Search PubMed⌕ Search

Biomedical subjects

J L Onwude

Publications and source records attributed to J L Onwude.

At least 19 recordsLinked to original sources
PubMed2006

Recurrent stillbirths: a matched case-control study of unexplained stillbirths at term.

The aim of this study was to assess the recurrent risk of an unexplained stillbirth at term. A total of 75 women who delivered stillbirths were matched for maternal age and parity with 75 controls. After excluding explained stillbirths, matched cases and controls were compared for maternal age, length of gestation, birth weight and 'interval to next birth'. The main outcome measure was the frequency of recurrence of a stillbirth. Both groups were similar for maternal age and length of gestation. Birth weight was marginally different (odds ratio (OR) = 0.997, 95% confidence interval (CI) 0.996, 0.999) and 'interval to next birth' was longer (OR = 1.08, 95% CI 1.00, 1.17). There were no stillbirths in cases and controls at follow-up. We conclude that a woman who has had an unexplained stillbirth at term has no greater risk of recurrence than a matched control. However, the 'interval to next birth' was significantly longer.

Adult↗
PubMed2005

Large babies and unplanned Caesarean delivery.

OBJECTIVE: The relationship between birth weight > or =4000 g and unplanned Caesarean delivery was examined. DESIGN: A retrospective cohort study. SETTING: A district general hospital. POPULATION: Two thousand three hundred and ninety-three women who delivered babies weighing > or =2500 g. METHODS: The mode of delivery of babies who weighed > or =4000 g was compared with those who weighed between 2500 and 4000 g. Comparative analysis of data was followed by regression analysis of explanatory variables. The effect of increasing birth weight on unplanned Caesarean delivery was determined. RESULTS: Women who had an unplanned Caesarean were delivered at an earlier gestation (OR = 0.89, 95% CI 0.81-0.97; P = 0.007), and were more likely to be primiparous (OR 5.4, 95% CI 4.1-7.1; P = 0.0001). Further, women who had an unplanned Caesarean were more likely to have babies weighing > or =4000 g (OR = 2.24, 95% CI 1.61-3.12; P = 0.003). The odds of having an unplanned Caesarean were increased 16.9-fold with a previous Caesarean (95% CI 9.24-30.8; P = 0.001). When a previous Caesarean was combined with a baby weighing > or =4000 g, the odds of having an unplanned Caesarean increased 37.8 times (95% CI 18.8-75.8), compared to a woman who previously had a normal vaginal birth and a baby weighing between 2500 and 4000 g. CONCLUSION: Birth weight > or =4000 g is associated with more than a two-fold increased risk of an unplanned Caesarean delivery. The risk increased further (37.8 x) when a previous Caesarean delivery was combined with a birth weight > or =4000 g.

Adult↗
PubMed2004

Interstitial cystitis.

Interstitial cystitis (IC) is a debilitating chronic inflammatory disorder of the bladder. It affects predominantly middle-aged Caucasian women. The diagnosis, made from the combination of symptoms, cystoscopic findings and bladder biopsies, is often delayed in the gynaecology setting because of a low index of suspicion. The pathophysiology is incompletely understood, although mast cell activation, altered bladder epithelial permeability and sensory afferent nerve up-regulation are thought to play key roles. Recent theories include the role of an antiproliferative factor. A wide assortment of therapies is available and many more are under trial. Until the causes and pathogenesis of IC are unraveled, mainstream medical treatment will remain palliative and cystectomy with urinary diversion, the only potential cure. In addition to our long experience on managing this disorder, we present a comprehensive review of the current thoughts on the aetiology and management of IC.

Cystitis, Interstitial↗
PubMed2003

Autotransfusion for ruptured ectopic pregnancy.

OBJECTIVES: Clinical outcomes following the exclusive use of autotransfusion in the management of ruptured ectopic pregnancy are reviewed. METHODS: A MEDLINE search (1966-2002) for relevant articles documenting the exclusive use of autotransfusion, and data collection and analysis was made. RESULTS: There were 21 studies, 16 from developing and five from developed countries, involving 632 cases of ruptured ectopic pregnancies. Hypovolemic shock with significant hemoperitoneum (>500 ml) was the most common complication. The procedure was performed completely manually in developing countries and with the help of a device in developed countries. The mean volume of autotransfused blood was over 1000 ml, with mean hemoglobin levels ranging from 6 to 12.5 g/dl. Mean posttransfusion hemoglobin levels were higher than pretransfusion levels. There was one death, thought to be due to pulmonary embolism, and nine major and minor complications. CONCLUSIONS: Autotransfusion is useful in the management of ruptured ectopic pregnancy.

Blood Transfusion, Autologous↗
PubMed2002

Interstitial cystitis coexisting with vulvar vestibulitis in a 4-year-old girl.

Interstitial cystitis (IC) is a disorder that is difficult to diagnose and is thought to be uncommon in children. We report the first case of IC coexisting with vulvar vestibulitis in a 4-year-old girl. She presented with urinary symptoms and pelvic and vulvar pain. Cystoscopic and histological investigation confirmed interstitial cystitis and vulvar vestibulitis. Gynecologists are often called upon to deal with symptoms referable to the genital tract. It is important to always include interstitial cystitis in the differential diagnosis of urinary symptoms associated with pelvic pain.

Analgesics, Non-Narcotic↗
PubMed1997

The relationship between laparoscopic disease, pelvic pain and infertility; an unbiased assessment.

OBJECTIVES: To measure the relationship between laparoscopically detected pelvic pathology and pelvic pain or infertility. METHODS: Women undergoing diagnostic laparoscopy either for the investigation of pelvic pain, for sterilisation or for the investigation of infertility were studied. The indication for surgery was recorded before laparoscopy. At operation a series of 35-mm slide photographs were taken of the pelvis and later scored by two independent assessors without knowledge of the indication for surgery. RESULTS: Satisfactory photographs were obtained in 298 women. Minimal endometriosis was not associated with pain (adjusted OR 1.3; 0.5-2.8), although moderate disease was non-significantly so (2.5; 0.4-7.1). Severe disease was significantly more common and never occurred in patients being sterilised (P = 0.02). The odds of pain were not increased in the presence of dilated veins > 9 mm diameter (OR 1.1; 0.4-3.2) or adhesions (OR 0.6; 0.2-4.7). The odds of infertility were non-significantly increased in the presence of minimal and moderate endometriosis (OR 2.0; 0.8-5.3, and OR 4.2; 0.6-25 respectively) and again significantly more common in the presence of advanced disease (P = 0.002). The odds of infertility tended to be lower in the presence of severely dilated veins (OR 0.2; 0.032-1.2). There was no clear effect of adhesions (OR 0.9; 0.1-5.9). CONCLUSIONS: The long established associations between severe endometriosis and pelvic pain, and between endometriosis in general and infertility are confirmed. However there is little or no association between minimal endometriosis, pelvic adhesions or dilated pelvic veins and pain. Previously reported associations may have been an artefact of the surgeon's knowledge of the indication for operation when assessing the pelvis.

Endometriosis↗
PubMed1996

A comparative study of the cosmetic appeal of abdominal incisions used for hysterectomy.

OBJECTIVE: To assess the cosmetic appeal of abdominal incisions used for hysterectomy. DESIGN: A comparative study. SETTING: St James's University Hospital, Leeds. PARTICIPANTS: One hundred women, including 50 consecutive women attending a gynaecology clinic for the first time and 50 hospital staff. RESULTS: Sixty-eight percent of women preferred a Pfannenstiel incision as the incision of first choice, while 31% chose the laparoscopic assisted vaginal hysterectomy incisions (LAVH). When women who had undergone previous abdominal surgery were compared with women with no previous surgery, there was a significant difference in their choice (80% Pfannenstiel, 18% LAVH compared with 54% Pfannenstiel, 45% LAVH). CONCLUSIONS: In gynaecological surgery there is already a cosmetically-favoured incision. One cannot assume that if a gynaecologist uses a minimally invasive surgical technique at hysterectomy that this will be cosmetically acceptable to the woman. Gynaecologists should not use cosmetic appeal in counselling women for LAVH and should concentrate on the other proven benefits of minimally invasive surgery.

Abdominal Muscles↗
PubMed1995

A randomised double blind placebo controlled trial of fish oil in high risk pregnancy.

OBJECTIVE: To determine whether n-3 fatty acid (EPA/DCHA) prophylaxis is beneficial in high risk pregnancies. DESIGN: A randomised, double blind, placebo controlled trial. SETTING: Antenatal clinic of St James's University Hospital, Leeds. SUBJECTS: Two hundred and thirty-three pregnant women at high risk of developing proteinuric or nonproteinuric pregnancy induced hypertension or asymmetrical intrauterine growth retardation. INTERVENTION: Active treatment was 2.7 g of MaxEpa daily (1.62 g of eicosapentaenoic acid and 1.08 g of docosahexaenoic acid). Placebo were matching air-filled capsules. MAIN OUTCOME MEASURES: Occurrence of proteinuric, nonproteinuric pregnancy induced hypertension or birthweight < 3rd centile. RESULTS: There was no difference in an intention to treat analysis between the placebo and active treatment groups for occurrence of proteinuric pregnancy induced hypertension (relative risk (RR) = 0.88; 95% CI 0.47-1.66), nonproteinuric pregnancy induced hypertension (RR = 0.89; 95% CI 0.48-1.64), birthweight < 3rd centile (RR = 0.89; 95% CI 0.48-1.64), or the duration of pregnancy (difference of mean durations = 0.1 days; 95% CI -4.8 to 4.9 days). Analyses stratified by use of tobacco, and analyses excluding known major protocol violators gave essentially identical results. CONCLUSION: There is no evidence from this study for any useful effect of fish oil supplementation for women at high risk of adverse outcomes from a pregnancy, but a small protective effect remains a possibility.

Adult↗
PubMed1994

Pain after laparoscopy: an observational study and a randomized trial of local anesthetic.

Our objective was to determine if local anesthesia reduces pain after a laparoscopy. Eighty women were assigned randomly 10 ml of 0.5% bupivacaine or 0.9% saline flushed over the peritoneal folds and into the abdominal wall after laparoscopy under general anesthesia. Pain scores from the deep abdomen, skin, shoulder, and back were collected 30 min, 2 h, 4 h, and the day following laparoscopy. Pain scores also were correlated with patients' height, weight, operative findings, surgical technique and procedure, and volume of gas insufflated into the abdomen. Bupivacaine has a small effect on abdominal and skin pain 2 h after surgery (p = 0.01) but has no effect on shoulder or back discomfort. Women who have been sterilized, have not had previous abdominal surgery, or have evidence of old pelvic inflammation report more postoperative backache and deep abdominal pain but no greater skin or shoulder discomfort. Weight, height, whether the abdominal wall was picked up, and the volume of gas used to insufflate the abdomen are independent of all postoperative pain scores. Local anaesthetic instilled down the laparoscopy trocar reduces skin discomfort 2 h after surgery, but this beneficial effect is small compared with other factors influencing pain after laparoscopy.

Anesthesia, General↗
PubMed1992

Convulsions in pregnancy in related gorillas.

Two related gorillas, the second the granddaughter of the first, had pregnancies complicated by convulsions and edema. They may have suffered from eclampsia, indicating that this is not an exclusively human disease and that in gorillas, as in humans, there is a familial factor.

Animals↗
PubMed1990

Prognosis of ovarian cancer.

Fifty-three patients were treated in the gynaecological unit of the Mater Hospital for ovarian cancer between 1980-86. The demographic features of the patients reviewed were similar to those of the Southern Tumour Registry (1981-85), and in the absence of a national tumour registry are presumed to be representative of the country as a whole. Data from the STR indicates that the annual incidence of ovarian cancer is 20/100,000; extrapolating from these figures to the national would suggest that approximately 280 women develop ovarian cancer each year. The majority of Mater patients (72%) had either stage I or stage II ovarian cancer which is at variance with other studies and may reflect an under-staging at initial laparotomy. Their survival rates were better than those of the STR, probably because they had presented earlier and had a lower portion of undifferented tumours. Ovarian cancer is the main cause of death from genital cancer in Ireland. While the stage of disease at diagnosis is critical to survival, chemotherapy did not influence survival.

Female↗