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PubMedDate not supplied

Concepts and methods for assessing the quality of essential obstetric care.

Approaches to reducing maternal mortality and morbidity have attracted much attention in the last decade. It is recognized that availability and use of essential obstetric care (EOC) of sound quality by women in labor would reduce the burden of illness and death resulting from pregnancy. However, the literature on methods for defining, assessing and improving the quality of EOC at the point of service delivery in developing countries is quite weak. Drawing upon fundamental concepts of quality assurance, statistics, clinical practices and health service management, this article presents unifying concepts and methods for defining, assessing and improving the quality of EOC in developing country settings. It argues that any intervention that would improve the quality of EOC must act through at least one of three mechanisms: improve the clinical management of uncomplicated labor; improve the detection of complications of labor; or, improve the clinical management of complications of labor. The text presents the basis for using quantitative and qualitative methods to assess the quality of EOC. It concludes that any method to assess the quality of EOC, as a basis for improvement at the health center level, must satisfy the following seven criteria: (i) be derived from scientifically sound and locally defined guidelines for what constitutes care of good quality; (ii) enable objectively verifiable measurements of the performance of critical tasks; (iii) be sufficiently discriminating to detect variations in quality among health centers, thereby enabling managers to focus on improving care in those health centers providing care of lower quality; (iv) facilitate production of visual aids within each health center, thereby enabling midwives, doctors and their supervisors to use information for improving their work on a daily basis; (v) include qualitative assessments to facilitate interpretation of quantitative information; (vi) be reasonably simple to use without unsustainable foreign technical assistance; and, (vii) be affordable within the limited resources of public health facilities and District Health Management Teams.

Developing Countries↗
PubMed2000

Relationship of obstetric complications and differences in size of brain structures in monozygotic twin pairs discordant for schizophrenia.

OBJECTIVE: The aim of the study was to determine whether a history of obstetric complications and congenital minor physical anomalies are related to differences in the characteristics of brain structures observed within monozygotic twin pairs discordant for schizophrenia. METHOD: The size of the bilateral hippocampi and cerebral ventricles was studied by magnetic resonance imaging in 22 monozygotic twin pairs discordant for schizophrenia. Obstetric complications and minor physical anomalies were independently assessed through parental report and examination, respectively. RESULTS: Compared with the well co-twins, the ill twins consistently had smaller left and right hippocampi as well as larger left lateral ventricles and third ventricles. Relatively small left and right hippocampi were each significantly related to labor-delivery complications and to prolonged labor per se. Relatively large right lateral ventricle size and large total ventricle size were significantly related to labor-delivery complications, prolonged labor, neonatal complications, and total complications for the entire reproductive sequence. In contrast, these brain size differences were not significantly associated with pregnancy complications or minor physical anomalies. CONCLUSIONS: Trauma at the time of labor and delivery and especially prolonged labor appear to be of importance for brain structure anomalies associated with schizophrenia.

Adult↗
PubMed2000

[Causes of premature labor in pregnancy complicated by diabetes depend on diabetes progression].

The aim of this study was to demonstrate what factors influence preterm termination of pregnancy complicated by diabetes, in dependence of diabetes progression. The following factors have been analysed: rate and causes of preterm labours according to White classification, mean duration of pregnancy, mode of delivery, birth weight, Apgar score and diabetes control in the preterm delivered women with different progression of disease. As a result we observed, that in G/A and G/B classes and in short lasting class B, the most common cause of preterm labour was spontaneous delivery and prematurity rate was low, oscillated between 1.7 and 15.8 percent. In those classes we also observed that diabetes control was very good or adequate. In D, R, F, and RF classes the most common cause of preterm labour is intrauterine fetal distress, that causes preterm termination of pregnancy, despite immaturity, and prematurity rate is 30-50 percent. We observed bad diabetes control in above mentioned classes.

Adult↗
PubMed1988

Obstetric complications of macrosomic babies in African women.

A prospective analysis has been made on 145 consecutive deliveries resulting in babies weighing 4.5 kg and above delivered at the University of Nigeria Teaching Hospital (U.N.T.H.), Enugu, over a 1-year period (1985). Babies weighing 4.5 kg and over are regarded as macrosomic babies. The incidence of macrosomic babies in this study is 11 per thousand deliveries or 1 in 90. Factors that predisposed to the birth of macrosomic babies include: excessive weight gain during the course of pregnancy, tall height of the woman, multiparity and prolonged gestation. Diabetes mellitus was not a significant factor. Complications include prolonged labor, post-partum hemorrhage, ruptured uterus, shoulder dystocia and an increased perinatal mortality rate. Maternal mortality was also increased. Ninety percent of the multiparous women achieved spontaneous vaginal delivery while only 42% of the primigravidae achieved vaginal delivery. The implications are discussed.

Adult↗
PubMed1992

Medical complications in pregnancy and delivery of gifted children.

A questionnaire on medical complications in pregnancy, labor and delivery was given to 195 families of gifted children. 156 (80%) answered the questionnaire. The incidence of medical disorders in this group did not differ from the accepted incidence in a normal obstetric population. There was a sex ratio of 71.5% boys and 28.5% girls, and a higher probability of another gifted child in these families.

Adolescent↗
PubMed2004

Procalcitonin in cervicovaginal secretion in pregnancies complicated by preterm labor--a preliminary report.

OBJECTIVES: Although the usefulness of procalcitonin (PCT) in clinical practice is increasing, no data are available on procalcitonin during pregnancy. The purpose of this study was to investigate whether procalcitonin was present in the cervicovaginal secretion of pregnant women and, if so, to evaluate the practical value of determining the concentration. STUDY DESIGN: A total of 53 patients in whom preterm labor (PTL) was expected and 31 healthy pregnant women were enrolled in this study. In the preterm labor group procalcitonin concentrations were analyzed with reference to laboratory indices suggestive of infection. The outcome of pregnancy was recorded in each case, with mention of the gestational age at delivery and of the time between admission to hospital and delivery. RESULTS: Concentrations of procalcitonin in the preterm labor group were comparable to those in the healthy pregnant women. In the preterm labor group no significant correlations were observed between procalcitonin concentration and laboratory indices of infection. Nor were any correlations observed between procalcitonin concentration at the onset of preterm labor and gestational age either at the onset of labor or at delivery. However, procalcitonin concentrations at the onset of preterm labor were higher in patients who delivered prematurely than in those who delivered near term after treatment to delay labor. Procalcitonin concentrations in women whose babies were delivered within 3, 7 and 14 days of admission and in those whose babies were born at later times were comparable. CONCLUSIONS: In this study, procalcitonin was determined in the cervicovaginal secretion of pregnant women for the first time. However, no association was observed either between procalcitonin concentration at the onset of preterm labor and laboratory signs of infection or between procalcitonin concentration and time between admission to hospital and delivery. Procalcitonin determination would be unsatisfactory as a prognostic indicator of the length of time between admission to hospital and delivery.

Adult↗
PubMed1997

The use of the polymerase chain reaction to detect bacteria in amniotic fluid in pregnancies complicated by preterm labor.

OBJECTIVES: The purpose of this investigation was to determine the feasibility of using the polymerase chain reaction to detect bacteria in amniotic fluid and to compare pregnancy outcomes in subsets of women categorized by amniotic fluid culture, polymerase chain reaction, and interleukin-6 findings. STUDY DESIGN: Amniotic fluid from 54 pregnancies with preterm labor and no clinical evidence of intraamniotic infection was evaluated with use of the polymerase chain reaction, interleukin-6, and bacterial culture. Gestational age, newborn weight, and time between amniocentesis and delivery were compared between subsets of women categorized by these tests. RESULTS: With use of the polymerase chain reaction <100 bacteria per milliliter could be detected in amniotic fluid. A total of 55.5% of the amniotic fluid samples were polymerase chain reaction positive, whereas 9.2% of culture results were positive. Birth weights and gestational age at delivery were less and time from amniocentesis to delivery was shorter in the polymerase chain reaction-positive group (p < 0.05). Nine samples (15%) had elevated interleukin-6 concentrations; of these, six were polymerase chain reaction positive. CONCLUSIONS: The polymerase chain reaction is a sensitive means of detecting bacteria in amniotic fluid. These results provide further evidence of an association between preterm delivery and intraamniotic infection. Not all amniotic fluid samples with elevated interleukin-6 levels have bacteria detectable by the polymerase chain reaction. We anticipate that the polymerase chain reaction will provide another avenue for the detection of bacteria in amniotic fluid.

Adult↗
PubMed1977

Perinatal asphyxia and renal failure in neonatal patients.

Herein we discuss oliguria and azotemia in neonatal patients associated with perinatal complications, including difficult labor and delivery, and respiratory asphyxia. Renal failure in these patients is accompanied by proteinuria, microscopic hematuria and red blood cell casts, and it generally resolves in 7 to 10 days. Umbilical aortography can be helpful in determining the presence of normal kidneys in these patients.

Asphyxia Neonatorum↗
PubMed2006

Adverse perinatal outcomes and risk for postpartum suicide attempt in Washington state, 1987-2001.

OBJECTIVE: Postpartum suicide attempts are serious events with a significant impact on women and their families. Our objectives were to determine the temporal risk period for these events and to assess whether maternal complications and adverse infant outcomes are associated with risk for postpartum suicide attempt. METHODS: We performed a case-control study that compared 520 women who were hospitalized for a postpartum suicide attempt with 2204 control women who were not hospitalized for a postpartum suicide attempt in Washington State from 1987 to 2001. We performed logistic regression to evaluate whether maternal complications and adverse infant outcome, after controlling for other risk factors, were associated with a hospitalization for a suicide attempt within 1 year after delivery. RESULTS: Most attempts were the result of poisoning (63.6%). Suicide attempts were most frequent in the first and 12th months after delivery. Maternal complications including labor and delivery complications and cesarean delivery were not associated with risk for postpartum suicide attempt. After adjustment for age and marital status, fetal or infant death was associated with postpartum suicide attempt. Other adverse infant outcomes, including preterm delivery, low birth weight, and congenital malformations, were not associated with attempts. CONCLUSIONS: Maternal complications were not associated with hospitalizations for suicide attempts in the year after delivery. However, fetal death or the death of an infant in the first year after delivery was strongly associated with hospitalization for a suicide attempt. These risk factors may be useful predictors for health care providers who care for women or children during the postpartum period.

Adolescent↗
PubMed2004

[Nursing diagnoses and most common collaboration problems in high-risk pregnancy].

This study identified the demographic profile, obstetric and clinical diagnoses, nursing diagnosis and most common collaboration problem among pregnant women subject to high-risk at a hospital in São Paulo, Brazil. Data were collected by means of a form based on Gordon's Functional Health Patterns. Nursing diagnoses were determined on the basis of the NANDA (North American Nursing Diagnosis Association) taxonomy. The nursing diagnoses found in 50% or more of the pregnant women were: risk for infection (90.1%), altered health maintenance (84.5%), altered comfort (80.3%), risk of ineffective breastfeeding (59.2%), altered sexuality patterns (52.1%), fear (52.1%) and pain (50.7%). The collaboration problem found in 50% or more of the cases was: potential complication: preterm labor (62.0%), potential complication: maternal tachycardia (54,9%) and potential complication: hypotension (54,9%). Thus, these results will allow us to guide the nursing care rendered to these pregnant women.

Adolescent↗