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PubMedDate not supplied

Obstetric urogenital fistula: the Ilorin experience, Nigeria.

A study of thirty-four cases of obstetric urogenital fistula managed over a ten-year period (1st January, 1989 to 31st December, 1998) at the University of Ilorin Teaching Hospital is reported. The incidence of obstetric urogenital fistula is 1.1 per 1000 births. The condition is associated with illiteracy and poorly supervised delivery. The peak incidence is in 15-19 years age group and primipara accounting for 26.5% and 50% respectively. Prolonged obstructed labour was the most common aetiological factor in 28 (82.4%) of cases. Juxta-cervical region was the most common site of obstetric urogenital fistula. Eight (23.5%) patients were separated/divorced from their husbands. Obstetric urogenital fistula can be prevented by improving socio-economic condition of the populace, educating the populace to utilize health facilities and advice against teenage pregnancy. Labour should be supervised by trained health personnel and difficult labour referred early to appropriate health care facility.

Adolescent↗
PubMed1976

Obstetrics in family practice: a personal and political perspective.

A heated debate is currently taking place concerning the style, methods and location of future obstetrical and neonatal care. On the one hand, there is a trend toward increasing technology of obstetrical and neonatal care with some professional groups favoring regionalization of these services to large regional centers. On the other hand, there are counterforces to such regionalization including community hospitals, many practicing obstetricians, nurse midwives, the women's liberation movement, the "alternative lifestyle movement," the Leboyer concept of delivery, the family-centered maternity care movement, and the family practice movement. This paper explores these issues and presents important reasons for family-oriented obstetric and neonatal care involving the family physician in community settings readily accessible to patients. The inclusion of obstetrical care as an integral part of family practice is important to the growth and development of the specialty.

Delivery, Obstetric↗
PubMed2000

[Childbirth preparation courses: obstetrical and neonatal evaluation].

From 1997, R.A.T. (Respiratory Autogenous Training) and "Stretching" training have been performed into the Department of Obstetrics and Gynecology University of Parma, for childbirth preparation. The aim of this study is to evaluate the obstetric characteristics of these women during labor and delivery. We compared the labour and delivery characteristics of 200 women who have completed antepartum R.A.T. and stretching training with 100 matched controls who have not. Preparation is significantly related to reduction in dystocic deliveries (operative vaginal delivery and cesarean section) and emergency cesarean section. Epidural analgesia (an obstetric procedure that is not routinely offered in the department of Parma) is more frequently performed in women prepared with ante-partum training. The neonatal outcome is good in all the three groups. "Prepared-childbirth" courses offer measurable clinical, obstetrical and neonatal advantages and psychological support, providing a useful link between prenatal ambulatory care and hospital labor and delivery care.

Adult↗
PubMed2003

Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study.

BACKGROUND: The aim of the study was to evaluate the obstetric and neonatal outcome of pregnancies after assisted reproduction technology (ART) in comparison with matched controls from spontaneous pregnancies. METHODS: A total of 12 920 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, from 1 January 1995 to 31 December 2001 were subjected to retrospective analysis. Two hundred and eighty-four singleton, 75 twin and 17 triplet pregnancies after ovulation induction (n = 114; 30.3%), intrauterine insemination (n = 33; 8.8%) and in vitro fertilization (n = 229; 60.9%) were evaluated. The pregnancy outcome of the singleton and twin pregnancies was compared with that for controls matched with regard to age, gravidity and parity and previous obstetric outcome after spontaneous pregnancies. RESULTS: Twenty-four percent of the assisted reproductive pregnancies were multiple pregnancies. The incidences of singleton intrauterine growth retardation (IUGR) and preterm birth were reasonably similar to those among the controls (IUGR: 6.3% vs. 4.2%; preterm births: 13.0% vs. 9.9%, for the cases and the controls, respectively). As compared with the controls, there was an increased incidence of cesarean section among the singleton (41.2% vs. 34.5%, p = 0.12; OR 1.33; 95% CI 0.95-1.87) and twin assisted reproduction pregnancies (66.7% vs. 60.0%), but without significant differences. CONCLUSIONS: Increased obstetric risk could be observed concerning threatened preterm delivery and cesarean section rate in the study group. The perinatal outcome of singleton and twin pregnancies following assisted reproductive techniques is comparable with that of spontaneously conceived, matched pregnancies.

Adult↗
PubMed2006

[Anal incontinence caused by an obstetric trauma. Experience with the technique of overlapping sphincteroplasty].

INTRODUCTION: Anal incontinence (IA) could be of idiopathic, congenital, neurological origin, or secondary to trauma. Obstetric trauma is the most common cause of the traumatic anal incontinence. OBJECTIVE: To analyze results of a group of patients with anal incontinence secondary to obstetric trauma, with overlapping sphincteroplasty. PATIENTS AND METHODS: All patients with anal incontinence secondary to obstetric trauma without neurological damage, between January 2002 to January 2006 were studied; all of them underwent overlapping sphincteroplasty. We evaluated improvement in incontinence score according Jorge and Wexner incontinence scale, pre and postoperatively as well as morbi-mortality rates. RESULTS: 16 patients, most of them with total anal incontinence, with preoperative values between 16 to 20 points at the Jorge and Wexner scale; 14 patients (87.5%) referred improvement in their values with 4 to 0 points postoperatively, two patients did not refer significant improvement, both of them with defects in both sphincters and loss of the 50% of the entire sphincteric complex. They were sent to bio-feedback therapy. There was not mortality. Seven patients (43.7%) had skin dehiscence. CONCLUSIONS: Overlapping sphincteroplasty is an accurately technique for repair obstetric trauma injuries of the anal sphincter, with a success rate of 70 to 80%, and a low morbidity rate.

Adult↗
PubMed1989

[Obstetrical surgical interventions in teenagers younger than 16 years of age].

The age of adolescence is not biologically the proper one for performing obstetric interventions regarding both the individual psychosomatic growth of the girl and the requirements of the reproductive and dermatographic practice. The authors analyzed in the present study the incidence of major obstetric operative interventions according to the indications and age distribution on the basis of 10,182 deliveries, 271 of which belonged to teenagers. The incidence of cesarean section was 3%; forceps delivery--2.2%; vacuum extraction--0.4%; assisted breech delivery and breech extraction--2.2%; version--0.4%; inspection of the uterine cavity: manual 1.8%; instrumental--0.7%. The total incidence of major obstetric operative interventions in teenagers was 11% and compared with the operative practice in the clinic in general it was almost equal or even less. The incidence of the small obstetric repairs was significant: perineal lacerations--32.1%, cervical lacerations--2.2%, vaginal lacerations--11%. The low incidence of cesarean section (total incidence for the clinic 6-9%), contrary to expectations, was not due to fetal-pelvic disproportion in the teenagers. The aforementioned results are a part of a study, covering a three year period, designed to clarify problems on different aspects, regarding the medical and social grounds of the pregnancy and delivery in teenagers.

Adolescent↗
PubMed1989

[Can surgeons be in charge of an obstetric department?].

At Rana sykehus there are neither obstetricians nor pediatricians. The obstetric ward is run by the surgeons. Pregnant women suspected of being at increased risks are transferred to Nordland Sentralsykehus before the expected delivery. The following data were obtained by analyzing 1,009 deliveries. 19.2% of all the deliveries needed emergency assistance by a doctor. Emergency cesarean section was performed in 6.2% of the cases, and vacuum extraction was needed in 3.2%. Elective cesarean section was done in 4.9% of all births. Emergency and elective cesarean section together made up 11.1% of the 1009 deliveries. The cesarean section rates were lower than the average number in Nordland and in the country as a whole. The perinatal death rate was lower than the average rate for the rest of the country (0.49% versus 0.8%). Infants with potential dangerous conditions were transferred for pediatric care at Nordland Sentralsykehus (3.96%). Our conclusion is that general surgeons can be responsible for an obstetric ward, when it is done voluntary, and it is approved by a responsible obstetrician. In our area there is a need for an obstetric ward, and the surgeons here have built a certain expertise in obstetrics. In difficult cases, however, the surgeons always consult the obstetricians and pediatricians at Nordland Sentralsykehus for evaluation of the patients.

Critical Care↗
PubMed1979

Management of obstetric complications at a small rural hospital.

To determine if there is a way of identifying obstetric patients in whom complications will develop, the experience of one small hospital was reviewed. It was found that there is no satisfactory method presently available that allows a hospital to select such patients so that they can be referred to a large centre. While the scoring system designed by Goodwin, Dunne and Thomas for assessing antepartum fetal risk is fairly effective in selecting fetuses at risk, its results do not correlate well with the frequency of obstetric complications. Since in a significant proportion of obstetric patients complications develop that require emergency intervention, it is important that hospital staff maintain their ability to do safe cesarean sections and to obtain blood for transfusion quickly. Hospitals in which there are fewer than 100 deliveries per year probably do not have a sufficient caseload to maintain the ability to do safe cesarean sections; it is therefore suggested that they discontinue obstetric practice. At hospitals with a larger caseload elective cesarean sections should be done so that the ability to do emergency procedures can be maintained.

Apgar Score↗
PubMed1995

Obstetrics hysterectomy--five years experience at Jinnah Postgraduate Medical Centre, Karachi.

During the five years period (1st January 1988 to 31st December 1992), 106 hysterectomies were performed for obstetric indications in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. The frequency was 1 in 331 deliveries (total 35,172 deliveries). In all except one hysterectomy was performed as a life saving measure. The major indications were ruptured uterus in 61 (58%) cases and severe postpartum haemorrhage due to uterine atony in 18 (17%). Other indications included haemorrhage due to placenta praevia in 11 (10%), placenta accreta 7 (7%) and abruptio placentae 5 (5%), severe infection 2 (2%) and broad ligament haematoma following caesarean section 1 (1%). There were 10 (9%) maternal deaths all due to severity of the conditions necessitating hysterectomy. Obstetric hysterectomy can save many lives but requires proper judgement and skill. Senior resident staff in obstetric units in the developing countries should be trained for it.

Adolescent↗
PubMed1994

Obstetrical practice after a family medicine residency.

To determine factors influencing physicians to provide obstetrical care, a questionnaire was sent to all 149 graduates of the University of Western Ontario family medicine program from 1987 to 1991, inclusive. Few (37.1%) of the 105 respondents still performed low-risk deliveries. Most frequently cited negative factors included interference with lifestyle, interruption of regular office routine, and insufficient training in obstetrics. Rural postal code, neonatal advanced life support training, and older age positively correlated with obstetrical practice. Ways in which residency training programs could address the alarming decrease in family practice obstetrics are discussed.

Adult↗
PubMed1994

Quality assurance: measuring its effect on a busy obstetric service.

OBJECTIVE: To evaluate the effect of establishing a new quality assurance program in obstetrics at a large teaching hospital. METHODS: Seven obstetric clinical indicators were selected. After the computerized data base identified the patients as outliers from these indicators, the medical record of each patient was reviewed. Each case was presented to the nine-member committee, which made recommendations or actions for changes or improvement in patient care. The number of patients coming to review and the number of clinical indicators from the year before the program were compared to the results of the second year of the program. RESULTS: The new program significantly reduced the number of patient records reviewed and the clinical indicators. Of the clinical indicators, prolonged hospitalization after both vaginal and cesarean births was decreased. Recommendations to the department included the need for better chart documentation, specific educational presentations as grand rounds, and a protocol for antibiotic use for postpartum endomyometritis. CONCLUSION: A quality assurance program in obstetrics may decrease the number of clinical indicators after only 1 year. This decreasing trend and better documentation may be considered as measures of improvement in obstetric care.

Connecticut↗
PubMedDate not supplied

Obstetric performance in Ethiopian immigrants compared with Israeli parturients.

It was the aim of this study to evaluate the obstetric performance of Ethiopian Jewish immigrants in comparison to the general Jewish obstetric population. The study was performed at the Soroka Medical Center, Beer Sheva, which manages the busiest delivery ward in Israel. Between 1988 and 1991 a total of 20,047 non-Ethiopian women (Group N) and 431 parturients of Ethiopian origin (group E) delivered at the Soroka Medical Center. Group E included a significantly higher percentage of grandmultiparous women than group N. Among diseases complicating pregnancy there was a statistically significant higher incidence of severe pregnancy-induced hypertension (PIH) in group E than in group N. Mild PIH and chronic hypertension were of comparable prevalence in both groups. The prevalence of class A diabetes mellitus was significantly lower in group E than in group N; the same trend was also observed for diabetes class B but without reaching statistical significance. There was no significant difference between the groups in the prevalence of polyhydramnios, postdatism and poor obstetric history, or fetal distress, s/p cesarean section, and prolapse of cord. Statistical analysis indicated a tendency towards significance for higher prevalence of premature rupture of membranes in group N. Malpresentations and malpositions were of similar prevalence in both groups. The incidence of premature delivery in group E showed a higher relative risk, suggesting a tendency of significance. The incidence of meconium-stained amniotic fluid in group E was significantly higher than in group N. There was no significant difference in the prevalence rates of placental complications such as placenta previa and abruption of placenta between the groups. The mode of delivery, the prevalence of complications during the third stage of labor, birthweight of infants and perinatal mortality were similar for both groups. In conclusion, the obstetric performance in Ethiopian Jewish immigrants is surprisingly similar to that of Israeli Jewish parturients. The only prominent pathology that does not seem to be related to life-style and nutrition is pregnancy-induced hypertension.

Birth Weight↗
PubMed1997

Transcutaneous electrical nerve stimulation (TENS) as a pain-relief device in obstetrics and gynecology.

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological and non-invasive pain-relief method that has been proven effective for a variety of conditions. Electrical therapy has been recognized for a long time but its practical clinical application in the form of TENS has been evaluated only during the last 30 years as a result of several theories on pain. The most known of these with regard to TENS development is the "gate theory", although several others have also played a role. In obstetrics and gynecology, TENS has been found to be effective in alleviating labor pain and in the treatment of primary dysmenorrhea. It has also been used successfully following obstetric and gynecologic surgery. In order to be effective in clinical use for obstetric and gynecologic indications, a TENS device must have certain properties, which are detailed in this review. Although new TENS devices that meet all the necessary requirements have been developed and tested, their use is still far from widespread. Patients and medical staff should be encouraged to try the TENS device for obstetric and gynecologic indications, since it is non-invasive, efficient, and easy to use.

Dysmenorrhea↗
PubMed1998

[Quality of data acceptable for perinatal epidemiology surveillance: assessment of the health certificate at birth and the national obstetrics medical file. Study in three Seine-Maritime maternal wards].

Data from several sources could be used for perinatal epidemiology surveillance aimed at an assessment of regional programs such as those proposed by the Superior Committee for Public Health. A retrospective study of 561 births was conducted in three maternity wards in the French Seine Maritime department in order to evaluate the reliability of two data sources: the national obstetrics medical file and the health certificate at birth. The delivery room records were used as the gold standard. The sensitivity of the obstetrics file was better than that of the health certificate. With the obstetrics file, it was possible to identify almost all the vaginal route interventions, almost all the premature births and all the cesareans. With the health certificate, 39-58% of the vaginal route interventions, 61% of the premature births and 61-72% of the cesareans performed in the three wards studied were identified. The quality of data in the obstetrics file appears to be better than that in the health certificate but only concerns 40% of births in the geographical area studied. Inversely, the health certificate is theoretically delivered for all births (actually delivered for 93%). Integrating these two information systems could be an optimum solution.

Bias↗
PubMed1992

Neonatal morphometry. Relation to obstetric, pediatric, and menstrual estimates of gestational age.

OBJECTIVE: To determine gestational age-dependent neonatal morphometrics based on last menstrual periods (LMPs), Ballard examinations, and obstetric estimates of gestational age. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of 38,818 live-born neonates at a tertiary care center in Detroit, Mich. SELECTION PROCEDURES: Consecutive sample of all viable, structurally normal, singleton neonates delivered at Hutzel Hospital from 1984 through 1991. MEASUREMENTS/MAIN RESULTS: Neonatal weights, lengths, and head circumferences were recorded at birth. Gestational age-dependent morphometrics were based solely on LMPs and compared with those based on obstetric estimates (using LMPs corrected by fetal ultrasound). Ballard examination had an 85.4% concurrence (within 14 days) with obstetric estimates of gestational age, but only a 69.9% (P less than .0001) agreement with LMP. Dating only by LMP significantly overestimated the prevalence of prematurity (odds ratio [OR], 1.3; 99% confidence interval [CI], 1.3 to 1.4) and postmaturity (OR, 5.0; 99% CI, 4.6 to 5.4), distorting apparent growth patterns, especially for preterm neonates. In contrast to previous studies based solely on LMPs, morphometric measurements increased beyond 40 weeks when dated by obstetric estimates. CONCLUSIONS: Gestational age-dependent neonatal morphometrics should not be based solely on LMPs.

Anthropometry↗
PubMedDate not supplied

Relationship between endocervical canal length between 15-24 weeks gestation and obstetric history.

The object was to determine whether there is a correlation between the obstetric history and the ultrasonographically determined endocervical canal length between 15 and 24 weeks gestation. A retrospective cohort study was performed in singleton pregnancies of multigravidas with normal and abnormal obstetric histories. They underwent sonographic evaluation for the determination of the endocervical canal length between 15 and 24 weeks gestation. The shortest endocervical canal length measurements between 15 and 20 weeks and also between 21 and 24 weeks of gestation were recorded. An ultrasound diagnosis of cervical incompetence was defined as progressive shortening of the endocervical canal length to <2 cm or a single endocervical canal length measurement <2 cm. A multivariable general linear regression model was used to correlate the relationship between endocervical canal lengths at 15-20 weeks and 21-24 weeks gestation in the current pregnancy with the earliest gestational age at delivery of prior pregnancies. Chi-square test was used to determine the relationship between the development of an ultrasound diagnosis of cervical incompetence and the earliest gestational age at delivery of prior pregnancies. A total of 155 pregnancies were studied. The number of women according to the obstetric history categories were: 57 had delivered <24 weeks, 12 between 24 and 26 weeks, 16 between 27 and 32 weeks, 16 between 33 and 36 weeks, and 54 delivered > or =37 weeks. There was a significant correlation between the endocervical canal length measurements between 15-20 (P < 0.0001) weeks and 21-24 weeks (P < 0.0001) in the studied pregnancy and the earliest gestational age at delivery of prior pregnancies. A significant relationship between the ultrasound diagnosis of cervical incompetence and the obstetric history category (P = 0.0026) was observed. There were 36 cases of ultrasound diagnosed cervical incompetence with 91.7% (33/36) occurring in women who had a prior <27 weeks' gestation delivery. These data provide further evidence that cervical incompetence is a relative condition and not an "all or none" phenomenon. In addition, women with a prior delivery <30 weeks gestation should be followed with second trimester serial cervical sonography to rule out cervical incompetence.

Adult↗
PubMed1992

Survey of computerized obstetric information systems in Austria.

The aim of this study was to evaluate obstetric electronic data processing (EDP) in Austria and to analyse its problems, advantages and acceptance in a single big obstetric department. We sent questionnaires to every obstetric department in the country. The overall response rate was 77% (73 departments). Only 24 (33%) were using computer aided documentation, but these covered 63% of deliveries in Austria. The proportionate times spent on documentation were 57% for physicians and 43% for midwives, with physicians playing a bigger role in larger departments using electronic documentation. Sixty-five percent of physicians and 31% of midwives readily accepted computerization. We also studied an obstetric department with over 3000 births per year. Twenty-five percent of the medical staff did not believe that computerization saved time, although they appreciated its value to administration and for producing printouts. Advantages in completeness (92%) and accuracy (76%) were recognized. After 6 month's use acceptance of EDP documentation improved significantly.

Attitude of Health Personnel↗
PubMed2004

Obstetrical and neonatal outcome in young adolescents of low socio-economic status: a case control study.

OBJECTIVE: The purpose of this study was to determine obstetrical and neonatal outcome among early adolescent pregnancies (< or =15 years). METHOD: We compared obstetrical and neonatal outcome of early adolescent nulliparas with outcome of nulliparous women aged 20-30 years. RESULTS: Two hundred and one (201) early adolescent nulliparous patients of low socio-economic status were enrolled at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil-Ecuador, and matched for gestational age with 201 low socio-economic nulliparous controls aged 20-30. Mean maternal age of the adolescent group was 14.2+/-0.6 years. The incidence of cervicovaginal infections during current pregnancy was significantly higher among adolescents (trichomoniasis: 11.4% vs. 5% and candidiasis: 27.8% vs. 12.4%, p<0.05). The incidence of eclampsia was higher in adolescents (2.5% vs. 0%, p<0.05). The preterm rate in each group was 4.9%. There were no differences in labor characteristics and the rate of cesarean section, labor complications and abnormal puerperium between both studied groups. Nevertheless, mean neonatal weight was lower and the incidence of low birth weight infants (<2,500 g) and adverse neonatal outcome was significantly higher in the adolescent group (2,837.6+/-454 g vs. 3,017+/-547 g; 19.9% vs. 11.4% [OR=1.92, 95% CI: 1-3.5] and 9.5% vs. 3.5% [OR=2.9, 95% CI: 1.1-7.7] respectively, p<0.05). CONCLUSION: Pregnancy in young adolescents (< or =15 years) of low socio-economic status did not impose adverse obstetrical outcome, however it did increase the risk for low birth weight, adverse neonatal outcome and cervicovaginal infections.

Adolescent↗