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Biomedical subjects

S Bewley

Publications and source records attributed to S Bewley.

At least 37 records · Page 2Linked to original sources
PubMed1997

'Near-miss' obstetric enquiry.

A near-miss maternal mortality enquiry was performed at University College Obstetric Hospital, London, by reviewing retrospectively all 30 obstetric admissions to the intensive care unit (ITU) over a two-year period. The obstetric admission rate to ITU was 0.5 (95% CI 0.32-0.67%), or one per 200 women delivered. Haemorrhage and severe pre-eclampsia were the two commonest causes of admission. Sub-standard care was identified in 52% of cases. Blood loss was often massive ( 2000 ml), underestimated and required large volume transfusions (mean transfusion 6.4 units, range 1-24). Although there are problems with definitions, ascertainment and validity, 'near-miss' review is feasible. It is worthwhile for every hospital to carry out its own 'near-miss' enquiry using appropriate local criteria to identify potential areas for improvements. 'Near-misses' are more prevalent than deaths and are dominated by conditions that are amenable to treatment. They may be even more sensitive to improvement or deterioration in obstetric services than mortality data.

Journal Article↗
PubMed1995

First trimester fetal nuchal translucency: problems with screening the general population. 1.

OBJECTIVE: To evaluate the feasibility of measuring first trimester nuchal translucency in an unselected population, to assess the relationship with gestation and maternal age and to measure reproducibility. DESIGN: A prospective observational study. SETTING: University College Hospital, London. SUBJECTS: One thousand and four women attending for a routine first trimester dating scan between eight and thirteen weeks of gestation. Measurements of nuchal translucency were attempted in 1368 (80.3%) and successful in 1127 (82% of attempts). RESULTS: Nuchal translucency is most easily measured at 11 weeks of gestation. If a cut-off of > or = 3 mm is used, 6% of unselected fetuses between eight and thirteen weeks of gestation are classified as abnormal. Nuchal translucency increases with gestational but not maternal age. Reproducibility is poor: by repeating measurements with a different operator, the same operator using a different still image, or the same operator using the same still image, 18.8%, 17.5% or 12.4% of nuchal translucency measurements, respectively, change their classification as normal or abnormal. CONCLUSIONS: If nuchal translucency > or = 3mm were used as an indication for karyotyping, 6% of the normal pregnant population would be screen positive. However, the percentage will vary greatly depending on the gestational age profile of the screened population. The poor reproducibility of nuchal translucency measurement could diminish its usefulness as a screening test for Down's syndrome.

Adult↗