PubMed Health⌕ Search

Biomedical subjects

Z J Penn

Publications and source records attributed to Z J Penn.

5 recordsLinked to original sources
PubMed1996

Elective or selective caesarean delivery of the small baby? A systematic review of the controlled trials.

OBJECTIVE: To compare a policy of elective caesarean delivery with a policy of selective caesarean delivery for women in spontaneous preterm labour. DESIGN: Systematic review of relevant randomised controlled trials. PARTICIPANTS: One hundred and twenty-two women from six trials. INTERVENTIONS: Random allocation to "intention to deliver by caesarean section' (elective caesarean policy), compared with "intention to deliver vaginally' (selective caesarean policy). MAIN OUTCOME MEASURES: Actual use of caesarean delivery, low Apgar score, neonatal intubation, intracranial pathology, perinatal death, and major maternal complications. RESULTS: One in six women in both groups were not delivered as allocated. Typical odds ratios for all adverse neonatal outcomes tended to favour the elective group, but for all outcomes studied the confidence intervals were wide and did not exclude clinically important hazards of the policy. The odds of serious maternal morbidity were increased in the caesarean section group (OR 6.2; 95% CI 1.3-30.1). CONCLUSION: A policy of elective caesarean delivery increases the risks of maternal morbidity, but it remains unclear whether these are offset by benefits for the infant.

Anesthesia, Obstetrical↗
PubMed1996

A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant.

OBJECTIVE: To determine the optimum mode of delivery for women in preterm breech labour at a gestational age of 26 to 32 weeks. DESIGN: A multicentre randomised controlled trial. SETTING: Twenty-six hospitals in England, UK. PARTICIPANTS: Women with a singleton breech fetus in spontaneous preterm labour between 26 and 32 completed weeks of gestation, with no clear indication for a caesarean section or vaginal breech delivery. INTERVENTION: Random allocation to either "intention to delivery vaginally' or "intention to deliver by caesarean section'. MAIN OUTCOME MEASURES: Perinatal mortality, neonatal morbidity, maternal morbidity and gestation at delivery. RESULTS: The trial was closed after 17 months because of low recruitment, by which time substantial numbers of women had been in the eligible gestation period. Thirteen women from six hospitals were recruited. One infant, randomised to and delivered vaginally, was stillborn. Three fetal presentations were cephalic at delivery despite a diagnosis of breech presentation at trial entry. No formal statistical analysis was performed due to the small numbers. CONCLUSIONS: No conclusions about the optimum mode of delivery for women in preterm labour with a fetus presenting by the breech can be drawn from this trial. The low accrual rate was due to clinicians' reluctance to randomise eligible women, reflecting the circumstances and nature of the trial.

Adult↗
PubMed1991

How obstetricians manage the problem of preterm delivery with special reference to the preterm breech.

A questionnaire regarding the route of birth for the preterm fetus with particular reference to the management of the preterm breech was sent to 180 consultants in England and Wales. Only 23% of respondents use electronic fetal monitoring below 26 weeks gestation and only 12% use caesarean section routinely for fetal indications at less than 26 weeks. Only 12% will use caesarean section for the preterm fetus presenting by the vertex in uncomplicated labour. Only 35% of all respondents consider that there is sufficient evidence to support the use of caesarean section for the uncomplicated preterm breech, but 76% will actually use caesarean section for this indication. Overall 71% reported that they are affected by medicolegal considerations in their management of the preterm breech. Overall, 83% said that they might change their practice regarding the mode of delivery of the preterm breech in the light of the findings of a randomized prospective controlled trial.

Breech Presentation↗
PubMed1990

Reasons for declining participation in a prospective randomized trial to determine the optimum mode of delivery of the preterm breech.

Increasing numbers of preterm breech infants are being delivered by cesarean section, which confers no proven advantage to the infant and subjects the mother to increased risk. In order to assess the feasibility of performing a randomized controlled trial to compare elective with selective cesarean delivery for the preterm breech infant, consultants in 36 hospitals were asked if they would be willing to participate. In 25 hospitals all consultants agreed to participate, whereas in 11 universal support was not obtained. The reasons given for nonparticipation included the potentially time-consuming nature of the consent procedure, which it was proposed should be undertaken with all women during the antenatal period, concern that a large proportion of non-English speak women would not be able to give truly informed consent, anxiety about the seniority, availability, and requisite skill of the personnel delivering the preterm breech, doubts about the details of the protocol, medicolegal considerations, and disagreement about the desirability of the trial among the consultant members of a department. If prospective evaluation of clinical practice is to be carried out in the future the staffing levels of obstetric departments must taken into account the additional work load that this entails.

Breech Presentation↗