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Biomedical subjects

M P O'Connell

Publications and source records attributed to M P O'Connell.

At least 19 recordsLinked to original sources
PubMed2004

The role of investigations for term stillbirths.

The aim of the study was to document the role of laboratory investigations for unexpected stillbirths at term. It was a retrospective casenote review of 75 unexpected stillbirths at term from 1995 to 1999, at the National Maternity Hospital, Dublin, Republic of Ireland. Investigations performed included blood tests, chromosomal analysis, autopsy and placental histology. Perinatal autopsy was the most informative investigation with positive findings in 49% of cases. There were positive placental findings in 37% of cases. Six of the 26 cases showed abnormal karyotyping. Of the blood tests performed, the Kleihauer-Betke test was most informative, revealing a feto-maternal haemorrhage in 8% of cases and anticardiolipin antibodies were positive in 4% of cases. FBC, TORCH and glycosylated Hb were negative in all 75 patients. Despite thorough investigations 32 of cases (43%) remained unexplained.

Adolescent↗
PubMed2003

Active management of labour revisited: the first 1000 primiparous labours in 2000.

This was a prospective observational study in a tertiary referral obstetric unit in Dublin to ascertain the delivery outcome in the first 1000 nulliparous women in 2000. The initial diagnosis of labour was confirmed in the first 1000 consecutive nulliparous women in spontaneous labour with cephalic presentation at term. All patients underwent active management of labour. Active management included strict criteria for the diagnosis of labour, early amniotomy, 2-hourly vaginal examinations, oxytocin augmentation where progress of labour was slow and the presence of a companion (personal nurse) in labour. Epidural analgesia was freely available. Mode of delivery, duration of labour, analgesia usage and maternal and perinatal complications were the main outcome measures. All patients presented with painful uterine contractions, 75% with show in addition, and 36% had spontaneous rupture of membranes on admission. Eighty per cent presented with a cervical dilatation of 12 hours) was 4.3%. Postpartum haemorrhage occurred in 3.8% of mothers and 1.6% of babies were admitted to the special care baby unit. Our study suggests that active management of labour is associated with a low incidence of prolonged labour and a low caesarean section rate.

Female↗
PubMed2003

Factors associated with a prolonged second state of labour--a case-controlled study of 364 nulliparous labours.

The aim of the study is to identify factors associated with a second stage of labour greater than 2 hours in nulliparous women delivering at term. It a retrospective case-control study of 182 women with a second stage less than 2 hours' duration, matched with 182 women with a second stage greater than 2 hours. Women with a short second stage of labour were significantly younger (mean age 23.2 vs. 24.9 years) and had significantly smaller babies (mean weight 3315 g vs. 3463 g) than women with a long second stage. Long duration of the second stage of labour was significantly associated with oxytocin and epidural use. The intervention rate did not rise above 50% until the second stage exceeded 5 hours duration. The fetal outcome was good in both groups of patients.

Adult↗
PubMed2003

Electrical impedance measurements: an objective measure of prelabor cervical change.

OBJECTIVE: To investigate the use of electrical impedance measurements of the pregnant cervix as an objective measure of cervical favorability (Bishop score > or = 5). METHODS: A prospective study of 86 women, investigating electrical impedance measurements of the pregnant cervix at the time of induction of labor. Transfer electrical impedance measurements were made by placing a tetrapolar pencil probe of 8 mm in diameter on the surface of the cervix. A Bishop score was determined simultaneously. RESULTS: A mean resistivity (standard error of the mean) of 7.03 (6.01-8.04) omega(m) was measured for the unfavorable group and 5.34 (4.61-6.07) omega(m) for the favorable group. This was a statistically significant difference (p = 0.016). CONCLUSION: We highlight the ability of this safe, painless technique to differentiate the favorable from the unfavorable cervix at induction of labor.

Adolescent↗
PubMed2003

The philosophy of practice governs the rate of obstetric intervention: analysis of 212 units in the United Kingdom.

OBJECTIVE: To investigate the relationship between the practices of obstetric intervention in individual units. STUDY DESIGN: A retrospective analysis of the annual statistical returns to the Royal College of Obstetricians and Gynaecologists of 222 units in the UK for 1997-98. RESULTS: A total of 212 units that delivered more than 1000 babies were analyzed. A positive correlation was found between the rates of assisted vaginal delivery and emergency Cesarean section (Spearman's rho = 0.207, p = 0.003) and the rates of emergency and elective Cesarean section (Spearman's rho = 0.205, p < 0.001). There was a significant difference between unit size and the rate of spontaneous vaginal delivery (Kruskall-Wallis chi2 = 14.5, p = 0.002) with larger units having a lower spontaneous vaginal delivery rate. CONCLUSION: These results indicate that those units which have a high emergency Cesarean section rate also have a high elective Cesarean section rate and assisted vaginal delivery rate. The philosophy of an individual unit towards intervention is a general philosophy and determines the intervention rates for all procedures.

Cesarean Section↗
PubMed2003

Pheochromocytoma, sickle cell disease and pregnancy: a case report.

Pheochromocytomas are rare catecholamine-secreting tumors with a 2-4% maternal morbidity rate and a fetal loss rate of 11%. Sickle cell disease is also associated with increased maternal and fetal mortality. We report the first case of a primigravid woman with both conditions and a successful pregnancy outcome.

Adult↗
PubMed2001

The management of the second stage of labor.

OBJECTIVE: To review obstetric practice in a single maternity hospital with respect to the assisted vaginal delivery rate. METHOD: A retrospective analysis of the hospital statistics, labor ward records, casenotes and management protocols with respect to the second stage of labor was performed in a single maternity unit in the UK; the study included 43352 women who delivered a baby between the years of 1987 and 1997. The study looked at the rate of assisted vaginal deliveries, cesarean section, epidural in labor, and as well as the perinatal mortality rate. RESULTS: In the 11-year period of the study, 43352 women delivered with a mean assisted vaginal delivery rate of 3.70%, cesarean section rate of 12.4% and an epidural rate of 31.5%. CONCLUSION: The management of the second stage of labor in this unit results in an assisted vaginal delivery rate significantly below the national average. The authors highlight the paucity of research in this important area of practice.

Anesthesia, Epidural↗
PubMed2001

Epidural analgesia.

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Analgesia, Epidural↗
PubMed2001

Reversal of asymptomatic cervical length shortening with cervical cerclage: a preliminary study.

This is a prospective observational study which highlights the value of serial transvaginal cervical length measurements to identify asymptomatic cervical length shortening and the effect on cervical length following insertion of a McDonald cerclage. Four out of 14 patients exhibited asymptomatic cervical length shortening. Only patients whose cervical length was <2 cm underwent cerclage. All patients showed an increase in cervical length post-cerclage. The possible mechanisms responsible for these changes are discussed.

Cervix Uteri↗