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Biomedical subjects

J Lumley

Publications and source records attributed to J Lumley.

At least 91 records · Page 5Linked to original sources
PubMed1995

The prevalence and timing of obstetric ultrasound in Victoria 1991-1992: a population-based study.

A statewide study to ascertain the number of ultrasound scans received by women in pregnancy, to identify the proportion having a scan at 16 to 20 weeks' gestation, and to establish where the scan at 16 to 20 weeks was performed was carried out between January, 1991 and June, 1992 in Victoria. Additional data were collected by midwives and entered on the perinatal morbidity statistics form routinely completed for all births. Of 52,319 women providing responses, 3.1% did not have a scan. Of the remaining 96.9% who had a scan, 73.5% were scanned at 16 to 20 weeks' gestation. Predictors of not having a scan were maternal birthplace and higher parity: previous perinatal death(s), and attendance at nonteaching hospitals predicted the opposite. Predictors of being scanned were location of hospital (country), maternal birthplace, higher parity and maternal age (< 20 years). Substantial differences in frequency and timing were found between hospitals attended. Factors associated with the pattern of scanning are not readily explicable in terms of risk of malformations or women's choices.

Adult↗
PubMed1994

Depression after childbirth. Does social context matter?

OBJECTIVE: To explore the relationships between women's emotional well-being after childbirth and several measures of the social context of motherhood. DESIGN AND PARTICIPANTS: Case-control study of 45 women who were identified as depressed in a population-based postal survey 8-9 months after giving birth and 45 randomly selected women who were not depressed. At follow-up about two years after the birth, the women were interviewed at home about their experiences of motherhood and their emotional well-being since the birth. They also completed five standard questionnaires: Life Experiences Questionnaire; Toddler Temperament Scale; Social Support Questionnaire; Experience of Motherhood Questionnaire; and the Edinburgh Postnatal Depression Scale. RESULTS: Women in the case group were more likely to be depressed at follow-up than women in the control group. They reported less practical and emotional support from their partners and saw themselves as having less social support overall. They had also experienced more negative life events since the birth, had poorer health and were somewhat more likely to have a "difficult" toddler. CONCLUSIONS: It is important to take social context into account in understanding depression after childbirth and in helping mothers who are depressed.

Case-Control Studies↗
PubMed1994

Childbirth and soul loss: the case of a Hmong woman.

The health of a Hmong woman had been deteriorating since she underwent caesarean section. She believes that her ill health is caused by her soul leaving her body during general anaesthesia. A caesarean was essential for the survival of the fetus, but it could have been better managed. The situation might have been prevented if the cultural beliefs and practices of the Hmong had been taken into account. Nevertheless, the agreement of the hospital to a soul calling ceremony in the operating theatre and the concerns expressed by hospital staff about her well-being are positive aspects, showing that mainstream health services can provide culturally sensitive care to consumers if they are informed of these cultural beliefs and practices.

Adult↗
PubMed1994

Karyotype abnormalities in fetuses diagnosed as abnormal on ultrasound before 20 weeks' gestational age.

This study examined rates of karyotype abnormalities in fetuses diagnosed by ultrasound as abnormal before 20 weeks' gestational age and which prompted a follow-up amniocentesis or chorionic villus sampling. Those diagnosed before 20 weeks were compared with those diagnosed at or after 20 weeks. A retrospective study identified ultrasonographically abnormal fetuses in whom karyotyping had been undertaken, 306 fetuses before 20 weeks' gestational age and 241 after. Isolated malformations before 20 weeks had, on average, an 18 per cent risk of karyotype abnormality, compared with 20 per cent later. Specific rates were calculated; for example, heart abnormality was associated with karyotype abnormality in 7 per cent of cases before 20 weeks and in 14 per cent later. Multiple malformations and karyotype abnormalities were found together in 28 per cent of fetuses prior to 20 weeks and in 33 per cent of the older fetuses. Specific associations included nuchal oedema and trisomy 21 in 21 per cent of fetuses before 20 weeks. No karyotype abnormalities were found in fetuses diagnosed with choroid plexus cysts. An overview of trisomies in Victoria, in 1991, showed that 50 per cent of trisomy 18, 42 per cent of trisomy 13, and 9.5 per cent of trisomy 21 cases were identified by ultrasound in women less than 37 years of age. Another 28.6 per cent of trisomy 21 fetuses were detected in women of advanced maternal age who underwent amniocentesis or chorionic villus sampling, making a total of 38.1 per cent of trisomy 21 that were detected prenatally.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ethnic differences in the incidence of the sudden infant death syndrome (SIDS) in Victoria, Australia 1985-1989.

In order to describe ethnic differences in the incidence of the sudden infant death syndrome (SIDS) records of all livebirths in the State of Victoria, Australia, 1985-1989, excluding those who died in the first month of life, were linked to death certificates. Cases were defined as infants dying with a diagnosis of SIDS between 1 month and 1 year of age (n = 601) from the cohort of 308,052 neonatal survivors. Ethnicity was defined by the mother's country of birth. The SIDS incidence was 2.04/1000 in infants of Australian-born mothers. The relative risk of SIDS was 0.28 (95% confidence interval (CI) 0.15, 0.55) in infants whose mothers had been born in Southern Europe and 0.48 (95% CI 0.29, 0.78) in infants whose mothers had been born in Asia. SIDS in infants of Australian-born mothers was associated with low maternal age, high parity, marital status other than married, male sex, multiple birth, low birthweight and preterm birth. After adjustment for those factors in a case-control analysis using a logistic regression model the adjusted odds ratio for SIDS was 0.34 (95% CI 0.17, 0.69) comparing infants whose mothers were born in Southern Europe with infants of Australian-born mothers, and 0.60 (95% CI 0.35, 1.04) for infants whose mothers were born in Asia, compared with infants of the Australian-born. Thus there are substantial ethnic differences in SIDS which are not explained by the classic social and perinatal risk factors.

Adult↗
PubMed1994

Clomiphene citrate and pregnancy outcome.

Data from Australia and elsewhere have shown consistently that adverse perinatal outcomes such as preterm birth and perinatal mortality are more common in pregnancies resulting from assisted conception with IVF and GIFT than normally conceived pregnancies. Factors that may contribute to the excess of poor outcomes include maternal factors, the assisted conception procedures themselves and possibly the influence of drugs used to induce superovulation. This review examines the medical literature describing pregnancies following ovulation induction with one of the drugs used to induce superovulation, clomiphene citrate, and compares their outcomes with Australian IVF and GIFT pregnancy outcomes. The review shows that whilst some studies have suggested higher rates of ectopic pregnancy, spontaneous abortion and congenital malformations in clomiphene citrate induced pregnancies, the findings are inconsistent and the data are flawed. There are only very poor data available on the incidence of preterm birth. Multiple pregnancy is a well-recognized adverse outcome of clomiphene citrate induced pregnancies. Attempts to improve perinatal outcomes of pregnancies following assisted conception will be helped by a better understanding of the relative contributions of maternal and treatment factors and further studies of pregnancy outcome after ovulation induction are needed.

Abortion, Spontaneous↗
PubMed1994

Satisfaction with care in labor and birth: a survey of 790 Australian women.

Data on satisfaction with care in labor and birth were gathered in a survey conducted in conjunction with a review of maternity services in Victoria, Australia. All women who gave birth in one week in 1989 (> 1000) were mailed questionnaires eight to nine months after the birth, with a response rate of 790 (71.4%). When adjusted for parity in a logistic regression model, the following factors were highly related to dissatisfaction with intrapartum care: lack of involvement in decision making (p < 0.001), insufficient information (p < 0.001), a higher score for obstetric intervention (p = 0.015), and perception that caregivers were unhelpful (p = 0.04). No association was found between satisfaction and maternal age, marital status, total family income, country of birth, or health insurance status. The survey results were influential in shaping final recommendations of the Ministerial Review of Birthing Services by countering stereotypes about women who become dissatisfied with their care, providing evidence of far greater dissatisfaction with intrapartum than antenatal care, and demonstrating the importance of information, participation in decision making, and relationships with caregivers to women's overall satisfaction with intrapartum care.

Adult↗
PubMed1994

Birth events, birth experiences and social differences in postnatal depression.

A postal survey of all women who gave birth in Victoria in one week in 1989 was used to assess the contribution of birth events, satisfaction with care and social differences to depression after birth. The questionnaire was mailed to women eight to nine months after birth. The survey response was 71.4 per cent (790/1107) with underrepresentation of young women, single women and women of non-English-speaking background. Assessment of depression was made using the Edinburgh Postnatal Depression Scale, with a score of 13 or more indicating probable clinical depression. The point prevalence of depression was 15.4 per cent (95 per cent confidence interval 12.8 to 18.0). In the final logistic model two factors were associated with lower odds of depression: nonmetropolitan residence and maternal age over 34. Factors associated with increased odds of depression in the model were having a first child over the age of 34, assisted delivery (caesarean, forceps, vacuum extraction), bottle feeding, dissatisfaction with antenatal care, having unwanted people present at the birth and lacking confidence to look after the baby at the time of leaving hospital. When those factors were taken into account, being unmarried, being born overseas of non-English-speaking background, being dissatisfied with care in labour and after birth, and not having an active say in decision making, all of which were significantly associated with depression in univariate analyses, did not make any additional contribution to the model.

Adolescent↗
PubMed1993

Limb deficiencies, chorion villus sampling, and advanced maternal age.

Record linkage between a prenatal diagnosis register and a congenital malformation register in the state of Victoria, Australia, has enabled further evaluation of the suggested association between limb deficiencies and early chorion villus sampling (CVS). We found 3 anomalies in this category after later CVS (i.e., 9 weeks and beyond), but our data suggest that advanced maternal age may be a risk factor for both terminal and all limb deficiencies. The data from Victoria are tabulated with data obtained from other registers. Different birth prevalence figures are obtained by different registers, therefore limiting comparisons between registers.

Adult↗
PubMed1993

Triplets and quadruplets born in Victoria between 1982 and 1990. The impact of IVF and GIFT on rising birthrates.

OBJECTIVES: To examine the perinatal characteristics of all higher order multiple births (133 sets of triplets and six sets of quadruplets) in the State of Victoria between 1982 and 1990. To compare the rising higher order multiple birth rates in Victoria with those in the other States of Australia, and to assess the impact of in-vitro fertilisation (IVF) and gamete intrafallopian transfer (GIFT) on these rising birth rates. DESIGN: Retrospective review of all higher order multiple births registered in Victoria and other States of Australia between 1982 and 1990, and in particular those resulting from IVF and GIFT. DATA SOURCES: Victorian Perinatal Data Collection Unit, Australian Bureau of Statistics, National Perinatal Statistics Unit, data from Victorian IVF and GIFT units. MAIN OUTCOME MEASURES: Higher order multiple birth rates and perinatal mortality rates. RESULTS: The higher order multiple birth rates in Victoria rose from 3.5 per 10,000 in 1982 to 10.9 per 10,000 in 1990. The average perinatal mortality rates for the Victorian triplets and quadruplets born during this period were 10.8% and 25.0%, respectively. The rates of caesarean section were 70% and 83%; the proportions of deliveries in level III hospitals, 75% and 100%; and the mean maternal lengths of stay in hospital, 32 and 57 days, respectively. Endotracheal intubation was performed at birth in 18.5% of all infants. The proportions of triplet and quadruplet pregnancies in Victoria owing to IVF and GIFT rose during this period, reaching a peak of 42% in 1990. In the other States, the birth rates for higher order multiples increased at 1.8 times the rate observed for Victoria, with IVF and GIFT contributing to an estimated 43% of these conceptions between 1985 and 1989. CONCLUSION: Restrictions on the numbers of embryos/oocytes transferred during IVF and GIFT should reduce the frequency of higher order multiple births.

Adult↗
PubMed1993

Trends in neural tube defects 1980-1989.

OBJECTIVES: To determine trends in prevalence of neural tube defects in Australia over the past decade; to investigate the impact of terminations of pregnancy on the birth prevalence of neural tube defects; and to provide a baseline against which to evaluate the potential effects of preventive public health measures. DATA SOURCES: Two population-based registries in Victoria and Western Australia and a statewide survey from Tasmania. DESIGN AND METHOD: A cohort study. Data on the numbers and the prevalence proportions of neural tube defects from three States--Western Australia, Victoria and Tasmania--were compared by Poisson regression. RESULTS: The prevalence proportions for all neural tube defects for all three States remained level over the study period 1980-1989. Terminations of pregnancy for all neural tube defects increased significantly over the decade in all three States. By 1989, 39.9% of all neural tube defects were ascertained as terminations before 20 weeks' gestation, while 10 years previously only 2.9% were. The percentage of cases of anencephaly ascertained as terminations of pregnancy increased from 4.8% in 1980 to 58.6% in 1989. Corresponding figures for spina bifida were 1.4% (1980) and 26.9% (1989), and for encephalocele 0% (1980) and 12.5% (1989). This increase in terminations was associated with a decrease per year in the birth prevalence proportion for anencephaly of 7.0%, for spina bifida of 4%, and for encephalocele of 11.0%, and a reduction in the risk of a birth with a neural tube defect in 1989 of 47% compared with the risk in 1980. CONCLUSION: Complete ascertainment of all terminations for neural tube defects as well as births with neural tube defects is necessary to provide reliable baseline data on the prevalence of neural tube defects. Such data are essential in evaluating primary preventive measures such as the effect of an increase in folic acid intake by women of child-bearing age.

Abortion, Induced↗
PubMed1993

Perinatal mortality in Greece and Greek-born women in Victoria. What does a 'natural experiment' suggest?

A comparison of perinatal outcome in the Greek perinatal mortality survey of 1983 with the outcome of births to Greek born women who had migrated to Victoria, Australia found marked similarities in maternal age, parity, marital status and cigarette smoking. The birthweight distributions were almost identical in the two groups. Despite these similarities the perinatal mortality was substantially higher in Greece. Analysis by cause of death showed the differences to be marginal in all categories except deaths attributed to intrapartum asphyxia which were eight times as common in Greece.

Birth Weight↗
PubMed1993

The epidemiology of preterm birth.

Secular trends in the prevalence of preterm birth and international comparisons of the rates of preterm birth are difficult to interpret because of differences, both formal and informal, in the registration of extremely preterm births. Accurate estimation of gestational age is another problem in the measurement of preterm birth. Preterm birth is heterogeneous in several ways. It is heterogeneous in terms of the extent to which the birth is preterm (20-27 weeks, 28-31 weeks or 32-36 weeks of gestation); in whether the birth was elective or spontaneous; and among spontaneous idiopathic preterm births, in whether there was preterm labour or premature rupture of the membranes. Case-control study designs taking account of these subgroups have been a recent feature of epidemiologic approaches. The classic social associations of preterm birth--low socioeconomic status, extremes of maternal age, primiparity, being unmarried--apply to extremely preterm and moderately preterm births as well as to the mildly preterm group. The strength of these associations is small compared with factors in the prior reproductive history and with medical and obstetric complications of the current pregnancy. Recent epidemiological research activities have focused on the ways in which risk factors such as physical workload, drugs and alcohol, lack of social support and infection might be mediating factors between sociodemographic status and preterm birth. As Eastman (1947) pointed out almost 50 years ago, 'only when the factors causing prematurity are clearly understood can any intelligent attempt at prevention be made'.

Adult↗
PubMed1993

Births after a period of infertility in Victorian women 1982-1990.

Pregnancies following a period of infertility are often thought to be at increased risk of adverse outcomes. Between 1982-1990, 1465 births were reported to the Victorian Perinatal Data Collection Unit with a history of infertility. We present some characteristics of these births and compare them with all Victorian births in 1986 (n = 61,253) and Australian and New Zealand IVF and GIFT births 1979-1989 (n = 6,675). Women with a history of infertility were older than other Victorian women but younger than the IVF and GIFT group. Multiple births comprised 9% of the infertility group compared with 1.3% in the general Victorian population and 23.7% of IVF and GIFT births. The incidence of low birth-weight (18.6%) and very low birth-weight (4.2%) was higher than in other Victorian births (5.8% and 1.1% respectively) but lower than in IVF and GIFT births (34.6% and 8.9%). Perinatal mortality in the infertility group (33.4 per 1,000) was higher than in the general population (11.1 per 1,000) and similar to the IVF and GIFT group (34.9 per 1,000). The Caesarean section rate after infertility (41%) was more than double the rate in the rest of the Victorian population (16%), and showed a different pattern of indications. The relative risks of low and very low birth-weight, perinatal mortality and Caesarean delivery remained significantly increased for singletons after adjustment for maternal age and parity.

Adult↗