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PubMed1978

Obstetric service and perinatal mortality in Norway.

Information on personnel, equipment and care facilities at all maternity institutions has been related to the perinatal mortality among all single births in Norway, 1967--1973. There was a total of 454,358 single births during this seven year period which comprised the study data set. An obstetric score based on personnel and equipment as defined in a previous study has been used to divide the country into three groups of counties, with low, medium and high obstetric scores. Perinatal, fetal and early neonatal (less than seven days) mortality rates specific to birth weight categories in 500 gram intervals have been compared between the county groups. Significant differences were found in the mortality rates between the group of counties with low obstetric score and the two other groups. There is both a relative and absolute increased difference in mortality for births weighing 3000 grams or more compared to births less than 3000 grams. The major component in the perinatal mortality difference is due to a difference between the low and higher obstetric score county groups in the early neonatal mortality rates. Time trends indicate that the relative differences in perinatal mortality are not decreasing over the seven year period, but rather, have increased slightly. Potential differences in the populations at risk in the three county groups are discusses. An adjustment was made to eliminate the effects of some potential confounding variables, namely high parity and maternal age and illegitimacy, without basically changing the results.

Adult↗
PubMed1992

An epidemiological study of obstetric ultrasound examinations in Denmark 1989-1990.

OBJECTIVE: To provide an epidemiological description of the use of ultrasound in obstetrics in Denmark and to analyse whether screening per se reduces the mean number of obstetric ultrasound examinations for all pregnant women. DESIGN: Questionnaire study based on hospital records and patient interviews. SETTING: All Danish hospital departments with delivery services (n = 57). PATIENTS: 2268 women who gave birth to a child in a two week period February 1990. RESULTS: The main findings of the study are: 1) Women with an offer of screening had a significantly higher mean number of obstetric ultrasound examinations during pregnancy (1.8) than women without (1.3), no matter at which type of department they had antenatal care and their delivery; 2) 45% of the women without an offer of screening had an ultrasound examination on indication in the interval of 14-20 weeks of gestation--at which time an examination may include what is performed at a screening examination and 3) The study shows great regional variations in the use of ultrasound in obstetrics. CONCLUSION: The results question the presumption that screening per se will reduce the mean number of ultrasound examinations during pregnancy.

Adult↗
PubMed1997

Obstetric outcome of natural and assisted conception twin pregnancies is similar.

BACKGROUND: The risk of obstetric intervention and adverse fetal or neonatal outcome is considerably higher in multiple gestation than in singleton pregnancy. How assisted conception influences obstetric management and outcome in twin pregnancies has not been evaluated. METHODS: A survey of all twin pregnancies in Iceland and the Tayside Region, Scotland for a four year period, 1990-93, comparing twins after assisted fertilization with natural conception. RESULTS: The total number of twin pregnancies was 522, of which 453 were natural conceptions and 69 assisted. The twin rate was 1:75 among natural conceptions, but 1:5 in women having assisted fertilization. Mean gestational age in both groups was 36 weeks. Elective Cesarean section was used more often in the assisted conception group (odds ratio 2.57; p = 0.003). Induction rates did not differ to any significant degree and once labor commenced, no difference was seen between assisted and natural conception twins in the mode of delivery or neonatal short term morbidity. Birthweight, gestational length and perinatal mortality rates by conventional and extended classification were not different. CONCLUSION: After allowing for more frequent elective Cesarean section in the obstetric care of the assisted conception pregnancies, there was no major difference in obstetric and neonatal management or outcome between twins resulting from natural and assisted conception.

Adolescent↗
PubMed2000

The reliability and validity of self-reported reproductive history and obstetric morbidity amongst Birth to Ten mothers in Soweto.

OBJECTIVE: To assess whether self-reports of reproductive history and obstetric morbidity provide an accurate basis for clinical decision-making. SETTING, PARTICIPANTS AND METHODS: Self-reports of maternal age and reproductive history, together with clinical measurements of five medical disorders, were abstracted from the obstetric notes of 517 mothers whose children were enrolled in the Birth to Ten study. These data were compared to self-reported information collected by interview during the Birth to Ten study. FINDINGS: The reliability of self-reported age and gravidity was high (R = 0.810-0.993), yet self-reports of previous miscarriages, terminations, premature- and stillbirths were only fairly reliable (Kappa = 0.48-0.50). Self-reported diabetes and high blood pressure had specificities of more than 95% for glycosuria, hypertension and pre-eclampsia. However, the specificity of self-reported oedema for hypertensive disorders and the specificity of self-reported urinary tract infection for STD seropositivity were only around 65%. CONCLUSIONS: The modest reliability and limited validity of self-reported obstetric morbidity undermines the clinical utility of this information. RECOMMENDATIONS: These results strengthen the case for providing mothers with "Home-based Maternal Records" to facilitate access to accurate obstetric information during subsequent clinical consultations.

Child↗
PubMedDate not supplied

The utilization of nurse-midwives as providers of obstetric triage services. Results of a national survey.

Obstetric triage services are rapidly advancing, and the concept is becoming a popular practice pattern. As more pregnant women are evaluated in ambulatory settings, especially in high volume obstetric tertiary centers, it is now realized more and more that labor and other complaints cannot be addressed solely in labor and delivery units, nor are most of these complaints solely labor related. This article presents the results of a national survey designed to discover what contributions nurse-midwives are making to obstetric triage services. In addition, the results provide initial benchmark data on obstetric triage components against which other midwifery services can address practice issues.

Delivery Rooms↗
PubMedDate not supplied

[The role of obstetric complications in the pathogenesis of schizophrenia].

The article is a review of research data on the occurrence of pregnancy and delivery complications in schizophrenic patients and their possible contribution to developing schizophrenia in adolescence or adulthood. Many studies revealed that subjects who have a positive obstetric complications history are at higher risk of developing schizophrenia. Obstetric complications, especially those resulting in asphyxia, are often mentioned as possible environmental factors that can disturb the brain developmental processes, which can be responsible for developing schizophrenia in the future. Obstetric complications can act as an environmental pathogenic factor in some cases of schizophrenia (for example not genetically conditioned ones). They can also constitute an additional factor that, acting together with other (for example genetic factors, results in schizophrenia phenotype). There are still inconsistent data and many methodological problems concerning obstetric complications studies. The problem requires further investigation with improved and unified methodological procedures applied.

Asphyxia↗
PubMed2001

The bile acid taurocholate impairs rat cardiomyocyte function: a proposed mechanism for intra-uterine fetal death in obstetric cholestasis.

Obstetric cholestasis is a liver disease of pregnancy that can be complicated by sudden, hitherto unexplained, intra-uterine fetal death. Because intra-uterine death occurs suddenly, and because fetal heart rate abnormalities have been reported in obstetric cholestasis, we hypothesized that intra-uterine death is caused by impaired fetal cardiomyocyte function, resulting in fetal cardiac arrest. Obstetric cholestasis is associated with raised levels of maternal and fetal serum bile acids, and we propose that these may alter cardiomyocyte function. It was not possible to investigate the effects of bile acids on the intact human fetal heart at a cellular level. Therefore we used the closest available model of fetal myocardium at term: a primary culture of neonatal rat cardiomyocytes in which cells beat synchronously and develop pacemaker activity. The effect of the primary bile acid taurocholate (0.3 mM and 3 mM) on cultures of single cardiomyocytes, each with its own independent rate of contraction, was a reversible decrease in the rate of contraction and in the proportion of beating cells (P < 0.001). Addition of taurocholate to a network of synchronously beating cells caused a similar decrease in the rate of contraction. Furthermore, the integrity of the network was destroyed, and cells ceased to beat synchronously. Taurocholate also resulted in altered calcium dynamics and loss of synchronous beating. These data suggest that raised levels of the bile acid taurocholate in the fetal serum in obstetric cholestasis may result in the development of a fetal dysrhythmia and in sudden intra-uterine death.

Animals↗
PubMed2001

Validity of women's self-reported obstetric complications in rural Ghana.

This retrospective study assessed the utility of women's self-reports to identify obstetric complications in rural Ghana. All consenting obstetric and postpartum inpatients, presenting from the seventh month of gestation to 42 days postpartum, were interviewed at the Holy Family Hospital, Techiman and were asked about their signs and symptoms. A combination of clinical examination and laboratory testing of urine and blood samples was used for determining case status. Self-reported obstetric complications of 340 women were compared with the corresponding diagnostic status for their sensitivity, specificity, predictive value, and test-efficiency. Using algorithms that could not be practically applied at the community level, self-reported symptoms correctly identified the majority (75%) of complicated and uncomplicated pregnancies, but missed one-quarter of cases requiring emergency obstetric care. The positive predictive value of 50% indicates that women's self-reported symptoms should not be used in estimating the incidence of these conditions or in identifying women requiring referral in this population.

Algorithms↗
PubMed2001

[Maternal mortality: avoidable obstetrical complications].

Since 1996, maternal mortality is registered as part of a permanent confidential inquiry in France. The National Committee has studied all cases recorded to assess the cause of death and the avoidable obstetrical complications involved. Recommendations are proposed. In 1996 and 1997, there were 196 maternal deaths in France; 165 could be analyzed. The cause was obstetrical in 123 cases (74%), non-obstetrical in 26 (16%), and unidentified in 16 (10%). Ninety-seven direct deaths occurred (78% of the obstetrical mortality cases); 31 cases of hemorrhage including 19 post partum, 20 cases of pregnancy-induced hypertension, 10 cases of eclampsia and 7 of pre-eclampsia, 16 cases of amniotic fluid embolism, 11 cases of thromboembolism and 10 cases of sepsis. The National Committee considered that 54% of these deaths were avoidable: 87% for hemorrhage, 80% for sepsis, and 65% for hypertensive diseases. The deaths due to amniotic fluid embolism were not considered avoidable. This mortality stemmed from substandard care, delayed treatment, missed diagnosis, and professional errors. Clinical recommendations are proposed for post partum hemorrhage, pre-eclampsia and eclampsia, prevention of maternal infection, and thromboembolism prophylaxy.

Eclampsia↗
PubMed2003

Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience.

BACKGROUND: To retrospectively evaluate the efficacy and safety of emergent and prophylactic arterial embolization for obstetric hemorrhage within the past 4 years. METHODS: We retrospectively collected 21 obstetric patients with treatment of selective arterial embolization between 1999 and 2002. Two groups of patients were identified. The first group consisted of 15 patients who experienced postpartum hemorrhage and underwent emergent embolization. The second group was made up of 6 patients who underwent prophylactic embolization with risk factors of severe obstetric bleeding. They had abnormal placentation antepartum diagnosed and accepted termination of pregnancy followed by hysterectomy. RESULTS: In the first group, 12 of 15 cases had a favorable outcome treated by single embolization session. One patient expired 4 days after embolization due to severe disseminated intravascular coagulopathy and multiple organ failure. One retained placenta with recurrent bleeding was controlled by repeated selective arterial embolization. One uterine subinvolution with persistent mild bleeding and genital tract infection was improved by conservative treatment. Further surgical procedure was not necessary for all cases. One woman delivered her next baby 13 months after embolization. In the second group, all women had abnormal placentation with histopathological confirmation, including 1 accreta, 3 increta, and 2 percreta. No immediate complication was noted after embolization. The estimated blood loss during operation ranged from 300 to 3000 mL (mean, 1770 mL). CONCLUSIONS: Our study indicates that selective arterial embolization should be the early management for intractable postpartum hemorrhage after conservative treatment fails and before more invasive surgical intervention is considered. Our experience also confirms the effectiveness and safety of prophylactic selective arterial embolization for anticipated high morbidity or mortality of obstetric surgery.

Adult↗
PubMed2005

[Sub-standard factors in primary obstetric care].

OBJECTIVE: Investigating the frequency and nature of sub-standard care factors in non-complicated pregnancies in primary obstetric care. DESIGN: Retrospective investigation of medical files. METHOD: Data concerning obstetric care in 3 midwifery practices in the Delft area (Pijnacker, Nootdorp, Den Hoorn and Schipluiden), the Netherlands, from 1989-1999 were gathered from the primary National Obstetrics Register. Of the 8362 pregnancy records, 72 were selected at random. Using a checklist containing criteria based on the Obstetrics Indication List, the Cochrane Pregnancy and Childbirth Database, and from an expert panel, the records were analysed for the frequency of occurrence of sub-standard factors in perinatal care. RESULTS: Of the 72 pregnancy records, only 1 was found to contain no sub-standard factors. On average 1.7 sub-standard factors were seen with a maximum of 7. Most frequently found were: too few check-ups during the first trimester (39%), no testing for proteinuria at the first visit (26%) and no administration of prophylactic vitamin K1 (43%). Less frequently found sub-standard care factors were: no ultrasound despite indication (11%), no referral to secondary care in the event of foetal distress (6%), no consultation with secondary care in the event of hypertension (3%), or in the case of membranes ruptured for more than 24 hours (1%). Frequently the circumstances surrounding the departure from the main checklist criteria were found to justify the action. CONCLUSION: Sub-standard care factors were demonstrated in many of the pregnancies investigated. A limited number of these factors gave reason to question whether guidelines for good quality perinatal care are being properly applied.

Adult↗
PubMed2005

Men's role in emergency obstetric care in Osun State of Nigeria.

This study was conducted among the Yoruba of South-West Nigeria to examine the role of men in emergency obstetric care, as men determine whether and when their spouses visit health clinics in most cultures. Simple random sampling was used to select 900 households from three communities in Osun State, south-west Nigeria. Separate interviewers interviewed the man and his wife in each of the households. In polygamous families, two wives of reproductive age were also interviewed. The quantitative survey was complemented with a number of focus group discussions, in-depth interviews and key informant interviews. There was high level of awareness of emergency obstetric conditions by men, particularly in relation to pregnancy signs and labour pains (53.2%). Respondents reported that men play useful roles during their partner's obstetric conditions (89.2%). Women take decisions on health-seeking behaviour during emergency obstetric conditions in the absence of the male partner. Education is found to be the major determinant of this change in male knowledge and behaviour. There is a need to further promote universal basic education in the country especially in areas where the observable change in this study has not been noted. There is also a need to extend the study to other zones in Nigeria in order to have a national picture.

Adolescent↗
PubMed2005

Are process indicators adequate to assess essential obstetric care at district level?--a case study from Rufiji district, Tanzania.

To assess coverage and quality of essential obstetric care (EOC) and the appropriateness of using processindicators, a 3-month follow-up study was done in Rufiji district, Tanzania, involving 2 hospitals, 4 health centres, 10 large dispensaries and 10 randomly selected small dispensaries. Data collection was done on process indicators as suggested by UNICEF/WHO/UNFPA (UN) and 'unmet obstetric need (UON) for major obstetric intervention (MOI)'. With standard values in (brackets), the district had two comprehensive EOC facilities, births in EOC amounted to 62% (15%), met need for EOC was 76% (100%), caesarean section (C/S) rate 4.1% (> 5%), hospital case fatality rate (CFR) 1.0% (< 1%) and successful obstetric referrals 46% (100%). MOI for absolute maternal indication in the district was 2.6% (1-2%). All four maternal deaths occurred due to transport failures. The process indicators gave contradictory impressions on the coverage and quality of care and failed to link to the outcome of delivery complications in the study.

Female↗
PubMed1991

[Emergency obstetric hysterectomy: report of fifteen cases].

From June 1978 to June 1990, there were 41,989 deliveries, 13,396 cesarean sections and 15 emergency obstetric hysterectomies at Taipei Chang Gung Memorial Hospital. The incidence of emergency obstetric hysterectomy is 36/100,000 deliveries. The mean age of patients is 31.7 years old. The indications for hysterectomy were placental disorder (60.0%), uterine atony (26.7%), and uterine rupture (13.3%). The present series showed that 14 cases had total abdominal hysterectomy, while only one case had a subtotal hysterectomy. Total hysterectomy should generally be performed unless maternal instability mandates a more expeditious subtotal hysterectomy. The most common postoperative complication included unknown fever and urinary tract infection. For those four cases of post-cesarean hysterectomy, conservative treatment was tried but failed. All cases presented with hypotension (less than 80/60 mmHg), tachycardia (greater than 100 times/min) and with a mean hemoglobin of 9 mg% during the observation period. In these patients, blood loss, operating time and length of hospitalization was increased when compared with a group of 7 patients undergoing cesarean hysterectomy. In patients with placenta accreta, who are candidates for cesarean hysterectomy, initial hypotension, tachycardia and shock developed during cesarean section. It must be emphasized that conservative aggressive measures to control obstetric hemorrhage remain the mainstay of therapy, but emergency hysterectomy played the life-saving role with which every practitioner of obstetrics must be familiar and keep in mind.

Adult↗
PubMed1991

Screening for illicit drug use in a military obstetric population.

The purpose of our investigation was to determine the prevalence of illicit drug use within our socioeconomically heterogeneous obstetric population, in order to assess the need for institution of universal screening. Five hundred consecutive new obstetric registrants had urine collected for routine culture. Following removal of a small aliquot of urine for culture, the samples were sent to the Armed Forces Institute of Pathology, Division of Forensic Toxicology. Each specimen was screened for the presence of alcohol, cocaine metabolites, cannabinoids, opiates, and amphetamines using fluorescent polarization immunoassay techniques. All positive screening tests were confirmed by gas chromatography mass spectrometry. Thirty samples were either lost in processing or of insufficient quantity to test. Five of the 470 samples (1.06%) tested were positive. One subject was taking prescription narcotics, so the correlated prevalence was 0.85%. Three tested positive for tetrahydrocannabinol and two for opiates. Analysis of our data demonstrates that our obstetric population has a significantly lower prevalence of illicit drug use than other populations reported previously (P less than .01). We recommend that each institution providing obstetric services determine its specific prevalence of illicit drug use.

Cross-Sectional Studies↗
PubMed1989

An evaluation of the time of discovery of fetal malformations by an indication-based system for ordering obstetric ultrasound.

Circumstances of detection of 570 structural abnormalities in 364 fetuses were reviewed to determine whether referral for obstetric ultrasound according to specific indications resulted in late detection of abnormal fetuses and whether earlier detection might have changed pregnancy outcomes. A system of indication-based obstetric ultrasound discovered 124 abnormal fetuses (34%) at 22 weeks or less and 240 (66%) at 23 weeks or more. Most fetal abnormalities found at 23 weeks or more were probably detectable earlier, because the pattern of abnormalities discovered was reasonably similar in the two groups. Discovery of abnormal fetuses at 22 weeks or less was associated with a 67% termination rate and an 11% postnatal survival rate, whereas discovery at 23 weeks or more was associated with a 14% termination rate and a 51% postnatal survival rate. For fetal abnormalities not detected until 23 weeks or more, the indications that led to detection were present earlier in only 28%, and any indications were present earlier in only 44%. This study raises serious concern about the ability of the indication-based obstetric ultrasound system commonly used in the United States to detect fetal abnormalities before therapeutic options become limited. Evaluation of alternative systems for timing of obstetric ultrasound appears to be warranted.

Congenital Abnormalities↗
PubMed1988

The nitrite and leukocyte esterase tests for the evaluation of asymptomatic bacteriuria in obstetric patients.

The purpose of this investigation was to compare the reliability of a urine dipstick evaluation for nitrites and leukocyte esterase activity with that of a urine culture in diagnosing asymptomatic bacteriuria in obstetric patients. A clean-catch midstream urine specimen was obtained from 750 consecutive obstetric patients presenting for initial evaluation. One portion of the specimen was tested for nitrites and leukocyte esterase activity with Chemstrip LN dipsticks. A second aliquot of urine was plated on blood and MacConkey agar and incubated aerobically. The cost of the nitrite and leukocyte esterase test was $0.35. The per patient charge for the urine cultures would have been $28. Sixty-two women (8.3%) had urine cultures of 100,000 or more colony-forming units of a uropathogen per milliliter. The sensitivities of the nitrite and leukocyte esterase test in identifying patients with positive cultures were 43 and 77%, respectively, and the specificities were 99 and 96%, respectively. The sensitivity and specificity for the two tests combined (either test abnormal) were 92 and 95%, respectively. Five patients had negative screening tests but positive urine cultures; all five isolates were gram-positive organisms, three group B streptococci and two enterococci. We conclude that neither the nitrite test nor the leukocyte esterase test alone is a sensitive enough screening test to detect asymptomatic bacteriuria in obstetric patients. The combination of the two tests, however, may provide an acceptable cost-effective alternative to screening all asymptomatic obstetric patients with urine cultures.

Bacteriuria↗
PubMed1986

Patient satisfaction with obstetric care.

Patient satisfaction with obstetric care was studied in a cohort of postpartum women from a rural midwestern county. Birth certificate data defined the population, and satisfaction data were acquired through a mailed questionnaire. An indirect measure (satisfaction scale) was derived with acceptable construct validity and internal consistency. A direct measure (open-ended questions) elicited specific comments about each woman's recent experience with obstetric care. Satisfied women, as described by the scale, were more likely to have had good physician continuity and to have attended childbirth classes. The open-ended responses most frequently described problems relating to the physician-patient relationship. In comparing the indirect and direct measures, women with high satisfaction scores were more likely to make no critical comments about their obstetric care (chi 2 = 9.16, P less than .003). The patient's perception of the physician's attitude of concern emerged as an important issue in both measures. The data demonstrate that perceived physician concern is an important component of patient satisfaction with obstetric care.

Adult↗