The clinical utility of routine urinalysis in pregnancy.
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Diagnostic Tests, Routine↗
Biomedical subjects
Deirdre J Murphy
Publications and source records attributed to Deirdre J Murphy.
Cohort study of maternal views on future mode of delivery after operative delivery in the second stage of labor.
OBJECTIVE: The purpose of this study was to assess maternal views on the future mode of delivery after either previous instrument vaginal delivery or cesarean delivery at full dilatation. STUDY DESIGN: We conducted a prospective cohort study of 393 women with term singleton cephalic pregnancies. RESULTS: More than one half of the cohort intended to have a further pregnancy, with no significant differences between the instrument vaginal delivery and caesarean delivery groups (51% vs 54% before discharge; adjusted odds ratio, 1.04; 95% CI, 0.2, 6.0), and there was little change in maternal views over time. Women were more likely to aim for a future vaginal delivery after an instrument vaginal delivery (79% vs 39% before discharge; adjusted odds ratio, 4.5; 95% CI, 2.2, 9.2), but the proportion decreased over time (68% vs 42% at 1 year; adjusted odds ratio, 3.6; 95% CI, 1.6, 8.1). There were no significant differences in preferred future mode of delivery for women who had a caesarean delivery after a failed instrument delivery and those who were delivered by immediate caesarean delivery. CONCLUSION: A high proportion of women who have had a previous difficult instrument vaginal delivery would still prefer vaginal delivery in a future pregnancy.
Cesarean Section↗
Cohort study of operative delivery in the second stage of labour and standard of obstetric care.
OBJECTIVE: To assess the maternal and neonatal morbidity following operative delivery in the second stage of labour in relation to the standard of obstetric care. DESIGN: Cohort study. SETTING: Maternity units in two teaching hospitals in Bristol, United Kingdom. Three hundred and ninety-three women with term, singleton, cephalic pregnancies who required operative delivery in theatre at full dilatation between February 1999 and February 2000. METHODS: Morbidity was compared for completed instrumental delivery, failed instrumental delivery and immediate caesarean section in relation to duration of second stage of labour, number of pulls at attempted instrumental delivery, number of instruments used and operator experience. MAIN OUTCOME MEASURES: Maternal trauma, admission to special care baby unit, neonatal trauma. RESULTS: Failed instrumental delivery after a long second stage of labour was associated with increased maternal trauma (adjusted odds ratios [OR] 4.1, 95% confidence interval [CI] 1.1, 16.5). More than three pulls at attempted instrumental delivery was associated with increased neonatal trauma for completed (adjusted OR 4.2, 95% CI 1.6, 9.5) and failed deliveries (adjusted OR 7.2, 95% CI 2.1, 24.0). Babies delivered after failed instrumental delivery with more than three pulls were at increased risk of admission to special care baby unit (adjusted OR 6.2, 95% CI 1.6, 22.8) The use of multiple instruments was associated with increased neonatal trauma (adjusted OR 3.1, 95% CI 1.5, 6.8; adjusted OR 4.4, 95% CI 1.3, 14.4, for completed and failed deliveries, respectively). Excessive pulls and multiple instrument use were associated with an initial attempt at vaginal delivery by an inexperienced operator, 25/48 (52%) and 34/75 (45%). CONCLUSIONS: Guidelines for safe operative delivery in the second stage of labour should be developed and adhered to in order to reduce morbidity, particularly neonatal trauma.
Cesarean Section↗
An obstetric perspective.
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Delivery, Obstetric↗
Neurological sequelae in in-vitro fertilisation babies.
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Brain↗
Cohort study of near-miss maternal mortality and subsequent reproductive outcome.
OBJECTIVE: To determine the aetiology and outcome of near-miss mortality in obstetrical patients and the subsequent reproductive outcome where fertility is conserved. STUDY DESIGN: Retrospective cohort study of 51,576 women delivered at a University teaching hospital of whom 50 required transfer for critical care. RESULTS: Over the 12 year study period 1988-1999, 50 women required transfer for intensive care (0.97/1000) and there were three maternal deaths (5.8/100,000). The main indications for transfer were hypertensive disease (32%), haemorrhage (24%) and maternal cardiac disease (24%). The perinatal mortality rate was 14%. Thirty two women conserved their fertility potential and 16 had subsequent healthy liveborn children. CONCLUSIONS: This study of near-miss maternal mortality reminds us of the need for continuing vigilance in the provision of obstetrical care. The successful reproductive outcome highlights the resilience of many women to adverse events in pregnancy but the high loss of fertility potential reflects the physical and psychological morbidity incurred.
Adult↗
Maternal serum activin A, inhibin A, and follistatin in pregnancies with appropriately grown and small-for-gestational-age fetuses classified by umbilical artery Doppler ultrasound.
OBJECTIVE: The purpose of this study was to examine the relationship of maternal serum activin A, inhibin A, and follistatin with fetal growth and placental function. STUDY DESIGN: Inhibin A, activin A, and follistatin were measured in maternal serum that was stored from normally grown (control subjects, n = 50) and small-for-gestational-age pregnancies (n = 49), prospectively classified as normal small-for-gestational-age pregnancy or fetal growth-restricted pregnancy with the use of umbilical artery Doppler ultrasound. RESULTS: Activin A and inhibin A were significantly increased in fetal growth-restricted pregnancies compared with control subjects (activin A: regression coefficient, 0.54, P <.001; inhibin A: regression coefficient, 0.47, P =.003). The activin:follistatin ratio was significantly higher in fetal growth-restricted pregnancies compared with control subjects (P <.001). There were no significant differences between analyte levels of normal small-for-gestational-age pregnancies and control subjects. CONCLUSION: Maternal serum activin A, inhibin A, and activin:follistatin ratio are raised in fetal growth-restricted pregnancies but not in normal small-for-gestational age pregnancies. This provides further evidence of the difference between subgroups within small-for-gestational-age pregnancies and emphasizes the need to stratify for this in research.
Activins↗
Cohort study of the neonatal outcome of twin pregnancies that were treated with prophylactic or rescue antenatal corticosteroids.
OBJECTIVE: The purpose of this study was to compare the neonatal outcome of 2 approaches to antenatal corticosteroid therapy for threatened preterm delivery in twins: a prophylactic approach in which corticosteroids were administered every 2 weeks from 24 to 32 weeks of gestation and a rescue approach in which corticosteroids were given to women at immediate risk of preterm delivery. STUDY DESIGN: A retrospective cohort study of 1038 twin babies delivered between 1990 and 1996 in a University Teaching Hospital. One hundred thirty-six babies were exposed to prophylactic therapy, and 902 babies were treated expectantly with rescue therapy. RESULTS: Prophylactic corticosteroids were not associated with a significant reduction in respiratory distress syndrome (adjusted odds ratio, 0.7; 95% CI, 0.2-2.0). Unnecessary therapy was more likely with a prophylactic policy (relative risk, 7.5; 95% CI, 5.3-10.7) and was associated with a reduction in mean birth weight in term babies of 129 g (95% CI, -218 to -33; P =.008). CONCLUSION: Prophylactic corticosteroids have no proven beneficial effect on the risk of respiratory distress syndrome in preterm twin babies. Such a policy exposes a large number of babies to unnecessary treatment that adversely affects growth.
Birth Weight↗
The effect of mode of delivery and gestational age on neonatal outcome of the non-cephalic- presenting second twin.
OBJECTIVE: Our purpose was to compare the neonatal morbidity of the non-cephalic- and cephalicpresenting second twin in terms of mode of delivery and gestational age. STUDY DESIGN: A retrospective cohort study of 422 sets of twins with a cephalic-presenting first twin was performed. RESULTS: The non-cephalic-presenting second twin was less likely to be delivered vaginally than the cephalic second twin, odds ratio 0.5 (95% CI 0.3-0.8). There were no significant differences in low Apgar scores at 5 minutes and admission to the neonatal intensive care unit for non-cephalic-presenting compared with cephalic-presenting second twins, adjusted odds ratio 1.1 (95 % CI 0.5-2.2) and 1.4 (0.8-2.6). Delivery by caesarean section was associated with increased admission to the neonatal intensive care unit for cephalic second twins, adjusted odds ratio 3.8 (1.2-12.7). Neonatal morbidity after vaginal delivery was similar for non-cephalic-presenting and cephalic-presenting second twins, particularly at lower gestational ages (24-31 weeks, Apgar score at 5 minutes <7, adjusted odds ratio 0.8 [0.1-11.3]). CONCLUSION: Vaginal delivery for the non-cephalic-presenting second twin appears to be a reasonable management option, particularly at early gestational ages.
Apgar Score↗