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Biomedical subjects

D V Fairweather

Publications and source records attributed to D V Fairweather.

At least 19 recordsLinked to original sources
PubMed1989

Chlamydia trachomatis infection in a gynaecology clinic population: identification of high-risk groups and the value of contact tracing.

Of 1267 women attending a gynaecology clinic, who were screened for the presence of Chlamydia trachomatis, 45 (3.6%) were found to be infected. Infection with C. trachomatis was more common in women who were less than or equal to 25 years of age, unmarried, nulliparous, requesting termination of pregnancy, using oral contraception as opposed to barrier methods, and who had cervical ectopy or cervicitis. Using contact tracing techniques 35% of male sexual partners of women who harboured C. trachomatis were also found to be infected. 86% of these men were symptomless. Asymptomatic chlamydial infection is common in men as well as women. Selective screening to identify women at risk of infection and the use of contact tracing to identify symptomless men with chlamydial infection are shown to be of value.

Adolescent↗
PubMed1988

Isolation of Chlamydia trachomatis from endometriums of women with and without symptoms.

Chlamydia trachomatis was isolated from the endometrial cavities of three out of 19 women with positive cervical cultures, who were all symptomless sexual contacts of men with non-gonococcal urethritis (NGU). C trachomatis was recovered from the endometrial cavities of four out of 14 women with pelvic inflammatory disease (PID), three of whom had positive cervical cultures. Although endometrial biopsy is probably not justifiable as a routine procedure, it may be a useful adjunct to endocervical investigations for managing women with PID.

Chlamydia trachomatis↗
PubMed1985

Diagnostic fetal blood sampling for the haemoglobinopathies--10-year experience.

The development of methods for fetal blood sampling in the second trimester of pregnancy offers the possibility of fetal diagnosis for couples at risk for having children with a haemoglobinopathy. We review the evolution of 10 years' experience of fetal blood sampling for 681 patients. The obstetric risk associated with the procedure has fallen from an initial 15% (in the first 87 pregnancies) to about 3%, in parallel with increased experience, improved ultrasound control, identification of the causes of complications and implementation of simple steps to avert them.

Diseases in Twins↗
PubMed1984

Effect of fetal diagnostic testing on birth-rate of thalassaemia major in Britain.

A programme of prospective heterozygote detection and counselling, fetal diagnostic testing, and abortion of fetuses affected by thalassaemia major introduced in Britain in 1977 has proved highly acceptable to at-risk couples of Cypriot and East African Asian origin, but less so to couples of Pakistani origin. However, many at-risk couples are still not detected prospectively, the proportion of thalassaemia-major births prevented was only 32% by the end of 1981, and there is little evidence of a further fall since then. The thalassaemia-major birth-rate had fallen by 60% in Cypriots and by 20% in East African Asians, but it had not fallen at all in Pakistanis. Improved approaches to fetal diagnosis of thalassaemia major are becoming available, so a concerted effort is needed to inform all the at-risk ethnic groups of the existence of the problem and the possibility of detection of affected fetuses.

Africa, Eastern↗
PubMed1984

Problems of health manpower development in obstetrics.

The responsibility of obstetricians in encouraging the best use of available resources--both people and material--is addressed, stressing the need to "articulate" all components of the health team to bring about better coverage in the field of community and family health, especially maternal and child health care. The particular problems of developed countries where consumer demands call for review of obstetric care provision and training programmes are also discussed.

Developing Countries↗
PubMed1984

The effect of amniocentesis and drainage of amniotic fluid on lung development in Macaca fascicularis.

Amniocentesis and withdrawal of amniotic fluid was performed on pregnant monkeys (Macaca fascicularis) at two stages in development, either between 47 and 64, or between 85 and 95 days gestation. After birth the lungs of each infant monkey were studied using precise morphometric techniques, and compared with those in a control group of animals. The lungs after amniocentesis had alveoli of normal maturity but reduced in number and increased in size, features which both reduce the relative area for gas exchange. There was also a reduction in the number of respiratory airways. These changes occurred regardless of the time of amniocentesis, the amount of fluid removed and even if the membranes were simply punctured with no fluid removal. There is some evidence to suggest that similar sublethal effects may be present in human infants after maternal amniocentesis.

Amniocentesis↗
PubMed1984

Morphometric studies on the structural development of the lung in Macaca fascicularis during fetal and postnatal life.

The structural development of the normal monkey lung (Macaca fascicularis) from 61 days of gestation to 14 days postnatal age has been described using quantitative morphometric techniques. The lung of the adult monkey has also been studied. The airway and arterial branching pattern has been traced using serial sections. The alveolar number and size have been estimated and the structure of the arteries after postmortem arterial injection has been assessed. Comparison of lung morphology in monkey and man shows that there are similarities in segmental arrangement, structure and branching pattern of airways, in arterial structure and in changes in the arteries after birth. Although there are differences in the number of lobes, the number of generations of different types of airways and the number and size of alveoli, the overall structure in the monkey is more similar to that in man than is the structure of the lung in species such as sheep, pig or rat. During fetal life the monkey lung passes through the same stages of development as the human fetus but at birth the monkey has a full complement of airways and mature alveoli. Postnatal growth of airways and alveoli is due to increase in size rather than to multiplication. In man there is an increase in the number of alveoli and alveolar ducts after birth as well as an increase in size. Despite the differences between the species it seems appropriate to use the monkey in experimental studies on the lung.

Animals↗
PubMed1983

A randomized double-blind controlled trial of the value of stilboestrol therapy in pregnancy: long-term follow-up of mothers and their offspring.

In the early 1950s, a randomized, double-blind, controlled trial of the value of prophylactic stilboestrol therapy given antenatally to reduce the incidence of late pregnancy toxaemia and to improve perinatal mortality was conducted at University College Hospital, London. Women expecting their first baby were allocated to one or other of two groups. Those in the stilboestrol group started treatment at the 12th week of pregnancy on average and received a mean dose of about 11.5 g of the drug while those in the control group received placebo tablets. In spite of the fact that the original trial documentation was lost, it was possible to be fairly certain which was the treated group and follow-up data from 650 mothers and 660 offspring were obtained from death certificates, cancer registrations and questionnaires sent to general practitioners. We found no indication of any harmful long-term effect of stilboestrol exposure during pregnancy on the mothers--in particular 10 out of 331 women in the untreated group and 9 out of 319 women in the treated group were found to have developed breast cancer. Amongst the daughters, those in the treated group suffered an excess of minor benign lesions of the cervix uteri and an excess (not statistically significant) of unfavourable pregnancy outcomes. None of the daughters had developed clear cell adenocarcinoma of the vagina or cervix uteri. Amongst the sons, we discovered no evidence of any significant excess of genital tract disorders or of impaired reproductive performance in the treated group but one son developed a (fatal) teratoma of the testis. Unexpectedly, psychiatric disease (especially depression and anxiety) was reported by general practitioners about twice as often in the treated group offspring (sons and daughters) as in the untreated group. This result cannot be due to bias, and is unlikely to be due to confounding or chance, and may thus represent an adverse effect of exposure to stilboestrol in utero.

Breast Diseases↗
PubMed1982

Screening in pregnancy for congenital abnormality.

Screening programmes and techniques for antenatal diagnosis of a large number of congenital malformations and genetic disorders are now available. Most techniques requiring samples of fetal material for analysis carry some degree of risk to the pregnancy. These risks must be weighed against the degree of risk that a particular couple may have of producing a fetus suffering from any given congenital disorder before antenatal diagnosis is offered or undertaken. Careful and considerate counselling of the couple is an essential part of any screening programme.

Chromosome Aberrations↗
PubMed1981

Four years' experience of maternal alpha-fetoprotein screening and its effect on the pattern of antenatal care.

Estimation of alpha-fetoprotein (A.F.P.) in maternal serum was used as a screening method for the detection of fetal neural tube defect (N.T.D.) in 7315 women over a four year period. Of these, 5668 pregnancies were tested between 15 and 21 weeks. Action was advised in 129 patients (2.3 per cent). In 74 patients, the only action required was reviewing the notes, including the report of any ultrasound examination, and repeating the blood A.F.P. Detailed ultrasound including scanning the fetal spine was requested in 47 patients and amniocentesis was advised in 19 of these (0.33 per cent). In practice the incidence of amniocentesis was 0.28 per cent as three patients declined our advise. The programme gave detection rates between 15 and 21 weeks of 100 per cent and 75 per cent respectively for anencephaly and open spina bifida. A high fetal mortality was associated with persistently elevated blood A.F.P. levels whether amniocentesis was performed or not.

Amniocentesis↗
PubMed1981

Obstetric outcome and problems of mid-trimester fetal blood sampling for antenatal diagnosis.

Detailed follow-up is presented of 335 pregnancies in which mid-trimester fetal blood sampling was performed for the diagnosis of a haemoglobinopathy, mostly beta-thalassemia. There were three twin pregnancies. Thirty-eight fetuses were lost including four in whom a diagnosis of thalassemia major was made. Placentacentesis was particularly associated with fetal vessel trauma, exsanguination and early intrauterine fetal death, while late complications associated with fetoscopy or failed fetoscopy necessitating subsequent placentacentesis included spontaneous abortion, leakage of amniotic fluid and premature onset of labour.

Abortion, Spontaneous↗
PubMed1980

Effect of introducing antenatal diagnosis on reproductive behaviour of families at risk for thalassaemia major.

Families who were at risk of producing a child with thalassaemia major were studied to determine the sequential effects on their reproductive behaviour of knowing the risk and, subsequently, of knowing that antenatal diagnosis was available. Knowing the risk caused them virtually to stop reproduction and to seek termination of 70% of pregnancies, most of which were accidental. The introduction of antenatal diagnosis in 1975 permitted the resumption of nearly normal reproduction by at-risk families, with fewer than 30% of pregnancies being terminated for thalassaemia major. All couples at risk for thalassaemia major should be detected and counselled before they produce an affected child; responsibility for either choosing or refusing antenatal diagnosis should be theirs alone.

Abortion, Induced↗