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Biomedical subjects

S W Lindow

Publications and source records attributed to S W Lindow.

At least 55 records · Page 3Linked to original sources
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↗
PubMed2001

Reversal of asymptomatic cervical length shortening with cervical cerclage: a preliminary study.

This is a prospective observational study which highlights the value of serial transvaginal cervical length measurements to identify asymptomatic cervical length shortening and the effect on cervical length following insertion of a McDonald cerclage. Four out of 14 patients exhibited asymptomatic cervical length shortening. Only patients whose cervical length was <2 cm underwent cerclage. All patients showed an increase in cervical length post-cerclage. The possible mechanisms responsible for these changes are discussed.

Cervix Uteri↗
PubMed2001

The selenium status of women with a history of recurrent miscarriage.

OBJECTIVE: To assess the relationship between selenium levels in human blood and hair, and the risk of recurrent miscarriages. DESIGN: Case-control study. PARTICIPANTS: Two groups of non-pregnant women: 18 women with one or more successful pregnancies and no history of miscarriage (control group); 26 women with a history of recurrent miscarriage (> or = 3) with no subsequent successful pregnancies (study group). METHODS: Samples of venous blood and scalp hair were collected and the selenium content analysed by inductively coupled plasma mass spectrometry. RESULTS: No significance difference was found between the level of selenium in the blood samples of the women in each group. There was a significant reduction in the mean hair selenium level in the recurrent miscarriage group compared with the control group (0.14 microg/g vs 0.34 microg/g). Further analysis of the recurrent miscarriage group revealed no relationship between levels of serum or hair selenium with parity. There was a significantly greater proportion of women in the control group who ate cereals, vitamin supplements, and liver or kidney. CONCLUSION: There was evidence of selenium deficiency in women with recurrent miscarriages compared with a control group of women with a good reproductive performance. This difference was seen in hair samples but not serum samples and therefore may not represent a simple nutritional deficiency. The importance of selenium deficiency in miscarriage has still not been determined.

Abortion, Habitual↗
PubMed2001

Effect of intrathecal fentanyl on oxytocin secretion in pregnant women not in labour.

We studied the effects of spinal intrathecal fentanyl on oxytocin secretion in 20 healthy women prior to an elective caesarean delivery at term under spinal anaesthesia. The women were randomly allocated into two groups with respect to spinal anaesthesia. Group I (n=10) received intrathecal bupivacaine (15 mg) plus fentanyl (25 microgram), and Group II (n=10) received intrathecal bupivacaine (15 mg) alone, prior to caesarean section. The two groups were comparable demographically. Altogether, ten samples of 4.5 ml of blood (taken every 60 s) were obtained before and ten samples were obtained after the intrathecal administration of the drug and establishment of the T6 block, and plasma oxytocin concentrations were assayed for each subject. Oxytocin was measured by RIA. We found no significant differences in plasma oxytocin concentrations of individual subjects before and after intrathecal injection. In addition, there were no significant differences in plasma oxytocin concentrations between the two groups when pooled samples from the subjects were compared for the pre- and post-intrathecal injection phases. We conclude that the spinal intrathecal administration of fentanyl does not suppress oxytocin secretion in pregnant women who are not in labour at term.

Adult↗
PubMed2000

Biochemical screening for Down syndrome: patients' perception of risk.

OBJECTIVES: To determine the utility of the triple test in routine clinical practice and in addition to the document, the acceptability of a cut-off of 1:250 for invasive testing. DESIGN: Retrospective analysis of data from screening and invasive testing for Down syndrome over a 5-year period in Hull Maternity Hospital. Computer-based records were accessed and individual data drawn from case notes were analyzed. RESULTS: 14827 (78%) of all patients opted for the triple test. A positive result (1:250 or greater) was found in 586 (4%). Fifteen percent of this group refused further testing with amniocentesis. 0.08% requested amniocentesis despite a negative triple test result. Of the screened pregnancies the triple test and selective invasive testing identified nine out of 15 (60%) of Down syndrome cases. CONCLUSION: Sixty percent of Down syndrome pregnancies were identified with a 4% invasive testing rate. Fifteen percent of women who had a positive test did not agree with the cut-off of 1:250 and therefore declined invasive testing. Invasive procedure complication rates do not equate with patients' perception of Down syndrome.

Amniocentesis↗
PubMed2000

Trends in obstetric care in the United Kingdom.

This is a comparative study of the annual statistical returns to the Royal College of Obstetricians and Gynaecologists for 1993, 1994 and 1997/8. Over the study period there has been a decrease in normal vaginal deliveries of the order of 3% which is mirrored by a similar increase in caesarean section rates. Induction of labour rates have remained relatively constant 22.22%, 22.96% and 24.79% for 1993, 1994 and 1997/8, respectively. The overall instrumental delivery rate has changed little but there is an increasing preference for vacuum extraction over forceps. Analysis of the figures for each country (England, Scotland, Wales and Northern Ireland) show broadly similar trends.

Journal Article↗
PubMed2000

Is there a need for special antenatal clinic for women with a medical disorder?

A two year review of clinical practice in a medical antenatal clinic was performed. Forty-six per cent of the patients were diabetics and the other 54% were a mixture of endocrine, cardiac, vascular and other medical disorders. The referral rate was 1.5% of total deliveries during the time period and the perinatal mortality rate was 27/1000. The preterm delivery rate was 20%. The feasibility of this kind of clinic in a single hospital is discussed.

Journal Article↗
PubMed2000

Pregnancy outcome in a patient with chronic malnutrition: case report.

This case report describes the management of a chronically malnourished woman during her first and second pregnancies. The emphasis of the management is on the investigation of her dysphagia and subsequent bypassing of her colonic interposition by the formation of a percutaneous gastrostomy. The case highlights spontaneous conception with a body mass index of 14 and the safety of enteral feeding during pregnancy.

Adult↗
PubMed2000

An in vivo comparative study of the pregnant and nonpregnant cervix using electrical impedance measurements.

Electrical impedance may be measured using electrodes on the surface of the cervix and recording the potential that results when an electrical current is passed. Increased hydration of the cervix has been described throughout pregnancy and occurs most dramatically before labour. This study compared tissue impedance measurements of the pregnant and non-pregnant cervix and found a statistically significant lower value (P < 0.001) in pregnancy. Further work may show that such measurements alter in relation to labour onset.

Cervix Uteri↗
PubMed2000

24 hour rhythm to the onset of preterm labour.

UNLABELLED: OBJECTIVE To describe the time of onset of contractions which result in preterm delivery to investigate if there is a diurnal influence. DESIGN: The admission register for the neonatal unit was used to identify admissions for prematurity over a three-year period. Obstetric case records were then reviewed to obtain the recorded time of onset of contractions when delivery was preceded by spontaneous labour. SETTING: A maternity hospital in the United Kingdom. MAIN OUTCOME MEASURES: The time of onset of spontaneous contractions which result in preterm labour and delivery. RESULTS: Four hundred and twenty-five women in preterm labour were studied. A significant diurnal rhythm in the timing of onset of contractions was noted with 42% of deliveries occurring in labour which commenced between midnight and 0600 hours. Subgroup analysis indicated that there was a significant rhythm in second trimester preterm labours, male and female babies and that this rhythm was present during both the winter and summer months. CONCLUSION: The periodicity of preterm labour onset demonstrates a rhythm which is similar to the rhythm in the onset of labour at term. Preterm labour most commonly begins between midnight and 0600 hours.

Circadian Rhythm↗
PubMed1999

Do routinely measured delivery variables predict anal sphincter outcome?

PURPOSE: Trauma to the anal sphincter is a recognized complication of primiparous childbirth. This damage may be compounded during subsequent deliveries leading to symptoms. Earlier work is inconclusive as to which delivery variables are associated with such damage and may prove useful in predicting its occurrence, thereby allowing the potential for intervention in these later deliveries to protect the traumatized anal sphincter. The purpose of the present study was to determine whether routinely recorded obstetric variables can be correlated to anal sphincter damage in a consecutive series of females. METHODS: A prospective study was undertaken in a single maternity unit. Patients delivering were assessed before discharge using a symptom questionnaire and endoanal ultrasound. Delivery data were collected prospectively and analyzed statistically to see if a significant difference existed in the presence of an anal sphincter defect. RESULTS: A total of 159 patients were assessed. Endosonography revealed sphincter injuries in 8.7 percent of the normal vaginal delivery group and 83 percent of the forceps delivery group. No correlation was found between head circumference, baby weight, maternal body mass index, epidurals, episiotomy, length of each stage of labor, and duration of active pushing. Forceps delivery was the only factor to be significantly associated with sphincter trauma. CONCLUSION: Besides forceps delivery, commonly measured delivery variables are not useful predictors of anal sphincter trauma. Normal vaginal deliveries do not warrant routine postnatal anorectal assessment, but this should be routine for all instrument deliveries.

Adult↗