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PubMed2006

Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes.

OBJECTIVES: To examine the association between body mass index (BMI) and obstetrical and neonatal outcomes. METHODS: We conducted a cohort study comparing prepregnant BMI categories with obstetrical and neonatal outcomes using the McGill Obstetrical and Neonatal Database on all deliveries in 10 year period (1987-1997). Prepregnant BMI was categorized into underweight (<20), normal (20-24.9), overweight (25-29.9), obese (30-39.9), and morbidly obese (40+). Logistic regression analysis was used to adjust for age, smoking, parity, and preexisting diabetes using normal BMI as the reference. RESULTS: The population consisted of underweight 4,312 (23.1%), normal weight 10,021 (53.8%), overweight 3,069 (16.5%), obese 1,137 (6.1%), and morbidly obese 104 (0.6%). As compared to women with normal BMIs, overweight, obese, and morbidly obese women had an increased risk of preeclampsia 2.28 (1.88-2.77), 4.65 (3.71-5.83), 6.26 (3.48-11.26); gestational hypertension 1.56 (1.35-1.81), 2.01 (1.64-2.45), 2.77 (1.60-4.78); gestational diabetes 1.89 (1.63-2.19), 3.22 (2.68-3.87), 4.71 (2.89-7.67); preterm birth 1.20 (1.04-1.38), 1.60 (1.32-1.94), 2.43 (1.46-4.05); cesarean section 1.48 (1.35-1.62), 1.85 (1.62-2.11), 2.92 (1.97-4.34); and macrosomia 1.66 (1.23-2.24), 2.32 (1.58-3.41), 2.10 (0.64-6.86). Underweight women were less likely to have: preeclampsia 0.67 (0.52-0.86), gestational hypertension 0.71 (0.60-0.83), gestational diabetes 0.82 (0.69-0.97), cesarean section 0.89 (0.81-0.97), shoulder dystocia 0.88 (0.80-0.96), birth injuries 0.40 (0.21-0.77), and macrosomia 0.43 (0.28-0.68) but more likely to have small for gestational age infants 1.54 (1.37-1.72) and intrauterine growth restricted infants 1.33 (1.07-1.67). CONCLUSION: In a large Canadian teaching hospital, increasing prepregnancy BMI category was associated with an increasing risk of adverse pregnancy outcomes. Underweight prepregnancy BMI was associated with a reduced risk of adverse pregnancy outcomes.

Adult↗
PubMed2001

Elective caesarean section versus vaginal delivery. Whither the end of traditional obstetrics?

No other topic has dominated the obstetrical discussion to the same extent as caesarean section. Nor has any other aspect of obstetrics been subject to a comparable degree of professional controversy,quite recently the topic has been discussed in this journal by Ludwig and Loeffler. For some caesarean section remains a major surgical procedure with a corresponding level of risk, which must only be employed in the presence of specific complications and in conjunction with a clearly defined set of indications; others consider caesarean section quite simply to be the most efficient and straightforward means to deliver as well as the one attended by the least amount of risk. Opinion among those most immediately affected is likewise divided: For many women the experience of vaginal birth is among the most fulfilling of their entire life - comparable only to sexuality-related moments of ecstasy - other women come to regard birth as the worst thing that ever happened to them an experience attended by pain, fear, loneliness, perhaps even long lasting negative consequences. There can be no doubt that, this question also affects the foundations of patriarchal thinking, still so firmly embedded in peoples' minds: Are doctors to determine what exactly takes place in the delivery room and in the operating theatre, or will the patient - in obstetrics, the parturient - be enabled to assert her right to self-determination also in the medical context; especially in light of the fact that said right can currently be exercised in an almost unlimited fashion throughout the rest of one's adult life? It is against the wider background of this ongoing controversy that the ensuing article will seek to defuse the emotional charge characterising some of the commonly employed arguments and instead revert to a more rational and factually based approach to this question.

Cesarean Section↗
PubMed1977

Hematologic problems in pregnancy V. Obstetric transfusion therapy.

A study of 37,186 admissions, from 1970 through 1974, to a large southern charity hospital obstetrics service revealed a striking 63 per cent reduction in number of patients receiving blood transfusions. Analysis showed no change in patient population, bleeding disorders, toxemia, incidence of obstetric hemorrhage, serious febrile morbidity, or incidence of antepartum anemia. In the study period cesarean section rate increased 77 per cent and anemia at delivery markedly decreased. Transfusions associated with spontaneous abortion decreased by 70 per cent, and after the third study year no patient undergoing legal abortion received blood. The study demonstrated improvement in specific hematinic therapy of antepartum anemia and avoidance of transfusion therapy in the presence of uncharacterized antepartum or puerperal anemia. Despite the remarkable decrease in blood transfusions, obstetric outcome (including perinatal mortality rate, maternal mortality rate, and serious febrile morbidity) did not suffer but, indeed, improved.

Abortion, Legal↗
PubMed1982

Neonatal morbidity in deliveries conducted by midwives and gynecologists. A study of the system of obstetric care prevailing in The Netherlands.

The efficacy of the Dutch system of obstetric care was investigated by comparison of the outcomes of two groups of supposedly normal first pregnancies and deliveries that were solely cared for by midwives (n = 85) or by gynecologists (n = 27). The outcome was measured by pH, PCO2, and base deficit in arterial cord blood (early morbidity) and by neurological examination with Prechtl's method (late morbidity). The occurrence of 10 neurologically nonoptimal infants in the midwife group is thought incompatible with the basis philosophy of the Dutch obstetric system, which is that midwives are able to select the normal pregnancies out of the group of women who present for obstetric care and can assist in maintaining the normal state in these selected cases in the course of delivery. The acid-base values were less favorable in the midwife group than in the gynecologist group. Neurological nonoptimality in the midwife group was related to acidosis. The influence of the site of birth (home or hospital--ambulatory) could be virtually ruled out.

Acidosis↗
PubMed1984

Expanded care in obstetrics for the 1980s: preconception and early postconception counseling.

This paper is an essay in which the suggestion is made to expand obstetric care during this decade to include preconception as well as early postconception counseling. The development of perinatal and neonatal medicine is traced and medical problems that might be improved by medical counseling before pregnancy occurs are tabulated. Diabetes is suggested as a prototype of a medical disorder for which preconception counseling would be helpful. The expansion of obstetric services into an area of preventive medicine might well begin in already established regional medical centers but should quickly expand to the offices of private obstetricians. In this broader interpretation of obstetric care, prevention of maternal and fetal or neonatal problems could decrease the cost of high-risk medical care.

Counseling↗
PubMed1987

Computer applications in obstetrics.

The potential impact of the computer on the practice of obstetrics has long been recognized and is slowly being realized. Computers are already essential in many administrative aspects of obstetrics and indispensable in data storage and analysis for clinical research. Emerging applications include computer systems for taking the perinatal history, storage and on-line interpretation of fetal monitor tracings, information retrieval for case management and research purposes, and computer-assisted instruction. Future applications offer possibilities of computerized consulting for support of obstetric decisions and sophisticated case simulations for continuing education.

Computer-Assisted Instruction↗
PubMed1994

The role of obstetric interventions in the prevention of pediatric human immunodeficiency virus infection.

By the end of the decade 10 million children will be infected with human immunodeficiency virus. Several potential means of preventing vertical transmission of human immunodeficiency virus are under study. Although the perinatal use of antiretroviral agents can prevent some of these infections, those agents are neither uniformly effective nor universally available. A significant portion of vertical transmission may be an intrapartum phenomenon, potentially amenable to obstetric interventions, such as cesarean section or vaginal virucides. The utility of these obstetric interventions will be determined in large part by the timing of vertical transmission. This work reviews the evidence that human immunodeficiency virus can be transmitted during the intrapartum period and critically reviews the data supporting a role for obstetric interventions. Finally, we outline the necessary elements for the conduct of a conclusive efficacy trial and delineate a mechanism to arrive at a definitive standard of care in the absence or anticipation of a trial.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Computer prediction of congestion in the obstetric ward.

A computer system was developed to predict congestion of the obstetric ward in the near future. The admittance and stay in the obstetric ward of every registered patient are simulated based on the table of reservation and observed data of hospital stay, and from this the number of inpatients (occupied beds) is predicted. If the expected date of confinement of every obstetric patient is put into the computer and the information on patients who have already given birth is deleted, it is possible to obtain a reasonably accurate prediction.

Bed Occupancy↗
PubMed1990

Obstetric anesthetic outpatient clinics: an international survey.

An international investigation was undertaken into practices of pre-anesthetic evaluation provided for obstetrical patients in outpatient clinics. A questionnaire was completed by 21/36 (58%) obstetric units. Only 5 (23%) had an outpatient clinic for preanesthetic evaluation of the obstetric patient, but in 10 (37%) anesthetists take part in the prenatal examinations and give advice in cases of complicated pregnancy.

Anesthesia Department, Hospital↗
PubMed1992

The obstetric fistula: factors associated with improved pregnancy outcome after a successful repair.

A retrospective study of 155 pregnant patients with obstetric fistulae was conducted to determine the factors associated with improvement in the pregnancy outcome. The successful repair of the fistula was associated with a reduced abortion rate (4.0%), incidence of premature rupture of the membranes (1.3%) perinatal mortality (13.0%) as well as an increase in the mean fetal birthweight and reduced incidence of low birth (20.3%). Antenatal supervision of pregnancy increased the acceptance rate for elective cesarean section and was associated with early referral of cases to hospital during labor. The patients having their first pregnancies since the onset of their fistulae delayed longest in labor at home (15.6 h) hence had the highest perinatal mortality and rate of recurrence of obstetric fistula. Therefore the successful repair of the obstetric fistula together with an aggressive drive to improve antenatal supervision especially directed at the younger patients will improve acceptance of the policy of elective cesarean delivery and therefore the overall pregnancy outcome among these patients.

Abortion, Spontaneous↗
PubMed1991

Subspecialization in gynecology and obstetrics: advantages and disadvantages.

To discuss the problem of subspecialization in our discipline is presently very popular. Whether or not a complete separation into the three subdisciplines: (1) materno-fetal medicine - obstetrics (2) surgical gynecology - gynecologic oncology (3) gynecologic endocrinology - reproductive medicine is recommended remains unclear in most of the statements. Some describe forms of only a supplementary postgraduate education, a kind of prolongation of the basic gynecologic and obstetrical training concentrated on one of the three main fields. The complete separation, i.e., in obstetrical medicine, reproductive medicine, gynecologic pelvic surgery, has the advantage of a more effective concentration on each of the respective subdisciplines in clinical work and in research. On the other hand, the separation will certainly produce several disadvantages: (a) What is inbetween the subdisciplines will be difficult to integrate. (b) The principle of the gynecologist functioning as a primary health care physician for women will be weakened, i.e., his competence for family-planning, pregnancy and delivery of normal cases, for cancer screening of genital and breast tumors, for disorders of the cycle, for pelvic inflammatory diseases and for the care of postmenopausal women will be less integral. (c) The lectures will be more than at present split or overloaded with detailed facts. (d) The need of general gynecologic care - as well cost-effective as widely available - will less frequently be met than now. (e) The opportunities for younger colleagues to settle with an office of their own will be restricted. The disadvantages outweigh the advantages.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical, Graduate↗
PubMed1993

European multicentre studies in the field of obstetrics.

Within Europe a number of multinational, multicentre studies are performed in the field of Obstetrics and Gynaecology. Many of these are funded by the European Community. Unfortunately, concise information on currently ongoing European multicentre studies is not easily obtainable. There is no particular central information point. The current overview aims to provide insight in obstetrical EC/European multicentre studies which recently have been finished, are ongoing or have been planned for the near future. The various projects are described, and information on the number of participants, the research period, the responsible project leader and framework of each project is summarized in tables. A list with the addresses of the project leaders and/or contact persons in the EC member states is added. The paper hopes to facilitate researchers and institutes involved in Obstetrics within Europe to make easier contacts and to promote collaboration on the international level.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Term early-onset neonatal seizures: obstetric characteristics, etiologic classifications, and perinatal care.

OBJECTIVE: To describe obstetric characteristics and etiologic classifications and assess perinatal care in term neonates with early-onset seizures. METHODS: We performed a retrospective review of neonatal and obstetric records of neonates delivered at term with a diagnosis of early-onset seizures between January 1981 and December 1992 at Long Beach Memorial Medical Center. Data regarding obstetric characteristics and etiologic classifications of the seizures were abstracted from the medical records. Lack of antepartum testing in high-risk patients, delayed intervention with nonreassuring antepartum or intrapartum fetal heart rate patterns, birth trauma, and failure to use prophylactic antibiotics or treat infection were the criteria used for identifying seizures that were potentially preventable. RESULTS: Forty term neonates had early-onset seizures out of 60,712 live births (0.07%). These seizures were attributed to hypoxic events in 15 neonates (37.5%), cerebral malformations in seven (17.5%), cerebral infarcts in seven (17.5%), intracranial hemorrhage in five (12.5%), infection in three, and an unknown etiology in three. Twenty-three neonates had 5-minute Apgar scores of 7 or greater (cerebral malformations excluded). Seven of these neonates (30%) had cerebral infarcts. A review of all records identified nine cases (22.5%) of the early-onset seizures as potentially preventable. CONCLUSION: The majority of the term early-onset neonatal seizures identified did not appear to be preventable. Many of the neonates with 5-minute Apgar scores of 7 or greater had cerebral infarcts.

Adult↗
PubMed1995

Sexuality, reproduction, and contraception among residents in obstetrics and gynecology.

OBJECTIVE: To investigate the contraceptive practices and attitudes of residents in obstetrics and gynecology, both personally and professionally. METHODS: We conducted a national survey of obstetrics and gynecology residents. RESULTS: One thousand ninety-one questionnaires (29% of those mailed) were returned, representing 3761 residents in 218 of the 275 programs surveyed. Less than 2% of this population wishing to avoid conception failed to use contraception. The oral contraceptive (OC) pill, the most common current method of contraception (59%), was significantly more prevalent among female residents than among female partners of male residents (P < .001). Condom use was more prevalent among male residents than among partners of female residents (P = .005). When controlled for age, parity, and marital status, and using log linear analysis, gender had a statistically significant impact on the use of several contraceptive methods. Female residents were five times more likely than a comparably educated, nonphysician group of women to use OCs. Twenty-six percent of respondents stated that they would not use the intrauterine device (IUD) personally, but might recommend it to their patients. CONCLUSIONS: Residents in obstetrics and gynecology demonstrate a high prevalence of contraceptive use. Controlling for demographic variables, we found that male and female residents have different attitudes on contraceptive use. Residents believe that OC use is safe and reliable for themselves and their patients, but demonstrate doubt about their own use of an IUD.

Adult↗
PubMed1995

Development of a guidebook for senior students applying for residency training in obstetrics and gynecology.

This article describes a detailed residency guidebook that I developed over the course of 4 years based on interaction with 42 student advisees. Questions most frequently asked by the students were recorded, and comprehensive written responses were prepared that addressed their specific concerns. The completed guidebook contains several major sections. The introductory portion provides a general description of the discipline of obstetrics and gynecology, outlines the format of residency training programs, and assesses the competitiveness of residencies in obstetrics and gynecology compared with other disciplines. The second section lists deadlines for completing various tasks, such as selecting an adviser, planning the senior curriculum, requesting and submitting applications, preparing the curriculum vitae and personal statement, and soliciting letters of recommendation. The next section of the guidebook provides suggestions for the senior curriculum and specifically addresses the issue of "audition electives" in obstetrics and gynecology. The next two sections present formats for the student's personal statement and curriculum vitae. Next, guidelines for requesting letters of recommendation are presented. Thereafter, information is provided to help students determine the number of applications they should submit, and training programs targeted by the student are classified by size, type, and competitiveness. Finally, the guidebook addresses questions related to scheduling and preparing for interviews.

Gynecology↗
PubMed1984

Folk medicine in Tonga. A study of the use of herbal medicines for obstetric and gynaecological conditions and disorders.

We report on a study of the role of traditional medicinal practices in two communities in the South Pacific Kingdom of Tonga, with particular emphasis on obstetric and gynaecological complaints of women and the traditional practitioners consulted by them. Data on the nature and frequency of obstetric and gynaecological complaints, patterns of consultations and preferences for the type of practitioner, Western or traditional, were collected from housewives. The nature, range and extent of expertise possessed by traditional practitioners were also assessed. The results indicate that reliance on traditional medicine is rapidly declining in favour of Western medicine. This seems to be due to urbanisation, increased acceptance of Western values and a lack of availability of traditional practitioners in sufficient numbers. However, self-administration of herbal remedies was still common, especially in rural areas, and might even be on the increase. The practitioners treated a variety of obstetric and gynaecological complaints using 60 plant species which were collected and identified.

Back Pain↗
PubMedDate not supplied

The frequency of postdural puncture headache in obstetric patients: a prospective study comparing the 24-gauge versus the 22-gauge Sprotte needle.

STUDY OBJECTIVE: To compare the frequency of postdural puncture headache (PDPH) in obstetric patients when using the 24-gauge or the larger 22-gauge Sprotte needle. DESIGN: Prospective, randomized study. SETTING: Four hospitals. PATIENTS: 375 ASA physical status I and II cesarean section and postpartum tubal ligation patients. INTERVENTIONS: Obstetric patients were randomly assigned to receive spinal anesthesia via a midline dural puncture using the 24-gauge or the 22-gauge Sprotte needle. MEASUREMENTS AND MAIN RESULTS: The rate of PDPH was determined by a postoperative visit by the anesthesiologist as well as questioning patients by telephone 1 week or more after discharge. In the 24-gauge Sprotte needle group (n = 186), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.61%. In the 22-gauge Sprotte needle group (n = 189), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.59%. All headaches except 1 resolved within 72 hours with conservative treatment. One patient from the 22-gauge Sprotte needle group required an epidural blood patch. There were no failed blocks in either group. CONCLUSIONS: Our results suggest that the 22-gauge Sprotte needle, when compared with the smaller 24-gauge Sprotte needle, can be used in obstetric patients without increasing the frequency of PDPH.

Adult↗
PubMed2004

Universal SARS preventive measures in an obstetrics unit: experience of health care staff.

BACKGROUND: Severe acute respiratory syndrome (SARS) epidemics have affected populations in many countries, including Hong Kong. This disease is infectious, especially in hospital settings. Health care workers have expressed great concern, including those working in obstetrics wards, defined as high-risk areas. METHOD: Four weeks after implementation of universal precautionary measures at a teaching hospital in Hong Kong, a survey of the health care staff was conducted to identify their feelings and opinions. RESULTS: In spite of general knowledge about SARS epidemics and related mortality, most respondents stated that universal precautionary measures were not very necessary, especially in the obstetrics ward. In addition, respondents were generally dissatisfied with the measures, as most items imposed extra work, inconvenience, and burdens on the staff. CONCLUSION: Our findings reported the views and satisfaction levels of the front-line staff of an obstetric unit concerning precautionary measures against SARS. The importance of individualized design and implementation of infection control measures is highlighted and discussed.

Adult↗