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Biomedical subjects

D Elbourne

Publications and source records attributed to D Elbourne.

78 records · Page 5Linked to original sources
PubMed1984

Adverse outcome of pregnancy and the quality of obstetric care.

The case-control method was used to study the relation between four possibly preventable adverse outcomes of pregnancy and suboptimal antepartum and intrapartum obstetric care defined by clinical consensus. Fetuses whose deaths were ascribed to asphyxia or trauma, and babies born at term who had seizures within 48 h of delivery, were significantly more likely than controls to have received suboptimal care during pregnancy. Babies with seizures, as well as those with terminal apnoea, were also substantially more likely than controls to have been born after a failure to react appropriately to signs of severe fetal distress during labour. Most of the babies who received suboptimal obstetric care, however, did not have any of these adverse outcomes. In addition, most babies with these adverse outcomes had apparently received satisfactory obstetric care. No relation was detected between cerebral palsy and suboptimal obstetric care.

Adolescent↗
PubMed1984

West Berkshire perineal management trial.

One thousand women were allocated at random to one of two perineal management policies, both intended to minimise trauma during spontaneous vaginal delivery. In one the aim was to restrict episiotomy to fetal indications; in the other the operation was to be used more liberally to prevent perineal tears. The resultant episiotomy rates were 10% and 51% respectively. An intact perineum was more common among those allocated to the restrictive policy. This group experienced more perineal and labial tears, however, and included four of the five cases of severe trauma. There were no significant differences between the two groups either in neonatal state or in maternal pain and urinary symptoms 10 days and three months post partum. Women allocated to the restrictive policy were more likely to have resumed sexual intercourse within a month after delivery. These findings provide little support either for liberal use of episiotomy or for claims that reduced use of the operation decreases postpartum morbidity.

Adult↗
PubMed1984

Employment in pregnancy: prevalence, maternal characteristics, perinatal outcome.

Data from the Cardiff Births Survey was used to examine the relation between the nature of employment and perinatal outcome. The proportion of all expectant mothers who work during pregnancy increased from 38.7% in 1965/69 to 43.9% in 1975/79 (p less than 0.001). The percentage of working primiparas, however, remained unchanged at approximately 80%, whereas the percentage of working multiparas rose from 15.1% to 22.1%. The non-employed primiparas were more likely than the employed primiparas to be at the extremes of maternal age, to have a history of medical problems and previous abortions, and to attend less often for antenatal care. Perinatal outcome (measured in terms of perinatal mortality, birthweight, and length of gestation) was significantly better among the employed mothers. Non-employed mothers in social classes I and II seemed to be a particularly high risk group. Exclusion of mothers with an adverse obstetric or medical history considerably reduced the differences in perinatal outcome between the two groups. The findings suggest that healthy women without an adverse obstetric or medical history can safely continue in employment during pregnancy.

Birth Weight↗
PubMedDate not supplied

Costing neonatal care alongside the Collaborative ECMO trial: how much primary research is required?

Researchers working on economic evaluations alongside trials have to balance minimising data collection with maximising the ability to measure differences in costs. Using existing data sources may keep the costs of research down, but these data may not be entirely appropriate to the evaluation question. When evaluating technologies in intensive care it is particularly important to be able to classify patients correctly by their resource requirements especially when those requirements vary considerably from day to day. This paper describes and justifies methods for costing the care provided for babies in (one arm of) an on-going multi-centre trial, the Collaborative ECMO trial. This trial is evaluating alternative policies of life support for mature (full term) newborn babies with severe respiratory failure. The most reliable cost information on neonatal intensive care is available from a study, conducted independently from the trial, which has used simple cost apportionment on a large sample of units. By drawing on clinical opinion and carrying out a case note exercise we assessed whether this available information was appropriate to estimate 'baseline' costs for the control group during their initial 'acute' phase of illness. We concluded that the available cost estimates would need to be weighted to reflect the additional costs of drugs and investigations for this group of babies during the acute phase. Multidisciplinary collaboration on trials can help economists and other researchers to balance the requirement for simple cost measurements with more detailed primary research.

Cost-Benefit Analysis↗