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Biomedical subjects

F M Fairlie

Publications and source records attributed to F M Fairlie.

At least 19 recordsLinked to original sources
PubMed2004

Can formal education and training improve the outcome of instrumental delivery?

OBJECTIVE(S): The primary objective was to examine the effect of formal education and training on instrumental delivery with respect to its success rate and associated neonatal and maternal morbidity. The secondary objective was to determine factors that could influence the success rate of instrumental delivery. STUDY DESIGN: Prospective case-control study with historical controls set in a teaching hospital in Sheffield. The prospective group included all women who had instrumental deliveries between 1 November 1999 and 29 February 2000. The control group included all women who delivered between 1 February 1997 and 1 February 1998. An educational package involving formal postgraduate training and self-directed learning were introduced in the time period between the prospective and the control groups. Medical notes were reviewed in the historical controls. For both the control and prospective groups, the following patient characteristics were recorded: maternal age, parity, whether or not onset of labour was induced, use of oxytocin in the second stage of labour, delay in the second stage, operator grade, vaginal findings at delivery and the use of epidural analgesia. RESULTS: The overall failure rate was not different in the prospective group (16%) compared with the control group (18.5%). However, the introduction of an educational package was associated with significant decrease in maternal morbidity associated with cervical, severe labial and high vaginal tears (Odds Ratio (OR) 0.29, CI 0.09-0.97) and neonatal morbidity associated with admission to SCBU (OR 0.72, CI 0.02-0.60), severe neonatal scalp injury (OR 0.14, CI 0.02-0.98) and facial injuries (OR 0.02, CI 0.01-0.04). The factors identified to affect the success of instrumental deliveries were: OP and OT positions of the baby at delivery (OR 0.28, CI 0.17-0.44) and inexperienced operators (OR 0.11, CI 0.02-0.58). CONCLUSION: In this study, formal education and training of medical staff did not influence the success rate of instrumental delivery but was associated with improved safety for both mother and baby.

Anal Canal↗
PubMed2002

Is propess a better method of induction of labour in nulliparous women.

Slow release prostaglandin pessary (propess) is compared with instant release prostaglandin gel (prostin) for the induction of labour in nulliparous women with a modified Bishop's score of less than 6. In this randomised study 50 women received prostin gel and 45 received propess. More than one dose of prostaglandin was required to achieve amniotomy more often in the propess group (53%) compared with the prostin group (34%) (P=0.03). Propess was unable to demonstrate any advantage over Prostin gel group. Propess was not cost-effective in this study.

Delayed-Action Preparations↗
PubMed2001

Obstetric and neonatal outcome in women with a history of recurrent miscarriage: a cohort study.

Obstetric and neonatal outcomes of women who had a history of recurrent miscarriage were compared with a control population from 1 January 1992 to 30 June 1998. Amongst a total of 162 pregnancies which progressed beyond 24 weeks gestation in women with a history of recurrent miscarriage, there were four perinatal deaths and 16 babies were admitted to the special care baby unit. The rates of preterm delivery (13%), small-for-gestational-age (13%), perinatal loss (2.5%) and Caesarean section (36%) were significantly (P < 0.05) higher than those of the control group (3.9, 2.1, 1 and 16.7% respectively). The ratio of male to female babies was equal. There was no significant difference in the incidence of hypertension or diabetes between the two groups. Patients with recurrent miscarriage represent a population at high risk of obstetric problems and close surveillance in the antenatal period is therefore required.

Abortion, Habitual↗
PubMed1999

Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine.

OBJECTIVE: To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour. DESIGN: Double-blind randomised controlled trial. SETTING: The labour ward in a UK teaching hospital. PARTICIPANTS: Sixty-nine nulliparous women and 64 multiparous women in labour who requested narcotic analgesia and remained undelivered one hour after trial entry. METHODS: Nulliparous women were randomised to receive either 150 mg intramuscular pethidine or 7.5 mg intramuscular diamorphine. Multiparous women were randomised to receive either 100 mg intramuscular pethidine or 5 mg intramuscular diamorphine. All participants received the anti-emetic prochloroperazine at the same time as the trial drugs. MAIN OUTCOME MEASURES: Maternal analgesia assessed by a visual analogue score and verbal scales of pain intensity and pain relief, maternal sedation and vomiting, neonatal outcome assessed by Apgar scores and the need for resuscitation. RESULTS: More women allocated to receiving pethidine than to diamorphine reported slight or no pain relief at 60 minutes after administration of these drugs (P = 0.03). This trend was repeated in most of the other measures for maternal analgesia. There was no difference in maternal sedation, but the incidence of vomiting within 60 minutes was lower for women who received diamorphine (P = 0.02). Pethidine was associated with lower Apgar scores at 1 minute (P < 0.05). CONCLUSION: Intramuscular diamorphine in labour appears to have some benefits, compared with intramuscular pethidine, but the trial was small and further research, particularly into alternative opioids and long term effects on the infants is still needed.

Analgesics, Opioid↗
PubMed1996

The sequential in utero death of heterokaryotic monozygotic twins. A case report and literature review.

A case of monozygotic twins in a 19-year-old primigravida is presented. Ultrasound examination at 15 weeks' gestation showed one twin to have a cystic hygroma and hydrops fetalis. The other twin appeared normal. The twins appeared to occupy the same amniotic cavity. Fluid was taken from the cystic hygroma under ultrasound guidance for karyotyping and this showed 45,XO chromosomes. Conservative management was adopted. Serial ultrasound examination showed deteriorating hydrops and at 26 weeks the first twin died. Intensive monitoring of the remaining twin was undertaken with weekly ultrasound, cardiotocography (CTG), and clotting screens. At 29 weeks' gestation the CTG and clotting were normal, but ultrasound revealed that multicystic encephalomalacia had developed in the second twin. A very thin dividing membrane was seen for the first time between the twins. The parents decided to terminate the pregnancy. Prior to an intracardiac potassium chloride injection, a fetal blood sample was taken which revealed 46,XX chromosomes and a normal clotting screen including natural anticoagulant levels. Labour was then induced. Delivery took place 5 h later and the woman made an uneventful recovery. The mechanism for genetic differences between monozygotic twins is discussed and the literature reviewed. A non-disjunction event around the time of splitting of the twins is proposed as the cause. The prognosis for the remaining twin is also discussed, as is the pathogenesis of the cerebral damage.

Adult↗
PubMed1992

A comparative study of intramuscular ketorolac and pethidine in labour pain.

A single dose block randomised double-blind study comparing intramuscular ketorolac, 50 mg of pethidine and 100 mg pethidine was carried out in multiparous women. Pain intensity and sedation effect were recorded at inclusion to the study, half hourly for the first 2 h, then hourly until 6 h after delivery. Maternal and neonatal side effects were noted including the Apgar scores and the baby's requirements for resuscitation. All three treatments are relatively ineffective in relieving labour pain. There was no difference in the analgesic efficacy between the two doses of pethidine but both doses of pethidine were statistically more effective compared with ketorolac. There was no difference in the retrospective assessment of the three groups or when comparison was made with the previous labour. A similar number of patients required further analgesia in each group. In all three groups, no adverse effect occurred in the mother or fetus. Maternal sedation and fetal depression were statistically less in the ketorolac group. Although ketorolac had inferior analgesic effect, its use was not associated with clinically significant sequelae and it showed a superior safety profile compared with either dose of pethidine. The study was not powerful enough to detect a difference between 50 mg and 100 mg of pethidine.

Adolescent↗
PubMed1992

The effect of acute and chronic antihypertensive therapy on maternal and fetoplacental Doppler velocimetry.

Maternal and feto-placental Doppler flow velocity waveforms were studied during acute and chronic antihypertensive therapy in patients with pregnancy-induced hypertension. Eight primigravidae were acutely treated with oral nicardipine. Diastolic blood pressure fell at 30, 45 and 60 min after nicardipine. The uteroplacental systolic/diastolic ratio rose significantly at 30 min, but this change was no longer apparent at 60 min. Umbilical artery and maternal brachial artery systolic/diastolic ratios were unchanged. Fifteen patients with mild pre-eclampsia were chronically treated with oral pindolol. Diastolic blood pressure fell significantly within 24 h. The uteroplacental systolic/diastolic ratio rose 3 days after pindolol. Brachial artery or umbilical artery systolic/diastolic ratios were unchanged. A control group of 15 patients with untreated mild pre-eclampsia showed a significant rise in uteroplacental and umbilical artery systolic/diastolic ratios within 7 days of starting recordings. In patients with pregnancy-induced hypertension, acute and chronic blood pressure reduction was associated with no change in umbilical artery or maternal brachial artery Doppler systolic/diastolic ratios and a transient rise in the uteroplacental systolic/diastolic ratio.

Blood Pressure↗
PubMed1992

Umbilical artery and uteroplacental velocimetry in pregnancies complicated by idiopathic low birthweight centile.

Umbilical artery and uteroplacental Doppler flow velocity waveforms were studied in 35 pregnancies complicated by idiopathic low birthweight centile. Thirty fetuses (86%) were below the 5th centile birthweight for gestation. Fifteen (43%) had an abnormal umbilical artery systolic to diastolic ratio. Uteroplacental waveforms were recorded in 29 of the 35 pregnancies and five (17%) showed an abnormal systolic to diastolic ratio. Abnormal uteroplacental systolic to diastolic ratios were associated with a significantly earlier gestational age at delivery and significantly more cesarean sections for fetal distress compared with normal uteroplacental systolic to diastolic ratios (p less than or equal to 0.01). The absence of umbilical artery end-diastolic frequencies was associated with a significantly earlier gestational age at delivery compared with the presence of umbilical artery end-diastolic frequencies (p less than 0.005). No differences in pregnancy outcome were observed comparing normal with abnormal amniotic fluid volume assessment. These findings suggest that Doppler studies may be useful in estimating the risk of adverse perinatal outcome for small for gestational age fetuses with no identifiable cause.

Blood Flow Velocity↗
PubMed1991

Umbilical artery flow velocity waveforms during spinal anesthesia.

The umbilical artery Doppler flow velocity waveform was recorded during spinal anaesthesia prior to elective caesarean section in 15 uncomplicated pregnancies. Although spinal anaesthesia was associated with a significant fall in maternal systolic and diastolic blood pressure, there was no change in the umbilical artery Pulsatility Index either after preloading the maternal circulation with 750-1000 ml of Hartman's solution or for the first 15 min after subarachnoid injection of 0.5% bupivacaine. The fetal heart rate fell after preloading the maternal circulation, but was unchanged by the administration of bupivacaine. There was a weak negative correlation between fetal heart and the umbilical artery Pulsatility Index. These observations suggest that in normal pregnancy, spinal anaesthesia has no detrimental effect on the umbilical artery Pulsatility Index.

Anesthesia, Epidural↗
PubMed1991

Does the brachial artery Doppler flow velocity waveform reflect changes in downstream impedance?

Brachial artery Doppler flow velocity waveforms were recorded from 10 nonpregnant women and 19 women with uncomplicated pregnancies. The pregnant group showed higher peak systolic frequencies (3.24 compared with 2.26, p = 0.01), higher maximum end-diastolic frequencies (0.62 compared with 0.25, p = 0.01), and lower pulsatility indices (2.57 compared with 3.95, p = 0.06) when compared with the nonpregnant group. These Doppler changes could reflect the increase in maternal cardiac output and decline in systemic vascular resistance that occur in normal pregnancy. The effect on brachial artery Doppler of acutely increasing downstream impedance by hand immersion in ice-cold water was studied in nine women with uncomplicated pregnancies at 32 to 38 weeks' gestation. Immersion for 15 seconds was associated with a significant reduction in peak systolic frequencies (from 3.06 to 1.97, p less than or equal to 0.005) and maximum end-diastolic frequencies (from 0.82 to 0.03, p less than or equal to 0.005) and a significant increase in the pulsatility index (from 1.87 to 5.62, p less than or equal to 0.005). These changes persisted for the duration of immersion (60 seconds). After immersion, the brachial artery flow velocity waveform returned to its preimmersion pattern by 60 seconds. We conclude that in normal pregnancy, the maternal brachial artery Doppler flow velocity waveform reflects acute and chronic changes in downstream impedance.

Blood Flow Velocity↗
PubMed1991

Determinants of perinatal outcome in pregnancy-induced hypertension with absence of umbilical artery end-diastolic frequencies.

Forty-three pregnancies that were complicated by pregnancy-induced hypertension and either absence of umbilical artery end-diastolic frequencies (n = 32) or reversal of umbilical artery end-diastolic frequencies (n = 11) were reviewed. The incidence of perinatal mortality and morbidity was similar for the two Doppler patterns. Perinatal survival was highly dependent on the gestational age when hypertension first appeared. Presentation at greater than or equal to 30 weeks' gestation was associated with a perinatal survival rate of 86%. Presentation at less than 30 weeks' gestation was associated with a perinatal survival rate of 38% (p less than 0.005). Pregnancy-induced hypertension that presented before 30 weeks was more often associated with a 5-minute Apgar score less than 7 (p less than 0.005) and a nonreactive nonstress test (p less than 0.05) compared with pregnancy-induced hypertension that presented at or beyond 30 weeks. For pregnancies that presented before 30 weeks, the only difference between perinatal survivors (n = 11) and perinatal deaths (n = 18) was a higher incidence of birth weight at or below the 10th percentile among deaths (p = 0.02).

Diastole↗
PubMed1991

Umbilical artery flow velocity waveforms and cord blood viscosity.

The role of cord blood viscosity in determining the umbilical artery Doppler flow velocity waveform (FVW) was investigated in 22 normal pregnancies and 29 complicated pregnancies. FVWs were quantified by calculating the pulsatility index (PI). There was a significant correlation between an abnormal PI (more than 2 SD from the mean) and fetal growth retardation (less than 5th birthweight centile), cesarean section for fetal distress, and raised cord blood hematocrit. However, there was no relationship between whole blood or plasma viscosity measurements and the umbilical artery PI.

Birth Weight↗
PubMed1991

Doppler flow velocimetry in hypertension in pregnancy.

Early studies suggested that Doppler ultrasound held great promise as a noninvasive, repeatable, and simple method of predicting hypertension in pregnancy and identifying those hypertensive pregnancies at high risk of maternal and fetal complications. Further studies have tempered this early enthusiasm by revealing the multiplicity of factors that may influence the Doppler waveform pattern. This makes interpretation of changes in the FVW pattern difficult. Despite these difficulties, there is evidence to suggest that Doppler velocimetry may contribute to two aspects of the management of hypertensive pregnancies. First, as a noninvasive method of investigating the effect of pharmacologic agents on maternal, fetal, and placental circulations. Second, a number of studies support a useful role for Doppler ultrasound measurements in the assessment of fetal well being in hypertensive complications. Present knowledge suggests that the technique will not replace existing fetal monitoring tests or be capable of indicating the optimum time for delivery. It does however, appear to be a useful adjuvant in assessing the risk of perinatal complications, especially in hypertensive pregnancies presenting before 30 weeks' gestation.

Female↗
PubMed1990

The effect of nifedipine therapy on fetal and placental Doppler waveforms in preeclampsia remote from term.

Twenty patients with preeclampsia at a gestational age of 26 to 35 weeks were treated with oral nifedipine until delivery. The mean oral daily dose was 45.1 +/- 11 mg/day (range, 40 to 80 mg/day). Fetal aorta, internal carotid artery, umbilical artery, and uteroplacental Doppler flow velocity waveforms were recorded before treatment and then serially. The mean nifedipine concentration at the time of the Doppler studies was 60.3 ng/ml (range, 10 to 90 ng/ml). The use of nifedipine therapy was associated with a significant decrease in both maternal systolic blood pressure (baseline, 154 to 135 mm Hg, p less than 0.001) and diastolic blood pressure (baseline, 100 to 88 mm Hg, p less than 0.001). However, there was no significant difference in the resistance index between baseline and postnifedipine Doppler studies in either the fetal or uteroplacental vessels. The use of oral nifedipine to control blood pressure in preeclampsia does not affect the resistance indices in fetal or uteroplacental vessels as measured by the Doppler technique.

Administration, Oral↗
PubMed1990

Umbilical artery Doppler flow velocity waveforms and maternal prostaglandin E2 and F2 alpha metabolite concentrations during cervical ripening with prostaglandin E2.

In 20 women, the umbilical artery flow velocity waveform (FVW) was recorded immediately before and 30-40 min after administering vaginal or extraamniotic prostaglandin E2 to ripen the cervix. Maternal plasma concentrations of prostaglandin E2 (PGE2) and prostaglandin F2 alpha (PGF2 alpha) metabolites (bicyclo-PGEM and PGFM, respectively) were measured at the time of the Doppler recordings. The administration of prostaglandin E2 was associated with a significant rise in maternal plasma PGFM and bicyclo-PGEM concentrations, but there was no change in the umbilical artery FVW Pulsatility index (PI). These results suggest that cervical ripening with local prostaglandin E2 has no effect on the umbilical artery FVW.

Administration, Intravaginal↗
PubMed1989

Umbilical artery flow velocity waveforms in labour.

Doppler signals were recorded from the umbilical arteries in 103 women during labour. The pulsatility index (PI) did not alter with progress in labour. During uterine contractions the PI showed a change only if there was a deceleration in the fetal heart rate. Low birthweight (less than 10th centile) and delivery by caesarean section for fetal distress were significantly more frequent in patients with abnormal PI values (defined as greater than 2 SD above the mean in normal labours). Fetal scalp blood pH was measured in 24 patients. The PI was abnormal in only one case, but none of the 24 had a pH less than 7.20.

Blood Flow Velocity↗