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PubMed1978

[Economic and social problems posed by peridural anesthesia and obstetrical analgesia].

It is impossible not to note the small number of epidural anaesthetics given for obstetrics in France. The rarity of centres where it is offered by a team of specially trained anaesthetists and obstetricians contrasts with the increase in demand from the patients themselves. Study of the number of epidural anaesthetics predictable in obstetrics according to the criteria of indication indicates that the procedure could be used in as many as 30 to 50 per cent of deliveries. This implies a need for an increase in the number of anaesthetists, i.e. an increase not so much in the total number as in those trained in obstetrics with experience of epidural anaesthesia. Similar changes are necessary in hospital organisation, in such a way that the place of the anaesthetist in the maternity unit is recognised officially, this recognition being strengthened by routine out-patient consultation with all patients during their pregnancy. The economic aspect of a possible increase in the number of epidural anaesthetics carried out in France and in the number of anaesthetists performing the procedure is envisaged in terms of salaries in the public hospital system, costing of the procedure by the Social Security and the true cost of epidural anaesthesia.

Anesthesia, Epidural↗
PubMed1995

[Obstetric anesthesia-analgesia in Spain. A review of its historic evolution during the second half of the past century].

To examine the historical development of obstetric anesthesia in Spain during the second half of the nineteenth century. Research was based on in-depth analysis of accounts of anesthesia during the period covered, mainly from original sources, using established methods for studying the history of medicine. We collected a great deal of documentary evidence, much of it unpublished and of clear historical value for tracing the history of obstetric anesthesia in Spain and identifying the main factors that have influenced it. We emphasize that controversy limited to a large extent the use of anesthesia in obstetrics. The controversy seems to have been fed by physicians' uneasiness with anesthesia as well as by certain prejudices of a religious or moral nature that are deeply rooted in Spanish society.

Analgesia, Obstetrical↗
PubMed1997

Obstetrics in general practice. A rural perspective.

Obstetrics is one of the most demanding yet rewarding disciplines required of rural general practice although rising medical indemnity fees combined with medico-legal interest in this discipline make the current rural generalist obstetricians a threatened species. These factors, plus the difficulty generalist registrars have in obtaining good procedural training in this specialist field make obstetric practice less than attractive for future rural general practitioners. This article provides a brief overview of rural obstetric practice from the perspective of a rural generalist obstetrician with 18 years experience. Case studies are used to highlight the challenges of this field.

Australia↗
PubMedDate not supplied

One health maintenance organization's experience: obstetric costs depend more on staffing patterns than on mode of delivery.

The objective of this study was to examine whether the mode of obstetric delivery is related to resource costs, case mix, maternal length of stay, or neonatal morbidity. Patients (27,289) who delivered babies at nine hospitals within one health maintenance organization in 1989 were the source of data. Case-mix adjustment and outcome measures (maternal length of stay and neonatal morbidity) were computed from discharge abstract indicators, whereas cost data (direct professional hours) came from departmental financial reports. Costs and outcomes were adjusted by regression analysis for differences in case mix and then compared by correlation analysis. Neither adjusted nor unadjusted cesarean-section rates and obstetric cost per case were significantly correlated over the range of observed cesarean-section rates. Aggregate cesarean-section rates and outcome indicators were also statistically unrelated. Cesarean-section rate variation across hospitals was unrelated to the observed variation in obstetric costs, which were closely related to variations in staffing and less closely to differences in patient case mix and scale.

Adult↗
PubMed1997

[Zinc blood levels in 73 puerperal women. Correlation with obstetric and neonatal complications].

BACKGROUND: Low plasma zinc concentrations in pregnant women have been associated with certain obstetric and foetal complications. However, there is no agreement in previous studies and mediterranean populations have not been extensively studied. METHODS: The plasmatic zinc was tested in 73 mothers, within 24 hours post-partum, in order to evaluate an association between plasmatic zinc and various obstetric and fetal complications. The women were all from the Florence province and were admitted for delivery at the II Maternity Ward of the University of Florence (Third level Center); mothers of twins and foreign mothers were excluded. Subjects were consecutively included in the study. The values pointed out in a control group (n = 28) were compared with the hematic zinc of a) women who delivered by cesarean section (CS) for acute fetal distress or by operative delivery with vacuum extractor (n = 9), b,c) mothers whose children weighted over the 90th (LGA: n = 11) or under the 10th percentile (SGA: n = 13), and d) mothers who delivered prematurely (n = 12). The subjects included in two or more groups, were not considered. RESULTS: The plasmatic zinc of the control group has been significantly higher than that of mothers who delivered by vacuum extractor or by urgent CS (p < 0.0001) and than that of mothers whose newborns were LGA (p < 0.0024). The hematic zinc of the control group is not higher than that of mothers with SGA or premature children. CONCLUSIONS: The conclusions is drawn that even a relative zinc deficiency may negatively potentiate certain obstetric abnormalities in fetal development or in delivering.

Adult↗
PubMed1998

[Analgesia and anesthesia in obstetrics. Territorial investigation].

BACKGROUND: There is a more and more interest regarding methods of obstetric analgesia and anesthesia while there is a lack of epidemiological data about local experiences. METHODS: This survey on obstetric anesthesia and analgesia in Abruzzo and Molise is based on data obtained from questionnaires of 28 questions sent to all the departments of anesthesiology in the two regions. DISCUSSION: Out of 24 questionnaires sent, 18 were returned. By analysing the replies obtained in this investigation it is clearly pointed out how the possibility of having peridural analgesia during labor is often not available. In fact, only one center is able to guarantee an operative service 24 hours a day. Many colleagues have reported this deficit and in order to improve the situation they have proposed to activate chargeable services for labor analgesia and to increase the staff of anesthetists. Also the data concerning treatment of post vaginal delivery pain are not satisfactory. With regard to the Caesarean sections, locoregional anesthesia is performed in 24% of all cases, while the highest scores are registered in the hospitals of Castel di Sangro and L'Aquila, where general anesthesia is practically never employed. Merely in 67% of all patients postoperative analgesia is carried out on a regular basis. CONCLUSIONS: The data obtained only confirm the extent of a well-known problem. In spite of the growing interest by the medical community, the attention shown for obstetric anesthesia and analgesia is, nevertheless, insufficient, especially due to financial and organizational problems which prevent from establishing a permanent pain therapy center.

Analgesia, Obstetrical↗
PubMed1963

Trial and failed forceps in obstetrics.

Current literature dealing with trial and failed forceps is reviewed, and a representative case of each is presented. There is a place in modern obstetrics for trial forceps. "Failed forceps" is due to one or more of the following conditions: (1) cephalopelvic disproportion, (2) malposition of the head, (3) premature interference under conditions unfavourable for vaginal delivery, (4) incomplete dilatation of the cervix, and (5) constriction ring. A large caput succedaneum may occasion premature obstetrical interference. An adequate pelvic examination should be performed and/or lateral radiographs of the pelvis should be taken to prevent this mistake, i.e. attempted forceps extraction. There is no place in the management of failed forceps cases for version and extraction. It may be advisable to perform an elective Cesarean section following failed forceps, even with a dead fetus.

Birth Injuries↗
PubMedDate not supplied

Pregnancy in early adolescence: are there obstetric risks?

The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18-29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. The young adolescents were shorter, had an earlier age at menarche, a lower pregravid body mass index, and a higher gestational weight gain. The young teens were less likely to smoke cigarettes but were more likely to be Medicaid recipients. The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P < .05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara.

Adolescent↗
PubMed1988

Delayed external sphincter repair for obstetric tear.

In some patients with faecal incontinence due to an obstetric tear of the external and sphincter there is additional weakness of the anal sphincter muscles from damage to the innervation of these muscles during delivery. Of 19 patients who required surgical repair of an obstetric sphincter tear some months or years after injury, 9 (47 per cent) had evidence of pudendal nerve damage at pre-operative anorectal physiological investigation. The result of surgical repair was excellent or good in eight of the ten patients in whom there was no evidence of nerve damage, while this was the case in only one of the nine patients with nerve damage. These results are significantly different (P = 0.018). Thus the functional result of delayed anal sphincter repair after obstetric lesions is partly dependent upon whether the nerve supply is intact. Pre-operative physiological evaluation can give information on the probability of a successful surgical result.

Adult↗
PubMed2004

Price discrimination in obstetric services--a case study in Bangladesh.

This article examines the existence of price discrimination for obstetric services in two private hospitals in Bangladesh, and considers the welfare consequences of such discrimination, i.e. whether or not price discrimination benefited the poorer users. Data on 1212 normal and caesarean section patients discharged from the two hospitals were obtained. Obstetric services were chosen because they are relatively standardised and the patient population is relatively homogeneous, so minimising the scope and scale of product differentiation due to procedure and case-mix differences. The differences between the hospital list price for delivery and actual prices paid by patients were calculated to determine the average rate of discount. The welfare consequences of price discrimination were assessed by testing the differences in mean prices paid by patients from three income groups: low, middle and high. The results suggest that two different forms of price discrimination for obstetric services occurred in both these hospitals. First, there was price discrimination according to income, with the poorer users benefiting from a higher discount rate than richer ones; and second, there was price discrimination according to social status, with three high status occupational groups (doctors, senior government officials, and large businessmen) having the highest probability of receiving some level of discount.

Bangladesh↗
PubMed1978

Private practice use of real-time B scan ultrasound in obstetrics and gynecology.

An informal survey of 25 obstetrics and gynecology practices that use real time B scan ultrasound equipment was carried out to assess the economic and patient-care impact of such equipment. From this informal survey, it can be seen that the incorporation of real time B scan ultrasound scanning into private practice has become economically feasible and useful for the daily clinical management of obstetric patients. The implications and economics of such changes for obstetric health care costs remain to be assessed.

Gynecology↗
PubMed1996

A case-control study of obstetric complications and later autistic disorder.

The precise etiology of autism remains unclear. Obstetric adversity has been described as one factor that may increase the risk for the disorder. We examined the contemporaneous birth records of 49 children satisfying DSM-III-R criteria for autistic disorder, at four Dublin maternity hospitals, using the previous same-sex live birth in that hospital as a control. Data were evaluated blind to subject status using two obstetric complication (OC) rating scales. No significant differences in obstetric adversity were found between index and control groups. Autistic individuals did not differ from controls in terms of previously described risk factors for this disorder (maternal age, maternal parity, birth order, and low birth weight) in autism. These data do not support the view that OCs increase the risk for later autism.

Adolescent↗
PubMed1999

Anal sphincter repair in patients with obstetric trauma: age affects outcome.

PURPOSE: This study was designed to determine whether advancing age affects the outcome of anal sphincter repair in patients with obstetric trauma and fecal incontinence. METHODS: Anal sphincter repair was performed on 24 patients younger than 40 (median age, 30) years and on 14 patients older than 40 (median age, 57) years. All patients had previous obstetric trauma. RESULTS: Twenty patients younger than 40 years (83 percent; 95 percent confidence interval, 63-95 percent) became continent, or incontinent to flatus only, after anal sphincter repair, whereas four patients had unchanged incontinence. Among patients older than 40 years, six patients (43 percent; 95 percent confidence interval, 18-71 percent) became continent, whereas eight patients remained incontinent (40 percent difference in functional outcome between younger and older patients; 95 percent confidence interval, 10-70 percent). CONCLUSION: Older females have a poorer outcome of anal sphincter repair for obstetric trauma compared with younger females.

Adult↗
PubMed1997

Quality and retrieval of obstetrical anaesthesia randomized controlled trials.

PURPOSE: Randomized controlled trials (RCTs) are suitable for meta-analysis and systematic reviews provided they are of high quality and are easy to retrieve. We determined these attributes of RCTs in obstetrical anaesthesia in a sample of available journals that are indexed in MEDLINE. SOURCE: Randomized controlled trials published between January 1985 and December 1994 in seven anaesthetic and three obstetric journals were identified by a MEDLINE search, and by handsearch of the same journals. Each RCT was assigned a quality score by a blinded rater using a reliable and validated scaled. The quality of each RCT was described and compared over time and by journal. The comparative yield of MEDLINE and hand-search was evaluated. PRINCIPAL FINDINGS: Three hundred and forty RCTs were retrieved by MEDLINE and handsearch. Two hundred and twenty seven (65%) were identified by the MEDLINE search and 333 by the handsearch (98%). The median quality score was 3/5. There was no difference in score over time. Anesthesiology had the highest median score, Anaesthesia had the lowest (P < 0.05). CONCLUSIONS: Care must be taken when reviewing obstetrical anaesthesia research. Strategies in addition to a MEDLINE search must be used to identify RCTs since more than one third were missed using MEDLINE alone. Poor quality RCTs are more likely to be biased in favour of a new treatment. Therefore, to increase the validity of reviews sensitivity analyses based on quality should be done.

Anesthesia, Obstetrical↗
PubMed1995

Spinal anaesthesia in obstetrics.

Spinal anaesthesia has been used since the 1800s but, due to a number of complications, the popularity of this technique has waxed and waned. In the 1950s, it was the most widely used method of anaesthesia and analgesia in obstetrics but it fell out of fashion with the arrival of the epidural technique which allowed a continuous method of delivering analgesia with relatively few complications. Hypotension and the high incidence of postdural puncture headaches were two reasons for the decline in the popularity of spinal anaesthesia in the young, otherwise healthy pregnant population. With the development of newer needles and bevel designs and methods whereby the incidence of hypotension can be minimized, spinal anaesthesia is making a reappearance in obstetrical anaesthesia spheres. The purpose of this article is to review the history, effects, technique, indications, contraindications and complications of this method of anesthesia as it applies to the obstetrical patient.

Anesthesia, Epidural↗
PubMed1998

[Sevoflurane in obstetric anesthesia].

In obstetrics, general anaesthesia is increasingly being replaced by peridural anaesthesia. The cases where general anaesthesia is still used are those involving increased risk. It is therefore not surprising that, for example, maternal mortality in cases of caesarian section under general anaesthesia has not decreased. Indeed, large-scale statistical analyses in the USA and the UK show an increase in relative risk. For this reason, continuing efforts have to be made to improve obstetric general anaesthesia. Inhalational anaesthetics have an important role to play, as they represent the only acceptable compromise between the dangers of maternal awareness and neonatal depression. We used literature data and our own experience of urgent caesarian sections to investigate whether the new inhalational anaesthetic sevoflurane is suitable for this purpose. In a comparison of sevoflurane and peridural anaesthesia, there was no difference in outcome for the child and the maternal results showed only the expected procedure-specific differences in circulatory parameters and early postoperative analgesia requirement. A second study involving continuous pEEG monitoring (SEF90) showed advantages of sevoflurane over isoflurane in the initial phase of surgery and in the recovery phase. However, the value of sevoflurane in obstetric anaesthesia will have to be confirmed in more extensive studies.

Anesthesia, Epidural↗
PubMed2006

[Ephedrine as alternative to Akrinor in regional obstetric anesthesia].

Hypotension in anesthesia and obstetric anesthesia in particular, is a widespread problem. After the temporary withdrawal of Akrinor from the market, the internationally available drug ephedrine is available for prevention and therapy of hypotension in anesthesia and its effect is comparable with Akrinor. In obstetric epidural anesthesia the intravenous prophylactic drug application of ephedrine seems to be superior to therapeutic application only. The aim of this overview is to show alternatives to the currently administered catecholamines for prevention of hypotension in obstetric anesthesia.

Acidosis↗
PubMed2003

A study of the incidence and recognition of surgical glove perforation during obstetric and gynecological procedures.

OBJECTIVES: The purpose of this study was to compare the frequency of surgical glove perforation among obstetric and gynecological surgical procedures, and to evaluate surgeons' perceptions. MATERIALS AND METHODS: A cross-sectional study was conducted in which nursing personnel examined the gloves used in obstetric and gynecological procedures, immediately after the surgery, in order to detect perforations. RESULTS: Surgical glove perforation occurred in 20.8% of 817 obstetrics procedures and 24.4% of 131 gynecology procedures. The observed difference between groups was not statistically significant (p=0.35). Obstetricians perceived the occurrence of perforation in 30.6% of the events, and gynecologists in 37.5%. This difference was not statistically significant (p=0.44).

Brazil↗