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Biomedical subjects

P A Poma

Publications and source records attributed to P A Poma.

At least 19 recordsLinked to original sources
PubMed2000

Effect of decreasing cesarean births on maternal age-, parity- and ethnicity-associated cesarean rates.

OBJECTIVE: To evaluate the effect of decreasing cesarean births on the rates associated with maternal age, parity and ethnicity. STUDY DESIGN: During 1991-1997, 14,689 women delivered at our community hospital, 2,945 by cesarean (20.0%). The clinical and demographic characteristics of these women and their newborns were studied. The data were divided according to maternal age, parity and ethnicity. As cesareans began to decrease in our service during 1994, the data were also divided into two groups: group 1 (1991-1993) and group 2 (1994-1997). chi 2 analysis was used to evaluate the differences between the proportions. A P value < .05 was considered significant. RESULTS: Maternal and perinatal outcomes and some demographic characteristics did not change, while cesarean rates decreased. As compared to group 1, cesarean birth rates decreased in group 2, from 22.5% to 17.9% (P < .0001). The decrease was significant in every maternal age-, parity- and ethnicity-related subgroup, except for women with parity > 4 (16.7% vs. 16.3%, P = .835) and those > or = 36 years old (31.6% vs. 30.9%, P = .798); for them, cesarean birth rate for breech presentation increased in group 2 (1.3-4.7%, P = .002). CONCLUSION: Cesarean birth rates can be reduced safely, and further studies should determine the factors associated with higher cesarean rates among older women.

Adolescent↗
PubMed2000

Rupture of a cesarean-scarred uterus: a community hospital experience.

Concerns that a scarred uterus may rupture during labor have contributed to increased cesarean rates. A previous cesarean has become one of the most common indications for abdominal birth. More women must deliver vaginally after cesarean if we are to reduce cesarean rates. This study evaluates the effect of decreasing cesarean rates and increased vaginal birth after cesarean (VBAC) rates on the incidence of uterine rupture in a community hospital. We studied data for women who delivered at our obstetrical unit from 1988 through 1997. During 1994 our department adopted strategies to reduce cesarean rates. Data from women who delivered from 1988 through 1993 (period A, before the policy change) were compared with data for those who delivered from 1994 through 1997 (period B, after the policy change) and evaluated by chi-square analysis. p < 0.05 was considered significant. The total cesarean rate decreased from 24.3% (period A) to 17.9% (period B) (p < 0.0001), whereas the primary cesarean rate decreased from 14.9% to 10.3% (p < 0.0001), and the repeat rate decreased from 9.4% to 7.6% (p < 0.0001). The VBAC rate increased from 13.0 to 28.6 (p < 0.0001), whereas the incidence of uterine rupture did not change. During the study period, the cesarean rate decreased while the VBAC rate safely increased. The incidence of uterine rupture remained unchanged.

Adult↗
PubMed2000

Nonsurgical management of genital prolapse. A review and recommendations for clinical practice.

The prevalence of genital prolapse increases with age. Because more women are living longer, genital prolapse will become even more common in our daily practices. Currently this complication is treated surgically, and there is minimal information about nonsurgical treatments. The National Library of Medicine was electronically searched for current information about the nonsurgical treatment of genital prolapse. This article summarizes the anatomic basis, the standard nomenclature, common symptoms and nonsurgical treatment of prolapse. Pessaries offer an alternative, even temporarily, to surgical therapy. Some women use a pessary on a long-term basis. There is no evidence in the literature that monthly follow-up improves outcome. Once fitted satisfactorily, women who wear pessaries need to be evaluated every three to six months.

Female↗
PubMed1999

Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience.

OBJECTIVE: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates. STUDY DESIGN: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant. RESULTS: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. CONCLUSIONS: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.

Adult↗
PubMed1999

Correlation of birth weights with cesarean rates.

OBJECTIVE: To determine whether birth weights correlate with cesarean indications and whether a decrease in cesarean rates affects this relationship. MATERIALS AND METHODS: During the 1991-1997 period, 14 689 women delivered at Ravenswood Hospital Medical Center, Chicago; 2945 by cesarean (20.0%). We studied birth weight groups (Group 1, < or = 2500 g; Group 2, 2501-4000 g; and Group 3, > 4000 g) according to the indication for cesarean delivery. Group 3 was divided into two subgroups (3a: 4001-4500 g, and 3b: > 4500 g). As cesarean rates decreased in our unit after 1994, we separated the data into two periods: A (1991-1993) and B (1994-1997). The differences between proportions were analyzed using the chi2 tables. A P < 0.05 value was considered significant. RESULTS: Two out of 10 women admitted to our unit were delivered by cesarean. Compared to Group 2 (average weight), rates for breech and 'other' indications were higher in Groups 1 and 3 (P < 0.001); the repeat cesarean rate was the lowest in Group 1. Rates for dystocia increased with birth weight. In Group 3, one out of four newborns (one out of three newborns > 4500 g in Subgroup 3b) had a cesarean birth, more than half of them for indications other than dystocia. Compared to Period A, Period B shows lower cesarean rates in Group 2 (21.4 vs. 16.4, P < 0.0001) and Subgroup 3b (35.4 vs. 26.1, P = 0.041). CONCLUSIONS: Birth weights affect cesarean delivery rates. Small and large newborns have more cesarean deliveries than those of average weight, whereas cesarean for dystocia increases with birth weights. Cesarean rates for non-reassuring fetal status are similar in all groups. A decline in repeat and cesareans for dystocia determined the lower total cesarean rate during the second period. and snhtetricrr

Birth Weight↗
PubMed1999

Vanishing forceps delivery.

This study evaluates the effect of decreasing cesarean rates and increasing regional anesthesia use on the frequency of forceps deliveries. Data of women who delivered at our community hospital from 1990 through 1997 are reviewed. In 1994, the members of our department adopted several strategies to decrease cesarean deliveries. The cesarean rate decreased whereas regional analgesia use increased. We studied the frequency and type of vaginal operative deliveries during this 8 year period. These data were evaluated by chi2 analysis. Data of women who delivered in the first 4 years (group 1) were compared with data of those who delivered in the second 4 years (group 2). A p < 0.05 was considered significant. The demographic and clinical characteristics of these women remained unchanged during the study period. The total cesarean rate decreased from 23.2% in group 1 to 17.9% in group 2 (p < 0.0001). The proportion of women who received regional anesthesia increased from 18.8 in group 1 to 25.7 in group 2 (p < 0.0001). Vaginal operative deliveries increased from 3.6 to 5.5 (p < 0.0001), whereas the proportion of forceps deliveries decreased from 2.2 to 1.5 (p = 0.001). Perinatal morbidity and mortality did not change. The decrease in cesarean rate and increase in regional anesthesia use were associated with an increase in operative deliveries; however, forceps deliveries continue to decrease in our community hospital.

Analgesia, Obstetrical↗
PubMed1999

Influence of maternal ethnicity on infant mortality in Chicago, 1989-1996.

This study compared infant mortality rates between large ethnic groups in Chicago from 1989-1996. Infant mortality information about ethnic groups was compared using data from annual reports published by the Epidemiology Program, Department of Public Health, City of Chicago and vital statistics documents in Illinois, which include information on ethnicity. Chi-squared analysis was used to evaluate the differences between the proportions. A P value of < .05 was considered significant. During the study period, there were 461,974 births and 6407 infant deaths in Chicago. African Americans contributed 212,924 (46.1%) births and 4387 (68.5%) deaths; Hispanics 132,787 (28.7%) births and 1166 (18.2%) deaths; and whites 99,532 (21.6%) births and 780 (12.2%) infant deaths. Compared with the other groups. African Americans suffered a twofold increased mortality (P < .00001) for five of the six most common causes of infant mortality. Deaths from congenital malformations, although significant, were not excessively increased among African Americans (P = .014). Hispanics demonstrated a higher mortality rate than whites (P = .01), especially for postnatal mortality and respiratory distress syndrome. These data confirm excessive infant mortality among African Americans. Further studies are needed to evaluate the apparent low mortality among some Hispanics compared with the other groups studied.

Black or African American↗
PubMed1999

Cervical ripening. A review and recommendations for clinical practice.

Cervical ripening occurs before the onset of labor. The cervix is metabolically active during ripening and passive during active labor. A ripe cervix indicates readiness for labor and predicts successful induction of labor. Practitioners evaluate cervical readiness for labor using the Bishop score. Membrane stripping, mechanical dilators and prostaglandins are ripening methods used frequently because they are simple, effective, efficient, safe and well tolerated. Stripping of membranes, a Foley catheter and misoprostol tablets are less expensive than other available methods. Because prostaglandins may cause excessive myometrial activity and even labor, hospitalization and fetal monitoring are recommended. Despite their effectiveness, these methods often do not decrease the cesarean section rates. This finding may be explained by the fact that each study reviewed only included a small number of patients and that in most cases, amniotomy was done and induction started, when feasible, before the women reached a Bishop score > or = 9. Larger studies may have different outcomes. The type of ripening methods used depends on the urgency of the situation; balloon catheters and prostglandins often act within 12 hours, while membrane stripping is less predictable.

Adult↗
PubMed1999

Effect of prenatal care on infant mortality rates according to birth-death certificate files.

Infant mortality has decreased nationwide; however, our national rates still log behind those of other industrialized countries, especially the rates for minority groups. This study evaluates the effect of prenatal care and risk factors on infant mortality rates in Chicago. Using linked infant birth and death certificates of Chicago residents for 1989-1995, a total of 5838 deaths occurring during the first year of life were identified. Birth certificate variables, especially prenatal care, were reviewed. Variables were compared by stratified analysis. Pearson chi 2 analysis and odd ratios (ORs) were computed. Infant mortality rate (IMR) in Chicago decreased from 17 in 1989 to 12.6 in 1995 (P < .0001). Some factors increased IMR several fold: prematurity (OR 17.43), no prenatal care (OR 4.07), inadequate weight gain (OR 2.95), African-American ethnicity (OR 2.55), and inadequate prenatal care (OR 2.03). Compared with no care, prenatal care was associated with lower IMR; however, early care was associated with higher IMR and ORs than later care. These results demonstrate prenatal care is associated with lower IMR; however, compared with late prenatal care, early care does not improve IMR. Further studies should evaluate whether improving the quality of care improves IMRs.

Adolescent↗
PubMed1998

Effect of departmental policies on cesarean delivery rates: a community hospital experience.

OBJECTIVE: During 1994, our department adopted several strategies in an attempt to decrease our cesarean delivery rates. This study evaluates the effect of these changes on our cesarean delivery rates. METHODS: We studied data of women who delivered at our community hospital obstetric unit over a period of 6 years, from January 1, 1991, to December 31, 1996. During 1994, our department adopted labor management and cesarean delivery guidelines, with review of every cesarean delivery that did not meet guidelines and confidential individual feedback; established 24-hour in-house coverage; and attempted to achieve the goal of an annual cesarean delivery rate of less than 15%. These data were evaluated by chi2 analysis. Women who delivered in the first 3 years (group A) were compared with those who delivered in the second 3 years (group B) (ie, when the changes occurred). P < .05 was considered significant. RESULTS: Groups A and B shared similar demographic characteristics. The total cesarean delivery rate decreased from 22.5% (group A) to 18.6% (group B) (P = .001), whereas the primary cesarean delivery rate decreased from 13.5% to 10.6% (P = .001) and the repeat cesarean delivery rate decreased from 9.0% to 7.9% (P = .03). The proportion of women who received oxytocin and regional anesthesia and underwent vacuum-assisted deliveries increased (P < .001), whereas perinatal mortality and morbidity did not change. CONCLUSION: The cesarean delivery rate safely decreased. These data suggest the importance of the commitment of attending physicians to a lower cesarean delivery rate, of service improvements, and of detailed feedback.

Adolescent↗
PubMed1998

Bilateral hip dysplasia. A case report.

BACKGROUND: Hip dysplasia affects 1% of newborns. Our health system screening begins at birth, and our educational system requires health screens at various ages, so physicians in this country rarely find an adult with an undiagnosed congenital condition. CASE: Bilateral hip dislocation was diagnosed on a 20-year-old, nulliparous woman who had just arrived from Puerto Rico. She tolerated her abnormal gait well, unaware of the condition of her hips. After an unremarkable prenatal course, she was admitted at term with ruptured membranes for stimulation of labor. She developed secondary arrest of labor, and a healthy, 3,180-g, female infant was delivered by cesarean. CONCLUSION: In hip dysplasia, early diagnosis (and therapy) prevents long-term consequences.

Adult↗
PubMed1998

Hemoperitoneum in a postmenopausal woman.

As the number of postmenopausal women increases, physicians will have more opportunities to treat elderly women with gynecological complications. This case report describes a 76-year-old, obese, multiparous woman, known to have gallstones who presented with acute abdomen complaints and was admitted for observation. Treatment was delayed until significant blood loss was recognized. At laparotomy, a ruptured ovarian granulosa cell tumor was found.

Abdomen, Acute↗
PubMed1996

Premature rupture of membranes.

The management of patients with premature rupture of membranes has changed markedly in the past several years. The basis for this is a combination of a better understanding of newborn physiology, improved neonatal care, refinements in antibiotic therapy, and the widespread use of maternal and fetal monitoring. The best outcome for both mother and infant undoubtedly reflects data based on a combination of factors, among which are gestational age survival, evidence of fetal distress, presence or absence of labor and sepsis, and of course, the cervical condition as it is related to labor-readiness. An important recent advance is the recognition that an active observation management program is associated with less morbidity and mortality than the classic management course of delivery within 12 hours of membrane rupture. The fact that preterm premature rupture of membranes tends to recur in subsequent pregnancies offers an opportunity for prevention. Moreover, advances in perinatal and neonatal care will continue to improve the outcomes of these women and their children.

Female↗
PubMed1987

Pregnancy in Hispanic women.

This article addresses some of the characteristics present among Hispanic women that may influence their course of pregnancy and their health in general.Many Hispanic people in the United States retain the customs and traditions of their country of origin. As a result, their use of preventive health care measures is lower than the majority of the population. Use of screening tests such as breast examinations and Papanicolaou smears are minimal among Hispanic women.Because of the tradition of paternalism among some in the Hispanic population, women are used to being told what to do, and as a result, they are hesitant to participate in their own health care. Physicians should be aware of the cultural differences and beliefs when treating pregnant Hispanic women. If these differences are understood and respected, the patient, in turn, will better respect the physician's opinion and advice.

Cultural Characteristics↗