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Biomedical subjects

M Geary

Publications and source records attributed to M Geary.

At least 37 records · Page 2Linked to original sources
PubMed2001

Peripartum hysterectomy in the 1990s: any new lessons?

We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. This was a retrospective case review carried out at the National Maternity Hospital, Dublin, of all patients who underwent a peripartum hysterectomy from January 1990 to December 1999. Seventeen cases were performed during the study period from a total of 64 563 deliveries (0.03%). Mean maternal age was 34 years (21-43). There were no nulliparous patients. Eight patients had previous vaginal deliveries. The other nine had a history of previous caesarean section, four of whom had two or more caesarean sections. The indications for the hysterectomy were placenta praevia (5), secondary postpartum haemorrhage (3), abruptio placentae (3), atonic postpartum haemorrhage (2), placenta accreta (2), traumatic postpartum haemorrhage (1) and broad ligament haematoma (1). All patients received blood transfusions, 74% receiving more than 10 units. There were no maternal deaths. There were two neonatal deaths secondary to placental abruption (perinatal mortality rate 118/1000). In conclusion, there was no maternal death in this study but the associated maternal morbidity and perinatal mortality was high. More than half the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications, which should help to reduce the problems associated with peripartum hysterectomy.

Journal Article↗
PubMed2001

Shoulder dystocia: risk factors and maternal and perinatal outcome.

Shoulder dystocia (S.D.) is an obstetric emergency which may be catastrophic for both mother and baby. The aims of this study were to determine the incidence of S.D., the maternal and perinatal outcome, and which risk factors were important. This was a retrospective review of all cases of S.D. during 1997 and 1998. Controls were selected as the next vaginal delivery following the S.D. case, matched for age, parity and gestation at delivery. Risk factors were compared between the two groups. There were 54 cases of S.D. over the study period, an incidence of 0.57% of 9541 vaginal deliveries. There were significant differences between cases and controls in birth weight, active phase of 1st stage of labour, 2nd stage of labour, episiotomy rate, third-degree tear rate, admission to SCBU and trauma to the baby at delivery. There were two infants with fractured clavicle and two with Erb's palsy.

Journal Article↗
PubMed2001

The HELLP syndrome: maternal and perinatal outcome.

The HELLP syndrome is a rare condition with a variable presentation, and in general, the outlook for mother and baby is felt to be poor. The aims of this study were to determine the maternal and perinatal outcome in cases of the HELLP syndrome at the Rotunda hospital over a five-year period. A retrospective review of all cases of confirmed HELLP syndrome from 1/1/95 to 1/9/99 was undertaken. Antenatal, intrapartum and neonatal data and in particular, maternal and neonatal complications were recorded. There were 20 cases of HELLP syndrome over the 5-year period. Mean maternal age was 29.8 (19-43) years. 70% were nulliparous. 80% delivered within 24 hours of diagnosis. 85% were delivered by caesarean section. Mean gestation at delivery was 33.5 (24-41) weeks, 65% of which were preterm. 70% of the babies were admitted to the neonatal intensive care unit (NICU). Mean birth weight was 1923g (440-4640g). Mean length of stay was 23.8 (1-68) days. 40% developed respiratory distress syndrome (RDS) with a mean duration of ventilation for these infants of 2.4 (0.5-7) days. There were 2 perinatal deaths both of whom weighed <500g. 95% of women were admitted to the High Dependency Unit. There were no maternal deaths. The mean interval to resolution of laboratory indices to within normal reference ranges was 11 (2-30) days. Maternal morbidity was high, but short-term, with full resolution in all cases. Once the diagnosis was made, delivery was immediate. The neonatal morbidity was also high and was most closely related to the gestation at delivery.

Female↗
PubMed2000

Fetal cerebral blood flow redistribution in late gestation: identification of compromise in small fetuses with normal umbilical artery Doppler.

OBJECTIVE: To evaluate the role of middle cerebral artery Doppler in small fetuses during the late third trimester. DESIGN: Prospective observational study of structurally normal fetuses with an estimated fetal weight < 5th percentile for gestation. Perinatal outcome was determined using a structured datasheet sent to each referring obstetrician. SUBJECTS: Structurally normal fetuses at 35 or more weeks of gestation referred during a 2-year period to the fetal growth clinic of a regional fetal medicine unit in North London. Fetuses with aneuploidy and/or major structural abnormalities were excluded. METHODS: Umbilical artery and middle cerebral artery (MCA) Doppler waveforms were recorded and considered abnormal if above 95th or below 5th percentiles, respectively. Amniotic fluid was considered reduced if the maximum vertical cord-free pool was < 2 cm. The placenta was considered mature if the Grannum grade was II or III. The head circumference (HC)/abdominal circumference (AC) ratio was considered abnormal if > 95th percentile for gestation. Fetal growth, amniotic fluid, biophysical profile score and umbilical artery Doppler were used to advise the referring obstetrician about fetal well-being and he/she independently decided both the timing and mode of delivery. RESULTS: Forty-seven fetuses fulfilled the entry criteria. Thirty-four (72%) demonstrated normal umbilical artery Doppler waveforms. Sixteen (34%) demonstrated middle cerebral artery redistribution, of which nine (56%) had normal umbilical artery Doppler waveforms. MCA blood flow redistribution was associated with an increased incidence of cesarean delivery and need for neonatal admission. Of all gray-scale parameters, an elevated HC/AC ratio has the strongest association with MCA blood flow redistribution (15/16 vs. 1/31; P < 0.01). CONCLUSIONS: MCA Doppler may be a useful tool to assess the health of small fetuses in the late third trimester. Redistribution may occur in the presence of normal umbilical artery Doppler and should be suspected when the HC/AC ratio is elevated.

Adult↗
PubMed2000

The misoprostol third stage of labour study: a randomised controlled comparison between orally administered misoprostol and standard management.

OBJECTIVE: To compare misoprostol with standard oxytocic regimens in the prevention of postpartum haemorrhage. DESIGN: Randomised controlled trial. SETTING: Obstetric unit in a large teaching hospital. METHODS: One thousand women randomised to 500 microg misoprostol given orally or to standard oxytocic regimens of oxytocin, oxytocin with ergometrine, or ergometrine. MAIN OUTCOME MEASURES: Incidence of postpartum haemorrhage and the incidence and severity of side effects. RESULTS: Postpartum haemorrhage occurred in 12% of women given misoprostol and in 11% of women given standard oxytocic drugs (relative risk (RR) 1.10, 95% confidence interval (CI) 0.79, 1.55). Blood loss of 1000 mL or more occurred in 2% of women in each group. Nausea, headache, dizziness and tiredness were less frequent with misoprostol (RR (95% CI) 0.71 (0.59, 0.84); 0.53 (0.38, 0.74); 0.73 (0.61, 0.87) and 0.88 (0.83, 0.94) respectively). The main side effects of misoprostol were shivering (RR 1.95, 95% CI 1.69, 2.25) and a rise in temperature (difference in mean rise 0.34 degrees C, 95% CI 0.26, 0.42). CONCLUSION: Oral misoprostol for the prevention of postpartum haemorrhage was comparable to standard oxytocics. Many side effects were less common with misoprostol but shivering and pyrexia were more common. Larger randomised trials are needed before establishing the equivalence between misoprostol and standard oxytocic drugs in the prevention of postpartum haemorrhage.

Administration, Oral↗
PubMed1999

Ontogeny of serum leptin concentrations in the human.

OBJECTIVE: Serum leptin concentrations reflect the fat mass of an individual. Fetal growth is rapid and it might be expected that major changes in circulating leptin concentrations in the fetus and neonate take place. We have studied the ontogeny of serum leptin concentrations in cord blood samples obtained by cordocentesis between 14 and 32 weeks of gestation and in samples obtained at term. PATIENTS: Cordocentesis samples from 10 appropriately grown for gestational age (AGA) and 10 intrauterine growth restricted (IUGR) fetuses. The results were compared with cord serum leptin concentrations obtained in 39 term healthy pregnancies. RESULTS: In the AGA and term pregnancies serum leptin concentrations changed little up until 38 weeks of gestation when there was an increase in concentration (Pre 38 weeks 3.5 microg/l (SEM 0.3); Post 38 weeks 5. 6 microg/l (SEM 0.7): Mann Whitney P = 0.03). Serum leptin concentrations were similar in the AGA and IUGR fetuses (AGA 5.9 microg/l (SEM 3.0); IUGR 4.2 microg/l (SEM 1.5): Mann-Whitney P = ns). Serum leptin was strongly related to birth weight (r = 0.58; P < 0.001) and birth length (r = 0.32; P = 0.05) in the term babies but not in the AGA or IUGR groups. CONCLUSION: Serum leptin concentrations in the fetus appear to be independent of gestational age and only rise towards the end of gestation. This late change probably reflects the changes in the accretion of body fat. There appears to be little difference in serum leptin concentrations between AGA and IUGR fetuses.

Female↗
PubMed1999

Maternal cardiolipin, beta 2-glycoprotein-I and prothrombin antibody expression in high-risk pregnancies with bilateral abnormal uterine artery Doppler waveforms.

OBJECTIVE: To compare the frequency of maternal serum antiphospholipid antibodies (to cardiolipin, beta 2-glycoprotein I and prothrombin) in pregnancies presenting with bilateral abnormal uterine artery Doppler waveforms. DESIGN: Retrospective analysis of stored serum. SUBJECTS: Cases comprised 47 singleton pregnancies with bilateral abnormal uterine artery Doppler waveforms at 24 weeks of gestation, followed from 20 weeks, and controls were 100 healthy pregnancies with normal uterine artery Doppler waveforms. METHODS: Ultrasound examination utilized a 5-MHz curvilinear transabdominal transducer with pulsed and color Doppler facilities. Antiphospholipid antibodies were analyzed by ELISA methodology, and reference ranges were established using the geometric mean +/- 2 SD of healthy non-pregnant adults. Human chorionic gonadotropin (hCG) levels were obtained from patient notes. RESULTS: Anticardiolipin antibodies were detected in 11 (23%) of the cases (IgG, n = 7; IgM, n = 6) compared with ten (10%) of the controls (p < 0.05). Low titer anticardiolipin IgG (range, 5.5-35.3; median, 6.3 GPL units) and anticardiolipin IgM (range, 3.4-14.7; median, 5.3 MPL units) were detected in cases. Amongst the cases, adverse perinatal outcomes were more common in the presence of raised levels of anticardiolipin antibodies. Anti-beta 2-glycoprotein I IgG was not detected in any of the cases. Antiprothrombin IgG was not detected, but antiprothrombin IgM occurred in 10.6% of cases compared with 2% of controls. CONCLUSIONS: Women with persistent bilateral abnormal uterine artery. Doppler waveforms in mid-gestation were more likely to express raised levels of anticardiolipin antibodies than healthy controls with normal uteroplacental perfusion. Anticardiolipin antibodies without anti-beta 2-glycoprotein I binding may be involved in the pathogenesis of uteroplacental ischemia in a proportion of high-risk pregnancies.

Adolescent↗
PubMed1999

Murphy's Law and the pregnant medical doctor: is pregnancy outcome worse?

The 'Murphy's Law' concept that doctors have a higher incidence of adverse pregnancy outcome is often quoted anecdotally but has never been scientifically tested. A group of medical doctors (n =52) were prospectively matched closely with a group of non-doctors (n =52) and pregnancy outcome was recorded. There were no differences noted in pregnancy outcome between the two groups. Whilst a much larger number of doctors is probably required to show a statistically significant difference, this first small study shows no clinically relevant difference between the two groups. The perception of Murphy's Law and the pregnant medical doctor would appear to be a myth.

Journal Article↗
PubMed1999

Leptin concentrations in maternal serum and cord blood: relationship to maternal anthropometry and fetal growth.

OBJECTIVE: To determine 1. the relationship between maternal serum leptin concentrations and maternal anthropometry and 2. the relationship between cord serum leptin concentrations at birth and neonatal anthropometry. DESIGN: Prospective cohort study of fetal growth in low-risk pregnancies. SETTING: University teaching hospital. SAMPLE: Thirty-nine women and their babies taking part in a fetal growth study. METHODS: Blood was taken from the women between 10-20 weeks of gestation and from the umbilical cord of their babies at delivery. Serum leptin was measured by radio-immunoassay. Maternal anthropometric measurements were recorded at booking. Neonatal anthropometric measurements were recorded within 48 hours after delivery. Linear regression analysis was used to explore the relationship between serum leptin concentrations and anthropometric measures and multiple regression analysis then applied to determine which variables remained independently associated with leptin. RESULTS: The median (range) leptin concentration in maternal serum was 11.8 ng/mL (1.7-39.7) and in cord blood was 4.2 ng/mL (0.6-21.4). Maternal leptin levels correlated with maternal weight, body mass index, midarm circumference and skinfold thickness, but not with birthweight, placental weight or maternal height. Body mass index and midarm circumference remained significant after multiple regression analysis. Cord leptin levels correlated with birthweight, birthlength, placental weight and skinfold thickness but not with ponderal index. Birthweight and subscapular skinfold thickness remained significant after multiple regression analysis. Cord leptin concentrations did not correlate with maternal leptin concentrations. CONCLUSIONS: We suggest that there are very strong associations between maternal leptin and maternal adiposity in pregnancy, and between cord leptin at delivery and birthweight, as well as other anthropometric markers of fetal growth.

Adult↗
PubMed1999

Emotional reactions of haemophilia health care providers.

This study investigated the prevalence and impact of job burnout and job satisfaction among health care professionals working with HIV-infected patients with haemophilia, using a survey that included the Maslach Burnout Inventory (MBI). A minority (7.4%) of the 213 respondents met the criteria for job burnout as assessed by the MBI. Nearly 90% of the respondents reported 'liking' their job, although only 46% anticipated being in the same job in 5 years. The following factors were associated with increased degrees of burnout: greater perceived colleague stress, less overall job satisfaction, greater perceived stress in the working environment, fewer team meetings and fewer years of career experience. Mental health professionals were also less likely than physicians to report burnout. A multiple logistic regression found that providers who reported stress with colleagues were 42% more likely than their peers to be classified as experiencing a high level of job burnout. This study underscores the importance of a well-functioning team in buffering the inevitable stresses of caring for haemophilia patients with HIV.

Burnout, Professional↗
PubMed1998

Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study.

OBJECTIVE: To investigate whether rectally administered misoprostol is an effective treatment for postpartum hemorrhage unresponsive to conventional first-line management. METHODS: We studied 14 women with postpartum hemorrhage unresponsive to oxytocin and ergometrine (n = 10) or, when ergometrine was contraindicated, oxytocin alone (n = 4). While awaiting carboprost, misoprostol 1000 microg (five tablets) was administered rectally. RESULTS: In all 14 women, the hemorrhage was controlled, and sustained uterine contraction produced within three minutes of administration of misoprostol. CONCLUSION: Misoprostol appears to be absorbed effectively from rectal as well as oral and vaginal mucosa. Rectally administered misoprostol appears to be an effective treatment for postpartum hemorrhage unresponsive to oxytocin and ergometrine; therefore, it might be an alternative to parenteral prostaglandins or at least minimize the number of women requiring this invasive treatment. Given that it is an inexpensive and stable drug, misoprostol has considerable potential to reduce maternal mortality from postpartum hemorrhage in developing countries.

Administration, Rectal↗