S. W. Lindow

Domestic violence: prevalence and association with gynaecological symptoms

Objective  To determine the prevalence of domestic violence in a population of women attending a gynaecology outpatient clinic in the United Kingdom and also to investigate whether women who reported domestic violence were more likely to complain of certain gynaecological symptoms.

Inferior vena cava filter use in pregnancy: preliminary experience

Thromboembolism is the most common direct cause of maternal mortality in the UK. Inferior vena cava (IVC) filter placement is indicated in conditions where recurrent thromboembolism occurs despite adequate anticoagulation or when anticoagulation is contraindicated. The safety of IVC filter use in pregnancy is uncertain, as there are limited data available. In this study, we have reviewed pregnancy outcome in women with IVC filter use. Twelve pregnancies in six women, delivered in our hospital in the past 11 years, were identified from obstetric and radiology databases to have an IVC filter in situ. In four pregnancies, an IVC filter was placed during pregnancy. In eight pregnancies, an IVC filter was already in situ before pregnancy and continued for the entire duration of pregnancy. There were no antenatal complications noted due to IVC filter placement and no recurrent thromboembolism noted in pregnancies with an IVC filter in situ before conception. The mode of delivery was based on obstetric reasons in all cases. The mean birthweight was 2982 g, and all babies were born in good condition with Apgar scores within normal range. In conclusion, this case series did not identify any problems associated with IVC filter placement or continuation in pregnancy.

Symphysis pubis dysfunction: a review of the literature.

A review of the literature revealed a multitude of terms used to describe Symphysis Pubis Dysfunction (SPD). No unambiguous definition was found, rather the condition is described in terms of symptoms and signs. These occur due to the physiological pelvic ligament relaxation and increased joint mobility seen in pregnancy. The severity of symptoms varies from mild discomfort to severely debilitating pain. There appears to be no correlation between the degree of relaxation of the symphysis pubis and the level of pain and disability. Treatment is generally conservative and delivery is curative in the majority by 6 months post-partum. There is a need for standardisation of terminology, an agreed definition of SPD and a reliable means of assessment of the condition. Additionally there is a need for scientific evaluation of different forms of treatment.

The prevalence of occult obstetric anal sphincter injury following childbirth—literature review

Objective. To calculate the published prevalence of ultrasound-detected occult anal sphincter damage associated with different modes of delivery. Methods. A search of the English language literature for articles using keywords describing the prevalence of ultrasound-diagnosed anal sphincter injury following childbirth. The weighted mean prevalence of occult anal sphincter injury was calculated in the following groups: (1) primiparous women (unselected); (2) primiparous women after an unassisted normal vaginal delivery; (3) multiparous women (unselected); (4) following forceps delivery; (5) following ventouse delivery; (6) following cesarean section. Results. Nineteen articles described ultrasound-diagnosed occult anal sphincter injury. The prevalence in unselected primiparous women (excluding cesarean section) was 29.2% (288/983). After unassisted vaginal delivery in primiparae the prevalence was 21.7% (74/341). The incidence in multiparous women (unselected) is 32.3% (107/331); following forceps delivery 49.1% (131/267) and with ventouse delivery it is 45.2% (66/146). Only one woman (in 173 cases) had anal sphincter injury following cesarean section. Conclusions. After a review of the literature, occult anal sphincter injury is mostly associated with the first vaginal delivery and is particularly high following instrumental deliveries. Ventouse is less traumatic than forceps. Cesarean section is protective to the anal sphincter.

Maternal serum screening for Down syndrome: are women’s perceptions changing?

Objectives  To document trends in serum screening for Downs syndrome.

Neonatal outcome following maternal opiate use in late pregnancy

Objective: To determine the neonatal outcome in the form of use of morphine and triclofos to treat the neonatal abstinence syndrome following maternal opiate use in late pregnancy. Methods: Retrospective case study of 51 pregnancies associated with maternal opiate use between January 1992 and December 1997. Results: There were 51 pregnancies which resulted in 51 live births. In the third trimester 22 women took methadone only, 19 women used heroin and 10 women stopped opiate use during pregnancy. Babies of methadone using mothers were less likely to be treated with morphine or triclofos than heroin using women. Morphine, triclofos use was more common in high dose methadone users compared with low users. Conclusions: Successful methadone substitution compared with continued heroin use results in reduced morphine and triclofos use in the babies exposed.

The working relationship between midwives and junior doctors: a questionnaire survey of Yorkshire trainees.

Summary Recruitment to obstetrics and gynaecology has fallen dramatically over the last decade. Surveys of medical students and junior doctors have suggested that apart from work/life imbalance, other factors such as poor job satisfaction and an unfriendly environment can significantly affect the choice of career. We conducted a questionnaire survey for Yorkshire trainees to evaluate current working and professional relationships between junior doctors and midwives. A total of 68 trainees participated in the study. Some 22% of trainees found midwives to be disrespectful to and argumentative with junior doctors. A total of 69% did not get a chance to examine patients on the labour wards because of the midwives. Midwives when compared with consultants were less courteous towards trainees and 53% of trainees felt that there is a communication problem that needs to be addressed. Our study results suggest a high level of dissatisfaction among trainees of the Yorkshire region and point at an area that needs further work to bring about a change to a better work environment for future junior doctors.

The effect of maternal methadone use on the fetal heart pattern: a computerised CTG analysis

Using a computerised analysis, the cardiotocograph (CTG) from women who use methadone (n= 25) when compared with women who do not use methadone (n= 25) showed a significant reduction in the fetal heart baseline rate, with a significant reduction in number of accelerations and episodes of high variation. The short‐term variation, number of decelerations and episodes of low variation were not different between the two groups. The time taken to meet the standardised criteria was not different, and it is possible that a computer‐assisted CTG analysis could be more accurate than a naked eye interpretation.

Should we continue screening rhesus D positive women for the development of atypical antibodies in late pregnancy

Objective. The purpose of this study was to calculate the incidence of the new development of atypical antibodies (other than anti-rhesus D) in women attending for antenatal care, and to assess the clinical impact and cost-effectiveness of a second test to detect these antibodies. Method. A three-year retrospective analysis was undertaken to calculate the number of rhesus positive women who developed new antibodies in the last trimester of pregnancy. Results. Of 13 143 rhesus positive women, 20 (0.15%) developed new antibodies; fetal outcome was not compromised in any of these cases. Conclusion. Repeat testing in late pregnancy would appear an unnecessary expense in our population.

A comparative study of the prevalence of domestic violence in women requesting a termination of pregnancy and those attending the antenatal clinic.

To compare the prevalence of domestic violence (DV) in women requesting antenatal care (ANC) and termination of pregnancy (TOP) in North East England.