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PubMed1990

Obstetric outcome in homeless women.

OBJECTIVE: To characterise the pregnant homeless population booking and delivering at St Mary's Hospital, London, and ascertain whether their obstetric outcome was adversely affected by their homeless condition. DESIGN: Retrospective comparison of demographic characteristics of 185 homeless women booking for delivery with those of housed women booking in the same period and with the population of North West Thames region; comparison of obstetric performance of homeless women with subgroup of the housed population (group matched for age, parity, and ethnic origin). SETTING: Consultant obstetric unit, St Mary's Hospital, London. SUBJECTS: All women booking between April 1987 and March 1988 who subsequently had a registrable birth. MAIN RESULTS: 185 (8%) Of the 2308 women studied were homeless. Compared with the housed population, they had a larger proportion of young women, women of high parity, and Indo-Pakistani women and a smaller proportion of primiparas. Homeless women booked later and had had more previous obstetric problems than housed women. Pregnancy outcome (assessed by birth weight and prematurity rates) was worse than that of both women housed locally and the regional population. Antenatal attendance, complications, intrapartum performance, and perinatal outcome of homeless women did not differ from those in the control group. CONCLUSIONS: This study has been unable to show any significant differences in the outcome of pregnancy in homeless women that can be directly attributed to living in bed and breakfast accommodation, but these women have sociodemographic characteristics and obstetric risk factors that contribute to a poorer outcome in pregnancy than for the general population.

Adolescent↗
PubMed1999

The present state of family-centered obstetrics in Hungary: preparation for the delivery, open delivery-room, rooming-in.

This paper gives details of a survey carried out at hospitals in Hungary to examine how widespread family-centred obstetrics is, and to what extent obstetrics departments are able to meet the increasing demands exerted by society. Several aspects were focused on, including the characteristics of obstetrics departments, the preparation for delivery and maternity, open delivery-rooms, delivery with the partner, early mother-baby contact, rooming-in and to what extent they operate. The study describes the findings on the basis of data sent back by 87 maternity departments, 81.3% of the institutions in the country. The data reveals that 96.6% of wards have preparatory courses for delivery and maternity, 98.8% of open delivery-rooms welcome the partner at the delivery, early mother-baby contact is possible in 97.7%, and 95.6% offer rooming-in. The study gives a comprehensive view of the present state of family-centred obstetrics, offering an opportunity for everyone to re-evaluate their practices and set up new objectives so that every mother and family can have easy access to family-centred obstetrics.

Delivery Rooms↗
PubMed1999

[Recruitment and specialists' training in obstetrics and gynecology].

In 1996 the Norwegian Society of Obstetrics and Gynaecology appointed a committee to investigate and evaluate the situation concerning recruitment to specialist training in obstetrics and gynaecology. The evaluation was based on data from Section of Register and Statistics in the Norwegian Medical Association, "Utvalg for legestillinger"--a committee central in the regulation of number of doctors' positions, and information from a questionnaire sent to all departments of obstetrics and gynaecology in Norway. The availability of doctors is expected to increase from the beginning of the next century. The committee finds no reason to believe that there is a crisis of recruitment to obstetrics and gynaecology compared to other specialities. The increasing number of female trainees has no negative impact on the rate of production of specialists as time from authorization to specialist is shorter for women than for men. Immigration is a factor of uncertain impact, 20% of the trainees are from abroad, a higher number than in any other speciality. The committee has not found any increased flow of specialists from hospitals to private practice during the last two years. The factors of greatest impact on the future need for specialists is above all increase in the number of positions, changes in working hours and age limit for retirement. Today's rate of education of specialists in obstetrics and gynaecology is satisfactory in a situation where balancing loss is sufficient, but too low to cater for any increase in the number of positions.

Adult↗
PubMed2001

[Birth environmental modification: needs of mother and child in modern obstetrics].

This paper evaluates changes which all ready has been done and still are taking place in obstetrics according to World Health Organisation recommendations in relation to women's increasing expectation from obstetric hospitals and maternity units. The needs of parturients and theirs children are not in contrary to the needs of modern obstetrics. An attempt has been done to disclose concurrent points to work up the best obstetrics health care model after 2000 year. The author emphasizes that progressive technicalization in obstetrics could not indicate its dehumanization.

Environment↗
PubMed2005

Trends in pain relief in labour: implications for obstetric analgesia service in Nigeria.

Labour and delivery result in severe pain for most women. Attention to comfort and analgesia for women in labour is important for physiological reasons and out of compassion. A review of common methods of pain relief of labour was done. Inhalation method as well as intravenous administration of opioids for pain relief in labour is fast giving way to lumbar epidural analgesia. The use of local anaesthetic in labour offers superior pain relief, is effective and safe. The inhalation and parenteral routes seem reserved for patients with contraindication to insertion of epidural. The administration of high volume dilute concentration of local anaesthetic plus lipid soluble opioids, with some level of patient's control, appears to be the current trend in the management of labour pains. There is a body of evidence indicating that Nigerian women may want pain relief in labour. However, there is no organised labour analgesia service in Nigeria. An organised obstetric analgesia service can be developed within the limits of available manpower and technology in an emerging country like Nigeria. This article therefore, focuses on trends in obstetric analgesia and its implications on the development of organised obstetric analgesia services in Nigeria. Key words: obstetric analgesia, obstetric analgesia service, Nigeria.

Analgesia, Epidural↗
PubMed1988

Quality assurance in perinatal and obstetrical care: the Norwegian approach.

OBJECTIVE: To review the structure of all obstetrical units in Norway and to monitor the performance of care in terms of perinatal mortality, ultrasound examination and selected clinical events in routine obstetrical care. METHOD: I. Audit of all perinatal deaths (270) in five Norwegian counties during one year. II. Consensus conference to review the practice and distribution of all antenatal diagnostic ultrasounds performed country-wide over one week. III. Statistical review of quality indicators or flag events in routine obstetrical care. RESULTS: I. Identification of a significant percentage of "avoidable" perinatal deaths, most frequently related to antenatal and neonatal care rather than to obstetrical care--resulting in official guidelines for antenatal care and the routine audit of perinatal deaths. II. 96% of women surveyed had ultrasonography, an average of 2.5 examinations each. An investigational procedure already established practice, it was recommended that one ultrasound performed in week 17-20 should be offered each pregnant woman. III. Clinical obstetrical practice varied significantly and it was noted that junior obstetricians had not adhered to established routines. Short and long term monitoring of clinical trends is considered.

Delivery, Obstetric↗
PubMed1982

Epidural anesthesia in low-risk obstetrical patients.

The use of epidural anesthesia in obstetrics has increased markedly in the last decade, and some authorities are now stating that epidural block may be the anesthetic method of choice for most women. In spite of this growth in popularity, no studies have been reported that deal with the outcomes of epidural anesthesia in low-risk obstetrical patients, that group of women for whom family physicians are most likely to provide care. A retrospective cohort study of factors associated with epidural anesthesia in a low-risk obstetrical population was performed. Epidural anesthesia was administered by obstetrical anesthesiologists, and patients were monitored by nurses experienced with epidural anesthesia. Although retrospective studies cannot establish cause-and-effect relationships, it was found, when compared with deliveries without epidural anesthesia, that epidural anesthesia deliveries were associated with changes in several parameters of labor and delivery. Although epidural anesthesia was observed to be a very safe procedure, three of the variables (higher use of low forceps, increased use of oxytocin, and greater total costs) may be of some clinical importance and should be considered by both the delivering physician and the patients when choosing obstetrical anesthesia.

Adolescent↗
PubMedDate not supplied

[Centralization in obstetrics: pros and cons].

Possible advantages and disadvantages of a general centralization of German obstetric facilities are analysed in the study. The need for centralization of risk cases, especially premature births (regionalization) is pointed out. Centralization appears appropriate, since every fifth maternity unit in Germany (19.78%) has 300 or fewer deliveries per year. This one fifth of perinatal clinics accounts for 6.3% of all deliveries (N = 49450). There are appreciable differences between the old and new federal states (Bundesländer): in the recently acceded federal states, 48.7% of all perinatal clinics have deliveries of 300 and less per year. This group of perinatal clinics accounts for 29% of all deliveries in the new federal states. We have carried out a survey of the mother's attitude to centralization: out of 416 patients in the Detmold women's hospital whose mean age was 29.0 +/- 4.2 years, 90.4% were not in favor of general centralization of obstetrics. 43% were also against a centralization of risk cases (regionalization). 75% of the women surveyed objected to centralized obstetrics because of the 'possible absence of the family', the 'possible absence of students and trainees' (44.9%), the 'unfamiliarity with staff and premises' (41.8%) and 'fear of anonymity' (44.5%). The majority of all women (84.1%) did not want to have a drive more than 20 km to an obstetrics center. Fear of 'delivery in a taxi'(78.6%), the 'fear that the husband will come too late to the delivery' (65.4%) and that the 'overall course of the delivery might not be adequate for reasons of time'. The presence of a pediatrics department in conjunction with the perinatal clinic was rated very positively (93%). It is concluded from the data and further juridical considerations that centralization of risk cases (regionalization) is indispensable in the near future and that somewhat more further into the future decentralization should be carried out by closing obstetrics departments with substantially less than 350 deliveries per year. Attention is drawn to some consequences of such a structural reform which will probably have to be initiated by the German Association of Gynecologists and Obstetricians.

Adult↗
PubMed1998

[Organization of obstetric ultrasonography in Denmark 1995--description of the development since 1990].

With the aim to provide an overview of the current organisational status of obstetric ultrasound in Denmark and to describe the development since 1990, a questionnaire was sent in spring 1995 to all 49 departments responsible for the hospital antenatal care program. In addition a questionnaire was sent to the 14 imaging diagnostic departments providing ultrasound services for those of the 49 departments that had either insufficient or no ultrasound facilities. The response rate was 100. Since 1986 the National Board of Health in Denmark has recommended not to screen. At the time of the study the issue was under consideration as part of a general revision of the antenatal care program. Obstetric ultrasound was performed in 30 obstetric, 11 surgical, 12 radiological, 1 image diagnostic and 1 ultrasound department. In total approx. 140,000 obstetric ultrasound examinations were performed in 1994 in contrast to approx. 120,000 in 1989. Fifty-one point four percent of the pregnant population was routinely offered an ultrasound scan in the 10-20th week of gestation (1990: 39.9%). For 19.5% the offer included screening for foetal malformations (1990: 16.5%). In total 34 departments, responsible for the antenatal care of 86.3% of the pregnant population, wanted to continue or start giving an offer of ultrasound screening. The study documents a significant technology diffusion process of ultrasound into the specialty of obstetrics and gynaecology.

Denmark↗
PubMed1951

Specialist-general practitioner cooperation in an obstetrical department.

At a private hospital not affiliated with a teaching institution, a system was set up in the obstetrical department under which general practitioners carrying out deliveries had the advice and aid of specialists in obstetrics and were required to call for it in stated circumstances. General practitioners carried out about half of the 17,076 deliveries at the hospital in an eight-year period. Teamwork was stressed. Results were comparable with those reported from many of the well-known institutions.In addition, a special anesthetic service was organized for the obstetrical department. Anesthesia was administered by young physicians who not only were versed in anesthetic procedures but had special training in obstetrics. The service was available at any hour, and the physician carrying out delivery could count upon competently administered anesthesia when it was needed, as well as upon consultation and assistance should the need arise.

Anesthesiology↗
PubMed2005

Risk factors for obstetric admissions to the intensive care unit in a tertiary hospital: a case-control study.

OBJECTIVE: The objective was to review all obstetric admissions to the intensive care unit (ICU) at the Royal Free Hospital, London, UK, and to identify the risk factors for obstetric admissions to the ICU. METHOD: We carried out a retrospective case-control study. The cases consisted of women admitted to the ICU during pregnancy and up to 42 days postpartum between 1 January 1993 and 31 December 2003. Controls were women who delivered immediately before and after the indexed case. Demographic data, medical and surgical histories, pregnancy, and intrapartum and postpartum data were collected. Statistical analysis was done using SPSS software. RESULTS: Thirty-three obstetric patients were admitted to the ICU, representing 0.11% of all deliveries. The ICU utilization rate was 0.81%. Eighty percent of the admissions were postpartum. The main indications for admission were hypertensive disorders (39.4%), and obstetric haemorrhage (36.4%). There was no difference between cases and controls in, age, parity, smoking and employment status. Compared with controls, women admitted to the ICU were significantly more likely to be black (P<0.05), have a shorter mean duration of pregnancy (36.6 vs. 39.2 weeks; P=0.006), delivered by emergency caesarean section (P<0.001), and have higher mean blood loss at delivery (1,173 vs. 296 ml; P<0.001). The risk factors for obstetric ICU admission were black race (odds ratio [OR] =2.8, 95% confidence interval [CI] 1.05-6.28), emergency caesarean section (OR=14.9, 95% CI 5.38-41.45) and primary postpartum haemorrhage (OR=5.4, 95% CI 1.79-4.35). CONCLUSION: Women of black race, those delivered by emergency caesarean section and those with primary postpartum haemorrhage are more likely to be admitted to the ICU.

Adult↗
PubMed1986

Obstetric hospital stays by diagnosis related groups: a community-based analysis.

The study analyzed obstetric inpatient hospital stays by diagnosis related group in Sacramento, California, and Syracuse, New York, two areas with similar admission rates, between 1981 and 1984. The sample included 123,308 hospital discharges. The data indicated that aggregate obstetric stays in Syracuse were 32.9% longer than those in Sacramento, which was typical of differences between these stays in the western and northeastern United States. Obstetric stays in both areas declined between 1981 and 1984; however, the rate of decline in Sacramento (6.1%) was substantially higher than that of Syracuse (3.5%). Variability of obstetric stays was substantially lower in Syracuse for most diagnosis related groups, including those with the largest caseloads. These results suggest that community and regional differences in obstetric hospital stays may be produced by system-wide consumer preferences and physician practice patterns, more than by hospital bed availability, health maintenance organization activity, or other factors.

California↗
PubMed1995

Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community.

OBJECTIVE: The purpose of this study was to compare the obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives, supervised by a private practice group of four obstetricians, with the obstetric outcome of that group's private practice patients. STUDY DESIGN: A retrospective cohort study was performed. Obstetric outcome of 496 clinic patients was compared with that of 611 private patients in the same community from Aug. 1, 1991, to March 31, 1994. RESULTS: Obstetric outcomes as measured by (1) perinatal morbidity and mortality, (2) Apgar score, (3) birth weights, and (4) prematurity rates were comparable between the two groups. Significant was the cesarean section rate of 13.1% (10.5% primary) for the clinic patients and 26.4% (18.5% primary) for the private patients and the high percentage (81.8%) of private patients who elected to have repeat cesarean sections. CONCLUSIONS: (1) Low-income, uninsured, and underinsured women who have access to excellent prenatal care with supervised certified nurse-midwives can have obstetric outcomes similar to women having prenatal care with private obstetricians. (2) Prenatal care with supervised certified nurse-midwives can reduce the cesarean section rate without compromising infant outcome. (3) Utilization of certified nurse-midwives supervised by obstetricians may provide the optimum model for perinatal care, particularly for those women who are at high risk because of social and economic factors and who are currently underserved.

Adult↗
PubMed1996

Relationship of birth season to clinical features, family history, and obstetric complication in schizophrenia.

Birth in late winter and spring has been consistently shown to be a risk factor of schizophrenia. The relationship of late winter/spring birth to clinical characteristics and other putative risk factors, such as family history and obstetric complications, may provide clues to etiology. Data relating to season of birth, clinical features, family history, and obstetric complications were analyzed for 192 patients with schizophrenia as defined by Research Diagnostic Criteria (including schizoaffective disorder). There was no significant association of season of birth with any of the psychopathological dimensions nor was there a significant association with obstetric variables or family history. However, winter-born schizophrenic patients who had a negative family history were more likely to have a history of obstetric complications. These findings suggest that obstetric complications associated with schizophrenia are perhaps the result of some seasonal risk factors important in those without a family history of the disorder.

Adolescent↗
PubMed2004

Design, execution, interpretation, and reporting of economic evaluation studies in obstetrics.

OBJECTIVE: The purpose of this article was to propose guidelines for the design, execution, interpretation, and reporting of economic evaluation studies in obstetrics. Study design We performed a PubMed search of economic evaluation articles to identify those articles that deal with the quality of published economic evaluation studies, the development of guidelines, and the development of checklists/guidelines for the reporting of economic evaluation studies. All other articles were excluded from the review. RESULTS: We identified 160 articles. We included 8 articles in our review that reported on the quality of published economic analyses, 12 articles that reported on guidelines, and 3 articles that reported on checklists/guidelines that are used by journals. There were 2 articles that dealt with the quality of published economic evaluations in obstetrics and gynecology, both of which showed less than optimal quality. There were only 4 articles that provided some general guidelines for the reporting of economic evaluations in obstetrics and gynecology. We found no articles on any checklist/guidelines for the reporting of economic evaluation studies in obstetrics and gynecology. CONCLUSION: There is a need to improve the design, execution, interpretation, and reporting of economic evaluation studies in obstetrics.

Cost-Benefit Analysis↗
PubMed2005

A multicenter study to determine motivating factors for residents pursuing obstetrics and gynecology.

OBJECTIVE: This study was undertaken to determine why residents choose obstetrics and gynecology. STUDY DESIGN: Applicants to obstetrics and gynecology residency programs were surveyed; a 5-point scale (5 = most important) was used to rate various aspects of the specialty. Univariate statistics were performed. Bivariate analysis comparing results that were based on gender and timing of decisions was completed with Student t test, chi2, and Kruskal-Wallis tests. RESULTS: A total of 153 applicants (42% response rate) from 10 programs participated; 85.3% of respondents were female. Surgical opportunities, variety of clinical experience, and fast-paced/high-acuity experiences attract applicants to obstetrics and gynecology. When considering programs, resident camaraderie, gynecologic experience, and commitment to education were most important. Over 70% of residents decided to pursue obstetrics and gynecology during or after their third-year clerkship. CONCLUSION: Surgical opportunities and clinical variety appeal to applicants. The majority choose obstetrics and gynecology during or after their core clerkship. In addition, program dynamics are important when choosing a residency.

Adult↗
PubMed2005

Residency attrition rate in obstetrics and gynecology: are we losing more postgraduates today?

OBJECTIVE: The purpose of this descriptive study was to determine the attrition rate in 2003 and to establish where residents matriculate after leaving an obstetrics and gynecology residency program. STUDY DESIGN: A questionnaire was sent by e-mail to all program directors in obstetrics and gynecology residencies in the United States. The questionnaire asked for the number of residents who had left a program, what year of training the resident was in, and whether the departure was a transfer, withdrawal, or dismissal. It asked whether a transfer was to an obstetrics and gynecology residency program or to another specialty; if the resident transferred to another specialty, which specialty did the resident choose. RESULTS: Two hundred nineteen of 253 programs responded (86.5%). Of residents who left programs, 49% left in the first year of training; 34% left in the second year of training; 13% left in the third year of training, and 4% left in the fourth year of training. The reason for attrition was that 75% of the residents transferred to another residency program; 16% of the residents withdrew from training, and 8% of the residents were dismissed. Of the transferring residents, 60% remained in obstetrics and gynecology. CONCLUSION: Although resident attrition was higher than in 1992, more residents remained in obstetrics and gynecology.

Career Choice↗
PubMed2004

A short history of evidence-based obstetric care.

Evidence-based obstetric care is a relatively new concept, which had its origins in the early 1970s when Iain Chalmers and his colleagues in Oxford responded to the statement of Archie Cochrane that much of the evidence underpinning obstetric (and other) practices was flawed. They recognized the importance of the quality of evidence in informing clinical decision making, particularly evidence from randomized trials. This was a shift away from opinion-based obstetrics, which up until then had been the dominant paradigm. Since then, there has been an exponential increase in the number and quality of clinical trials in obstetrics, and with their dissemination through the Cochrane database of systematic reviews, there have been many improvements in obstetric practice, more closely aligning it with sound evidence.

Evidence-Based Medicine↗