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PubMed1988

Debate on use of spinal anesthesia in obstetrics: spinal anesthesia has definite indications in obstetrics.

Spinal anesthesia has the advantages of speed of onset, reliability and lack of toxicity over lumbar epidural block. Against this must be offset several disadvantages, but these can be largely eliminated by careful choice of equipment and meticulous attention to details of technique. Only experienced obstetric anesthetists should perform spinal anesthesia, especially for Caesarean section. Given these conditions, spinal block has a most important part to play in obstetric anesthesia.

Anesthesia, Obstetrical↗
PubMed1982

Research and development in obstetrics & gynaecology in the Department of Obstetrics & Gynaecology at the National University of Singapore.

This is a review of the research and achievements of the Department of Obstetrics and Gynaecology, National University of Singapore since 1949. The research activities reviewed are Fertility Control, Subfertility, Reproductive Endocrinology, In-Vitro Fertilization, Trophoblastic Disease, Prostaglandins and Perinatal Medicine. The University Department has kept abreast with the Singapore norm of two-child families by providing the most sophisticated technology and expertise. The perinatal mortality and stillbirth rates have been reduced to 11 and 6 per thousand births. Prostaglandin research in the Department includes an investigation of the involvement of these substances in various physiological processes, pharmacological studies with different prostaglandins and development of clinical applications. Between 1974 and 1981 we had studied 12 intrauterine contraceptive devices, both on a departmental basis and in conjunction with international agencies. The newer medicated devices have proved to offer significant advantages over the original inert plastic configuration. Metabolic changes in Singapore women on the oral pill and injection Depoprovera were studied. Impaired glucose tolerance and raised fasting total lipids were found in women on the pill. Marginal changes in carbohydrate metabolism only were found in women on injection Depoprovera. Hypercoagulation changes in the blood occurring in Singapore women varied with the dose of the synthetic or natural oestrogen medication. Initially, the fibrinolytic activity was enough to compensate for these changes; however after two years there were signs of decompensation. Progestogens affect coagulation via their influence on the liver functions. Hypercoagulation changes also occurred in pregnancy and was of a greater magnitude than oestrogen or progestogen medication. In many obstetric disorders, including hydatidiform mole, there was evidence of intravascular coagulation. The introduction of endocrine function tests has greatly improved patient care in our Department, in particular those related to endocrine disorders. Application of the immunoassays to basic research has shown that physiological levels of oestradiol exert a negative feedback effect on both FSH and LH secretions in men. The greater suppression of LH than of FSH secretion by pharmacological doses of estradiol is possibly due to different control mechanisms in the pituitary for the synthesis and release of both gonadotrophins. Physiological level of testosterone per se has a definite negative feedback effect on the secretion of LH but not on FSH. Pharmacological doses of the 5-alpha-reduced metabolites of testosterone have been shown to suppress both LH and FSH indicating that some of the actions of testosterone could be medicated by these metabolites of which the 3 alpha-androstanediol and 3 beta-androstanediol are the more likely candidates.

Academic Medical Centers↗
PubMed1978

[The organization of an obstetric center in relation to obstetrical analgesia].

In order that continous epidural anaesthesia may be given safely in an obstetric centre, the permanent presence of an anaesthetist is necessary. Obstetricians and midwives must be familiar with the management of labour using this method and team spirit involving continous cooperation between the anaesthetist, obstetrician and midwives is essential. Training related to epidural anaesthesia is necessary for the members of the obsteric centre, as well as education of the patients.

Anesthesia, Obstetrical↗
PubMed2000

[Non-obstetrical indications for cesarean section at the Obstetrics-Gynecology Department of the Higher Medical Institute, Plovdiv].

The authors have examined retrospectively the non-obstetrical indications for Caesarian section over a six-year period (1994-1999). Such indications have been related to extra-genital diseases. For this period there have been 6647 births, 908 of which (13.66%) by Caesarian section. For non-obstetrical indications 146 CS have been performed. The greatest number of CS is due to ophthalmological reasons--84. The current concepts for performing CS in cases of eye pathology and non-medical indications are discussed.

Bulgaria↗
PubMed1989

[The impact of a new strict obstetrical strategy on maternal mortality and obstetrical results].

In an attempt to reduce the caesarean section rate without an adverse effect on the obstetrical outcome, new guidelines for the management of dystocia, previous caesarean delivery, fetal distress, and breech presentation were introduced in September 1984 in a provincial hospital in Zimbabwe, Africa. Comparison of the two-year periods before and after September 1984 showed that the caesarean section rate had dropped from 16.8 to 8.0%, the maternal mortality rate from 2.0 to 0.5%, and the perinatal mortality rate from 71.9 to 56.2%. During the latter period use of oxytocin increased from 3.4 to 17.4%. These findings suggest that the adoption of strict guidelines can lead to a decrease of the caesarean section rate and an improvement of the obstetrical outcome in the absence of new technology.

Adult↗
PubMed1988

Assessing obstetric risk. A review of obstetric risk-scoring systems.

The primary purpose of formal risk assessment in obstetrics is the prevention and consequent reduction of perinatal morbidity and mortality through early identification and intervention. Obstetric risk scoring quantifies identified risk factors according to their relative contribution to adverse perinatal outcomes and aggregates individual factor scores. A review of existing scoring methods reveals consistently low positive predictive values and more accurate prediction when the assessment occurs closer to the time of actual delivery. While numerous scoring systems exist in the literature, few are convenient in practice, and none appear to assess effectively the dynamic character of pregnancy.

Female↗
PubMed1992

Multidimensional assessment of women's experience of childbirth: relationship to obstetric procedure, antenatal preparation and obstetric history.

Primiparous postnatal patients (N = 110) rated their experience of childbirth on a 20-item questionnaire based on an earlier survey of women's spontaneous descriptions. Principal components analysis of the ratings identified three independent dimensions, describing feelings of fulfillment, distress and difficulty, respectively. Ratings by 104 primiparous antenatal patients in the third trimester yielded similar dimensions. The postnatal sample was divided, in turn, according to obstetric procedure at delivery, antenatal classes attended, whether the present pregnancy was planned and history of previous termination. Their experience of childbirth was compared on each dimension. Forceps and unassisted deliveries were experienced similarly. Caesarian section was a less difficult, but also less fulfilling and more distressing, experience than either of these. Delivery was less distressing in those who attended antenatal classes, but only one type of class was associated with more fulfilling birth. Finally, delivery was more distressing in women whose pregnancy was unplanned, or in whom a previous pregnancy had been terminated. Future controlled investigations will be incomplete unless each of the three dimensions is measured.

Adult↗
PubMed1987

(Sub)specialization in obstetrics and gynecology: results of a survey by the American Board of Obstetrics and Gynecology.

Survey of department chairmen (n = 113) and former fellows (n = 599) revealed that from 1974 to 1984 the mean number of full-time faculty doubled and the increase was in subspecialists (5.1 per department). More than 60% of departments report trained subspecialists in three areas and 92.9% in one or more areas. Twenty-two chairmen report zero laboratory research funding. Of former fellows, 82% are certified in obstetrics and gynecology; 44% are certified in a subspecialty; 86.3% have passed the subspecialty written examination. Employment is full-time faculty for 60.8% and full-time private practice for 16.1%. They devote 49.1% of professional time to the subspecialty and 15.9% to research, most of which is clinical; 56.6% spend no time in laboratory research. While 40.3% have submitted no research grant applications since completion of fellowship, of all grants submitted to the federal government, 63.5% were approved and 34.5% were funded. The mean number of papers published since fellowship is 7.8. The number of fellows graduating may meet estimated need. The initial objectives of this new certification are being achieved.

Certification↗
PubMedDate not supplied

Obstetric complications as antecedents of schizophrenia: empirical effects of using different obstetric complication scales.

The new McNeil-Sjöström Scale for obstetric complications (OCs), as well as scales of Lewis et al. (Schizophrenia: Scientific progress. Oxford University Press, 1989) and Parnas et al. (British Journal of Psychiatry, 140, 416-420, 1982), were applied to the OC histories of 70 singleton schizophrenics and 70 demographically-matched controls from the same hospital delivery series, using blindly assessed hospital pregnancy and birth record information. With the McNeil-Sjöström scale, schizophrenics were found to have significantly increased rates of OCs for the total reproduction, as well as for labor-delivery and the neonatal period but not for pregnancy. Significant increases in OCs in these schizophrenics were also found in scores produced by the Lewis et al. scale but not by the Parnas et al. scale. Further application of these three scales to OC data obtained through parental report for 23 monozygotic (MZ) twin pairs discordant and 10 pairs concordant for schizophrenia, as well as seven normal control MZ pairs, showed a significant difference in OC rates across the different twin pair groups, when assessed by the McNeil-Sjöström and Parnas et al. scales, but not by the Lewis et al. scale. The particular scoring system used in a study is thus of considerable importance not only for findings concerning OC histories of schizophrenics vs. controls, but also for the relationship between OCs and other presumed etiological factors in schizophrenia. Among the three scales, the McNeil-Sjöström scale provided the most sensitive assessment of OC history for schizophrenics.

Adult↗
PubMed2006

The effect of the obstetrics and gynecology clerkship on students' interest in a career in obstetrics and gynecology.

OBJECTIVE: The goal of this study was to determine the influence of the third-year obstetrics and gynecology (OB/GYN) clerkship on male and female medical students' interest in a career in OB/GYN. STUDY DESIGN: Third-year medical students were surveyed about anticipated career field before and at the completion of the OB/GYN clerkship. The percentage of students considering OB/GYN as a career was computed before and after the clerkship. A multiple regression analysis was performed to examine the influence of various demographic factors on interest in OB/GYN. A Chi-square test was performed to establish different effects on males and females. RESULTS: A total of 268 students (55%) completed both surveys. Eight percent (mostly females) considered an OB/GYN career pre-clerkship and 15% post-clerkship. Interest in OB/GYN pre-clerkship was the strongest predictor of interest post-clerkship. CONCLUSION: The OB/GYN clerkship increases students' interest in a career in OB/GYN. Most males are not considering OB/GYN as a career choice before the start of the clerkship.

Adult↗
PubMed2004

Obstetric audit in resource-poor settings: lessons from a multi-country project auditing 'near miss' obstetrical emergencies.

This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations.

Africa↗
PubMed1977

A laryngoscope for obstetrical use an obstetrical laryngoscope.

Rapid tracheal intubation, using the standard Macintosh laryngoscope, can be hindered in obstetrical patients by the handle of the laryngoscope hitting the patient's engorged breasts and the hand of the assistant applying cricoid pressure. To overcome these difficulties a variation of the laryngoscope is described. The right angle of the blade to the handle is opened by a further 20 degrees.

Female↗
PubMed1999

[Risk management in gynecology and obstetrics. Forensic questions in connection with operative gynecology and obstetrics].

Due to the avalanche-like increase of malpractice suits, it has become mandatory for doctors in hospitals and private practices to acquire a profound knowledge relating to modern management and to become familiar with the legal aspects of medical procedures. The article at hand reviews the standards of medical documentation and risk information within the scope of operative gynaecology and obstetrics and provides guidelines for a structured behaviour once an incident has occurred. The typical sources of complications are presented and strategies to avoid them are outlined: professional clinical management including the definition of competences for all therapists working together in a hospital. By observing these principles a professional medical level even in administrative respect is provided and thus enables an atmosphere of mutual confidence among doctors and patients.

Female↗
PubMedDate not supplied

[Obstetrical complications and schizophrenia. Comparative study of obstetric antecedents in schizophrenic and bipolar patients].

Information on pregnancy and birth complications was recorded for 46 patients with DSM III-R schizophrenia or bipolar disorder. The biological mothers of the patients were interviewed personally to obtain obstetric information. There were no significant differences between schizophrenic and bipolar patients in age at the assessment, distribution of sex, paternal social class, age of the mother at birth, and birth order. Biological mothers of schizophrenics had more often than mothers of bipolar patients an history of miscarriage, but this trend failed to reach statistical significance. Pregnancy complications and birth weight were not significantly different between schizophrenic and bipolar patients. Birth complications were scored according to the method described by Parnas et al. (1982). Three scores were obtained for each patient: a frequency score, a severity score, and a total score. All the scores were significantly higher in the schizophrenic than in the bipolar group (frequency score p < 0.011; severity score p < 0.015; total score p < 0.01). Surprisingly, birth complications were more severe in female than in male schizophrenics (p < 0.017). The two groups of patients could not be differentiated by specific birth complication. The schizophrenic patients with a history of birth complication and those without such an history did not differ in age at onset, age at first hospitalization, family history of schizophrenic or non-affective psychotic disorder, neuroleptic resistance, and type of schizophrenia. Because of the small number of subjects in each group a type II error cannot be excluded for these negative results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Obstetric-perinatal status 1990 in the Oder region (a contribution to the obstetric-perinatal care in East Brandenburg)].

On the background of the first All-German-Perinatal-Study in 1992 the results in obstetrics and perinatology in the Oder-Region (east part of the State of Brandenbourg) in 1990 are described. In comparison to the results in a previous study (1985) we found a drastical decline in the number of births (newborns 1985: 10244; 1990: 7723); in addition to the changing in the reproduction- and health-care behaviour, too, we have noted a decreasing perinatal mortality from 7.5% in 1985 to 4.9% in 1990. The ameliorated monitoring-rate (cardiotocography-rate) of the fetus (1985: 71%, 1990: 88.4%) and the decreasing still-birth-rate may be the main cause of this phenomenon. Clinic-births were the most common deliveries, the house-birth was the great exception; only 0.2% of all deliveries occurred at home or otherwhere. Our data support that there is no difference, except the birth-rate, in relation to the situation in the "old" Federal Republic of Germany.

Birth Rate↗
PubMed2002

ACOG practice bulletin. Obstetric analgesia and anesthesia. Number 36, July 2002. American College of Obstetrics and Gynecology.

Labor results in severe pain for many women. There is no other circumstance in which it is considered acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician's care. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. Pain management should be provided whenever it is medically indicated. The purpose of this document is to help obstetrician-gynecologists understand the available methods of pain relief to facilitate communication with their colleagues in the field of anesthesia, thereby, optimizing patient comfort while minimizing the potential for maternal and neonatal morbidity and mortality.

Analgesia, Obstetrical↗