-trimester. Our conclusion was that color Doppler imaging allows for the accurate localization of both uterine and umbilical arteries. Doppler FVWs then obtained confirm the development of the low-resistance uteroplacental and umbilical circulations in the mid-trimester. Diastolic notching is common at 14 weeks in normal pregnancy but uncommon at 24 weeks.

Journal Article↗
PubMed1994

Transabdominal ultrasound as an aid to advanced hysteroscopic surgery.

At the Nepean Hospital transabdominal ultrasound has been used to assist the hysteroscopic surgeon when performing complicated transcervical operations. The 2 main areas of use appear to be either to direct the surgeon within the uterus to the site of pathology or to prevent inadvertent perforation of the uterine wall. The cases vary from haematometra following endometrial ablation to Asherman syndrome and subseptate uteri.

Adult↗