Henry Murray

Foetal intrauterine growth restrictions with Helicobacter pylori infection

Background : Helicobacter pylori infection has been associated with growth restriction in young children.

Ectopic Pregnancy in Lower Segment Uterine Scar

Summary: A case of ectopic pregnancy in a lower uterine segment scar following previous Caesarean section is reported. A significant scar defect may result in deep implantation within the myometrium with the risk of persistent pain and bleeding followed inevitably by uterine rupture. In this report we discuss a number of management options. Except in the special situation of superficial implantation in a shallow scar defect where there is ultrasound evidence of continuity of the gestational sac with the uterine cavity we would strongly advise termination of the pregnancy.

A Randomized Clinical Trial Comparing Oral Misoprostol With Synthetic Oxytocin or Syntometrine in the Third Stage of Labour

Summary: This is a multicentre, blocked, randomized trial to compare the efficacy of oral misoprostol 400μg with current injectable uterotonic agents (oxytocin/Syntometrine) used prophylactically in the third stage of labour. Main outcome measures were blood loss, use of a second uterotonic agent and difference in haemoglobin level from antepartum to postpartum. Data analysis from 863 women showed a statistically significant increase in both the mean blood loss (p < 0.001) and the rate of postpartum haemorrhage > 500mL, (RR 2.72: 95% Cl 1.73–4.27) in the misoprostol group compared to the oxytocin/Syntometrine group. The use of a second uterotonic agent was higher in the misoprostol group (RR 2.89: 95% Cl 2.00–4.18) as well as a greater decrease in postpartum haemoglobin (p = 0.015). Oral misoprostol 400μg is significantly less effective than the traditional intramuscular uterotonic agents currently used and therefore cannot be considered as a viable option to these agents in the management of the third stage of labour.

The effects of azathioprine on birth outcomes in women with inflammatory bowel disease (IBD)

AIM To investigate the effects of azathioprine/6-mercaptopurine (AZA/6-MP) on birth outcomes in women with inflammatory bowel disease (IBD). METHODS Details of pregnant women with IBD were obtained through an ObstetriX Database in 3 major teaching hospitals in Sydney from 1996 to 2006. Medical records were reviewed. Birth outcomes of interest were single live births, low birth weight (LBW) at term (<2500 g), preterm births (<37 weeks gestation), neonatal adverse outcomes, and congenital anomaly. Placental blood flow during third trimester of pregnancy was measured using arterial Doppler ultrasonography, where available. RESULTS All women had IBD diagnosed before pregnancy. 19 births were exposed to AZA/6-MP. 74 births that were never exposed to AZA/6-MP were selected as controls. Preterm birth was seen in 26.3% of the exposed group as compared to 13.5% of controls (p<0.001). However, in univariate analysis, preterm birth was not associated with AZA/6-MP (OR=2.28; CI: 0.67-7.73). There was 1 neonatal adverse outcome in the exposed group as compared to 4 in controls (5.3% vs 5.4%, p=0.97). One congenital anomaly was seen in each group (p=0.27). No LBW at term was seen in either group. Placental blood flow in 4 women exposed to AZA/6-MP was normal. CONCLUSION The use of AZA/6-MP during pregnancy in IBD women was not associated with an increased risk of preterm birth, LBW at term, neonatal adverse outcomes and congenital anomalies.

Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy

Background:  Neonatal abstinence syndrome (NAS) occurs in more than 50% of infants exposed to intrauterine opiates. Maternal opiate dosing has been investigated with conflicting results.

Oxidative stress in the fetal lamb brain following intermittent umbilical cord occlusion: a path analysis

Objective To evaluate the relative contribution of cord occlusion length intervals between occlusions and experimental duration on oxidative stress in the fetal lamb brain.

Efficacy of oral sucrose in infants of methadone-maintained mothers.

Background: One report indicated that taste-induced analgesia was sub-optimal in methadone-exposed (ME) infants. Objectives: The purpose of this work was to compare the effects of oral sucrose in infants born to methadone-maintained mothers with control infants. Methods: The aim was to compare the effects of an oral sucrose solution in infants scheduled to have a heel lance procedure for routine newborn screening. Infants received 0.05 ml (one drop) of a 24% sucrose solution by mouth 2 min before a heel lance procedure, then a further 0.05 ml of sucrose at the time of the heel lance; this was repeated every 1–2 min until 30 s after the completion of the procedure. The primary outcome measure was pain. We assessed pain using the Premature Infant Pain Profile (PIPP), which is a validated composite pain assessment tool. Results: PIPP scores were similar in both infant groups. Median PIPP scores of the ME infant group versus the control infant group were 2.0 (interquartile range (IQR) 0–7) versus 2.0 (IQR 0–9) at the time of the heel lance (p = 0.99) and 2.0 (IQR 0–4) versus 1.0 (IQR 0–4) 30 s after the completion of the heel lance procedure (p = 0.28). Conclusions: This study found no differences in the pain responses of ME infants and non-exposed infants when given sucrose during heel lance procedures.

Transplacental haemorrhage may explain the intrapartum transmission of HIV. A pilot study uses flow cytometry to quantify maternal red blood cells in infants born vaginally or by caesarean section.

Intrapartum transmission is epidemiologically important for some viruses such as HIV and hepatitis B virus, but its precise mechanism is unknown. We hypothesised that the ability of elective caesarean section to prevent HIV may be due to prevention of transplacental microtransfusions of blood during labour. Their frequency is not known so we performed a pilot study which showed evidence of transplacental transfusion from mother to fetus in one of ten mother–infant pairs delivering vaginally and none of ten delivering by elective caesarean section. We conclude that transplacental transfusion occurs and is one possible mechanism for the intrapartum transmission of viruses from mother to baby.

Sickle cell disease in pregnancy

Homozygous sickle cell anaemia (Hb S) is the most common major haemoglobinopathy in the United States, occurring in approximately 1 in 626 African Americans. While haemoglobinopathies involving Hb S occur commonly in blacks of African descent, they are also found in people of Middle Eastern, East Indian and Mediterranean origin. It is an uncommon disease, especially in homozygous form, in Australia. We present the case of a woman in her third pregnancy, originally from Ghana, with HB F, and discuss the current issues in the management of sickle cell disease in pregnancy.

Validation of a Time Coherent Enhanced Averaging Technique for the Analysis of the Fetal Electrocardiographic Waveform

The objective of this study was to determine the accuracy of time coherent enhanced averaging (TCEA) as a technique of fetal electrocardiogram (ECG) waveform isolation. Four 130 day fetal lambs from mixed breed ewes were chronically cannulated. Comparisons between the raw ECG waveforms and waveforms isolated by TCEA were made following administration of a hypoxic gas mixture to the ewe or 1.6 μg isoprenaline intravenously to the fetus. The TCEA technique accurately detected rapid morphological changes associated with hypoxic bradycardia and isoprenaline induced tachycardia. Corruption of potentials and time constants due to the averaging process was minimal. P and T wave heights were the most affected with variable attenuation depending on the heart rate. Maximal attenuation was P wave 0.89 ± raw signal and T wave 0.85 ± raw signal. In conclusion, TCEA is a reliable technique for fetal ECG waveform isolation and analysis.