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Biomedical subjects

T A Mahmood

Publications and source records attributed to T A Mahmood.

At least 37 records · Page 2Linked to original sources
PubMed1992

Breech delivery and epidural analgesia.

OBJECTIVE: To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks). DESIGN: A retrospective study. SETTING: Data Bank, Aberdeen Maternity Hospital. SUBJECTS: 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. OUTCOME MEASURES: Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. RESULTS: Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65). CONCLUSION: Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

Adult↗
PubMed1992

Role of prostaglandin in the management of prelabour rupture of the membranes at term.

OBJECTIVE: To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term. DESIGN: A prospective randomized study. SETTING: Labour Ward, Aberdeen Maternity Hospital. SUBJECTS: 230 primigravidae at terms with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. INTERVENTIONS: In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses. MAIN OUTCOME MEASURES: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. RESULTS: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section. CONCLUSION: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.

Administration, Intravaginal↗
PubMed1991

The impact of previous danazol treatment on circulating hormone levels, follicular development and oocyte maturity in minimal-mild endometriosis.

The purpose of this study was to assess the impact of previous danazol treatment on peripheral endocrinology, folliculogenesis, oocyte maturity and follicular fluid endocrinology in women with minimal-mild endometriosis in a spontaneous menstrual cycle. A group of 10 women previously treated with danazol (Group A) and another group of 10 women whose endometriosis was left untreated (Group B) were studied. A group of 10 women with tubal infertility acted as a Control. Circulating hormone levels and characteristics of an endogenous luteinizing hormone (LH) surge were studied. A diagnostic laparoscopy was performed 32 h after the onset of an endogenous LH surge in all women to undertake follicular aspiration. There were no significant differences in oocyte maturity, fertilisation and cleavage rate among women studied in three study groups. The presence of peritoneal endometriosis did not affect the steroidogenic potential of the granulosa cells, and the endocrine milieu of the pre-ovulatory oocyte was comparable in all study groups.

Adult↗
PubMed1991

The luteal phase after oocyte recovery in a spontaneous cycle.

There is disagreement as to whether follicular aspiration and oocyte recovery leads to a defective luteal phase. A group of 20 women with mild endometriosis was studied over two consecutive spontaneous cycles. Follicular aspiration and oocyte recovery was performed 32 hours after the onset of the endogenous luteinizing hormone surge during the second cycle. There was little disturbance of the luteal phase or in the pituitary gonadal relationship in the aspirated cycle. Although a significantly lower serum progesterone was noted on day 8 of post-oocyte recovery, all results were within the normal range seen in the control cycles.

Adult↗
PubMed1991

Folliculogenesis and ovulation in infertile women with mild endometriosis.

Twenty-one infertile women with laparoscopically documented minimal-mild endometriosis (AFS score 2-10) were studied during 27 cycles (six women had two cycles each) to investigate follicular development and ovulation. Of the 27 cycles studies, 24 (89%) appeared to be endocrinologically normal and ovulatory. Luteinized unruptured follicle (LUF) occurred in only one cycle (4%). One further patient exhibited abnormal endocrinology with evidence of premature ovulation over two (8%) consecutive cycles. This study indicates that the majority of women with minimal-mild endometriosis have endocrinologically normal menstrual cycles and that luteinized unruptured follicles occur infrequently.

Adult↗
PubMed1991

Prevalence and genesis of endometriosis.

A group of 1542 pre-menopausal Caucasian women were assessed prospectively to investigate the prevalence of endometriosis. The women were either having laparoscopy because of infertility (n = 654), undergoing laparoscopic sterilization (n = 598), having laparoscopy because of chronic abdominal and pelvic pain (n = 156) or undergoing abdominal hysterectomy for dysfunctional uterine bleeding (n = 134). Endometriosis was noted more frequently among women being investigated for infertility (21%) than among those undergoing sterilization (6%). Among those being investigated for chronic abdominal pain, the incidence of endometriosis was 15%, while among those undergoing abdominal hysterectomy, it was 25%. In all groups the total duration of combined pill usage was significantly higher in patients who had a normal pelvis compared to those with endometriosis. It is suggested that among susceptible women, both fertile and infertile, a prolonged period of regular spontaneous menstruation may play a causative role in the genesis of endometriosis.

Abdominal Pain↗
PubMed1991

Menstrual symptoms in women with pelvic endometriosis.

OBJECTIVE: To investigate menstrual symptoms in relation to pelvic pathology. DESIGN: A prospective questionnaire-based study. SETTING: Aberdeen Royal Infirmary, Scotland. SUBJECTS: 1250 questionnaires were sent out prior to planned admission and 1200 women (96%) brought the completed questionnaires. They comprised 598 women undergoing laparoscopic sterilization, 312 having laparoscopy because of infertility, 156 having laparoscopy because of chronic pelvic pain and 134 women undergoing abdominal hysterectomy for dysfunctional uterine bleeding. MAIN OUTCOME MEASURES: The occurrence of dysmenorrhoea, menorrhagia, menstrual regularity, premenstrual spotting, deep dyspareunia and pelvic pain in women with either endometriosis and post infective pelvic adhesions or a normal pelvis. RESULTS: Menorrhagia, menstrual irregularity and premenstrual spotting occurred with equal frequency in all groups. Deep dyspareunia, pain after intercourse and recurrent pain unrelated to menstruation or coitus was more common in women with endometriosis and those with post infective pelvic adhesions than in those with a normal pelvis. Dysmenorrhoea appears to be more prevalent among women having endometriosis. CONCLUSIONS: Menstrual symptoms, while raising a high index of suspicion for endometriosis, are not entirely reliable as indicators of disease. Dysmenorrhoea is the most common reported symptom in endometriosis sufferers. Diagnostic laparoscopy should be considered before institution of treatment in women complaining of pelvic pain and menstrual symptoms.

Dysmenorrhea↗
PubMed1991

Oocyte and follicular fluid characteristics in women with mild endometriosis.

The follicular development, fertilization and cleavage rates and follicular fluid endocrinology were assessed in 20 women with mild endometriosis during a spontaneous menstrual cycle. Diagnostic laparoscopy was performed 32 h after the onset of the endogenous luteinizing hormone (LH) surge in the 20 women with laparoscopically confirmed mild endometriosis and in a control group of ten women with tubal infertility. There was no significant difference in oocyte maturity or fertilization and cleavage rates between the women with mild endometriosis and those in the control group. The endocrine milieu of the pre-ovulatory oocyte at the time of aspiration was similar in the two groups.

Adult↗
PubMed1991

Peritoneal fluid volume and sex steroids in the pre-ovulatory period in mild endometriosis.

Twenty infertile women with laparoscopically confirmed mild endometriosis and ten women with tubal infertility underwent diagnostic laparoscopy 32 h after the onset of the endogenous luteinizing hormone (LH) surge during a spontaneous menstrual cycle. All visible peritoneal fluid was aspirated for assessment of volume and sex steroid content. There was no significant difference in peritoneal fluid volume or concentrations of oestradiol, progesterone and androstenedione between the two groups. Furthermore, in the endometriosis group there was no significant difference in peritoneal fluid volume and concentrations of sex steroids between those women who had been treated previously with danazol and those who were left untreated.

Adult↗
PubMed1991

Follicular development in spontaneous and stimulated cycles in women with minimal-mild endometriosis.

OBJECTIVE: To study follicle development in women with minimal-mild endometriosis. DESIGN: In women with endometriosis a spontaneous ovulatory cycle was compared with two subsequent cycles in which either clomiphene or clomiphene and FSH were given to stimulate folliculogenesis. Spontaneous cycles in women with tubal infertility provided a comparison group. SETTING: Infertility clinic, Aberdeen Maternity Hospital. SUBJECTS: 17 women with minimal-mild endometriosis and 10 women with tubal infertility. INTERVENTIONS: The women with endometriosis were treated with 150 mg clomiphene citrate from days 2 to 6 in one cycle and in a subsequent cycle with 150 mg clomiphene citrate on days 2 to 6 plus 75 iu FSH daily thereafter. MAIN OUTCOME MEASURES: Follicular size measured daily using ultrasound. Serum FSH estimated on days 5 and 7 and then daily. RESULTS: Spontaneous follicular growth in the women with endometriosis was similar to that in the women with tubal infertility. Follicular development began earlier in cycles with clomiphene/FSH and the leading follicle reached 16 mm 2 days sooner but the rate of growth was similar whether or not either regimen of stimulation was used. CONCLUSION: Follicular growth is not impaired by minimal-mild endometriosis. Infertility with this condition cannot be explained by altered follicular growth or responsiveness.

Adult↗
PubMed1990

Pathophysiology of mild endometriosis: review of literature.

Endometriosis is a puzzling condition and the literature is characterized by a large number of uncontrolled reports on its aetiology and pathophysiology. In particular the relationship between mild endometriosis and subfecundity is uncertain. This paper critically reviews the published literature on the pathogenesis, prevalence, menstrual symptomatology and natural history of endometriosis. Furthermore, factors implicated in causing subfecundity in relation to endometriosis and the impact of various treatments in enhancing fertility among women with mild endometriosis have been assessed.

Ascitic Fluid↗
PubMed1990

The impact of treatment on the natural history of endometriosis.

A group of 50 infertile female patients was assessed laparoscopically to study the natural history of endometriosis. They were treated either with danazol (n = 21), or diathermy ablation (n = 13) or had conservative surgery with postoperative danazol (n = 5) or were left untreated (n = 11). All these patients had second look laparoscopy performed after a mean interval of 12 months (range 9-18 months). Improvement was noted among 53% of those treated with danazol, 70% treated with diathermy, 80% treated with surgery and danazol and 27% of those left untreated. The status of endometriosis remained unchanged among 14% of those treated with danazol, 8% treated by diathermy and 9% of those left untreated. However, the disease became worse in the remaining women, 33% in the danazol treated group, 22% treated by diathermy, 20% treated with surgery and danazol and 64% of those left untreated. Thus treatment hinders progression in a majority of patients, and conversely, there is a small but definite spontaneous regression rate.

Adult↗
PubMed1990

The experience of termination of second trimester pregnancies using gemeprost vaginal pessaries in a district general hospital.

Experience with the use of Gemeprost pessaries (prostaglandin E1 analogue), in a group of 60 consecutive patients for second trimester termination in a Scottish District General Hospital, is presented. Gestation ranged from 12 to 20 weeks; there were 29 nulliparous (48%) and 31 (52%) multiparous women. Fifty-seven (95%) aborted within 36 hours; 29 (48%) aborted completely and did not require further uterine curettage. Nulliparous patients required more pessaries and the abortion was more often incomplete. Side effects were minimal. There were no serious problems; and antiemetics were required by 17% and parenteral analgesics by 13% of patients.

Abortion, Therapeutic↗
PubMed1990

The influence of maternal height, obstetrical conjugate and fetal birth-weight in the management of patients with breech presentation.

The value of erect lateral X-ray pelvimetry for selecting patients for a safe trial of vaginal delivery was assessed in a retrospective study of 424 women with a breech presentation. A trial labour was more often allowed in women with larger inlet conjugate measurements and the chance of successful vaginal delivery was better with larger pelvic measurements. However, there was no absolute level of pelvic contraction below which vaginal delivery was impossible. The size of the fetus did not determine the rate of planned elective Caesarean section. A fetus weighing greater than 3,500 g, had less than 50% chance of vaginal delivery. It is suggested that antenatal assessment of fetal size should be considered in patients with breech presentation before deciding on the mode of delivery.

Birth Weight↗
PubMed1990

A review of placenta accreta at Aberdeen Maternity Hospital, Scotland.

There were 7 cases of placenta accreta (a frequency of 1 per 12,700 deliveries) at the Aberdeen Maternity Hospital where emergency postpartum hysterectomies were performed on account of uncontrollable postpartum haemorrhage from January, 1977 to May, 1989. There was no maternal death. The presentation and risk factors are discussed.

Adult↗
PubMed1989

A prospective comparative study on the use of prostaglandin E2 gel (2 mg) and prostaglandin E2 tablet (3 mg) for the induction of labour in primigravid women with unfavorable cervices.

Eighty primigravid patients with singleton pregnancies, cephalic presentation and unfavourable cervices (score less than 5) between 37 and 43 weeks gestation were studied prospectively to compare the ripening effect of vaginal PGE2 (3 mg) tablet with that of PGE2 gel (2 mg). Following the use of gel, the final mean cervical score was considerably improved and half of the patients went into spontaneous labour. The requirement for oxytocin augmentation was also reduced. The priming-to-induction and induction-to-delivery intervals were also considerably shortened in gel-treated patients. The proportion of patients delivered by Caesarean section in the gel group was lower than that in the tablet group (30 vs. 15%).

Administration, Intravaginal↗
PubMed1989

The relationship between endometriosis and semen analysis: a review of 490 consecutive laparoscopies.

Laparoscopy was carried out on 490 infertile women whose partners had semen analyses showing a minimum of 5 X 10(6) motile spermatozoa/ml. Patients were divided into two groups using WHO criteria: those in whom the semen parameters were normal and those in whom there was any abnormality. The overall incidence of endometriosis was the same in both groups. Among women with primary infertility, mild endometriosis was significantly more common in the abnormal semen group. Thus among couples in whom there is an explanation for continuing sub-fertility, mild endometriosis is more common. This finding calls into question the causal relationship between endometriosis and primary infertility and suggests that in susceptible women, infertility may predispose towards the occurrence of endometriosis.

Adult↗