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PubMed1994

Risk of eye splash in obstetric procedures.

A prospective cross-sectional study was designed to determine the rates of upper facial splash during obstetric deliveries. Macroscopic splashes on the attached eye shields of surgical masks, worn for obstetric deliveries were enumerated for a sample of parturients during a 3-month period. Masks were collected for 68 vaginal and 44 cesarean deliveries, 31% of all deliveries during the study period. For cesarean deliveries, 68% (30) of all masks worn by primary surgeons had at least one splash; 57% (17) of which were heavily contaminated (more than five splashes). For the first assistant, 68% (30) of all masks had at least one splash; 23% (7) of which were heavily contaminated. During vaginal deliveries 44% (30) of masks worn by the delivering physician had at least one splash; 20% (6) of which were heavily contaminated. The primary surgeon in a cesarean section was 1.6 times as likely to be splashed (P < 0.04) when compared with vaginal deliveries and 4.6 times as likely to be heavily contaminated (P < 0.003). Estimated blood loss and the rate of eye splash were linearly related. Method of delivery was not independently associated with eye splash. These findings suggest that the risk of contamination by splash during obstetric procedures is high, particularly for cesarean deliveries because these deliveries tend to have greater blood losses.

Adult↗
PubMed1991

Effect of explicit criteria on nonstress test evaluation by obstetric nurses.

The ability to interpret five nonstress tests (NST) was evaluated with a mail survey of obstetric nurses. One group of nurses (402) used their own criteria for interpreting the test as reactive, nonreactive, or equivocal. The other group (396) used explicitly defined criteria. There was no relationship in either group between the accuracy of response to past training, number of years in nursing, or daily experience with the NST. Furthermore, the provision of diagnostic criteria did not affect either the accuracy of response or the translation of the NST into an assessment of fetal well-being. These responses of obstetric nurses were equivalent to those of obstetricians who evaluated these same tracings in a previous study. These data support a conclusion that the obstetric nurse can interpret the NST with a level of reliability commensurate with obstetricians.

Cohort Studies↗
PubMed1989

[Particular aspects of creation and assessment of an obstetrical data bank].

The use of computers improves data storage capacity and leads to a homogeneous documentation of data obtained. After extensive preparations documentation was started using in 1975 the 2nd Department of Obstetrics and Gynecology computer. The obstetrical-gynecological data base is used for organisational, epidemiological, scientific and mixed purposes. The main purpose is periodical evaluation of routine procedures. The evaluation of obstetrical data is often combined with specific problems. To compare the data obtained, clinical findings have to be entered in standardized form and to be related to the week of pregnancy. The expected date of birth has to be corrected often as a result of several investigations. Furthermore, it has to be differentiated between single and multiple pregnancy. Good cooperation between physician and medical computer expert is necessary for good quality of evaluation. The evaluated data enable one to find new aspects and connections, which may offer the impetus to perform new prospective research.

Expert Systems↗
PubMed1978

A follow-up study of residents in internal-medicine, pediatrics and obstetrics-gynecology training programs in Massachusetts. Implications for the supply of primary-care physicians.

A questionnaire survey of physicians who had been residents in internal medicine, pediatrics or obstetrics-gynecology in Massachusetts during the years 1967-1972 was undertaken to determine that specialties they now practice and the extent to which they deliver primary care. Over 600 physicians (74 per cent) responded. Devoting more than half their practice to a primary-care specialty were only 28 per cent of the former residents in internal medicine as compared with 56 per cent of those in pediatrics and 74 per cent of those in obstetrics-gynecology. For each group the fraction of full-time equivalent primary-care physicians produced was 0.27, 0.42 and 0.39 for the internal-medicine, pediatrics and obstetrics-gynecology programs respectively. These findings indicate that, although Massachusetts is meeting the requirements of PL 94-484 concerning the percentage of residency positions in the primary-care specialties, such compliance does not guarantee an adequate future supply of primary-care practioners.

Certification↗
PubMed2001

Obstetrics and gynecology at the crossroads--again? Still!

It seems, if one can believe presidential addresses, as if our specialty is always at some crossroads or other. In this "opinion piece," uniquely, I don't complain about managed care. I do attempt to identify some of the issues that will be of import for obstetrics and gynecology in the near and not-so-near futures. With regard to research, we await breakthroughs, for example, in the early detection of ovarian cancer, so as to finally be able to improve outcomes. A problem, though, is our failure to focus enough effort on developing a cadre of clinician scientists, who can work out research findings with direct clinical application; this is an issue with which the specialty needs to come to grips. Regarding education, I believe we need to refocus from what type of practitioners we might want to produce to best meet the needs of our patients. The bottom line should be more flexibility in training and emphasis on clinical competence, so that excellent practitioners with competence across the breadth of our specialty are available to provide a full range of appropriate women's health care. The concept of "women's health" is controversial and evolving rapidly. Review of several available sources suggests that reproductive medicine will remain an important component of women's health but that our specialty must now evolve to include other areas, as the major health problems of women change. We need to shift from an organ-based paradigm to a more holistic view, reflecting the woman-centered focus for our specialty. This "paradigm shift" will need to entail continuation of first-rate surgical and obstetrics services but will be expanded to include a full range of services, probably offered by highly trained and competent individuals with specific areas of expertise, practicing in a multi-single-specialty group. Obstetrics and gynecology at the crossroads, indeed!

Humans↗
PubMed2002

Women's perceptions of and experiences with medical student involvement in outpatient obstetric and gynecologic care in the United Arab Emirates.

OBJECTIVE: The purpose of this study was to determine the experiences, satisfaction, and comfort of women with medical student participation in outpatient care during obstetric and gynecology clerkships. STUDY DESIGN: A consecutive sample of 303 women who attended the clinic were interviewed before consultation; a structured questionnaire was used. RESULTS: Two hundred sixty-four women (87.1%) accepted student involvement; 158 women (59.8%) and 173 women (66.5%), respectively, preferred female students or preceptors. Comfort levels were significantly lower with male students or preceptors in all skills that were tested (P <.0001), particularly pelvic examination and the discussion of sexual problems. Acceptance was associated significantly with older age (P <.0001), higher parity (P <.0001), higher education (P =.002), husband's occupation (P =.006), obstetric consultation (P <.0001), previous teaching encounters (P =.0006), recognition of the students' roles (P =.004), and satisfaction with clinical service (P = 0.01). Reasons for nonacceptance (n = 39 women, 12.9%) were concern about privacy during examination (53.8%) or counseling (25.6%) and the extent of the students' involvement (20.5%). CONCLUSION: Most women agreed to participate in the teaching of obstetric and gynecologic skills to medical students.

Ambulatory Care↗
PubMed2003

Obstetric predictors of placental/umbilical cord blood volume for transplantation.

OBJECTIVE: Umbilical cord blood is an effective alternative to bone marrow as a source of hematopoietic stem cells in transplantation. However, the amount of donor blood and the cell content that are collected may be insufficient for engraftment in some adult recipients. This study identifies obstetric factors that affect retrievable placental cord blood volume. STUDY DESIGN: A retrospective analysis of factors that were obtained by direct observation or medical record review that were related to harvested cord blood volume was conducted; the analysis involved 9205 deliveries from mothers who donated placental cord blood through the obstetric services of two New York City hospitals between 1993 and 1999. RESULTS: Obstetric factors that influenced significantly the total volume of blood that was collected were route of delivery, induction of labor, presence of a nuchal cord, infant birth weight, multiple births, placental weight, and duration of labor. The length of the umbilical cord from the venipuncture site and the length of time to cord blood collection also affected the volume that was retrieved. Maternal ethnicity was associated with cord blood yield; Caucasian mothers provided larger quantities than either African American or Asian mothers. CONCLUSION: Our results confirm that the volume of residual placental cord blood that is collected for hematopoietic stem cell transplantation is influenced by several factors, the presence of which predict the likelihood of an adequate collection. Collected volumes can be improved when a longer length of the cord is left with the placenta and when there is a shorter time between the delivery of the placenta and the collection.

Blood Volume↗
PubMed2000

Minor physical anomalies and obstetric complications in schizophrenia.

OBJECTIVE: To evaluate the possibility of using congenital minor physical anomalies (MPA) and obstetric complications (OC) as individual-orientated, early life markers signalling increased risk for schizophrenia. METHOD: Previous findings using Waldrop and colleagues' MPA scale (and additional items) and systematic study of OC history are summarised concerning schizophrenia patients and individuals at heightened genetic risk for schizophrenia. RESULTS: Significantly increased rates of both MPA and OC are consistently found in patients with schizophrenia. Minor physical anomalies are stable characteristics over time and can be studied efficiently from early childhood onward. Minor physical anomalies predict a variety of mental disorders in normal-risk children, but the predictive efficiency of MPA for schizophrenia in genetic high-risk samples and in the general population is unknown. Obstetric complications predict serious mental disturbance and neurodisorder in genetic high-risk cases, as well as doubling or tripling the individual's risk for schizophrenia in the general population. Obstetric complication results are sensitive to methodology and are best investigated using prospectively recorded information and an efficient OC scale for scoring the information. CONCLUSIONS: Both MPA and OC should be included in batteries of methods for identifying individuals at an increased risk for schizophrenia. However, increased rates of MPA and OC are not pathognomonic for schizophrenia, but rather characterise individuals at risk of a much broader range of mental and physical abnormality, as well as normality. Minor physical anomalies and OC are not in themselves stigmatising, but their possible identification as markers for 'increased risk for schizophrenia' should be used judiciously. Further research is recommended regarding the MPA and OC patterns related to schizophrenia.

Adolescent↗
PubMed2006

How competent are obstetric and gynaecology trainees in managing maternal cardiac arrests?

The recent Confidential Enquiry (2000-2002) has emphasised 'emergency drills for maternal resuscitation should be regularly practised in clinical areas in all maternity units'. It was therefore planned to assess the knowledge of airway management and ventilation among obstetrics and gynaecology trainees in the Yorkshire Deanery (Training Region). Questionnaires were given to trainees attending the Modular Training Programme and were collected on the same day. A total of 71 questionnaires were collected which represents 62% of the 113 trainees in Yorkshire region. Replies were received from 39 registrars, 27 Senior House Officers (SHO), four Senior SHOs (SSHO) and one clinical fellow. MRCOG Part 1 was passed by 52% and 36% of trainees had MRCOG Part 2. A total of 69% of trainees did not know that chin lift opens the airway in some 70 - 80% of patients; 50% of trainees were not aware why jaw thrust is preferred over chin lift; 76% of the trainees knew the most common cause of airway obstruction in a patient with an altered level of consciousness--the tongue falls back and obstructs the pharynx ('swallowing the tongue'). Knowledge of the main cause of airway obstruction was good among obstetrics and gynaecology trainees, but their understanding of how to manage this was found to be relatively poor. Attendance at a local Basic Life Support course should be compulsory for obstetric and gynaecology trainees early in their career.

Education, Medical↗
PubMed1999

The obstetrical and postpartum benefits of continuous support during childbirth.

The purpose of this article is to review the evidence regarding the effectiveness of continuous support provided by a trained laywoman (doula) during childbirth on obstetrical and postpartum outcomes. Twelve individual randomized trials have compared obstetrical and postpartum outcomes between doula-supported women and women who did not receive doula support during childbirth. Three meta-analyses, which used different approaches, have been performed on the results of the clinical trials. Emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula. Labor support by fathers does not appear to produce similar obstetrical benefits. Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding, and increased sensitivity of the mother to her child's needs. The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor.

Breast Feeding↗
PubMed1997

Technical dependability of obstetric ultrasound transmission via ISDN.

OBJECTIVE: To evaluate the dependability of a live telemedicine link for the transmission of obstetric ultrasonograms using a commercial telephone network. MATERIALS AND METHODS: We established an integrated services digital network (ISDN), consisting of three dedicated telephone lines from three satellite offices, to our central prenatal diagnostic center. All patients had a sonographic evaluation recorded on videotape by a trained sonographer. A live interactive video telemedicine link was then established, and a perinatologist directed the sonographer through the scan. A report was issued on the basis of the telemedicine examination. The number of calls required to obtain satisfactory real-time images was recorded, as were the reasons for suboptimal transmissions. The first 150 transmissions were excluded from this study. The results in the subsequent 100 patients who agreed to participate were analyzed. RESULTS: We were able to provide obstetric interpretations in all 100 patients scheduled to be examined using the telemedicine link. A single connection was required in 85 cases, two calls in 5 cases, three calls in 8 cases, four calls in 1 case, and five calls in another case. A repeat call was required in 20 cases because of poor image transmission; other repeat calls were caused by failure to connect (5 cases), calls disconnected (2 cases), and no image transmission (2 cases). CONCLUSIONS: The provision of telemedicine services for obstetric ultrasonography in the community is feasible, but the need for repeat connections because of technical failures needs to be incorporated into cost and time analyses in order to provide a measure of the system's efficiency.

Female↗
PubMed2003

Costs of near-miss obstetric complications for women and their families in Benin and Ghana.

This paper estimates the total cost to women and their families associated with a spontaneous vaginal delivery and five types of 'near-miss' obstetric complication in Benin and Ghana, and assesses affordability in relation to household cash expenditure. A retrospective evaluation of costs was carried out among 121 mothers in three hospitals in Ghana. A prospective evaluation of costs was undertaken among 420 pregnant women in two hospitals in Benin. Information was collected on the cost of travel to the facilities and of direct medical and non-medical costs incurred during their stay in hospital. In Benin, costs ranged from an average of 15 US dollars for a spontaneous delivery to 256 US dollars for a near-miss complication caused by dystocia. In Ghana, average costs ranged from 18 US dollars for a spontaneous vaginal delivery to 115 US dollars for a near-miss complication caused by haemorrhage. Medical costs accounted for the largest share of total costs, mainly drugs and medical supplies in Ghana and costs of the delivery and any surgical intervention in Benin. Payments associated with a spontaneous vaginal delivery amounted to at least 2% of annual household cash expenditure in both countries. In the case of severe obstetric complications, costs incurred reached a high of 34% of annual household cash expenditure in Benin. The economic burden of hospital-based delivery care in Ghana and Benin is likely to deter or delay women's use of health services. Should a woman develop severe obstetric complications while in labour, the relatively high costs of hospital care could have a potentially catastrophic impact on the household budget.

Benin↗
PubMed2006

Do group practices have lower caesarean rates than solo practice obstetric clinics? Evidence from Taiwan.

OBJECTIVE: This study examined physicians' propensity for caesarean deliveries at solo versus group practice obstetrics/gynaecology (ob/gyn) clinics in Taiwan. METHOD: We used population-based (National Health Insurance) claims data covering all 253 618 singleton deliveries conducted at ob/gyn clinics, during 2000-02. The dependent variable, delivery mode, was treated as dichotomous [caesarean section (CS) = 1, vaginal delivery (VD) = 0]. The independent variable of interest was practice size, classified into four categories: 1, 2, 3 and 4+ physicians. Multilevel logistic regression modelling, accounting for clinic-level variation in CS rates, was used to examine CS likelihood by practice size, among the total delivery sample and among the sub-samples disaggregated by obstetric complication status. RESULTS: Solo practices have 7% excess caesarean cases relative to large group practices. After controlling for patient's age, physician demographics, the clinic's geographic location and size of delivery service, and clinic-level random effect, solo practice physicians were 5.38 times as likely as 4+ physician practices to provide caesarean delivery (CI = 4.18 approximately 6.93), 2-physician practices were 3.87 times (CI = 2.99 approximately 5.01) and 3-physician practices 2.72 times (CI = 2.06 approximately 3.59) as likely as 4+ physician practices to provide caesarean delivery. This effect is driven by higher CS propensity among solo and small groups among cases with obstetrically less salient complications and the 'no complications' subset of patients. Wide confidence intervals for odds ratios in these sub-samples also attest to wide variations in clinic-level CS rates among these patient groups. CONCLUSIONS: Solo physicians are the most likely to provide caesarean delivery, and CS likelihood decreases with increasing number of physicians in the practice. Group practice support may reduce the CS likelihood, when it is not clinically indicated. Policy makers should consider initiatives to limit full service delivery privileges to group practice obstetric clinics, in order to reduce unnecessary CS. Solo practice clinics should, at best, be licensed as birthing centres, required to transfer patients needing CS to a larger facility.

Adolescent↗
PubMed1985

Obstetrics in the physical therapy curriculum.

We report the status of obstetric education in physical therapy curricula. A questionnaire was sent to 83 accredited physical therapy education programs. Of the respondents from 69 programs, 47 (68%) included a specific unit or information on obstetrics in their program. The reporting programs averaged 7.5 hours for obstetric education. The unit was required in 45 of the 47 programs. Topics covered included anatomy and physiology, psychology, labor and delivery sequence, relaxation techniques, breathing techniques, prenatal and postpartum exercises, body mechanics, nutrition, fetal development, and birthing alternatives. Fifty-three percent of the units were taught by a physical therapist and combination of other professionals including a nurse, physician, nutritionist, psychiatric social worker, physiologist, or anatomist. We present behavioral objectives, required readings, and audiovisual aids used in the units.

Curriculum↗
PubMed1998

Sterility of anesthetic and resuscitative drug syringes used in the obstetric operating room.

UNLABELLED: Because of the constant threat of emergent cesarean delivery, anesthetic induction and resuscitation drugs are often drawn into syringes and stored in the obstetric operating room (OR). This study investigated the potential for bacterial and fungal contamination of six drugs (thiopental, succinylcholine, ephedrine, atropine, lidocaine, and oxytocin) often prepared in the obstetric OR. A total of 756 drug syringes were prepared and stored in the obstetric OR for 8 days using normal clinical practices. Starting on Day 0, and subsequently on Days 4 and 8 of the experiment, 42 syringes of each drug were randomly selected from the pool, filtered through a 0.45-microm porosity sterile cellulose filter, and cultured on 5% sheep blood agar. Of the 756 syringes tested, none grew organisms of any type, which indicates a probability of drug sterility of > or = 0.9961 (95% confidence interval [CI]). The data from the cultures performed on syringes on Day 0 indicate a probability of initial contamination of < or = 0.018 (95% CI). This study demonstrates a high probability of sterility in drugs drawn into sterile syringes and stored at room temperature in an OR environment for up to 8 days. IMPLICATIONS: Drug syringes stored in emergency operating rooms are discarded after 24 h because of possible contamination. We searched for microorganisms in drug syringes stored in the operating room for up to 8 days. No microbes were detected using standard sterility testing techniques. Adopting longer storage periods could result in significant cost savings.

Anesthesia, Obstetrical↗
PubMed2000

Informed consent for obstetric anesthesia research: factors that influence parturients' decisions to participate.

UNLABELLED: Patients who are approached to participate in clinical studies just before delivery may have insufficient time to make an informed decision and/or may feel pressured into participation. This study was designed to examine factors that influence parturients to consent or decline participation in an anesthesia study related to their delivery. Parturients who had been approached to participate in a continuing clinical obstetric anesthesia study were subsequently given a questionnaire that documented their reasons for consenting or declining participation. There were no demographic differences among the consenters (n = 166) and nonconsenters (n = 109). The most important factors in the patient's decision to consent were related to their understanding and perceived importance of the study and the potential benefit to other women. Forty-one (40. 6%) nonconsenters strongly considered their pain/discomfort a factor in declining participation. Only one patient felt some pressure to consent, suggesting that the overall environment was noncoercive. Logistic regression analysis demonstrated that patients who read the consent form completely, those who had participated in a previous research study, and those who were less anxious about participating were more likely to consent. IMPLICATIONS: Obtaining informed consent for obstetric anesthesia studies presents a challenge to the anesthesiologist. Results from this study suggest that the environment in which consent for obstetric studies is sought is not coercive. However, it is important that the anesthesiologist ensures that the patient fully understands the study and develops a rapport with the patient to allay any anxiety associated with her participation as a potential research subject.

Anesthesia, Obstetrical↗
PubMed1978

An ambulatory training model for an obstetrics and gynecology residency program.

An important educational objective of an obstetric-gynecologic residency program is to provide an ambulatory experience from which residents can develop attitudes and skills that will enable them to provide high-quality comprehensive care to their patients. Often traditional outpatient clinics hold second-class positions in a training program, with surgical or obstetrical procedures being more highly valued experiences. From the patients' point of view many of these clinics are uncomfortable, noisy, and unattractive; and the patients in many instances receive depersonalized, discontinuous care. There is, therefore, a pressing need to implement efficient strategies to meet the increasing community demands for outpatient services while at the same time providing an innovative and effective ambulatory experience for residents. This paper describes how in a cooperative effort between a hospital's Department of Ambulatory Services and Department of Obstetrics and Gynecology these educational objectives were successfully integrated with those of continuous and comprehensive patient care.

Ambulatory Care↗
PubMed1994

Obstetric patients who select and those who refuse medical students' participation in their care.

PURPOSE: To assess attitudes and expectations of obstetric patients toward the involvement of medical students in their care. METHOD: At the Medical Center Hospital of Vermont in 1991, questionnaire responses were collected from 222 obstetric patients who had been assisted by clerkship students from the University of Vermont College of Medicine and 78 patients who had refused the participation of students. The responses were analyzed for differences in demographic backgrounds, prior hospital experiences, and general expectations of student involvement, using chi-square, two-tailed t-tests and analysis of variance. RESULTS: Both groups of respondents consisted primarily of young, well-educated, married women, who appear to have made their decisions about student participation by balancing their personal needs and their sense of altruism. For example, 61% of those who had refused the participation of students ranked the desire for privacy as their primary reason, whereas 73% of those who had accepted student participation ranked as their primary reason the desire to contribute to a student's education. Although both groups of patients expected the students to perform few clinical procedures, the patients who had refused student participation expected the students to be more involved in patient care than did the patients who had allowed participation. Of the 25% of the patients who had had students involved in prior pregnancy care, those who had currently refused student participation had less positive views of prior student care. CONCLUSION: Patients' needs for privacy, past experiences with student care, and expectations of student performance should be considered to ensure the respectful incorporation of student involvement in obstetric care.

Altruism↗