Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “OBSTETRICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources
PubMed2002

[Indications and risk factors for emergency obstetric hysterectomy].

Emergency obstetric hysterectomy is a procedure that potentially preserves the life and the postpartum bleeding is the direct cause of its indication, the hemorrhage postpartum happens in 1% of obstetric patients. This study was carried out to identify women with potential risk for this event and to prevent this obstetric problem. The most frequent indications for hysterectomy were identified, as well as the sociodemographic characteristic of the patients. The surgical procedure carried out was extra-fascial technique with type Richardson hysterectomy modified; the surgical pieces went to the pathology service, to obtain the histopathological diagnosis. 43 cases of obstetric hysterectomy, were analyzed; the characteristics of this group showed that bigger percentage of this event was more frequent in 31 to 35 years (39.5%), with pregnancies at term (51.1%) in third pregnancies(27.9%), nulliparas (60.4%), with first cesarean section (39.5%), without previous abortions (79.0%). The most frequent obstetric complications were uterine atony and placenta accreta. The cause for uterine atony could be interstitial edema, as well as myometrial hypertrophy, because such histopathological diagnoses were the most common. Odds ratio showed that a patient with cesarean section has 1.16 more probabilities of suffering hysterectomy than a woman with childbirth. This study describes the histological presence of interstitial edema and myometrial hypertrophy as possible causes of uterine atony in the histological study of surgical specimen. This could be related to no response of myometrial to the uterus-tonic effect of oxytocin. Obstetric uterine dysfunction has multifactorial cause. Patients with the characteristics described in this study should be considered as high risk.

Adult↗
PubMed2002

[Breech presentation at term: a survey on obstetrical practice in France and a search for a homogeneous attitude associated with lower neonatal risk].

OBJECTIVES: 1- In order to define a "consensual attitude" in case of breech presentation, we queried the AUDIPOG network on obstetrical practice in search for the more frequently accepted criteria for normal delivery. 2- For consensual practices that could be identified, early neonatal complications were compared between women cared for in maternity wards applying these practices and those cared for in maternity wards not applying these practices. MATERIALS AND METHODS: 1- A confidential survey was sent to participating obstetrics units to determine their practical attitude in case of breech presentation. A consensual attitude was established on the basis of their responses. 2- Crude and adjusted comparisons were made concerning neonatal results between the consensual and non consensual groups of obstetrics units. RESULTS: Response rate was 85% for 175 obstetrics departments consulted. Six criteria were identified leading to classification of 42% of the units as consensual obstetrics units. The risk of major neonatal complications was lower in the consensual group than in the non-consensual group: adjusted OR=0.27 (95% CI: 0.09-0.85). CONCLUSION: A questionnaire on obstetrical practice can help define consensual attitudes associated with lower risk of neonatal complications.

Attitude of Health Personnel↗
PubMed2003

[Obstetrical hysterectomy].

OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.

Abruptio Placentae↗
PubMed1992

The role of obstetric factors in determining fetal viability.

OBJECTIVE: To study the influence of primary obstetric complications on the survival and short-term morbidity rates of very-low-birth-weight (VLBW) babies. DESIGN: A 1-year retrospective, descriptive study. SETTING: Department of Obstetrics and Gynaecology, Tygerberg Hospital, CP. STUDY POPULATION: 257 women admitted with live singleton fetuses and who eventually delivered babies with birth weights ranging from 750 to 1,499 g. MANAGEMENT: Primary obstetric complications responsible for the delivery of the VLBW babies were clinically diagnosed. Active management was undertaken if the fetus was viable and obstetric and neonatal resuscitation were applied. Management was conservative when the fetus was considered non-viable. This decision on the initial treatment option was taken by the obstetrician who managed the case. MAIN OUTCOME MEASUREMENTS: Survival and short-term morbidity rates of the babies. RESULTS: Spontaneous preterm labour (45%) and hypertensive disorders (39%) were equally responsible for delivery of VLBW babies at Tygerberg Hospital. The only obstetric factor influencing the babies' outcome, however, was the initial management decision by the obstetrician. There was a survival rate of 160/213 (75.1%) in the actively managed group compared with only 1/44 (2.3%) in the conservatively managed group. Other factors that significantly influenced neonatal survival of VLBW babies were: birth weight, gestational age, Apgar score at 5 minutes and length of time between admission to hospital and the delivery. CONCLUSION: The obstetric complication responsible for delivery of the VLBW baby did not influence the survival rate. The major determinant of neonatal survival was the obstetrician's decision to manage the fetus either actively or conservatively. It seems that the outcome of VLBW babies is influenced primarily by the intrinsic characteristics of the neonates' gestational age, birth weight and condition at birth, and not the reason for delivery.

Delivery, Obstetric↗
PubMed2006

[Difficulty of epidural puncture for obstetric analgesia: risk factors].

INTRODUCTION: Predicting technical difficulties in performing an epidural block can affect the anesthesiologist's choice of technique or decisions about who should carry it out. Our aim was to determine patient characteristics associated with difficulty in performing an epidural block for obstetric analgesia. MATERIAL AND METHODS: We designed a prospective observational study in 540 pregnant women who requested epidural analgesia for obstetric labor. Patient characteristics (age, weight, height), anatomical features (body constitution, visible and/or palpable spinal apophyses, structural anomalies), technical features (number of attempts, repositioning of the needle), anesthesiologist's experience (resident or staff), block success, time taken to accomplish the procedure, and obstetrical variables (parity, gestational age, cervical dilatation). RESULTS: The factor that best correlates with puncture difficulty in the obstetric patient is the presence of visible or palpable spinal apophyses and palpation prior to carrying out the block. Factors like weight, body constitution, or anesthesiologist's experience seem to influence the rate of success or failure of the epidural block for obstetric analgesia, although to a lesser degree. CONCLUSIONS: The most important factor for predicting success of an epidural block for obstetric analgesia in our practice is the presence of palpable spinal apophyses.

Adolescent↗
PubMed1991

Relationship of infant mortality to the availability of obstetrical care in Indiana.

BACKGROUND: Projects that are currently under way in Indiana to improve access to obstetrical care have not addressed the availability of these services in nonmetropolitan areas. This study was designed to identify all physicians who were providing obstetrical services in every county throughout the state to determine if there is a correlation between the availability of these services and the infant mortality rate in nonmetropolitan counties. METHODS: A state-wide physician profile maintained by the Indiana Academy of Family Physicians was cross-referenced with a telephone survey of all hospitals in the state to identify those physicians providing obstetrical services within each county in Indiana. The number of physicians in each county was then compared with the number of births per year by mothers from that county to determine whether nonmetropolitan counties had sufficient physicians to provide obstetrical services. Finally, these findings were compared with the most recent infant mortality rate for each nonmetropolitan county. RESULTS: A total of 610 family physicians, 311 obstetricians, and 75 general practitioners were providing obstetrical care in Indiana. There were 10 counties that did not have a physician who delivered babies practicing in that county. Thirty-two counties had more women who needed obstetrical care than the current number of physicians could serve. There was a negative correlation between physician availability and infant mortality in Indiana's nonmetropolitan counties (r = -.38; P less than .02). CONCLUSIONS: Access to care for pregnant patients is a major problem in rural Indiana and hampers Indiana's ability to reduce its current infant mortality rate.

Catchment Area, Health↗
PubMedDate not supplied

Changing patterns of obstetric practice in Washington State: the impact of tort reform.

Rapidly rising malpractice premiums have profoundly altered patterns of obstetrical practice. In the summer of 1986, the state of Washington enacted major tort reform legislation intended to stabilize the costs of liability insurance. Following passage of the legislation, we surveyed obstetricians, family physicians, and midwives in the state to assess the likely impact of tort reform on future practice patterns. Largely because of malpractice concerns, 40% of family physicians, 15% of obstetricians, and 27% of midwives had discontinued obstetrical practice. Although obstetrical participation has decreased most dramatically for family physicians, the mean number of deliveries per physician has increased to the extent that the proportion of deliveries attended by family physicians has remained stable at about 30%. However, as fewer family physicians practice obstetrics, the availability of care has diminished in rural areas. The passage of tort reform legislation has induced one-third of those respondents currently practicing obstetrics to at least temporarily continue to practice obstetrics. Despite tort reform, however, the majority of respondents either do not provide or ration care to the medically indigent. The major deleterious social impact of the professional liability problem is reduced access to care in rural areas and a severe curtailment of care to the medically indigent. Tort reform alone will not solve these problems.

Family Practice↗
PubMed1984

[Studies on the relationship between quantitative histometry and obstetric complications].

Quantitative histometry of the placenta seems to make it possible to correlate the histopathological changes with various obstetric complications and disorders more precisely. In the present paper, the relationship between the histopathological changes in the placenta and the obstetric complications was investigated by quantitative histometry based on the standardized categories with uncomplicated normal cases as the controls. Among the obstetric complications, special emphasis has been placed on the pregnancies complicated by toxemia of pregnancy and diabetes mellitus. The obstetric disorders of postmature pregnancy and prolonged delivery have also been related to the quantitative histometry. It was revealed that the cytotrophoblast proliferation associated with the formation of syncytial knots was a very common finding both in toxemia and in these obstetric disorders. However, there was a great difference between the two in that impairment of the vasculature was highly specific in the placentae in the case of toxemia. The most conspicuous histopathological change recognized in the placentae due to diabetes was villous edema, which would be due to the osmotic imbalance. However, it is so unusual to find cases complicated by severe diabetes that typical villous edema is rarely observed. The quantitative approaches in the field of histopathology may leave some problems in that the specimens taken from the organ could not always be representative of the whole organ. However, quantitative histometry based on the fairy standardized categories has been shown to offer more promising information on the relationship between the histopathological changes in the placentae and the obstetric disorders.

Female↗
PubMed1994

[On the 100th anniversary of the Gynecology-Obstetrical Clinic in Sarajevo].

In the second half of the 19th century the Viennese Gynecology-Obstetrics Clinics with professors Semmelweiss, Schauta, Wertheim created the synecology and obstetrics science in the scientific and professional world. Doz. Dr Otto Weiss was the first chief of the Gynecology and Obstetrics Department of the Regional Hospital (Landesspital) in Sarajevo. Direct and energetic in his manners, he introduced the Viennese clinics protocols in the diagnostic and therapeutic procedures. The well kept diseases histories are undoubtedly, of a high world level of the gynecological doctrine. Even now, in the library, one can find the well bound journals: Monatsschrift fur Geburtskunde, Archiv für Gynekologie (1869), American Journal of Obstetrics (1879). Dr Weiss had died in 1900, 15 chief doctors (primarius) applied for the job. All of them belonged to the clinics in Vienna, a fact speaking in favour of the attractiveness of the Department. In addition to the professional qualities the chief should master one of the Slavic languages. It was necessary, because, simultaneously, the midwives' school was organized to give a proper education, primarily to decrease mothers' mortality in Bosnia and Herzegovina. Later, the Department was headed by Dr Mikucki, Dr Bokonjić and Dr Bazala. The Gynecology Obstetrics Clinic was established in April, 1947, headed by Prof. Szabo. In April, 1960, the Gynecology Department was joined to the Clinic, had 320 beds. Afterwards, the Clinic was headed by Prof. Berić, Prof. Knezević, Prof. Simić and Prof. Idrizbegović. The Clinic with the Obstetrics (Secondary) School became a centre of staff education (various types)--Internship, specialization, postgraduate level, doctorship of the gynecological perinatal service of the Republic.(ABSTRACT TRUNCATED AT 250 WORDS)

Bosnia and Herzegovina↗
PubMed1997

Attitudes toward obstetrics training. Residents surveyed at McGill University and University of Montreal.

OBJECTIVE: To determine family medicine residents' attitudes toward family practice training in obstetrics and neonatology before and after implementation of a modified obstetrics curriculum at McGill University (MG). DESIGN: Two-group pretest and posttest. Fifty-seven respondents, 31 at MG, 26 at University of Montreal (UM), were case matched as first-year and second-year residents. SETTING: Departments of Family Medicine at MG and UM. PARTICIPANTS: Family medicine residents at MG and UM. INTERVENTION: A modified obstetrics curriculum was introduced at MG (study group); no modifications were introduced at UM (control group). First- and second-year residents' attitudes toward the adequacy of training were assessed through responses to a questionnaire administered in July 1992 and July 1994. MAIN OUTCOME MEASURES: Changes in response scores before and after implementation of the modified curriculum. RESULTS: Repeated multivariate analysis of variance (MANOVA) showed respondents believed family practice obstetrics training was adequate in general, but that family practitioners were inadequately trained in emergency obstetric skills. Scores for items assessing neonatology skills increased significantly in the MG group after the intervention. CONCLUSIONS: Residents' overall confidence in their obstetrics training did not appear to improve, but this might be due to a time lag between curriculum modification and attitudinal change. McGill residents' confidence in neonatology skills improved significantly after curriculum modification.

Adult↗
PubMed1997

Dilemma of rural obstetrics. One community's solution.

PROBLEM BEING ADDRESSED: Increasing workload and concerns about physician exhaustion necessitated reorganizing the delivery of obstetric services on Manitoulin Island in Ontario. OBJECTIVE OF PROGRAM: To organize obstetrics in a remote rural community to provide safe, accessible care, improve working conditions for local physicians, and involve the local hospital and health care workers in the solution. MAIN COMPONENTS OF PROGRAM: A prenatal clinic for all obstetric care on the island was established. It was based at the local hospital and organized by a nurse-midwife. Local physicians rotated through the clinic and provided obstetric coverage on their on-call days. CONCLUSIONS: The clinic has helped improve working conditions for local physicians and maintain high-quality obstetric care in this remote area. Local women's initial resistance to the clinic seems to be disappearing with time. Ongoing chart audits reveal intervention rates similar to those found in other Canadian studies of rural obstetric care.

Family Practice↗
PubMed1993

The effect of anxiety and depression during pregnancy on obstetric complications.

OBJECTIVE: To investigate the effects of anxiety and depression during pregnancy on obstetric complications using the data collected from the St George's Birthweight Study. DESIGN: Prospective population study. SETTING: District general hospital in inner London. SUBJECTS: A consecutive series of 1860 white women booking for delivery were approached. Of these, 136 refused and 209 failed to complete the study for other reasons, leaving a sample of 1515. MAIN OUTCOME MEASURE: Data were obtained by research interviewers at booking, 17, 28, and 36 weeks gestation and from the structured antenatal and obstetric record. The predictor variables were the anxiety and depression scores measured using the General Health Questionnaire. The outcome variables were five obstetric complications: preterm delivery; nonspontaneous onset of labour; major analgesia in the first and second stages of labour; and nonspontaneous vaginal deliveries. The possible confounding effects of 35 socio-economic, psychological and personal variables were investigated using logistic regression. RESULTS: The factors that had the strongest relation with the outcomes were parity and maternal age. Depression during pregnancy was unrelated to the obstetric complications. Anxiety was weakly related to analgesia/anaesthesia in the second stage of labour (P = 0.04). However, anxiety accounted for only 0.1% of the variance in use of major analgesia/anaesthesia. The most effective model, that for analgesia/anaesthesia in the first stage of labour, accounted for only 7.3% of the variance. CONCLUSIONS: In the general population of pregnant women, anxiety and depression during pregnancy, while undesirable in themselves, are of little importance in the evolution of obstetric complications.

Adolescent↗
PubMed1999

Demands on obstetrical care in the urban environment: postpartal survey.

In recent years, obstetrical management reflecting the individual needs of parturient women and newborn children has acquired an increasing significance. Today, the majority of obstetrical departments provide alternatives to traditional methods of delivery. The purpose of this study was to analyze the current obstetric situation as perceived by the women concerned. During the lying-in period spent in the care of the obstetrical department, 386 women were interviewed as to their birth experience. The questionnaire employed used a predominantly structured format. The present study examined a total of six of Vienna's municipal hospitals. The majority of women interviewed were satisfied with the standard of care provided by obstetricians and midwives. However, certain administrative and organizational aspects were subject to criticism, for example, shift changes among the medical staff as well as the presence of an excessive number of people during delivery were felt to detract from the intimate character of giving birth. In general, the standards of care provided by urban obstetrical departments as well as the experience of giving birth itself confirmed women's expectations. However, certain areas remain where improvements seem both desirable and feasible without requiring undue effort. Women who gave a positive assessment of their personal experience of delivery also tended to carry away a favorable impression of their stay in hospital as a whole.

Adult↗
PubMedDate not supplied

Alaska's obstetrical delivery systems: a descriptive epidemiologic study.

Delivery of obstetrical care in rural Alaska can be very challenging, due to remoteness, lack of medical resources and transportation difficulties. This descriptive study looks at what the current delivery systems for obstetrical care in Alaska are. Alaska's obstetrical delivery systems can be divided into three basic systems. 1) Full comprehensive obstetrical care limited only by lack of neonatal ICU capability. 2) Cesarean delivery capable, but with limited resources. 3) Low risk vaginal deliveries with no cesarean delivery capability except by transports approaching 6 hours. This study raises questions about which system is most effective for which communities. Further studies need to be undertaken to better understand how to provide effective obstetrical care in rural and bush Alaska at an acceptable risk, and at reasonable cost.

Alaska↗
PubMedDate not supplied

The effects of obstetric conditions on neonatal behaviour in Japanese infants.

The effects of obstetric conditions on neonatal neurological status and neonatal behaviour were studied using a sample of 159 Japanese infants who were neurologically and obstetrically low-risk. Observations were made using Prechtl's neonatal neurological examination and Brazelton's neonatal behavioural assessment on the 5th day after birth. The main obstetric conditions which relate to neurological status and behaviour are anaesthesia, induction of labour, previous spontaneous abortion, previous induced abortion and maternal alcohol consumption. The main areas of neurological status and behaviour which are affected by obstetric conditions are lability of states, alertness, orientation, habituation, activity, hand to mouth activity, defensive movements, head control and resistance to cuddle. The results of the present study suggest that even a small difference of low-risk obstetric conditions is related to differences in neonatal neurological status and neonatal behaviour. On the one hand inter-item relations were found and on the other hand the results supported Prechtl's finding [16] that an analysis of the relation between obstetric conditions and neonatal status as a whole is preferable to an item by item comparison.

Alcohol Drinking↗
PubMed1997

Mobilizing the community to utilize obstetric services, Cross River State, Nigeria. The Calabar PMM Team.

PRELIMINARY STUDIES: Twenty-one focus groups and a survey in two rural communities revealed socioeconomic and cultural barriers to utilization of emergency obstetric services. INTERVENTIONS: To facilitate the use of services, 20 community educators were trained and an education campaign was conducted beginning in 1994. Educational activities emphasized the need for women with obstetric complications to use obstetric services at two local health facilities and one teaching hospital. Communities were also mobilized to set up loan and transport programs. RESULTS: Awareness of obstetric complications increased in both communities and for all complications: increases ranged from 5% (for obstructed labor) to 63% (for hemorrhage). Fourteen of 39 project communities established new loan programs (six communities already had them). Loans were granted in only nine communities. Transport systems were established in nine communities. Referrals to the teaching hospital of women with major obstetric complications from two health facilities in the study area increased from three in 1990 to 11 in 1995 in one community and from four to eight in the other. COSTS: The cost of the mobilization activities was approximately US $6500. CONCLUSION: Community education and mobilization can help increase awareness of obstetric complications.

Female↗
PubMed1999

Towards effective obstetric anaesthetic audit in the UK.

Obstetric audit is multidisciplinary, but maternal mortality data represent the only national obstetric anaesthetic audit currently available in the UK. Maternity and neonatal audit is progressing towards the collection of both numerator and denominator data in order to compare local, regional and national figures. Obstetric anaesthetists as a professional group play a significant role in maternity care and have in the past developed a minimum data set. Such a set now requires revision of items, agreement on definitions and integration with national projects. Since local and regional obstetric anaesthesia data collection systems are available, albeit in various manual or computerized forms, this is an achievable target. A standard maternity and neonatal data set which incorporates obstetric anaesthetic clinical items could offer a qualitative comparison of process variables and outcome, but should be under professional anaesthetic control. In addition, the process may enable professional standards to be defined and tested so that high quality obstetric anaesthetic care can be maintained.

Journal Article↗
PubMed2002

The association between inherited thrombophilia, antiphospholipid antibodies and lipoprotein A levels with obstetrical complications in pregnancy.

OBJECTIVES: To evaluate the association between obstetrical complications in pregnancy and thrombophilic factors. STUDY DESIGN: 75 pregnant women with obstetrical complications and 66 controls with live births without obstetrical complications were tested for thrombophilia. All subjects were negative for thromboembolic disease. RESULTS: The obstetrical complications in the study group were unexplained oligohydramnios = 16 (21%), IUGR = 17 (23%), preeclampsia <32 weeks = 15 (20%), recurrent abortions = 42 (56%), fetal demise = 14 (19%), abruption = 8 (11%). Comparing women with obstetrical complications versus controls, factor V Leiden mutation was present in 7 (10%) versus 1 (2%) P =.064, odds ratio (OR) = 7, 95%, CI = 0.8-58.5, antiphospholipid antibody syndrome in 14 (19%) versus 2 (3%) P =.003, OR = 7, 95% CI = 1.7-35, high lipoprotein A levels 13 (30%) versus 6 (10%) P =.019, OR = 3.8, 95% CI = 1.3-11. In the study group, there was a case each of prothrombin gene mutation, elevated homocysteine level, antithrombin III, protein S&C deficiencies. Major thrombophilia diagnosis was present in 24 (32%) versus 3 (5%) of controls p =.001, OR = 9.8. No association was found with the methylenetetrahydrofolate reductase gene mutation. In 22 women who subsequently became pregnant, prophylactic anticoagulant therapy compared to pretreatment control pregnancies showed 22 versus 11 live births P =.001, 95% CI = 0.3-0.7 and obstetrical complications of 2 (9%) versus 22 (100%) P =.001, OR = 11, 95% CI = 2.9-41.2. CONCLUSION: An association is suggested between non-thromboembolic pregnancy complications and hypercoagulable disorders. Prophylactic anticoagulant therapy may be associated with improved pregnancy outcome.

Adult↗