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Biomedical subjects

I D Nuttall

Publications and source records attributed to I D Nuttall.

10 recordsLinked to original sources
PubMed2001

Audit on the use of thromboprophylaxis during caesarean section.

Thromboembolic disease is still a main cause of maternal morbidity and mortality. In 1995 the RCOG working party on prophylaxis against thromboembolism has suggested that patients undergoing caesarean section should have a risk assessment and be given heparin prophylaxis if deemed to be high risk. In Stepping Hill Hospital this was audited. The outcome was that 0% of emergency caesarean sections, and only 25% of elective caesarean sections who were considered to be high risk had heparin prophylaxis. A structured risk assessment form was introduced for every patient undergoing caesarean section and the outcome was re-audited; 72.7% and 85.7% of emergency and elective caesarean sections, respectively,that were deemed high risk had adequate heparin thromboembolic prophylaxis. Filling in a risk assessment form before performing a caesarean section reminds and reinforces the need to consider thromboprophylaxis. A risk assessment form has been formally incorporated into all the maternity case records.

Journal Article↗
PubMed1991

The efficacy and acceptability of a low-dose levonorgestrel intravaginal ring for contraception in a UK cohort.

The efficacy and acceptability of a levonorgestrel-releasing intravaginal ring (IVR) for contraception was assessed in a British cohort studied as part of a multicentre, multinational clinical trial performed under the auspices of the World Health Organisation. One-hundred-and-fifty women took part in the study in two UK centres and completed 1417.5 months of method use. Fifty-nine women discontinued use of the IVR before the end of one year giving an overall discontinuation rate of 39.9 per 100 woman-years. The discontinuation for pregnancy with the ring in situ, was 3.0 per 100 woman-years (life table analysis). Menstrual disturbance, vaginal problems and involuntary expulsion resulted in discontinuation rates of 8.9, 8.4 and 1.6 per 100 woman-years, respectively. This method is an acceptable and effective method of contraception for women.

Adolescent↗
PubMed1985

The progestagen releasing vaginal ring.

The results of the Manchester study and its reinforcement from data from the multicenter study indicate that the ring is a well-tolerated delivery system for low-dose progestagens. The expulsion rate is low and vaginal tolerance satisfactory. The pregnancy rate and bleeding pattern is of the same order as oral low-dose progestagens. Indeed, there is an indication that the pregnancy rate and abnormal bleeding rate may be even lower. Data from other more extensive phase 3 studies will be required to confirm this impression. The subjective assessment is that the majority of patients are enthusiastic about this method of contraception, bearing in mind that many of them had become disenchanted with existing marketed contraceptive methods. Because of its high level of acceptability, the gap between theoretical and use-effectiveness in narrowed and once inserted, a high degree of motivation is not required since the existing ring only needs to be reinserted after 90 days of use. The acceptability of vaginal methods of contraception as evidenced by the rapid uptake of the vaginal sponge suggests that there is considerable potential for increased use of vaginal methods. In the present state of knowledge, it would appear that the woman for whom the progestagen only conception is particularly appropriate is the one who is lactating or for the older woman whose fertility is on the wane. For the woman who wishes to space her family, the progestagen only contraceptive is also appropriate. With increased refinements and experience of this method, there is a likelihood that the ring may extend the use and application of progestagen only contraception to a wider range of potential patients.

Biology↗
PubMed1982

The effect of ethinyl estradiol 20 mcg and levonorgestrel 250 mcg on the pituitary-ovarian function during normal tablet-taking and when tablets are missed.

A new combined pill containing 20 micrograms of ethinyl estradiol and 250 micrograms of levonorgestrel has been developed. The safety margin of this type of low-dose preparation needed to be assessed and this was done by evaluating daily levels of LH, FSH, estradiol, progesterone, 1-NG and EE2 as well as cervical mucus characteristics in six patients when one and then two consecutive pills were deliberately omitted mid-way through the cycle. Results demonstrated that there was no evidence of breakthrough ovulation, although there was some continued ovarian steroidogenesis, a feature consistent with previous studies using combined preparations. Existing instructions to patients regarding missed pills should continue in order to ensure maximal contraceptive safety.

Adolescent↗
PubMed1980

A suppurative ovarian cyst in pregnancy due to Salmonella typhi.

A 23-year-old primigravida with suppurative ovarian dermoid cyst due to Salmonella typhi is presented. The organism could not be isolated from the blood, faeces or urine and it was felt that the patient was an example of non-excretory carrier in whom S. typhi was lying dormant in the ovarian tissue for a long time.

Adult↗