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Biomedical subjects

P Boylan

Publications and source records attributed to P Boylan.

At least 19 recordsLinked to original sources
PubMed1997

Maternal satisfaction with management in labour and preference for mode of delivery.

The aim of this study was to assess women's level of satisfaction with management during labour and to ascertain their preference for mode of delivery. The basis for the findings was the cross-sectional anonymous questionnaire survey of 520 women at a Dublin obstetric hospital. Visual analogue scales were used to assess degree of satisfaction. The response rate was 63% (520 of 830). 98.5% of women had hoped for a vaginal delivery and 1.5% for a Cesarean section. All primiparas had wanted a vaginal delivery. The majority of women were satisfied with their care in labour (65% had a score of > or = 7). Factors significantly associated with high levels of satisfaction were good analgesia during labour (particularly epidural), vaginal delivery, adequate preparation for labour and if personal wishes were listened to by staff. Almost all women have a preference for vaginal delivery. Satisfaction with care in labour is significantly influenced by vaginal delivery, empathetic communication by staff and good analgesia in labour.

Analgesia, Obstetrical↗
PubMed1996

Prolonged labor in nulliparas: lessons from the active management of labor.

OBJECTIVE: To define factors causing prolonged labor in nulliparous women undergoing active management of labor. METHODS: We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin. RESULTS: In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g. CONCLUSION: Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.

Adult↗
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

Effect of active management of labor on the incidence of cesarean section for dystocia in nulliparas.

The hypothesis that introduction of a defined policy of managing labor in nulliparas, active management of labor, would reduce the incidence of cesarean section (CS) for dystocia was examined by the introduction of active management at Hermann Hospital, the University of Texas affiliated hospital in Houston. The study was conducted over four consecutive 6-month periods. Observational data were accumulated for the year preceding introduction of active management, which served as the control period. The overall incidence of CS in nulliparas in the two control periods was 23 and 25%, and declined significantly to 20 and 17.7% in the intervention periods. The incidence of CS for dystocia fell significantly from 13 and 15% to 10 and 8.1%, whereas the incidence for other indications was unchanged. There were no significant differences in perinatal outcome judged by incidence of fetal death in labor, neonatal death associated with asphyxia, rate of admission to neonatal care with a diagnosis of asphyxia, or incidence of neonatal seizure. The data suggest that active management of labor reduces the incidence of cesarean section significantly and that these results can be achieved without detriment to mother or child.

Adolescent↗
PubMed1991

Fetal assessment in postterm pregnancy.

There is considerable disagreement over the management of postterm pregnancies. The main controversy is whether to adopt a policy of routine induction or one of selective induction allied to frequent fetal surveillance. Current evidence suggests that routine induction at 42 weeks' gestation does not increase the risk of instrumental delivery or cesarean section. To adopt the former approach, it is important that gestation is confirmed by early ultrasound examination, which has reduced the true incidence of postterm pregnancy to less than 6%. There have been no recent significant advances regarding methods of fetal surveillance in the postterm pregnancy.

Female↗
PubMed1987

Intrapartum fetal monitoring.

From the fetal viewpoint, labour is a prolonged contraction stress test which most pass without incident. Labour also represents the obstetrician's last opportunity to influence perinatal outcome and ensure that those fetuses who have suffered chronic hypoxia antenatally are recognized promptly, so that labour is supervised in a way that does not place them at increased risk of either death or birth asphyxia. In the case of the fetus who enters labour healthy, with normal reserves, labour is managed with the same aim in mind, but with the foreknowledge that visualization of a normal volume of clear amniotic fluid and reasonable duration of labour makes the development of hypoxia and asphyxia unlikely. Those at increased risk of hypoxia should be monitored electronically, but, for the remainder, intermittent auscultation is satisfactory until labour lasts in excess of 5 hours, or if the patient requires oxytocin, or if an epidural is placed. If EFM is used, then it is important to provide adequate education in trace interpretation, with particular emphasis on the importance of short-term variability. Widespread use of EFM has provided us with an immense amount of knowledge about fetal physiology, but it is critically important for the practising obstetrician to understand that, in the low-risk patient, EFM is not more effective than IA in preventing death from asphyxia, that EFM does protect against asphyxial seizures, but that widespread use of the technique has not been associated with a significant reduction in the population of permanently handicapped infants. This information is particularly relevant in developing nations where money spent on sophisticated monitoring equipment might be better spent in other areas. From the maternal point of view, intensive fetal monitoring has profound implications by virtue of its usual effect on incidence of Caesarean birth, although the Dublin trial results, with regard to incidence of Caesarean section, emphasize the importance of considering intrapartum fetal monitoring as just one part of the overall supervision of labour. Finally, it must be emphasized that the method of fetal monitoring chosen may be strongly influenced by factors other than scientific evidence, as in the United States where the medicolegal climate is such that failure to rigorously document absence of fetal distress/true birth asphyxia may result in a harrowing lawsuit. It is a position this author has developed considerable sympathy with in recent years.

Amniotic Fluid↗
PubMed1987

Ultrasound placental grading and amniotic fluid quantitation in prolonged pregnancy.

Serial ultrasound examinations were performed every three to five days to monitor 200 singleton pregnancies with gestations of 42 weeks or longer. Scanning was used to measure the deepest amniotic fluid pool and to grade placental echogenic changes. Oligohydramnios, defined as an amniotic fluid pool less than 30 mm, was detected in 33 patients (17%) and was an indication for intervention. Grade III placenta was found in 53 patients (27%), and no grade could be assigned in 13 (7%). Intrauterine growth retardation and meconium-stained or absent amniotic fluid at amniotomy occurred significantly more often in association with oligohydramnios than with grade III placenta, which was found before spontaneous labor in only 24% of cases. Ultrasound placental grading appears to offer little useful additional information to amniotic fluid quantitation in satisfactory monitoring of prolonged pregnancies.

Amniotic Fluid↗
PubMed1986

An overview of hydramnios.

Hydramnios, defined as a volume of amniotic fluid in excess of 2,000 mL, is frequently diagnosed in contemporary obstetric practice by ultrasound. A pocket of amniotic fluid in excess of 8 cm X 1 cm is a satisfactory upper limit of normal volume using ultrasound. The etiology of hydramnios is not clear cut, but there is a significant 20% association with fetal anomaly. Maternal complications are rare, while fetal complications are usually related to an underlying anomaly or preterm birth. There is no specific treatment for hydramnios apart from drainage, which should be performed if maternal symptoms are sufficiently distressing. Perinatal outcome is generally determined by gestation at delivery or fetal anomaly.

Female↗