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Biomedical subjects

J E Spring

Publications and source records attributed to J E Spring.

4 recordsLinked to original sources
PubMed2004

A free-standing low-risk maternity unit in the United Kingdom: does it have a role?

This study aimed to evaluate the safety of this birth setting for low-risk deliveries based on our hospital protocol. The study was carried out at Heatherwood Hospital, Ascot (a low-risk unit) and Wexham Park Hospital, Slough, Berkshire (a consultant-led unit). This was a retrospective analysis of the computerised records and statistics of low-risk women delivered at Heatherwood Hospital, Ascot, UK following the unit protocol between July 1995 and December 2001. Women were assessed to be at low risk in accord with the unit protocol. Those who had antenatal and intrapartum care at Heatherwood Hospital and those who were transferred to the consultant unit for delivery were included in this study. We analysed the appropriateness of the structure of the unit with its medical staff input, reviewed the inclusion and exclusion criteria, analysed the perinatal and maternal mortality rates and evaluated the safety of this birth setting. We have had a total of 5468 women delivered at this low-risk maternity unit since the unit was opened. Approximately 1950 women were transferred to consultant care during this period. The intrapartum transfer in the first 18 months was 7.9%. However, since 1997 it has been static at 2.7% as confidence has grown in this model of care. The antenatal transfer rate has been static around 23%. Our emergency caesarean section rate was around 6% and the normal delivery rate was around 85%. For the first time we noted a rise in the emergency caesarean rate in 2001 at 9.5%. There were no maternal deaths. We had no serious postpartum complications accounting for long-term maternal morbidity. The antepartum stillbirths accounted for the majority of the perinatal mortality for 19/23 babies. Intrauterine growth retardation accounted for 4/23 babies in this group. The perinatal mortality rate in this low-risk population was 4.2 per 1000 total births and the stillbirth rate was 3.6 per 1000 total births. We conclude that this birth setting is safe to deliver low-risk women with less intrapartum intervention and a low transfer rate and should be setting an example for any future similar birth centre in this country.

Adult↗
PubMed1988

Detection of abnormal cervical smears. A comparative study.

The inefficiency of the Ayres Spatula in detecting abnormality in cervical cytology has been demonstrated recently in a number of trials. In a randomized single-blind trial we have compared the Multispatula with the Ayres Spatula in a group of 158 women who previously had abnormal smears and had been referred to colposcopy clinics in the Lewisham and North Southwark Health Authority of London. The quality of the smears, as assessed by the presence or absence of endocervical cells, revealed that the Multispatula (87.3% pick-up) produced significantly better smears (p less than 0.005) compared with the Ayres Spatula (54.4% pick-up). In 149 smears collected with the Multispatula, atypia was confirmed. However, in only 129 smears taken with the Ayres Spatula were abnormal smears detected (p decreases less than 0.005). We concluded that the Multispatula produces a better quality smear which results in a decreased false negative rate in comparison with the Ayres Spatula.

Clinical Trials as Topic↗
PubMed1986

The use of a birthroom: a randomized controlled trial comparing delivery with that in the labour ward.

A randomized controlled trial of two environments for delivery was conducted at Queen Charlotte's Maternity Hospital. A total of 253 parous women expecting to have a labour ward delivery were invited to participate in the trial but only 148 agreed. These women were randomly allocated to be delivered either with standard labour ward management (n = 72) or in the birthroom--a small bedroom decorated in a homely manner, without facilities for epidural analgesia or electronic fetal monitoring (n = 76). Eleven women in the birthroom group and 10 in the labour ward group withdrew from the trial before labour and four were transferred from the birthroom to the labour ward when in labour. A questionnaire sent in the postnatal period to the women who completed the trial was returned by 80%. In the birthroom group there was significantly (i) decreased admission-to-delivery interval (ii) less analgesia (iii) more freedom of movement (iv) less suturing (v) increased rooming-in. No difference was found in the assessment of difficulty of labour nor in the method of subsequent infant feeding.

Clinical Trials as Topic↗