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PubMed1993

French obstetric anaesthetists and acid aspiration prophylaxis.

In 1988, a confidential postal questionnaire was prepared in order to assess the techniques used routinely in France for prophylaxis of aspiration of gastric contents in obstetrics. Of the 297 anaesthetists who responded, 81% (237) worked almost always and 19% worked occasionally in obstetric anaesthesia. Although obstetric anaesthesia is considered to carry a particular risk of aspiration of gastric contents (88.5% of responders), only 23% used in every case a complete set of prophylactic measures. The use of antacids has recently increased in France. Particulate antacids are no longer used whereas sodium citrate, cimetidine and ranitidine are prescribed by about 30%, 50% and 15% respectively of practitioners. Among the users of cricoid pressure, 52% were able to describe precisely the technique. Tracheal intubation is considered mandatory when general anaesthesia is performed for Caesarean section but not for uterine revision or instrumental manoeuvre. 74% of obstetric anaesthetists believe that regional anaesthesia is the best anaesthetic technique for Caesarean section. This survey has shown both positive results indicating that continuing medical education of French anaesthetists follows at least in part the 'state of the art' and insufficiencies indicating that training continues to be necessary to reduce the mortality related to aspiration of gastric contents.

Anesthesia, General↗
PubMed1995

[Immigrant women and health services. Experience with hospital obstetric-gynecologic department (1992-94)].

In order to know more about immigrant women who have applied for obstetrical and gynaecological care and the results of these requests, data on those admitted have been analyzed at the obstetric and gynaecological ward of the general hospital of Perugia during the period from July 1992 to June 1994. The following observations were made: a) African and eastern european women comprised the group that most frequently applied for abortion; b) the percentage of cesarean sections was lower among foreign women than Italians women; c) with respect to average of all immigrant admitted for obstetrical pathologies, the largest group, according to the area of origin, was comprised of women from Africa and it was decided that the quality of obstetrical assistance received by this group should be verified.

Adolescent↗
PubMed1996

How family influences practice of obstetrics. Do married women family physicians make different choices?

PURPOSE: To examine the influence of family, past and current, on married women family physicians' and to understand why and how some women continue to practise obstetrics. PARTICIPANTS: Purposive sample of nine married women family physicians who currently practise obstetrics. METHOD: Qualitative in-depth interviews. FINDINGS: Analysis identified four main influences of family on participants' practice of obstetrics: family of origin, transitions in the life cycle, children, and the marital relationship. CONCLUSIONS: These women described how they combined the roles of wife, mother, daughter, sister, and doctor. Family was a powerful influence throughout their practice lives. Finding a balance between the demands of practice, particularly obstetrics, and family relationships was an ongoing process. The process was also influenced by transitions in the life cycle.

Adaptation, Psychological↗
PubMed1997

[Obstetrics and gynecology in the last 40 years].

In the Netherlands the last 40 years have seen major changes in obstetrics and gynaecology: Progressive expansion of evidence-based medicine. A measurable, greatly improved quality policy during gynaecologists' training and the subsequent period. Increase of diagnostic possibilities during pregnancy (such as real-time echography, Doppler measurements, amniocentesis and umbilical-cord puncture). Foundation of the Landelijke Verloskunde Registratie (LVR. National Obstetrical Registry) in 1982, in which by now 90% of the specialists and 80% of the midwives are participating. Implementation of the 'Dutch model' of obstetrical care. Decrease of the number of home deliveries and increase of the obstetrical interventions. More attention for sex problems. Better results in the treatment of gynaecological tumours. Great progress in the field of reproduction endocrinology (both pharmaceutical and surgical).

Female↗
PubMed1997

Methodological considerations in the design of an obstetric database abstracted from medical records.

The quality of maternal information contained within contemporary obstetric notes was investigated by abstracting data from the medical records of multiparous women who were admitted to a major city hospital in the South Thames Region. Potential sources of error were identified by comparing information recorded in different sections of each obstetric notes and within the obstetric notes of consecutive pregnancies. The format of the obstetric notes largely determined which variables were recorded and, to some extent, the accuracy of information collected. However, the quality of the data ultimately depended upon whether each variable was self-reported or directly measured. Self-reported variables were subject to selective omission and subjective bias, while measured variables were susceptible to inaccurate equipment and poor measurement practice. By interviewing a sample of midwives currently involved in antenatal care at the Trust it was possible to confirm that extensive variation in measurement and recording procedures routinely occurred.

England↗
PubMed1998

Early obstetric discharge: does it make a difference to health outcomes?

Clinicians in several countries have expressed concerns about possible adverse effects of shortening obstetric length of stay. A population-based survey of 1366 mothers who gave birth in Victoria, Australia, in 1993 was used to investigate social and obstetric characteristics of mothers discharged home 'early', and to assess whether shorter stays were associated with adverse health outcomes, or a lesser degree of satisfaction, or both. Women's views and experiences of length of hospital stay were gathered via a statewide postal survey of women who gave birth in a 2-week period; 62.5% (n = 1336) responded. Assessment of the relationship between length of stay (1-2 days vs. > or = 5 days, and 3-4 days vs. > or = 5 days) and four main outcome measures (infant feeding at 6 weeks, period prevalence of feeding problems, maternal confidence and depression) showed no association between these variables and length of stay after adjusting for other obstetric and social factors in separate regression analyses. For stays of 3-4 days, the adjusted odds ratio (OR) for formula feeding at 6 weeks was 1.35 [95% confidence interval (CI) 0.9-1.9]; for feeding problems OR = 0.87 [0.7-1.2]; for lacking confidence OR = 0.81 [0.6-1.2]; and for depression OR = 0.96 [0.7-1.4]. Large randomised trials of early obstetric discharge are required to resolve continuing uncertainties about the safety, and possible benefits of shorter hospital stays.

Breast Feeding↗
PubMed1998

[Obstetric hysterectomy].

UNLABELLED: An analysis of indications for obstetric hysterectomy in Central Teaching Hospital of Ministry of Internal Affairs in Warsaw between 1985-1997 is presented. There have been 15 caesarean or post partum hysterectomies over that period, which makes 0.11% of all deliveries and 0.67% of caesarean sections. All operations followed caesarean sections. In two patients (13.3%) procedure was performed electively because of myomas. In the remainder emergency or post-partum hysterectomy was necessary. The most common indication was haemorrhage connected with placenta praevia, adherent placenta and abruption of placenta (53.3%). Other indications included ruptured uterus (6.7%), severe postpartum or intrapartum haemorrhage due to uterine atony (20.0%) and HELLP syndrome (6.7%). CONCLUSION: 1. Complications associated with pathologies of placenta are the most common indication for obstetric hysterectomy in our study. 2. Patients that are mostly exposed to the risk of obstetric hysterectomy are multiparous women especially with previous caesarean section. 3. The incidence of obstetric hysterectomy seems to be rising, possibly as a consequence of the rising rate of caesarean section and uterine curretage.

Adult↗
PubMed1998

[Analysis of medical catalog terms using the MAOUSSC model: application to Gyncecology-Obstetrics].

BACKGROUND: The Model of Assistance and Orientation of a User within a System of Coding (MAOUSSC) used to describe activity in human medicine was used to analyse French medical nomenclature in Gynecology and Obstetrics. METHODS: French medical nomenclature for gynecology and obstetrics was translated with the multiaxial model (MAOUSSC) to allow critical analysis. RESULTS: All the 119 medical acts in the French nomenclature involving the female genital tract and obstetrics could be translated with the model. 24% of the acts were imprecise, ambiguous or implicit: the nature of the procedure was not explicit in 7 cases, the surgical route was not given in 86 and the surgical instrumentation not named in 75. Activities involving numerous medical specialties and ambulatory activity can be described with the MOUSSC model. CONCLUSION: The MAOUSSC model is still in the experimental stage. It is however easy to implement, has a high potential for describing various medical acts and is suitable for the description of gynecological and obstetrical activity both in terms of economical and medical efficacy.

Computer Simulation↗
PubMed1993

The obstetrical anaesthesia assessment clinic: a review of six years experience.

We reviewed the out-patient consultation notes of 136 pregnant women seen at the Ottawa Civic Hospital from 1985 to 1991 to evaluate the efficacy of an Obstetric Anaesthesia Assessment Clinic (OAC). In addition, their anaesthetic records from labour and delivery were reviewed. For each patient the reason for referral was recorded according to the involved organ system. The anaesthetic management at delivery was compared with the proposed anaesthetic plan by the OAC consultant (obstetric anaesthetist). The majority of women 84 (62%) had complaints related to the musculo-skeletal system. In addition, 18 patients were referred because of previous anaesthetic problems, ten with a history of cardiac disease, and eight with neurological disease. Lumbar epidural analgesia (LEA) was a safe and effective choice for parturients with low back pain, history of lumbar fractures or single level discectomies without lumbar fusion. Parturients with posterior instrumentation experienced an increased incidence of inadequate pain relief from LEA. Individualized anaesthetic management plans were executed for parturients with spina bifida occulta, neurological, cardiac, and haematological disease as well as for women, with a history of adverse drug reactions and previous problems with regional or general anaesthesia. It is concluded that the OAC has provided a valuable service to obstetricians and anaesthetists for the anaesthetic management of pregnant women with co-existing disease. The OAC gave an opportunity for patient education regarding anaesthetic options for labour and delivery. The attending anaesthetist was provided with a risk assessment and anaesthetic management plan which was adhered to with only two exceptions. Finally, the obstetrician was given consistent advice regarding anaesthesia management that may affect obstetrical decisions.

Analgesia, Epidural↗
PubMed1980

Alternative birthing center: experience in a teaching obstetric service.

The Illinois Masonic Medical Center's (IMMC) experience with an Alternative Birthing Center (ABC), established as an integral part of the conventional obstetric suite, has proved to be a safe and efficacious method of providing a true alternative to high technology obstetric care to those carefully screened, low-risk patients who elect this form of childbirth experience. However, the high transfer rate (23.8%) and substantial cesarean birth rate (9.17%) in this low-risk group of patients do demonstrate the necessity for the immediate availability of conventional and high technology obstetric facilities, as well. The low incidence of neonatal morbidity demonstrates that the ABC is a safe environment for the neonate. Acceptance and utilization of the ABC by consumers and professionals is rapidly increasing as it is demonstrated to be a safe alternative to birth in a conventional delivery suite or home delivery.

Adult↗
PubMed2000

[Urinary incontinence and pregnancy, vaginal childbirth and obstetric interventions].

The aim was to examine the association between pregnancy, vaginal childbirth (VC) and obstetric techniques, and the prevalence of urinary incontinence (UI). A cross-sectional survey enrolled a random population sample of 6240 women aged 20-59 years, who were mailed a self-administered questionnaire on UI and, among other things, experience of VC and obstetric intervention. More than 75% responded. The present analysis includes 4345 women. Multivariate UI prevalence odds ratios were increased in relation to UI during pregnancy, UI following immediately after a VC, and age 30 or more at the second VC. No multivariate association was found in relation to forceps delivery or vacuum extraction delivery, episiotomy or perineal suturing. In conclusions, not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent UI. Perineal suturing may be associated with prevalent UI, whereas other obstetric techniques inspected do not seem to be so.

Adult↗
PubMed2006

Correlation of pelvic organ prolapse quantification system scores with obstetric parameters and lower urinary tract symptoms in primiparae postpartum.

This study investigated the correlation between results of the pelvic organ prolapse quantification (POPQ) system at 3 days and at 2 months postpartum with obstetric parameters and lower urinary tract symptoms (LUTS) in 125 primiparae with vaginal delivery. The clinical characteristics, prevalence of pregnancy-related LUTS, and POPQ scores were evaluated. Regarding the relationship of obstetric parameters with POPQ scoring, the gh was found positively correlated with the body mass index and vaginal laceration at 2 months postpartum. The POPQ evaluation did not find the LUTS to be significantly related to the prolapse score. The mean scores of points C and D were significantly increased, and gh, pb, and tvl were significantly decreased between the initial and 2-month follow-up scores. Our results revealed that a decrease in vaginal size is the principal change during the first 2 months postpartum and that with the exception of gh, neither the obstetric parameters nor the LUTS were associated with the POPQ scoring system.

Adult↗
PubMed2006

Effect of instrument preference for operative deliveries on obstetrical and neonatal outcomes.

OBJECTIVES: To examine the relationship between physicians' instrument preference and obstetrical and neonatal outcomes. STUDY DESIGN: A retrospective cohort study comparing obstetrical and neonatal outcomes of second stage deliveries between obstetricians who prefer forceps (forceps >/=90%) with obstetricians with no preference to forceps (either instrument <90%) was completed using the McGill Obstetrical and Neonatal Database. Logistic regression analysis was used to obtain an adjusted odds ratio controlling for maternal, intrapartum and neonatal confounders. RESULTS: Two thousand and three hundred thirteen infants were delivered by 5 obstetricians who preferred forceps, and 9261 infants were delivered by 15 obstetricians with no instrument preference. Baseline characteristics were similar between the two groups. As compared to obstetricians who preferred forceps, obstetricians with no instrument preference had a higher rate of operative vaginal deliveries 1.5 (1.1-2.0), a higher cesarean section rate 2.5 (1.3-4.9) and a higher episiotomy rate in non-operative vaginal deliveries 3.4 (2.7-4.3). Infants delivered by obstetricians with no instrument preference were less likely to have significant bruising 0.3 (0.2-0.6) but more likely to have a cephalohematoma 3.0 (1.1-8.3). CONCLUSION: Physician instrument preference is an important determinant of outcomes that should be considered in studies evaluating instrumental deliveries.

Adult↗
PubMed2003

Single-shot intrathecal sufentanil with bupivacaine in late labour--analgesic quality and obstetric outcome.

OBJECTIVES: To investigate the analgesic effect and obstetric outcome after single-shot intrathecal sufentanil with bupivacaine in late labour. STUDY DESIGN: Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 microg and bupivacaine 2 mg. Pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded. Apgar score and umbilical artery pH were noted. RESULTS: Median visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were 1.5, 0.5, 0, 1, 1.5, 2 and 3, respectively. Seventy-seven percent of the parturients scored the analgesic quality as excellent. Six parturients had hypotension. Motor block, sedation and nausea were rare. Pruritus was seen in 85% of the cases. No ceasarean section was performed. Vacuum extraction was done in six (15%) cases. Oxytocin augmentation was needed in 26 (65%) of the parturients. Fetal heart rate disturbances following the spinal block were seen in four cases. Apgar scores were high. No neonate had Apgar < 7. CONCLUSIONS: Intrathecal block with sufentanil 7.5 microg in combination with bupivacaine 2 mg is a very effective pain relief in late labour. Due to its limited duration it is important to select women in rapid progress of labour, and active obstetric management is necessary. It is also very important that the obstetrician is aware of the risk of non-reassuring fetal heart rate changes after intrathecal block.

Analgesia, Obstetrical↗
PubMed1986

Obstetric anaesthetic services in Scotland in 1982.

A recent survey of Scottish obstetric anaesthesia practice revealed that the majority of deliveries take place in the larger hospitals; these also have the highest epidural rates, both for relief of pain in labour and for Caesarean section. However, as epidural blockade is an essential part of modern obstetric practice, it is a matter of concern to achieve an equal standard in the medium-sized hospitals, whilst accepting that special arrangements are required in the very small obstetric hospitals.

Anesthesia, Epidural↗
PubMed1990

The availability of epidural anaesthesia and analgesia in obstetrics.

This survey analyses the provision of obstetric epidural services on national and regional bases and also by size of obstetric unit. Epidural anaesthesia and analgesia in obstetrics is not readily available to all women who wish for it, or in whom it is recommended on medical grounds, in spite of the recommendations of the Social Services Committee and other advisory bodies. Deficiencies in the provision of facilities are obvious but further analysis at a local level is required to determine the reasons and the remedies.

Analgesia↗
PubMed1999

Does an inflatable obstetric belt facilitate spontaneous vaginal delivery in nulliparae with epidural analgesia?

OBJECTIVE: To assess whether an inflatable obstetric belt, synchronised to apply uniform fundal pressure during a uterine contraction, reduces operative delivery rates when used in the second stage of labour. DESIGN: Randomised controlled trial. METHODS: Five hundred nulliparae with a singleton cephalic pregnancy at term and with an epidural in labour were recruited during the first stage and randomised at full dilatation. Standard care involved one hour passive second stage and one hour active pushing after which instrumental delivery was performed if delivery was not imminent. Those randomised to the belt group, in addition to standard care, had the inflatable obstetric belt for the whole second stage of labour. MAIN OUTCOME MEASURE: Mode of delivery. RESULTS: One hundred and eleven of the 260 women in the belt group (42.7%) compared with 94 of the 240 in the control group (39.2%) had a spontaneous vertex delivery (P = 0.423). The lift-out instrumental delivery rate was similar between the two groups: 108 belts (41.5%), compared with 101 controls (42.1%) (P = 0.902), whereas rotational instrumental deliveries in the belt group were 26 belts (10%) compared with 36 controls (15%) (P = 0.09). Fifteen women (5.8%) in the belt group and nine women (3.8%) in the control group had a caesarean section in the second stage (P = 0.292). An intact perineum was more likely in the belt group (16.5% compared with 9.6%, P = 0.022) as was a third degree tear (6.5% compared with 0.4%, P = 0.001). CONCLUSION: The inflatable obstetric belt did not significantly reduce operative delivery rates when used in this clinical setting in the second stage of labour.

Adult↗
PubMed1985

General practitioner obstetrics in the Northern region in 1983.

In late 1983 a four page questionnaire on general practitioner obstetrics was sent to a 50% random sample of general practitioners in the Northern region of England; 84% responded. Half of them said that they had access to general practitioner facilities for delivery, and half of these used them. A quarter of all respondents had provided intranatal care previously but had given it up, most of them during the late 1970s. Younger general practitioners were more highly qualified in obstetrics than older ones but did not do more intranatal work. Isolated general practitioner maternity units were much more likely to be used than those that were alongside consultant units or integrated with them. Ninety per cent of respondents provided antenatal care, 77% of these at special clinics and 88% with midwives in attendance. Teamwork, however, was not well developed. Increasing general practitioner participation in obstetric care seems feasible but depends heavily on more appropriate training and intranatal facilities being provided for general practitioners in association with specialist units.

Delivery, Obstetric↗