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Biomedical subjects

S W Lindow

Publications and source records attributed to S W Lindow.

At least 19 recordsLinked to original sources
PubMed2003

Pregnancy outcome in Type 1 diabetes mellitus treated with insulin lispro (Humalog).

AIMS: The use of insulin lispro in pregnancy has not been systematically investigated despite its increasing use. Pooled data from seven centres with experience in the use of insulin lispro were accumulated to evaluate pregnancy outcome in women with Type 1 diabetes. METHODS: Seven units with specialist obstetric diabetes services were recruited to describe their total experience with insulin lispro in pregnancy. Outcomes with respect to the rate of miscarriage, congenital abnormality, perinatal mortality and maternal parameters were recorded in a standardized format. RESULTS: Outcomes on 71 babies from 76 pregnancies were documented. There were six (7.8%) early miscarriages. All 71 babies were liveborn with a mean gestational age of 37.2 weeks, and median birthweight of 3230 g. Seven babies weighed > 4 kg. There were four congenital abnormalities (5.6%). There was a 72% increase in the mean insulin dose (0.75-1.29 IU/kg per day). Maternal glycaemic control improved throughout pregnancy. No women developed retinopathy de novo during pregnancy and six with established retinopathy required laser therapy during pregnancy. CONCLUSIONS: The use of insulin lispro in Type 1 diabetes during pregnancy results in outcomes comparable to other large studies of diabetic pregnancy.

Adult↗
PubMed2003

Factors associated with a prolonged second state of labour--a case-controlled study of 364 nulliparous labours.

The aim of the study is to identify factors associated with a second stage of labour greater than 2 hours in nulliparous women delivering at term. It a retrospective case-control study of 182 women with a second stage less than 2 hours' duration, matched with 182 women with a second stage greater than 2 hours. Women with a short second stage of labour were significantly younger (mean age 23.2 vs. 24.9 years) and had significantly smaller babies (mean weight 3315 g vs. 3463 g) than women with a long second stage. Long duration of the second stage of labour was significantly associated with oxytocin and epidural use. The intervention rate did not rise above 50% until the second stage exceeded 5 hours duration. The fetal outcome was good in both groups of patients.

Adult↗
PubMed2003

The philosophy of practice governs the rate of obstetric intervention: analysis of 212 units in the United Kingdom.

OBJECTIVE: To investigate the relationship between the practices of obstetric intervention in individual units. STUDY DESIGN: A retrospective analysis of the annual statistical returns to the Royal College of Obstetricians and Gynaecologists of 222 units in the UK for 1997-98. RESULTS: A total of 212 units that delivered more than 1000 babies were analyzed. A positive correlation was found between the rates of assisted vaginal delivery and emergency Cesarean section (Spearman's rho = 0.207, p = 0.003) and the rates of emergency and elective Cesarean section (Spearman's rho = 0.205, p < 0.001). There was a significant difference between unit size and the rate of spontaneous vaginal delivery (Kruskall-Wallis chi2 = 14.5, p = 0.002) with larger units having a lower spontaneous vaginal delivery rate. CONCLUSION: These results indicate that those units which have a high emergency Cesarean section rate also have a high elective Cesarean section rate and assisted vaginal delivery rate. The philosophy of an individual unit towards intervention is a general philosophy and determines the intervention rates for all procedures.

Cesarean Section↗
PubMed2003

The prevalence of domestic violence in pregnant women.

OBJECTIVE: To determine the prevalence of domestic violence in a population of pregnant women. DESIGN: Questionnaire survey. SETTING: Antenatal booking clinic in a north of England hospital. POPULATION: Five hundred consecutive women were included. METHODS: Anonymous confidential questionnaire to women who were not accompanied by their partners. MAIN OUTCOME MEASURES: Disclosure of a past history of physical, emotional or sexual abuse. RESULTS: Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26-30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity. CONCLUSIONS: The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.

Adolescent↗
PubMed2003

Maternal and neonatal hair mercury concentrations: the effect of dental amalgam.

OBJECTIVE: To evaluate maternal and fetal hair mercury levels in relation to the placement of dental amalgam tooth restorations. DESIGN: Cross sectional study involving women who never had dental amalgam restorations placed, women who had amalgam restorations placed before pregnancy and women who had restorations placed during the index pregnancy. SETTING: North of England Maternity Hospital. SAMPLE: Fifty-three healthy women who delivered healthy babies at term. METHODS: Maternal and fetal hair was collected in a standardised manner in the first few days following delivery. MAIN OUTCOME MEASURES: Maternal and neonatal hair mercury concentrations. RESULTS: When compared with women without restorations, there was a significant increase in the maternal hair mercury concentration in women who had dental amalgam placed outside of the index pregnancy and also in women who had dental amalgam placed during the index pregnancy. The fetal hair mercury concentration was significantly higher in babies when mothers had been exposed to dental amalgam either before pregnancy or during pregnancy compared with unexposed babies. There was no difference in the maternal or fetal hair mercury levels in the groups of patients who had dental amalgam placed before or during pregnancy. CONCLUSIONS: Maternal and fetal hair mercury levels were significantly higher in women who previously had dental amalgam restorations placed. There was no evidence that placement of dental amalgam restorations in pregnant women who had already similar restorations increased the maternal or fetal hair mercury level.

Adult↗
PubMed2003

An open-label, multicentre study to assess the safety and efficacy of a novel reflux suppressant (Gaviscon Advance) in the treatment of heartburn during pregnancy.

This study investigated the efficacy and safety of a novel reflux suppressant, Gaviscon Advance, in the treatment of heartburn during pregnancy. The study was an open-label, multicentre, phase IV study in general practice and antenatal clinics in the UK and Republic of South Africa. Pregnant women (< or = 38 weeks gestation; n=150) aged 18-40 years suffering from heartburn were instructed to take Gaviscon Advance 5-10 ml, as required, to relieve symptoms. The main outcome measures were the efficacy rating of the study medication by the investigator and women after four weeks using a five-point efficacy scale. After four weeks the investigators' and women's rating of efficacy was 'very good' or 'good' in 88% and 90% of women, respectively. Most women (57%, n=83) reported symptom relief within 10 minutes. Thus Gaviscon Advance effectively and rapidly treats heartburn during pregnancy. Its use during pregnancy presents no known significant safety concerns for mother or child.

Adolescent↗
PubMed2002

An analysis of maternal and fetal hair lead levels.

Lead contamination of the environment is an important public health consideration. There is evidence of declining blood lead levels in Britain, however, there is still concern about chronic exposure of the fetus and young children to low levels of lead and the effect that this has on neurodevelopment. Hair lead levels have been found to correlate well with body lead contamination. This study is the first to document the level of hair lead in pregnant women and their babies from an urban British population. There was no evidence of toxic maternal lead levels and the fetus is protected by the placental barrier.

Adult↗
PubMed2002

Development of an instrument to measure nausea and vomiting in pregnancy.

Severity of nausea, retching and vomiting was determined using a newly developed nausea and vomiting in pregnancy instrument (NVPI) in two groups of pregnant women at two gestational time periods. Participants at Time 1 (approximately gestational week 9), completed a postal questionnaire (N = 643) and those at Time 2 (approximately 13 weeks) completed the instrument at the clinic (N = 284). The three scale items forming the instrument had acceptable internal reliability (Time 1 alpha = 0.76; Time 2 alpha = 0.82). It was noted that approximately 60% of women did not vomit, approximately 30% experienced no retching, but 30-40% experienced nausea either all the time or more than once a day. The instrument may prove to be useful as a research tool to study nausea and vomiting in pregnancy.

Diagnostic Techniques, Digestive System↗
PubMed2002

A randomised controlled trial of the closure or non-closure of peritoneum at caesarean section: effect on post-operative pain.

OBJECTIVE: To compare the analgesic requirement in the post-operative period after closure or non-closure of the peritoneum at the caesarean delivery with a standardised anaesthetic and surgical technique. DESIGN: A randomised double-blind controlled trial was performed on 100 women who underwent elective caesarean delivery. MAIN OUTCOME MEASURES: Analgesic requirement assessed by morphine usage via patient controlled analgesia pump over the first 24-hour period after surgery, oral analgesia used during the first four days, postoperative pain assessed by a visual analogue scale and a verbal rating scale, and patient satisfaction assessed by verbal rating scale were the main outcome measures. RESULTS: Pain scores at 24 hours were similar in both groups (43.5 in closure and 40.5 in non-closure) but during the first 24 hours the non-closure group had used significantly less morphine than the closure group (0.64 mg/kg of body weight vs 0.82 mg/kg, P = 0.04). The patients in non-closure group had significantly higher satisfaction scores after 24 hours than the closure group. CONCLUSION: Non-closure of both visceral and parietal peritoneum at the caesarean section produces a significant reduction in the post-operative use of patient controlled analgesia pump morphine and significantly higher patient satisfaction at 24 hours post-operatively.

Adult↗
PubMed2002

A double-blind randomised controlled trial of continuous oxygen therapy for compromised fetuses.

OBJECTIVE: To investigate the effect of chronic oxygen therapy in fetuses with absent end diastolic flow in the umbilical artery assessed by doppler analysis at 24-30 weeks of gestation. DESIGN: A double-blind, randomised control trial was performed with patients blindly allocated to receive humidified oxygen or humidified air. SETTING: A tertiary referral hospital in South Africa. PARTICIPANTS: Thirty-two women who presented between 24 and 30 weeks of gestation with a confirmed finding of absent end diastolic flow in the umbilical artery. METHODS: After randomisation patients were allocated to receive a 40% mixture of humidified oxygen or humidified air from uniform coloured gas cylinders which were marked either 'a' or 'b' All women received betamethasone from 27 weeks of gestation on a weekly basis. Cardiotocographs were used from 28 weeks of gestation; after 28 weeks of gestation an amniocentesis was considered to confirm fetal maturity. Women were expected to breath the allocated gas continuously apart from meals and visits to the toilet. MAIN OUTCOME MEASURES: Survival of the fetus was the main outcome measure with secondary outcome measures documenting improvement in the fetal condition in utero. RESULTS: There were 16 women randomised to receive oxygen and 16 to receive air. There were nine survivors in the oxygen group (56.3%) and six in the air group (37.5%) (relative risk 1.5, 95% confidence interval 0.7-3.2). There was a nonsignificant increase in mean birthweight in the oxygen group (858.3 grammes vs 774.4 grammes) and a nonsignificant increase in mean duration of treatment in the oxygen group (12.8 days vs 10.4 days). CONCLUSION: This study did not demonstrate that chronic oxygen therapy provides any benefits to compromised fetuses between 24 and 30 weeks of gestation. Larger studies with sufficient power are necessary to assess whether oxygen therapy can reduce perinatal mortality by a clinically useful amount in this group of patients.

Cardiotocography↗
PubMed2001

The management of the second stage of labor.

OBJECTIVE: To review obstetric practice in a single maternity hospital with respect to the assisted vaginal delivery rate. METHOD: A retrospective analysis of the hospital statistics, labor ward records, casenotes and management protocols with respect to the second stage of labor was performed in a single maternity unit in the UK; the study included 43352 women who delivered a baby between the years of 1987 and 1997. The study looked at the rate of assisted vaginal deliveries, cesarean section, epidural in labor, and as well as the perinatal mortality rate. RESULTS: In the 11-year period of the study, 43352 women delivered with a mean assisted vaginal delivery rate of 3.70%, cesarean section rate of 12.4% and an epidural rate of 31.5%. CONCLUSION: The management of the second stage of labor in this unit results in an assisted vaginal delivery rate significantly below the national average. The authors highlight the paucity of research in this important area of practice.

Anesthesia, Epidural↗
PubMed2001

Neonatal outcome following maternal opiate use in late pregnancy.

OBJECTIVE: To determine the neonatal outcome in the form of use of morphine and triclofos to treat the neonatal abstinence syndrome following maternal opiate use in late pregnancy. METHODS: Retrospective case study of 51 pregnancies associated with maternal opiate use between January 1992 and December 1997. RESULTS: There were 51 pregnancies which resulted in 51 live births. In the third trimester 22 women took methadone only, 19 women used heroin and 10 women stopped opiate use during pregnancy. Babies of methadone using mothers were less likely to be treated with morphine or triclofos than heroin using women. Morphine, triclofos use was more common in high dose methadone users compared with low users. CONCLUSIONS: Successful methadone substitution compared with continued heroin use results in reduced morphine and triclofos use in the babies exposed.

Analgesics, Opioid↗
PubMed2001

Epidural analgesia.

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Analgesia, Epidural↗
PubMed2001

Preliminary experience with the use of insulin lispro in pregnant diabetic women.

Insulin lispro (IL) possesses characteristics (decreased hypoglycaemia, greater convenience in timing of administration and better post-prandial glucose control) which may favour its use in women with diabetes. We report pregnancy outcomes in seven women with Type I diabetes treated with IL. Mean age was 30 years (2241), duration of diabetes from 3 to 21 years. Two were using IL pre-conception; others transferred at various stages of pregnancy. Mean daily dose of IL within the last month of pregnancy ranged from 0.59 to 1.13 U/kg. Mean HbA1C from 4.4 to 8.5%. Babies were delivered at 3438 weeks' gestation, birth weights from 2900 to 4125 g (mean 3434 g). There were no congenital abnormalities. All patients elected to continue with IL after pregnancy. Our experience suggests that IL is convenient and practical therapy for women with Type I diabetes in pregnancy.

Journal Article↗