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Biomedical subjects

F P Meehan

Publications and source records attributed to F P Meehan.

At least 19 recordsLinked to original sources
PubMed1993

Post caesarean section delivery.

Recent clinical attention has focused upon the rising rate of caesarean sections being performed and whether patients with a previous caesarean section should be allowed a vaginal delivery. In this paper, the worldwide trend of caesarean section and the role of trial of scar following single and multiple caesarean surgery is reviewed. The role of oxytocin and regional epidural analgesia is evaluated as well as perinatal and maternal mortality. On the basis of the available data, there is no justification for the current clinical practice of almost 99% prevalence of elective repeat caesarean section in some hospitals in the North America. Oxytocin and epidural analgesia, when carefully monitored, are safe and reasonable in these patients. Watchful waiting has always been an essential virtue in obstetric management and should not be replaced by hopeful expectancy. This aspect of the art of obstetrics would appear to require rejuvenation if we are to stem the rising tide of caesarean sections.

Analgesia, Epidural↗
PubMed1993

Caesarean section survey in Galway--1973 through 1987.

We review the trend, indications and maternal mortality with caesarean section at University College Hospital Galway from 1973 to 1987. The caesarean section rate (CSR) rose from 6.06% in 1973 to 10.18% in 1987, primary sections from 3.58% to 6.51% and repeat sections from 2.49% to 3.67% during the same interval. The four major indications for section were cephalopelvic disproportion, foetal distress, previous section and malpresentations. Lower segment caesarean section was the commonest operation and a slight increase in the classical operation was noted due to an increased intervention in prematurity. The maternal mortality rate was 11.2/10,000 in the 15-year period and the complications leading to death were ultimately ascribable to primary postpartum haemorrhage. Strategies for reduction in the CSR are discussed.

Adult↗
PubMed1992

Acardius in a triplet pregnancy: cytogenetic and morphological profile.

We describe a rare case of acardius in a triplet pregnancy terminated by Caesarean Section at 32 weeks gestation. Morphological and chromosomal abnormalities of the fetus as well as structural abnormalities of the placenta are presented. Cytogenetic analysis and examination of the single disc triplet placenta provide evidence for the two major theories of pathogenesis of acardius, the twin reversed arterial perfusion (TRAP) sequence and the genetic theory, which we believe are not necessarily mutually exclusive.

Abnormalities, Multiple↗
PubMed1992

The frequency of salivary progesterone sampling and the diagnosis of luteal phase insufficiency.

A profile of salivary progesterone concentrations, based on daily samples taken over a full menstrual cycle, provides a detailed picture of changes in luteal function, at the expense of analyzing a large number of samples. Strain can be placed on analytical services by assaying daily samples instead of one or a few serum (or saliva) samples. This study sought to determine the minimum number of salivary progesterone determinations which adequately describe luteal function. Daily salivary progesterone levels from 215 cycles, of which 29 cycles had progesterone profiles indicative of luteal phase insufficiency, were analyzed to ascertain the efficiencies of various sampling patterns of reduced frequency. A single mid-luteal salivary progesterone estimation or the mid-luteal Lenton progesterone index (n = 4) satisfactorily reflected the normal luteal phase, but a frequency of one sample every 3 days over the luteal phase (n = 5-6) was necessary to allow recognition of a short luteal phase or poor progesterone surge.

Adult↗
PubMed1992

The return of postpartum fertility monitored by enzyme-immunoassay for salivary progesterone.

A longitudinal study in which daily salivary progesterone and estrone were measured by solid-phase enzyme-immunoassays was performed in 30 postpartum women to monitor the return of ovarian activity. Ovulation was inferred from a sustained rise in salivary progesterone over 251 pmol/l, but salivary estrone measurements were not as informative as progesterone in this regard. Recovery of ovarian activity was slower in lactating women compared with non-lactators; the mean delivery-menstruation interval were 123 (+/- 10) and 57 (+/- 7) days, respectively. An abnormal luteal phase was noted in 35% of the first ovulatory cycles, 20% had short luteal phases and 15% were less than the 5th percentile of a normal control corridor. The pregnancy rate in this study of 3.3% was lower than the anticipated rate of 8.8%. We conclude that salivary progesterone measurements are useful for monitoring the return of ovarian activity postnatally.

Adult↗
PubMed1990

True rupture/scar dehiscence in delivery following prior section.

Fear of uterine rupture has led to the widespread practice of 'Once a section, always a section'. Between 1972 and 1982, 1498 patients with one or more previous cesarean sections were delivered at University College Hospital, Galway. Trial of labor was undertaken in 844 patients, while the remaining 654 patients underwent repeat elective section because they had two or more prior sections. Eight true ruptures and 22 scar dehiscences were found. Regional analgesia and oxytocin did not significantly affect the rate of true rupture. The mean parity with uterine rupture was five, and it occurred most frequently in the initial trial of labor. There were four perinatal deaths associated with true rupture. Failure to detect the already compromised fetus before labor and delivery, rather than the method of delivery, was responsible for fetal demise in some instances. Five true ruptures were found in the trial of labor group (i.e. a ratio of 1:169), with the loss of three babies. A further baby was stillborn in a mother who ruptured a classical scar before labor. There were no maternal deaths in trial-of-labor patients and one in the elective section group. Two patients with true rupture had their uterus repaired, and were subsequently delivered by section. Another two patients with bloodless dehiscence and no repair, had two subsequent elective repeat sections each, and the unrepaired scar dehiscence was not evident.

Cesarean Section↗
PubMed1990

Stillbirths: a clinicopathological survey (1972-1982).

A survey of 325 stillbirths from 27,072 babies delivered at University College Hospital Galway from April 1, 1972 to March 31, 1982, gave a stillbirth rate of 12 per thousand, which, when corrected for 66 lethal congenital abnormalities, became 9.6 per thousand. The cause of death in each stillbirth was determined clinically and pathologically where possible and was classified according to a modified Aberdeen classification of perinatal death. Consideration of the birth weights of the babies who died showed that 223 (68.6%) weighed over 1,500 g, and excluding those with abnormalities, they must be considered salvageable with the application of intensive neonatal care. There were 54 (16.6%) intrapartum deaths, which must also be considered preventable. The application of ultrasonic surveillance should complement clinical acumen, by allowing easier detection of the fetus at risk, thereby facilitating earlier intervention which in turn should reduce antenatal stillbirths.

Autopsy↗
PubMed1989

Update on delivery following prior cesarean section: a 15-year review 1972-1987.

Fear of true rupture remains the main indication for repeat section. Between 1972 and 1987 there were 2434 patients with one or more prior section and 1350 (55%) were permitted trial of labor, the remainder, having had two or more previous sections (maximum number, 10), had repeat surgery. Induction was employed in 31% and oxytocin for induction or acceleration in 32% patients. The first period (1972-1982) had 844 and the second period (1982-1987) had 506 trial of labor patients. Improved management resulted in the true rupture rate falling from 0.6% (1:169) to 0.2% (1:506) and the elimination of procedure-related perinatal death. There were two maternal deaths with repeat section and none with trial of labor. We have achieved a plateau for cesarean section (10-11%) and a continuing fall in the uncorrected hospital perinatal mortality, which has averaged 10.6/1000 for the years 1982-1986 inclusive.

Cesarean Section↗
PubMed1989

True rupture of the caesarean section scar (a 15 year review, 1972-1987).

In a 15 year period (1972-1987) a total of 2434 parturients with one or more previous Caesarean sections were delivered at University College Hospital, Galway. There were 1084 (44.5%) patients booked for elective repeat Caesarean delivery, because they had two or more prior sections (maximum number = 10) or a recurrent indication for section other than the prior section. Trial of labour was undertaken in 1350 (55.5%) patients, and 81.26% achieved a vaginal delivery. Regional analgesia was employed in 25.5% and oxytocin in 31.9%. There were 6 (0.44%) or 1:225, true scar ruptures, resulting in 1 stillbirth and 2 neonatal deaths with no maternal death. There were 4 (0.37%), or 1:271, uterine ruptures in patients booked for elective repeat section: a classical scar rupture before labour, with a fresh stillbirth; placenta praevia percreta with bladder involvement in two patients (both resulting in maternal death), and a patient with placenta praevia accreta.

Anesthesia, Conduction↗
PubMed1989

Trial of labour following prior section; a 5 year prospective study (1982-1987).

Between 1982 and 1987, 506 women previously delivered by Caesarean section were subjected to a trial of labour. Vaginal delivery was achieved in 78.6% with only 1 true rupture of the scar (0.2%). There were no intrapartum or neonatal deaths. Moreover, 7 of the 8 antepartum stillbirths were due to asphyxia, and, as the perinatal mortality rate for the study group was higher than for the overall population, the need for antenatal surveillance in previously sectioned patients is emphasized. Induction of labour was performed in 127 patients with 74.1% achieving vaginal delivery. Oxytocin was administered to 162 patients for either induction or augmentation of labour and 80.3% had a vaginal delivery, with 1 true rupture and 4 bloodless dehiscences. It is concluded that trial of labour following prior section is associated with little risk of true rupture, and with no added risk to the fetus. Our policy and management has helped maintain over the past 5 years an overall moderate Caesarean section rate (10-11%) with a low perinatal mortality rate.

Cesarean Section↗
PubMed1989

Delivery following cesarean section and perinatal mortality.

The perinatal mortality in 1498 patients with one or more previous cesarean section scars delivered between 1972 and 1982 was analyzed. Repeat elective cesarean section was performed in 654 (44%) patients and 844 (56%) were subjected to a "trial of scar." Successful vaginal delivery occurred in 702 (83%) patients and 142 (17%) had emergency repeat operations. There were 46 perinatal deaths, giving a perinatal mortality rate (PMR) of 30.3/1000. It was lowest in patients who electively had a cesarean section (10.6/1000). The corrected PMR was twice as high in the trial of scar group. The PMR for the overall hospital population (27,072 babies) during the study period was 22.5/1000. There were four perinatal deaths in association with dehiscence of the uterine scar. The PMR in trial of scar patients decreased from 40/1000 to less than 20/1000 without a major change in policy. Meanwhile the unit cesarean section rate increased from 5 to 10%, but the repeat section rate was consistent at around 38.5%. Regional analgesia was used in 192 patients, for repeat section in five and trial of scar in 187. Oxytocin was given to 546 (65%) patients. Scar rupture is considered the major contraindication to a trial of scar, but emphasis was not laid on the possible increased perinatal mortality with this procedure before the 1980s. In view of the improvement in the PMR and the added risk to the mother with cesarean delivery, we advocate a policy of trial of scar with informed consent in selected cases.

Cesarean Section↗
PubMed1989

Follicular growth and corpus luteum function in women with unexplained infertility, monitored by ultrasonography and measurement of daily salivary progesterone.

Ovarian function was evaluated over a minimum of 3 consecutive menstrual cycles from each of 41 women with unexplained infertility. Follicular development and ovulation were monitored using real time ultrasonography and luteal function was evaluated by daily salivary progesterone measurement. In 129 spontaneous cycles, normal single ovulations were detected in 121 (93.8%). Luteal phase insufficiency was identified in 21 (17.4%) of these 121 cycles and this was a recurrent phenomenon in the cycles of 5 of the 41 women (12.2%). A successful pregnancy was seen only in association with consistently normal salivary progesterone profiles or where the empirical use of clomiphene citrate therapy had corrected previously diagnosed luteal phase insufficiency. Basal body temperature records or mid-luteal serum progesterone measurements were less satisfactory indices of luteal function than a salivary progesterone profile.

Adult↗
PubMed1988

Normal salivary progesterone levels throughout the ovarian cycle as determined by a direct enzyme immunoassay.

This study, which is concerned with establishing clinically relevant corridors defining normal progesterone (P) levels in saliva, has addressed some of the shortcomings associated with previous equivalent studies (e.g., limited data, inadequately monitored ovulations, inadequately defined subjects). A sensitive, direct, microtiter plate, enzymeimmunoassay (EIA) for progesterone developed in the authors' unit, was used to determine daily salivary progesterone concentrations over 41 menstrual cycles in 41 women. Each woman was without associated factors known to affect ovarian function and each cycle included was judged to be (single) ovulatory by serial pelvic ultrasound examinations. Daily salivary progesterone levels from these cycles were statistically analyzed and corridors of progesterone concentrations associated with normal luteal function were established.

Female↗
PubMed1988

Perinatal mortality in multiple pregnancy patients.

A study of perinatal mortality in multiple pregnancy over a period of 12 years, 1972 to 1984, showed prematurity and low birthweight as the major causes of fetal loss. The highest risk was found at 28 to 30 weeks gestation (306/1,000). There was a significantly greater risk to babies delivered by the breech (136/1,000), and likewise in the second twin when compared with the first, ratio 1:14. A significant drop in the perinatal mortality rate, from 98/1,000 to 39/1,000, was observed between 1972-1978 and 1979-1984. Ultrasound has facilitated the earlier diagnosis of twins and provides more accurate serial fetal assessment. Bedrest, more vigilant antenatal care, intrapartum surveillance and improved neonatal care, are required to maintain and further reduce the perinatal mortality rate. When regional analgesia was employed in labour, the number of babies lost was 41/1,000, vs 93/1,000 in patients not receiving regional analgesia. External cephalic version and vertex delivery of the second twin is preferable to internal version and breech extraction. It should also be contemplated, as an alternative to elective cesarean section for a transverse lie or breech presentation of the second fetus.

Birth Order↗