First trimester maternal blood rheology and pregnancy induced hypertension.

This study evaluates the relationship between the first trimester assessment of maternal rheology and the subsequent development of pregnancy induced hypertension. This is a prospective observational study based in the Glasgow Royal Maternity Hospital, Scotland. From an original population of 744 consecutive antenatal attendees a total of 579 women were booked at less than 14 weeks' gestation.

Audit can ensure the safe and effective introduction of seizure prophylaxis with magnesium sulphate in obstetric practice.

Objective: To audit the effectiveness and safety of intravenous magnesium sulphate therapy in severe pre-eclampsia.

Design: A complete audit cycle including the first eight cases receiving therapy, an intervention with staff instruction and the re-audit of eight further consecutive cases. The issues for audit were compliance with the protocol and the achievement and maintenance of therapeutic magnesium concentrations.

A complete audit cycle of intrapartum group B streptococcus prophylaxis.

Introduction: Group B Streptococcus (GBS) colonises the intestines of approximately one third of women and can result in intermittent colonisation of the vagina. The principal route of neonatal infection is from the vagina during delivery which can cause morbidity and mortality in the neonate. We recently introduced a protocol of intrapartum prophylaxis based on recognised risk factors.

Can cardiotocography prior to induction of labour predict obstetric intervention? A pilot study.

We set out to study the value of cardiotocography (CTG) performed before induction of labour for prolonged pregnancy in predicting obstetric intervention. This was a prospective observational study, based in a district general hospital. We studied 100 consecutive patients who underwent induction of labour for prolonged pregnancy.

Chorionicity determination in twin pregnancies: how accurate are we?

Objectives: To determine the accuracy of antenatal prediction of chorionicity in twin pregnancies in our institution.

Methods: Antenatal chorionicity was determined using the number of placental masses, the presence or absence of a twin peak sign and the fetal sex. The gestational age at assessment was documented.

Vaginal application of the nitric oxide donor isosorbide mononitrate for preinduction cervical ripening: a randomized controlled trial to determine effects on maternal and fetal hemodynamics.

Objective: Our aim was to assess the effects of vaginally administered isosorbide mononitrate (a nitric oxide donor) on maternal and fetal hemodynamics in pregnant women at term.

Study Design: We conducted a randomized controlled trial. Women were randomly selected to receive vaginally administered isosorbide mononitrate, 20 mg (n = 13) or 40 mg (n = 11), or to undergo a vaginal examination only (n = 12).

Interval between fetal measurements in predicting growth restriction.

Objective: To determine the influence of the interval between fetal measurements on performance of fetal growth velocity for predicting infants with anthropometric features of fetal growth restriction (FGR).

Methods: Two hundred seventy-four low-risk women had serial fetal biometry at scheduled intervals. Growth velocity of the fetal abdominal area for each was calculated with 2-, 4-, and 6-week scan intervals in which the second measurement was the last scan before delivery.

Using unconditional and conditional standard deviation scores of fetal abdominal area measurements in the prediction of intrauterine growth restriction.

Objective: To compare the performance of unconditional and conditional standard deviation scores (Z scores) of fetal abdominal area (FAA) measurements in the antenatal identification of infants born with anthropometric features of intrauterine growth restriction.

Methods: A prospective observational study, involving 274 low-risk women participating in a longitudinal study of serial ultrasound in pregnancy. Conditional Z scores were established for the last FAA prior to delivery with reference to measurements made both 28 and 56 days previously.

Antenatal use of enoxaparin for prevention and treatment of thromboembolism in pregnancy.

Objective: To assess the safety and efficacy of enoxaparin use for thromboprophylaxis or treatment of venous thromboembolism during pregnancy.

Design: Retrospective review of casenotes of women who received enoxaparin during pregnancy.

Setting: Obstetric Medicine Unit at Glasgow Royal Maternity Hospital.

Care of the woman with hypertension in pregnancy: the viewpoint of the midwife.

Key principles underpin good midwifery care of every pregnant woman, including a sound knowledge base, meeting the woman's needs and enhancing care. Normal antenatal care, with regular measurement of blood pressure, remains the mainstay of screening for hypertension in pregnancy. The midwife's role is that of accurate assessment and communication when detecting the first signs of hypertension.

Intramuscular opioids for maternal pain relief in labour: a randomised controlled trial comparing pethidine with diamorphine.

Objective: To compare the pain relief and side effects of intramuscular pethidine with intramuscular diamorphine in labour.

Design: Double-blind randomised controlled trial.

Setting: The labour ward in a UK teaching hospital.

Single and serial estimates of amniotic fluid volume and umbilical artery resistance in the prediction of intrauterine growth restriction.

Objectives: To determine whether single or serial estimates of both the amniotic fluid index (AFI) or pulsatility index (PI) of the umbilical artery Doppler waveform can usefully identify infants with anthropometric features of intrauterine growth restriction (IUGR).

Methods: A total of 274 women underwent serial antenatal ultrasound examinations at predetermined intervals. Four biophysical parameters were considered: AFI and PI prior to delivery and change in AFI and PI over a 28-day period in the third trimester.

Comparison of epidural bolus administration of 0.25% bupivacaine and 0.1% bupivacaine with 0.0002% fentanyl for analgesia during labour.

We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.

Shoulder dystocia.

Shoulder dystocia is an unpredictable and potentially serious obstetric emergency. By applying a recognized and rehearsed series of manoeuvres, maternal and neonatal morbidity can be minimized.

Puerperal thromboprophylaxis: comparison of the anti-Xa activity of enoxaparin and unfractionated heparin.

Low molecular weight heparins are used extensively for thromboprophylaxis. The aim of this study was to compare the activity of the low molecular weight heparin, enoxaparin, 20 mg and 40 mg, given once per day with unfractionated heparin, 7500iu given twice per day, in terms of their anti-Xa activity in puerperal women following caesarean section and with an additional risk factor for venous thromboembolism. Seventeen women were randomised to receive one of the three treatments.

The rise in caesarean section rate: the same indications but a lower threshold.

Objective: To investigate the reasons for the rise in caesarean section rate and note any change in indications.

Design: A retrospective, descriptive study comparing the years 1962 and 1992.

Setting: A large city centre teaching hospital.

Fetal growth velocity in the prediction of intrauterine growth retardation in a low risk population.

Objective: To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation.

Design: Prospective observational study.

Setting: Department of obstetric ultrasound, Ninewells Hospital, Dundee.