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PubMed2004

[Obstetric epidural analgesia: relationship between obstetric variables and the course of labor].

OBJECTIVES: To analyze the relationship between epidural analgesia and diverse obstetric and fetal variables as well as the impact of epidural analgesia on the rates of instrumental and cesarean delivery. PATIENTS AND METHODS: Observational study of women who gave birth at Fundación Hospital Alcorcón over a period of 3 years. All the women were offered obstetric epidural analgesia based on 0.0625% bupivacaine plus 2 microg/mL of fentanyl. The following data were recorded: age, nulliparity (yes/no) administration of epidural analgesia (yes/no), induction of labor (yes/no), stimulation of uterine activity with oxytocin (yes/no), type of delivery, fetal weight, duration of dilation, duration of expulsion, cause of cesarean. RESULTS: The records of 4364 women were gathered. The percentages of inductions, nulliparas, oxytocin stimulation, and fetal weight greater than 4 kg and less than 2.5 kg were higher among women taking epidural analgesia. The age of women who received epidurals was significantly lower. The durations of dilation and expulsion were longer among women receiving epidural analgesia, and epidural analgesia was associated with greater risk of instrumental and cesarean deliveries. The significant increase in administration of epidural blocks over the 3-year period of the study was not accompanied by an increased rate of instrumentally assisted deliveries or cesareans. CONCLUSIONS: It is difficult to evaluate the real influence of epidural analgesia on certain aspects of labor and its evolution. The strength of the association between epidural analgesia and greater risk of increased rates of instrumental and cesarean deliveries may be influenced by factors not considered in the present study.

Adult↗
PubMed2005

[Obstetrical forceps: yesterday, today and tomorrow. Toward a new classification of obstetrical forceps].

OBJECTIVE: Obstetrical forceps are used worldwide since more than 400 years. In 2003 forceps deliveries accounted for 6.3% of all deliveries of the AURORE Grand-Lyon perinatal network. Although more than 400 different forceps have been described, obstetrics handbooks neither describe experimental forceps nor provide any chapter dedicated to instrumental delivery training. Our aim was to provide junior obstetricians with information that will allow them to select the best instrument and to let them know about experimental as well as pedagogic forceps. PATIENTS AND METHODS: International literature review using the terms "forceps" and "delivery" and a four year experimental work involving a close collaboration between obstetricians and biomechanics of the INSA engineering school. RESULTS: Two instruments are presented as well as a new forceps classification. DISCUSSION AND CONCLUSION: This classification distinguishes between three types of forceps: operational forceps designed to delivers neonates, experimental forceps designed to study biomechanics and training forceps designed for resident training. For the first time the classic blind forceps procedure is transformed in a full screen real time procedure.

Equipment Design↗
PubMed1978

[The development of Obstetrics at the 2nd Department of Obstetrics and Gynecology, University of Vienna, Medical School, during the last 20 years (author's transl)].

Including the deliveries in 1956, 1961, 1967, 1970, 1971, 1975, 1976 the development of obstetrics at the 2nd Department of Obstetrics and Gynecology, University of Vienna, Medical School, is shown. The frequency of vaginal operative deliveries was reduced, the indicence of ceasarean sections increased from 1.6 to 6.9%. In premature newborns it was possible to gain a higher birthweight, perinatal and postpartum mortality fell from 4.4 to 2.8% and from 3.3 to 1.5% respectively. The connections between these positive results and the new methods and possibilities introduced at the department are discussed.

Austria↗
PubMed1997

A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study.

OBJECTIVES: The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia, birth trauma, neonatal hypoglycemia, and operative delivery. The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study, by determining realistic accrual rates, and by detecting any major adverse outcomes in the control group that received routine obstetric care. STUDY DESIGN: The study was a prospective randomized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes. Women randomized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care, and women in the control arm received routine obstetric care. RESULTS: Three hundred women with gestational diabetes mellitus were studied. There was no difference in maternal age, weight, or length of gestation between groups. The treatment mean birth weight was 3437 +/- 575 gm compared with 3544 +/- 601 gm in the control group, a difference of 107 gm (not significant). Macrosomia rates were similar. There was no birth trauma in either group. The frequency of neonatal hypoglycemia and other metabolic complications was the same. The mode of delivery also showed similar patterns. The treatment group had significantly lower preprandial and postprandial glucose levels by 32 weeks' gestation, which continued to term. CONCLUSION: This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight, birth trauma, operative delivery, or neonatal metabolic disorders. It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings.

Adult↗
PubMed1997

Anti-beta 2 glycoprotein I antibodies in a general obstetric population: preliminary results on the prevalence and correlation with pregnancy outcome. Anti-beta2 glycoprotein I antibodies are associated with some obstetrical complications, mainly preeclampsia-eclampsia.

OBJECTIVE: To evaluate the prevalence in normal pregnancies of anti-32 glycoprotein I (anti-beta2GPI) antibodies, and their association with obstetrical complications. STUDY DESIGN: Prospective study of anti-beta2GPI and anticardiolipin (CL) antibodies in 510 healthy pregnant women at 15-18 weeks. According to the results, women were categorized into three groups: group I, negative for both antibodies; group II, positive for anti-beta2GPI antibodies; group III, positive for aCL only. The rates of fetal loss, abruptio placentae, preeclampsia-eclampsia, and fetal growth retardation were compared in the three groups. RESULTS: Anti-beta2GPI antibodies were found in 20 women (3.9%) and aCL in 8 patients (1.6%). Obstetrical complications were more frequent, even if not significantly different, in group II, 15%, than in group I, 4.1% (difference 10.9%; 95% confidence interval (CI): 1.6-20.2%; p=0.0575), while no complications were seen in group III. Preeclampsia-eclampsia were significantly more frequent in group II (10%) than in group I (0.8%; difference 9.2%; 95% CI: 4.4-14%; p=0.021). The prevalence of fetal growth retardation was not significantly different in the two groups (5% vs. 2%, respectively). COMMENT: Our findings indicate that anti-beta2GPI antibodies are associated with some obstetrical complications, mainly preeclampsia-eclampsia, even if more conventional antiphospholipid antibodies are not present. This observation suggests that these antibodies should be investigated in such cases, in order to improve the outcome of subsequent pregnancies, as well as in women with a history of early and/or recurrent severe preeclampsia in order to start a prophylactic treatment (i.e. low-dose aspirin or heparin).

Abruptio Placentae↗
PubMedDate not supplied

Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy.

New findings and diagnostic advances warrant revisiting key features of acute non-obstetric abdominal pain in pregnancy. Four of the most frequently seen conditions warranting surgical intervention are: appendicitis, cholecystitis, pancreatitis, and bowel obstruction. Because pregnancy often masks abdominal complaints, effectively assessing and triaging abdominal pain in pregnant women can be difficult. Working in obstetric triage settings and triaging obstetric phone calls demand continual updating of abdominal assessment knowledge and clinical skills.

Abdominal Pain↗
PubMed1988

[The obstetrical future of the post-fractured pelvis of the child. Medico-legal evaluation of obstetrical damages].

When the paediatric orthopaedic surgeon is required to treat a fracture of the pelvis in a young girl, by an orthopaedic method or by appropriate open reduction and fixation, he should evaluate the future obstetric sequelae in order to be able to answer the specific questions raised by the injured child's family and also by legal experts appointed by the court. The authors have classified the various fractures of the pelvis in children by analysing the elements of functional prognosis of these lesions based on the types of fractures and on the particular factors of vitiation reported in the literature, consisting of series which are too short to be truly demonstrative. It is obviously impossible to precisely determine the obstetric prognosis, as only trial of labour following induction will confirm the intact patency of the pelvic osteo-articular passage. However, the collaboration of the paediatric orthopaedic surgeon immediately after the accident will allow a prudent evaluation of the obstetric prognosis, allowing the court expert to allocate funds and to define the bases for compensation of bodily damages in the light of this prognosis.

Child↗
PubMed1993

Guidelines for Regional Anesthesia in Obstetrics: potential impact on obstetric anesthesia services in rural Alabama.

When the American Society of Anesthesiologists published its Guidelines for Regional Anesthesia in Obstetrics, I did a survey to determine what impact a broadly implemented strict interpretation of those guidelines might have on obstetric anesthesia care in small rural Alabama hospitals. Thirty-six rural Alabama hospitals with fewer than 200 beds were included in the survey, with a response rate of 50%. Data included total deliveries, cesarean section rates, utilization rates of anesthesia services, personnel providing anesthesia care, and identification of physician personnel available during labor and cesarean section. Results showed that anesthesia care is provided for approximately 52% of births in the responding hospitals. Of these, approximately 60% of cesarean sections and 90% of vaginal deliveries are not routinely attended by anesthesiologists. If these data also reflect the nonrespondent hospitals, statewide access could be limited for approximately 6000 parturients annually. The Guidelines should be interpreted with caution. Rather than conform to related policies, interpretation should allow implementation consistent with the capabilities of the individual institutions, while ensuring quality anesthesia care for the parturients.

Alabama↗
PubMed1992

[The inventors of the obstetric forceps and the obstetric lever].

A multiple lineage is proposed for the invention of the obstetric forceps. Having been conceived by a member of the Chamberlen family in fifteenth- or seventeenth-century England, the instrument seems to have been reinvented in Flanders by Jan Palfyn and in Holland by Rogier Roonhuyse. Later, Roonhuyse invented a more effective instrument for coping with the impacted head: the obstetric lever. Palfyn's "Iron Hands" inspired Dussé to produce the "French" forceps which bears his name.

Belgium↗
PubMed1998

[Eduard C. H. von Siebold: "The use of sulfur ether vapor in obstetrics" (1847). A contribution to the beginning of modern obstetric analgesia and anesthesia in Germany].

In 1847 J.Y. Simpson in Scotland was the first to describe the administration of ether for analgesia in painful deliveries. Only a few days later E.C.J. von Siebold (1801 in Würzburg-1861 in Göttingen) performed the first systematic study on ether in obstetrics. Following a preceding evaluation of the action of ether on non-pregnant woman and on pregnant women not in active labour, he administered ether for analgesia during the second stage of labour in eight parturients. The first administration was on February 25th 1847. While he was satisfied with the good analgesia without sequelae of the new-born, he was discouraged by the termination of uterine contractions observed in all his patients. He concluded that ether was not a useful substance for analgesia during vaginal delivery, since it disturbed the natural course of labour. On the other hand, von Siebold was very pleased with the administration of ether for operative obstetric procedures such as forceps deliveries or placental retention.

Anesthesia, Obstetrical↗
PubMed2006

The availability of life-saving obstetric services in developing countries: an in-depth look at the signal functions for emergency obstetric care.

OBJECTIVE: This paper examines the frequency with which a set of life-saving interventions or signal functions was performed to treat major obstetric complications. METHODS AND RESULTS: The basic signal functions include parenteral antibiotics, anticonvulsants and oxytocics, and the procedures of manual removal of the placenta, removal of retained uterine products, and assisted vaginal delivery. Comprehensive functions include the six basic functions, cesarean delivery, and blood transfusions. Data from 1906 health facilities in 13 countries indicate that the most likely functions to be reported are oxytocics and antibiotics. The basic function least likely to be reported is assisted vaginal delivery. Many of the facilities surveyed did not have the infrastructure to perform operations or provide blood transfusions. CONCLUSIONS: These data can help governments allocate their budgets appropriately, help policy makers and planners identify systemic bottlenecks and prioritize solutions. Monitoring the performance of the functions informs us of the capacity of the health system to provide key interventions when obstetric emergencies occur.

Anti-Bacterial Agents↗
PubMed1997

An obstetric and gynecologic clerkship's influence on a medical community. The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship.

OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci. STUDY DESIGN: Data were obtained on former clerks to determine choice of specialty and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship. RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship. CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians.

Alaska↗
PubMed1997

[Evaluation of hemostasis before obstetrical epidural anesthesia: a survey in 435 French obstetric departments].

OBJECTIVES: To specify by which means French anaesthesiologists evaluate the haemostasis profile of pregnant women before epidural analgesia. STUDY DESIGN: Nationwide retrospective survey. MATERIAL: Questionnaire sent of 847 French obstetrical units. METHODS: Comparison of categorical qualitative parameters using a chi 2 test. RESULTS: Answers from 435 centres, including 1,834 anaesthesiologists, performing 227 x 10(3) epidurals for 411 x 10(3) deliveries/year were obtained. A preanaesthetic clinical assessment was performed systematically in two out of three units, and blood samples for PT, aPTT and platelet count were taken in more than 90% of the centres. These laboratory examinations were often made during the 9th month of pregnancy (74%). For more than one-third of the anaesthesiologists, biological data are not essential before epidural puncture. In addition, the lower limits considered as being safe before epidural puncture were highly variable between the teams. CONCLUSIONS: Coagulation laboratory tests are almost always ordered before epidural obstetrical analgesia in France. The rationale to perform them is not always related to pregnancy induced haemostatic changes. Therefore, this problem should be clarified by a consensus conference for both practical and economical reasons.

Adult↗
PubMed1995

Obstetric antecedents of surgically treated obstetric brachial plexus injuries.

OBJECTIVE: To determine whether the anatomy of an obstetric brachial plexus lesion (OBPL) is causally related to the preceding obstetric history. DESIGN: Anatomical classification of the OBPL during reconstructive neurosurgical treatment in consecutive infants who had surgery for OBPL between 1986 and 1994 and relating these findings with the characteristics of the preceding birth. SETTING: De Wever Hospital, Heerlen, The Netherlands. SUBJECTS: All infants who had surgical treatment for OBPL between 1 April 1986 and 1 January 1994 (n = 130). RESULTS: An Erb's C5-C6 injury was preceded more frequently by a difficult breech birth (19/26 cases or 73%). In contrast, the more extensive forms of Erb's palsy classified as a C5-C7 injury or a total palsy with a C5-T1 injury were observed more frequently after complicated cephalic birth (52/59 or 88%, and 43/45 or 96%, respectively). The extent of anatomical damage as expressed by the incidence of an avulsion of one or more spinal nerves was 18/26 (69%) in Erb C5-C6, 13/59 (22%) in Erb C5-C7 and 21/45 (47%) in total C5-T1 palsy. CONCLUSION: The Erb's C5-C6 palsy, occasionally bilateral and/or complicated by phrenic nerve injury, was the most frequent form of OBPL after a breech birth. The more extensive form of Erb's palsy and the total palsy were observed more frequently after delivery in a cephalic presentation. The pure form of Erb's palsy and the total palsy were characterised by a higher incidence of nerve avulsions than the extensive form of Erb's palsy.

Birth Weight↗
PubMed1996

Psychological morbidity in obstetric-gynaecology patients: testing the need for expanded psychiatry services in obstetric-gynaecology facilities.

OBJECTIVE: The present study set out to determine general levels of distress, anxiety and depression in an obstetric-gynaecology inpatient population and to ascertain levels of patient satisfaction with services. METHOD: 200 English-speaking consecutive admissions to the hospital filled out a package of questionnaires consisting of a demographic data form, the 30-item General Health Questionnaire, the Speilberger State-Trait Anxiety Inventory, the Inventory to Diagnose Depression and a Patient Satisfaction with Services Questionnaire. 134 packages were fully completed. RESULTS: The most significant findings were: first, that high levels of anxiety prevailed, with approximately 1/3 of patients at or above the 75th percentile for anxiety levels; and second, that those patients born in non-English speaking countries were significantly more dissatisfied with their care. CONCLUSIONS: The results of this study suggest that there is a need for increased awareness of and further research into the psychological needs of obstetric-gynaecology patients.

Adult↗
PubMedDate not supplied

[Follow up of obstetric nurses graduated from training and specialization courses in obstetric nursing at the nursing school of the University of Sao Paulo].

The purpose of this study was to show the prevalence of characteristics in former students from the Specialization Course on Obstetric Nursing of the University of São Paulo College of Nursing, Brazil. The population consisted of 92 former students who graduated in 1980 to 1985, of whom 50% worked in the field of obstetric nursing. Of these, 73.2% were clinical nurses and 26.8% were university faculty. Concerning those who no longer performed in that field, 76.0% did so after graduation and 24.0% never worked in the area. Regarding professional satisfaction, 71.7% reported to be satisfied and 28.3% were dissatisfied. The reasons given for stopping working in that area suggest very important points to be analyzed professional representation entities as well as by those who are responsible for the education of these professionals.

Adult↗
PubMedDate not supplied

[Report on obstetrical activity during the triennium 1985-1987. 4th Obstetrics and Gynecology Clinic, University of Milan, Institute of Biomedical Sciences, S. Gerardo Hospital, Monza].

The data of three years of activity (1985-1987) at the 4th Obstetrics and Gynecology Department of the University of Milan, S. Gerardo Hospital in Monza, for a total of 5595 deliveries and 5672 new-borns are reviewed. Each case of perinatal death has been evaluated for gestational age, weight, way of delivery and preexisting or pregnancy-induced maternal diseases, trying to single out the primary causes of death. In order to compare these data with the ones of the previous three years the results have been divided, following the gestational age, in two groups (less or more and equal than 28 weeks). Late perinatal death rate (including all the babies older than 24 weeks of gestational age, still-born or live-born and dead within the 28th day of life) has been 1.8%, compared to the 2.1% in the previous 3 years. Obstetrical procedures and neonatal outcomes are analyzed in depth. Puerperium was pathological in 8.9% of patients. Only 4.2% of women decided not to breast-fed their babies.

Adult↗
PubMed2005

[Incidence and indications for cesarean section in the Obstetrics Clinic in the University Hospital of Obstetrics and Gynecology "Maichin Dom" in Sofia].

The incidence and the indications for Cesarean section in the Obstetric Clinic of the University Hospital of Obstetrics and Gynecology were analysed and compared to a study carried out 20 years ago In 2003 - 2004 there were 2700 pregnant women treated in the clinic 558 had Cesarean section (incidence 20.7%). For comparison the incidence of Cesarean section in 1985 was 6.67% (160 Cesarean sections for 2096 patients) and for 1986 the incidence was 7.63% (131 Cesarean Sections for 1865 patients. The leading indication for the both studies was "previous Cesarean section" the indication "contracted pelvis" was the second and infertility and breech presentation were on the third and forth place. There was no change in the indications for Cesqarean section in the present study and the study carried out 20 years ago. There was a relative increase of the indications 'contracted pelvis' and 'increased age in a nulliparous patiet' compared to the previous years.

Breech Presentation↗