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PubMed2000

Obstetric complications and schizophrenia. Two case-control studies based on structured obstetric records.

BACKGROUND: Most previous case-control studies of obstetric complications in schizophrenia have been small scale and many have relied on retrospective information. AIMS: To determine which obstetric complications are more common in probands with schizophrenia than matched controls. METHOD: Two hundred and ninety-six probands with an in-patient diagnosis of schizophrenia who had been born in Scotland in 1971-74, and a further 156 born in 1975-78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth. RESULTS: Not a single complication of pregnancy or delivery was significantly more common in the probands with schizophrenia than the controls in the 1971-74 birth cohort and only emergency Caesarean section and labour lasting over 12 hours were significantly more common in the schizophrenia probands in the 1975-78 cohort. CONCLUSION: The evidence that schizophrenia is associated with a raised incidence of obstetric complications is weaker than has recently been assumed.

Adolescent↗
PubMed2000

Obstetric complications and affective psychoses. Two case-control studies based on structured obstetric records.

BACKGROUND: Unlike schizophrenia, little interest has been taken in the incidence of obstetric complications in affective psychoses. AIMS: To find out whether obstetric complications are more common in affective psychoses than matched controls. METHOD: Two hundred and seventeen probands with an in-patient diagnosis of affective psychosis who had been born in Scotland in 1971-74, and a further 84 born in 1975-78, were closely matched with controls and the incidence of obstetric complications in the two compared using obstetric data recorded in a set format shortly after birth. RESULTS: Abnormal presentation of the foetus was the only complication significantly more common in the affective probands in the 1971-74 birth cohort and artificial rupture of the membranes was the only event more common in the probands in the 1975-78 cohort. Both are probably chance findings. CONCLUSION: It is unlikely that the incidence of obstetric complications is raised in people with affective psychoses of early onset.

Adolescent↗
PubMed1991

Ethics, an emerging subdiscipline of obstetric ultrasound, and its relevance to the routine obstetric scan.

Ethics is an emerging subdiscipline of obstetric ultrasound because there are clinical dimensions of obstetric ultrasound that only ethics can identify and address. These dimensions concern the ethical obligations of physicians to their patients. Ethics is defined as the disciplined study of morality. Two fundamental principles of ethics are described, beneficence and respect for autonomy. How ethics can bring to light clinical dimensions of obstetric ultrasound that are insufficiently appreciated is illustrated with the example of the routine use of obstetric ultrasound in the second trimester. The authors conclude that prenatal informed consent for sonogram should be an integral part of obstetric care in countries, such as the United States, in which routine ultrasound is not endorsed.

Beneficence↗
PubMed2001

Swedish midwives' care of women who are at high obstetric risk or who have obstetric complications.

OBJECTIVE: to describe how midwives experience the care of women who are at high obstetric risk or who have an obstetric complication during pregnancy, childbirth and early parenthood. DESIGN: a qualitative approach using a phenomenological method. PARTICIPANTS: 10 Swedish midwives, recognised as highly skilled clinicians with at least five years of clinical experience in the studied context, from four different hospitals. FINDINGS: the essence of midwifery when caring for women at high obstetric risk or with a manifested complication was defined as 'a struggle for the natural process'. Women's transition, physically as well as emotionally, during pregnancy, childbirth and early parenthood, was described as a genuinely natural process. The midwives' struggle consisted of encouraging and preserving this process within each woman. It was based on embodied knowledge and included a balancing between the medical and natural perspectives. Prerequisites, and therefore part of the struggle for the natural process, were sensitivity to the spontaneous, mutual interaction with the woman and enduring presence. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: the midwives' responsibility is to promote the natural process during pregnancy, childbirth and puerperium within every woman at high obstetric risk or with obstetric complications. The findings could serve as a basis for reflection on the professional role of midwives, and on the organisation of modern maternity care.

Adaptation, Psychological↗
PubMed2001

Management of obstetric emergencies and trauma (MOET): regional questionnaire survey of obstetric practice among career obstetricians in the United Kingdom.

Across specialties in the UK concern exists that the shortened training time, combined with the restriction on hours of work, will result in trainees being short of the necessary depth and breadth of experience for independent practice at the end of their defined training period. In terms of risk management, it is recognised that high reliability organisations anticipate the worst and equip themselves to deal with it at all levels in the organisation. Alternative methods of assessment and training need to be utilised, including models and scenario teaching. While it is important for clinicians to learn common skills well before practising on the labour ward, it is correspondingly more important that rare complications be rehearsed with models. In the UK, the MOET (Managing Obstetric Emergencies and Trauma) course has been developed to allow specialist obstetricians to learn, or revise, how to undertake procedures on models, and then to have their skills tested in scenarios. This survey aimed to ascertain the views of career obstetricians in terms of their ability to respond to some of the course scenarios and how frequently the rarest procedures have been undertaken. A one-page questionnaire with 15 questions, based on clinical scenarios taught on the MOET (Managing Obstetric Emergencies and Trauma), course was sent to all career obstetricians in the West Midlands region. Participants were asked to indicate whether they thought a particular management was 'good practice', 'bad practice' or 'good practice but would prefer a caesarean section' and to indicate the number of such procedures they had undertaken in their obstetric career. The response rate was 40% (97/243). There was a broad spectrum in obstetric views about 'good' and 'bad' practice. Overall the respondents agreed with the literature in terms of practices that are regarded as 'good' and 'bad'. A large proportion of respondents, however, would rather undertake a caesarean section than carry out a 'good' practice. Twenty-six obstetricians had experience in the rare obstetric procedures. Of these, 16 (66%) had worked outside the UK, either in the Middle East, South East Asia, Africa or the Caribbean. This survey highlights the need for training courses to teach and revise operative procedures.

Journal Article↗
PubMed1997

Observed versus expected obstetric complications: an assessment of coverage of obstetric care in developing countries.

The objective of this study was to evaluate access to obstetric care in a rural district in East Africa using easily collected and evaluated data and avoiding expensive field surveys, complicated study design or statistical methods. The number of observed obstetric complications occurring during 12 months in a rural East African district hospital (the only institution with surgical facilities and access to blood transfusion in the district) were compared to the number of expected complications the district should 'generate'. Of the expected > 10000 deliveries < 25% took place in the district hospital. The place of confinement for the other deliveries was not determined. As compared to the total number of expected conditions within the study district < 25% of the breech and < 45% twin deliveries took part in the district hospital and < 10% of pregnancies complicated by placental abruptions and < 5% of the pregnancies complicated by placenta praevia were managed in the district hospital. Comparing the number of serious pregnancy complications which were managed in the hospital to the total expected number for a particular region allows a simple assessment of the accessibility of obstetric care. This ratio might be more useful when evaluating obstetric care than traditional parameters as it stresses the importance of accessibility of care for the whole community.

Africa↗
PubMed1994

The advanced life support in obstetrics course. A national program to enhance obstetric emergency skills and to support maternity care practice.

Unexpected emergencies occur during routine maternity care. Perceived or actual deficiencies in training may decrease the quality of care and increase liability risks and anxiety among providers. This may lead the provider to discontinue obstetrics, which results in problems in access to care. To improve the training for obstetric emergency management, an Advanced Life Support in Obstetrics (ALSO) course was developed. This skill-enhancing course, modeled after other life support courses, is designed to improve the quality and availability of maternity care through standardized training in the management of emergencies and improved communication between maternity care providers. A total of 1315 physicians and nurses attended 35 ALSO courses from 1991 through 1993. Seventy-six percent were family physicians in practice; 20% were from rural areas. About 15% were in hospitals with no obstetricians or pediatricians on staff. Attendees reported a significant increase in their level of comfort in the management of obstetric emergencies and a greater intention to continue maternity care.

Adult↗
PubMed2000

Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study.

OBJECTIVE: This study was undertaken to determine the prevalence of mental disorders among obstetric-gynecologic patients and to assess the validity and utility of the PRIME-MD Patient Health Questionnaire (PHQ) in this population. STUDY DESIGN: A total of 3000 patients were assessed by 63 clinicians at seven obstetrics-gynecology outpatient care sites. The main outcome measures were PRIME-MD PHQ diagnoses, psychosocial stressors, independent diagnoses made by mental health professionals, functional status measures, disability days, health care use, and treatment or referral decisions. RESULTS: Current mental disorders were fairly prevalent, present in 1 in 5 obstetric-gynecologic patients. Patients with PRIME-MD PHQ diagnoses had more functional impairment, disability days, health care use, and psychosocial stressors than did patients without PRIME-MD PHQ diagnoses (P <.005 for all measures). Although most clinicians judged the PRIME-MD PHQ to be useful in management decisions, the questionnaire diagnosis of mental disorder rarely led to therapeutic intervention. CONCLUSION: The PRIME-MD PHQ is a useful instrument for the assessment of mental disorders, functional impairment, and recent psychosocial stressors in the busy obstetrics-gynecology setting.

Adolescent↗
PubMed1996

Obstetric complications and schizophrenia: a case control study based on standardised obstetric records.

BACKGROUND: There have been many reports of a higher incidence of 'obstetric complications' in the histories of schizophrenics than of controls, but because of the methodological shortcomings of most of these comparisons the relationship remains controversial. METHOD: Comprehensive records covering all psychiatric hospital admissions and all hospital deliveries in Scotland since 1971 made it possible to identify the obstetric records of people born in 1971-74 who were subsequently admitted to hospital with a diagnosis of schizophrenia, and then to compare their standardised obstetric records with those of closely matched controls. RESULTS: One hundred and fifteen schizophrenic/control pairs were compared. The former showed a highly significant (P < 0.001) excess of complications of both pregnancy and delivery. In particular, there was a significant excess of pre-eclampsia (10 v. 2) and of infants detained in hospital for neonatal care (18 v. 6). CONCLUSION: The raised incidence of obstetric complications often reported in people with schizophrenia is genuine and probably contributes to the aetiology of the condition.

Adolescent↗
PubMed1983

[Pregnancy, labor and perinatal outcome: comparison between an obstetric-pediatric multi center study of the Perinatal Preventive Medicine subproject of the National Research Council and clinico-statistic study in the second semester 1981 at the Obstetrics and Gynecology Clinic of Parma].

The data collected from women who delivered in the Institute of Obstetrics and Gynecology of the University of Parma since 1/7/81 till 31/12/81 were compared to those of the Obstetric-Pediatric Policentric Study of the Subproject of Perinatal Medicine sponsored by N.R.C. (National Research Council) collected since 1973 to 1977. The maternal wish of pregnancy and the total number of obstetrical controls during pregnancy were higher in the data of Parma than in the data of N.R.C. No differences between the two groups were noted in the obstetrical pathological patterns. Spontaneous labor and elective cesarean section are more frequent in Parma meanwhile there is a minor incidence of low weight newborn and perinatal mortality. No difference was noted in the preterm labor incidence.

Body Weight↗
PubMed1996

Information and concerns about obstetric anesthesia: a survey of 320 obstetric patients.

This study was undertaken to assess women's knowledge and concerns about obstetric anesthesia and to determine if they perceive a need for an anesthesia interview before the onset of labor. A 17 item questionnaire was distributed to 407 women on postpartum day one. The women were questioned about their knowledge, anxiety and concerns regarding obstetric anesthesia. The questionnaire was completed by 320 women, 57% of whom were Caucasian and 28% of whom had some postgraduate education. Most of the women (74%) had either a regional or general anesthetic for their delivery and 86% of the women admitted to having some anxiety about anesthesia. Although 82% of the women attempted to obtain information about anesthesia before labor, 28% did not feel adequately informed. The majority (59%) of the women would have wanted a preoperative visit with an anesthesiologist before labor. These results illustrate that most women are anxious about obstetric anesthesia and do not feel adequately prepared. Efforts at educating women about obstetric anesthesia would be welcomed by them and methods to accomplish this goal are discussed.

Journal Article↗
PubMed1988

[Pharmacokinetic, bacteriological and clinical studies of cefuzonam in the field of obstetrics and gynecology. Study group of cefuzonam in the field of obstetrics and gynecological infections].

A multi-center open study was conducted to investigate cefuzonam (CZON, L-105) regarding to its pharmacokinetic, bacteriological and clinical aspects in the field of obstetrics and gynecology with the participation of 31 medical institutions and the related facilities. The results are summarized as follows. 1. Peak MICs of CZON for Staphylococcus aureus, coagulase (-) staphylococci, Escherichia coli, Klebsiella pneumoniae, Bacteroides fragilis group, Peptostreptococcus spp. isolated from obstetrical and gynecological infections with relatively high frequencies were 0.39, 0.20, 0.024, 0.024-0.05, 12.5, 0.20 microgram/ml, respectively, with an inoculum size of 10(6) CFU/ml. 2. When 1 g of CZON was given through bolus injection, the maximum concentration (Cmax) of CZON in pelvic dead space exudate was 18.7 micrograms/ml at 60.9 minutes (Tmax) after the injection; Cmax's in all female genital tissues were observed at 0.6-27.9 minutes and ranged from 11.9-26.3 micrograms/g. The Cmax 8.3 micrograms/ml, in the pelvic dead space exudate was noted at 97.0 minutes after the end of the intravenous drip infusion of 1 g over 1 hour, and Cmax's in genital tissues were 14.3-30.0 micrograms/g at the end of infusion. With 1 hour drip infusion of 2 g, Cmax's in genital tissues were 35.0-53.9 micrograms/g at the end of infusion. 3. The clinical efficacy of CZON was evaluated in 206 evaluable patients with obstetric and gynecologic infections. Efficacy rates classified by types of infections were 97.1% (67/69) for intrauterine infections, 81.6% (31/38) for intrapelvic infections, 91.8% (45/49) for adnexitis, 95.2% (20/21) for infections of the external genital organs and 86.2% (25/29) for other infections. 4. Side effects were observed in 7 of the 262 patients: eruption in 6 cases, itching in 2, diarrhea in 1. Abnormal laboratory test values were noted in 9 of the 256 patients. Most of them were slight elevation of hepatic function values. CZON showed satisfactory clinical efficacy and potent antibacterial activity, hence it appears that CZON will be a very useful antibiotic for obstetric and gynecologic infections.

Bacterial Infections↗
PubMed1986

[Fundamental and clinical studies of imipenem/cilastatin sodium in the field of obstetrics and gynecology. Study group of imipenem/cilastatin sodium in the field of obstetric and gynecological infections].

Fundamental and clinical studies were performed by our study group to evaluate the usefulness of the combination (1:1) of imipenem (MK-0787), a carbapenem antibiotic, and cilastatin sodium (MK-0791), an inhibitor of dehydropeptidase-I, in the treatment of patients with obstetric and gynecologic infections. The following results were obtained. Antimicrobial activities of MK-0787 were tested with inocula of 10(6) cells/ml of organisms isolated from patients with obstetric and gynecologic infections. Peak MIC's of MK-0787 were less than or equal to 0.20 micrograms/ml for S. aureus, less than or equal to 0.20 micrograms/ml for S. epidermidis, 1.56 micrograms/ml for E. faecalis, 0.39 micrograms/ml for E. coli, less than or equal to 0.20 micrograms/ml for K. pneumoniae and less than or equal to 0.20 micrograms/ml for B. fragilis. When 0.5 g/0.5 g of MK-0787/MK-0791 was administered by a 30-minute intravenous drip infusion, maximum concentrations of MK-0787 in all female genital tissues were obtained at the end of the infusion, and Cmax ranged from 9.4 micrograms/g to 17.0 micrograms/g. In addition, the maximum concentration of MK-0787 in pelvic dead space exudate was 13.2 micrograms/ml at 88 minutes after the start of the infusion. The penetration of MK-0787/MK-0791 into female genital tissues and dead space exudate was found to be good and sufficient to cover MIC's against organisms isolated from patients with obstetric and gynecologic infections. Clinical efficacy was evaluated in 201 evaluable patients out of a total of 253 patients with obstetric and gynecologic infections. Clinical responses were excellent in 2, good in 181 and poor in 18 patients, and the efficacy rating was 91.0 percent. Efficacy ratings classified by types of infections were 93.2% (82/88) for intrauterine infections, 83.0% (39/47) for intrapelvic infections, 100% (26/26) for adnexitis, 90.0% (18/20) for infections of the external genital organs and 90.0% (18/20) for other infections. Side effects were observed in 6 of the 253 patients; rash in 4, nausea and vomiting in 1 and diarrhea in 1 patient. Abnormal laboratory findings were observed in 10 of the 253 patients; elevation of GOT, GPT, LDH and Al-P in 1, elevation of GOT, GPT and Al-P in 1, elevation of GOT and GPT in 4, elevation of GPT in 1, elevation of BUN in 1, increase of eosinophiles in 1, decrease of segmented neutrophils in 1 patient.

Adult↗
PubMed1993

The Hay's flexion rotation obstetric forceps: reestablishing relevance in modern obstetrics.

A prospective evaluation of 140 forceps deliveries with the Hay's flexion rotation obstetric forceps was undertaken over a 5-year period. The Hay's forceps was used for a variety of indications and included outlet forceps application in 35.7%, low or midforceps application in 29.3% with forceps rotation in 16.4%, 19.3% of applications for an aftercoming head and 19.3% applications at caesarean section. Outlet forceps deliveries had maternal and neonatal outcomes comparable with the Wrigley's short obstetric forceps. Midforceps applications were compared to the Simpson's long forceps, with maternal morbidity at 21% being significantly less, blade marks being the only neonatal morbidity and the Apgar scores being significantly higher with the Hay's forceps. Every forceps application at caesarean section resulted in an easy delivery. Thus the Hay's forceps with innovations such as parallelism and flexion potential could revalidate the role of the forceps in contemporary obstetrics.

Cesarean Section↗
PubMed1982

Survival of departments of obstetrics and gynecology: ten points for Association of Professors of Gynecology and Obstetrics action in the 1980s.

Major changes have occurred in medicine during the past few years: the number of medical students who graduate per year has recently doubled, the federal government pays a significant portion of health care costs, and the body of scientific information is expanding logarithmically. The changes which will occur during the next 10 to 15 years will be equally dramatic, and in order for our specialty to increase its presence and position in medicine, it needs to begin to consider these changes and take actions to capitalize on them. Four areas of change were singled out and discussed in terms of their significance and possible plans of action to address them. The four include the increased numbers of women in obstetrics and gynecology, the demand for departments to generate more practice income, the reduced support for research, and the large numbers of physicians being trained in obstetrics and gynecology. Ten places for action by academic departments of obstetrics and gynecology were outlined, and these are listed in Table III. Continued review of the past and the present will allow us to be prepared for the future.

Education, Medical, Graduate↗
PubMed2005

The essential elements of undergraduate medical education in obstetrics and gynecology: a comparison of the Association of Professors of Gynecology and Obstetrics Medical Student Educational Objectives and the National Board of Medical Examiners Subject Examination.

OBJECTIVE: The objective of this study was to investigate whether the essential elements of the Association of Professors of Gynecology and Obstetrics (APGO) Medical Student Educational Objectives were adequately represented on the National Board of Medical Examiners (NBME) obstetrics and gynecology subject examination, and that the topics questioned on that examination were covered by the APGO objectives. STUDY DESIGN: The Undergraduate Medical Education Committee of APGO and the NBME staff separately reviewed the same 2 NBME obstetrics and gynecology subject examinations. The questions were mapped to the 15 essential elements of the APGO educational objectives and comparisons were made to check how well they matched. RESULTS: All the essential elements of the educational objectives were covered by the NBME subject examination. Of the questions on the examination, 99% were deemed appropriate for medical students with 70% of the questions mapping to "Priority 1" objectives. CONCLUSION: The NBME examination provides an appropriate assessment of mastery of what a medical student should learn, as represented by the APGO Medical Student Educational Objectives.

Education, Medical, Undergraduate↗
PubMed2003

The University of Missouri Rural Obstetric Network: creating rural obstetric training sites for a university-based residency program.

This paper describes a rural obstetric experience that was developed for a university-based family practice residency program and designed to increase the number of deliveries per resident, the number of graduates practicing in rural areas, and the number of graduates doing obstetrics. Rural hospitals can be a source of deliveries for residency training programs. This rural obstetric experience also offers more training months in a rural setting and more months training with family physicians.

Family Practice↗
PubMed1988

[Development and responsibilities of clinical obstetrics and gyne- cology in the 19th century at the Greifswald University--a contribu- tion on the 110 year existence of the clinic of gynecology and obstetrics].

At the university of Greifswald clinical obstetrics developed at the beginning of the 19th century with priority for education of physicians and midwives. For further support of education in the middle of the century an obstetrical outpatients' department has been founded. Approximately at the same time gynaecological diseases were treated in both institutes so that the teaching combination obstetrics and gynaecology gradually came into existence and medical attendance and scientific work became more importance. There was a similar process at other German universities in the last century.

Germany↗