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PubMed1990

Obstetric complications, the putative familial-sporadic distinction, and tardive dyskinesia in schizophrenia.

Obstetric complications were more common in the histories of those schizophrenic outpatients without a family history of psychiatric disorder, and were associated with an earlier onset of their illness. Those patients with tardive dyskinesia were more likely to have a family history of psychiatric disorder, less likely to have experienced obstetric complications, and showed greater cognitive deficit. Obstetric complications should be considered in juxtaposition with genetic factors in evaluating the putative familial-sporadic distinction in schizophrenia. Additionally, familial/genetic factors appears to contribute to vulnerability to tardive dyskinesia.

Adult↗
PubMed2000

Identifying core obstetric and gynecologic skills required of, and used by, graduates of the Faculty of Medicine and Health Sciences, United Arab Emirates University.

BACKGROUND: Acquisition of core practical skills by students assures quality and relevance of medical education. PURPOSE: To determine whether students and interns are acquiring core obstetric and gynecologic skills. METHODS: A self-administered questionnaire was sent to obstetric and gynecology clerkship coordinators (n = 3), consultants (n = 14), residents (n = 13); interns (n = 13) and final-year students (n = 29; n = 93, response rate = 77%, N = 72). The questionnaire contained a stimulus list of 21 clinical, 8 communication, and 5 professional skills. RESULTS: Of 34 listed skills, 24 were identified as core skills. At least 50% of consultants, faculty, and residents expected 28 core skills to be covered in the undergraduate program. At least 50% of interns believed that 21 core skills had been acquired at graduation. CONCLUSION: Our curriculum is facilitating acquisition of core obstetric and gynecologic skills.

Adult↗
PubMed2002

Medical students' gender is a predictor of success in the obstetrics and gynecology basic clerkship.

BACKGROUND AND PURPOSE: The objective of this study was to investigate whether a gender difference exists in student performance on any component of the grading scheme in an obstetrics and gynecology clerkship. METHODS: Evaluation of medical students' performance in the obstetrics and gynecology clerkship at our institution includes an Objective Standardized Clinical Examination with an interpersonal skills subsection, a written examination, and faculty evaluations. Performance data from 355 medical students enrolled in the clerkship between 1995 to 1998 were analyzed. RESULTS: Female students performed better than their male colleagues on the written examination (d = .56), the overall Objective Standardized Clinical Examination (d = .46) and its interpersonal skills subsection (d = .49), and the final clerkship score (d = .48). There were no differences between male and female students in faculty evaluation scores. Female students received better final scores for the clerkship. CONCLUSIONS: Female students performed about 1/2 standard deviation better on the majority of the assessment tools used in the obstetrics and gynecology clerkship.

Clinical Clerkship↗
PubMed2004

Failed obstetric tracheal intubation and postoperative respiratory support with the ProSeal laryngeal mask airway.

UNLABELLED: The ProSeal laryngeal mask airway (ProSeal LMA) provides a better seal and probably better airway protection than the classic laryngeal mask airway (classic LMA). We report the use of the ProSeal LMA in a 26-yr-old female with HELLP syndrome for failed obstetric intubation and postoperative respiratory support. Both laryngoscope-guided tracheal intubation and face mask ventilation failed, but a size 4 ProSeal LMA was easily inserted and high tidal volumes obtained. A gastric tube was inserted through the ProSeal LMA drain tube and 300 mL of clear fluid was removed from the stomach. There were no hemodynamic changes during ProSeal LMA insertion. Postoperatively, the patient was transferred to the intensive care unit, where she was ventilated via the ProSeal LMA for 8 h until the platelet count had increased and she was hemodynamically stable. Weaning and ProSeal LMA removal were uneventful. There is anecdotal evidence supporting the use of the LMA devices for failed obstetric intubation (19 cases) and for postoperative respiratory support (8 cases). In principle, the ProSeal LMA may offer some advantages over the classic LMA in both these situations. IMPLICATIONS: We report the successful use of the ProSeal laryngeal mask airway for failed obstetric intubation and postoperative respiratory support in a patient with HELLP syndrome.

Adult↗
PubMed1991

Developing chaplain/physician relationships in obstetrics.

Effective and comprehensive pastoral care within the obstetrical hospital unit depends on a close working relationship with the entire health care team. This article describes the intentionality, time and energy required to develop these relationships and openness to pastoral ministry. A brief history of obstetrics and pastoral care within this hospital is discussed. Building relationships with obstetricians requires involvement in clinical situations with patients/families, response to ethical issues, and contribution to their continuing medical education. Lastly, the article describes some advantages of a woman chaplain in obstetrics.

Chaplaincy Service, Hospital↗
PubMed1997

The new obstetrics: its integration into neonatal clinical practise, teaching and research.

Most neonatologists have not yet incorporated into their teaching, clinical service and research the advances in high risk obstetrics particularly as it relates to fetal surveillance. This brief review emphasizes some of the "new obstetrics" from the viewpoint of perinatal medicine, particularly in terms of neonatal teaching and the design of future neonatal research. The information that can be obtained about an infant prenatally by the use of ultrasound. power doppler, computerized fetal heart rate monitoring, cordocentesis, etc is extensive and yet, has rarely been utilized in the design of neonatal research protocols. It is becoming imperative that the "new obstetrics" be recognized and utilized in modern neonatal thinking if a truly "perinatal medicine" is to be practised.

Cordocentesis↗
PubMed2006

Implementation and case-study results of potentially better practices for collaboration between obstetrics and neonatology to achieve improved perinatal outcomes.

OBJECTIVE: The objective of this study was to make improvements in communication and collaboration between neonatal and obstetric specialties. Five NICUs from the Vermont Oxford Network's Evidence-Based Quality Improvement Collaborative in Neonatal and Perinatal Medicine tested potentially better practices that overlap obstetric and NICU care. METHODS: One area of practice improvement was the management of the pregnancy at the margin of viability. Another included the use of team training and video simulation to improve team performance during high-risk deliveries using aviation-based communication techniques. Another focus of the collaborative was the creation of a multicenter database to measure combined perinatal and neonatal outcomes. RESULTS: The principle outcomes are increased patient satisfaction with teamwork between neonatology and obstetric services and improved team response times for emergent deliveries and the increased use of team communication skills during video simulations of high-risk deliveries. CONCLUSIONS: Implementing these potentially better practices can result in improved communication and collaboration related to perinatal and neonatal care.

Communication↗
PubMed2006

[Delivery center and obstetric assistance focused on the parturient's needs].

As an obstetric nurse working in a Delivery Center and considering the studies and reflections on the new model of assistance to labor and birth (humanized assistance), I started to think about this concept, given the various connotations attributed to the term. This article was written with the aim of divulging our proposal of replacement of the expression "humanized assistance to child-birth" for "obstetric assistance focused on the parturient's needs", and to describe the assistance given at the Delivery Center of the General Hospital of Itapecerica da Serra, in the São Paulo Metropolitan Region, where a protocol of obstetric behavior and rules recommended by the Ministry of Health is followed.

Female↗
PubMed1995

Obstetrical judgments of viability and perinatal survival of extremely low birthweight infants.

OBJECTIVES: The purpose of the study was to determine whether the obstetrical judgment of viability makes a difference to fetal and neonatal survival of extremely low birthweight infants (500-749 g). METHODS: We assessed the effect of the antenatal judgment of viability in a group of 66 infants born weighing from 500 to 749 g. These infants were alive at maternal hospital admission and were subsequently live-born or stillborn between January 1, 1984, and December 31, 1985. We related the antepartum assessment of viability and other factors recorded in the medical record to fetal survival and to postneonatal survival to hospital discharge. RESULTS: The obstetrical judgement of viability was strongly associated with outcome. After birthweight and gestational age were controlled, fetuses considered viable were 18 times more likely to survive (95% confidence interval = 2, 175) than those considered nonviable. CONCLUSIONS: The effects of obstetrical practices on perinatal mortality must be taken into consideration in estimating the survival potential of very small fetuses and in evaluating the relationship between survival and disability.

Apgar Score↗
PubMed1988

Comparison of the antimicrobial prophylactic efficacy of cefotaxime and cephazolin in obstetric and gynaecological surgery. A randomised multicentre study.

A prospective randomised multicentre study was designed to assess the efficacy of 2 different cephalosporins as short term prophylactic treatment in obstetric and gynaecological surgery. A single dose of cefotaxime (2g IV before surgery) was compared with 2 doses of cephazolin (2g IV before surgery and after 8 hours). Patients exposed to antibacterial drugs within 7 days, who had preoperative infections, or with known beta-lactam hypersensitivity were excluded. 612 patients entered the study, of whom 552 were evaluable. 276 were given cephazolin (group A) and 276 cefotaxime (group B). Groups A and B were similar for mean age, obesity, diabetes, types of diseases and obstetric history. No significant differences were observed in type of surgery (vaginal hysterectomy, abdominal hysterectomy, myomectomy and caesarean section) between 2 groups. The mean duration of surgery was 89 and 85 minutes in group A and B, respectively. 25 patients (9.1%) in group A and 20 (7.2%) in group B developed wound infections (not statistically significantly different). The percentages of patients with infections other than surgical infections were similar (i.e. 13.0 and 11.2 for the cefotaxime and the cephazolin groups, respectively). These preliminary data show that a single 2g IV dose of cefotaxime and two 2g IV doses of cephazolin have equal antimicrobial prophylactic activity in obstetric and gynaecological surgery.

Adult↗
PubMed1996

Progress and evaluation of a consultation-liaison psychiatry service to an obstetric-gynaecology hospital.

OBJECTIVE: Recently we described the establishment and first 6 months of a psychiatric consultation-liaison service to a Melbourne obstetric-gynaecology teaching hospital. The follow-up report evaluates the service in two ways: first, it compares referral data for the 12 months of 1992 with that of the first 6 months of operation in 1990; and second, it reports on results of a survey of referrer and patient satisfaction with the service. METHOD: Referral data were collected for the data comparison from the consultation-liaison referral book and patients' files. Referrer and patient satisfaction was evaluated by questionnaires sent to 45 medical staff, 7 charge nurses, and 100 consecutive patients. RESULT: A fairly constant referral rate for inpatients has emerged at 0.8%, this very low referral rate being some cause for concern. An internal shift in the type of referrals over time has developed, with an increase in obstetric and a decrease in gynaecology referrals. High referrer satisfaction, with 86% of the doctors finding the consultation(s) "very" or "quite" helpful, and high patient satisfaction, with 83% of respondents having found the consultation(s) "very" or "quite" helpful, was found. CONCLUSIONS: Despite high referrer and consumer satisfaction, and objective evidence of need, this pioneering consultation-liaison service in obstetric-gynaecology continues to be grossly under-utilised. Increasing the referral rate will be one of the greatest challenges in the future of this service.

Adaptation, Psychological↗
PubMed2002

Munchausen syndrome in obstetrics and gynecology.

Munchausen syndrome (MS) is a well-defined clinical psychiatric entity. Furthermore, it is a complicated and intriguing problem in medicine in general and in obstetrics and gynecology in particular. The proportion of MS cases in obstetrics and gynecology is rising. This review covers relevant reports from the last four decades. Emphasis is put on the clinical expression of MS cases in obstetrics and gynecology. A discussion about their validity as such is included. Awareness of attending physicians to this type of illness in the era of patient rights, on the one hand, and the existence of defensive medicine on the other, is crucial.

Abdominal Pain↗
PubMed1995

Private health insurance and a healthy personality: new risk factors for obstetric intervention?

In this study 242 nulliparous pregnant women completed standardized psychometric questionnaires and semi-structured interviews in the latter half of pregnancy and again 4-6 weeks postpartum. Discriminant function analysis revealed that the use of operative obstetric interventions was measurably influenced by psychosocial factors. Privately insured women were significantly more likely to experience instrumentally assisted (relative risk = 1.53, 95% CI: 1.05, 2.25) and Caesarean (relative risk = 1.91, 95% CI: 1.05, 3.46) deliveries than those receiving care in the public hospital system. The likelihood of experiencing these procedures was increased further among those who in late pregnancy were thinking clearly, had high self-esteem, mature means of dealing with anxiety, were confident in their knowledge of childbirth procedures and in secure partnerships with highly educated men. There was no evidence that either elevated anxiety or abnormalities of personality contributed to obstetric outcome. These findings indicate that obstetric decision-making is significantly influenced by patient personality and socioeconomic circumstances. In particular, they suggest that fear of malpractice litigation, physician convenience factors and the response of obstetricians to assured, well pregnancy-educated pregnant women may be influencing the use of operative intervention in delivery.

Adult↗
PubMed2000

Obstetric complications and asthma in childhood.

Studies have shown that perinatal factors are associated with childhood asthma. The current analyses examined the association between obstetric complications and risk of asthma at the age of 7 years using a prospectively population-based birth cohort in northern Finland. Results indicated that obstetric complications were associated with a higher risk of asthma among children. Those children who were administered special procedures at birth, i.e., cesarean section, vacuum extraction, and other procedures, including use of forceps, manual auxiliary, and extraction breech, had an adjusted odds ratio (OR) for asthma of 1.38 (95% confidence interval [CI] 1.00-1.92), 1.32 (95% CI 0.80-2.19), and 2.14 (95% CI 1.06-4.33), respectively, as compared to children who were delivered normally. Children who had a lower Apgar score at the first and the fifth minute after birth also had a higher risk as compared to those who had an Apgar score of 9-10. The results encourage further evaluation of the association between obstetric complications and risk of asthma among children in other populations, and further exploration of possible mechanisms underlying the association.

Adult↗
PubMedDate not supplied

Obstetric medicine training: picking up where the licentiate in midwifery left off.

Obstetric medicine is the care of women with medical problems in pregnancy. Medical problems may predate or arise de novo in pregnancy. Some are common and some are dangerous. Both obstetricians and physicians recognise the need for greater numbers of appropriately trained clinicians to care for such women. There is a demand for such training, particularly from trainee obstetricians. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Physicians (RCP) agree that there is a need for more formalised training in maternal/obstetric medicine and they are working together to develop special interest training in maternal medicine. The training will be open to both obstetricians and physicians and include theoretical and practical components. The practical training will take place in centres with established medical obstetric clinics and will be tailored (with appropriate modules) to the amount of previous experience in medicine or obstetrics.

Education, Medical, Graduate↗
PubMed2005

Three- and 4-dimensional ultrasound in obstetrics and gynecology: proceedings of the American Institute of Ultrasound in Medicine Consensus Conference.

The American Institute of Ultrasound in Medicine convened a panel of physicians and scientists with interest and expertise in 3-dimensional (3D) ultrasound in obstetrics and gynecology to discuss the current diagnostic benefits and technical limitations in obstetrics and gynecology and consider the utility and role of this type of imaging in clinical practice now and in the future. This conference was held in Orlando, Florida, June 16 and 17, 2005. Discussions considered state-of-the-art applications of 3D ultrasound, specific clinical situations in which it has been found to be helpful, the role of 3D volume acquisition for improving diagnostic efficiency and patient throughput, and recommendations for future investigations related to the utility of volume sonography in obstetrics and gynecology.

Female↗
PubMed2005

Three- and 4-dimensional ultrasound in obstetric practice: does it help?

OBJECTIVE: The purpose of this article was to review the published literature on 3-dimensional ultrasound (3DUS) and 4-dimensional ultrasound (4DUS) in obstetrics and determine whether 3DUS adds diagnostic information to what is currently provided by 2-dimensional ultrasound (2DUS) and, if so, in what areas. METHODS: A PubMed search was conducted for articles reporting on the use of 3DUS or 4DUS in obstetrics. Seven-hundred six articles were identified, and among those, 525 were actually related to the subject of this review. Articles describing technical developments, clinical studies, reviews, editorials, and studies on fetal behavior or maternal-fetal bonding were reviewed. RESULTS: Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, especially facial clefts. There is also evidence that 3DUS provides additional diagnostic information in neural tube defects and skeletal malformations. Large studies comparing 2DUS and 3DUS for the diagnosis of congenital anomalies have not provided conclusive results. Preliminary evidence suggests that sonographic tomography may decrease the examination time of the obstetric ultrasound examination, with minimal impact on the visualization rates of anatomic structures. CONCLUSIONS: Three-dimensional ultrasound provides additional diagnostic information for the diagnosis of facial anomalies, evaluation of neural tube defects, and skeletal malformations. Additional research is needed to determine the clinical role of 3DUS and 4DUS for the diagnosis of congenital heart disease and central nervous system anomalies. Future studies should determine whether the information contained in the volume data set, by itself, is sufficient to evaluate fetal biometric measurements and diagnose congenital anomalies.

Clinical Trials as Topic↗
PubMed1999

[Algorithms for oxygenation and difficult intubations in obstetrics].

The obstetrical population is prone to difficult or failed intubation. Control of the airway is complicated by several factors specific to obstetric anesthesia; time of apnea is short due to a reduced functional residual capacity, pregnancy-induced hypertension and obesity are relatively frequent; anesthetist's skill can also be mentioned. The best approach to this problem lies in its prevention, using epidural analgesia as soon as possible. Furthermore, the number of difficult intubations can be considerably reduced by a thorough pre-anesthetic examine. Each anesthetist must keep an algorithm in mind, should a difficult or failed intubation in obstetrical patient. Whichever method is used (ventilation through a facial mask or laryngeal mask, transtracheal oxygenation), the anesthetist must never forget that the first priority is always the safety of the mother.

Algorithms↗