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PubMedDate not supplied

[Masters of obstetrics in the area of Vojvodina in the 18th and 19th century].

The author reviews data about masters of obstetrics, physicians and surgeons nonphysicians, who worked in Vojvodina from the second half of the 18th till the beginning of the 20th century. They used to be the professional and time bridge as well as extremely important developmental link of continuity between the obstetrics of untrained and subsequently educated midwives and physicians gyneco--surgeons, later specialists gynecologists--obstetricians all as a part of integral discipline of gynecology and obstetrics in the area of Vojvodina. The existence of about 30 masters of obstetrics in the area of today's Vojvodina from the 18th to the 20th century, educated at medical faculties of Vienna, Budapest and Graz, points to the fact that obstetrics and gynecology in our regions in the 18th and especially 19th and 20th centuries, used to have similar, and somewhere identical trends and directions of development, like the obstetrics and gynecology of Central Europe of that time and that it used to be, just like it is today, a part of European gynecology and obstetrics.

History, 18th Century↗
PubMed1993

An assessment of obstetric services in Mississippi.

Seven hundred and six (80.6% response rate) obstetricians, family physicians, and general practitioners responded to a survey designed to elicit information regarding their obstetric practice. Results of the study were compared to a similar survey conducted in 1985. The proportion of obstetricians offering obstetric care has remained relatively constant since 1985. Among family physicians and general practitioners, however, there was a significant decrease in the proportion who practice obstetrics (p < .01), and a significant increase in the proportion who have discontinued obstetric practice in the last five years (p < .01) and who plan to discontinue obstetric care in the next five years (p < .05). Consistent with the 1985 data, cost of malpractice insurance, threat of litigation, and time demand were the three most frequently reasons for discontinuing obstetric care. Without changes in the current system, the provision of obstetric care in rural areas will continue its current dramatic decline.

Adult↗
PubMed1997

Critical care in obstetrical patients: an eight-year review.

OBJECTIVE: To review the clinical characteristics and outcomes of critically ill obstetrical patients and to determine the outcome predictability using the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. METHODS: A retrospective data collection of all obstetrical patients (n = 49) admitted for more than 24 hours to the Intensive Care Unit at Kwong Wah Hospital from 1988 to 1995 was conducted. Demographics, obstetric data, preexistent medical problems, diagnosis, days staying in the ICU and ICU related data were recorded for each patient. RESULTS: Obstetric admissions to ICU during the study period represented 0.12% of all deliveries during this period. There was a predominance of postpartum admissions and obstetric diagnosis responsible for the patients' critical illness. Massive postpartum haemorrhage was the single most common cause of ICU admission, representing 53.0% of all patients. Preeclampsia and eclampsia (14.3%), anaesthesia related complications (14.3%), and medical diseases complicating pregnancy (14.3%) were the other common disease categories for ICU admission. Two cases (4.1%) of surgical disease complicating pregnancy were admitted. The maternal mortality rate was 5.1 deaths per 100,000 total births, or 2 maternal deaths in 39,354 total deliveries in this study period. All deaths were due to nonobstetric causes. The perinatal mortality rate was 10.0% (5 cases) in this study group. CONCLUSIONS: When applying the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system in predicting the final outcome in this group of obstetric patients, we found that our obstetric patients requiring intensive care had a better outcome than predicted, as expressed by a low mortality ratio (0.25).

Adult↗
PubMed1976

[Frequency of obstetrical operations and perinatal mortality before and after admission of continuous fetal monitoring (author's transl)].

Two groups of obstetrical patients were statistically analyzed with a computer. The first group A (2339 deliveries, January 1967-June 1968) was controlled by conservative obstetrical methods, the second group B (2512 deliveries, January 1973-June 1974) was controlled by continuous monitoring of fetal heart rate and by analysis of fetal blood during labour. The results of the statistical analysis can be summarized: 1. The frequency of obstetrical operations (vacuum, obstetrical forceps, Caesarean section) increases from 12.8% (group A) to 22.5% (group B). 2. The percentage of Caesarean sections decided on for the sake of the child rose from 45.7% (group A) to 54.7% (group B). 3. Vital indications fell due to increasingly preventive obstetrics from 54.3% to 45.3%. 4. The frequency of Caesarean sections rose due to increasing indication "absolute or relative pelvic disproportion" of the mediterranean patients. 5. However the analysis of fetal blood during labour and the continuous monitoring of fetal heart rate has prevented a further increase of Caesarean sections. 6. The increasing percentage of obstetric forceps was due to our intention of preventing prolonged labour. 7. Maternal mortality after operative delivery reached 0.04% in group A and 0% in group B. 8. Perinatal mortality of children, delivered by operation, has decreased from 3.0% (group A) to 0,7% (group B). 9. The Apgar scores after operative deliveries were much better in group B (continuous fetal monitoring) than in group A (without fetal monitoring).

Apgar Score↗
PubMed1997

Critical care management of the obstetric patient.

PURPOSE: To review a series of critically ill obstetric patients admitted to a general intensive care unit in a Canadian centre, to assess the spectrum of diseases, interventions required and outcome. METHODS: A retrospective chart review was performed of obstetric patients admitted to the intensive care unit of an academic hospital with a high-risk obstetric service, during a five-year period. Data obtained included the admission diagnosis, ICU course and outcome. Daily APACHE II and TISS scores were recorded. RESULTS: Sixty-five obstetric patients, representing 0.26% of deliveries in this hospital, were admitted to the ICU during the study period. All had received prenatal care. Admission diagnoses included obstetric (71%) and non-obstetric (29%) complications. The mean APACHE II score was 6.8 +/- 4.2 and mean TISS score was 24 +/- 8.1. Twenty-seven patients (42%) required mechanical ventilation. No maternal mortality occurred and the perinatal mortality rate was 11%. CONCLUSIONS: A small proportion of obstetric patients develop complications requiring ICU admission. The outcome in this study was excellent, in contrast to that reported in other published studies with similar ICU admission rates. The universal availability of prenatal care may be an important factor in the outcome of this group of patients. The lack of a specific severity of illness scoring system for the pregnant patient makes comparison of case series difficult.

Adult↗
PubMed2006

Obstetric admissions to the intensive care unit: a 12-year review.

OBJECTIVE: The objective was to ascertain the prevalence, causes and outcome of critically ill obstetric patients admitted to the intensive care unit (ICU). DESIGN: The design was a retrospective collection of data. SETTINGS: The setting was a multidisciplinary ICU in a University hospital. PATIENTS: All obstetric patients admitted to the ICU over a 12-year period from May 1992 to April 2004 were reviewed. METHODS: Data collected included demographic characteristics of the patients, pre-existing medical conditions, obstetric complications, invasive procedures required in the ICU and outcome of the patients. RESULTS: The incidence of obstetric admissions to the ICU represented 0.22% of all deliveries during the study period. The majority (84.4%) of patients were admitted to the ICU postpartum. Obstetric haemorrhage (32.8%) and pregnancy-induced hypertension (17.2%) were the two main obstetrical reasons for admission. The remainder included medical disorders (37.5%) and other causes (6.2%). Associated major complications included adult respiratory distress syndrome (ARDS) and HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome. The perinatal mortality rate was 20% and the maternal mortality rate 9.4%. CONCLUSIONS: A team approach consisting treatment by obstetricians, intensive care specialists and anaesthesiologists provided optimal care for the patients. Improved management strategies for obstetric haemorrhage and hypertension may significantly reduce maternal morbidity.

Adult↗
PubMed2004

Animal models of obstetric complications in relation to schizophrenia.

Epidemiological studies have provided strong evidence that exposure to obstetric complications is associated with an increased risk for later development of schizophrenia. These human studies have now begun to tease out which specific pregnancy, labor/delivery or neonatal complications might confer greatest risk for schizophrenia. Animal modeling can be a useful tool to directly ask if a particular obstetric complication can actually cause changes in brain function or behavior resembling changes in schizophrenia. This review describes currently available animal models for some of the obstetric complications with greatest effect size for schizophrenia, including maternal diabetes, preeclampsia, infection and stress during pregnancy, intrauterine growth retardation and fetal/neonatal hypoxia. Where available, evidence that these types of obstetric complications in animals produce alterations in CNS function or behavior, related to features of schizophrenic pathology, is presented. Animal models might provide insights into the mechanisms by which specific obstetric complications have long-term influence on brain development leading to increased risk for schizophrenia. Factors common to several obstetric complications associated with schizophrenia may also be discerned. In this way, animal modeling may provide the framework for human studies to ask further more refined questions concerning the role of specific obstetric factors contributing to schizophrenia, and may provide clues to prevention.

Animals↗
PubMed1997

Community education to encourage use of emergency obstetric services, Kebbi State, Nigeria. The Sokoto PMM Team.

PRELIMINARY STUDIES: Focus group discussions and a mini-survey in Kebbi State, Nigeria, revealed poor knowledge of obstetric complications, lack of confidence in health services, and cultural barriers to seeking care. INTERVENTIONS: After upgrading services in emergency obstetric facilities, the team began community education to encourage utilization. Messages focused on recognition and need for prompt treatment of complications, and addressed men's role as decision-makers. Beginning in 1992, messages were disseminated through weekly meetings with community opinion leaders, video shows, posters and handbills. RESULTS: A post-intervention mini-survey showed knowledge gains of over 30% among women and men. The increase was greatest (59% increase among women and 55% among men) on the need for prompt care for women with obstetric complications. However, utilization of emergency obstetric services did not increase. At Maiyama Maternity Center, referrals declined from 18 in 1992 to four in 1995. At Jega Health Center, referrals remained relatively stable at 20-30/year, but the number of women with major obstetric complications treated declined from 234 in 1992 to 136 in 1995. At Birnin Kebbi Specialist Hospital, the referral center, the number of women with complications treated declined from 200 in 1990 to 152 in 1995. COSTS: The cost of community education was approximately US $9500, of which 15% was contributed by the community. CONCLUSIONS: Increased awareness of the signs of obstetric complications and the need for prompt treatment among community women and men did not result in greater utilization of emergency obstetric services at the facilities studied.

Community Health Services↗
PubMed2003

Microsatellite marker association at chromosome region 2p13 in Finnish patients with preeclampsia and obstetric cholestasis suggests a common risk locus.

The pathophysiology of preeclampsia is incompletely understood, but the familial nature of the disease has long been recognized. Recent genome-scan studies have indicated linkage at the p23 region of chromosome 2. We have previously reported microsatellite marker association at chromosome region 2p13 in patients with obstetric cholestasis. We conducted population-based association screening with microsatellite markers to find potential preeclampsia-associated loci on chromosome region 2p13-p12 and to test whether preeclampsia and obstetric cholestasis share a single risk locus. The study was carried out among 115 unrelated control women, 133 preeclamptic women and 57 cholestatic women. Screening with microsatellite markers at the 2p13-p12 region revealed that the marker D2S286 was significantly associated with obstetric cholestasis in the overall association analysis (P=0.03), while it revealed only borderline association with preeclampsia (P=0.08). However, single allele association analysis indicated that both preeclampsia and obstetric cholestasis showed a statistically significant association with a common allele (P < 0.05), which was overrepresented in both the obstetric cholestasis (0.42) and preeclamptic (0.37) groups when compared with the control group (0.28). In conclusion, These findings suggest a possible genetic link between chromosome region 2p13-p12, preeclampsia and obstetric cholestasis. More specifically, these data suggest that there may be a common risk locus associated with both obstetric complications located in the vicinity of the 2p13-p12 association region.

Alleles↗
PubMed2006

Obstetrical antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disease manifested by a thrombotic or obstetrical event in the presence of antiphospholipid antibodies. Obstetrical APS was initially described in the 1950s. Obstetrical features presently include recurrent pre-embryonic and embryonic miscarriage, fetal demise, preeclampsia, intrauterine growth restriction, and possibly placental abruption. Since the first description of obstetrical APS, researchers have unraveled some of the pathophysiology involved in the disease. At present, there are numerous antiphospholipid antibodies that can be measured in human serum, each of which requires evaluation with regard to whether an association with obstetrical events exists. Clinical trials have provided some insight into optimal treatment protocols, but to date, such trials are limited. On the basis of small, randomized trials, live birth rates of approximately 70 to 80% have been reported with the use of low-dose acetylsalicylic acid and heparin. Despite such encouraging results, ongoing pregnancies are fraught with maternal and fetal morbidity. This review will highlight the obstetrical morbidity associated with APS, discuss the limitations of the present criteria for diagnosis, appraise published treatment trials, and summarize directions for future study of obstetrical APS.

Abortion, Habitual↗
PubMed2006

Obstetric critical care: a blueprint for improved outcomes.

INTRODUCTION: Obstetric patients are generally young and healthy. However, the potential for catastrophic complications is real, and despite the therapeutic advances of the last few decades, maternal morbidity and mortality continue to occur. This may be related to the pregnancy itself, aggravation of a preexisting illness, or complications of the (operative) delivery. PURPOSE: The purpose of this review is two-fold: first, to provide an update on currently available reports pertaining to important critical care issues of the obstetric patient population and, second, to present current comprehensive treatment options for preeclampsia and massive obstetric hemorrhage because both are responsible for the majority of maternal mortality and morbidity worldwide. RESULTS: The most common reasons for intensive care unit admission are hypertensive disorders and massive obstetric hemorrhage. Timely delivery and prompt initiation of antihypertensive therapy for severe hypertension form the mainstay of care in preeclampsia. Restoration of circulating blood volume and rapid control of bleeding and impaired coagulation are the main factors in the management of massive obstetric hemorrhage. Puerperal morbidity has become the main topic of quality of care issues in maternity care. Although the Acute Physiology and Chronic Health Evaluation II score is commonly used in the intensive care unit, it does not seem to be appropriate for pregnant women because it overestimates their mortality rates. A high-dependency care unit suits the needs for at least half of the obstetric patient population in need of higher acuity care and will save considerable cost. CONCLUSION: Emphasis on early detection of maternal problems and prompt referral to tertiary centers with intensive care unit facilities to provide optimum care of the circulation, blood pressure, and respiration at an early stage could minimize the prevalence of multiple organ failure and mortality in critically ill obstetric patients.

Critical Care↗
PubMed2000

Obstetric risk factors for early-onset schizophrenia in a Finnish birth cohort.

OBJECTIVE: Although case-control investigations have shown an association between obstetric complications and schizophrenia, particularly among patients with early onsets, cohort studies have mostly failed to confirm this effect. The authors examined whether a history of fetal hypoxia and other obstetric complications elevated risk for early-onset schizophrenia in a 1955 Helsinki birth cohort. METHOD: The subjects were 80 randomly selected patients with schizophrenia (36 with early and 44 with later onsets) representative of all available probands in the cohort, 61 of their nonschizophrenic siblings, and 56 demographically matched nonpsychiatric comparison subjects. Psychiatric diagnoses were obtained from structured clinical interviews, and obstetric data were taken from standardized, prospectively ascertained obstetric records. A score for hypoxia-associated obstetric complications was entered into logistic regression models, along with measures of prenatal infection and fetal growth retardation. RESULTS: Hypoxia-associated obstetric complications significantly increased the odds of early-onset schizophrenia but not of later-onset schizophrenia or unaffected sibling status, after prenatal infection and fetal growth retardation were taken into account. CONCLUSIONS: These findings support an association between obstetric complications and increased risk for early-onset schizophrenia. The authors advance a model whereby the neurotoxic effects of fetal hypoxia may lead to an early onset of schizophrenia due to premature cortical synaptic pruning.

Adult↗
PubMed2002

The knowledge of obstetric complications among primigravidae in a rural health centre in the district of Blantyre, Malawi.

UNLABELLED: An informed individual is better placed to make reasonable decisions. It is therefore of vital importance that women be knowledgeable about obstetric complications to enable them to respond appropriately to complications that may arise. This study aimed to explore primigravidae's knowledge of obstetric complications. A descriptive study design was used to determine what knowledge primigravidae had of obstetric complications. Recognition of obstetric complications in pregnancy, during labour and after delivery and actions that participants would take if they developed any complications in pregnancy and after delivery were explored. Participants' actions were not sought for problems faced during labour because the researcher felt the participants would have little control of the situation with regard to choice during labour. METHODS: Participants were selected by means of purposive sampling from a population of pregnant women who fitted defined criteria attending antenatal clinic at a health centre. Thirty-three primigravidae from the rural setting with a gestation period between 28 and 42 weeks were interviewed. RESULTS: The findings showed that participants were more aware of obstetric complications that could occur in pregnancy than of complications that may occur during and after delivery. Participants had limited knowledge of complications that may need immediate treatment during all three periods. Eighty-two percent (95% ci: 67-96) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with pregnancy complications. Sixty-one percent (95% ci: 42-79) of the primigravidae had knowledge and could make an informed decision to go to a health facility with complications after delivery. These findings have critical implications for the provision of information on obstetric complications. The information given should cover all three periods, with emphasis on those obstetric complications that require immediate treatment.

Adolescent↗
PubMed2004

Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention.

The Forensic Medicine Association was established in Turkey by law number 2659 for the purpose of providing expertise in legal cases. In this study the opinions given by the lawcourts and public defenders in the Forensic Medicine Association's First, Second, Third, and Fifth Specialization Divisions between the years 1990 and 2000 (approximately 680,000 files) were examined retrospectively. It was determined from these that there were 636 cases of medical malpractice. In examining the distribution of cases based on specialty branch, it was established that 16.82% (n=107) were in the area of obstetrics and gynecology, 10.69% (n=68) in general surgery, 10.53% in neurology and neurosurgery, and the remaining areas were found to be at lower percentages. It also showed that in recent years there has been an increase in the number of cases claiming medical malpractice in the area of obstetrics and gynecology, and that 58% of the cases (n=62) from 1998 to 2000 were in this area. 96% of the 107 cases that claimed malpractice in the area of obstetrics and gynecology were found to be related to obstetrics and 3.8% (n=4) to gynecology and surgical procedures. In 31% (n=33) of the 107 cases fault was found; all of the cases where medical malpractice was found were in the area of obstetrics and none of the cases related to gynecology were found to have an element of error. Cases that had an element of error were evaluated from the aspect of profession of the health care personnel at fault, areas of fault, places where fault occurred, situations that resulted in death, cause of death, whether or not an autopsy was done, injury that resulted from fault, intervention that was done, and obstetric and gynecologic risk factors that set the stage for claims. Care standards and breach of standards were examined.

Autopsy↗
PubMed2004

Compliance as strategy: the importance of personalised relations in obstetric practice.

This paper highlights the importance of personalised relations in institutionalised obstetric care. It seeks to explore the link between objectification and agency, by examining the way in which women find a new subjectivity in motherhood within the walls of the obstetric institution. The paper focuses on obstetric encounters through the lens of labour and intrapartum routine procedures, and argues that when expectant women enter the obstetric institution, a series of relations ensue through their efforts to become connected with the official obstetric system. The hospital organisation and network of relations that originate in it reflect and reproduce a passive role for expectant women and mothers; however, it would be misleading to represent their behaviour as simply "compliant". Expectant mothers value the connectedness with the obstetric system exemplified by personalised patient-practitioner relations because it is a guarantee of safety. They are happy to follow clinicians' instructions, even when this implies significant sacrifice or suffering because they are projected towards fulfilling their parenting desires. Compliance, like resistance then, is here intended to be understood as yet another maternal strategy, and as such it is the most widespread, deployed by women in order to achieve their ideals and desires.

Anthropology, Cultural↗
PubMed1992

Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies.

OBJECTIVE: To compare the obstetric outcome of in vitro fertilization pregnancies with normally conceived pregnancies. STUDY DESIGN: The obstetric outcome of in vitro fertilization pregnancies achieved in 763 British residents at two in vitro fertilization clinics resulting in the births of 961 babies were compared by means of the relative risk statistic with a control group of naturally conceived primiparous pregnancies matched by maternal age and multiplicity of pregnancy. RESULTS: Twenty-five percent of in vitro fertilization pregnancies were multiple pregnancies. The incidence of singleton term breech presentation was similar to that among controls. As compared with controls there was an increased incidence among in vitro fertilization pregnancies of vaginal bleeding and hypertension requiring hospitalization (p less than 0.001) and cesarean births (p less than 0.001) and, among in vitro fertilization singleton pregnancies, an increased incidence of intrauterine growth retardation (p less than 0.05), placenta previa (p less than 0.05), and preterm delivery (p less than 0.001). The congenital malformation, stillbirth, and perinatal mortality rates were comparable with maternal age-standardized national rates. CONCLUSIONS: Although the majority of in vitro fertilization pregnancies have a satisfactory obstetric outcome, there are a number of increased obstetric risks that may reflect the history of infertility, the relatively high incidence of poor obstetric history, and the lower threshold for obstetric intervention in in vitro fertilization patients.

Adult↗
PubMed2003

ASA closed claims in obstetrics: lessons learned.

What have we learned so far from the Closed Claims database? For the most part, analysis of the claims made supports the generally held beliefs about the medico-legal risk of obstetrical anesthesia. However, the obstetric files do reveal a risk profile that differs significantly from the nonobstetric files. One of the most surprising observations was the large proportion of relatively "minor" injuries in the obstetric files in contrast to the nonobstetric files. These claims may simply be the result of an increased incidence of such problems in obstetric patients. However, careful review of statements made in the files revealed that a substantial number of patients were unhappy with the care provided and felt themselves ignored and mistreated. Meyers has suggested that malpractice litigation serves the purpose not only of reparation of injury for substandard care but also one of emotional vindication [19]. Not unexpectedly, anesthesiologists are frequently named in claims involving bad fetal outcomes. Most of these claims, for whatever reason, do not result in payments to the litigant. Problems involving airway management, focusing on difficult intubation and pulmonary aspiration, are unfortunately well represented in the obstetrical files. There is no clear indication that this is changing. One of the principle causes of major adverse outcomes with regional anesthesia is local anesthetic toxicity. There is evidence that the frequency of these claims is on the decline. Nerve injury as a result of direct neural trauma continues to appear at regular intervals in the claims files. It is clear from review of the ASA Closed Claim database that there are many unrecognized factors, separate from major injuries, that must be important motivating factors in patients who bring claims against anesthesiologists. A lawsuit does not necessarily signify injury. It has been suggested that the number of patients harmed by negligent care who actually file a claim may be less than 2% [12]. In contrast, lawsuits are usually not filed unless people perceive that they or a family member have been wronged by the system. Anesthesia care providers should give attention to conducting themselves in such a manner that patients will not be motivated to bring suit for an unexpected outcome [20]. Therefore, merely focusing one's attention on reducing the potential for major injuries may have little effect on solving the medico-legal dilemma in obstetrical anesthesia. The uniqueness of the ASA Closed Claims database is that it reflects the consumer's perspective. This point can not be emphasized enough because one of the best measures of quality of care comes from the patient's perspective. What can help? Careful personal conduct Establish good rapport Involvement in prenatal education Early pre-anesthetic evaluation Provide realistic expectation Regularly review potential major and minor risks.

Anesthesia, Obstetrical↗
PubMed1992

Obstetric fractures.

The purpose of this study was to determine the risk factors predisposing to an obstetric fracture, and their long-term outcome. We reviewed 28 obstetric fractures treated in the County of Vaud, Switzerland, between 1976 and 1989. There were 12 fractures of long bones, 10 clavicles and 6 depressed skull fractures. The belief that obstetric fractures occur in large babies or after breech deliveries is no longer valid. The common risk factors of these fractures are obstetric maneuvers during delivery (75% of cases), especially Cesarean sections (35%), prolonged labor (33%), and prematurity (25%). Cephalic presentation (64.2% of cases) is more frequent than breech position (32.1%). Weight, size, age of gestation, age of the mother, parity, gestity, and time of delivery cannot be considered as risk factors for obstetric fractures. For each type of fracture some specific risk factors are pointed out: maneuvers at birth for depressed skull fracture, Cesarean section, breech delivery with assistance and low birth weight for the fractures of long bones. All fractures were treated conservatively, except for skull fractures with a depression of more than 2 cm. Early consolidation is achieved within 2 weeks. Long-term prognosis for obstetric fractures is good without sequelae.

Birth Injuries↗