PubMed Health⌕ Search

Biomedical subjects

R J Pepperell

Publications and source records attributed to R J Pepperell.

At least 37 records · Page 2Linked to original sources
PubMed1987

Unexpected problems in patients selected for birthing unit delivery.

Although delivery in the Family Birthing Unit of our hospital has been associated with good perinatal results, unexpected serious complications were observed necessitating the availability of immediate resuscitation facilities for both mother and baby. Of the 1,794 patients initially selected for confinement in the Family Birthing Unit, 326 were transferred out because of antenatal complications, 241 were transferred out because of intrapartum complications, and the incidence of postpartum haemorrhage and/or neonatal asphyxia in the remaining lowest risk patients were 3.7% and 1.3% respectively. Ten of these lowest risk patients required blood transfusions and 4 babies required admission to the Special Care Baby Unit because of neonatal asphyxia.

Delivery, Obstetric↗
PubMed1987

Immunogenetic studies in habitual abortion.

Recent evidence suggests that immunological factors could play a role in the aetiology of habitual abortion. In this study, 71 couples with habitual abortion (i.e. more than 3 successive abortions) were investigated. Sharing of HLA-A, B, DR between partners was not found to be significantly increased. Anti-HLA antibodies in women against their partners' lymphocytes were found in 18.3%. After immunization with 10(7)-10(8) lymphocytes obtained from husband or unrelated donor, there was a seroconversion rate of 61% in those without antibodies initially. This was not dependent on the number of cells injected, source of cells, degree of sharing of HLA antigens or whether the couple were primary aborters (i.e. having had no advanced pregnancy), or secondary aborters. Seven pregnancies have resulted following the immunization procedure so far, 5 occurring in cross-match positive patients and 2 in cross-match negative. Growth retarded infants resulted from the pregnancy of 1 primary aborter and 2 secondary aborters.

Abortion, Habitual↗
PubMed1987

Mild to moderate abnormalities of semen do not affect pregnancy rates during ovulation induction with gonadotrophins.

One or more semen analysis results were available for 195 men whose wives responded to ovulation induction with gonadotrophins performed at The Royal Women's Hospital since 1963. Fifty-three men (27%) has subnormal semen analyses by conventional criteria: sperm concentration less than or equal to 20 X 10(6)/ml, motility less than or equal to 40% or normal morphology less than or equal to 50%. The lifetable pregnancy rates were not significantly different for those with subnormal and normal semen (chi 2 = 0.169), by six cycles 64% (s.e.m. = 7) with subnormal semen had conceived compared with 59% (s.e.m. = 5) with normal semen. It appears that lower limits of semen quality could be relaxed for women needing ovulation induction with gonadotrophins.

Female↗
PubMed1985

Unexplained infertility: a review.

When investigations fail to reveal a cause for infertility, treatment must then be based on possible, but unproven, causes, and since there is a high spontaneous pregnancy rate in unexplained infertility the effect of any treatment is difficult to assess. Such treatment has included correction of anatomical variants such as uterine retroversion and the use of hormonal manipulation during the follicular and luteal phases of the menstrual cycle. Ovum entrapment, occult spontaneous abortion and faults in sperm fertilizing capacity have all been implicated, and it is likely that immunological factors play a substantial role in unexplained infertility. Evidence does not support the use of bromocriptine in the absence of hyperprolactinaemia. Successful treatment by intrauterine insemination is unlikely if there are circulating anti-sperm antibodies in the partner. Improving cervical mucus by treatment with oestrogens and clearing infections with antibiotics may have a modest place but it is very difficult to show that these treatments have more than a placebo effect. Endometriosis is often missed and the possibility of it having developed after initial investigation warrants repeat laparoscopy after 2 years. Three approaches are currently acceptable in the management of the couple with unexplained infertility: await spontaneous pregnancy, the empirical use of clomiphene and in-vitro fertilization.

Adult↗
PubMed1985

Paediatric follow-up of pregnancies complicated by subnormal oestriol excretion.

A cohort of 1238 consecutive women seen early in pregnancy for accurate assessment of gestation had urinary excretion of oestriol measured at 30, 35 and 40 weeks; 92 had a low urinary oestriol excretion confirmed in hospital on at least one occasion. The women in the low-oestriol group were matched for racial origin and maternal age with 90 women in the study population who had persistently normal urinary oestriol excretion values (control group) and their infants were compared. Three infants born in the low-oestriol group and two in the control group subsequently died; 85 of the 89 (95.5%) survivors in the low-oestriol group and 84 of 88 (95.5%) control children were assessed by a paediatrician and a psychologist at the age of 6 years. Anthropometric measurements of children in the low-oestriol group at 6 years of age did not differ significantly from controls and their performance on most psychological tests was not significantly different. The subgroup of 25 children born to women with persistently low oestriol excretion during pregnancy showed a significant reduction in weight and head circumference at 6 years compared with the values in the control group and in the other children in the low-oestriol group. The children born to women with low oestriol excretion during pregnancy showed no increased evidence of developmental, neurological or physical defects at 6 years of age.

Birth Weight↗
PubMed1985

Hydatidiform mole in Victoria: aetiology and natural history.

A retrospective study was made of 455 patients referred to the Hydatidiform Mole Register of the Royal Women's Hospital from 1973-1982 who fulfilled the criteria for diagnosis of hydatidiform mole. The incidence of hydatidiform mole was 1:1,357 livebirths in Victoria. Age greater than 40 years (P less than 0.001), nulliparity (P less than 0.005) and parity greater than 4 (P less than 0.001) were the only predisposing factors found. An association with artificial insemination with donor semen was also noted (P less than 0.025). The need for further treatment for persistent trophoblastic activity (13.6% of patients) was independent of the method of evacuation employed and of gestation at evacuation. Only 2 cases of histologically proven postmolar choriocarcinoma occurred, one of which was also the only death recorded from all patients registered following a molar pregnancy.

Adult↗
PubMed1985

Malignant sequelae of molar pregnancy in Victoria.

In a retrospective study of 455 patients with confirmed molar pregnancy, registered with the Hydatidiform Mole Register of the State of Victoria in the years 1973-1982 inclusive, treatment for persistent trophoblastic activity was necessary in 62 (13.6%) patients. The need for treatment was independent of levels of urinary chorionic gonadotrophin (UCG) excretion prior to evacuation of the molar pregnancy, age, parity or blood group. All patients achieved initial remission of UCG levels within 5 courses of treatment. Risk factors were scored retrospectively and patients responded poorly if therapy inappropriate to risk factors was given. Only 2 cases of histologically proven choriocarcinoma occurred and the only death recorded was in 1 of these patients.

Adult↗
PubMed1985

Outcome for the very low birth-weight (500-1,499g) singleton breech: benefit of caesarean section.

Between January 1, 1977 and March 31, 1982, 84 of 131 (64.1%) consecutive liveborn very low birth-weight (VLBW) singletons delivered after breech presentation were discharged home alive. Of babies delivered by Caesarean section 40 of 47 (85.1%) survived, versus 44 of 84 (52.4%) delivered vaginally (X2 = 12.6, p less than 0.0005). When differences in birthweight and antenatal steroid therapy were adjusted by multiple regression analysis, after excluding a lethally malformed baby who was diagnosed antenatally and babies who were not treated aggressively because they were thought to be too immature (n = 19), those delivered by Caesarean section were still more likely to survive (p = 0.038). In survivors completely assessed at 2 years of corrected age, there was a statistically significant association between Caesarean section and reduced handicap (p = 0.019). For the VLBW singleton breech, there is good evidence that delivery by Caesarean section is beneficial.

Apgar Score↗
PubMed1985

Cesarean section or vaginal delivery at 24 to 28 weeks' gestation: comparison of survival and neonatal and two-year morbidity.

A large cohort of consecutive live births with gestational ages assessed antenatally from 24 to 28 weeks from one tertiary center was studied to determine the association between mode of delivery and in-hospital mortality and morbidity and morbidity at two years of age. Between 1 January 1977 and 31 March 1982, 52.8% (172 of 326) of such infants survived their primary hospitalization. Obstetric factors independently associated with improved survival were increasing gestational age (P less than .0001), the absence of maternal hypertension (P = .007), singleton pregnancy (P = .007), and antenatal steroid therapy (P = .018). Although 62.7% (32 of 51) of infants delivered by cesarean section survived compared with 50.9% (140 of 275) of infants delivered vaginally, the increased survival was not statistically significant (X 2 = 1.97). Moreover, the trend favoring cesarean section disappeared after adjustment for confounding obstetric factors. In univariate analyses cesarean births more frequently required ventilatory support and there was a trend toward a lower incidence of cerebroventricular hemorrhage; again, however, when adjusted for extraneous factors these associations disappeared. Of the 172 in-hospital survivors, five died at home unexpectedly; 162 of the remaining 167 were traced; 18 (11.1%) had cerebral palsy and two (1.2%) were deaf. Of the 111 children who were fully assessed, 13.5% had major handicaps, 23.4% were suspect, and 63.1% were free of handicap at two years' corrected age. There was no association between mode of delivery and frequency of handicap. Little evidence was found from mortality or morbidity data to support routine delivery of infants of borderline viability by cesarean section.

Birth Weight↗
PubMed1984

The dilemma of mild hyperprolactinaemia.

Ninety-eight women with mild hyperprolactinaemia (less than 4N) were followed for a mean duration of 5.5 years. Where pregnancy was desired treatment with bromocriptine (+/- clomiphene) was effective in 87%. Following cessation of bromocriptine therapy almost one-third had a 'spontaneous' resolution of hyperprolactinaemia and resumed cyclical menstrual activity and fertility. Pituitary tumours were identified on coned-view assessment in 9% of patients at the time of presentation and a further 10% during follow-up. Although some of these latter tumours may have been diagnosed earlier had CAT scans been performed routinely in all hyperprolactinaemic patients, such a policy would be hard to justify for those with mild hyperprolactinaemia as the tumours were small, produced no harmful effects, and would almost certainly have responded to bromocriptine should this have been administered. All patients found to have pituitary tumours and given bromocriptine, showed no evidence of tumour progression subsequently, even where pregnancy occurred and the bromocriptine therapy was ceased. In addition, patients without pituitary tumours who were given bromocriptine to achieve pregnancy, were less likely to develop tumours during follow-up even when pregnancy had occurred. Bromocriptine therapy can thus be justified in mildly hyperprolactinaemic patients to reduce troublesome galactorrhoea, achieve pregnancy, improve the chance of 'spontaneous' resolution of the menstrual problem and infertility, control or reduce tumour growth where a pituitary tumour has been identified, and reduce the risk of tumour development in patients with normal radiographs at the time of presentation.

Bromocriptine↗
PubMed1984

The outcome of pregnancies complicated by narcotic drug addiction.

The incidence of known narcotic drug addiction at 2 Maternity Hospitals in Melbourne was 0.06% (45 of 80,950 confinements). The obstetric results of these 45 pregnancies were unexpectedly favourable, the main complications being fetal growth retardation (27%) and premature birth before 37 weeks (27%). There were no fetal malformations and only 1 perinatal death. Follow-up information is necessary to ascertain if the main hazard to these infants lies in the environment to which they return.

Adolescent↗