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Fullerton G.,Aberdeen Maternity Hospital | Danielian P.J.,Aberdeen Maternity Hospital | Bhattacharya S.,University of Aberdeen
BJOG: An International Journal of Obstetrics and Gynaecology

Objective To assess the outcomes of pregnancy following postpartum haemorrhage (PPH) in the first pregnancy. Design Cohort study. Setting Aberdeen Maternity Hospital, Scotland, UK. Population All women with first deliveries recorded in the Aberdeen Maternity and Neonatal Databank (AMND) between 1986 and 2005. Methods All women identified from the AMND were classified into exposed and unexposed cohorts, according to whether or not they had PPH in their first delivery. They were then linked to any records of a second pregnancy. Main outcome measures Any second pregnancy, time to second pregnancy, early or late pregnancy loss, and prevalence of PPH in the second pregnancy. Results Out of 34 334 women, 10% had a PPH in their first pregnancy. There was no statistically significant difference in the time to a second pregnancy, nor in the outcome of that second pregnancy, between women who had experienced a PPH in their first pregnancy and women who had not. For women with a caesarean delivery, there was a significant reduction in the proportion conceiving again, comparing the exposed and unexposed cohorts. Conclusions From this cohort study we can conclude that if a PPH occurs in a first pregnancy, there is no delay in achieving a second pregnancy, and no detrimental effect on the outcome of that pregnancy. Significantly fewer women conceive a second pregnancy if they have a caesarean section in their first pregnancy that is complicated by PPH. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG. Source

Gibreel A.,University of Aberdeen | Bhattacharya S.,Aberdeen Maternity Hospital
Biologics: Targets and Therapy

Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for controlled ovarian hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in controlled ovarian hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes. © 2010 Gibreel and Bhattacharya. Source

Bhattacharya S.,Dugald Baird Center for Research on Womens Health | Prescott G.J.,University of Aberdeen | Black M.,Aberdeen Maternity Hospital | Shetty A.,Aberdeen Maternity Hospital
BJOG: An International Journal of Obstetrics and Gynaecology

Objective To examine the risk of recurrence of stillbirth in a second pregnancy. Design Retrospective cohort study. Setting Scotland, UK. Population All women who delivered their first and second pregnancies in Scotland between 1981 and 2005. Methods All women delivering for the first time between 1981 and 2000 were linked to records of their second pregnancy using routinely collected data from the Scottish Morbidity Returns. Women who had an intrauterine death in their first pregnancy formed the exposed cohort, whereas those who had a live birth formed the unexposed cohort. Main outcome measure Stillbirth in a second pregnancy. Results After adjusting for confounding factors, the odds of recurrence of stillbirth in a second pregnancy were found to be 1.94 (99% CI 1.29-2.92) compared with women who had had a live birth in their first pregnancy. Other factors associated with recurrence of stillbirth in a second pregnancy included placental abruption (adjusted OR 1.96; 99% CI 1.60-2.41), preterm delivery (adjusted OR 7.45; 99% CI 5.91-9.39) and low birthweight (adjusted OR 6.69; 99% CI 5.31-8.42). A Bayesian analysis using minimally informative normal priors found the risk of recurrence of stillbirth in a second pregnancy to be 1.59 (99% CI 1.10-2.33). Conclusions Women who have stillbirth in their first pregnancy have a higher risk of recurrence in their next pregnancy. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology. Source

Ruiz-Mirazo E.,Aberdeen Maternity Hospital | Lopez-Yarto M.,Autonomous University of Barcelona | McDonald S.D.,McMaster University
Journal of Obstetrics and Gynaecology Canada

Objective: To compare the effects of group prenatal care (GPC) and individual prenatal care (IPC) on perinatal health outcomes, including our primary outcomes of preterm birth (PTB < 37 weeks) and low birth weight (< 2500 g). Data Sources: We searched Medline, Embase, CINAHL, and the references of selected articles. Study Selection: Two reviewers independently performed each step of the systematic review. Of the 4178 non-duplicate titles and abstracts identified, 77 were selected for full-text review. An additional eight full-text articles were selected from reference lists. Overall, 85 full-text articles were reviewed. Studies included assessed maternal or infant health outcomes. Data Extraction and Data Synthesis: Two reviewers independently extracted data from eligible full-text articles. Statistical analyses were completed using Review Manager, version 5.0 (Copenhagen: The Nordic Cochrane Centre, Cochrane Collaboration, 2011), whereby dichotomous variables and continuous outcomes were analyzed using relative risk and mean difference, respectively. The random effects model was employed to pool data. Where available, adjusted data were used to assess the independent effect of GPC. Eight studies of mostly low quality (three randomized controlled trials and five cohort studies) were included, involving 3242 women, most at high risk. Women randomized to GPC had lower rates of PTB (RR 0.71; 95% CI 0.52 to 0.96), no difference in rates of LBW (RR 0.91; 95% CI 0.65 to 1.27) or IUGR (RR 0.85; 95% CI 0.61 to 1.19), fewer Caesarean sections (RR 0.80; 95% CI 0.67 to 0.93), and slightly higher rates of breastfeeding (RR 1.08; 95%CI 1.02 to 1.14). Conclusion: Studies comparing GPC with IPC are mostly of low quality and in high-risk groups, although two randomized studies, one a secondary analysis, showed improvement in some outcomes, including rates of PTB in women participating in GPC. In order to determine generalizability, more high-quality studies of GPC are needed. © 2012 Society of Obstetricians and Gynaecologists of Canada. Source

Pandey S.,Assisted Reproduction Unit | Shetty A.,Aberdeen Maternity Hospital | Hamilton M.,Assisted Reproduction Unit | Bhattacharya S.,University of Aberdeen | Maheshwari A.,University of Aberdeen
Human Reproduction Update

Background: Earlier reviews have suggested that IVF/ICSI pregnancies are associated with higher risks. However, there have been recent advances in the way IVF/ICSI is done, leading to some controversy as to whether IVF/ICSI singletons are associated with higher perinatal risks. The objective of this systematic review was to provide an up-to-date comparison of obstetric and perinatal outcomes of the singletons born after IVF/ICSI and compare them with those of spontaneous conceptions. Methods: Extensive searches were done by two authors. The protocol was agreed a priori. PRISMA guidance was followed. The data were extracted in 2 × 2 tables. Risk ratio and risk difference were calculated on pooled data using Rev Man 5.1. Quality assessment of studies was performed using Critical Appraisal Skills programme. Sensitivity analysis was performed when the heterogeneity was high (I2 > 50%). Results: There were 20 matched cohort studies and 10 unmatched cohort studies included in this review. IVF/ICSI singleton pregnancies were associated with a higher risk (95% confidence interval) of ante-partum haemorrhage (2.49, 2.30-2.69), congenital anomalies (1.67, 1.33-2.09), hypertensive disorders of pregnancy (1.49, 1.39-1.59), preterm rupture of membranes (1.16, 1.07-1.26), Caesarean section (1.56, 1.51-1.60), low birthweight (1.65, 1.56-1.75), perinatal mortality (1.87, 1.48-2.37), preterm delivery (1.54, 1.47-1.62), gestational diabetes (1.48, 1.33-1.66), induction of labour (1.18, 1.10-1.28) and small for gestational age (1.39, 1.27-1.53). Conclusions: Singletons pregnancies after IVF/ICSI are associated with higher risks of obstetric and perinatal complications when compared with spontaneous conception. Further research is needed to determine which aspect of assisted reproduction technology poses most risk and how this risk can be minimized. © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. Source

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