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  • 1
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To determine the nature and outcome of obstetric cholestasis in a United Kingdom population.Design Prospective analysis of clinical outcome in women diagnosed with obstetric cholestasis that is actively managed.Setting Antenatal population of three London hospitals between August 1999 and April 2001.Population Seventy women with obstetric cholestasis defined as abnormal liver function (one or more abnormality in gamma-glutamyl transpeptidase, alanine amino-transferase, aspartate amino-transferase and total bile acids) in a pregnant woman with pruritus, in the absence of other pathology.Methods All women were interviewed weekly regarding their symptoms. All were actively managed according to a standardised protocol, which included early delivery before 38 weeks. Obstetric outcome was recorded.Results Seventy women of mean age 30 (6) years delivered 73 infants. The median gestation at onset of pruritus was 30 (range 4–39) weeks and at diagnosis of obstetric cholestasis was 33.7 (range 21–40.7) weeks. Asian women were more likely to be diagnosed with obstetric cholestasis. Pruritus was usually severe and generalised, and commonly worst on the palms and/or soles of the feet. There were no stillbirths or perinatal deaths. Twenty-five women required caesarean section (36%); only four (16%) were for fetal distress. Twelve women (17%) delivered before 37 weeks, of which eight (67%) were iatrogenic. Ten (14%) infants required admission to the special care baby unit of which four (40%) were ventilated.Conclusions Policies of active management result in increased intervention and associated complications. This must be balanced against possible reductions in perinatal mortality.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective To establish the accuracy the Welch Allyn ‘Vital Signs’ blood pressure monitor in pregnancy and pre-eclampsia according to a modified British Hypertension Society protocol.Design Prospective observational study.Setting Maternity Unit/Obstetric Ward, Guy's and St Thomas' Hospital, London, UK.Population Forty-three pregnant women of whom 12 had pre-eclampsia.Methods Nine sequential same-arm measurements were taken from each woman by two trained observers, alternating between a mercury sphygmomanometer and the device. The last seven readings were analysed according to the British Hypertension Society protocol. The accuracy of the device was determined using the grading scale indicated by the British Hypertension Society protocol (grade A/B = pass, grade C/D = fail).Main outcome measures Grading criteria of the British Hypertension Society Protocol.Results The Welch Allyn ‘Vital Signs’ monitor achieved a grade A for both systolic and diastolic pressures in pregnant women who did not have pre-eclampsia. In those women with pre-eclampsia, it achieved a grade D and B for systolic and diastolic pressures, respectively. The mean differences between the observers and the device in women without pre-eclampsia were −2.6 (6.4) and −1.5 (7.2) mmHg for systolic and diastolic pressures [and in pre-eclamptic women −7.8 (6.3) and −5.5 (6.5)mmHg]. It therefore fulfils criteria set by the Association for the Advancement of Medical Instrumentation (mean 〈5 mmHg and standard deviation 〈8 mmHg) in pregnancy, but not in pre-eclampsia.Conclusion This is the first automated device suitable for robust clinical use that can be recommended for use in pregnancy. However, it should be borne in mind that—similar to other devices—it significantly under-recorded readings obtained in pre-eclamptic women.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Obstetric cholestasis is a liver disorder unique to pregnancy, which typically presents with pruritus. However, pruritus is common in pregnancy and the diagnosis of obstetric cholestasis is confirmed by finding abnormal liver function. We report 10 cases in which pruritus occurred before any abnormality in liver function tests (including total serum bile acids) and discuss the implications of this for clinical practice.
    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: Objective  To assess the accuracy of an automated blood pressure device (Microlife 3BTO-A) in pregnancy and pre-eclampsia according to the British Hypertension Society (BHS) protocol.Design  Prospective observational study.Setting  Antenatal ward and clinics at Guy's and St Thomas' Hospital, London, UK.Population  One hundred and five pregnant women including 35 women with non-proteinuric hypertension and 35 with pre-eclampsia.Methods  Two trained observers took nine sequential same-arm measurements from each woman. Measurements alternated between a mercury sphygmomanometer and the device.Main outcome measures  Grading criteria of the BHS protocol (A/B grade = pass; C/D grade = fail).Results  The device passed the BHS protocol by achieving an A/B grade. It also achieved criteria of the Association for the Advancement of Medical Instrumentation for systolic and diastolic pressures respectively, in normotensive [−0.5 (5.7) mmHg; −0.07 (7.7) mmHg], non-proteinuric hypertensive [−3.3 (6.9) mmHg; −2.4 (6.6) mmHg] and pre-eclamptic pregnancy [−4.1 (6.4) mmHg; −1.3 (7.9) mmHg].Conclusion  The Microlife 3BTO-A can be recommended for use in a pregnant population, including pre-eclampsia, according to the BHS protocol.
    Type of Medium: Electronic Resource
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