Respiratory distress syndrome in infants of Cardiff residents during 1965-75.

The incidence of respiratory distress syndrome (RDS) among singleton infants of Cardiff residents was greater during 1970-4 than in the preceding five years. This was consistent with changes in the distribution of gestational age and birth weight. Case fatality rates among infants with RDS fell only slightly during the period examined. Detailed examination of secular trends during 1965-75 suggested (a) that increased use of elective delivery without assessment of pulmonary maturity increases the risk of RDS, and (b) that innovations in the management of RDS during the early 1970s cannot be assumed to have had widespread impact on case fatality rates.     

Obstetric practice in the Oxford Record Linkage Study Area 1965-72.

The secular trends in induction in 111 818 births over eight years in the largely rural areas of Oxfordshire and west Berkshire were analysed. Although the induction rate started to rise only in 1969, the forceps and episiotomy rates had been increasing throughout, but both procedures were always twice as prevalent in induced as in non-induced cases. The proportion of women given an anaesthetic was also consistently higher in induced cases, but that of women with long labours fell considerably over the period. The reduction in stillbirth rate was more apparent in induced than in non-induced births.     

Obstetric outcome in homeless women.

OBJECTIVE--To characterise the pregnant homeless population booking and delivering at St Mary''s Hospital, London, and ascertain whether their obstetric outcome was adversely affected by their homeless condition. DESIGN--Retrospective comparison of demographic characteristics of 185 homeless women booking for delivery with those of housed women booking in the same period and with the population of North West Thames region; comparison of obstetric performance of homeless women with subgroup of the housed population (group matched for age, parity, and ethnic origin). SETTING--Consultant obstetric unit, St Mary''s Hospital, London. SUBJECTS--All women booking between April 1987 and March 1988 who subsequently had a registrable birth. MAIN RESULTS--185 (8%) Of the 2308 women studied were homeless. Compared with the housed population, they had a larger proportion of young women, women of high parity, and Indo-Pakistani women and a smaller proportion of primiparas. Homeless women booked later and had had more previous obstetric problems than housed women. Pregnancy outcome (assessed by birth weight and prematurity rates) was worse than that of both women housed locally and the regional population. Antenatal attendance, complications, intrapartum performance, and perinatal outcome of homeless women did not differ from those in the control group. CONCLUSIONS--This study has been unable to show any significant differences in the outcome of pregnancy in homeless women that can be directly attributed to living in bed and breakfast accommodation, but these women have sociodemographic characteristics and obstetric risk factors that contribute to a poorer outcome in pregnancy than for the general population.     

Changes in distribution of gestational age and birth weight among firstborn infants of Cardiff residents.

We studied data on firstborn singleton infants born to primiparous Cardiff residents during the decade 1965-1974. Both mean birth weight and gestational age at delivery fell appreciably during 1965-74. Changes in maternal age, height, smoking habits, or history of abortion did not explain these findings. The increased proportion of infants weighing less than 2500 g may be explained by the overall reduction in gestational age at delivery, which, in turn, may have resulted from increased use of elective delivery during the second quinquennium.     

The Liverpool urban obstetric flying squad: changing patterns of practice 1965-84.

Obstetric flying squads operate from most maternity units in the United Kingdom. The 20 years from 1965 to 1984 saw 860 calls being made to the obstetric flying squad in the Liverpool urban area, with striking changes occurring in both the number of calls made and the reasons for making the calls. Management of the problems encountered has now become almost exclusively conservative, with such procedures as blood transfusion and general anaesthesia being virtually eliminated from practice.     

Reversal of changes in distribution of gestational age and birth weight among firstborn infants of Cardiff residents.

Firstborn singleton infants born to primiparous Cardiff residents during the decade 1970-9 were studied. Both mean birth weight and gestational age at delivery rose during the period. Changes in maternal age, height, smoking habits, and history of spontaneous or induced abortion did not explain these findings. The decreased proportion of infants weighing less than 2500 g may be explained by the overall increase in gestational age, which in turn may have resulted from decreased use of induction of labour during 1975-9.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF(2alpha) (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.     

Oxidative stress early in pregnancy and pregnancy outcome

The objectives of this study were to determine whether oxidative stress early in pregnancy influenced pregnancy outcome. A combination of assays were used for exogenous and endogenous anti-oxidants together with two well accepted biomarkers for oxidative stress, the urinary excretion of 8-iso-PGF_2α (a biomarker marker for lipid oxidation, n=508) and 8-oxo-7,8 dihydro-2 deoxyguanosine (8-OHdG, a biomarker for DNA oxidation, n=487). The two biomarkers tracked different pregnancy outcomes. Isoprostanes were associated with an increased risk of pre-eclampsia and a decreased proportion of female births. In contrast, 8-OHdG tracked lower infant birthweight and shortened gestation duration. Birth defects were associated with low levels of 8-OHdG.     

Asthma deaths in Cardiff 1963-74: 53 deaths in hospital.

In a study of factors associated with death from bronchial asthma in hospital 53 patients were investigated. Typically the fatal attack persisted for several days before admission to hospital and normally occurred in patients with a long history of asthma. The patient or doctor often underestimated the severity of the attack. On admission most patients were severely ill, and over a third died within 24 hours. Peak flow rate and blood gases were rarely measured. Corticosteroid treatment was often underused, and patients rarely received assisted ventilation before death. Infection played a part in 14 deaths, five of them associated with assisted ventilation. Admitting asthmatics to a special respiratory ward with facilities for standardised assessment and treatment and introducing a self-admission service may help to prevent some of these deaths.     

Asthma deaths in Cardiff 1963-74: 90 deaths outside hospital.

In a detailed study of factors associated with death from bronchial asthma outside hospital 90 patients were investigated. The fatal attack was typically short and was most likely to occur in patients with a long history. Deaths often occurred before effective medical help was obtainable, but occasionally the patient or the doctor underestimated the severity of the attack. Patients especially at risk were those recently discharged from hospital after a previous attack. These deaths might be prevented by better patient education, a self-admission service for selected asthmatics, and by doctors using objective measurements of severity of asthma for the control of treatment. The underuse of corticosteroids is an important factor associated with death.     

Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice.

OBJECTIVE: To estimate the miscarriage rate in a cohort of pregnant women and the final outcome of pregnancy. DESIGN: Two year prospective community study. SETTING: Women registered with four semirural practices at one health centre. SUBJECTS: 626 pregnant women from a population 21448, 5140 of whom were women aged 15-44 years. MAIN OUTCOME MEASURES: Vaginal bleeding and outcome of pregnancy. Results: 76 of the 89 women with an unwanted pregnancy requested a termination. In the 550 ongoing pregnancies bleeding occurred before the 20th week in 117 (21%), and 67 (12%) ended in miscarriage. The risk of miscarriage was not significantly increased after a miscarriage in the previous pregnancy (11 (15%) women had miscarriage v 55 (12%) women who had not had miscarriage) who had previously had a live birth). Of the 117 women with bleeding, 64 were not admitted to hospital by the general practitioner; 42 of these women had an ultrasound examination at the health centre and 19 subsequently miscarried at home. In hospital 41 of 46 women who miscarried had evacuation of the uterus. CONCLUSIONS: Bleeding occurred in one fifth of recognised pregnancies before the 20th week and over half of these miscarried. Treatment of women with miscarriage at home means current statistics on miscarriage in Britain are missing many cases.