PubMed · 5550554
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W B MacDonald. 1971-04-03. Multiple rib fractures.. https://pubmed.ncbi.nlm.nih.gov/5550554/
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OBJECTIVE: To obtain descriptive data on deliveries performed by family physicians in Connecticut during 1 year. DESIGN: All family physicians in Connecticut who provided obstetric care were personally contacted to enlist their participation in a research network. All such physicians agreed to participate and were instructed to mail a 15-item delivery data card to the author following each delivery that they participated in during calendar year 1996. MAIN OUTCOME MEASURES: Method of delivery, use of obstetric intervention (eg, oxytocin administration, episiotomy, and epidural anesthesia), and obstetric consultation rates. RESULTS: Thirty-two physicians, representing 9.0% of the family practice workforce in Connecticut, provided obstetric care. These 32 physicians, who practice in only 7 of the 31 acute care hospitals in the state, delivered 478 neonates during 1996. Most deliveries were by the spontaneous vaginal route, with forceps and vacuum used in 2.1% and 5.0% of vaginal deliveries, respectively. The primary cesarean section rate of these family physicians was low at 5.6% compared with a statewide rate for all providers (physicians and certified nurse midwives) of 12.4% (odds ratio, 0.42; 95% confidence interval, 0.28-0.63). Rates of certain obstetric interventions, such as oxytocin administration, epidural anesthesia, and episiotomy, varied greatly by hospital. Obstetric consultation rates also varied greatly among hospitals, ranging from 12.8% to 49.6%. CONCLUSIONS: Family physician involvement in maternity care in Connecticut is low. This study confirms a low rate of instrument-assisted and cesarean delivery in births attended by family physicians. Use of obstetric interventions and obstetric consultation varies greatly within the state.
BACKGROUND: Fetal heart rate changes are common following regional analgesia during labour. Reduced uterine blood flow from maternal hypotension may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension. OBJECTIVES: The objective of this review was to assess the effects of prophylactic intravenous fluid preloading prior to epidural analgesia during labour on maternal and fetal well-being. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trial register and the Cochrane Controlled Trials Register were searched. Date of last search: December 1997. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing prophylactic intravenous preloading before epidural analgesia during labour with a control group (dummy or no preloading). DATA COLLECTION AND ANALYSIS: The reviewer assessed trial quality and extracted data. MAIN RESULTS: One study involving 102 women was included. There was potential for considerable bias in this trial. Preloading with intravenous fluids was associated with a reduction in hypotension (relative risk 0.07, 95% confidence interval 0.01 to 0.53). It was also associated with a reduction in fetal heart rate abnormalities (relative risk 0.36, 95% confidence interval 0.16 to 0.83). No differences were detected in other perinatal and maternal outcomes. REVIEWER'S CONCLUSIONS: There are methodological limitations in the only trial of preloading with intravenous fluids prior to epidural analgesia. However preloading may have beneficial fetal and maternal effects in healthy women. Further investigation of the risks and benefits of intravenous preloading for women with pregnancy complications is required.