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PubMed1983

[Collection of obstetrical data in international cooperation].

Authors deal with the question of collecting obstetrical data within the framework of international co-operation. They mention that data collecting by individual obstetrical institutes is not suitable for getting reliable data on the degree of development of major geographical regions or countries in the field of obstetrical provision. Instead of this the authors suggest to acquire obstetrical-geographic data of central statistical institutes of the individual countries and to evaluate them in a centralized way.

Data Collection↗
PubMed1981

Bacteremia in obstetrics: clinical course.

The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). No deaths, clinical evidence of septic shock, or cases of postinfection endocarditis were found. The most common bloodstream isolates were Escherichia coli (57), group B streptococcus (28), and Bacteroides sp (26). The patients with endoparametritis had a fever index of 86.2 +/- 47.1F-hours, an average hospital stay of 6.5 +/- 3.1 days, a 7.3% rate of complications, and a 19.5% rate of failure of primary antibiotics. The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.

Adolescent↗
PubMed1995

Preconceptual obstetric risk assessment and health promotion.

Preconceptual risk assessment is an increasingly important part of obstetric care in the era of fetal therapeutics, invasive diagnostic techniques and "premium" pregnancies. The constant rates of the two greatest contributors to infant morbidity and mortality--congenital malformations and low birth weight--suggest that our basic approach to obstetric care is not sufficiently preventive. Preconceptual obstetric risk assessment, along with health promotion, education and therapeutic intervention, can reduce risk and improve outcome. A medical and psychosocial emphasis on preconceptual and early pregnancy care, along with promotion of the health of the pregnant woman, the fetus, the infant and the family up to one year after birth, may prove to be a way of decreasing infant morbidity and mortality. The identification of important risks associated with demographics, systemic disease, infection, environment, genetics and lifestyle will assist the family physician in promoting health strategies in obstetric care.

Adolescent↗
PubMed1994

Maternal gallbladder assessment during obstetric ultrasound: results, significance, and technique.

BACKGROUND: Gallbladder disease is four times as common in women as in men, and pregnancy appears to contribute to the development of gallstones. During pregnancy, most women receive ultrasound scans, which are highly sensitive to the detection of gallstones. The purpose of this study was to examine the additional time and effort required to scan the gallbladder during obstetric ultrasound scanning. METHODS: The maternal gallbladder was examined in 228 consecutive obstetric ultrasound scans performed for medical indications at any time during pregnancy. Scanning was conducted by family physician faculty located in two university settings and one rural private practice. Patients were not required to fast prior to the scan. RESULTS: Gallstones were found in 5.3% of the patients, and an additional 3.1% had undergone prior cholecystectomy, for an overall incidence of current or previous gallbladder disease among 8.4% of the patients. The gallbladder was visualized in 97.4% of patients without a previous cholecystectomy. In 95.7% of cases, obtaining this additional information required less than 2 minutes. CONCLUSIONS: This study suggests that an evaluation of the maternal gallbladder at the time of obstetric ultrasound scans can be performed rapidly without special patient preparation. The study further suggests that obstetric ultrasound skills may allow family physicians to expand their diagnostic use of ultrasound to include gallbladder evaluation. Scanning techniques and the clinical significance of having this information in the patient's medical record are discussed.

Adolescent↗
PubMed1995

The sustained impact of a group and screen and maximum surgical blood ordering schedule policy on the transfusion practice in gynaecology and obstetrics.

A retrospective study was carried out to examine the durability of the impact of Group and Screen (GS) and Maximum Surgical Blood Ordering Schedule (MSBOS) policy on transfusion practices. The study involved the Gynaecology and Obstetrics wards of the three Aberdeen teaching hospitals, all of which are supplied with blood and services by the transfusion laboratory of Aberdeen and North East of Scotland Blood Transfusion Service. The transfusion laboratory and hospital records were examined and analysed for all transfusion events in Gynaecology and Obstetrics during the three periods of 6 months immediately before, immediately after and 2 1/2-3 years following the introduction of a GS and MSBOS policy in November 1986. The number of units of blood crossmatched and units transfused decreased consistently and progressively to half the pre-GS and MSBOS level in both Gynaecology wards and Obstetrics wards during the study periods. This reduction was not associated with a decrease in the clinical workload. However, the crossmatched/transfused ratio (CTR) showed an immediate but transient improvement (3.6 to 2.2 to 3.4) and only partial and delayed improvement (10.1 to 9.6 to 7.7) with regard to blood use in the Gynaecology wards and the Obstetrics wards (respectively) during the three periods of 6 months indicated above. We conclude that the introduction of a GS and MSBOS policy can have a significant and sustained impact in reducing unnecessary blood ordering. The CTR may not be as sensitive an indicator of the effect of the introduction of GS and MSBOS as the total blood usage and a more detailed examination of blood use is necessary to assess performance and long-term impact.

Blood Grouping and Crossmatching↗
PubMed1995

[Effect of obstetric factors on neonatal hypoxic-ischemic brain injuries].

OBJECTIVE: To determine the effect of high risk obstetric factors on neonatal hypoxic-ischemic brain injuries. The obstetric factors were investigated, including maternal complications during pregnancy and labor, the mode of delivery. METHODS: Intensive B-ultrasound brain monitoring in 211 newborns within the first 48 hours of life was carried out. The abnormalities were followed up by B-ultrasound. We assessed the extent of hypoxic-ischemic brain injuries with two kind of types, mild and severe. The mild type included 1-2 degree intracranial hemorrhage and the local hypoxic-ischemic encephalopathy. The severe type included 3-4 degree intracranial hemorrhage and extensive cerebral edema. RESULTS: Thirty-nine cases (18.5%) were diagnosed intracranial hemorrhage and 22 cases (10.4%) were diagnosed hypoxic-ischemic encephalopathy (HIE) or cerebral edema. The total positive rate was 28.9%. Of the positive cases, 67.2% were mild brain injuries without clinical symptoms. Those cases need no medical treatment and recovered in a natural course. The rates of brain injuries in groups of pregnancy induced hypertension, fetal distress, neonatal asphyxia and premature newborns, were 46.1%, 48.9%, 66.7% and 71.4% respectively. It suggested that high risk obstetric factors were closely related to neonatal brain injuries. 15.9% of positive cases were from normal mothers without any obstetric complications. The brain injuries in those cases were mild. CONCLUSIONS: The study showed that as a non-invasive procedure, B ultrasound brain examination is necessary for newborns with perinatal high risk factors of brain injuries. The study also suggested that perinatal care and systematic fetal monitoring were key-points for reduction of neonatal brain injuries.

Asphyxia Neonatorum↗
PubMedDate not supplied

[Preliminary experience with a new tumor marker in obstetrics and gynecology: UGP (Urinary Gonadotropin Protein)].

AIM: To evaluate the use of UGP (urinary gonadotropin protein) as a tumor marker in gynaecologic and obstetric malignant diseases. MATERIALS AND METHODS: The study was carried out in the division of Gynaecology and Obstetrics of the Ospedali Riuniti in Bergamo. 63 patients, with obstetric or gynaecologic benign or malignant diseases, entered the study. 66 healthy volunteers were examined as a group-control. In both the groups UGP levels were determined in morning urine, using an immunoenzymatic commercial kit. RESULTS: Results, expressed in fmol UGP/ml of urin, show that UGP is produced by several neoplasms, but the false-positive percentage is still high; a higher precision can be obtained with an accurate choice of the cut-off value and with a standardization of the analytical technics. Besides, the contemporary determination of UGP and CA 125 levels reduces the possibility of false-positive and false-negative results. CONCLUSIONS: More studies must be carried out to confirm the value of UGP as a tumor marker in obstetrics and gynaecology. Anyway, this recently purified protein can already be useful, in combination with the usual tumor markers, in the prompt diagnosis and management of primary neoplasms or recurrences, with a higher sensibility in comparison with traditional clinical and radiological examinations.

Adolescent↗
PubMed1996

Air transport of obstetric critical care patients to tertiary centers.

OBJECTIVE: To evaluate critical care diagnoses and their frequency in an air transport situation. STUDY DESIGN: A retrospective review was done of all obstetric air transports performed by Samaritan AirEvac to tertiary hospitals in Phoenix, Arizona, from January 1, 1990, to August 31, 1991. RESULTS: In the 20-month study period, 1,541 maternal transports were performed. Critical care diagnoses were found in 360 (23.4%) of the patient. The following categories were used: hypertensive crisis, 188/360 (52%); hemorrhage, 131/360 (36%); trauma, 21/360 (6%); and respiratory compromise, 11/360 (3%). CONCLUSION: Critical care diagnoses represented about 25% of all obstetric air transports in this study. Our transport team is made up of an obstetric flight nurse and another team member (adult trauma nurse, neonatal flight nurse, flight respiratory therapist of flight paramedic). Skill in both obstetric diagnosis and management and in critical care necessary in these situations.

Air Ambulances↗
PubMed1996

[Non-obstetric indications for cesarean section from five years of material].

During the period 1990-94, in the Institute of Obstetrics and Gynecology. The Medical Academy of Gdańsk 13,079 deliveries took place including 1635 cesarean section, which makes 12.5%. In 282 women (17 percent of these) surgical procedures were performed due to a non-obstetrical indications, 122 pregnancies were complicated by maternal diabetes mellitus-these women were excluded from the present study. A constant percentage increase of cesarean sections was observed-by 1.45% every year, from 10.23% to 15.97%, but the percentage of non-obstetrical indications for operative delivery was stabilized to approximately 9.79%. The most frequent non-obstetrical indications for the cesarean section were pregnancies complicated by: hypertension-33.75%, ophtalmological-20.57%, uterine myomas-16%, women heart diseases-10%, pelvic pathology-8.75%, neurological disorders-8.12%. The indications for cesarean section did not have influence on gestational age.

Cesarean Section↗
PubMed1998

Emergency hysterectomy in modern obstetric practice. Changing clinical perspective in time.

OBJECTIVE: Emergency hysterectomy in obstetric practice is generally performed in the setting of life-threatening hemorrhage. A retrospective review based on hospital data of 67 patients undergoing emergency peripartum hysterectomy over 10 years was undertaken. METHODS: Comparison of two different time periods regarding the incidence and the indications of obstetric hysterectomies was made. RESULTS: The number of patients with hysterectomy in the first 5 years of the study period (1985-1989) was 43 and during the last 5 years (1990-1994) it was 24. The incidence of hysterectomy during 1985-1989 was 1 in 2495 deliveries and the most common indication for hysterectomy was uterine atony (42%) followed by placenta accreta (25.5%) and uterine rupture (21%). On the other hand, the incidence of hysterectomy during 1990-1994 was 1 in 4228 deliveries and the ranking of indications of hysterectomy was slightly different from group 1 as mostly placenta accreta (41.7%) followed by uterine atony (29.2%). The maternal mortality rate was 4.5% in this series. CONCLUSION: This study showed that over the last decade the incidence of emergency hysterectomy in obstetric practice has declined in our clinic due to availability of high standard obstetric care and more liberal use of cesarean section at risk deliveries, better controlled use of oxytocin and internal iliac artery ligation.

Adult↗
PubMed1983

Obstetric events and risk of periventricular hemorrhage in premature infants.

The relationships between selected obstetric factors and the occurrence of periventricular-intraventricular hemorrhage (PIH) was studied in a group of 77 infants weighing 1,200 g or less at birth. The diagnosis of PIH was made using ultrasonography or at autopsy in 42 (55%) of these infants. Univariate associations between PIH and gestational age (less than 30 weeks), duration of labor (greater than or equal to six hours), and vaginal delivery were found. Multivariate analysis, however, did not substantiate an association between PIH and any single obstetric factor. Log-linear analysis of multiway frequency tables showed significant second-order associations of PIH with gestational age and presentation during delivery and with duration of labor and presentation. A model for the risk of PIH based on gestational age, presentation, and duration of labor was derived using stepwise logistic regression. This model correctly predicted PIH in 70% (55) of the infants. Although obstetric factors may have a role in the pathogenesis of PIH, the interactions among factors, rather than single factors alone, are important.

Cerebral Hemorrhage↗
PubMed1993

Predisposing factors in obstetrical fractures.

To compare various obstetrical methods with different types of obstetrical fractures, 29 neonates with fractures were evaluated retrospectively. Plain films of skull, limbs and chest were obtained. Transfontanellar ultrasonography was performed in one case and a computed tomographic scan of the skull in two. We reviewed 12 fractures of long bones, 7 fractures of the skull, and 10 fractures of the clavicle. Ten fractures occurred during caesarean sections and 11 in vaginal delivery requiring medical assistance. Depressed skull fractures were associated with manoeuvres and the use of forceps during delivery. Fractures of the long bones were associated with caesarean section, breech delivery with assistance and low birth weight. All fractures were treated conservatively except for skull fractures with depression of more than 2 cm. Early consolidation occurred in all fractures of long bones. The long-term follow-up of all fractures but one revealed no persisting disability. The belief that obstetrical fractures occur primarily in large babies or after breech delivery is not supported by this study.

Adult↗
PubMed1981

Obstetrical anaesthesia practice in the University of Toronto affiliated hospitals and some randomly selected community hospitals.

A questionnaire was designed to determine the type of personnel that provide obstetrical anaesthesia care and the techniques used in the provision of this care. All seven hospitals with an obstetrical unit affiliated with the University of Toronto and seven community hospitals responded. All anaesthetics were given by physicians. Ninety-two per cent of those in University affiliated hospitals and 63 per cent of those in the community hospitals had obtained their specialty qualification. Standards for preoperative assessment and communication with the patients should be similar to those applied to patients receiving anaesthesia for other reasons. It was clear from our survey that pre-anaesthetic assessment of obstetrical patients differs from that advocated for other surgical patients. For vaginal deliveries, epidural analgesia was clearly the preferred choice, Subarachnoid block was rarely used. The majority of anaesthetists did not use a test dose. Eleven per cent in University-affiliated hospitals and 50 per cent in community hospitals sometimes conducted surgical anaesthesia without tracheal intubation for vaginal delivery. More than 60 per cent routinely encouraged their patients to accept general anaesthesia for Caesarean section. The doctors providing neonatal resuscitation may require further training. Surveys such as this are important if standards of anaesthetic practice are to be established.

Anesthesia, Obstetrical↗
PubMed2003

Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study.

PURPOSE: Epidural anesthesia may be difficult in pregnancy. We intended to evaluate the teaching possibilities of ultrasonography as a diagnostic approach to the epidural region. METHODS: Two groups of residents performed their first 60 obstetric epidurals under supervision. One proceeded in the conventional way using the loss of resistance technique (control group = CG). The other group proceeded in the same way but was supported by prepuncture ultrasound imaging, giving them information about the optimal puncture point, depth and angle (ultrasound group = UG). Success was defined as adequate epidural anesthesia requiring a maximum of three attempts, reaching a visual analogue scale score of less than 1, while neither changing the anesthesia technique, nor starting at another vertebral level. In addition, intervention by the supervisor was defined as failure. RESULTS: In the CG we observed a success rate of 60% +/- 16% after the first ten attempts followed by a nearly continuous rise of the learning curve. Within the next 50 epidurals the rate of success increased to 84%. In the UG the rate of success started at 86% +/- 15%. Within 50 epidural insertions it rose up to a level of 94%. The difference between the two groups remained significant (P < 0.001). CONCLUSION: Using ultrasound imaging for teaching epidural anesthesia in obstetrics we found a higher rate of success during the first 60 attempts compared to conventional teaching. We believe this shows the possible value of ultrasound imaging for teaching and learning obstetric regional anesthesia.

Anesthesia, Epidural↗
PubMed1997

[The current standing of obstetrical analgesia and anesthesia. A survey of North Rhein-Westfalia].

BACKGROUND: The purpose of this study was to determine obstetrical pain management practices for labour for spontaneous and operative vaginal deliveries since there were no comparative German data available for the past 10 years. METHODS: A mail survey was sent to the chief anaesthetists of all hospitals in North Rhine-Westfalia designated to have obstetrical beds. The confidential and standardised questionnaire consisted of 24 mainly multiple-choice questions relating to general issues and methods of analgesia and anaesthesia for vaginal deliveries. RESULTS: In all, 118 completed replies to 258 sent questionnaires were received, giving a response rate of 46%. Among the 118 hospitals there were 79,157 vaginal deliveries annually. All participating hospitals practiced either systemic analgesics/spasmolytics and/or regional-anaesthetic methods (Table 2). Perineal local infiltration (23.7% of vaginal deliveries, in 99% of cases performed by the obstetrician) and epidural analgesia (23.2% of vaginal deliveries, in 81% of cases performed by an anaesthetist) were the commonest regional-anaesthetic methods. Pudendal nerve blocks were performed in 18.5% of vaginal deliveries (Table 1). Of all participating hospitals, 97% provided a 24-h epidural service. The method of epidural anaesthesia was widely homogeneous in all 118 hospitals (Table 3). Other methods of regional analgesia (i.e., epidural infusions or patient-controlled epidural analgesia) were performed only rarely. CONCLUSIONS: The methods of obstetrical analgesia and anaesthesia are on a high level and show a broad homogeneity in all hospitals. Overall, the results indicate, in comparison to former studies and in common with other countries, steadily increasing use of regional anaesthesia performed by anaesthetists in contrast to decreasing numbers of local infiltrations performed by obstetricians.

Analgesia, Obstetrical↗
PubMed1998

[Current practices in obstetrical analgesia in German university clinics. Results of a 1996 survey. Part 2].

UNLABELLED: Obviously there is a world-wide trend towards regional analgesia for pain relief during delivery. Data on the current practice in Germany are lacking. METHODS: In 1996 questionnaires on obstetric anaesthesia and analgesia were mailed to all university departments of anaesthesia. RESULTS: All 38 university hospitals with obstetric units replied (100%). Mean annual delivery rate was 1156. Epidural analgesia (EA) (n = 22), intramuscular injection of opioids (n = 18), and non-opioids as a suppository (n = 17) were often used for pain relief during labour. Intravenous injections (n = 12) or pudendus anaesthesia (n = 7) were practised as well. Entonox (N2O/O2), paracervical blocks or transcutaneous electrical stimulation (TENS) was rarely used. EA for relief of labour pain was offered in all university hospitals. Twelve of them had an epidural rate of less than 10%, in nine the rate was 10-19%, in eight hospitals 20-29% and 30% or more in nine. Indication for EA was a demand by the parturient (n = 34), by the obstetrician (n = 26) or the midwife (n = 18), predominantly because of prolonged labour (n = 32) or significant pain (n = 21). Half of the university departments used an epidural combination of local anaesthetics (bupivacaine) and opioids (sufentanil (n = 12) and/or fentanyl (n = 9)). In all but one department the application of an epidural catheter was performed by anaesthesiologists exclusively. In some hospitals obstetricians (n = 10) or midwives (n = 4) were allowed to give epidural top-up injections. Of the 38 university departments 11 had an anaesthesiologists on duty 24 h a day responsible for the obstetric unit exclusively. CONCLUSION: In 1977, 14 of 18 university departments of anaesthesiology offered epidural analgesia for parturients. This option was available in all university departments in 1996. A mean rate of 10-20% epidurals for vaginal delivery is well within the limits reported from other countries, whereas the rate of regional anaesthesia for scheduled caesarean section (40%) still is rather low in Germany, as reported in part 1 of this survey (Anaesthesist 1998;47:59-63).

Adult↗
PubMed2001

Obstetric outcome in grand multipara in the United Arab Emirates. A case control study.

OBJECTIVE: To compare the obstetric outcome in grand multiparous and low parous United Arab Emirates women. METHOD: The records of 418 grand multiparous women (study group), defined as having had given birth at least 5 times after completed 22 weeks gestational age, and 418 women of parity 2-4 (control group) were reviewed. RESULTS: Mean parity in the study group was 7.9 +/- 2.4. The number of subjects who attended for antenatal care and the number of visits were equal in both groups. Diabetes mellitus (both overt and gestational) was significantly more common in the study group (p < 0.0001) but there was no significant increase in the incidence of other obstetric complications nor in perinatal mortality rate. Babies of grand multiparous mothers required significantly more admissions to special care unit because of maternal diabetes mellitus (p < 0.0002). CONCLUSION: Diabetes mellitus was more common in grand multiparous United Arab Emirates women but the incidence of other obstetric complications was similar to lower parity women.

Case-Control Studies↗
PubMed2001

Obstetric outcome of teenage pregnancies in North Jordan.

OBJECTIVE: The purpose of this study was to investigate obstetric outcomes of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls. METHODS: A review of hospital records from 1997-1999 was done to compare the obstetric outcome in 760 teenage first pregnancies (study group) with that in control group i.e. 20 years to 29 years selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls. RESULTS: Revealed that incidence of complications of pregnancy like anemia, pregnancy induced hypertension and antepartum hemorrhage were similar in study and control groups. Pregnancy weight gain, prelabour rupture of membranes and gestational diabetes were significantly lower among teenage mothers. The normal mode of delivery was commoner in teenagers (89.5%) in comparison to control group (72%), probably because of higher number of low birthweight babies. Although in study group the mean birthweight was lower and the incidence of preterm labour and small for gestational age infants higher, there was also increased incidence of large for gestational age infants. While there was no difference in the types of labour, there were lower caesarean and instrumental deliveries. A statistically non-significant higher incidence of perinatal deaths was observed in teenagers. CONCLUSIONS: These results indicated that the course and outcome of pregnancy in teenage mothers had in most respects better obstetric outcomes, despite the higher incidence of preterm labour.

Adolescent↗