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Risk Women (risk + woman)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Fetal fibronectin test predicts delivery before 30 weeks of gestation in high risk women, but increases anxiety

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2005
Andrew Shennan
Objective To assess efficacy of cervico-vaginal fetal fibronectin as a predictor of spontaneous preterm birth in a high risk antenatal population, and to evaluate the psychological impact of fetal fibronectin testing. Design An observational study. Setting The antenatal clinic at a tertiary referral hospital. Population One hundred and forty-six pregnant women with known risk factors for spontaneous preterm birth. Methods Women designated as ,at risk' for preterm delivery by clinical history were screened for fetal fibronectin at 24 and again at 27 weeks of gestation. Anxiety levels were assessed by questionnaire and compared with anxiety levels of 206 low risk women also tested for fetal fibronectin. Fetal fibronectin results were disclosed to the woman and her clinician. Main outcome measures Maternal anxiety and efficacy of the 24-week fetal fibronectin test to predict delivery before 30, 34 and 37 weeks of gestation. Results Maternal anxiety was higher pretesting in those at high risk compared with low risk women undergoing the test. Among the high risk women, anxiety was raised to clinically significant levels in those receiving a positive fetal fibronectin screening test result. In all women, 5%, 9% and 21% delivered <30, <34 or <37 weeks of gestation, respectively. Nine percent (n= 13) tested positive for fetal fibronectin at 24 weeks. Predictive power for fetal fibronectin (24 weeks) was greatest for delivery <30 weeks of gestation, with a likelihood ratio of 15 for a positive test (6/13 positive women delivered before 30 weeks). Conclusions Fetal fibronectin was most efficient as a predictor of preterm spontaneous delivery <30 weeks of gestation, but was associated with high levels of anxiety. [source]

Antenatal home blood pressure monitoring: a pilot randomised controlled trial

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2000
H. Ross-McGill Research Midwife
Objective To measure recruitment to, compliance with, and the acceptability of a trial designed to test whether a reduced schedule of antenatal visits combined with training in self-measurement of blood pressure at home may improve hypertension screening and save money. To test the specific hypothesis that even after taking into account extra unscheduled visits, the reduced schedule with ambulatory monitoring reduces total visits. Design A pilot randomised controlled trial. Setting Four urban and four rural general practices in Yorkshire and Lancashire. Population One hundred and five low risk women in the third trimester of pregnancy. Eighty women participated. Intervention Women were invited to participate at 24,28 weeks. Those who accepted were allocated either to a standard nine subsequent visit schedule (30, 32, 34, 36, 37, 38, 39, 40, 41 weeks) or to a reduced schedule (34, 38, 41 weeks). Those in the latter group measured their blood pressure weekly using a portable sphygmomanometer at home. Main outcome measures Recruitment, total number of clinic visits, frequency of blood pressure measurement, schedule preference, and anxiety. Results Although there were more unscheduled visits in the home monitoring group, this did not outweigh the reduction in scheduled visits, (total visits reduced from 7.4 to 4.5, P < 0.001), and blood pressure was measured during more weeks (9 vs 7 weeks, P < 0.001) in the experimental group. Most women expressed a preference for the reduced schedule both when the idea was first suggested, and after they had experienced it, and there were no significant differences in anxiety. Conclusion Replacement of antenatal screening visits with home blood pressure monitoring is acceptable to women. The reduction in clinic visits is not compensated by an increase in visits for other reasons and overall blood pressure measurement is omitted less often. Whether it reduces adverse outcomes or has any rare side effects will require a larger trial, but this pilot study indicates that it is likely to be safe, and that such a large trial would be feasible. [source]

Targeted group antenatal prevention of postnatal depression: a review

ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2003
M.-P. Austin
Objective:, To review the efficacy of antenatal group interventions aimed at reducing postnatal depression (PND) in ,at risk' women. Method:, Medline, Psyclit, HEALTHSTAR, EMBASE, Cochrane library, UK National Research Register and CINHAL searches were performed from 1960 to December 2001 focussing on randomized controlled trials (RCTs). Results:, As statistical synthesis of the studies was not feasible, a qualitative review is provided. All five studies reviewed suffer from substantial limitations including small numbers; unrealistic effect sizes; large attrition rates; lack of a systematic approach in identifying those ,at risk' and thus clinically heterogenous samples. Three of the studies used unvalidated interventions that were educational or supportive in approach. While one such study reported a benefit of intervention, the largest study using a structured intervention, reported no effect. A very small study using interpersonal therapy, was promising but needs replication with an adequate sample size. Conclusion:, There is currently little evidence from RCTs to support the implementation of antenatal group interventions to reduce PND in ,at risk' women. Further studies addressing the significant methodological limitations are recommended before concluding that antenatal targeted interventions have no place in maternity care. [source]

A Festschrift in Honor of Professor R.W. Smithells

BIRTH DEFECTS RESEARCH, Issue 4 2009
Mary Seller
This issue of Birth Defects Research Part A: Clinical and Molecular Teratology, comprises a Festschrift, a tribute to Professor R. W. (Dick) Smithells (1924-2002). In the 1970s, Dick initiated a study on the prevention of neural tube defects (NTD) by periconceptional multivitamin and folic acid supplementation of ,at risk' women. A significantly positive result was obtained,the first time that the primary prevention of any congenital malformation had ever been achieved. This important discovery stimulated an explosion of similar and related studies, and over the years, an extension of research into many closely allied but disparate fields. The papers in this Festschrift tell some of this story. However, the story itself has, as yet, no ending, because despite Dick's pioneering work and all our accumulated knowledge, the precise cause of NTD, and its mechanism, remains unknown. The authors contributing to this issue dedicate their work to the memory of Dick, and together with many other scientists, doctors and patients worldwide acknowledge and pay homage to his inspiration, industry and foresight. Birth Defects Research (Part A), 2009. © 2009 Wiley-Liss, Inc. [source]