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Biomedical subjects

F J Stanley

Publications and source records attributed to F J Stanley.

At least 73 records · Page 4Linked to original sources
PubMed1992

Trends in perinatal mortality and cerebral palsy in Western Australia, 1967 to 1985.

OBJECTIVE: To analyse the trends in stillbirths, neonatal deaths, and cerebral palsy in all infants born in Western Australia from 1967 to 1985. To relate these trends to changes in perinatal care, particularly in relation to avoidance of intrapartum asphyxia in term infants and the increased survival of low birthweight infants. DESIGN: Descriptive epidemiological study calculating population rates for perinatal deaths and cerebral palsy according to year of birth and birth weight. SETTING: Western Australia. SUBJECTS: All infants born after 20 weeks' gestation or weighing at least 400 g (live and stillborn). MAIN OUTCOME MEASURES: Stillbirths, neonatal deaths (from perinatal death certificates), and cerebral palsy (from a population based register). RESULTS: Overall stillbirth rates fell from 12.1/1000 total births in 1967-70 to 8.1 in 1983-5. Early neonatal mortality fell from 13.0/1000 live births to 4.4 over the same period whereas total cerebral palsy rates remained at around 2-2.5/1000 live births. Death rates fell in all birth weight categories, particularly in low birthweight infants between 1975 and 1985, the period when birthweight data were available. In contrast, cerebral palsy rates in infants under 1500 g rose significantly over this period (from 12.1 in 1968 to 64.9 in 1985). The rise was seen in all spastic categories, including severely and multiply handicapped children. CONCLUSIONS: Large increases in the use of interventions aimed at reducing birth asphyxia and handicaps had not (by 1985) resulted in lower rates of cerebral palsy. This suggests that birth asphyxia is not a major cause. The increased survival of low birthweight infants has resulted in more cerebral palsy in this group, due either to postnatal complications of immaturity or prenatal damage to the fetal brain. These findings have implications for planning perinatal care and for litigation for putative obstetric malpractice in cerebral palsy cases.

Asphyxia Neonatorum↗
PubMed1992

Prevalence of intellectual handicap in Western Australia: a community study.

OBJECTIVE: To produce comprehensive community based data on individuals with intellectual handicap, the level of retardation, associated handicaps and demographic data. DESIGN: Multiple sources of ascertainment were used to identify all children in birth cohorts, 1967-1976 inclusive, who had an IQ less than 70. SETTING: The majority of cases were ascertained through Western Australian government agencies that provide services for the intellectually handicapped. Other sources included the support branch of the education department, private schools and the children's hospital. PATIENTS: In all, 1602 children, aged between 6 and 16 years, fitted the study criteria. RESULTS: The prevalence of intellectual handicap was found to be 8.9 per 1000 live male births and 6.3 per 1000 live female births with an overall rate of 7.6. The figures for mild, moderate, severe and profound retardation were 3.0, 2.4, 1.0 and 0.6 per 1000, respectively, with 0.8 per 1000 with an unknown IQ. Cerebral palsy occurred in 20% and epilepsy in 13% in addition to intellectual handicap. There was a significantly higher rate among those from rural compared with urban areas: 9.9 v. 6.5 per 1000 live births, respectively. CONCLUSIONS: This comprehensive epidemiological data on intellectual handicap in Western Australia will be of value in the planning of services, including screening and genetic counselling, and for the evaluation of care. The rural preponderance, in particular, is worthy of further evaluation.

Adolescent↗
PubMed1992

The epidemiological characteristics of unexplained antepartum stillbirths.

All antepartum stillbirths weighing 1000 g or more born in Western Australia from 1980 to 1983 were categorised as 'unexplained' or 'explained' based on information from Perinatal Death Certificates. Using data from hospital and doctors' antenatal records a number of variables in each stillbirth category were compared by unconditional logistic regression. Significant differences were observed between the two groups in medical disorders and abnormalities of pregnancy, thus confirming our classification system. Compared with mothers of 'explained' antepartum stillbirths, mothers of unexplained antepartum stillbirths tended to have younger ages at delivery and had associated lower parity, more antenatal visits to the medical practitioner, fewer hospital admissions, a greater chance of having received care by a general practitioner than by a specialist obstetrician and were of more advanced gestation at the time of diagnosis. The results of this study indicate that the epidemiological characteristics of pregnancies resulting in unexplained antepartum stillbirths differ from those resulting in explained antepartum stillbirths. This suggests that unexplained antepartum stillbirths are not merely the result of inadequate obstetrical management but consist of a series of fetal disease states which are not currently amenable to detection.

Case-Control Studies↗
PubMed1992

Survival and cerebral palsy in low birthweight infants: implications for perinatal care.

Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight, recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them. This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths, neonatal deaths and survivors to address the issues of increased survival, cerebral palsy and timing of brain damage. The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants. The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care. The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote. Further studies of low birthweight infants with cerebral palsy are urgently required. They should include antenatal factors, investigating the various aetiological pathways to preterm birth, randomised controlled trials of neonatal interventions and searching for better neonatal predictors of brain damage.

Birth Weight↗
PubMed1992

A case-control study of unexplained antepartum stillbirths.

OBJECTIVE: To ascertain factors that will identify women who are at increased risk of unexplained antepartum stillbirth. DESIGN: Matched case-control study. The cases and controls were initially analysed as a whole group and again after dichotomizing into those of low birthweight (< 2500 g) and those of normal birthweight (> or = 2500 g). SETTING: Western Australia 1980-1983. SUBJECTS: Unexplained antepartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants individually matched for year of birth, plurality, sex and birthweight of infant and race of mother (controls). RESULTS: The case pregnancies had more polyhydramnios (OR 10.83, 95% CI 2.41-48.69) and cord problems (OR 6.57 95% CI 1.36-31.75) than the controls but, paradoxically, other obstetric and medical complications were less common in the cases. The association with polyhydramnios persisted when the analysis was confined to those with low birthweight. With normal birthweight fetal distress was more frequent in the cases (OR 3.65 95% CI 1.36-9.80) but there were few other differences. CONCLUSIONS: The clinical and diagnostic systems currently in use are unable to identify many fetuses at risk of death. Decreases in the rate of unexplained antepartum stillbirths await the discovery of new preventable causes, or of innovations in clinical or laboratory aspects of obstetric care.

Birth Weight↗
PubMed1992

A case-control study of intrapartum stillbirths.

OBJECTIVE: To determine antenatal and intrapartum risk factors for intrapartum stillbirths in a total population. DESIGN: Matched case-control study. SETTING: Western Australia 1980-1983. SUBJECTS: Intrapartum stillbirths of > or = 1000 g birthweight (cases) and liveborn infants (controls) individually matched for year of birth, plurality, sex and birthweight of infant and race of mother. RESULTS: Intrapartum stillbirths were more likely than controls to have had placental abruption (OR = 9.55, CI = 2.09-43.69), fetal distress (OR = 4.64, CI = 1.92-11.19), cord prolapse (OR = 10.00, CI = 1.17-85.60) and unhealthy placentas (OR = 2.26, CI = 1.13-4.52), and more likely to have been born by vaginal breech manoeuvre (OR = 3.51, CI = 1.40-8.80) and emergency caesarean section (OR = 2.15, CI = 1.13-4.10); mothers of intrapartum stillbirths were less likely to have had no labour (OR = 0.14, CI = 0.04-0.55) and to have been delivered normally (OR = 0.20, CI = 0.10-0.40). Mothers of cases born by emergency caesarean section had longer labours than mothers of controls born by this method. All intrapartum stillbirths with breech presentation were born by vaginal breech manoeuvre compared with only 53% of the controls; the remainder of the controls were born by caesarean section. CONCLUSIONS: Results indicate that little could have been done early in pregnancy to prevent the intrapartum stillbirths as no antenatal risk factors predicted these deaths. Most of the risk factors identified related to labour and delivery problems. Considering cases born by emergency caesarean section, delivery of the mother earlier in labour may have prevented some of the deaths.

Case-Control Studies↗
PubMed1992

Periconceptional vitamin supplementation and neural tube defects; evidence from a case-control study in Western Australia and a review of recent publications.

STUDY OBJECTIVE: The aim was to assess the association of neural tube defects with periconceptional vitamin supplementation. DESIGN: This was a matched, population based case-control study. SETTING: Western Australia, 1982-1984. PARTICIPANTS: Mothers of 77 cases (93% of those eligible) with isolated neural tube defects, mothers of 77 matched control infants with defects other than neural tube defects (control group I), and mothers of 154 liveborn, matched, control infants with no birth defects (control group II) participated in the study. MEASUREMENTS AND MAIN RESULTS: Information was collected by interview and self administered questionnaire. Crude and adjusted odds ratios (and their 95% confidence intervals) showed a small but non-significant protective effect of folate supplementation in comparisons with both control groups. The adjusted ratios for the three months before pregnancy were 0.69 (0.06, 8.53) with control group I, and 0.11 (0.01, 1.33) with control group II. In the first six weeks of pregnancy, the adjusted odds ratios were 0.70 (0.32, 1.52) with control group I and 0.74 (0.29, 1.88) with control group II. The odds ratios for vitamin supplementation of any kind were all very close to or greater than one, and all confidence intervals embraced unity. CONCLUSIONS: These data do not provide evidence of an association between periconceptional vitamin supplementation and neural tube defects, although a protective effect of folate supplementation cannot be excluded with confidence, due to the low power of the study. Of three other observational studies of vitamins and neural tube defects, two have shown an association. While further studies of this kind may be of value, evidence must now be sought from randomised controlled trials.

Case-Control Studies↗
PubMed1991

Genitourinary tract infections in pregnancy and low birth weight: case-control study in Australian aboriginal women.

OBJECTIVE: To investigate the association between genital and urinary tract infections in pregnant Aboriginal women and low birth weight. DESIGN: Retrospective case-control study controlling for potential confounding variables. SETTING: Western Australia from 1985 to 1987. SUBJECTS: All Aboriginal women (n = 269) who had given birth to singleton infants weighing 2250 g or less (cases), and 269 randomly selected Aboriginal women who had given birth to singleton infants weighing 3000 g or more (controls). MAIN OUTCOME MEASURES: Proportions of women in case and control groups who had had genital and urinary tract infections; odds ratios for low birth weight when genitourinary tract infection was present; population attributable fraction of low birth weight to genitourinary tract infection. RESULTS: At the time of delivery 51% of women in the case group (109/215) had genitourinary tract infections compared with 13% of controls (35/266). After controlling for potential confounding variables the odds ratio for giving birth to infants weighing 2250 g or less when genitourinary tract infection was present was 4.0 (95% confidence interval 2.3 to 7.0). The proportion of infants with low birth weight attributable to genitourinary tract infection in the whole population of Aboriginal women was 32% (95% confidence interval 17% to 49%). CONCLUSIONS: There was a strong association between low birth weight and the presence of genitourinary tract infections in Aboriginal women both during pregnancy and at the time of delivery. A community intervention trial of screening and treatment of genitourinary infections in this population is recommended.

Case-Control Studies↗
PubMed1991

Why have we failed to reduce the frequency of cerebral palsy?

OBJECTIVE: To review the data on children with cerebral palsy in relation to quality of obstetric care. DATA SOURCES AND STUDY SELECTION: In our Institute, a regular Medline print-out, certain key journals and Current Contents are perused to create an updated computerised file of publications on the epidemiological, aetiological and other aspects of cerebral palsy. For this study we reviewed data from the Western Australian Cerebral Palsy Register, more than 150 publications from which studies were chosen for sound methodology in countries with modern obstetric practices, and recent population data on cerebral palsy. DATA EXTRACTION AND SYNTHESIS: Three major areas were studied to see: (i) if the prevalence of cerebral palsy has fallen with increasing use of obstetric and neonatal interventions aimed at reducing birth asphyxia; (ii) if there is any evidence that cerebral palsy is caused by birth asphyxia; and (iii) if there is any evidence that intrapartum fetal monitoring or caesarean section reduces the prevalence of cerebral palsy. CONCLUSIONS: We concluded that: cerebral palsy proportions are not falling in spite of significant increases in obstetric and neonatal interventions aimed at reducing asphyxia; cerebral palsy proportions in low birthweight infants are rising in most developed countries, coincident with increases in the neonatal survival of low birthweight babies; few cases of cerebral palsy seem to be caused by birth asphyxia and those that are may not have been preventable by obstetric care; and parents will continue to sue if obstetricians keep promising perfection from obstetric care in the face of 2.0-2.5 cases of cerebral palsy per 1000 children born.

Asphyxia Neonatorum↗
PubMed1991

A comparison of recurrent and isolated small-for-gestational-age term births.

In this study, based on total Western Australian singleton Caucasian births, women who had repeatedly given birth to small-for-gestational-age (SGA) term infants ('repeater' mothers) were compared with multiparous women who had had only one such infant ('non-repeater' mothers). Women with any preterm births were excluded. The study population comprised 678 repeater and 986 non-repeater mothers. Multiple logistic regression analysis indicated that weight loss or static weight in the third trimester of pregnancy, paternal smoking, low maternal birthweight, short maternal height and unknown family disease history were independent risk factors for repeater status compared with non-repeaters. The risk associated with paternal smoking was confined to mothers who were non-smokers themselves. There may have been a direct association between paternal smoking and recurrent fetal growth retardation or paternal smoking may have acted as a 'marker' for certain behavioural, environmental, social and economic factors which were not measured. Neonatal outcome was worse for the SGA infants of non-repeater mothers than for those of repeater mothers, although the latter were significantly more likely to weight less than 2500 grams.

Female↗
PubMed1991

Randomized controlled trial of antenatal social support to prevent preterm birth.

OBJECTIVE: To test the effect of a programme of additional antenatal social support on the occurrence of preterm birth (a birth from 20 to 36 weeks gestation) in women at risk of preterm birth. DESIGN: A prospective randomized controlled trial. The design was one of randomization before consent for a new treatment. SETTING: Three public hospital antenatal clinics in Perth and the offices of 87 obstetricians and general practitioners in Western Australia. SUBJECTS: 1970 pregnant women with poor obstetric histories entered the trial; 983 of these were randomly allocated to the programme group and 987 to the control group. INTERVENTIONS: Normal antenatal care was provided for both groups. In addition, members of the programme group were offered an intervention aimed at providing expressive (emotional) social support, consisting of antenatal home visits and telephone calls by midwives. Of the women allocated to the programme group, 24 refused consent and 69 were not traced before completion of their pregnancies, the remaining 890 women (90.5%) agreed to enter the programme, and each received at least one intervention. MAIN OUTCOME MEASURES: Gestational age at completion of the pregnancy. A pregnancy ending before 20 weeks was labelled a miscarriage. RESULTS: There were 126/981 (12.8%) preterm births in the programme group and 147/986 (14.9%) in the control group. The outcome data for two women in the programme group and one in the control group could not be found. The unadjusted odds ratio for preterm birth in the programme was 0.84 (95% CI 0.65-1.09). The observed relative reduction in preterm births associated with the programme was 13.8% (95% CI -8.2% to +31.5%) and the trial had a 60% power to exclude a true relative reduction of 25%. CONCLUSIONS: The results of this trial and those of other controlled clinical trials provide little evidence for the effectiveness of social support interventions in the prevention of preterm birth in women with poor obstetric histories.

Female↗
PubMed1990

Trends in caesarean section in Western Australia, 1980-1987.

During the 1980s the incidence of both emergency and elective caesarean section in Western Australia increased, accompanied by a decrease in that of all other delivery methods. The proportion of emergency caesarean sections increased from 5.9%. of all deliveries in 1980 to 8.2% in 1987 and that of elective sections from 5.3% to 8.7%. For each year studied less than 50% of primiparous women delivering singletons had a normal vaginal delivery. Emergency caesarean sections were more common in primiparas and at the teaching hospital and elective sections in multiparas and at the metropolitan private hospitals. The proportion of primiparas having either emergency or elective caesarean sections rose with maternal age, but for multiparas the proportion having elective sections rose, but there were few differences in emergency sections with increasing age. Repeat caesarean sections, which made up 28.8% of the total in 1987, have contributed increasingly to the rising proportion of caesarean section deliveries. Unless the number of emergency sections in primiparous women falls and the challenge of vaginal birth after caesarean section is met, it is likely that the caesarean section rate in Western Australia will continue to increase over the next decade.

Adult↗
PubMed1989

Aboriginal and white births in Western Australia, 1980-1986. Part I: Birthweight and gestational age.

This article describes the distributions of birthweight and gestational age of all singleton Aboriginal and white live-born infants in Western Australia for the period 1980-1986. At early gestational ages, the mean birthweight was greater for Aboriginal infants. However, after 34-weeks' gestation for male infants and 32-weeks' gestation for female infants, the pattern was reversed. More Aboriginal infants were of low birthweight--male Aboriginal infants, 9.8%; male white infants, 4.0%; female Aboriginal infants, 12.4%; and female white infants, 4.6%, this excess only occurred in term (37- to 41-weeks' gestation) and post-term (42- to 52-weeks' gestation) infants. The birthweight distributions for Aboriginal and white infants were similar in preterm infants, but at term and beyond Aboriginal infants tended to be lighter. Preterm (fewer than 37-weeks' gestation) births were more common among Aborigines (male Aboriginal infants, 16.0%; white male infants, 6.8%; female Aboriginal infants, 15.9%; and female white infants, 6.0%). Thus, it seems that the distributions of both birthweight and gestational age in Aboriginal infants are shifted downward compared with those for white infants. Aboriginal infants normally may be smaller and more likely to be born earlier than are white infants as well as having a definite shift towards pathological growth retardation at term and beyond.

Birth Weight↗
PubMed1989

Dietary folate as a risk factor for neural-tube defects: evidence from a case-control study in Western Australia.

A population-based case-control study was conducted to test the hypothesis that the risk of the occurrence of neural-tube defects in infants with no other birth defects (isolated neural-tube defects) is associated inversely with the maternal dietary intake of free and/or total folate in early pregnancy. Information was collected from the mothers of 77 case subjects with isolated neural-tube defects who were born in Western Australia from 1982 to 1984, from the mothers of 77 control subjects with birth defects other than neural-tube defects (control group 1) and from the mothers of 154 control subjects with no birth defects (control group 2). The case and control subjects were matched individually by the date of the mother's last menstrual period. Odds ratios were adjusted for a number of potentially-confounding variables, such as the country of birth of the parents, paternal social class, previous pregnancy outcome, interval between index and previous pregnancy and pregnancy order. Crude and adjusted odds ratios showed a protective effect of an increasing intake of free folate in the first six weeks of pregnancy. Adjusted odds ratios, with reference to the lowest quartile of intake, (and their 95% confidence intervals) were 0.72 (0.25-2.08), 0.37 (0.11-1.23) and 0.31 (0.10-0.97) for quartiles 2-4 when control group 1 was used, and 0.44 (0.17-1.13), 0.34 (0.13-0.90) and 0.16 (0.06-0.49) when control group 2 was used. Similar, but weaker, trends were seen when total folate intake was the exposure variable. These findings support the hypothesis that the dietary intake of folate in early pregnancy protects against the occurrence of isolated neural-tube defects in infants. Measures of postpartum dietary folate and of postpartum serum and red-cell folate levels showed no association with the occurrence of neural-tube defects in infants.

Diet↗
PubMed1989

Screening for congenital dislocation of the hip by child-health nurses in Western Australia.

The child-health nurse screening programme for the presence of congenital dislocation of the hip in Western Australia was evaluated by the use of data that were collected as a routine from the Congenital Malformations Registry, the records of child-health nurses and the Hospital Morbidity System. The programme performed well operationally, with a sensitivity of 68.5%, a specificity of 98.8%, and a positive predictive value of 15.1%. Of the children who were born in the study period (1981-1983), 450 children were diagnosed with congenital dislocation of the hip, and 46 (10.2%) of these children required 104 hospital admissions for the treatment of their dislocation. Of the children whose hips were found to be dislocated in screening (those who were screened as "true-positive" cases), 10.1% were hospitalized, whereas 16.1% of those children who were missed by screening (who screened as "false negative") required hospitalization (95% confidence interval [CI] for the difference in proportions, -7.8% to 19.9%). A comparison of the measures of hospitalization was made between the children who were found to be "true positive" on screening and the children whose dislocation was diagnosed in the hospitals of their birth--a group that generally is considered to show the best outcome. A somewhat-higher proportion of children who were screened as "true positive" required an open surgical procedure (5.0% of children compared with 2.8% of children; 95% CI for the difference, -2.1% to 6.5%). The differences in the other measures of hospitalization between the two groups were small.

Child↗