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John Keogh

Publications and source records attributed to John Keogh.

5 recordsLinked to original sources
PubMed2005

Making choices for childbirth: a randomized controlled trial of a decision-aid for informed birth after cesarean.

BACKGROUND: Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances. The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy. METHOD: A prospective multicenter randomized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practices in New South Wales, Australia. Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks' gestation; 115 were randomized to the intervention group and 112 to the control group. A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks' gestation. Main outcome measures included level of knowledge, decisional conflict score, women's preference for mode of birth, and recorded mode of birth. RESULTS: Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group (increasing by 2.17 vs 0.42 points on a 15-point scale) (p < 0.001, 95% CI for difference = 1.15-2.35). The intervention group demonstrated a reduction in decisional conflict score (p < 0.05). The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section. Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women. CONCLUSION: A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evidence suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship.

Adult↗
PubMed2004

Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth.

OBJECTIVE: To evaluate the efficacy of hands and knees position and pelvic rocking exercises on the incidence of fetal occiput posterior position at birth. DESIGN: Multicentre randomised controlled trial. SETTING: Seven maternity units in New South Wales, Australia, encompassing teaching hospitals and district general hospitals. PARTICIPANTS: 2547 pregnant women at 37 weeks' gestation; 1292 randomised to the intervention group and 1255 to the control group. INTERVENTION: Hands and knees position and pelvic rocking exercises from 37 weeks' gestation until the onset of labour. MAIN OUTCOME MEASURE: Incidence of fetal occiput posterior position at birth. RESULTS: 1046 women in the intervention group and 1209 women in the control group remained in the study until they went into labour. No significant difference existed between the groups for the incidence of occiput posterior position at birth: 105 (8.1%) women in the intervention group and 98 (7.8%) in the control group had a baby in a posterior position at delivery (difference in risk 0.3%, 95% confidence interval -1.8 to 2.4). The incidence of fetal transverse arrest was 3.4% (44 women) in the intervention group and 3.0% (38 women) in the control group (difference in risk 0.4, -1 to 1.7). No differences occurred between intervention and control groups for induction of labour, use of epidural, duration of labour, mode of delivery, use of episiotomy, or Apgar score. CONCLUSION: Hands and knees exercise with pelvic rocking from 37 weeks' gestation to the onset of labour did not reduce the incidence of persistent occiput posterior position at birth.

Adult↗
PubMed2003

Incidence of fetal macrosomia and birth complications in Chinese immigrant women.

OBJECTIVE: To compare rates of fetal macrosomia (birthweight > 4000 g) and birth complications in both Chinese women immigrants and Caucasian women for two time periods: 1992 and 1999-2000. POPULATION: Chinese women immigrants and Caucasian women attending the Royal North Shore Hospital and Hornsby Ku-Ring-Gai Hospital in Sydney's northern health region. METHODS: Data used were extracted from the Northern Suburbs Area Health Service OBSTET database. Significance of trends were assessed using chi2 test. RESULTS: The results show a rise in macrosomic babies born to Chinese immigrants from 4% of total Chinese births in 1992 to 9.8% in 1999-2000 (P = 0.02). There was no significant difference in the rate of macrosomia among Caucasian women with respective rates of 11 and 14% for the same periods. The incidence of post-partum haemorrhage increased significantly in both Chinese immigrants and Caucasian women (P < 0.001). CONCLUSION: Australia has a multicultural population and yet the normal ranges defined for many obstetric investigations do not adjust for ethnicity. The application of values derived from a Caucasian population to other ethnic populations may be inappropriate and conceal important pathologies.

Birth Weight↗