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At least 811 records · Page 45Linked to original sources
PubMed1999

[Do obstetric causes of death explain the differences in maternal mortality between France and Europe?].

In view of understanding why the level of maternal mortality is higher in France than in other European countries, a specific study of frequency and causes has been carried out in these 13 countries. Two different sources of data were used: the annual civil death data from national offices which are published by the WHO, and the MOMS data. It was hypothesized that the pattern of causes plays a role in the level of maternal mortality. This hypothesis was checked with results issuing from a European concerted action where deaths were classified by a European group of medical experts using identical criteria. There were apparently more cases of hemorrhage, direct obstetric causes, and indirect obstetric causes in France than in the other European countries. The higher level of indirect obstetric causes may be explained by stronger registration regulations for maternal deaths recently implemented in France. Due to the higher level of hemorrhage as cause of maternal death in France, we suggest in-depth research is needed in the near future to study prevalence and management of obstetrical hemorrhage in France.

Cause of Death↗
PubMed1994

[Gynecology and obstetrics of the Song Dynasty].

There are great gynecological achievements in the Song Dynasty, featuring the establishment of a discipline on obstetrics with an obstetrical professor who specialized in the training of students in gynecology and obstetrics and pushed forward the development of these departments; the appearance of obstetricians and gynecologists as well as relevant monographs; accomplishment of basic theories, and technical know-how on diagnosis and therapy. By then, obstetrics and gynecology were developed into an independent discipline.

China↗
PubMed2002

Obstetric complications: the health care seeking behaviour & cost pressure generated from it in rural Bangladesh.

The study was done throughout 2001 to find out the health care-seeking behavior & cost analysis generated from obstetric complications in rural Bangladesh. Total 350 women in postnatal period who had obstetric complications were interviewed from the study area of 150 km apart in the rural section of Bangladesh namely Dewangonj & Trishal Upazila. Majority of the respondents belonged to the age group 17-35 years & all the mothers had obstetric complications. Major obstetric complications were haemorrhage, prolonged labour, premature rupture of membrane, eclampsia, septic abortion, obstructed labour, prolonged labour etc. 74% had history of home delivery out of which 26% were reported to the hospital. Majority of them (74%) was reluctant to take the health utilization system. The major problem was financial burden, which seems to divert the major changing of health care seeking behavior.

Bangladesh↗
PubMedDate not supplied

Differences in the obstetric malpractice claims filed by Medicaid and non-Medicaid patients.

BACKGROUND: Many physicians believe Medicaid patients are more likely than non-Medicaid patients to file malpractice claims. This study examines the accuracy of this belief in regard to obstetric malpractice claims. METHODS: Claims filed between January 1982 and June 1988 from the major malpractice insurer in Washington State were used to compare obstetric malpractice claims filed on behalf of Medicaid and non-Medicaid patients. RESULTS: Eleven percent (7/62) of all closed obstetric claims were filed by Medicaid patients, whereas 19 percent of all births in Washington State were to Medicaid patients between 1982 and 1988. Failure to diagnose or treat a fetal condition was the most commonly alleged negligence in both Medicaid and non-Medicaid groups. Most claims in both groups were settled before the cases went to court; a substantial minority of claims were dropped. The mean cost of Medicaid claims ($406,984) was three times that of non-Medicaid claims ($133,743), suggesting that paid Medicaid claims were more severe than paid non-Medicaid claims. CONCLUSIONS: Medicaid patients appear no more likely to file obstetric malpractice claims than non-Medicaid patients. The low likelihood of filing claims, coupled with large settlements, suggests that Medicaid patients may have less access to legal services than non-Medicaid patients.

Female↗
PubMed2004

[Treatment of early and late obstetric brachial plexus palsy].

The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.

Age Factors↗
PubMed2004

[Obstetric hysterectomy--analysis of indications in years 1992-2001].

AIM OF THE STUDY: Analysis of indications and post-operative course in patients after obstetric hysterectomy. MATERIAL AND METHODS: 45 cases of obstetric hysterectomy were analysed. RESULTS: Mean age of operated woman was 32.18 +/- 4.31 years. Mean gestational age was 35.9 +/- 1.76 weeks. The estimated rate of obstetric hysterectomy was 2.5 per 1000 deliveries. The most frequent indication for urgent hysterectomy were placentation disorders. Elective hysterectomy was performed because o invasive cervical cancer and uterine myomas. Mean time of duration of surgery was 91.67 min. CONCLUSIONS: 1. Indications for obstetric hysterectomy should be stated very carefully and the operation should be performed by the most experienced staff. 2. In case of severe intraoperative bleeding internal iliac artery ligation should be performed.

Adult↗
PubMed1992

[Forensic problems in bovine obstetrics and gynecology].

In the published statistical reports of liability insurance companies for veterinarians a high percentage of damage claims falls into the field of obstetrics and gynaecology, particularly in the bovine species. Veterinarians are held responsible for the consequences of insufficient clinical examinations of female animals or, after a correct diagnosis, initiation of therapeutic measures that ar not indicated. An increasing number of damage claims is due to the fact that the veterinarian has not informed the owner of an animal in advance about the possible medical or economic risks of a particular treatment. From the expert opinions requested of our clinic by insurance companies and law courts, it can be concluded that in veterinary obstetrics, lesions and damages occurring during vaginal deliveries are still the most frequent cause of compensation claims. Veterinarians are blamed for the use of too much traction force (number of persons assisting in an extraction, use of mechanical calf-pullers) and for incorrect procedures during the manual or instrumental correction of postural or positional abnormalities or a uterine torsion. Also, in case of complications after obstetrical surgery owners suspect failure of the veterinarian. Many losses in the puerperal period are due to the fact that the clinical examination after an obstetrical intervention has not been performed with the necessary accuracy or has been completely omitted. Compensation claims after gynaecological procedures are mostly based on a falsely positive or negative pregnancy diagnosis and complications after surgery involving the ovaries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

[Nalbuphine in obstetrical analgesia].

OBJECTIVE: Comparison between particular methods of obstetrics analgesia, their analgetic efects and influence on the progress of delivery and postpartum adaptation of fetus. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynecology and Obstetrics of the Teaching Hospital and the 2nd Medical Faculty of the Charles University in Prague. METHODS: A prospective study of 92 patients who received intravenous infusion nalbuphine (28 women) or epidural analgesia (31 women) or pethidin (33 women). Assessment of maternal analgesia, satisaction was carried out. Apgar scores and resuscitative measures required for the neonate were note at delivery. RESULTS: The best analgesic effect was in the group with using peridural analgesia, where max. score was 3. The highest value was in the group of women who received pethidin. The most significant decrease of score after application of analgesia was in group with epidural analgesia, the least decrease of score was in the group with pethidin. The Apgar score at 1. minute was the lowest in the group with epidural analgesia, the highest score was in the group with nalbuphine. CONCLUSION: The mixed agonist/antagonist narcotic analgesic like nalbuphine have the place in clinical practice. The obstetric analgesia is very common in obstetrics practice. The epidural analgesia is very popular but not always accessible. Nalbuphine is the option which is effective in analgesia and have minimal side-effects.

Analgesia, Epidural↗
PubMed2005

Obstetric anesthesia - then and now.

In 1947 John Bonica as new Chief of Anesthesiology at Tacoma General Hospital organized one of the first around-the-clock labor anesthesia services and when became the first chairman of the new Department of Anesthesiology at the University of Washington (1960), caudal anesthesia was the primary technique used for providing labor analgesia. In 1967 the first volume of Bonica's classic textbook ''Principles and practice of obstetric analgesia and anesthesia'' was published. The text was a comprehensive treatise that pulled together virtually everything that was known in that field. Perhaps the most significant development in obstetric anesthesia in the past 20 years has been the introduction of spinal opioid analgesia.. Bonica predicted the probable success of these techniques in the last edition of his ''Obstetric analgesia and anesthesia'' handbook published in 1980. Current obstetric anesthetic practice, though quite different from what it was 30 or 40 years ago, has its roots in the priorities, techniques and teachings of Dr. John J. Bonica.

Adult↗
PubMed2005

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology.

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.

Clinical Competence↗
PubMed2006

[Informed consent in gynecology and obstetrics].

OBJECTIVE: A systematic review of recent available literature on the topic of informed consent, evaluation of the terminus a quo and the creation of theoretical basis for execution of the process of informed consent in clinical practice with attention to specific aspects in gynecology and obstetrics. TYPE OF STUDY: Review of literature. SETTING: Mother and Child Care Institute Prague, Chair of Gynecology and Obstetrics, IPVZ, Prague. METHODS: Review of publications on the given topic and implementation of general principles of medical ethics in the area of gynecology and obstetrics. RESULTS: The branch of gynecology and obstetrics brings about various controversial clinical situations, which arise from specific features of the branch. The informed consent is an integral part of the diagnostic-therapeutic process and precondition of the correct (lege artis) procedure. The adequate agreement with the therapy should be informed, free and competent. It prevents ethical crisis in conditions of an ethical conflict. The paper defines the content and structure of the informed consent and draws attention to its technical prerequisites so as to fulfill the truthfulness and legal validity. CONCLUSION: The informed consent is an important part of communication between the physician and the patient. The physician provides a complex, qualified, truthful and complete information. A competent patient accepts this kind of information and decides, based on full understanding, when and in what form, undergoes the recommended procedure or refuses it.

Conflict of Interest↗
PubMedDate not supplied

Laparoscopy training in United States obstetric and gynecology residency programs.

OBJECTIVES: To assess laparoscopic training curriculums in US Obstetrics and Gynecology residency programs. METHODS: A list of E-mail addresses was obtained for the accredited Obstetrics and Gynecology residency programs in the US from the CREOG Directory of Obstetric-Gynecologic Residency Programs and Directors. An E-mail survey containing 8 questions regarding laparoscopy training was sent to all residency directors with current E-mail addresses. RESULTS: Seventy-four residency directors responded to the survey for a response rate of 41%. Residency programs from all sections of the US were included in the study. Results of the survey indicate that 69% of residency programs had implemented a formal laparoscopy training program. At least half of the program directors surveyed stated that lack of faculty time and funds were the main barriers to laparoscopic surgery training. Seventy-two percent of those surveyed thought that in the future the health-care industry would demand proof of competency in laparoscopy as standard of care. CONCLUSIONS: Most US Obstetrics and Gynecology residency programs have implemented a formal laparoscopy training curriculum, use more than one method to train their residents, and involve almost half of their faculty on average in training residents to perform laparoscopic surgery.

Curriculum↗
PubMed2006

[Infection of the surgical site. Experience of two years in the gynecology and obstetric service of Mexican General Hospital].

OBJECTIVE: To know the incidence and causal agents of the surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico. MATERIAL AND METHOD: A retrospective, descriptive and analytical study was performed on patients with surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico during January 1st, 2000 to December 31st, 2001. RESULTS: A global low rate of surgical site infection was observed, with predominance on the third life decade patients and on obstetrics events (69.5%). The initial treatment consisting of 600 mg intravenous clindamycin every eight hours and 500 mg intravenous amikacin every 12 hours showed high efficacy. The mean time of hospital stay was nine days; 97% of the discharges were due to improvement, with a minimum rate of mortality. CONCLUSIONS: The index of surgical site infections for gynecological and obstetric procedures is lower than the accepted percentage, but it is more frequent in patients submitted to total abdominal hysterectomy.

Adult↗
PubMed2006

A novel management database in obstetrics and gynaecology to introduce the electronic healthcare record and improve the clinical audit process.

OBJECTIVES: To design a system capable of recording complete and accurate electronic patient records with respect to obstetrics and gynaecology, with the ability to perform instant statistically summaries of data. BACKGROUND: Electronic patient records have been shown to provide numerous benefits for the clinician, with respect to patient consultation, accurate recording of data, medical audit and statistical analysis. In Northern Ireland there is no database designed to cover all the major clinical aspects of obstetrics and gynaecology. This project incorporates all aspects of obstetrics and gynaecology into a single database. METHODS: Database designed using Filemaker pro 7, Macromedia Fireworks 8, and Microsoft photodraw. Problems specific to obstetrics and gynaecology included recording multiple pregnancy data, and the lack of a unique patient number (the current system in Northern Ireland gives patients a unique hospital number, and a separate maternity number for each pregnancy). Linking all of these sources was a major component of this database. The database contains many intrinsic tabulations, relationships, programming scripts and calculations to combine files and calculate important statistical information for clinicians automatically. RESULTS: A successful audit of delivery statistics for December 05 was performed using the system. Several additional audits are currently under completion using the database. The major audit, completion date end April 06, is a 5 month summary of delivery data (Dec-April) based on mode of delivery, Robson groups, and Caesarian -Section rate among specified patient sub-groups. CONCLUSION: The system has been successful in its initial stages with obvious improvements to the medical audit process already apparent. The system should prove to be a valuable addition to the department and ultimately improve patient care. The ability to provide instant access to clinical data and statistics will simplify and improve the audit process, improving clinical governance. The management of the OB/GYN department should benefit greatly.

Computer Communication Networks↗
PubMed1992

[The main obstetrical problems].

Development og antenatal care and obstetrics in Denmark during the past decades has been carried out by distribution of advisory guiding principles from the Ministry of the Interior (Ministry of Health) and the Board of Health, most recently in 1985. On the basis of a review of the current problems in obstetrics, reassessment of the guiding principles is suggested, particularly development of obstetrics on the basis of well controlled assessments of new possibilities. As possibilities for improving the results of obstetrics, the problems concerning preconceptional examination, alternative methods, mini-centre arrangements, care of sick pregnant women in their own homes, employment of ultrasound and cardiotocography are described. Modern furnishing of maternity departments, improved midwifery and better cooperation between the staff groups involved are considered necessary to ensure that maternity care in Denmark can become even better than it is at present.

Denmark↗
PubMed1991

Obstetrical practice survey report. Healthy Futures Program, May 2, 1991.

Oklahoma physicians in three specialty areas (ob/gyn, family practice, and general practice) were surveyed in regard to their practice of obstetrics. The 611 physicians who responded included a representative sample in regard to county of practice, rural vs urban, age, degree (DO & MD), specialty, and type of practice. Respondents accounted for 51% of the total 1989 births in Oklahoma during calendar year 1989. The vast majority (greater than 90%) of respondents report that they normally provide delivery services and prenatal care in combination. Cesarean sections are performed by almost all ob/gyns (97.6%), more than half of the family practitioners (56.5%), and a very few general practitioners (18.9%). Half of all physicians responding have made changes in their obstetric practice in the last 3 years. The most common changes are: reducing care of medically high risk, uninsured, and/or Medicaid patients. The most important reasons for these changes are: fear of obstetric malpractice suits, inconvenience of obstetrics and excessive professional liability insurance premiums. Specific reasons for reducing care to medically high risk patients were reported to be: increased medical legal liability, belief that high risk patients should be cared for by specialists, and lack of Medicaid reimbursement for diagnostic services. Almost 90% of the physicians responding to the survey are required to carry a minimum amount of professional liability insurance by the hospital where they practice with the most frequently stated amount being $1,000,000. Current average "global fees" reported by the respondents were $1,202 for a spontaneous vaginal delivery and $1,543 for a cesarean delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Differences in the obstetric practices of obstetricians and family physicians in Washington State.

In response to the obstetric malpractice crisis, both obstetrician-gynecologists and family physicians have raised their fees and preferentially selected lower risk patients. In addition, large numbers of general and family physicians have left obstetric practice altogether. The impact of these responses was explored by examining the differences in the demographic and clinical profile of patients served by these two disciplines in the State of Washington. Eighty-five percent (45,540) of all complete records from 1983 births attended by physicians in the State of Washington were matched to physician specialty information. These births represent 67% of the total deliveries in Washington State in 1983. Although twice as many general and family physicians as obstetricians were practicing obstetrics, obstetricians delivered 2.5 times as many infants as did general and family physicians. Obstetricians served an older patient population with more low-birthweight infants, multiple births, and complications of pregnancy than family physicians. General and family physicians were more likely to care for minorities, teenagers, and unmarried and rural mothers. Obstetricians cared for patients with higher medical risks, whereas general and family physicians provided care to more socially vulnerable and geographically isolated populations. To the extent that general and family physicians are differentially abandoning obstetric practice because of the current malpractice crisis, access to care for rural and socially vulnerable groups may deteriorate rapidly.

Adolescent↗
PubMedDate not supplied

A survey of obstetric malpractice in western frontier areas.

A mail survey of 524 physicians in the frontier areas of Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming, and the rural areas of Utah was conducted; 286 valid responses were collected (54.6%). Of the respondents, 97% had at some time practiced obstetrics, and, of those now practicing obstetrics, 39% reported they would discontinue providing obstetrical care within the next year. Of those stopping, 95% indicated that malpractice was a major factor in their decision. Of the respondents, 74% indicated that access to obstetric services would be a problem in their areas if they discontinued this type of care.

Humans↗