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Cauldwell M, Adamson D, Batia K, Bhagra C, Bolger A, Everett T, Fox C, Girling J, Head C, English K, Hudsmith L, James R, Johnson M, MacKiliop L, McAuliffe FM, Mariappa G, Orchard E, O'Brien M, Siddiqui F, Simpson L, Simpson M, Timmons P, Vause S, Wander G, Walker N, Steer PJ. Direct current cardioversion in pregnancy: a multicentre study. BJOG 2023. [PMID: 37039253 DOI: 10.1111/1471-0528.17457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld. DESIGN Retrospective cohort study. SETTING Seventeen UK and Ireland specialist maternity centres. SAMPLE Twenty-seven pregnant women requiring DCCV in pregnancy. MAIN OUTCOME MEASURES Maternal and fetal outcomes following DCCV. RESULTS Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV. CONCLUSIONS Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts.
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Affiliation(s)
- M Cauldwell
- Department of Obstetrics, Maternal Medicine Service, St George's Hospital, Blackshaw Road, London, UK
| | - D Adamson
- Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - K Batia
- Department of Obstetric Anaesthesia, St Mary's Hospital Manchester, Manchester, UK
| | - C Bhagra
- Department of Cardiology, Addenbrookes Hospital, Cambridge, UK
| | - A Bolger
- Department of Adult Congenital Heart Disease, Glenfield Hospital, Leicester, UK
| | - T Everett
- Department of Obstetrics, Leeds Teaching Hospitals, Leeds, UK
| | - C Fox
- Department of Obstetrics, Birmingham Women's and Children's Hospital, Mindelson Way, Birmingham, UK
| | - J Girling
- Department of Obstetrics, West Middlesex University Hospital, Isleworth, UK
| | - C Head
- Cardiology Department, Norfolk and Norwich University Hospital, Norfolk, UK
| | - K English
- Department of Adult Congenital Heart Disease, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Hudsmith
- Department of Adult Congenital Heart Disease, University Hospitals Birmingham, Birmingham, UK
| | - R James
- Sussex Cardiac Centre, University Hospitals Sussex, Brighton, UK
| | - M Johnson
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - L MacKiliop
- Women's Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - G Mariappa
- Department of Obstetrics, West Middlesex University Hospital, Isleworth, UK
| | - E Orchard
- Department of Cardiology, Oxford University Hospitals, Oxford, UK
| | - M O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - F Siddiqui
- Department of Obstetrics, Royal Leicester Infirmary, Leicester, UK
| | - L Simpson
- Department of Obstetrics, Edinburgh Royal Infirmary, Edinburgh, UK
| | - M Simpson
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - P Timmons
- Maternal Medicine Service, Norfolk and Norwich University Hospital, Norfolk, UK
| | - S Vause
- Saint Mary's Managed Clinical Service, Manchester University Foundation Trust, Manchester, UK
| | - G Wander
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
| | - N Walker
- Scottish Adult Congenital Cardiac Service, NHS Golden Jubilee, Clydebank, UK
| | - P J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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Mitchell AL, Ovadia C, Syngelaki A, Souretis K, Martineau M, Girling J, Vasavan T, Fan HM, Seed PT, Chambers J, Walters J, Nicolaides K, Williamson C. Re-evaluating diagnostic thresholds for intrahepatic cholestasis of pregnancy: case-control and cohort study. BJOG 2021; 128:1635-1644. [PMID: 33586324 DOI: 10.1111/1471-0528.16669] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis. DESIGN Case-control, retrospective cohort studies. SETTING Antenatal clinics, clinical research facilities. POPULATION Women with ICP or uncomplicated pregnancies. METHODS Serial TSBA measurements were performed pre-/postprandially in 42 women with ICP or uncomplicated pregnancy. Third-trimester non-fasting TSBA reference ranges were calculated from 561 women of black, south Asian and white ethnicity. Rates of adverse perinatal outcomes for women with ICP but peak non-fasting TSBA below the upper reference range limit were compared with those in healthy populations. MAIN OUTCOME MEASURES Sensitivity and specificity of common TSBA thresholds for ICP diagnosis, using fasting and postprandial TSBA. Calculation of normal reference ranges of non-fasting TSBA. RESULTS Concentrations of TSBA increased markedly postprandially in all groups, with overlap between healthy pregnancy and mild ICP (TSBA <40 μmol/l). The specificity of ICP diagnosis was higher when fasting, but corresponded to <30% sensitivity for diagnosis of mild disease. Using TSBA ≥40 μmol/l to define severe ICP, fasting measurements identified 9% (1/11), whereas non-fasting measurements detected over 91% with severe ICP. The highest upper limit of the non-fasting TSBA reference range was 18.3 µmol/l (95% confidence interval: 15.0-35.6 μmol/l). A re-evaluation of published ICP meta-analysis data demonstrated no increase in spontaneous preterm birth or stillbirth in women with TSBA <19 µmol/l. CONCLUSIONS Postprandial TSBA levels are required to identify high-risk ICP pregnancies (TSBA ≥40 μmol/l). The postprandial rise in TSBA in normal pregnancy indicates that a non-fasting threshold of ≥19 µmol/l would improve diagnostic accuracy. TWEETABLE ABSTRACT Non-fasting bile acids improve the diagnostic accuracy of intrahepatic cholestasis of pregnancy diagnosis.
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Affiliation(s)
- A L Mitchell
- Department of Women and Children's Health, King's College London, Guy's Campus, London, UK
| | - C Ovadia
- Department of Women and Children's Health, King's College London, Guy's Campus, London, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K Souretis
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Martineau
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London, UK
| | - J Girling
- Obstetrics and Gynaecology Department, West Middlesex University Hospital, Middlesex, UK
| | - T Vasavan
- Department of Women and Children's Health, King's College London, Guy's Campus, London, UK
| | - H M Fan
- Department of Women and Children's Health, King's College London, Guy's Campus, London, UK
| | - P T Seed
- Department of Women and Children's Health, King's College London, St Thomas' Campus, London, UK
| | - J Chambers
- Women's Health Research Centre, Imperial College London, London, UK
| | - Jrf Walters
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, London, UK
| | - K Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - C Williamson
- Department of Women and Children's Health, King's College London, Guy's Campus, London, UK
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Georgiadis G, Bonatsos V, Koulouris A, Girling J, Foroutan-Sabzevari H, Gupta S. Isolated peripheral nerve sheath tumour involving the urinary bladder neck. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415814528326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- G Georgiadis
- James Paget University Hospital, UK
- Maidstone & Tunbridge Wells NHS Trust, Maidstone Hospital, UK
| | | | - A Koulouris
- James Paget University Hospital, UK
- Norfolk and Norwich University Hospital, UK
| | | | | | - S Gupta
- James Paget University Hospital, UK
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Griffin M, Seed PT, Webster L, Myers J, MacKillop L, Simpson N, Anumba D, Khalil A, Denbow M, Sau A, Hinshaw K, von Dadelszen P, Benton S, Girling J, Redman CWG, Chappell LC, Shennan AH. Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height. Ultrasound Obstet Gynecol 2015; 46:182-190. [PMID: 25826778 PMCID: PMC4744762 DOI: 10.1002/uog.14860] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH). METHODS This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. RESULTS Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. CONCLUSIONS For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
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Affiliation(s)
- M. Griffin
- Women's Health Academic CentreKing's College LondonLondonUK
| | - P. T. Seed
- Women's Health Academic CentreKing's College LondonLondonUK
| | - L. Webster
- Women's Health Academic CentreKing's College LondonLondonUK
| | - J. Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | | | - N. Simpson
- Section of Obstetrics & Gynaecology, Institute of Biochemical & Clinical SciencesUniversity of LeedsLeedsUK
| | - D. Anumba
- Academic Unit of Reproductive and Developmental MedicineUniversity of SheffieldSheffieldUK
| | - A. Khalil
- St George's Hospital Medical SchoolUniversity of LondonLondonUK
| | | | - A. Sau
- University HospitalLewishamLondonUK
| | | | - P. von Dadelszen
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - S. Benton
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - J. Girling
- West Middlesex University HospitalIsleworthMiddlesexUK
| | - C. W. G. Redman
- Nuffield Department of Obstetrics and GynaecologyUniversity of OxfordOxfordUK
| | - L. C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUK
| | - A. H. Shennan
- Women's Health Academic CentreKing's College LondonLondonUK
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Touqmatchi D, Cotzias C, Girling J. Venous thromboprophylaxis in pregnancy: The implications of changing to the 2010 RCOG guidelines. J OBSTET GYNAECOL 2012; 32:743-6. [DOI: 10.3109/01443615.2012.711387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Diac M, Kenyon A, Nelson-Piercy C, Girling J, Cheng F, Tribe RM, Goodman J, Shennan A, Williamson C. Dexamethasone in the treatment of obstetric cholestasis: A case series. J OBSTET GYNAECOL 2009; 26:110-4. [PMID: 16483964 DOI: 10.1080/01443610500443246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Twelve women with obstetric cholestasis were given dexamethasone after failure to respond to ursodeoxycholic acid. Clinical improvement was achieved in eight cases, without complete resolution of symptoms. Biochemical response was achieved in seven cases. All but two cases had good correlation between clinical and biochemical response. Women of Asian and South American origin were more likely to respond to dexamethasone than Caucasians. There were no reported maternal or fetal side-effects. However, the subsequent consequences of dexamethasone treatment for the mother and fetus have not been thoroughly evaluated. Therefore, even in Asian and South American women, larger studies of dexamethasone are required before this treatment can be recommended as a universally safe and effective treatment for obstetric cholestasis.
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Affiliation(s)
- M Diac
- Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
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Abstract
We describe 2 cases of uterine compression suture without hysterotomy, only described once in the literature previously (Hayman et al. 2002). We consider in detail the suture material used for this technique and show photos of the compression suture at laparoscopy 4 weeks after insertion to demonstrate why it is inappropriate to use a non-absorbable suture. Modified compression sutures are being used increasingly and a wide variety of suture materials are being chosen, including vicryl, PDS and nylon (verbal communications). We feel it important to report our findings so that others can avoid the use of non or slowly absorbable sutures.
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Affiliation(s)
- C Cotzias
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10, UK.
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Sharma S, Fazal N, Girling J. Postpartum diagnosis of renal carcinoma in pregnancy: Important learning points. J OBSTET GYNAECOL 2008; 28:235-6. [PMID: 18393032 DOI: 10.1080/01443610801931352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S Sharma
- Department of Obstetrics and Gynaecology, Northwick Park Hospital NHS Trust
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Abstract
A 35-week pregnant 38-year-old woman presented with isolated thrombocytopenia (platelet count 4 x 10(9)/l). Investigations confirmed immune thrombocytopenic purpura, and she received treatment with prednisolone and intravenous immunoglobulins with no increment in the platelet count. At 37 and 38 weeks of the pregnancy, she received two doses of WinRho (anti-D immunoglobulin) at 50 microg/kg. Five days later, with a platelet count of 46 x 10(9)/l, she had an uncomplicated normal vaginal delivery. WinRho is a useful adjunct to other first-line treatment modalities for immune thrombocytopenia in pregnancy.
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Affiliation(s)
- K Sieunarine
- Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Middlesex, UK
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Kenyon AP, Dann AT, Girling J, Nelson-Piercy C, Williamson C, Tribe R, Shennan AH. Cord liver function and bile acids in actively managed obstetric cholestasis (OC) are not abnormal. J OBSTET GYNAECOL 2003. [DOI: 10.1080/713938725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
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.
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Affiliation(s)
- Anna P Kenyon
- Guy's, Kings' and St Thomas' Hospital School of Medicine, Maternal and Fetal Research Unit, St Thomas' Hospital, London, UK
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Kenyon AP, Piercy CN, Girling J, Williamson C, Tribe RM, Shennan AH. Pruritus may precede abnormal liver function tests in pregnant women with obstetric cholestasis: a longitudinal analysis. BJOG 2001; 108:1190-2. [PMID: 11762661 DOI: 10.1111/j.1471-0528.2003.00281.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- A P Kenyon
- Guy's, King's and St Thomas' School of Medicine, Maternal and Fetal Research Unit, St Thomas' Hospital, London, UK
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Girling J, de Swiet M. Maternal thyroid disease: a risk factor for newborn encephalopathy. BJOG 2001; 108:769-70. [PMID: 11467710 DOI: 10.1111/j.1471-0528.2001.00155.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Inherited thrombophilia is associated with an increased risk of thrombosis. Classically it consists of protein C and protein S deficiency, activated protein C resistance and antithrombin III deficiency. In pregnancy, in addition to thrombosis, inherited thrombophilia is associated with poor obstetric outcome, including recurrent miscarriage, late fetal loss, abruption and pre-eclampsia. Hyperhomocysteinaemia is a newly recognized cause of familial thrombophilia. It is likely that further causes such as prothrombin gene mutations will be added to the rapidly expanding list. The diagnosis of some forms of genetic thrombophilia must, however, be approached with caution during pregnancy, particularly protein S deficiency and activated protein C resistance.
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Affiliation(s)
- J Girling
- West Middlesex Hospital, Isleworth, UK
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Abstract
The antiphospholipid syndrome is the most common cause of acquired thrombophilia. For obstetricians, it is important because of its association with recurrent miscarriage as well as either venous or arterial thrombosis. The evidence linking anticardiolipin antibodies and the lupus anticoagulants with thrombosis will be examined, as will the diagnostic dilemmas which arise. Thromboprophylaxis, both during pregnancy and lifelong, as well as for gynaecological surgery, will be discussed, as will management options for women suffering from recurrent miscarriage.
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Affiliation(s)
- J Girling
- Department of Obstetrics, Northwick Park Hospital, Harrow, Middlesex, UK
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Girling J, de Swiet M. Predictors of neonatal encephalopathy in full term infants. More information needed about possible role of thyroxine. BMJ 1996; 312:580; author reply 580-1. [PMID: 8595310 PMCID: PMC2350302 DOI: 10.1136/bmj.312.7030.580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Elkind A, Girling J, Jones L. Community care. PASS (practice agreements with social services) notes. Health Serv J 1995; 105:30-1. [PMID: 10143682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Elkind
- Salford Family Health Services Authority, UK
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Peek MJ, Shennan A, Girling J. Cervical assessment and preterm delivery. Lancet 1994; 344:1374. [PMID: 7832890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Wollstein L, Girling J. Orthopaedic appliances for leprosy patients. The fixed ankle brace walker. LEPROSY REV 1971; 42:158-66. [PMID: 5151818 DOI: 10.5935/0305-7518.19710019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Girling J, Hameed MA, Selvapandian AJ, Fritschi EP. Further advances in special footwear and moulded soles. LEPROSY REV 1967; 38:103-6. [PMID: 6045739 DOI: 10.5935/0305-7518.19670019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Girling J, Hameed MA, Selvapandian AJ. Experimental moulded soles and shoe lasts. LEPROSY REV 1966; 37:103-7. [PMID: 5930237 DOI: 10.5935/0305-7518.19660019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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