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The Walker project. Deirdre J Murphy University of Dundee. Overview. Walker cohort Epidemiology of operative delivery Forceps and epilepsy in adulthood Forceps and pelvic floor surgery Conclusions. Walker Cohort. Walker cohort. Dundee Hospital Birth cohort 1952-1966

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The Walker project


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the walker project

The Walker project

Deirdre J Murphy

University of Dundee

overview
Overview
  • Walker cohort
  • Epidemiology of operative delivery
  • Forceps and epilepsy in adulthood
  • Forceps and pelvic floor surgery
  • Conclusions
walker cohort4
Walker cohort
  • Dundee Hospital Birth cohort
  • 1952-1966
  • 75.4% of all births
  • City archives confirm representative
  • CH numbers identified
  • 21,915 current Tayside residents
  • Follow-up of babies 37-53 years
walker dataset
Walker dataset
  • Birth record cards
  • Predefined dataset
  • Parental demographics
  • Past obstetric history
  • Past medical history
  • Current pregnancy
  • Intrapartum care and outcome
  • Postnatal factors
record linkage
Record linkage
  • CHNo
  • MEMO 1993-2004
  • SMR 1980-2004
  • DARTS 1992-2004
  • GRO 1990-2004
slide8

Background

  • Rising caesarean section rate
  • UK - constant instrumental delivery rate
  • US – fall in instrumental delivery rate
  • Increasing preference for vacuum
  • Increasing preference for caesarean
balance of risks
Balance of Risks
  • Short-term versus Long-term
  • Maternal versus Fetal
  • Indication versus Procedure
forceps and epilepsy in adulthood

Forceps and Epilepsy in Adulthood

Murphy et al AJOG 2004 (In Press)

forceps and epilepsy
Forceps and Epilepsy
  • 21,441 babies
  • Record linkage to MEMO

All anti-convulsant prescriptions

  • Record linkage to SMR1

All hospital admissions with epilepsy

  • Sensitivity analysis excluding carbamazepine
hypothesis
Hypothesis

Does delivery by forceps increase the

baby’s risk of epilepsy in adulthood?

  • Assoc with neonatal encephalopathy
  • Assoc with trauma,intracranial bleed
  • Perinatal events assoc with first fit in adulthood

Badawi BMJ 98/Towner NEJM 99/Leone Neur Sc 02

results
Results

Forceps delivery 8.6%

Caesarean section 5.6%

Adult epilepsy 2.8%

risk factors
Risk factors

Family history OR 2.36 (1.72, 3.22)

Carstairs score OR 1.14 (1.04, 1.24)

Male gender OR 1.36 (1.03, 1.79)

forceps delivery
Forceps delivery

Forceps vs All other deliveries

OR 1.00 (0.56, 1.80)

Forceps vs SVD

OR 0.75 (0.18, 3.10)

* Preterm birth OR 1.95 (1.19, 3.19)

summary
Summary

Reassuring data on long-term

neurological consequences

of delivery by forceps

mode of del pelvic floor surgery
Mode of Del & Pelvic Floor surgery
  • Management of first pregnancy
  • Record linkage SMR1 (1980-2003)

All hospital admissions for PFR

  • 352 cases
  • 1408 controls
hypothesis27
Hypothesis

Does mode of delivery influence the

risk of pelvic floor surgery

in later life ?

  • Assoc between forceps delivery and increased risk of incontinence
  • Elective CS assoc with reduced risk of incontinence

Van Kessel AJOG 2001/MacLennan BJOG 2000/O’Herlihy 1999

results28
Results
  • Grand multiparity

OR 1.68 (1.22, 2.32)

  • Carstairs score

OR 0.83 (0.62, 1.10)

mode of delivery
Mode of delivery
  • Forceps vs SVD

OR 0.95 (0.71, 1.27)

  • Caesarean vs SVD

OR 0.40 (0.22, 0.72)

summary30
Summary

Forceps delivery appears to be no worse than SVD

Caesarean section appears to protect against pelvic floor surgery

even in the 50s!!

conclusions
Conclusions
  • Reassuring data on long-term neurological risk to infant following forceps
  • Caesarean section may protect against pelvic floor surgery
  • Walker cohort is a powerful resource
  • Further research
acknowledgement
Acknowledgement
  • Prof James Walker
  • Walker Group
  • Uma Ramalingam
  • Gillian Libby
  • Tenovus Scotland