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Helen Cheyne

Publications and source records attributed to Helen Cheyne.

6 recordsLinked to original sources
PubMed2006

Making the diagnosis of labour: midwives' diagnostic judgement and management decisions.

AIM: This paper reports a study examining midwives' perceptions of the way in which they diagnose labour. BACKGROUND: Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. METHODS: This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. FINDINGS: Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organizational factors and Justifying actions). Midwives' decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. CONCLUSIONS: Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour.

Adaptation, Psychological↗
PubMed2004

The trials and tribulations of intrapartum studies.

OBJECTIVE: To review the reporting of randomised controlled trials for intrapartum interventions. METHODS: This was a literature search addressing the period from the publication of the CONSORT statement i.e. 1996-2002. Databases searched: Medline and CINAHL. Search terms: pregnancy, low-risk, normal, intrapartum, labour and labor. INCLUSION CRITERIA: randomised controlled trials reported in English which involved women experiencing: normal or 'low risk' pregnancy; intrapartum interventions; women who had a spontaneous onset of labour. DATA EXTRACTION: timing of consent and randomisation, proportion of eligible women recruited, 'losses' to the study. Included Studies fourteen published and one unpublished study that fitted the inclusion criteria were identified. Three studies were subsequently excluded because of a lack of information about the method and a further study was excluded due to its small sample size. FINDINGS: Three strategies for recruitment and randomisation for intrapartum studies were reported in the literature: antenatal recruitment and randomisation; consent and randomisation conducted on admission in labour or at the time of the intervention; staged recruitment and randomisation, which may be two- or three-staged. Different study designs have done much to improve the appearance of intrapartum studies and reduce post-randomisation losses. However, the problem of bias in RCTs is not limited to attrition alone and these designs may simply be moving the problem to an earlier stage in the study resulting in selection bias and limiting generalisability. CONCLUSIONS: The importance of accurate documentation of numbers at all stages in the research process is highlighted, in particular the number of eligible people not recruited, to allow the reader to assess the generalisability of the study.

Adult↗
PubMed2003

Classic and novel risk factor parameters in women with a history of preeclampsia.

Epidemiological studies demonstrate a relation between preeclampsia (PE) and an increased risk of maternal coronary heart disease (CHD) in later life. However, there are few data available to explain any underlying mechanism. We recruited 40 primigravid women with a history of proteinuric PE delivering between 1975 and 1985 and 40 controls, matched as a group for time of index pregnancy, smoking, and current body mass index to assess classic (lipids, blood pressure) and novel (adhesion molecules, insulin, leptin) risk factor pathways. Women with a history of PE had higher diastolic blood pressure compared with controls (83 vs 76 mm Hg, P<0.05), but there were no significant differences in fasting lipoprotein concentrations (P>0.20). However, concentrations of vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 (ICAM-1) in particular were higher in the PE group by 14% (P=0.038) and 44% (P=0.002), respectively. The cases also demonstrated a tendency toward higher fasting insulin (P=0.08) concentrations and had higher glycosylated hemoglobin levels (P=0.004). Leptin concentrations were not significantly elevated. Interestingly, significantly more of the women with history of PE were classified as menopausal (37.55% vs 17.5%, P=0.045). The differences in ICAM-1 concentration persisted (P=0.010) after adjustment for potential confounders, including hormonal use/menopausal status, antihypertensive or lipid-lowering therapy, and social class. We conclude that classic risk factors alone cannot fully explain the elevated CHD risk in women with a history of PE. Rather markedly elevated ICAM-1 concentrations and specific but subtle features of the metabolic syndrome (glucose, blood pressure) are likely to be involved.

Adult↗
PubMed2003

A randomised controlled trial of admission electronic fetal monitoring in normal labour.

AIM: To test the hypothesis that the use of admission Electronic Fetal Monitoring (EFM) for healthy pregnant women in spontaneous labour would result in an increase in continuous EFM when compared to women who have had no admission EFM. DESIGN: A randomised controlled trial. SETTING: The Midwives Birth Unit in Glasgow Royal Maternity Hospital, a major urban teaching hospital with approximately 5000 births per year. PARTICIPANTS: Healthy pregnant women admitted in normal labour, deemed low risk based on the midwives' birth unit admission criteria. INTERVENTION: Women were randomly allocated either to receive a routine 20-minute period of EFM at the time of admission (control group), or to receive no routine admission EFM (study group). OUTCOME MEASURES: Primary study outcomes, use of continuous EFM; and use of EFM additional to the admission test. SECONDARY OUTCOMES: artificial rupture of membranes, use of fetal scalp electrode, fetal blood sample, syntocinon, epidural analgesia, number of vaginal examinations, rate of transfer to labour ward, and reason for transfer. KEY FINDINGS: There was no statistically significant difference between the groups for use of continuous monitoring, but significantly more women in the control group did receive additional EFM. There was no statistically significant difference between groups for any of the interventions studied. CONCLUSION: The use of admission EFM did not in itself lead to a cascade of intervention. Other factors including setting of care and philosophy of caregivers may have an effect on the rate of intervention in labour.

Adolescent↗