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Biomedical subjects

C Crowther

Publications and source records attributed to C Crowther.

At least 19 recordsLinked to original sources
PubMed2005

Antioxidants for preventing pre-eclampsia.

BACKGROUND: Oxidative stress has been proposed as a key factor involved in the development of pre-eclampsia. Supplementing women with antioxidants during pregnancy may help to counteract oxidative stress and thereby prevent or delay the onset of pre-eclampsia. OBJECTIVES: To determine the effectiveness and safety of any antioxidant supplementation during pregnancy and the risk of developing pre-eclampsia and its related complications. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2004). SELECTION CRITERIA: All randomised and quasi-randomised trials comparing one or more antioxidants with either placebo or no antioxidants during pregnancy for the prevention of pre-eclampsia, and trials comparing one or more antioxidants with another, or with other interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, data extraction and trial quality. Data were double-entered into the Review Manager software. MAIN RESULTS: Seven trials involving 6082 women are included in this review. The largest trial (5021 women) was quasi-random and only three of the seven included trials were rated high quality. Supplementing women with any antioxidants during pregnancy compared with control or placebo was associated with a 39% reduction in the risk of pre-eclampsia (relative risk (RR) 0.61, 95% confidence intervals (CI) 0.50 to 0.75, seven trials, 6082 women). Women receiving antioxidants compared with control or placebo also had a reduced risk of having a small-for-gestational-age infant (RR 0.64, 95% CI 0.47 to 0.87, three trials, 634 women), their infants had a greater mean birthweight (weighted mean difference 91.83 g, 95% CI 11.55 to 172.11, three trials, 451 women), but they were more likely to give birth preterm (RR 1.38, 95% CI 1.04 to 1.82, three trials, 583 women). There were insufficient data for reliable conclusions about possible effects on any other outcomes. AUTHORS' CONCLUSIONS: These results should be interpreted with caution, as most of the data come from poor quality studies. Nevertheless, antioxidant supplementation seems to reduce the risk of pre-eclampsia. There also appears to be a reduction in the risk of having a small-for-gestational-age baby associated with antioxidants, although there is an increase in the risk of preterm birth. Several large trials are ongoing, and the results of these are needed before antioxidants can be recommended for clinical practice.

Antioxidants↗
PubMed2002

The placebo response and effect of time in a trial of acupuncture to treat nausea and vomiting in early pregnancy.

OBJECTIVES: The sham control is widely used in acupuncture research, and its adequacy may be assessed by exploring the 'credibility' of the intervention. We aimed to examine the credibility of the study intervention, to quantify the size of the placebo response and effect of time in reducing nausea in early pregnancy. DESIGN: Five hundred and ninety-three women with nausea or vomiting in early pregnancy volunteered to participate in a randomised controlled trial, conducted at the Women's and Children's Hospital, South Australia. OUTCOME MEASURES: Women completed the Rhodes Index of Nausea and Vomiting and the Credibility Rating Scale. RESULTS: The credibility of the acupuncture and sham acupuncture interventions were not different. The relative change in nausea at the end of the first week of the study was estimated to be 28% attributed to a time effect and 7% to the placebo response. At the end of the third week, there was a further small increase in time effect (32%) and the placebo response (17%). CONCLUSION: Sham acupuncture is a credible control and allows assessment of the size of the placebo response.

Acupuncture Therapy↗
PubMed2002

Pregnancy outcome following women's participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy.

OBJECTIVES: Recent studies have concluded that acupuncture is safe in the hands of a qualified practitioner. This study assessed the risk of adverse effects of acupuncture administered during pregnancy. METHODS: 593 women with nausea and vomiting in early pregnancy volunteered to participate in a randomised controlled trial, conducted at the Women's and Children's Hospital, in South Australia. Patients were given either traditional acupuncture, formula acupuncture, sham acupuncture or no acupuncture. OUTCOME MEASURES: Data were collected on perinatal outcome, congenital abnormalities, pregnancy complications and the newborn. RESULTS: No differences were found between study groups in the incidence of perinatal outcome, congenital abnormalities, pregnancy complications and other infant outcomes. CONCLUSION: Our findings suggest that no serious adverse effects arise from acupuncture administered in early pregnancy.

Acupuncture Therapy↗
PubMed2001

Perineal massage in labour and prevention of perineal trauma: randomised controlled trial.

OBJECTIVE: To determine the effects of perineal massage in the second stage of labour on perineal outcomes. DESIGN: Randomised controlled trial. PARTICIPANTS: At 36 weeks' gestation, women expecting normal birth of a singleton were asked to join the study. Women became eligible to be randomised in labour if they progressed to full dilatation of the cervix or 8 cm or more if nulliparous or 5 cm or more if multiparous. 1340 were randomised into the trial. INTERVENTION: Massage and stretching of the perineum during the second stage of labour with a water soluble lubricant. MAIN OUTCOME MEASURES PRIMARY OUTCOMES: rates of intact perineum, episiotomies, and first, second, third, and fourth degree tears. SECONDARY OUTCOMES: pain at three and 10 days postpartum and pain, dyspareunia, resumption of sexual intercourse, and urinary and faecal incontinence and urgency three months postpartum. RESULTS: Rates of intact perineums, first and second degree tears, and episiotomies were similar in the massage and the control groups. There were fewer third degree tears in the massage group (12 (1.7%) v 23 (3.6%); absolute risk 2.11, relative risk 0.45; 95% confidence interval 0.23 to 0.93, P<0.04), though the trial was underpowered to measure this rarer outcome. Groups did not differ in any of the secondary outcomes at the three assessment points. CONCLUSIONS: The practice of perineal massage in labour does not increase the likelihood of an intact perineum or reduce the risk of pain, dyspareunia, or urinary and faecal problems.

Adult↗
PubMed2000

Anti-D administration after childbirth for preventing Rhesus alloimmunisation.

BACKGROUND: The development of Rh immunisation and its prophylactic use since the 1970s has meant that severe Rhesus D (RhD) alloimmunisation is now rarely seen. OBJECTIVES: The objective of this systematic review was to assess the effects of giving anti-D to Rhesus negative women, with no anti-D antibodies, who had given birth to a Rhesus positive infant. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, MEDLINE (from 1966 to January 1999) and reference lists of relevant articles. Date of last search of Cochrane Controlled Trials Register: January 1999. SELECTION CRITERIA: Randomised trials in Rhesus negative women without antibodies who were given anti-D immunoglobulin postpartum compared with no treatment or placebo. DATA COLLECTION AND ANALYSIS: Assessments of inclusion criteria, trial quality and data extraction were done by each author independently. Initial analyses included all trials. Other analyses assessed the effect of trial quality, ABO compatibility and dose. MAIN RESULTS: Six eligible trials compared postpartum anti-D prophylaxis with no treatment or placebo. The trials involved over 10,000 women, but trial quality varied. Anti-D lowered the incidence of RhD alloimmunisation six months after birth (relative risk 0.04, 95% confidence interval 0.02 to 0.06), and in a subsequent pregnancy (relative risk 0.12, 95% confidence interval 0. 07 to 0.23). These benefits were seen regardless of the ABO status of the mother and baby and when anti-D was given within 72 hours of birth. Higher doses (up to 200 micro grams) were more effective than lower doses (up to 50 micro grams) in preventing RhD alloimmunisation in a subsequent pregnancy. REVIEWER'S CONCLUSIONS: Anti-D, given within 72 hours after childbirth, reduces the risk of RhD alloimmunisation in Rhesus negative women who have given birth to a Rhesus positive infant. However the evidence on the optimal dose is limited.

Female↗
PubMed2000

Patterns of medication use during and prior to pregnancy: the MAP study.

We interviewed 140 pregnant women of any gestational age attending antenatal clinics at the Women's and Children's Hospital in Adelaide during September-October 1999 to elicit information about their patterns of medication use during and in the 3 months prior to their current pregnancy. Demographic information, information on women's prescribed, non-prescribed, and non-medicinal drug use during and in the 3 months prior to pregnancy, and information about both their general sources of information on medication use and their specific reasons for medication uptake/cessation during pregnancy were obtained. The women used an average of 0.7 0.8 prescribed and 2.3-2.6 non-prescribed medications (total 3.1-3.3) in the 3 pregnancy trimesters, compared with 1.0 prescribed and 2.2 non-prescribed prior to pregnancy. Use of a prescribed or non-prescribed medication was 96-97% across trimesters. Simple analgesics, vitamin/mineral supplements, and antacids were the most commonly taken medications. Antibiotics were the most commonly prescribed medication. Use of class A medications increased during pregnancy while use of non-class A medications decreased. Peri-conceptional folate supplementation was 31%. Alcohol consumption and cigarette smoking decreased after diagnosis of pregnancy. Both prescribed and non-prescribed medication use is common during all trimesters of pregnancy. However, overall use changes little compared with pre-pregnancy values. Rates of peri-conceptional folate supplementation are low.

Adolescent↗
PubMed2000

The impact of nausea and vomiting on women: a burden of early pregnancy.

Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF-36). Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF-36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.

Activities of Daily Living↗
PubMed2000

Universal antenatal group B streptococcus screening? The opinions of obstetricians and neonatologists within Australia.

Group B streptococcus (GBS) is the leading infectious cause of morbidity and mortality in Australian newborns. Although intrapartum chemoprophylaxis is recommended to reduce the risk of neonatal GBS transmission and disease, controversy exists as to the best method to select women 'at risk' for this treatment. Our study aimed to survey the opinions of obstetricians and neonatologists currently in practice in Australia on GBS screening and treatment. Of the 488 obstetricians and 68 neonatologists currently in practice who responded to the survey, 271 obstetricians (56%) and 40 neonatologists (61%) supported universal antenatal screening. Of those respondents who did not support a universal antenatal screening policy, 196 (93%) and 24 (92%) of the obstetricians and neonatologists respectively, supported antenatal screening based on risk factors. This diversity in practitioner opinion highlights the lack of certainty in the literature as to the best management strategy to prevent neonatal GBS sepsis.

Anti-Bacterial Agents↗
PubMed1999

Knee-chest postural management for breech at term: a randomized controlled trial.

BACKGROUND: In 3 to 4 percent of all term births, the fetus presents as a breech. The objectives of this trial were to assess if assuming the knee-chest position reduced the frequency of breech presentation at delivery, increased the success of the subsequent external cephalic version, or both, and to determine if this management plan reduced the need for cesarean delivery. METHODS: A randomized clinical trial recruited 100 women from two hospitals in Adelaide, South Australia, with a singleton breech presentation and a gestational age equal to or more than 36 weeks. Women in the treatment group were advised to assume the knee-chest position for 15 minutes three times a day for one week. Women in the control group did not perform postural management. All participants were reviewed one week later, and women whose baby remained as a breech presentation were offered an external cephalic version. RESULTS: Postural management did not increase the success of the external cephalic version, reduce the frequency of breech presentation at delivery, or reduce the need for cesarean delivery in women with a breech presentation at term. CONCLUSIONS: Findings from this trial included in a meta-analysis of postural management for breech presentation at term suggested that this is not an effective form of care to be offered routinely to women with a breech presentation at term.

Adult↗
PubMed1998

A dark talent: silence in analysis.

This paper is presented jointly by two analysts who have worked with patients whose silence stretched over years. They taxed our professional selves and our therapeutic repertoire of responses and techniques to the limit. Partly in response to these experiences, each analyst found herself needing to talk with another who could verify disturbing countertransference reactions from the standpoint of similar experience. The patients' (largely silent) attacks on analysis and their inability to use it conventionally constellated the need in us to talk, in an effort to relieve projected anxiety. Our conversations provided some containment of the destructive fantasies which we found developing in response to lack of verbal interaction with our patients. Unlike patients who project into an analyst in the unconscious hope of finding containment, silent patients project the need for containment, which they then disavow, leaving the analyst carrying the need, and feeling helpless, baffled and undermined in their therapeutic identity (Colman, private communication). In keeping with the theme of this conference, we found that our collaboration about what chronic analytic silence may mean helped to counteract its destructive effect on the analyst-patient relationship.

Humans↗
PubMed1995

Thyrotropin-releasing hormone: does two hundred micrograms provide effective stimulation to the preterm fetal pituitary gland compared with four hundred micrograms?

OBJECTIVE: Our purpose was to compare the response of the fetal pituitary-thyroid axis to 200 and 400 micrograms of thyrotropin-releasing hormone administered to the mother immediately before delivery with a control group. STUDY DESIGN: A randomized controlled trial was conducted of 26 women at gestational ages between 24 weeks and 33 weeks 6 days who had received one or more doses of betamethasone who were expected to be delivered within 1 to 4 hours. Women received either 200 or 400 micrograms of thyrotropin-releasing hormone or were in the control group. RESULTS: Thyroid-stimulating hormone determinations on cord blood had a higher mean level in both treatment groups compared with the control group. No differences were seen in cord blood results between the two treatment groups for thyroid-stimulating hormone, thyroxine, triiodothyronine, free thyroxine, free triiodothyronine, and prolactin levels. The only other differences found were in a higher level in total thyroxine and a lower level of free thyroxine in the 400 micrograms thyrotropin-releasing hormone group compared with the 200 micrograms group in the 48-hour blood determinations. CONCLUSION: Both 200 and 400 micrograms of thyrotropin-releasing hormone provided fetal pituitary stimulation, as reflected in fetal thyroid-stimulating hormone levels in cord blood, and both gave significantly higher levels compared with a control group.

Adult↗