PubMed Health⌕ Search

Biomedical subjects

M Wingfield

Publications and source records attributed to M Wingfield.

At least 19 recordsLinked to original sources
PubMed2003

Pregnancy in women with Marfan's Syndrome.

Marfan's Syndrome (MFS) is an autosomal dominant condition resulting in a generalised weakness of the supporting tissues of the body. In its classical form it is associated with abnormalities of the eye, the skeletal system and the cardiovascular system. The prevalence of classical Marfan's Syndrome is 4-6 per 100,000 people. It has significant implications for affected women who are contemplating pregnancy. A multidisciplinary approach involving the specialities of maternal fetal medicine, cardiology and clinical genetics is optimal for provision of care to women with Marfan's Syndrome.

Bone and Bones↗
PubMed1999

Not just a cervical ectropion. Three case reports of diethylstilbestrol (DES) exposed women presenting with vaginal discharge and cervical ectropion.

Typical changes in the cervix are described in three women following in utero exposure to diethylstilbestrol. It is important that these changes are recognised on colposcopy and appropriate follow-up colposcopy arranged. In the absence or cervical intraepithelial neoplasia, local destructive therapy is not indicated as this may be associated with cervical stenosis.

Journal Article↗
PubMed1999

Increasing incidence of ectopic pregnancy: is it iatrogenic?

The incidence of ectopic pregnancy at the National Maternity hospital in 1996 was double that of the previous year. The rise in incidence coincided with the introduction at the hospital of both serum quantitative bHCG (beta human chorionic gonadotrophin) testing and a clear protocol for the early diagnosis of ectopic pregnancy. The aim of this study was to determine whether the increased incidence in 1996 was due to an increase in pre-existing risk factors for the development of ectopic pregnancy or to increased diagnosis of the condition. For the years 1986, 1995 and 1996, the incidence of ectopic pregnancy at the National Maternity Hospital was 1.8, 4.8 and 8.3 respectively per thousand pregnancies. There was no significant difference between the three years in terms of maternal age, parity or risks factors for ectopic pregnancy. The median gestational age at diagnosis decreased from 8 weeks gestation in 1995 to 6 weeks in 1996 (p < 0.001). However, the incidence of ruptured ectopic and blood transfusion was similar in both years. This study suggests that the two-fold increase noted in the incidence of ectopic pregnancy is related to earlier diagnosis of the condition. This is aided by the availability of serum quantitative bHCG testing. These findings have important implications for the management of women with ectopic pregnancy.

Adult↗
PubMed1998

Labour ward activity and the lunar cycle.

To refute the commonly held belief by the general public that the lunar cycle affects labour, we studied 10 027 deliveries over an 18-month period in a large maternity unit in Ireland. There was no increase in the total number of deliveries during the times of a full moon compared with other times. The caesarean section, instrumental vaginal delivery, and pre-term delivery rate remained unchanged over the times of a full moon. We conclude that the lunar cycle has no influence on labour ward activity.

Journal Article↗
PubMed1997

Factors associated with rapid labour in nulliparae.

The objective of this study was to assess the factors which may influence rapid labour in nulliparae. This is a cohort study of 991 consecutive nulliparae who were admitted in spontaneous labour with a singleton pregnancy and cephalic presentation. The setting was the National Maternity Hospital, Dublin where active management of labour is applied to all nulliparae fitting the above criteria. Rapid labour of 2 hours or less occurred in 82 patients (8.3%). Dilatation of 2 cm of the cervix on admission in labour, gestation of less than 37 weeks, and diminishing birthweight, were more common in rapid labours compared with other labours. Women in rapid labour were not surprisingly less likely to require oxytocin augmentation, or to need operative vaginal delivery or Caesarean section, receive epidural anaesthesia, or attend antenatal classes, compared with other women in labour. Rapid labour was not influenced by the finding that the membranes were already ruptured before admission, the time spent at home with contractions, or social background. Women with rapid labour were more likely to arrive in hospital within 4 hours compared with other women in labour. Rapid labour depends on the efficiency of uterine action which is reflected by the dilatation of the cervix on admission.

Journal Article↗
PubMed1995

Cell proliferation is increased in the endometrium of women with endometriosis.

OBJECTIVE: To compare the proliferation of endothelial, epithelial, and stromal cells in the endometrium of women with endometriosis and normal controls. DESIGN: Proliferating cells were identified using the monoclonal antibody antiproliferating cell nuclear antigen. A second antibody (CD34) was used to identify endothelial cells (ECs). SETTING: University Department of Obstetrics and Gynaecology. PATIENTS: Women with laparoscopically proven endometriosis, n = 30. Controls were women with a normal pelvis at laparoscopy performed for tubal sterilization or for infertility due to a male factor, n = 27. MAIN OUTCOME MEASURES: Endothelial cells: proliferative index. Epithelial and stromal cells: semi-quantitative immunostaining score. RESULTS: The mean EC proliferative index was significantly greater in those with endometriosis compared with controls. This difference was most marked during the proliferative phase of the menstrual cycle. Proliferative phase epithelial and stromal cells demonstrated significantly higher immunostaining scores in endometriosis patients than in controls. CONCLUSIONS: We have demonstrated increased numbers of proliferating ECs as well as epithelial and stromal cells in proliferative phase endometrium of women with endometriosis. This suggests that the endometrium of these women might have an enhanced ability to implant and survive in ectopic locations.

Antigens, CD↗
PubMed1994

Endometrial ablation: an option for the management of menstrual problems in the intellectually disabled.

OBJECTIVE: To evaluate endometrial ablation as an alternative to hysterectomy for intellectually disabled women with inadequate menstrual hygiene. DESIGN AND SETTING: A retrospective review of all intellectually impaired women referred to a menstrual management clinic at a university teaching hospital for management of inadequate menstrual hygiene between October 1989 and September 1992. RESULTS: Endometrial resection was considered an appropriate alternative to hysterectomy for eight intellectually disabled women. To date, seven women have undergone the procedure and one is receiving medical treatment. Endometrial ablation was performed with roller-ball electrocautery. Three patients underwent sterilisation at the time of surgery. The mean operating theatre time was 75 minutes. Postoperative hospital stay was less than 48 hours for all but one patient, who underwent minilaparotomy for sterilisation--postoperative analgesia was required only by this patient. There were no complications during or after surgery. Six weeks after surgery, all patients were amenorrhoeic and they and/or their carers expressed satisfaction with the procedure. Four women, followed up for between 16 and 38 months, remain amenorrhoeic and two, followed up for six months, have each experienced one episode of spotting but are otherwise amenorrhoeic. The seventh patient has had irregular bleeding but this is deemed due to erroneous continuation of progesterone therapy and is being monitored. CONCLUSION: Endometrial ablation provides a valuable alternative to hysterectomy. It should be the surgical treatment of choice for intellectually disabled women with inadequate menstrual hygiene unresponsive to medical therapy.

Adolescent↗
PubMed1994

Gynaecological care for women with intellectual disability.

Optimal gynaecological care for women with intellectual disability is complex. Many of these women suffer unique problems with regard to menstrual hygiene, sexuality, contraception and susceptibility to sexual abuse. Complex medical, ethical, social and legal issues must be carefully considered to address these problems. We discuss the "gynaecological" management of intellectually disabled women, with particular reference to contraception and menstrual suppression. We advocate endometrial ablation as an alternative to hysterectomy for women with intractable menstrual problems. Some ethical issues are reviewed which must be addressed to determine which approach is in the patient's "best interest" and adopts the "least restrictive option". Finally, we present Federal and State laws governing informed consent for medical procedures for women and children with intellectual disabilities.

Adult↗
PubMed1994

Follicular and luteal phase salivary progesterone profiles in women with endometriosis and infertility.

Twenty-three women with laparoscopically diagnosed early-stage endometriosis collected daily saliva samples at home and brought them to the laboratory at the completion of each menstrual cycle. Levels of progesterone in the saliva were determined by enzymeimmunoassay. Samples were collected for three cycles by one patient, for two cycles by 15 patients and for one cycle be seven women, resulting in a total of 40 cycles for analysis. Only 20 (50%) cycles were classified as normal. In 18 cycles (45%) progesterone levels exceeded the 95th percentile of the normal range. These high levels occurred in the follicular phase only in seven (18%) cycles, in the luteal phase only in eight (20%) and in both follicular and luteal phases in three (7.5%) cycles. Three cycles were anovulatory. One of these cycles also demonstrated elevated progesterone levels in the follicular phase and is therefore included in the 18 cycles mentioned above. We conclude that ovarian function is altered in a significant number of infertile women with endometriosis. However, these alterations are often subtle and only detected by detailed investigation.

Adult↗
PubMed1993

Endometriosis: medical therapy.

The management of women with endometriosis is complex and necessitates individualization of patient care. The most commonly used medical therapies are danazol, GnRH agonists, medroxyprogesterone acetate and gestrinone. Studies to date have shown these drugs to have equal efficacy in terms of reduction in laparoscopic score and relief of symptoms. However, their side-effects make them unsuitable for long-term use. The addition of low dose hormone replacement therapy to GnRH agonist regimens may allow prolonged use but the current cost of these agents is high. Low dose oral contraceptive pills deserve further investigation. The role of medical treatment for women with endometriosis and infertility is controversial. There is no place for hormonal therapy in such women with stage I or II disease. When expectant management fails, gamete intrafallopian transfer offers excellent results. For those with stage III or IV disease, surgery is preferable with adjunctive medical therapy in selected cases. If pregnancy does not ensue, in vitro fertilization and embryo transfer are the next line of management, and results are optimized by prior medical therapy and aspiration of endometriomas. Major advances have been made in the medical management of endometriosis. However, current treatment strategies are ineffective in eliminating the disease in most women. New approaches are required in both basic and clinical research in order to finally eradicate this often devastating disease.

Danazol↗
PubMed1992

DES clinic--the first six months.

In October 1990 a DES (Diethylstilbestrol) clinic was established at the National Maternity Hospital, Dublin. We describe the results of the first six months of the clinic. During this time, 172 inquiries were received; 95 women were seen at the clinic, 16 were deemed to be DES--exposed and eight were classified as possibly DES exposed. Classical cervicovaginal signs of DES exposure were noted in 15 women, a further eight women showed cervical epithelial abnormalities at colposcopy, the history of in utero DES exposure was confirmed in eight cases. No cases of cervical intraepithelial neoplasia or vaginal clear-cell adenocarcinoma were detected. Pregnancy related problems possibly attributable to DES exposure were documented in six women.

Adenocarcinoma↗
PubMed1991

The miscarriage clinic: an audit of the first year.

We preview the results of the first year in a Miscarriage Clinic set up in 1989 in an effort to improve the support and counselling of women who have a miscarriage. Of 381 patients referred, 79% attended. The only statistically significant difference between the women who attended and those who did not attend was in the proportion of women who had planned their pregnancies (65% versus 33%, P less than 0.01). Of the 300 patients who attended, 4% reported no grief reaction; 75% experienced a reaction which had resolved within one month and 21% experienced a reaction which had not resolved. No factor was identified which could predict the duration of the grief reaction. This audit demonstrates that there is a strong demand and need for this service for couples who experience a miscarriage.

Abortion, Spontaneous↗