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PubMed1989

[The place of x-ray pelvimetry in obstetrical practice].

The frequency of roentgenological pelvimetry, its changes in accordance with obstetric management of labour and its place in the obstetric practice were studied at the Research institute of Obstetric and Gynecology for the period of 1979-1988. It was established that its mean frequency for the investigated period was 7.0%, but its highest frequency--11.1% during 1982. During the following years its frequency gradually diminished and it was stabilized within the ranges of 3.5 to 5.0% during the last three years. It is indicated that roentgenological pelvimetry should be made compulsory in women with secondary deformed pelvis and in women with fetal breech presentation, whose parturition should be managed per vias naturales. It is stressed that the roentgenological pelvimetry has its place in the obstetric practice and it is a valuable diagnostic method.

Bulgaria↗
PubMed1989

Obstetric privileges for family physicians: a national study.

In 1988 the American Academy of Family Physicians sampled 4400 active members whose mailing address was in one of the 50 states or the District of Columbia. The sample was stratified by nine census regions; after two mailings a 76.2% response rate was achieved. Nine in ten active members have hospital admission privileges. A higher proportion of family physicians in the West North Central census region have privileges at various levels of obstetric care than in other census regions. For those family physicians who do not have privileges for any obstetrics, most indicated that they chose not to include obstetric care in their hospital practices. Family physicians most likely to have obstetric privileges include those who practice in nonmetropolitan areas and those who have completed a family practice residency program. Although disparities in the proportion of family physicians with certain hospital privileges exist among regions, the majority in each region indicated that the privileges afforded them were appropriate.

Family Practice↗
PubMed1987

[Historical development of obstetrical anesthesia].

Pain is a primary component of normal childbirth as evidenced by the behavior of parturients in primitive societies. Methods of pain relief such as the use of herbs and plant extracts were described in ancient writings. Modern obstetric analgesia employing ether began in 1847, three months after the first successful surgical anesthetic. Administration of chloroform and nitrous oxide followed. Twilight sleep, a combination of morphine and scopolamine, became popular in the beginning of the twentieth century as did regional analgesia, first single injection and later continuous blockade via catheter. Simultaneously, psychologic methods were propagated, but were not uniformly successful. Continuous lumbar extradural analgesia has evolved as the optimal method of bsotetric pain relief, both subjectively and objectively, and its combination with childbirth education is considered to be complementary. The increasing utilization of obstetric analgesia and the recognition of marked physiologic and pharmacologic differences between pregnant and nonpregnant patients has led to the development of the subspecialty of obstetric anesthesia as well as to the foundation of obstetric anesthesia societies.

Anesthesia, Obstetrical↗
PubMed1988

Multidisciplinary program for promoting single prophylactic doses of cefazolin in obstetrical and gynecological surgical procedures.

A multidisciplinary cost-containment program for promoting the use of single prophylactic doses of cefazolin for obstetrical and gynecological surgical procedures is described. Following a one-month review of patient charts to identify the antimicrobial regimens used most frequently for prophylaxis in obstetrical and gynecological surgical procedures, the department of pharmacy services, with the cooperation of the pharmacy and therapeutics (P&T) committee and the departments of obstetrics and gynecology and infectious diseases, implemented an educational program to promote the use of single doses of cefazolin for surgical prophylaxis. The program included inservice education and distribution of letters of support and a therapeutics newsletter. Drug stocking patterns in the operating and delivery rooms were changed to make cefazolin more accessible, and the P&T committee formally restricted the use of prophylactic antimicrobial agents in obstetrical and gynecological surgical procedures to single doses of cefazolin unless a consulting infectious-disease physician recommended otherwise. Compliance with the program increased as each step was implemented; data collected 16 months after the program was initiated demonstrated a compliance rate of 78.8%. Based on comparison of data collected before initiation and six months after initiation of the program, an actual cost savings of +7,125 was realized, which extrapolates to +14,250 annually. No apparent adverse effects on patient care were noted. The multidisciplinary approach to promoting the use of single doses of cefazolin was effective.

Cefazolin↗
PubMed1986

[Obstetrics and gynecology in the medical education curriculum in the 19th century].

The paper gives a survey on development of teaching in obstetrics and gynaecology at German universities in 19th century. Three aspects of these part of medical education are described: the establishment of obstetrics and gynaecology in the medical curriculum and orders of examination, institutional development of obstetrics and gynaecology as an obligatory part of medical education, the growth of specific methods of teaching in obstetrics and gynaecology.

Curriculum↗
PubMed1987

[Obstetrical urogenital fistulas then and now].

An analysis was made of the aetiology and localisation of 83 obstetric urogenital fistulae, in 15-year intervals, which had been treated at the Gynecological Hospital of Charité over the past 45 years, with the view to finding out, if obstetrics continues to play a causative role in fistulation. With overall figures having stayed nearly constant (31, 25 and 27 fistulae), an increase has been primarily recordable from causes relating to caesarean section and from fistula localisations in the vesico-uterine region. Obstetric causes accounted for 10 per cent and gynaecological causes for 90 per cent of 808 urogenital fistulae throughout the entire period under review. Hence, at least surgical obstetrics should not even today be underestimated as a cause of fistulation. These findings have given rise to considerations of strategy and to conclusions regarding prophylaxis against fistulation with particular reference to caesarean section.

Cesarean Section↗
PubMed1987

The quality of obstetric care in family practice: are family physicians as safe as obstetricians?

A literature review on the quality of obstetric care in family practice was conducted to determine whether family physicians are as competent in providing obstetric care as obstetricians. Three types of studies were reviewed: case series, historical cohorts, and population-based studies. No conclusion on the quality of obstetric care in family practice can be drawn from the available studies because of research design limitations. Available evidence suggests, however, that family physicians are as safe as obstetricians when delivering babies, particularly when they concentrate their efforts on providing personal prenatal care, refer high-risk pregnant women appropriately, and practice less technologically oriented care on women who deliver normal-weight babies. In addition, no evidence emerged that family physicians provided significantly poorer obstetric care than obstetricians. In fact, the results from population-based studies suggest that family physicians may be safer than obstetricians in delivering normal-weight infants because of their hypothesized less use of technological interventions in that low-risk group of patients. Further studies, especially prospective randomized trials in which the outcomes are assessed in a blinded fashion and case mix is rigorously controlled, are needed to provide a definitive answer. As practical, ethical, and economic constraints are likely to preclude such studies, the case-control design may provide a reasonable alternative.

Clinical Competence↗
PubMed1984

Anesthesiologists' practice of obstetric anesthesiology.

Physicians trained in obstetric anesthesia and no longer practicing it were questioned regarding conditions that were responsible for their leaving the field. A questionnaire was prepared to determine whether the physicians' activity in obstetric anesthesia continued after fellowship training. The survey yielded a response rate of 76%. Forty-two percent of the respondents spend more than 40% of their clinical anesthesia time in obstetric anesthesia, and 58% spend less than 40% in it. The reasons for less of an emphasis on obstetric anesthesia were finances, personal matters, lack of recognition, long hours and too much call, and lack of stimulation.

Anesthesia, Obstetrical↗
PubMed1983

[Experience with preoperative preventive care in obstetrics and gynecology].

The clinical behaviour and post-operative course of 60 patients who had undergone obstetrics or gynaecological surgery is compared. In 30 cases (20 obstetric and 10 gynaecological), antibiotic prophylaxis took the form of a single i.m. injection of 600 mg of lincomycin and 80 mg of gentamycin, 30 minutes before the operation. In the remaining 30 cases (20 obstetric, 10 gynacological), the antibiotic cover was administered postoperatively by i.v. injection of doxicyclin (100 mg every 12 hours for 3 days and 100 mg every 12 hours per os for a further 2 days). From a comparison of the 2 groups, and keeping obstetric and gynaecological cases separate, it is concluded that preoperative antibiotic prophylaxis is comparable in its results to post-operative antibiotic cover. Postoperative haematochemical tests were also done and, as has been reported, showed no significant alterations from the tests administered preoperatively, thus confirming the high tolerance of the drugs in question in the above-stated doses. No cochleovestibular disturbances were encountered nor were drug-resistant bacteriological strains. The efficacy of this prophylactic treatment is confirmed and though comparable in results to the alternative postoperative types is indubitably advantageous both in the lower cost to the community and the short duration of the treatment itself.

Adult↗
PubMed1982

[Economic aspects of intensive care in obstetrics].

An intensive obstetric care unit has been established at investment costs of 646,167.--Mark which broke down into 220,248.--Mark for prepartum attention, 268,010.--Mark for intrapartum attention, and 157,909.--Mark for neonatal attention. Operational expenditures on equipment and services were found to amount to 144,052.--Mark per annum.--Specific outlays resulted from intensive obstetrics, as compared to conventional procedures. They varied between 48.--Mark and 96.--Mark per delivery, depending on annual numbers of deliveries and on the use of equipment quantitatively adapted to requirements. Individual costs for intrapartum attention varied by bedside equipment combinations and turnover of patients (n/labour bed/d) and were between 12.--Mark and 36.10 Mark.--Something between 2000 and 3000 births per annum, with patient turnovers between 1.5 and 2.0 per bed and die, was considered optimum. The cost of intensive obstetrics went up under such optimum conditions to something between 48.--Mark and 58.--Mark, with something between 14.80 Mark (BMT 504 biomonitor, Lineomat, FTS 101 foetal-function recorder) and 21.60 Mark (BMT 9141 biomonitor, Lineomat) being required for intrapartum monitoring of one birth.--Reduction in perinatal mortality, as compared to figures of conventional obstetrics and to cost factor between 519,168.--Mark and 627,328.--Mark for equipment and other hardware, yielded a benefit for 10,816 births of something between 46.9 and 167,5 million Mark.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Obstetrical anesthesia and resuscitation in Africa].

In Africa, the obstetrical risk is related to the difficulty to monitor the pregnancy during which obstetrical emergency may occur and will have to be treated by the practitioner with, sometimes, inadequate facilities. The authors examine the problems concerning successively the expectant mother, the foetus and the placenta. Then, they propose some solutions in the field of anesthesia and intensive care. The expectant mothers are exposed to the heat and sometimes are suffering from undernutrition, so it requires special attention when using anesthetics. In addition, they frequently present an increased morbidity:--universal diseases among which renovascular syndromes often lead to eclampsia and to abruptio placentae;--tropical diseases may raise problems either to anesthesia (sickle cell anemia, bilharziosis) or to intensive care (algid pernicious fever, malignant amebiasis). Children are subject to an increased stillbirth rate in accordance with pregnancy duration and with the intensive facilities available at the time of the birth. Either infective or mechanical complications may occur in placenta and they may cause some distress to both mother and foetus. With respect to all these cases, the authors examine the various analgesia methods for obstetrical purpose and point out their indications and contraindications. It seems that regional anesthesia is suitable for health posts without facilities. Peridural anesthesia is operative with a great number of situations but it requires some technical training. Then methods to monitor both mother and foetus are exposed. According to the available facilities, ways and means are given to solve problems of anesthesia: labour maternal complications (Mendelson's syndrome, eclampsia, obstetrical complications either mechanical and hemorrhagic) or secondary complications (bacterial or parasitic complications, renal insufficiency); foetal complications either during labour, or at birth, or after delivery.

Africa↗
PubMed1983

Common accreditation and educational problems in obstetrics-gynecology residencies.

The Accreditation Council for Graduate Medical Education (ACGME) accredits U.S. institutions that offer graduate medical education, including that in obstetrics and gynecology. The ACGME's 23 Residency Review Committees (RRCs) monitor these programs. The RRC for obstetrics and gynecology has identified 18 common problems in obstetrics-gynecology residency programs. Upon identifying one or more of these problems in an obstetrics-gynecology residency program, the RRC can withdraw accreditation or grant probation or continued probation.

Accreditation↗
PubMedDate not supplied

Obstetric problems in the adolescent Zambian mother studied at the University Teaching Hospital, Lusaka.

The Obstetric performance of teenage primigravida aged 12-15 years was studied retrospectively and analysed in the local population attending the University Teaching Hospital, Lusaka. The leading Obstetric complications were cephalo-pelvic disproportion (3.6%) and acute toxeamia (2.2%). The caesarean section rate (7.5%) and operative vaginal delivery rate (11%) were both high. There was one maternal death due to Obstetric shock. The rates for prematurity (154/1,000), still births (30.8/1000), and neonatal death (101.9/1,000) were increased. Perinatal mortality rate was 123/1,000. The incidence of pregnancy between 12-15 years was 1.2%. Overall incidence of teenage pregnancy (12-19 years) was 22.5% and parity of 5 was observed at the age of 18 and 19. The study concluded that early teenage pregnancy carried obstetrical risks and was associated with a high perinatal loss.

Adolescent↗
PubMed1981

Postgraduate medical education in obstetrics and gynecology.

In a survey mailed to all obstetric and gynecologic residents in January 1978, the content of residency training programs was evaluated in regard to quantity of procedures and quality of supervision. The interaction of family practice residents, nurse midwives, and nurse clinicians was explored as it related to residency training in obstetrics and gynecology. A resident's assessment of his or her training program and an evaluation of the various opportunities of continuing medical education were also included in the survey. The results confirmed the known lack of training in human sexuality problems and practice management, although it was demonstrated that nearly all residency programs provide adequate clinical experience in all other areas of obstetrics and gynecology. Family practice residents do not appear to be altering the quality of obstetric and gynecologic residency training. The survey also indicated that, in most cases, the wide variety of postgraduate educational material is being used by residents.

Curriculum↗
PubMed1980

Non-rotational teaching of obstetrics in a family practice residency.

The E. W. Sparrow Family Practice Residency Program has developed a unique system of training family practice residents in obstetrics. A continuous obstetrical training experience is provided on a non-rotational basis over the three-year residency training period. This experience has been arranged through the creation of the family practice obstetrical population, the use of family practice faculty as primary teachers, and the use of residents and faculty in obstetrics-glynecology as consultants. Extensive documentation and evaluation is used to allow residents to progress through varied levels of privileges in preparation for private practice.

Curriculum↗
PubMedDate not supplied

Do increases in payments for obstetrical deliveries affect prenatal care?

Raising fees is one of the primary means that State Medicaid Programs employ to maintain provider participation. While a number of studies have sought to quantify the extent to which this policy retains or attracts providers, few have looked at the impact of these incentives on patients. In this study, the authors used Medicaid claims data to examine changes in volume and site of prenatal care among women who delivered babies after the Maryland Medicaid Program raised physicians fees for deliveries 200 percent at the end of its 1986 fiscal year. Although the State's intent was to stabilize the pool of nonhospital providers who were willing to deliver Medicaid babies, it was also hoped that women would benefit through greater access to prenatal care, especially care rendered in a nonhospital setting. The authors' hypotheses were that (a) the fee increase for obstetrical deliveries would result in an increase in prenatal visits by women on Medicaid, and (b) the fee increase would lead to a shift in prenatal visits from hospital to community based providers. The data for Maryland's Medicaid claims for the fiscal years 1985 through 1987 were used. Comparisons were made in the average number of prenatal visits and the ratio of hospital to nonhospital prenatal visits before and after the fee increase. Data for continuously enrolled women who delivered in the last 4 months of each fiscal year were analyzed for between and within year differences using Student's t-test and ANOVA techniques. The findings indicate very little overall change in either the amount or location of prenatal care during the year after the large fee increase for deliveries.Though significant increases in the number of prenatal visits occurred for women who lived outside of Baltimore City, it is difficult to attribute these changes solely to the fee increase. Where an effect was observed, it appeared to be greatest in non urban areas of the State, probably because coordination of care by fewer Medicaid providers is more common in such areas.The findings do not support the hypotheses that raising fees for obstetrical deliveries uniformly increase community-based prenatal care. Instead, the findings suggest that tying fee increases for obstetrical deliveries to the amount of prenatal care provided for each patient may be the best way of increasing the commitment of Medicaid obstetrical providers to give their patients more comprehensive perinatal care.

Adult↗
PubMedDate not supplied

[Headache following dural puncture in pregnant patients at term. Comparative study with non-obstetric patients].

OBJECTIVES: To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients. PATIENTS AND METHODS: A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced. RESULTS: Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups. CONCLUSIONS: The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.

Adolescent↗
PubMed1993

[Obstetric care in Ytre Nordhordland 1858-87. A comparison with national statistics].

In Ytre Nordhordland, a rural district of western Norway, the number of stillbirths and maternal deaths was 50-60% above the national average. Local unskilled midwives assisted with deliveries, but were of little use in the event of complications. The first educated midwife was appointed in 1860, the second in 1874. In this study, multiple regression analyses were undertaken to examine how educated midwives and obstetric operations influenced maternal mortality and the number of stillbirths during the 30-year period 1858-87. The explained variation was 42% for stillbirths, but only 6% for maternal mortality. While the number of skilled midwives was associated with fewer stillbirths, the opposite was found for obstetric operations, probably because obstetric operations were reserved for the most extreme cases. It is concluded that the local doctors' struggle for appointment of educated midwives was of greater importance than their obstetric skills.

Female↗