Showing papers by "Peter Brocklehurst published in 1996"

Clinical trials and rare diseases - Trials of adequate size are possible with the right organisation

Abstract: EDITOR,—Richard J Lilford and colleagues have opened the debate on the difficult problem of clinical trials in rare diseases with insight and clarity.1 We are concerned, however, that some of the messages conveyed in their article may be open to misinterpretation. Firstly, readers should not accept that a trial that is not powerful enough to provide a definitive answer is as good (that is, clinically useful) as one that is appropriately sized. There …

The Management of Recurrent Genital Herpes Infection in Pregnancy: A Postal Survey of Obstetric Practice

Abstract: Objective To determine clinical practice amongst bstetricians in the UK in the antepartum and intrapartum management of pregnant women with recurrent genital herpes infection. Methods All Members and Fellows of the Royal College of Obstetricians and Gynaecologists resident in the UK were sent a questionnaire requesting information concerning their management of pregnant women with recurrent genital herpes infection. Results There was a 76% response rate to the questionnaire. Of the 1201 obstetricians who responded, only 369 (31%) admitted to having a formal policy governing the management of herpes in pregnancy within their unit. However, regular screening was advocated by 718 (60%), of whom 463 (64%) performed regular antenatal swabs for viral culture. At the time of presentation in labour 974 obstetricians (81)routinely examined the genitals for evidence of a recurrence. When asked in what circumstances caesarean section would be considered an appropriate method of delivery in women with genital herpes infection, 1107 (92%) felt that visible active lesions at the time of labour was sufficient. However, when the membranes had been ruptured for more than four hours in the presence of genital lesions, only 678 (56%) considered this an indication for caesarean section. Caesarean section was more likely to be considered appropriate in this situation by obstetricians who performed antenatal screening (χ2= 30.38, P < 0.0001). Five hundred and ninety-six obstetricians (50%) felt that a positive viral culture obtained at antenatal screening from the most recent occasion prior to presentation in labour was an indication for caesarean section, although of this group 192 (32%) said they did not perform antenatal screening by viral culture. The reporting of a recurrence by the patient without visible evidence of disease was considered an appropriate indication for caesarean section by 438 respondents (36%). Maternal request for caesarean section regardless of recurrences at delivery was onsidered an acceptable indication for operative delivery by 745 obstetricians (62%). Conclusions 1. There seems to be little agreement amongst obstetricians in the UK regarding the management of recurrent genital herpes infection in pregnancy. 2. The management possibilities are reviewed and suggestions are made for a more cohesive approach to the problem.