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Felicity Reynolds

Publications and source records attributed to Felicity Reynolds.

8 recordsLinked to original sources
PubMed2003

Caesarean section in Malawi: prospective study of early maternal and perinatal mortality.

OBJECTIVE: To examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section in Malawi. DESIGN: A prospective observational study of 8070 caesarean sections performed between January 1998 and June 2000 and associated complications. SETTING: 23 district and two central hospitals in Malawi. PARTICIPANTS: 45 anaesthetists from hospitals that carried out caesarean sections. MAIN OUTCOME MEASURES: Associations between maternal or perinatal deaths in the first 72 hours and various quantifiable risk factors. RESULTS: Questionnaires were returned for 5236 caesarean sections in district hospitals and 2834 in central hospitals; 7622 (94%) were emergencies, 5110 (63%) were because of obstructed labour. Preoperative haemorrhagic shock was present in 610 women (7.6%), anaemia in 503 (6.2%), and ruptured uterus in 333 (4.1%). Eighty five women died (1.05%), 68 of whom died postoperatively on the wards. Higher maternal mortality was associated with ruptured uterus (adjusted odds ratio 2.3, 95% confidence interval 1.3 to 4.0), little anaesthetic training (2.9, 1.6 to 5.1), general as opposed to spinal anaesthesia (6.6, 2.3 to 18.7), and blood loss requiring transfusion of >or= 2 units (21.0, 11.7 to 37.7). Perinatal mortality up to 72 hours was 11.2% overall and was significantly associated with ruptured uterus and general rather than spinal anaesthesia. CONCLUSION: In sub-Saharan Africa high maternal and perinatal mortality at caesarean section is associated with major preoperative complications that are unusual in developed countries. Improved training in anaesthetics, wider use of spinal anaesthesia, and improved surveillance and resuscitation in postoperative wards might reduce mortality.

Cesarean Section↗
PubMed2002

Analgesia in labour and fetal acid-base balance: a meta-analysis comparing epidural with systemic opioid analgesia.

OBJECTIVE: To assess the effect of epidural versus systemic labour analgesia on funic acid-base status at birth. DESIGN: A systematic review of trials, both randomised and non-randomised, comparing epidural with systemic opioid analgesia. POPULATION: Babies of 2102 mothers taking part in trials comparing epidural with systemic analgesia in five countries. METHODS: From the published and unpublished figures obtained from authors, fetal pH data from 12 studies (eight randomised) (1098 babies in the epidural group + 1004 controls) and base excess from 8 studies (four randomised) (856 epidural + 842 controls) were subjected to random effect meta-analysis. MAIN OUTCOME MEASURES: Umbilical artery pH and base excess values. RESULTS: Fetal pH was higher in the epidural than in the control group in the randomised trials (difference +0.009, 95% CI +0.002 to +0.015), but when all studies were included, the difference was not significant (+0.004, 95% CI -0.005 to +0.014). Fetal base excess was higher in the epidural group in the four randomised studies (difference +0.779 mEq/L, 95% CI +0.056 to +1.502) and in all eight studies (difference +0.837 mEq/L, 95% CI +0.330 to +1.343). CONCLUSION: Umbilical artery pH is influenced by maternal hyperventilation. Base excess is therefore a better index of metabolic acidosis after labour. Epidural analgesia is associated with improved neonatal acid-base status, suggesting that placental exchange is well preserved in association with maternal sympathetic blockade and good analgesia. Although epidural analgesia may cause maternal hypotension and fever, longer second stage of labour and more instrumental vaginal deliveries, these potentially adverse factors appear to be outweighed by benefits to neonatal acid-base status.

Acid-Base Equilibrium↗