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J M Stronge

Publications and source records attributed to J M Stronge.

34 records · Page 2Linked to original sources
PubMed1983

Pregnancy in the diabetic patient: timing and mode of delivery.

The clinical outcome of 141 consecutive diabetic pregnancies managed in the National Maternity Hospital between January 1, 1979, and October 31, 1982, is described. Patients with gestational diabetes were excluded. There were 12 spontaneous abortions, and the perinatal mortality in 129 viable pregnancies was 31/1000. The malformation rate was 6.4%. Significant perinatal morbidity occurred in 20% of infants. The incidence of cesarean section was 20%. Spontaneous labor after 38 weeks occurred in 30% because there was a deliberate policy to allow all uncomplicated pregnancies to continue to term. This policy had benefits for the infant as well as the mother because there was a notable reduction in neonatal morbidity. Possible explanations of high cesarean section rates in other centers are discussed.

Birth Weight↗
PubMed1977

Pregnancy complicated by clinical diabetes mellitus. A study of 600 pregnancies.

In a consecutive series of 600 pregnancies (618 infants) in 300 clinically diabetic patients, treated in Dublin, Ireland, the maternal mortality was 0 and the loss of viable infants was 9.5%. Therapeutic abortion and sterilization were not practiced. The cesarean section rate was 23%. The major causes of perinatal loss were hyaline membrane disease and congenital malformations. Recent routine estimation of the L/S ratio in amniotic fluid led to a reduced incidence of respiratory distress syndrome and a consequent improvement in perinatal mortality. At a very early stage in pregnancy diabetic patients should be referred to a center in which physician, obstetrician, nurse, and pediatrician operate as a team. Strict control of diabetes is essential.

Congenital Abnormalities↗
PubMed1973

Active management of labour.

Active management of labour has been developed to the extent that an assurance is given to every woman who attends this hospital that her first baby will be born within 12 hours. This assurance could lead to a welcome change in present attitudes because the mere prospect of prolonged labour is often a cause of serious concern during a first pregnancy. Labour of strictly limited duration makes it possible to provide every woman with a personal nurse, and it places the problem of pain in a new setting.The results of a prospective study of 1,000 consecutive primigravidae are presented, and the guidelines to a standard policy of management are defined. Difficulty in meeting the commitment to early delivery arose almost exclusively in cases in which the diagnosis of labour was in doubt; only seven women were retained in the delivery unit for 12 hours.

Anesthesia, Epidural↗
PubMedDate not supplied

Outcome of diabetic pregnancy with spontaneous labour after 38 weeks.

One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred and twenty-four patients (84 per cent) had a normal vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent) caesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed 4 Kg or more, however there was only 1 case of shoulder dystocia. We compared these results with those of the general hospital population of 1987. The 2 main differences are; 1) the Caesarean section rate in labour was higher for this diabetic group than for the general hospital population, 7 per cent versus 3.4 per cent, 2) the birth weight was heavier, 33 per cent of infants of the diabetic group weighed 4 Kg or more versus 18 per cent of the general hospital population. The other parameters were comparable. We conclude that conservative management of pregnancy in well controlled diabetic women is advantageous, resulting in a high vaginal delivery rate without an increase in shoulder dystocia, and a low perinatal morbidity and mortality rate.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Management of antepartum spontaneous membrane rupture after one previous caesarean section.

The management of patients with one previous caesarean section whose membranes rupture spontaneously (SROM) before labour poses a clinical problem. This paper reports the outcome in a consecutive series of 56 such patients who presented after 37 weeks' gestation over 5 years (1983-1987). Vaginal examination was avoided before labour to minimise the risk of infection. Oxytocin was not used for induction, and the spontaneous onset of labour was awaited. The mean SROM-to-delivery interval was 42.6 hours. Only five (9%) patients required a repeat caesarean section. There was no case of scar dehiscence, and only five patients required oxytocin augmentation in labour. There was one case of postpartum endometritis, and none of the neonates showed clinical evidence of infection. In patients with one previous caesarean section whose membranes rupture spontaneously before labour, we suggest that awaiting the spontaneous onset of labour can safely achieve a high rate of vaginal delivery and avoid the need to induce labour with oxytocin.

Cesarean Section↗
PubMedDate not supplied

Wernicke's encephalopathy presenting in the puerperium.

A case of Wernicke's encephalopathy presenting in the puerperium is described. The clinical diagnosis was supported by dramatic reversal of the symptoms and signs following the administration of intravenous thiamine. A similar case report not identified on review of the literature.

Adult↗