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Biomedical subjects

S W Lindow

Publications and source records attributed to S W Lindow.

At least 73 records · Page 4Linked to original sources
PubMed1999

Obstetric anal sphincter injury: prospective evaluation of incidence.

PURPOSE: An obstetrically damaged anal sphincter is the principal cause of the development of fecal incontinence in otherwise healthy females. Reports suggest that such damage complicates as many as 35 percent of primiparous vaginal deliveries, with 13 percent of first-time mothers becoming symptomatic. In maternity units delivering 3,000 patients annually, it would follow that 390 symptomatic patients would develop new symptoms each year. This incidence of dysfunction does not reflect current clinical practice. We have investigated this discrepancy to establish the actual incidence of anal sphincter trauma associated with childbirth. METHODS: During a six-week period, 159 females (105 primiparous and 54 para-I) were prospectively assessed postnatally using a standardized symptom questionnaire, endoanal ultrasound, and anal manometry. This group constituted 84 percent of all eligible deliveries occurring in the unit during the study period. RESULTS: One patient developed fecal urgency after this delivery; there were no reports of fecal incontinence. Anal sphincter injuries were identified ultrasonically in 6.8 percent of primiparous patients, 12.2 percent of para-I patients having vaginal deliveries, and 83 percent of patients having forceps deliveries overall. Manometric data provided confirmatory evidence, with significantly reduced maximum squeeze pressures in patients with a disrupted anal sphincter (P<0.0005). CONCLUSIONS: A symptom questionnaire is inadequate to identify anal sphincter injuries. The incidence of sphincter injury in relation to vaginal delivery has been overestimated in previous published work. This study demonstrates that the true incidence is 8.7 percent overall and that symptoms of sphincter dysfunction are uncommon this is in keeping with current clinical practice.

Adolescent↗
PubMed1999

The outcome of pregnancy associated with amphetamine use.

Thirty cases of pregnancy associated with maternal amphetamine use were studied retrospectively fifteen out of the 30 women used amphetamines alone and the other 15 used other drugs in addition to amphetamines. Women who simultaneously used opiates were excluded from this analysis. Women were cared for in a multidisciplinary setting and all delivered in one hospital. With support all women were encouraged to discontinue drug use. There were 2 perinatal deaths, 1 from each group (amphetamines alone or amphetamines plus others). The mean birth weight were 2878 and 2959 grams respectively and gestational age 38.23 and 37.47 weeks respectively. If the whole group was divided into women who ceased amphetamine use and continued use in pregnancy, there was no marked difference between outcome in these 2 subgroups, however, the 2 perinatal deaths both occurred in women who continued amphetamine use. The risk of prematurity was 28.6% and low birth weight 25%, rates which were not reduced by an alteration in drug use.

Journal Article↗
PubMed1999

The incidence of maternal dental treatment during pregnancy.

A questionnaire was given to women who had delivered a live baby to assess their knowledge and uptake of dental treatment during their recent pregnancy of the 496 women surveyed, 95% knew that dental treatment was free on the National Health Service for 1 year after that pregnancy. Despite a high level of knowledge in this area, 64% underwent a dental check-up during pregnancy and of those women who had a check-up 27% had dental restorations placed in their teeth during that pregnancy. Only 26% of women were advised to see a dentist by a health professional. The exact incidence of dental treatment during pregnancy is not known, however, if our area is typical of the United Kingdom, large numbers of women are undergoing dental treatment during pregnancy and the contribution that this makes to maternal and fetal health should be studied.

Journal Article↗
PubMed1999

A randomised, controlled study of uterine exteriorisation and repair at caesarean section.

OBJECTIVE: To determine the surgical and anaesthetic benefits and problems associated with the practice of routine exteriorisation of the uterus to facilitate repair at caesarean section. DESIGN: A randomised controlled study of women undergoing caesarean section. After establishment of anaesthesia, women were randomised to either exteriorisation and uterine repair or suture of the uterus in the abdomen. SETTING: A maternity hospital in the United Kingdom. MAIN OUTCOME MEASURES: Peri-operative haemoglobin change, duration of operation, maternal morbidity and length of hospital stay. Intra-operative pain, nausea, vomiting, pulling or tugging sensations were secondary outcome measures. RESULTS: Three hundred and sixteen women were randomised, of whom 288 were subsequently analysed (139 women in whom the uterus was exteriorised and 149 where the uterus was not exteriorised). Exteriorisation of the uterus, an elective caesarean section and a spinal or general anaesthesia each had a statistically significant association with reduced blood loss (P < 0.05). There were no statistically significant differences between the two groups with regard to intra-operative complications or pain, nor were there any statistically significant difference in post-operative wound sepsis, pyrexia, deep vein thrombosis, blood transfusion or length of hospital stay. CONCLUSION: With effective anaesthesia, exteriorisation of the uterus for repair following caesarean delivery is not associated with significant problems and is associated with less blood loss.

Adult↗
PubMed1999

Morphine suppresses the oxytocin response in breast-feeding women.

The activity of opiate-mediated regulatory mechanisms of oxytocin secretion during breast-feeding was studied by the administration of either morphine, naloxone or placebo to women prior to the commencement of breast-feeding. Seventeen healthy women in the first week after delivery who had established lactation were randomized to receive either intravenous morphine 5 mg (n = 6), naloxone 2.4 mg (n = 6) or a placebo, sterile water (n = 5), which was given prior to commencement of breast-feeding. Oxytocin levels were measured by radioimmunoassay prior to initiation of breast-feeding and then at 2-min intervals until the feed was complete. Breast-feeding produced a significant rise in oxytocin levels in the control and naloxone groups but no significant rise in the patients given morphine. There was a significant reduction in oxytocin response following morphine administration when compared to placebo but not between naloxone and placebo. In conclusion, oxytocin secretion to breast-feeding is inhibited by exogenous morphine when compared to a control group but the administration of naloxone did not produce a significant difference from control.

Adult↗
PubMed1998

The effect of emotional support on maternal oxytocin levels in labouring women.

OBJECTIVE: The presence of a supportive companion to women in labour has been found to reduce the duration of labour and the incidence of oxytocin augmentation. The mechanism which produces this improvement is unknown but work in animals suggests that environmental disturbance produces changes in endogenous oxytocin secretion. This study was carried out to assess maternal oxytocin secretion in relation to the presence of a supportive companion in labour. STUDY DESIGN: A randomised controlled trial involving allocation of unsupported women in the first stage of labour to a period of 1 h with a supportive companion or 1 h without. Sixteen women with uncomplicated singleton pregnancies who were in the active phase of the first stage of labour were studied. Maternal oxytocin levels were assayed by radioimmunoassay for 16 min (eight specimens) before and after the support or control period. RESULTS: There are no differences between maternal oxytocin levels in the two groups of patients. There was no difference in either of the two groups between the oxytocin levels pre and post the support/control period. CONCLUSIONS: One hour of birth support in the first stage of labour did not improve maternal oxytocin levels when compared to a control group.

Adult↗
PubMed1998

Effects of morphine administration on the fetal production of oxytocin in labour.

1. Animal and human work has indicated that maternal oxytocin secretion is under the control of endogenous opiates. Previous workers have described the fetal production of oxytocin in addition to maternal production. The study of the interaction between exogenously administered opiates and oxytocin secretion may give insight into the activity of any opiate-mediated regulatory mechanism of oxytocin secretion in the fetus. This study was designed to investigate the effect of an opiate (5 mg of morphine) given to the mother on the fetal production of oxytocin in labour. 2. Morphine was given by the attending clinicians for analgesic purposes to women in the first stage of labour. After delivery umbilical artery vein and maternal vein specimens were taken. 3. Four groups of patients were studied: women after normal vaginal delivery without analgesia in labour (n=10); women after normal vaginal delivery who had morphine administration in the first stage of labour (n=12); women who had an emergency Caesarean section in the first stage of labour (n=11); women who had an elective Caesarean section at term who were not in labour (n=11). 4. Oxytocin levels were measured by radioimmunoassay in the maternal vein, umbilical artery and umbilical vein specimens. Morphine was measured by radioimmunoassay in the umbilical vein specimens. 5. The umbilical artery minus vein concentration of oxytocin was calculated for each patient (A-V). There was no change in the umbilical (A-V) concentration of oxytocin if morphine had been given to the mother in labour; this applied to fetuses delivered vaginally or by Caesarean section. When the fetuses who were exposed to morphine were analysed separately, there was no correlation between the umbilical vein morphine concentration and the umbilical (A-V) oxytocin concentration either in Caesarean or vaginal deliveries. 6. Fetal oxytocin production was not affected by the maternal administration of morphine in the first stage of labour. This applies to the oxytocin production in the first and second stage of labour.

Analgesia, Obstetrical↗
PubMed1997

Spontaneous recovery of chemotherapy-induced primary ovarian failure: implications for management.

A 14-year-old female patient presented with a swelling, which was excised, over the left forearm. Histology revealed a poorly differentiated rhabdomyosarcoma and she was treated with multiple chemotherapy for 2 years, including cyclophosphamide, cisplatin and vincristine. She developed secondary amenorrhoea shortly after commencing treatment which persisted on its completion. Biochemical investigations were consistent with ovarian failure, which was assumed to be chemotherapy-induced and permanent. She was given hormone replacement with a conjugated equine oestrogen/norgestrel combination, resulting in regular withdrawal bleeding. At 22 years of age; she presented with amenorrhoea for 3 months. Investigations revealed FSH 2.7 IU/l, LH > 50 IU/l and oestradiol > 1320 pmol/l. A pregnancy test was positive and subsequent ultrasound scanning confirmed the presence of a foetus of 18 weeks gestation. The patient initially considered a termination as she had been unprepared for this event but later elected to continue the pregnancy which proceeded uneventfully and resulted in the birth of a normal infant. Ovarian function should be reassessed periodically in patients with chemotherapy-induced gonadal damage and/or the oral contraceptive pill should be used as hormone replacement unless fertility is desired.

Adolescent↗
PubMed1997

Maternal opiate use: pregnancy outcome in patients managed by a multidisciplinary approach.

The outcome of 39 pregnancies in 35 pregnant opiate users is reported. These women were managed by a multidisciplinary team resulting in 36 live births, one stillbirth. one spontaneous miscarriage and one induced abortion. The majority of patients were stabilised on methadone before the third trimester. The women were characterised by a high prevalence of previous obstetric and medical problems, 43.6% of the women were single and 87.2% unemployed The mean (SD) gestational age was 38.2 +/- 2.3 weeks, mean (SD) birth weight was 2980 +/- 543 g. There were eight cases of preterm deliveries, all occurred beyond 32 weeks' gestation. One preterm and two term babies had a birth weight below the 10th centile. Thirty-two (86.5%) women had a normal vaginal delivery, seven (10.8%) had caesarean section and one (2.7%) had forceps delivery. Comprehensive antenatal care in conjunction with methadone maintenance appears to result in a pregnancy outcome comparable with a general obstetric population.

Journal Article↗