The effects of pregnancy on previous incontinence surgery. Case report.
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Adult↗
Biomedical subjects
L D Cardozo
Publications and source records attributed to L D Cardozo.
Assessment of urinary symptoms in early pregnancy.
OBJECTIVES: To determine the correlation between lower urinary tract symptoms and urodynamic findings in early pregnancy. SETTING: The termination clinic and gynaecology ward at King's College Hospital. DESIGN: Observational study. SUBJECTS: 47 women before termination of pregnancy at between 6 and 15 weeks. INTERVENTIONS: Women filled in symptom questionnaires and then had urodynamic investigations, consisting of uroflowmetry and subtracted provoked cystometry. MAIN OUTCOME MEASURES: The occurrence of lower urinary tract symptoms and their association with urodynamic findings. RESULTS: Lower urinary tract symptoms were fairly common but there was poor correlation with the urodynamic findings. CONCLUSIONS: The findings suggest that lower urinary tract symptomatology alone is insufficient to study lower urinary tract dysfunction in pregnancy.
Adolescent↗
Retention of the second twin: a viable option? Case reports.
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Abortion, Spontaneous↗
The treatment of detrusor instability in post-menopausal women with oxybutynin chloride: a double blind placebo controlled study.
Idiopathic detrusor instability is a common cause of incontinence in the elderly for which anticholinergic agents are regularly prescribed. Oxybutynin chloride combines anticholinergic action with direct muscle relaxant properties. We performed a double blind placebo controlled fixed dose cross over study of oxybutynin chloride in post-menopausal women suffering from detrusor instability. We found oxybutynin chloride significantly more effective than placebo at reducing the symptoms of urgency and urge incontinence and more effective at reducing the height of the highest unstable detrusor contraction. This was at the expense of an increased residual urine and considerable side effects.
Aged↗
The prevalence of variation of resting urethral pressure in women and its association with lower urinary tract function.
Variation of resting urethral pressure has been reported and it has been postulated that this is important in the genesis of lower urinary tract symptomatology in women. In order to differentiate between normal and abnormal urethral pressure variations several arbitrary values have been chosen and the prevalence of abnormality in symptomatic women reported. However, large variations in urethral pressure may be seen in healthy, asymptomatic volunteers. We have identified the prevalence of urethral pressure variation in a large group of female volunteers and have shown that "abnormal" urethral pressure variation is not associated with lower urinary tract symptomatology.
Female↗
Internal urinary sphincter in maintenance of female continence.
The integrity of the bladder neck was assessed in 98 continent women. Radiological and physiological evidence showed that half of these women had an incompetent bladder neck, but they were still continent. These data devalue the urodynamic finding of an incompetent bladder neck as an indication for surgery for incontinence and question the physiological importance of the internal sphincter.
Climacteric↗
Perineal pad weighing versus videographic analysis in genuine stress incontinence.
A comparison was made of the sensitivity of perineal pad testing and the videographic diagnosis of genuine stress incontinence (GSI) in postmenopausal women. The 99% upper confidence limit for pad weight gains in 90 normal women was 1.4 g. Ninety-nine women with urodynamically proven GSI were studied and 14 had false negative pad tests. There was no significant correlation between the videographic assessment and the gain in pad weight. We recommend the use of the pad test to confirm incontinence only in the absence of imaging facilities as the latter is more sensitive.
Adult↗
Subcutaneous hormone implants for the control of climacteric symptoms. A prospective study.
55 postmenopausal women on established hormone replacement therapy were treated with either oestradiol and testosterone implants or placebo at the time of return of climacteric symptoms. Their response to therapy was assessed prospectively. The statistically highly significant levels of symptom relief that followed an oestradiol and testosterone implant were contrasted sharply with the lack of any significant relief with placebo. Despite the success of oestradiol and testosterone implants in relieving symptoms of the climacteric, symptoms returned once the treatment was stopped. Evidence is presented that it is the fall in hormone levels rather than the level itself that provokes the return of climacteric symptoms.
Adult↗
Biofeedback: a 5-year review.
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Biofeedback, Psychology↗
Should we abandon Kielland's forceps?
To assess the risks associated with the use of Kielland's forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.5%) were delivered with Kielland's forceps. There was no difference in early neonatal outcome (as judged by Apgar scores, intubations, and admission to the special care baby unit) between these babies and those delivered normally or by non-rotational forceps, but a higher proportion of the 127 (10.7%) delivered by emergency caesarean section were compromised. Of the 1517 multigravid patients, only 57 (3.8%) underwent instrumental delivery, 15 (1.0%) by Kielland's forceps. Among these babies, also, the outcome was no worse than for those delivered normally, but the babies delivered by caesarean section showed a greatly increased incidence of low Apgar scores, intubations, and admission to the special care baby unit. There were no stillbirths or neonatal deaths among babies delivered by Kielland's forceps, nor were there any cases of severe birth trauma or of obvious neonatal morbidity.
Apgar Score↗
Obstetric characteristics in different racial groups.
A detailed analysis of 2632 consecutive pregnancies in white, black and Asian women, who were delivered during the period 1978 to 1980, found significant differences between the three ethnic groups. Asian primiparae had the longest first and second stages of labour, with the highest incidence of prolonged latent phase (14%) and primary dysfunctional labour (30%). Black primiparae and multiparae had the highest incidence of secondary arrest in the first stage of labour (10% and 4% respectively) and of primary dysfunctional labour, with the greatest recourse to emergency caesarean section (13% and 4% respectively). The mean birthweight for singletons born between 37 and 42 weeks was 3.37 kg for white babies, 3.25 kg for black babies and 3.14 kg for Asian babies. There was no racial difference in perinatal mortality or morbidity in this survey.
Adult↗
Predictive value of cervimetric labour patterns in primigravidae.
From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage of labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean 'observed first stage' of 6.3 h and a caesarean section rate of 8.7%. There was one stillbirth due to multiple congenital abnormalities and no increase in perinatal morbidity. Our data show that the type of first stage cervimetric pattern is helpful in predicting the outcome of labour. A normal cervimetric pattern resulted in a vaginal delivery rate of 98.4%; primary dysfunctional labour, which could be improved by oxytocin, had a 93.8% incidence of vaginal delivery, but if there was no improvement in the rate of cervical dilatation when this was administered the vaginal delivery rate was only 22.7% . A prolonged latent phase was associated with a caesarean section rate of 16.7% and the incidence of neonatal intubation was nearly as high as that found in uncorrected primary dysfunctional labour. The neonatal asphyxia in secondary arrest was minimal with an overall caesarean section rate of 28.4%; there was no increased incidence of neonatal morbidity with this cervimetric type.
Cervix Uteri↗
Prolonged pregnancy: is induction of labour indicated? A prospective study.
A prospective controlled study of 2000 patients to determine the incidence of postmaturity and the effect of a policy of non-induction of labour in prolonged pregnancy is reported. 'Certain postmaturity' was identified in 4% of the patients and was associated with an increased incidence of babies with Apgar scores of less than 5 at 1 min; induction of labour at 42 weeks gestation did not affect the neonatal outcome compared with that in patients allowed to go into spontaneous labour. Induction of labour in patients designated as 'certain postmature' and 'uncertain postmature' reduced the number of vaginal deliveries and increased the caesarean section rate from 9.6 to 26.7 and from 2.2 to 31.2% respectively. The failure to improve the perinatal outcome does not support or justify induction of labour for uncomplicated postmaturity.
Adult↗
Social and obstetric features associated with smoking in pregnancy.
The smoking habits of 2000 consecutive pregnant women have been analysed in relation to their race, social features and obstetric results. Only 60% of white patients were non-smokers compared with 80% of blacks and 90% of Asians, and whereas 20% of white patients smoked heavily only 3% of blacks or Asians did. Smokers booked later and were more frequently unsure of their dates, unemployed, unmarried and defaulters from the antenatal clinic. The incidence of antepartum haemorrhage was doubled amongst the heavy smoking multigravid patients in spite of a slightly decreased incidence of hypertensive disease. More non-smokers required induction of labour for raised blood pressure, and more smokers for fetal distress. The most significant differences between the smokers and non-smokers were the decrease in mean birth-weight associated with increased smoking (3.31 kg for non-smoking primigravidae compared with 3.14 kg for heavy smokers) and the threefold increased incidence of small-for-dates babies amongst the heavy smokers. There was no significant difference in the perinatal mortality.
Adult↗
Outcome of spontaneous labour in multigravidae.
From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean 'observed first stage' was 3.4 h, and the caesarean section rate 1.4%. Normal labour occurred in 88.5%, with a vaginal delivery rate of 99.5% in this group. Stimulation was indicated in 98 patients (11.6%), augmentation improving the rate of progress in 86 (87.8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.
Apgar Score↗
Urological complications of traumatic diastasis of the symphysis pubis in the female.
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Aged↗
Evaluation of flurbiprofen in detrusor instability.
Thirty women with detrusor instability (27 cases idiopathic, and three secondary to multiple sclerosis) completed a double-blind, cross-over trial of the prostaglandin synthetase inhibitor flurbiprofen and a placebo, results being evaluated by questionnaire and cystometry. Frequency, urgency, and urge incontinence were all significantly reduced with flurbiprofen (P less than 0.001, P less than 0.025, and P less than 0.025 respectively), as was the detrusor-pressure rise during bladder filling (P less than 0.01). Side effects, however, occurred in 13 patients while taking flurbiprofen compared with five while taking placebo (P less than 0.025). After the trial 19 patients wished to continue with flurbiprofen. Flurbiprofen is a useful treatment for idiopathic detrusor instability and is well tolerated by most patients.
Adult↗
A comparison between bromocriptine and indomethacin in the treatment of detrusor instability.
Our 32 patients with urinary symptoms owing to detrusor instability (either primary or secondary to an upper motor neuron lesion) have completed a clinical trial of bromocriptine and indomethacin. Each drug was administered for 1 month, using a single blind crossover method. The symptoms and any side effects were assessed by means of a questionnaire before entry into the trial, after administration of the first drug and at the end of the trial. The improvement in diurnal and nocturnal frequency owing to indomethacin was shown by McNemar's test to be statistically highly significant.
Bromocriptine↗