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R H de Courcy-Wheeler

Publications and source records attributed to R H de Courcy-Wheeler.

8 recordsLinked to original sources
PubMed1995

The association between small size for gestational age and perinatal and neonatal death in a UK Regional Health Authority.

Confidential enquiry into stillbirth and death in infancy is a health service requirement in England, Wales and Northern Ireland. A confidential review of perinatal death has been conducted in South-East Thames Region since 1988. Data collected for this review are analysed here. Among the 1662 singleton deaths in the enquiry from 1988 to 1991, 530 (32%) babies were small for gestational age (SGA < 10th centile): 338 of these (64%) were < 3rd centile and the remainder were between 3rd-10th centile. Small size for gestational age was significantly associated with a previous SGA baby (P = 0.02), proteinuric hypertension (P = 0.001) and increased placental-birthweight ratio (P = 0.008). Only 135 (25%) SGA fetuses were identified antenatally and multiple logistic regression showed that antenatal detection was independently related to proteinuric hypertension [odds ratio (OR) = 2.47, 95% confidence interval (CI) 1.47-4.17, P = 0.001) and to being < 3rd centile rather than 3rd-10th centile (OR = 3.16, 95% CI 1.96-5.10, P = 0.001). Although confidential enquiries have been criticised for a lack of objectivity the study indicates how data from such an enquiry can increase knowledge of events influencing peri- and neonatal outcome allowing strategies to be devised to effect change.

Data Collection↗
PubMed1995

Use of the CRIB (clinical risk index for babies) score in prediction of neonatal mortality and morbidity.

A prospective study of the outcome of care of a regional cohort of very low birthweight (< 1500 g) and very preterm (< 32 weeks) infants was carried out. Its aims were to assess the ability of the CRIB (clinical risk index for babies) score, rather than gestational age or birthweight, to predict mortality before hospital discharge, neurological morbidity, and length of stay, and to access CRIB score as an indicator of neonatal intensive care performance. 676 live births fulfilled the criteria and complete data were available for 643 (95%). Compared with gestation and birthweight, CRIB was better for the prediction of mortality, was as good for the prediction of morbidity, and was not as good for the prediction of length of stay. CRIB adjusted mortality did not demonstrate better performance in units providing the highest level of care. Either the CRIB score was not sensitive to performance or the level 3 hospitals in this study were performing badly. On the basis of this analysis purchasers and providers of neonatal intensive care cannot yet rely on the CRIB score as a performance indicator.

Birth Weight↗
PubMed1992

Hysteroscopy in the diagnosis of suspected interstitial pregnancy.

Three cases are reported in which interstitial pregnancy was suspected on ultrasound scan. The first was managed by scans and laparoscopy, but resulted in rupture of the uterus and hysterectomy at 20 weeks. In the following cases hysteroscopy was used to refute the diagnosis in one patient and confirm it in another within the first trimester. A case is made for the use of hysteroscopy in the assessment of patients with suspected interstitial pregnancy.

Adult↗
PubMed1991

Contraceptive use in young women: uptake, availability and education.

Despite increased availability of contraception and a relaxation of prescribing laws unplanned pregnancies will still occur. However when the right to life of the unborn child is enshrined in the constitution it is vital to provide adequate sex education and ensure the availability of all methods of contraception to reduce unplanned pregnancies to a minimum. This paper surveys the use of contraception prior to pregnancy in a group of unmarried mothers who delivered at a Dublin maternity hospital. It also surveys the availability of contraception from the pharmacies within the hospital's catchment area and the provision of sex education in the surrounding schools.

Adult↗