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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 100 (1993), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    BJOG 110 (2003), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To compare the prevalence of criteria suggesting acute intrapartum hypoxia in children with cerebral palsy who have and have not been the subjects of clinical negligence legal claims.Design Nested cohort study within a geographically defined cohort.Setting The former Oxfordshire Health Authority.Population Singleton children with cerebral palsy born between 1984 and 1993, excluding cases with a recognised postnatal cause for cerebral palsy.Methods Retrospective review of medical records by blinded observer.Main outcome measures Three ‘essential’ criteria defined by the International Cerebral Palsy Task Force which identify acute intrapartum hypoxia.Results One-fifth (27/138) of all singleton cerebral palsy children were the subject of a legal claim. The presence of all three criteria was significantly more likely to lead to a legal claim (P 〈 0.01), but in 74% (20/27) of claims, all three were not fulfilled and 36% (4/11) of those satisfying all three criteria did not claim. At least one of the three criteria was met in 82% (91/111) of the cases where there was no claim. Data on fetal or neonatal arterial blood gases were available in only 57% (78/138). Of the 27 claims, 12 were discontinued, 8 were settled and in 7 the legal process is still pending. The presence of the three essential criteria for acute intrapartum hypoxia did not increase the likelihood of a legal claim being settled.Conclusion The prevalence of the ‘template essential’ criteria is high in all cases of cerebral palsy. Although the presence of all three essential criteria was more likely in the claims group, this did not appear to influence the outcome of a claim. It remains to be seen whether the existence of the template leads to change in the pattern of decisions made by the courts.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK and Malden, USA : Blackwell Science Ltd
    BJOG 112 (2005), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  External cephalic version (ECV) reduces the incidence of breech presentation at term and caesarean section for non-cephalic births. Tocolytics may improve success rates, but are time consuming, may cause side effects and have not been proven to alter caesarean section rates. The aim of this trial was to determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt.Objective  To determine whether tocolysis should be used if ECV is being re-attempted after a failed attempt.Design  Randomised, double-blinded, placebo-controlled trial.Setting  UK teaching hospital.Population  One hundred and twenty-four women with a breech presentation at term who had undergone an unsuccessful attempt at ECV.Methods  Relative risks with 95% confidence intervals for categorical variables and a t test for continuous variables. Analysis was by intention to treat.Main outcome measures  Incidence of cephalic presentation at delivery. Secondary outcomes were caesarean section and measures of neonatal and maternal morbidity.Results  The use of tocolysis for a repeat attempt at ECV significantly increases the incidence of cephalic presentation at delivery (RR 3.21; 95% CI 1.23–8.39) and reduces the incidence of caesarean section (RR 0.33; 95% CI 0.14–0.80). The effects were most marked in multiparous women (RR for cephalic presentation at delivery 9.38; 95% CI 1.64–53.62). Maternal and neonatal morbidity remain unchanged.Conclusions  The use of tocolysis increases the success rate of repeat ECV and reduces the incidence of caesarean section. A policy of only using tocolysis where an initial attempt has failed leads to a relatively high success rate with minimum usage of tocolysis.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing
    BJOG 110 (2003), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine whether the reported association of maternal fever with neonatal encephalopathy is independent of other associated intrapartum risk factors.Design Prospective cohort study.Setting Dublin teaching hospital delivery ward.Population 4915 low risk women in labour at 36-41 weeks of gestation.Methods Using logistic regression with odds ratios and 95% confidence intervals, the incidence of neonatal encephalopathy and other neonatal outcomes of women who had an intrapartum fever 〉37.5° C was compared with those who did not.Results The cohort comprised 33% of all deliveries during the study period. Neonatal encephalopathy was diagnosed in 3.25/1000 births. The incidence of intrapartum fever was 6.8%. Maternal fever was strongly associated with neonatal encephalopathy (crude OR 10.8, 95% CI 4.0-29.3). Univariate analysis showed maternal fever was associated with epidural analgesia, nulliparity, induction, longer labour, oxytocin administration, greater fetal birthweight and gestational age and instrumental vaginal delivery, but not with prolonged (〉24hours) prelabour rupture of the membranes. The association of fever with neonatal encephalopathy persisted having adjusting for these covariates (adjusted OR 4.72, 95% CI 1.28-17.4).Conclusions The relationship between maternal intrapartum fever and neonatal encephalopathy is independent of other known intrapartum risk factors. This provides further evidence for the role of inflammatory processes in the aetiology of neonatal neurological morbidity.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    BJOG 106 (1999), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Although maternal choice increasingly influences intrapartum care, little is known about maternal attitudes about many outcomes and interventions, particularly the length of labor. Early amniotomy decreases the length of labor and particularly the frequency of prolonged (〉 12 hr) labor but is often avoided by health professionals. The objective of this survey was to assess the attitudes of women in a major Dublin teaching hospital about the length of labor, amniotomy, and epidural analgesia. Methods: An anonymous, structured, self-completed questionnaire was given to 438 women at their booking visit to the hospital antenatal clinic in February 1998. Participants could ring “agree,”“disagree,”“don't know,” or “don't care” to seven different statements. Results: The questionnaire was returned by 398 (92%) women; demographic details were similar to those for the overall hospital population. Of these, 73.5 percent of women wanted a quick labor; 82 percent wanted it to last less than 12 hours. Nearly one-half specifically wanted epidural analgesia. Only 13 percent wished to avoid amniotomy; significantly more multiparas disagreed with “avoiding amniotomy.” Conclusions: Many women want a quick and painless labor, and do not object to the interventions that help achieve this.
    Type of Medium: Electronic Resource
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