Marion H. Hall

Diet in pregnancy and the offspring's blood pressure 40 years later

Objective To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life.

Quantifying severe maternal morbidity: a Scottish population study

Objective  To quantify the incidence of severe maternal morbidity in Scotland and determine the feasibility of doing so.

The repetition of spontaneous preterm labour

Summary. The likelihood of repetition of preterm birth after spontaneous onset of labour has been studied in 6572 reproductive careers after excluding stillbirths. multiple births. all careers in which any labour had been induced, and all careers in which the gestation length in any pregnancy was not certain. The analysis was controlled not only for pregnancy number, but for the nature of the reproductive outcomes. In most reproductive xqucnces thcrc was a weak correlation bctween the gestation in one pregnancy and subsequent ones. The risk of preterm birth was tripled after one previous preterm birth with or without a preceding abortion, and increased six‐fold after two previous preterin births. However, the attributable risk was low, and most multiparae with preterm births did not have a previous history.

Long term outcome by method of delivery of fetuses in breech presentation at term: population based follow up

Abstract Objective: To compare the long term outcome of infants delivered in breech presentation at term by intended mode of delivery. Design: A population based comparison of outcomes up to school age. Data obtained from maternity, health visitor, and school medical records and handicap register. Setting: Grampian region 1981-90. Subjects: 1645 infants delivered alive at term after breech presentation. Main outcome measures: Handicap, developmental delay, neurological deficit, psychiatric referral. Results: Elective caesarean section was performed in 590 (35.9%) cases. The remainder (1055; 64.1%) were intended vaginal deliveries. Handicap or other health problem was recorded in 269 (19.4%) of 1387 infants for whom records were available. Proportions of elective caesarean sections and intended vaginal deliveries in this group were 37.2% (100 cases) and 62.8% (169) respectively, almost the same as in the total cohort. There were no significant differences between elective caesarean section and planned vaginal delivery in terms of severe handicap or any other outcome measure. Case records were obtained for 23 of 27 infants with severe handicap. 11 (47.8%) were delivered by elective caesarean section. Of these, three had undiagnosed congenital abnormalities and seven were unexplained. Of the 12 (52.2%) planned vaginal deliveries, in only one was handicap possibly attributable to delivery and four cases were unavoidable even if elective caesarean section had been planned. Conclusion: In selected cases of breech presentation at term planned vaginal delivery with caesarean section if necessary remains as safe as elective caesarean section in terms of long term handicap. It was not possible to determine whether particular babies would have fared better had they been delivered by elective caesarean section. Key messages There is no reason for all fetuses in breech pres- entation at term to be delivered by elective caesar- ean section A prospective randomised trial is urgently needed to provide definitive evidence on the safest method of delivering fetuses in breech presentation at term

Taking folate in pregnancy and risk of maternal breast cancer

Taking folate before conception and then for the first three months of pregnancy reduces the risk of recurrence of neural tube defects,1 and fortification of food has been proposed. The effects of long term exposure to high concentrations of supplemental folate are unknown, and antimetabolite effects are theoretically possible.2 Data on the long term effects of increased folate intake in pregnancy are limited. We followed up a large trial of folate supplementation in pregnancy from the 1960s.3 4 We examined the association between folate status and death, and we also analysed the effects of folate supplementation. From June 1966 to June 1967, 3187 women were identified as potentially eligible for a trial of folate supplementation.3 4 At her booking visit, the mothers age, gestation, parity, weight, and blood pressure were recorded, and blood was taken to …

An investigation of women's involvement in the decision to deliver by caesarean section.

Objective To assess the degree and nature of womens involvement in the decision to deliver by caesarean section, and womens satisfaction with this involvement.

Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians.

Abstract Objective: To compare routine antenatal care provided by general practitioners and midwives with obstetrician led shared care. Design: Multicentre randomised controlled trial. Setting: 51 general practices linked to nine Scottish maternity hospitals. Subjects: 1765 women at low risk of antenatal complications. Intervention: Routine antenatal care by general practitioners and midwives according to a care plan and protocols for managing complications. Main outcome measures: Comparisons of health service use, indicators of quality of care, and womens satisfaction. Results: Continuity of carer was improved for the general practitioner and midwife group as the number of carers was less (median 5 carers v 7 for shared care group, P<0.0001) and the number of routine visits reduced (10.9 v 11.7, P<0.0001). Fewer women in the general practitioner and midwife group had antenatal admissions (27% (222/834) v 32% (266/840), P<0.05), non-attendances (7% (57) v 11% (89), P<0.01) and daycare (12% (102) v 7% (139), P<0.05) but more were referred (49% (406) v 36% (305), P<0.0001). Rates of antenatal diagnoses did not differ except that fewer women in the general practitioner and midwife group had hypertensive disorders (pregnancy induced hypertension, 5% (37) v 8% (70), P<0.01) and fewer had labour induced (18% (149) v 24% (201), P<0.01). Few failures to comply with the care protocol occurred, but more Rhesus negative women in the general practitioner and midwife group did not have an appropriate antibody check (2.5% (20) v 0.4% (3), P<0.0001). Both groups expressed high satisfaction with care (68% (453/663) v 65% (430/656), P=0.5) and acceptability of allocated style of care (93% (618) v 94% (624), P=0.6). Access to hospital support before labour was similar (45% (302) v 48% (312) visited labour rooms before giving birth, P=0.6). Conclusion: Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit. Key messages Key messages Care by general practitioners and midwives improved continuity of care: there were fewer carers, non-attendances, and hospital admissions, and marginally fewer routine visits than with specialist led shared care; incidences of hypertension, proteinuria, pre-eclampsia, and induction of labour were also lower Overall there were few deviations from the care protocol, but a greater proportion of Rhesus negative women in the general practitioner and midwife group did not have an appropriate check for antibodies The women in both trial groups were equally highly satisfied with all aspects of their care; only a small minority of women in the general practitioner and midwife group said they would have liked to have seen a hospital doctor but did not Although there was no net benefit from routine specialist antenatal visits, over half of women developed some complication during their pregnancy; in the general practitioner and midwife model of care, low risk women see a specialist when required and not at predefined routine visits

Assessment of patients with menorrhagia: How valid is a structured clinical history as a measure of health status?

A patient-administered questionnaire for menorrhagia based on the type of questions asked when taking a gynaecological history was developed and tested using the following steps: literature reviews, devising the questions, testing responses for internal consistency and test-retest reliability and validating the questionnaire by comparing patients scores with their responses to the SF-36 general health measure, and with family practitioner perceptions of severity. The main sample consisted of 351 women with menorrhagia, 246 referred to gynaecology ambulatory clinics and 105 from four large training practices in North-east Scotland. Following testing, two questions were discarded from the questionnaire. The final questionnaire demonstrated a good level of reliability and the resulting patient scores correlated significantly with their scores on the scales making up the general health measure. The questions asked in taking a clinical history from a woman with menorrhagia can be used to construct a valid and reliable measure of health status. This clinical measure may be a useful guide in selection for treatment and in the assessment of patient outcome following treatment.

Urinary tract injuries during obstetric intervention

A retrospective case record review of obstetric urinary tract injury in the Grampian region from 1976 to 1993 identified 16 cases of bladder injury (0.1 per 1000 deliveries, 1.4 per 1000 caesarean sections and four cases of ureteric injury (0.03 per 1000 deliveries, 0.27 per 1000 caesarean sections). Diagnosis of bladder injury was immediate, but of ureteric injury often delayed. Although the injury rates are lower than previously reported and previously reported risk factors not confirmed, this audit has resulted in guidelines for junior staff, compliance with which will be monitored, and every case of urinary tract injury will be reviewed.

Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data.

Objective To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications.