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Biomedical subjects

J Girling

Publications and source records attributed to J Girling.

14 recordsLinked to original sources
PubMed2006

Dexamethasone in the treatment of obstetric cholestasis: a case series.

Twelve women with obstetric cholestasis were given dexamethasone after failure to respond to ursodeoxycholic acid. Clinical improvement was achieved in eight cases, without complete resolution of symptoms. Biochemical response was achieved in seven cases. All but two cases had good correlation between clinical and biochemical response. Women of Asian and South American origin were more likely to respond to dexamethasone than Caucasians. There were no reported maternal or fetal side-effects. However, the subsequent consequences of dexamethasone treatment for the mother and fetus have not been thoroughly evaluated. Therefore, even in Asian and South American women, larger studies of dexamethasone are required before this treatment can be recommended as a universally safe and effective treatment for obstetric cholestasis.

Anti-Inflammatory Agents↗
PubMed2005

Uterine compression suture without hysterotomy--why a non-absorbable suture should be avoided.

We describe 2 cases of uterine compression suture without hysterotomy, only described once in the literature previously (Hayman et al. 2002). We consider in detail the suture material used for this technique and show photos of the compression suture at laparoscopy 4 weeks after insertion to demonstrate why it is inappropriate to use a non-absorbable suture. Modified compression sutures are being used increasingly and a wide variety of suture materials are being chosen, including vicryl, PDS and nylon (verbal communications). We feel it important to report our findings so that others can avoid the use of non or slowly absorbable sutures.

Adult↗
PubMed2002

Obstetric cholestasis, outcome with active management: a series of 70 cases.

OBJECTIVE: To determine the nature and outcome of obstetric cholestasis in a United Kingdom population. DESIGN: Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed. SETTING: Antenatal population of three London hospitals between August 1999 and April 2001. POPULATION: Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology. METHODS: All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded. RESULTS: Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4-39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21-40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated. CONCLUSIONS: Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.

Adolescent↗
PubMed2001

Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis.

Obstetric cholestasis is a liver disorder unique to pregnancy, which typically presents with pruritus. However, pruritus is common in pregnancy and the diagnosis of obstetric cholestasis is confirmed by finding abnormal liver function. We report 10 cases in which pruritus occurred before any abnormality in liver function tests (including total serum bile acids) and discuss the implications of this for clinical practice.

Adult↗
PubMed1998

Inherited thrombophilia and pregnancy.

Inherited thrombophilia is associated with an increased risk of thrombosis. Classically it consists of protein C and protein S deficiency, activated protein C resistance and antithrombin III deficiency. In pregnancy, in addition to thrombosis, inherited thrombophilia is associated with poor obstetric outcome, including recurrent miscarriage, late fetal loss, abruption and pre-eclampsia. Hyperhomocysteinaemia is a newly recognized cause of familial thrombophilia. It is likely that further causes such as prothrombin gene mutations will be added to the rapidly expanding list. The diagnosis of some forms of genetic thrombophilia must, however, be approached with caution during pregnancy, particularly protein S deficiency and activated protein C resistance.

Biomarkers↗
PubMed1997

Acquired thrombophilia.

The antiphospholipid syndrome is the most common cause of acquired thrombophilia. For obstetricians, it is important because of its association with recurrent miscarriage as well as either venous or arterial thrombosis. The evidence linking anticardiolipin antibodies and the lupus anticoagulants with thrombosis will be examined, as will the diagnostic dilemmas which arise. Thromboprophylaxis, both during pregnancy and lifelong, as well as for gynaecological surgery, will be discussed, as will management options for women suffering from recurrent miscarriage.

Antiphospholipid Syndrome↗