BJOG: An International Journal of Obstetrics and Gynaecology
1470-0328
Cơ quản chủ quản: WILEY , Wiley-Blackwell Publishing Ltd
Lĩnh vực:
Obstetrics and Gynecology
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Randomised controlled trials – the gold standard for effectiveness research
Tập 125 Số 13 - Trang 1716-1716 - 2018
Autoimmune ovarian failure with elevated serum levels of luteinizing hormone and enlarged ovaries Case report
Tập 97 Số 4 - Trang 362-364 - 1990
Fear of childbirth in nulliparous and multiparous women: a population‐based analysis of all singleton births in <scp>F</scp>inland in 1997–2010 Objective To identify risk factors for fear of childbirth (FOC ) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes. Design A cohort study. Setting The Finnish Medical Birth Register. Population All 788 317 singleton births during 1997–2010 in Finland. Methods Fear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression. Main outcome measures Prevalence of, risk factors for and outcomes of FOC .Results Fear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR ), 6.35; 95% confidence interval (CI ), 5.25–7.68], advanced maternal age (aOR , 3.78; 95% CI, 3.23–4.42) and high or unspecified socioeconomic status. In multiparous women, the strongest risk factors for FOC were depression (aOR , 5.47; 95% CI, 4.67–6.41), previous caesarean section (CS ) (aOR , 3.02; 95% CI, 2.93–3.11) and high or unspecified socioeconomic status. Among both nulliparous and multiparous women, FOC was associated with higher rates of CS (3.3‐fold and 4.5‐fold higher, respectively) and a lower incidence of low birthweight (<2500 g), small for gestational age babies, preterm birth and low Apgar scores at 1 minute. Conclusions High and unspecified socioeconomic status, advanced maternal age and depression are predisposing factors for FOC regardless of parity. Among multiparous women, a previous CS increases vulnerability to FOC . FOC is associated with increased rates of CS , but does not adversely affect other pregnancy outcomes.
Tập 121 Số 8 - Trang 965-970 - 2014
Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery Please cite this paper as: Adams S, Eberhard‐Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG 2012;119:1238–1246.Objective To assess the association between fear of childbirth and duration of labour.Design A prospective study of women from 32 weeks of gestation through to delivery.Setting Akershus University Hospital, Norway.Population A total of 2206 pregnant women with a singleton pregnancy and intended vaginal delivery during the period 2008–10.Methods Fear of childbirth was assessed by the Wijma Delivery Expectancy Questionnaire (W‐DEQ) version A at 32 weeks of gestation, and defined as a W‐DEQ sum score ≥ 85. Information on labour duration, use of epidural analgesia and mode of delivery was obtained from the maternal ward electronic birth records.Main outcome measures Labour duration in hours: from 3–4 cm cervical dilatation and three uterine contractions per 10 minutes lasting ≥1 minute, until delivery of the child.Results Fear of childbirth (W‐DEQ sum score ≥ 85) was present in 7.5% (165) of women. Labour duration was significantly longer in women with fear of childbirth compared with women with no such fear using a linear regression model (crude unstandardised coefficient 1.54; 95% confidence interval 0.87–2.22, corresponding to a difference of 1 hour and 32 minutes). After adjustment for parity, counselling for pregnancy concern, epidural analgesia, labour induction, labour augmentation, emergency caesarean delivery, instrumental vaginal delivery, offspring birthweight and maternal age, the difference attenuated, but remained statistically significant (adjusted unstandardised coefficient 0.78; 95% confidence interval 0.20–1.35, corresponding to a 47‐minute difference).Conclusion Duration of labour was longer in women with fear of childbirth than in women without fear of childbirth.
Tập 119 Số 10 - Trang 1238-1246 - 2012
Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin ABSTRACT Objective
To assess the effect of moderate obesity on the outcome of induction of ovulation with low dose gonadotrophin in women with polycystic ovary syndrome (PCOS).Design
Retrospective analysis of women with PCOS treated consecutively. An analysis of the impact of obesity on outcome of pregnancy using data from the North West Thames Regional (NWTR) obstetric database was included for comparison. Setting Induction of ovulation clinic at the Samaritan Hospital for Women (St. Mary's Hospital Group).Subjects
100 women with clomiphene‐resistant anovulation associated with PCOS. 75 were of normal weight (BMI 19–24. 9 kg/m2 , lean group) and 25 were moderately overweight (BMI 25–27.9 kg/m2 , obese group).Interventions
Induction of ovulation using low doses of gonadotrophins with small, stepwise increments in dosage as required.Main outcome measures
Rates of ovulation, pregnancy and miscarriage; daily and total doses of gonadotrophin required for induction of ovulation.Results
The proportion of ovulatory cycles was significantly greater in the lean group (77%) compared with the obese group (57%) (χ2 9.8, P<0.001 ). Obese women required larger doses of gonadotrophin to achieve ovulation (P <0.001vs 48%) but miscarriage was more frequent in the obese group (60%vs 27%; P <0.05Conclusions
Moderate obesity in women with PCOS, treated with low dose gonadotrophin, is associated with an increased risk of miscarriage. This is reflected in the results of analysis of the effect of obesity on outcome of pregnancy in the general population. It is therefore important to encourage weight reduction in obese women with PCOS before considering therapy to induce ovulation.
Tập 99 Số 2 - Trang 128-131 - 1992
ADENOCARCINOMA OF THE BODY OF THE UTERUS Summary A series of 129 cases of adenocarcinoma of the uterus treated by Wertheim's hysterectomy and lymphadenectomy is reported. Preoperative radium was given together with postoperative irradiation when pelvic lymph nodes were involved in metastatic cancer. The five‐year survival was 71·5 per cent. This figure rose to 74 per cent when the growth did not involve the cervix. The incidence of lymph node involvement was 13·2 per cent, or 11·2 per cent when the cervix was free from growth. The incidence of node involvement was related to the degree of differentiation of the tumour and the depth of myometrial invasion. Thirty‐six per cent of patients with positive nodes survived 5 years when lymphadenectomy was combined with external radiation. When death occurred the metastatic deposits were usually outside the pelvis. It is concluded that lymphadenectomy need be performed only in patients with poorly differentiated and deeply invasive growth. Postoperative external irradiation is indicated if the nodes contain cancer.
Tập 77 Số 4 - Trang 343-348 - 1970
Screening for neural‐tube defects and maternal anxiety Summary. Anxiety levels were studied in 176 women with raised serum α‐fetoprotein levels at 16–18 weeks gestation, at the time they attended a central assessment clinic, and again 2–3 weeks later in those not found to have a fetus with a neural‐tube defect. Methods of imparting information about the serum screening tests and the manner in which a normal amniotic fluid result was conveyed to the patient were also studied. Overall, women attending the clinic for further assessment were extremely anxious, irrespective of the source of their information. Anxiety scores 2–3 weeks after testing were greatly influenced by whether the patient had been given a definite normal result or whether she was told to assume that the result was normal if she did not hear from the clinic. Patients who, after reassessment, did not require amniocentesis had some residual anxiety in spite of verbal reassurance.
Tập 89 Số 3 - Trang 218-221 - 1982
A double‐blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour Objective
Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour.Design
Double‐blind, randomised, placebo controlled.Setting
Leyenburg Hospital, The Hague, The Netherlands.Population
Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation.Methods
All women were included in early labour (2cm–4cm of cervical dilatation) and were allowed to drink at will.Main outcome measures
The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries.Results
Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29–6.54).Conclusions
Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.
Tập 109 Số 2 - Trang 178-181 - 2002
Feto‐maternal consequences of high‐dose glucose infusion during labour Summary. The effects on the fetus of high doses of glucose given to the mother in labour to correct maternal ketonuria were investigated. Three groups of patients were compared: one group received 1 litre of 10% (w/v) glucose intravenously over 1 h, the second group received 1 litre of 0.9% sodium chloride solution intravenously over 1 h and the final group had no supplementary infusion. It was observed that whereas glucose administration rapidly corrected maternal ketonaemia, there was a significant fall in pH and a rise in lactate in fetal blood. These effects were not observed in the other two groups. It was concluded that the use of high doses of intravenous glucose in labour should be avoided.
Tập 89 Số 1 - Trang 27-32 - 1982