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Biomedical subjects

R L Bryce

Publications and source records attributed to R L Bryce.

At least 19 recordsLinked to original sources
PubMed1991

Support in pregnancy.

Both observational studies and nonrandomized controlled trials have found the presence of support during pregnancy to be associated with superior outcomes in terms of preventing abortion, extending the length of gestation, and reducing interventions in labor. However, randomized controlled trials of supportive interventions in pregnancy have not demonstrated any physical benefits from the interventions. It is also unlikely there are any significant adverse effects. Psychological benefits do appear to result from supportive interventions, including better enjoyment of the pregnancy and better postnatal status.

Clinical Trials as Topic↗
PubMed1991

Randomized controlled trial of antenatal social support to prevent preterm birth.

OBJECTIVE: To test the effect of a programme of additional antenatal social support on the occurrence of preterm birth (a birth from 20 to 36 weeks gestation) in women at risk of preterm birth. DESIGN: A prospective randomized controlled trial. The design was one of randomization before consent for a new treatment. SETTING: Three public hospital antenatal clinics in Perth and the offices of 87 obstetricians and general practitioners in Western Australia. SUBJECTS: 1970 pregnant women with poor obstetric histories entered the trial; 983 of these were randomly allocated to the programme group and 987 to the control group. INTERVENTIONS: Normal antenatal care was provided for both groups. In addition, members of the programme group were offered an intervention aimed at providing expressive (emotional) social support, consisting of antenatal home visits and telephone calls by midwives. Of the women allocated to the programme group, 24 refused consent and 69 were not traced before completion of their pregnancies, the remaining 890 women (90.5%) agreed to enter the programme, and each received at least one intervention. MAIN OUTCOME MEASURES: Gestational age at completion of the pregnancy. A pregnancy ending before 20 weeks was labelled a miscarriage. RESULTS: There were 126/981 (12.8%) preterm births in the programme group and 147/986 (14.9%) in the control group. The outcome data for two women in the programme group and one in the control group could not be found. The unadjusted odds ratio for preterm birth in the programme was 0.84 (95% CI 0.65-1.09). The observed relative reduction in preterm births associated with the programme was 13.8% (95% CI -8.2% to +31.5%) and the trial had a 60% power to exclude a true relative reduction of 25%. CONCLUSIONS: The results of this trial and those of other controlled clinical trials provide little evidence for the effectiveness of social support interventions in the prevention of preterm birth in women with poor obstetric histories.

Female↗
PubMed1989

To what extent would women prefer chorionic villus sampling to amniocentesis for prenatal diagnosis?

Sixty-six pregnant women and 46 doctors were interviewed about their preferences for chorionic villus sampling (CVS) or amniocentesis for prenatal diagnosis in a hypothetical situation where the indication was late maternal age. The standard gamble method was used to calculate each individual's degree of preference for one procedure over the other (utility) expressed in terms of the risk of miscarriage associated with the preferred procedure that would be tolerated in order to have that procedure. Utilities for each group were calculated and compared. Pregnant women nominated a median utility for CVS of a miscarriage rate of 0.9%, while doctors nominated a median utility for CVS of a miscarriage rate of 1.2%. The difference between these utilities was not statistically significant. The method described in this study can enable potential consumers of a new procedure to provide the minimum 'clinically important difference' between a new procedure and an existing procedure necessary for calculation of the sample size in a controlled clinical trial.

Adolescent↗
PubMed1985

Six myths about controlled trials in perinatal medicine.

Despite a historical commitment to evaluation of the results of practice, obstetrics has missed many opportunities to assess new therapies adequately prior to their widespread use. Although randomized controlled trials are generally recognized as the best method of evaluating therapy, a number of myths about these trials have impeded both their performance and the implementation of their results. The unscientific nature of these myths is discussed, and examples from the perinatal literature are presented.

Clinical Trials as Topic↗
PubMed1985

Association between indicators of perinatal asphyxia and adverse outcome in the term infant: a methodological review.

There are conflicting opinions about the significance of 5 perinatal findings felt to be indicators of asphyxia (meconium staining of the amniotic fluid, abnormal fetal heart rate patterns, acidotic fetal scalp blood gases, low Apgar scores, and acidotic cord blood gases). A review of the literature was undertaken to determine the strength of association of each of these findings with adverse outcomes. Although all studies contained methodological problems, these indicators were found to have strong associations with one or more adverse outcomes such as perinatal death, low Apgar scores or cerebral palsy. The strength of the association (relative risk) was found to vary inversely with the prevalence of the outcome.

Acidosis↗
PubMed1984

Maternal plasma inhibition of prostaglandin synthase during human pregnancy, parturition and the puerperium.

To study the possibility that circulating endogenous inhibitor(s) of prostaglandin synthesis (EIPS) represent a control mechanism for prostaglandin production during human pregnancy and parturition, we have measured maternal plasma EIPS levels serially during pregnancy, labour and the puerperium, and cross-sectionally during the course of labour. No significant trends were detected in relation to pregnancy or parturition. These results do not support a role for maternal plasma EIPS in the control of prostaglandin production during human pregnancy or labour.

Cyclooxygenase Inhibitors↗
PubMed1982

The prostaglandin synthase inhibiting ability of maternal plasma and the onset of human labor.

Using an enzyme incubation-radioimmunoassay technique we have cross-sectionally studied the prostaglandin synthase inhibiting ability of plasma in relation to human pregnancy. The inhibitory potency of human plasma did not change with the onset of pregnancy, at parturition or during the puerperium. A significant decrease in potency did occur however in the third trimester of pregnancy. This preparturient decrease raises the possibility of a role in the onset of human labor for the factor(s) causing the inhibition.

Adult↗
PubMed1982

The value of ultrasound, gonadotropin, and estradiol measurements for precise ovulation prediction.

The exact prediction of ovulation is becoming more important in the management of infertile women. Graafian follicle diameter, measured by ultrasound and plasma follicle-stimulating hormone, luteinizing hormone, and estradiol levels were compared retrospectively as predictors of ovulation in 14 normal women in whom ovulation was dated by conventional ultrasound techniques. Follicle diameter was found to be a better predictor of the anticipated time of ovulation than endocrine estimations for short-term as well as long-term predictions in normal women. The relationship between follicle diameter and plasma estradiol for each day before ovulation was linear but contained a great amount of scatter, suggesting that the assessment of normality of follicular development in infertile women may not be possible with the use of these parameters.

Estradiol↗
PubMed1982

Endosalpingiosis in pregnancy. Case report.

At caesarean section, an unusual cystic lesion was found on the anterior uterine surface and on both ovaries. Biopsy established a diagnosis of endosalpingiosis. The pathogenesis and possible significance of the lesion are discussed, this being the first time this condition has been described in pregnancy.

Adult↗
PubMed1978

Depressed skull fracture in the newborn. A report of 3 cases.

Three cases of depressed skull fractures in neonates are reported. Two of the fractures were related to birth trauma, but the third probably occurred antenatally. Treatment differed in all 3 cases. One baby underwent surgical elevation of the fracture, and another vacuum elevation, while the third received no treatment. We stress the fact that non-surgical elevation of depressed skull fracture may be successful and preferable to more drastic surgical procedures.

Female↗