SEARCH · Search PubMed

Results for “OBSTETRICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,171 records · Page 65Linked to original sources

PubMed1994

Variation in obstetric care within and between hospital levels in Finland.

OBJECTIVE: In obstetrics, both area and hospital variation has previously been documented for operative procedures, but not for other treatments or diagnostic procedures. This study investigated the extent of variation in care during pregnancy, at birth and after birth. DESIGN AND METHODS: The variation was studied by hospitals (n = 52) by hospital level. To account for differences in women's background characteristics, logistic regression analyses were done. The data came from the 1991 Finnish Birth Register which records data on all births (n = 64,171). RESULTS: All interventions and care practices studied varied notably from one hospital to another, with the variation usually being greater within hospitals of the same level than between hospitals of different levels. Each of the seven non-operative interventions showed a larger variation than did each of the four operative interventions. Standardisation for mothers' background characteristics did not eliminate this variation. Some interventions, but not all, were clustered in the same hospitals. CONCLUSIONS: Such large variation indicates a need for further studies on the benefits of obstetric interventions and of care practices, and on better application of research results to obstetric care.

Female↗

PubMed2004

Clinical outcome in a series of cases of obstetric cholestasis identified via a patient support group.

OBJECTIVE: To explore the clinical features of obstetric cholestasis pregnancies in UK white Caucasians. DESIGN: A questionnaire survey. SETTING: Study coordinated at Queen Charlotte's Hospital. POPULATION: Clinical features of 352 affected pregnancies in 227 Caucasian women identified via a patient support group. METHODS: Evaluation of the gestation at which prematurity and intrauterine death occur, and recording of additional clinical features in pregnancies complicated by obstetric cholestasis. MAIN OUTCOME MEASURES: The timing of pregnancies complicated by intrauterine death and prematurity. RESULTS: Among the affected pregnancies, 23 (7%) were complicated by intrauterine death (20 singletons and 3 twins) and 133 (38%) were delivered prematurely (56 spontaneous and 77 iatrogenic). Eighteen of the 20 singleton intrauterine deaths occurred after 37 weeks. All three intrauterine deaths in twin pregnancies occurred before 37 weeks. Pruritus started earlier in pregnancies complicated by spontaneous prematurity, but not in those complicated by intrauterine death. CONCLUSIONS: Intrauterine death in singleton pregnancies complicated by obstetric cholestasis death mainly occurs after 37 weeks. The gestation at which pruritus is first reported may help to predict spontaneous prematurity.

Cholestasis↗

PubMed1989

Variations between midwives regarding administration of obstetrical analgesia.

Variations among 32 midwives involved in a total of 1578 deliveries were studied regarding attitudes to and use of obstetrical analgesia. Relevant data were obtained from the register of the maternity department of a Swedish regional hospital. This was complemented with information about the midwives' attitudes to pharmacological pain relief in labour and delivery, collected by means of a mailed questionnaire. Variations between midwives (range), expressed as percentages of each midwife's total number of deliveries, were considerable: epidural block (EDA), 9-48%; Pethidine, 0-41%; Entonox (N2O/O2), 8-62%; pudendal block (PDB), 11-71%. Midwives working on night-shift used less EDA, but more pethidine, than their day-shift colleagues. 59% of all the midwives were critical of current levels of obstetrical use of analgesics in Sweden, while 41% felt the level to be about right. Night-shift midwives were rather more critical than day-shift midwives. Midwives critical of current levels of obstetric medication used EDA and PDB less often than their more enthusiastic colleagues, but the difference was not statistically significant. On the other hand, critical midwives used more Pethidine (p less than 0.05) and also more Entonox than their less critical colleagues, though again the difference was statistically non-significant.

Anesthesia, Obstetrical↗

PubMed2004

Transperineal repair of obstetric-related anovaginal fistula.

BACKGROUND: To describe an operative technique for the repair of anovaginal fistulae secondary to obstetric injury and to assess its functional outcome and patient satisfaction. METHODS: An operative repair involving division of the anovaginal fistula, closure of rectal and vaginal walls, anterior levatoplasty and overlapping sphincteroplasty is described. Postoperative complications and recurrence were recorded. A telephone interview was carried out to assess the functional outcome and the satisfaction score. RESULTS: Seven consecutive patients had a repair of an obstetric-related anovaginal fistula. Their mean age was 34 years (range: 22-72). They had a mean duration of symptoms of 14 months (range: 1.5-54). Four patients did not have any previous repair and no stoma was necessary in any of the seven patients. There was no significant postoperative complication and only one recurrence. Telephone interviews were conducted for six patients and one was lost to follow-up. The mean follow-up period was 24 months (11-35). The Wexner's continence score improved from a mean preoperative score of 13.4 to a mean postoperative score of 5.6. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), five patients scored 1 and one scored 0. CONCLUSION: This technique is straightforward and effective in healing obstetric-related anovaginal fistula. It achieves improved continence and reasonable satisfaction.

Adult↗

PubMed2005

Obstetric ectoscopy, also a paediatric concern.

By coining a new concept, "obstetric ectoscopy", attention is drawn to the fact that undergraduate and postgraduate training in obstetrics and perinatal medicine in low-income countries is not geared towards community obstetrics, rather to more prestigious and lucrative endoscopy. It is argued that the devastation of maternal mortality leaves the clinical profession inactive and indifferent and that a more ectoscopic spirit would better prepare future obstetricians in efforts to enhance maternal and perinatal survival.

Developing Countries↗

PubMedDate not supplied

The integration of a QA/RM program in a rural healthcare obstetrical service.

Obstetrical services in a rural healthcare setting have special problems because the number of deliveries per month is below 100, with some facilities averaging fewer than 10 to 15 births per month. Medical resources may include obstetricians, pediatricians, or family practitioners, but not necessarily all three. Because it is not cost-effective to staff an obstetrical unit 24 hours a day when a low census is the norm, staffing patterns may be atypical and creative. The development of an effective credentialing system for both nursing and medical staffs is the first component of a QA/RM plan. Nursing staff play a vital role in modifying potential risk. When nurses do not routinely provide care on a unit, an efficient quality assurance plan is vital. Components of the plan must include staffing patterns and ratios, policies and procedures, and documentation. QA indicators should address both volume and outcome-oriented clinical indicators. Medical follow-up when indicated should also be part of the plan. Ongoing communication among team members and utilization of outside resources can assist in promoting an effective program. Although obstetrics is an area where the potential for risk exposure remains great, it is possible to create an efficient, practical risk management system.

Communication↗

PubMed1990

"Short report" staffing in practice: five years' experience of a consultant based service in obstetrics and neonatal paediatrics.

Recent government plans include the concept of a core of doctors of intermediate grade providing 24 hour emergency cover in hospital departments. Hinchingbrooke Hospital has, since its opening in 1983, been run on a two tier basis, with consultants and a part time senior registrar supported only by senior house officers in their first post, usually on general practice vocational training schemes. With a planned rate of around 2000 deliveries per year all high risk obstetric and neonatal paediatric procedures, including ventilation of very small babies, have been carried out within the hospital. A study of the first five complete years of operation of the obstetric and paediatric departments showed that the perinatal mortality rate was low (hospital rate 4.7/1000 in 9149 deliveries during 1984-8 v district rate 5.1/1000 during 1986-8), and patient satisfaction seemed to be high. In a separate prospective study of out of hours work performed by consultants in paediatrics (four weeks) and obstetrics (20 days) three consultants in paediatrics spent 71 hours working out of hours; for the obstetricians, of the 56 request for advice and 38 interventions, only five and six respectively occurred between midnight and 9 am. Although successful at this hospital, the two tier system would be expensive under the Royal College of Obstetricians' guidelines of one consultant to a maximum of 500 deliveries. An equal mixture of two tier and three tier systems might be the best solution for patient care and training of junior doctors.

Consultants↗

PubMed1990

Obstetric audit using routinely collected computerised data.

OBJECTIVE: To examine the use of routinely collected computerised data in clinical audit. DESIGN: Retrospective review of all analyses of obstetric practice based on a computerised data system from January 1983 to June 1988. SETTING: Maternity department of the regional referral hospital in Oxford. MAIN OUTCOME MEASURES: Congruence with the principles of clinical audit; that is, comparing clinical practice with previously agreed standards and changing practice to meet these standards if necessary. RESULTS: Over the five and a half years of the study the data formed the basis of 130 special inquiries into different aspects of obstetric practice. Most inquiries seemed to be aimed only at describing current activities and identifying trends. Genuine clinical audit was rare. Simple audits--for example, concerning induction for pregnancy after term--could be supported by the computerised data, but for detailed and wide ranging audits--for example, reducing antenatal clinic visits for low risk multiparas--the data had to be supplemented from other sources. CONCLUSIONS: Routinely collected computerised data enable ongoing clinical audit, but it becomes a reality only when clinicians agree on standards of practice and have a flexible attitude towards change. Even then, genuine clinical audits of obstetric practice demand more detailed and comprehensive data than are generally available on such systems.

Data Interpretation, Statistical↗

PubMed1994

Antenatal screening: its use in assessing obstetric risk factors in Zimbabwe.

STUDY OBJECTIVE: To assess the predictive utility of obstetric risk factors for identifying before the onset of labour those women at high risk of obstetric complications in a developing world setting, where home deliveries predominate and emergency transport is scarce. DESIGN: Risk factors derived from two population based, case-control studies (one of cephalopelvic disproportion and one of post partum haemorrhage), carried out in Zimbabwe were used to construct weighted and unweighted scores, a variety of screening algorithms, and sets of probabilities estimated from logistic regression models. These screening tests were evaluated for sensitivity, specificity, positive predictive value, and "cost" (the proportion of the population testing positive). Each complication was evaluated separately and the two were then pooled. PARTICIPANTS: All were Harare residents with singleton, vertex deliveries and spontaneous onset of labour. A total of 201 experienced cephalopelvic disproportion, 150 had post partum haemorrhage, and 299 had normal, unassisted deliveries. MEASUREMENTS AND MAIN RESULTS: Largely because of the very low incidence of the two complications studied (1% or less), positive predictive values were low (less than 7%). Holding "cost" constant at 10%, a screening test for cephalopelvic disproportion could predict 42.3% of cases compared with only 35.0% of those with post partum haemorrhage. Weighted scores had little advantage over unweighted ones, and probabilities from the logistic regression models did not differentiate cases from controls very well. CONCLUSIONS: With simple algorithms based on maternal height, parity, and obstetric history, more than one third of women at risk for potentially fatal complications could be identified at relatively small cost to themselves or the health care system.

Adult↗

PubMed1995

Perinatal death: worse obstetric and neonatal outcome in a subsequent pregnancy.

A retrospective case-control study was undertaken of women with a history of a previous stillbirth or neonatal death, who subsequently delivered in BMH Rinteln. Their obstetric and neonatal outcome was compared to that of a control group of women of similar age and parity and its relationship to specific socio-economic factors assessed. Index patients had a worse obstetric and neonatal outcome. They were statistically significantly more likely to be admitted to hospital during their pregnancy (46% vs 26%), to have medical complications (58% vs 34%), to be delivered prematurely (16% vs 8%), and by Caesarean section (22% vs 9%). Their babies were more likely to have complications (28.8% vs 20.4%), to be of low birth weight (14% vs 7%), require intubation (11% vs 5%) and be admitted to the Special Care Baby Unit (SCBU) (13% vs 7%). Apart from small stature, no differences in socio-economic factors between the two groups could be identified. Index patients were four times more likely than controls to have their pregnancy terminated prematurely as a result of complications (6.7% vs 1.6%), but there was also a high level of obstetric intervention in the absence of clear medical indications. Although perinatal mortality was not statistically increased, the results were suspicious and it is concluded that these women should continue to be considered a high-risk group.

Adult↗

PubMed2000

Monitoring quality of audit in obstetrics and gynaecology.

OBJECTIVE: To develop a questionnaire to assess audit activity and to use it to evaluate systematically the quality of audit in obstetrics and gynaecology within NHS hospitals in the UK. DESIGN: Retrospective review of 212 consecutive questionnaires completed at hospital recognition committee visits for training accreditation, between 1 January 1993 and 31 August 1998, validated against hospital trust annual audit reports. MAIN MEASURES: Use of seven quality criteria developed within the Royal College of Obstetricians and Gynaecologists clinical audit unit and also assessment of support for audit and participation in regional and national audit. Results were compared between 1993/4 (n = 72), 1995/6 (n = 72), and 1997/8 (n = 68) for evidence of improvement. RESULTS: After modifications to the questionnaire the version used from 1993 proved to be a satisfactory tool with minimal need for subsequent change. The results showed that there has been a significant improvement in the quality of obstetric and gynaecology audit with time (p < 0.0001) with 36 (53%) of departments in the previous two year period meeting all seven criteria. Similarly by this stage, 60 (88%) of departments had reached the stage of re-audit and 55 (81%) had conducted patient satisfaction surveys, both of these having significantly improved with time. Critical incident monitoring also became used more widely with time. Validation of topics audited was possible for 45% of hospitals where trust annual audit reports were available and these showed a high level of correlation. CONCLUSIONS: It has proved possible to conduct an audit of audit using the current system of hospital recognition visits for training accreditation. This has shown a great variety in the depth and breadth of audit that is being undertaken within individual obstetric and gynaecology departments. Since 1993 there has been an improvement in the quality of audit programmes undertaken, in particular in the number of hospitals carrying out critical incident monitoring, patient satisfaction surveys, and re-audit. This should be associated with improvements in staff training and in patient care.

Adult↗

PubMed2000

Obstetric US imaging: the past 40 years.

Although diagnostic ultrasonography (US) was developing in the late 1940s and early 1950s, it was not until the 1960s, with the availability of commercial equipment, that its usefulness in obstetrics began to be realized fully by radiologists and obstetricians around the world. Advances from A-mode to bistable and then to gray-scale static imaging were followed by the introduction of automated compound imaging and real-time US. Also, the development and initial use of Doppler US for the detection of fetal heart motion and the eventual use of pulsed and color Doppler US for the evaluation of such fetal structures as the major vessels and heart chambers contributed to increasing the usefulness of US in obstetrics. The development of specialized transducers--in particular, endovaginal probes--resulted in images of the early fetus. At the present time, the development of multiplanar, three-dimensional imaging shows great promise for more complete imaging of the fetus. The importance of US in the examination of the pregnant patient and, in particular, of the fetus has led to its worldwide dominance as the imaging modality of choice. The contributions of obstetric US to improving maternal well-being and fetal health have been recognized as a key component in all countries around the world.

Female↗

PubMed2003

[The Gynecologic and Obstetric Review (Gynaekologisch-geburtshilfliche Rundschau) faces a new challenge!].

The Austrian Society of Gynecology and Obstetrics gave notice of organ membership and at the same time of the compulsory subscription to the Gynecologic and Obstetric Review/ Gynäkologisch-geburtshilfliche Rundschau in favor of a journal oriented more towards professional politics. Thus ends a long-standing international tradition. This also means a new challenge for the Gynecologic and Obstetric Review/Gynäkologisch-geburtshilfliche Rundschau.

Austria↗

PubMed1996

[Champagne administered by spoon for peritonitis after cesarean section. From the history of obstetrics in Erlangen--data from about 60,000 deliveries in 100 years].

The University of Erlangen has been engaged in clinical obstetrics for approximately 170 years. During this time, Erlangen University's delivery house, opened in 1828 and at first having considerably less than 50 births a year, developed into a perinatal centre with approximately 1,700 births a year. For the period from 1880 to 1981, a group of MD students reviewed the existing records and evaluated 60,000 births with respect to more than 40 parameters. Part of the results obtained are shown with special reference to operative obstetrics. Apart from the general influence of the scientific development on decisions and results within obstetrics, individual factors were also recognizable, factors which are linked with the experiences, insights and specialized working areas of the particular head of the hospital.

Cesarean Section↗

PubMed1984

Psychosocial stress and its relation to obstetrical complications.

A Greek adaptation of the Schedule of Recent Experience of Holmes and Rahe was employed to study the relationship of psychosocial stress to symptoms during pregnancy, obstetric complications, family planning and breast feeding. An initial experiment with 130 pregnant women in the third trimester indicated that psychosocial stress was not related to education, whether they were from Athens or the provinces, nor age. The second experiment with 103 mothers 3 or 4 days after delivery indicated that high psychosocial stress is related to increased symptom scores during pregnancy and to obstetric complications. Symptoms were not related to obstetric complications, nor were family planning nor breast feeding. Psychosocial stress was also related to family planning and also to whether or not the mother breast fed.

Adaptation, Psychological↗

PubMed1999

Obstetrical complications and childhood-onset schizophrenia.

OBJECTIVE: Increased obstetrical complications have been reported in individuals with adult-onset schizophrenia, with several studies finding an association between such complications and an earlier age at onset. Consequently, obstetrical records were examined for individuals with childhood-onset schizophrenia to determine if birth complications were more prevalent. METHOD: The birth records of 36 patients with childhood-onset schizophrenia and 35 sibling comparison subjects were rated for birth complications by two psychiatrists who were unaware of group membership. RESULTS: There were no significant differences between the groups in rates of obstetrical complications. Patients with such complications did not have a relatively earlier age at onset of schizophrenia. CONCLUSIONS: A very early age at onset of schizophrenia is probably not due to birth complications.

Age of Onset↗

PubMed1989

Acid aspiration prophylaxis in Australian obstetric hospitals--a survey.

During 1987 a confidential survey of all hospitals in Australia providing obstetric services was undertaken to determine the antacid medications used routinely as prophylaxis against acid aspiration pneumonitis. Of the 567 hospitals surveyed, 379 (67%) responded. Of these, 243 hospitals provide an obstetric service which includes caesarean section, and 67% of these perform less than 500 deliveries per annum. Aspiration prophylaxis during labour was used in 22.4% of responding hospitals. Prior to elective caesarean section, 11.5% used no prophylaxis, and 39.4% used particulate antacids such as magnesium trisilicate mixture (33.3%) or Mylanta (6.1%). Sodium citrate mixture was the most popular therapy (37%). Results were similar in the emergency caesarean section group. The use of cimetidine or ranitidine was uncommon in all groups. Results of this survey suggest marked differences in attitudes towards acid aspiration prophylaxis between Australian and British obstetric anaesthetic practices.

Anesthesia, General↗

PubMedDate not supplied

Reversal of diurnal cortisol rhythm and suppression of plasma testosterone in obstetric residents on call.

OBJECTIVE: The study was undertaken to quantify the psychologic and physiologic responses to the stresses of an obstetrics/gynecology residency program. METHODS: Six male residents were studied on four occasions: one day during the first 2 weeks of their residency, one day immediately following a vacation period, one day after a night on call in obstetrics, and one day while in the gynecology clinic. Stress was evaluated by validated psychologic instruments and by levels of plasma testosterone, luteinizing hormone (LH), cortisol, and prolactin in morning and afternoon blood samples. RESULTS: Self-reported stress was significantly elevated during the first 2 weeks of the residency after a night on call. Anxiety scores were significantly elevated after a night on call as were depression subscores for some residents. Plasma testosterone was highly significantly suppressed after the obstetrics night on call and during the first 2 weeks of the residency in comparison with the vacation period. Luteinizing hormone levels were also significantly lower after the obstetrics on-call experience. Plasma cortisol levels after a night on call were suppressed in the morning and normal or elevated in the afternoon. In comparison, the gynecology rotation was associated with normal levels of testosterone and lower levels of cortisol. CONCLUSION: In this small sample of residents, we observed an inverse relationship between self-reported stress levels and the concentrations of plasma testosterone and LH. The high levels of stress and anxiety expressed after a night on call also disrupted the normal pattern of plasma cortisol levels.

Anxiety↗