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Biomedical subjects

Stephen Robson

Publications and source records attributed to Stephen Robson.

11 recordsLinked to original sources
PubMed2006

Outcome of fetal cerebral posterior fossa anomalies.

INTRODUCTION: Limited data exist on the outcome of Dandy-Walker malformation (DWM), Dandy-Walker variant (DWV) and mega-cisterna magna (MCM). We report the first population-based study of posterior fossa anomalies from the northern region of England. METHODS: Cases were identified from the Northern Congenital Abnormality Survey (NorCAS) and regional Fetal Medicine Unit databases for the period 1986-2004 for DWM/V and 1995-2005 for MCM (defined as a cisterna magna > or =10 mm). Outcome data was obtained from pediatric records and/or general practitioner/health visitor questionnaires for all survivors. RESULTS: A prenatal diagnosis of a posterior fossa abnormality was made in 91 cases, with a further 12 cases of DWM/V diagnosed postnatally, giving incidences of DWM/V and MCM of 1/11574 and 1/8268 births respectively. In five cases where DWM/V was suspected prenatally, the diagnosis was not confirmed. Of the 47 with DWM/V, 41 (87%) had additional anomalies. There were three survivors, all with neurodevelopmental disability. Of the 39 cases of MCM, 24 (62%) had additional anomalies. There were 30 survivors; one child died at 3 months and the outcome was normal in 25 children including 12/13 (92%) with isolated MCM. SUMMARY: Posterior fossa anomalies are relatively common. The outcome is very poor in DWM/V owing to the high rate of associated anomalies. The outcome appears better with MCM, especially if this is an isolated finding.

Adult↗
PubMed2006

Women's preferences in screening for Down syndrome.

OBJECTIVES: In this article, we seek to establish women's preferences (expressed as utility values) for a number of scenarios relating to the process and associated outcomes of first- and second-trimester screening for Down syndrome. METHODS: We used the standard gamble (SG) approach with a sample of 100 pregnant women. Standard gamble is a choice-based preference elicitation technique that values scenarios on a 0-1 scale. RESULTS: A true negative screening test, whether obtained in the first or second trimester, had the highest utility scores (both 0.98), which were not significantly different from the scores for the false-positive scenarios leading to first- or second-trimester invasive testing but the birth of a healthy infant (0.95 and 0.94, respectively). The mean utility score for the false-negative scenario resulting in the birth of a Down syndrome infant (0.77) was lower than both the true negative scenarios and the false-positive healthy baby scenarios (p < 0.000). CONCLUSION: We did not find any differences in the values of the key scenarios regarding either the timing of reassurance of a healthy fetus or the ability to access early surgical termination, rather than later medical termination for a Down syndrome fetus.

Adult↗
PubMed2006

Obstetric management of the next pregnancy after an unexplained stillbirth: an anonymous postal survey of Australian obstetricians.

BACKGROUND: Women who have an unexplained stillbirth are more likely to be delivered early, by induced labour or Caesarean section, in their next pregnancy. It is unclear whether these birth outcomes result from characteristics of the next pregnancy, or represent management strategies of obstetricians. AIM: To investigate obstetricians' management strategies in the next pregnancy after an unexplained stillbirth. METHODS: Anonymous postal survey of Australian obstetricians. Respondents were given a clinical scenario regarding a previous unexplained stillbirth and were asked about management. RESULTS: The response rate was 69%. Tests of 'fetal well-being' were undertaken by the majority of respondents. Additional third trimester ultrasound surveillance was recommended by 87% of respondents, regular cardiotograph monitoring by 72% and formal fetal movement charting by 39%. Elective induction of labour (in the absence of any other obstetric indication) was recommended by 93% of respondents, and elective Caesarean delivery by 35%. CONCLUSIONS: The tendency for subsequent pregnancies after an unexplained stillbirth to be delivered earlier, and more often by Caesarean section, may be due in part to altered management strategies, not solely as a result of complications of the pregnancy itself.

Adult↗
PubMed2006

Birth outcomes for teenage women in New South Wales, 1998-2003.

BACKGROUND: Pregnancy and childbirth in teenage women are associated with obstetric and social risks, and there is evidence that the birth rate among teenagers in rural and remote areas of Australia is not in decline. The combination of non-urban residence and young age at delivery might define a subgroup of women at special risk of adverse birth outcomes. AIMS: To compare birth outcomes of New South Wales (NSW) teenagers residing in rural and remote areas with those living in larger centres with greater access to services. METHODS: Outcomes for all singleton deliveries to teenage women living in NSW during the period 1998-2003 were reviewed. The women's place of residence was assigned an ARIA (Accessibility/Remoteness Index of Australia) classification according to remoteness and access to services. Analysis included obstetric factors (such as parity), and smoking status. Logistic regression analysis was undertaken to examine the impact of maternal factors on obstetric outcomes. RESULTS: During the study period, 21 880 teenage women had singleton deliveries. Babies of teenage mothers in very remote areas had higher rates of preterm birth, small-for-gestational age and stillbirth. Rates of smoking were higher in more remote areas, and smoking correlated with preterm birth and stillbirth. CONCLUSIONS: Teenagers living in remote areas of NSW face a higher risk of adverse pregnancy outcomes than their urban cousins.

Adolescent↗
PubMed2005

An anonymous survey of provincial, rural and remote obstetricians' long-term practice intentions; implications for the provision of specialist obstetric services outside metropolitan areas in Australia.

BACKGROUND: Objective data and anecdotal reports suggest that non-metropolitan Australia may face a severe shortage of specialist obstetricians in the near future. AIMS: To assess the workload and practice intentions of specialist obstetricians working in provincial, rural and remote areas of Australia. METHODS: 1. A structured questionnaire posted to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) who undertake part or all of their work in provincial, rural or remote areas of Australia. 2. A telephone survey of all non-metropolitan hospitals in Australia. MAIN OUTCOME MEASURES: Demographic data (e.g. age, sex); length of time working in the area; practice characteristics; professional supports; workload; intentions for future practice; factors that might improve practice satisfaction. RESULTS: Approximately 30% of Australia's births occur in non-metropolitan hospitals, of which 57% do not currently have specialist obstetric cover. Survey response rate of 73%. The rural workforce is older than the metropolitan demographic, and almost half of respondents intended to cease obstetric practice within 5 years. CONCLUSIONS: These data may presage a major public health crisis for rural Australia.

Attitude of Health Personnel↗
PubMed2004

Throwing out the baby with the spa water?

Australia is now one of the safest countries in the world in which to be born. This is largely a result of the many advances in obstetric and neonatal medicine of the past 50 years. However, the "medicalisation" of birth has tended to diminish women's satisfaction with their experience of childbirth. It has been shown that women are most satisfied by care from a single practitioner, and when they themselves have input into decision-making. Although maternal satisfaction is important, it should not be promoted at the expense of the health of mothers and babies. More realistic antenatal education and preparation should be available for all pregnant women so that both maternal satisfaction and good perinatal outcomes can be achieved.

Australia↗
PubMed2003

Should obstetricians support a 'term cephalic trial'?

Recent analyses of the published data suggest that the risks of elective Caesarean delivery in an uncomplicated pregnancy may not outweigh the benefits of vaginal birth by as much as has been supposed. Indeed, this balance may be so close that the place of elective Caesarean delivery of a term cephalic baby might be considered as a worthwhile subject of a randomised controlled trial. We discuss the potential consequences of such a trial and what effect it could have on obstetric practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Expression of Gsalpha, connexin-43, connexin-26, and EP1, 3, and 4 receptors in myometrium of prelabor singleton versus multiple gestations and the effects of mechanical stretch and steroids on Gsalpha.

OBJECTIVE: We tested the hypothesis that multiple pregnancies would be associated with altered expression of the following three groups of proteins that are key regulators of myometrial function: (i) Gsalpha, (ii) connexins-43 and 26, and (iii) prostanoid EP1, EP3, and EP4 receptors. METHODS: An in vitro model was used to determine the effects of mechanical stretch on myometrial cell Gsalpha expression. Then the effects of the steroid hormones beta-estradiol and progesterone were tested on Gsalpha expression in vitro. All in vitro studies were performed using myometrium from nonlaboring women. RESULTS: There were no differences in the expression of Gsalpha, prostaglandin E2 receptors, or gap junction proteins in myometrium of singleton versus multiple pregnancies. Mechanical stretch did not alter Gsalpha expression in vitro, and Gsalpha expression was unaffected by steroid hormones. CONCLUSION: These results suggest that the methods whereby stretch can promote myometrial contraction are complex or require additional factors than those tested here. Alternatively, cases of multiple gestation that do not result in preterm labor perhaps compensate for the increased stretch by preventing aberrant expression of the proteins investigated in this study.

Biomechanical Phenomena↗