Jane Thomas

Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and can also occur in the period following the procedure. To assess the efficacy of pharmacological and non-pharmacological interventions given prophylactically to prevent nausea and vomiting in women undergoing regional...

Prostaglandins have been used for induction of labour since the 1960s. Initial work focused on prostaglandin F2a as prostaglandin E2 was considered unsuitable for a number of reasons. With the development of alternative routes of administration, comparisons were made between various formulations of vaginal prostaglandins. To determine the effects o...

To examine the association between decision to delivery interval and maternal and baby outcomes. National cross sectional survey. Maternity units in England and Wales. SUBJECTS REVIEWED: 17 780 singleton births (99% of all births) delivered by emergency caesarean section in England and Wales between 1 May 2000 and 31 July 2000. Association between...

Background: Nausea and vomiting are distressing symptoms which are experienced commonly during caesarean section under regional anaesthesia and in the postoperative period. OBJECTIVES: To assess the efficacy of pharmacological and non-pharmacological interventions versus placebo or no intervention given prophylactically to prevent nausea and vomit...

Background: Prostaglandins have been used for induction of labour since the 1960s. This is one of a series of reviews evaluating methods of induction of labour. This review focuses on prostaglandins given per vaginam, evaluating these in comparison with placebo (or expectant management) and with each other; prostaglandins (PGE2 and PGF2a); differe...

The past three decades have seen considerable change in the understanding of clinical research methods. There has been an acceptance that RCTs are the best way of establishing treatment effectiveness and a recognition that, while single studies are useful, pooling knowledge from a complete body of work is likely to provide the best evidence. Advanc...

Background: Several systematic reviews compared recombinant gonadotrophin with urinary gonadotrophins (HMG, purified FSH, highly purified FSH) for ovarian hyperstimulation in IVF and ICSI cycles and these reported conflicting results. Each of these reviews used different inclusion and exclusion criteria for trials. Our aim in producing this review...

Various interventions are used as prophylaxis for aspiration pneumonitis in obstetric anaesthesia. This review, based on a Cochrane systematic review currently being updated, examines whether interventions given before caesarean section reduce the risk of aspiration pneumonitis. Twenty-two studies, involving 2658 women providing data in a usable fo...

Background Various interventions are used as prophylaxis for aspiration pneumonitis in obstetric anaesthesia. This review, based on a Cochrane systematic review currently being updated, examines whether interventions given before caesarean section reduce the risk of aspiration pneumonitis.

Background: Aspiration pneumonitis is a syndrome resulting from the inhalation of gastric contents. The incidence in obstetric anaesthesia has fallen, largely due to improved anaesthetic techniques and the increased use of regional anaesthesia at caesarean section. However, aspiration pneumonitis is still a cause of maternal morbidity and mortalit...

The rationale for antenatal breast examination has included the need to determine whether any problems with breastfeeding could be anticipated, using the time during examination as an opportunity for the healthcare provider to introduce and discuss the importance of breastfeeding, and for the detection of breast cancer during pregnancy. Despite the...

Background: Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been propos...

Rates of caesarean section are of concern in both developed and developing countries. We set out to estimate the proportion of births by caesarean section (CS) at national, regional and global levels, describe regional and subregional patterns and correlate rates with other reproductive health indicators. We analysed nationally representative data...

Background: Dilatation and effacement of the cervix are not only a result of uterine contractions, but are also dependent upon ripening processes within the cervix. The cervix is a fibrous organ composed principally of hyaluronic acid, collagen and proteoglycan. Hyaluronic acid increases markedly after the onset of labour. An increase in the level...

The role of corticosteroids in the process of labour is not well understood. Animal studies have shown the importance of cortisol secretion by the fetal adrenal gland in initiating labour in sheep. Infusion of glucocorticosteroids into the fetus has also shown to induce premature labour in sheep. Given these studies it has been postulated that cort...

To quantify the amount of variation in caesarean section (CS) rates between maternity units explained by case mix differences. Cross-sectional study. All 216 maternity units in England and Wales. Women giving birth at these maternity units between May and July 2000. Logistic regression models were developed to investigate the relationship between c...

Plain Language Summary Breast stimulation appears beneficial in relation to the number of women not in labour after 72 hours, and reduced postpartum haemorrhage rates. Breast stimulation causes the womb to contract, though the mechanism remains unclear. It may increase levels of the hormone oxytocin, which stimulates contractions. It is a non‐medic...

To assess the quality of care provided to women undergoing induced abortion. The design was a single round audit questionnaire aimed at the providers of abortion services throughout England and Wales (NHS hospitals, clinics under NHS, agency agreements and private units. The levels of care were assessed against agreed audit criteria. Responses were...

Prostaglandins have been used for induction of labour since the 1960s. Initial work focused on prostaglandin F2a as prostaglandin E2 was considered unsuitable for a number of reasons. With the development of alternative routes of administration, comparisons were made between various formulations of vaginal prostaglandins. This is one of a series of...

Editor—The clinical effectiveness support unit of the Royal College of Obstetricians and Gynaecologists has recently developed the guideline of the National Institute for Clinical Excellence (NICE) on the use of electronic fetal monitoring.1 One of the potential benefits of guidelines is to highlight gaps in research evidence. As part of the guidel...

In England and Wales, one in five pregnant women now have caesarean births (Thomas and Paranjothy, 2001). The National Sentinel Caesarean Section Audit (NSCSA) has been completed and findings were published in a report in October 2001. This was a vast study with data on demographic and clinical characteristics of over a 150000 women who gave birth...

Concerns about the rise in the number of caesarean sections (CS) and possible variation in rates between maternity units have been a matter of public debate. There has been a global increase in CS rates over the last 30years, the timing and rate of increase has differed between countries and international comparisons have been hindered by a lack of...

An evidence-based guideline produced by the RCOG with funding from the NHS Executive and the National Institute for Clinical Excellence (NICE).

Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The...

Evidence Based Clinical Guideline on the use and interpretation of cardiotocography in intrapartum fetal surveillance. Produced by the Clinical Clinical Effectiveness Support Unit of the Royal College of Obstetricians and Gynaecologists. With funding from the NHS.

Background: Castor oil, a potent cathartic, is derived from the bean of the castor plant. Anecdotal reports, which date back to ancient Egypt have suggested the use of castor oil to stimulate labour. Castor oil has been widely used as a traditional method of initiating labour in midwifery practice. Its role in the initiation of labour is poorly un...

The objective of this study was to compare the knowledge, attitudes, responses and levels of detection of domestic violence among a variety of healthcare workers in different specialities.Self-administered questionnaires were sent to community and hospital based healthcare workers in Oxfordshire working in primary care, obstetrics and gynaecology,...

Caesarean section rates have increased from 9% in 1980 to 15.5% in 1994-5 (NHS Maternity Statistics, 1997), the last year for which national data is available. There is no correct rate for caesarean section, but there is concern that the rate is rising. A consensus statement from the World Health Organization suggests there is no increase in health...

The role of prostaglandins for cervical ripening and induction of labour has been examined extensively. Human semen is the biological source that is presumed to contain the highest prostaglandin concentration. The role of sexual intercourse in the initiation of labour is uncertain. The action of sexual intercourse in stimulating labour is unclear,...

Dilatation and effacement of the cervix are not only a result of uterine contractions, but are also dependent upon ripening processes within the cervix. The cervix is a fibrous organ composed principally of hyaluronic acid, collagen and proteoglycan. Hyaluronic acid increases as pregnancy progresses, increases markedly after the onset of labour and...

The role of corticosteroids in the process of labour is not well understood. Animal studies have shown the importance of cortisol secretion by the fetal adrenal gland in initiating labour in sheep. Infusion of glucocorticosteroids into the fetus has also shown to induce premature labour in sheep. Some assumptions have been proposed regarding the mo...

Background: Relaxin is a protein hormone composed of two amino acid chains. The role played by relaxin in human pregnancy and parturition is unclear. Its use and involvement as a cervical ripening agent has been debated since the 1950s. Because the main source of human relaxin is the corpus luteum of pregnancy much of the early work on induction o...

The aim of this retrospective study was to compare the efficacy and complications associated with early medical and surgical pregnancy termination. The study population comprised 932 consecutive women undergoing pregnancy termination at gestations of 63 days or less. There were no age or parity differences between the study groups. Medical terminat...

Background: Studies in sheep showed that there is a pre-labour rise in oestrogen and a decrease in progesterone, both of these changes stimulate prostaglandin production and may help initiate labour. Though oestrogen has been suggested as an effective cervical ripening or induction agent, research in humans have failed to demonstrate a similar phy...

OBJECTIVE To determine whether the addition to tibolone to gondotropin-releasing hormone agonist (GnRHa) treatment for uterine leiomyomata reduces the hypoestrogenic side-effects without decreasing effectiveness. DESIGN Randomized, double-blind, placebo-controlled trial. The study had sufficient power to detect an absolute difference of 16% in chan...