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R G Farquharson

Publications and source records attributed to R G Farquharson.

At least 19 recordsLinked to original sources
PubMed1998

Mid-trimester loss--appraisal of a screening protocol.

The main causes for mid-trimester loss are known. There is likely to be overlap with those of first trimester loss, but the proportions may be different. We wished to perform an aetiological survey in a large population of patients with a history of recurrent miscarriage, for possible explanations for their second trimester miscarriages. Database analysis of 636 patients attending a UK University Teaching Hospital dedicated miscarriage clinic between 1991 and 1996 revealed a 25% prevalence (n = 158) for second trimester miscarriage. Results from an investigative screening protocol were positive in 50% of cases: 33% (n = 52) tested positive for antiphospholipid syndrome (APS); 8% (n = 13) fulfilled strict criteria for cervical incompetence; there was a 4% prevalence of uterine anomaly; 3% for infection (n = 5) and 2% of patients (n = 3) proved to be hypothyroid. Importantly, dual pathology was found in 5% of patients with a history of second trimester miscarriage. As idiopathic mid-trimester loss is a diagnosis by exclusion, a high index of suspicion is required, as are modern diagnostic techniques.

Abortion, Habitual↗
PubMed1998

Ultrasound detection of vault haematoma following vaginal hysterectomy.

OBJECTIVE: To assess whether ultrasound detection of vault haematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy. DESIGN: Prospective observational study of consecutive cases of vaginal hysterectomy performed between 1991 and 1994. SAMPLE: Two hundred and twenty-three women having undergone vaginal hysterectomy. METHODS: All women had transvaginal ultrasound examination by an independent observer on the third post-operative day. Routine observations and clinical assessments were made by established management protocol, by staff blinded to the ultrasound findings. MAIN OUTCOME MEASURES: Febrile morbidity; haemoglobin drop; need for blood transfusion; length of stay in hospital; re-admission rate and length of stay. RESULTS: Of the 223 scanned women, 55 (25%) had a vault haematoma. This group was compared with the 168 women with no haematoma. Significant increases in febrile morbidity (31% vs 7%), post-operative haemoglobin drop (2.5 g/dL vs 1.6 g/dL), need for blood transfusion (14.5% vs 1.2%), representation to hospital (25.5% vs 5.4%) and length of hospital stay (8.87 days vs 6.25 days) were seen in the haematoma group. CONCLUSION: Ultrasound detection of vault haematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, need for blood transfusion, longer hospital stay and higher re-admission rate. In view of increasing demand for early discharge, driven by purchasers and patients, post-operative ultrasound identifies a high risk population and is both convenient and noninvasive. To further reduce morbidity, it also offers the opportunity to perform a controlled trial of prophylactic antibiotics in this identified subset.

Female↗
PubMed1997

The hypo-osmotic swelling test in recurrent miscarriage.

OBJECTIVE: To determine whether there is any association between sperm membrane integrity as determined by the hypo-osmotic swelling test score and unexplained recurrent miscarriage. DESIGN: Prospective observational study. SETTING: Tertiary referral center for recurrent miscarriage. PATIENT(S): Semen samples from 20 male partners of women who had had three or more first trimester miscarriages of unexplained etiology and semen samples from 20 prospective semen donors of unknown fertility potential. MAIN OUTCOME MEASURE(S): Sperm density, sperm motility, sperm morphology, and hypoosmotic swelling test score. RESULT(S): There was no difference in the median sperm density, the mean sperm motility, or the mean sperm morphology between the two groups. However, the recurrent miscarriage group had a significantly lower hypo-osmotic swelling test score than the control group. CONCLUSION(S): The hypo-osmotic swelling test score is significantly lower in samples from men whose partners have had unexplained recurrent spontaneous abortions. With the exception of cytogenetic abnormalities in peripheral blood karyotype, this is the first study to identify a male factor component in recurrent miscarriage.

Abortion, Habitual↗
PubMed1997

Obstetric outcome in antiphospholipid syndrome.

The presence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are associated with recurring pregnancy loss. Of 387 consecutive patients investigated at a Recurring Miscarriage Clinic over a three year period, 63 (16%) were positive for LA and ACA or both. Fifty-nine patients by definition were classified as having antiphospholipid syndrome and four also had systemic lupus erythematosus (SLE). Fifty-three subsequent pregnancies occurred in 63 patients and of these 37 ended in a live birth giving an overall livebirth rate of 70%. Treatment included low dose aspirin alone in 37 pregnancies and low dose aspirin and low molecular weight heparin (LMWH) in 16 pregnancies. The decision for treatment was made empirically on past obstetric history and level of LA and ACA, and past history of venous thromboembolic disease. Obstetric outcome was worst in the group who were positive for both LA and ACA, with a success rate of 53%, compared to 72 or 81% in the single parameter groups. Complications in the 37 successful pregnancies included eight Caesarean sections, four cases of intra-uterine growth restriction, one case of pregnancy induced proteinuric hypertension, one deep vein thrombosis and one pulmonary embolism. Patients with antiphospholipid syndrome are at high risk of pregnancy loss as well as maternal morbidity, especially thrombo-embolic disease. A randomised prospective controlled trial is necessary to determine the optimum therapy for pregnancy conservation and thrombprophylaxis.

Abortion, Spontaneous↗
PubMed1994

Human chorionic gonadotropin supplementation in recurring pregnancy loss: a controlled trial.

OBJECTIVES: To investigate the efficacy of hCG in the management of recurrent early pregnancy loss. DESIGN: A prospective, randomized, controlled trial. SETTING: Miscarriage Clinic, Women's Hospital, Liverpool, United Kingdom. SUBJECTS: Eighty-one women attending the miscarriage clinic with idiopathic recurrent pregnancy loss were randomized to receive hCG supplementation or placebo in early pregnancy. MAIN OUTCOME MEASURE: The success rate or live birth rate. RESULTS: In women with regular menstrual cycles it was found that hCG had no beneficial effect, the pregnancy success rate being 86% in both groups. However, women with oligomenorrhea had a pregnancy success rate of 40% in the placebo group but a statistically significant improvement to 86% if hCG was given. CONCLUSIONS: Human chorionic gonadotropin can be recommended for idiopathic recurrent pregnancy loss in women with oligomenorrhea.

Abortion, Habitual↗
PubMed1993

Predicting recurring miscarriage: what is important?

OBJECTIVE: To audit the Miscarriage Clinic in Liverpool and to categorize women into those at low and high risk of a subsequent pregnancy loss. METHODS: Over 4 years (1989-1992), 203 consecutive couples attended the Miscarriage Clinic in Liverpool. A data base was designed and a mathematical model formulated that described the data base. RESULTS: A successful pregnancy outcome was most likely in the presence of the following features: menstrual regularity, fewer than four previous miscarriages, maternal age of less than 30 years, absence of antiphospholipid antibodies, and a previous live birth. Oligomenorrhea was a considerably more significant feature than any other in predicting a subsequent miscarriage. These high-risk oligomenorrheic women were found to have low luteal phase estradiol levels, but normal luteal phase progesterone profiles and normal LH profiles throughout the menstrual cycle. CONCLUSIONS: Women suffering from recurring miscarriage can be placed into differing risk categories. Women with a good prognosis require counseling alone. Women at high risk of a subsequent miscarriage had oligomenorrhea and an isolated deficiency of estradiol in the luteal phase of the menstrual cycle.

Abortion, Habitual↗
PubMed1988

Serum DHAS in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy.

The authors measured the serum levels of dehydroepiandrosterone sulfate (DHAS) in the maternal vein (MV), the umbilical vein (UV) and the umbilical artery (UA) during the 28th-36th weeks of pregnancy (n = 74) and in the 40th week (n = 34), to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found: (1) The DHAS concentration increased significantly in MV, up to twice the concentration from the 28th-32nd weeks to the 33rd-36th weeks (p less than 0.01). From the 33rd-36th weeks to the 40th week it decreased significantly to one third of this value (p less than 0.01). DHAS levels revealed a decreasing tendency in the UA and UV serum from the 28th-32nd weeks to the 33rd-36th weeks, and there was a tendency to rise from the 33rd-36th weeks to the 40th week. (2) The serum DHAS values were found to be higher than in the MV, the UA-UV difference was not significant; however, the 'UA/UV X 100' value remained higher than 100% during the 28th-40th weeks. (3) The MV DHAS value showed slight correlation with the UV and UA DHAS concentration (r = 0.2951, p less than 0.01, n = 106; r = 0.2930, p less than 0.01, n = 100). There was a close correlation between the UV and UA serum DHAS levels (r = 0.8432, p less than 0.01, n = 98). The authors consider that the adrenal activity increases independently of the maternal adrenal cortex at term.

Adolescent↗
PubMed1988

Unconjugated 17 beta-oestradiol and oestriol in maternal serum and in cord vein and artery blood at term and preterm delivery.

The serum level of unconjugated 17 beta-oestradiol (E2) and oestriol (E3) in the maternal vein (MV), the umbilical vein (UV) and artery (UA) immediately after term (n = 34) and preterm (n = 74) labour was measured to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found. (1) The level of E2 and E3 increased equally in the MV, UV and UA serum from the 28th-32nd week to the 33rd-36th week of pregnancy. From the 33rd-36th week to the 40th week there was no change in the MV, but the value of E2 and E3 decreased significantly in the UV and UA serum. (2) The serum level of E2 in the MV was significantly higher than that in the UV and UA during every gestational period. In contrast, the serum concentration of E3 in the MV was significantly lower than that in the UV and UA. (3) The value of 'UA/UV X 100' of E2 and E3 was about 30% during the 28th-40th week. (4) A weak correlation was found between the MV serum level of E2 and E3 and UA serum concentrations. A strong correlation was found between the UV and UA serum levels of E2 and E3. The authors suggest that though there is a close connection between the fetal and the maternal organism, the fetus is still capable of maintaining its hormonal environment independently.

Adult↗