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Biomedical subjects

J C Girling

Publications and source records attributed to J C Girling.

11 recordsLinked to original sources
PubMed2000

Re-evaluation of plasma creatinine concentration in normal pregnancy.

Renal function improves during pregnancy, a well-known clinical manifestation of this being a fall in plasma creatinine concentration. However, there are no secure data upon which to determine the extent to which creatinine concentration changes during pregnancy. A well-defined reference range is important for the correct interpretation of results, but to date one has not been published. This study uses a large cohort of women experiencing normal pregnancy, modern laboratory technique and robust statistical analysis to construct a cross-sectional reference interval. This study shows that the upper limit of normal for creatinine in pregnancy is higher than previously suggested, although still much lower than outside pregnancy. Values for the upper limit of normal can be taken as 85 micromol/l, 80 micromol/l and 90 micromol/l in the first, second and third trimesters of pregnancy respectively. This information is important for the clinical assessment of a result from a pregnant woman, particularly in conditions such as pre-eclampsia where abnormalities of renal function may occur.

Journal Article↗
PubMed2000

Factors influencing postnatal liver function tests.

OBJECTIVE: To investigate liver function tests (LFTs) changes in the puerperium and the influence of specific obstetric events on these changes. DESIGN: A longitudinal observational study. SETTING: West Middlesex University Hospital, Twickenham. POPULATION: Ninety-four women with uncomplicated pregnancy who delivered at term. METHODS: Aspartate transaminase (AST), alanine transaminase (ALT), gamma glutamyl transferase (GGT), total bilirubin (Bilirubin) and alkaline phosphatase (ALP) were measured in early labour and on day 1, day 2, day 5 and day 10 postnatal. MAIN OUTCOME MEASURES: Peak enzyme concentration, time of peak enzyme concentration, the area under the curve for each enzyme and the rate of change of enzyme level from predelivery to peak concentration. RESULTS: All LFTs were affected by delivery (P < 0.001), increasing by 88% (0-500%) on day 2 or day 5 for AST, 147% (0-1140%) on day 5 for ALT and 63% (0-450%) on day 5 or day 10 for GGT. Multiple linear regression showed that caesarean section and opioid administration was associated with a faster rise in AST (P = 0.001, P = 0.033 respectively). The mean peak GGT concentration was 39% higher in women having caesarean section compared with vaginal delivery (P = 0.015). Univariate analysis showed that perineal trauma, use of Entonox, maternal age at delivery and breastfeeding also influenced LFT concentration significantly. CONCLUSION: Liver enzyme levels change significantly in the puerperium and are affected by common obstetric events, particularly caesarean section. This study aids clinical interpretation of postnatal LFTs in women recovering from liver-related illnesses, by facilitating the differentiation of physiological and pathological processes.

Adolescent↗
PubMed2000

Thyroid disease in pregnancy.

Some interesting recent developments have influenced the modern management of thyroid disease in pregnancy and enhanced our understanding of the interaction between maternal and fetal thyroid function, including the complex role of the placenta. This article will review the latest ideas in this area.

Antithyroid Agents↗
PubMed1997

Liver function tests in pre-eclampsia: importance of comparison with a reference range derived for normal pregnancy.

OBJECTIVES: To determine reference ranges for liver function tests in uncomplicated pregnancy and to relate abnormal results by these criteria to outcome in pre-eclampsia. DESIGN: Prospective, cross-sectional study to establish the reference ranges. Prospective observational study of women with pre-eclampsia. SETTING: Antenatal clinics and obstetric unit of St Mary's Hospital, London. PARTICIPANTS: Four hundred and thirty women with uncomplicated pregnancies and 85 consecutive women with gestational hypertension. MAIN OUTCOME MEASURES: Aspartate transaminase (AST), alanine transaminase (ALT), bilirubin and gamma glutamyl transferase (GGT) were measured to determine their ranges in normal pregnancy. The severity of pre-eclampsia was determined by the maximum blood pressure, creatinine and 24 h urinary protein; minimum platelet count; maternal complications; mode of and gestation at delivery; and fetal outcome with centile weight adjusted for gestational age and sex. RESULTS: AST, ALT, bilirubin and GGT were each lower in uncomplicated pregnancy than the nonpregnant laboratory reference ranges. Of those cases with elevated liver function tests in the pre-eclampsia group, 37% were abnormal only by the new reference ranges. Using the new ranges, the prevalence of elevated liver function tests was significantly higher in the pre-eclampsia group (54%) than in those with pregnancy induced hypertension (14%) (P < 0.01). Amongst those with pre-eclampsia, abnormal liver function tests were associated with greater proteinuria (P < 0.05), lower platelet count (P < 0.001) and more maternal complications (P < 0.01) than normal liver function tests; there was no difference in the severity of hypertension between the groups. CONCLUSIONS: Liver function tests are lower in normal pregnancy than the reference ranges currently used. Our pregnancy-derived ranges allow more precise identification of abnormal liver function in women with pre-eclampsia than is possible using standard reference ranges derived from a nonpregnant population.

Adolescent↗
PubMed1996

Thromboembolism in pregnancy: an overview.

Thromboembolism is a major cause of maternal mortality. Recent advances in the management of thromboembolism in pregnancy include the discovery of a new, inherited thrombophilia, an improved understanding of the indications for thromboprophylaxis, and the increased use of low-molecular-weight heparin instead of unfractionated heparin.

Anticoagulants↗
PubMed1992

Thyroxine dosage during pregnancy in women with primary hypothyroidism.

OBJECTIVE: To assess whether pregnancy changes the thyroxine requirements of hypothyroid women. DESIGN: A retrospective, longitudinal study. SETTING: Queen Charlotte's and Chelsea Hospital for Women. SUBJECTS: 32 women referred for antenatal care during 35 pregnancies. MAIN OUTCOME MEASURES: Changes in thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels as pregnancy progresses. RESULTS: In most of the pregnancies (80%), no change in thyroxine dose was required (mean dose 129 micrograms). The mean TSH levels in early (1.8 mU/l) and in late pregnancy (1.5 mU/l) were unchanged (P greater than 0.5). In the remaining pregnancies, thyroxine dose was increased after the first antenatal clinic appointment, on the basis of thyroid function test results, from a mean of 104 micrograms to a mean of 172 micrograms (P less than 0.01). These women had a mean early pregnancy TSH of 12.3 mU/l, which decreased by 95% to 1.3 mU/l (P less than 0.01). CONCLUSIONS: Most of the hypothyroid patients presenting to an antental booking clinic are well controlled in early pregnancy and will remain so throughout pregnancy. The dose of thyroxine does not need to be changed, and further assessments of thyroid function should not be necessary. It is unlikely that the patients were all 'overtreated' before conception, since they were referred to us by a large number of independent doctors. Women who are under-treated before the pregnancy are likely to require both increased thyroxine dose and further thyroid function assays. They can generally be easily detected, biochemically, at the first hospital visit.

Adult↗
PubMedDate not supplied

Thyroid disease and pregnancy.

Thyroid disease is the most common pre-existing endocrine complaint occurring in pregnancy, reflecting in part its predilection for women of childbearing age. It is the fifth most frequent disorder in our general obstetric medicine clinic. When optimal management is achieved, a good outcome is likely for both the mother and child.

Adult↗