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PubMed1990

Obstetrics and gynecology in the USSR.

Knowledge of Soviet obstetrics and gynecology has been mostly inaccessible to Western physicians. We share our experience regarding medical education and practice in the USSR. Medical education lasts 6 years and is followed by 2 years of postdoctorate training. Residency is limited to clinical obstetrics and gynecology. No formal subspecialty training exists. Research projects are funded and guided by the Health Ministry and Academy of Medical Science. Most articles are published in Russian and are therefore unknown to physicians in the West. Modern medical technology is not available in the practice of obstetrics and gynecology. Abortion remains the leading method of contraception. Perinatal and infant mortality in the USSR is higher than that in comparable Western countries.

Education, Medical↗
PubMed1990

Obstetric care in rural Missouri: the loss of rural general and family practitioners.

Family and general practitioners have historically provided a substantial portion of obstetric care in rural parts of the United States, including Missouri. The authors surveyed 328 rural general physicians to determine their participation in obstetrics. Their findings show a dramatic loss of physician obstetric services in rural Missouri and suggest that the dilemma is not likely to be easily remedied.

Adult↗
PubMed1990

[A computerized follow up system of obstetric and genetic care].

The authors have implemented and introduced a new filing system representing the complexity of obstetric, genetic and neonatal care for the three counties of the Eastern part of Hungary. Data about the pre-, peri- and postnatal management are supplied by the genetic/teratologic, obstetric, neonatal and pathological units and processed at the Department of Obstetrics and Gynaecology, University Medical School of Debrecen with an IBM compatible AT computer. This computerised registry is based on the personal identification number, so it is easy to handle for storing data about the course and outcome of a large number of pregnancies as well as the detection and follow-up of fetal malformations and genetic diseases. The computer register is suitable for easy and systematic storage of the more than 20 thousand pregnancies screened by both maternal serum AFP and ultrasound including nearly 500 prenatal diagnosis cases per year. When devising the system, the classic parameters of the "revised Tauffer statistics" have been taken into consideration, but the emphasis has been put mostly on the assessment of fetal/infantile health status and the prevention of malformations and genetic diseases. This computerised system greatly facilitates the correct assessment of statistical parameters in related medical fields and provides better possibilities for studying the cause and effect relationship between the efficacy of medical care and perinatal events.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Rate↗
PubMed1989

Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery.

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.

Adolescent↗
PubMed1989

[Adaptive behavior of mature newborn infants following obstetric pain control with peridural fentanyl].

Obstetric pain relief using fentanyl epidurally is a safe and efficient method. In this study the effects of this obstetric analgesia on the adaptation pattern of 26 eutrophic newborns in the first hour of live have been estimated with cardiorespirograph in comparison with a normal groups. We did also determinations of acid-base-balance in arterial blood of umbilical artery and in hyperemic capillary blood of newborns. There were significant differences in basal frequency and the duration till the beginning of resting phase in the cardiorespirogramm. The differences to normal newborns may be correlated to the slight increase of partial pressure of carbon dioxide in the newborns following obstetrical analgesia. During the first hour of life newborns can good compensate. There is no sedation of newborns by fentanyl.

Acid-Base Equilibrium↗
PubMedDate not supplied

Family practice obstetrics: style of practice.

Prevalent birth practices reflecting a family-centered, minimally invasive style of obstetrical practice were surveyed among 235 family physicians practicing obstetrics in Michigan. Respondents older than 35 years and those without an academic affiliation reported fewer "family-centered" and more "intrusive" practices than did younger or academically affiliated respondents. Compared to published data on California obstetricians, Michigan family physicians were more likely to report practices that appear family centered and, particularly for more recent graduates, ones less likely to routinely involve obstetrical interventions.

Adult↗
PubMedDate not supplied

[Autologous and heterologous blood transfusion in obstetrics].

We retrospectively analyzed the frequency and details of blood transfusions in a group of 12,578 obstetrical patients. We found 250 patients who received red blood cell transfusions resulting in a transfusion rate of 2 in 100. In most of these cases, there were no risk factors placing patients at high risk for blood transfusions. The administration of one or two units of blood was adequate in 76% and of up to three units adequate in 87% of cases. Our results do not support a commercial blood bank's recent claim of frequent transfusions in obstetrical patients. We feel that the routine storage of blood for autologous transfusions is not warranted in obstetrical patients.

Blood Transfusion↗
PubMed1988

[Effects of obesity and weight gain during pregnancy on obstetrical factors].

The relationship between the body weight or weight gain during pregnancy and various obstetrical factors was investigated in 731 patients who delivered in San-ikukai Hospital for in the year 1986. The patients were classified into three groups according to their body weight in non-pregnant states: slender (n = 214), ordinary (n = 379) and obese (n = 138), according to the standard for "The decision diagram for the estimation of obesity and emaciation in Japanese" published in 1986 by the Ministry of Health and Welfare, Japan. Each of these groups was further divided into two groups according to the degree of weight gain during pregnancy (more or less than 15kg). Then, the duration of labor, the blood loss during delivery, the birth weight, the placental weight and the obstetrical abnormalities (prolonged labor, arrested labor, blood loss of more than 500 ml, fetal distress and toxemia of pregnancy) were investigated in these groups. The blood loss, the neonatal birth weight and the placental weight in the obese groups were much greater than those in the ordinary or the slender group (p less than 0.005). However, there was no significant difference in the duration of the labor among these groups. The incidence of obstetrical abnormalities in the obese group was significantly higher than in the ordinary or the slender group (chi 2 = 4.37, p less than 0.05, chi 2 = 5.27, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗
PubMed1987

The future of obstetrics and gynecology. Council on Long Range Planning and Development with the cooperation of the American College of Obstetricians and Gynecologists.

The American Medical Association Council on Long Range Planning and Development has identified trends in the environment of medicine that are likely to affect the future of obstetrics and gynecology practice. The professional liability crisis is among the most potent factors affecting the types and numbers of services that obstetricians and gynecologists will provide in the future. The setting for obstetrics and gynecology practice is likely to be affected by advances in technology and trends in delivery and reimbursement systems. Two factors with potential to affect the organization of practice are the high numbers of women entering the specialty and increasing practice expenses, largely associated with liability costs. Other factors affecting future patterns of delivery include the anticipated aging of the female population and the changing social and economic roles of women. In particular, the feminist movement has focused more attention on women's health care and is expected to have a continuing impact on the delivery of obstetric and gynecologic care. The Council concludes that the most salient issues for the specialty in the future will be the following: (1) the direction of the professional liability crisis, (2) medical practice competition, (3) the feminization of poverty, (4) ethical issues arising from technological and social imperatives, (5) the changing gender profile of the specialty, and (6) the impact of the feminist movement on women's health care.

Ethics, Medical↗
PubMed1988

[Computer-assisted obstetric data collection and processing--trial with a system solution].

A system is introduced for the registration and utilization of obstetrical dates. It is based on a new birth journal and a file for date collection in agreement to that. With the aid of a bureau computer a short delivery report will be given for the out-patient department of post-clinical medical attendance, as well as a label with the most important obstetrical dates for the postnatal care will be printed. An extensive birth report can be requested. The voluminous obstetrical statistics will be concentrated in form of charts.

Female↗
PubMed1988

[Value of the preventive use of antibiotics following vaginal obstetric operations].

For a period of 6 years 838 puerperal cases after vaginal obstetric operations (forceps delivery, vacuum extraction, delivery with speculum, manual placenta separation, palpation of the uterus) were critically analysed. The result of the studies suggest that an antibiotic or chemoprophylaxis after vaginal obstetric operations is not successful because of the relatively low infectious morbidity. In obstetrics this prophylaxis is indicated only in delivery by caesarean section as a perioperative short-time prophylaxis.

Chloramphenicol↗
PubMedDate not supplied

Longitudinal teaching of obstetrics in family practice residency programs.

Family practice residency programs teach obstetrics using both hospital service block rotations and longitudinal management of family practice center pregnant patients. A national survey was conducted to identify characteristics and outcomes of residencies using family physicians and/or obstetricians as preceptors for the longitudinal teaching of obstetrics. Obstetricians were used as preceptors in both outpatient and delivery room settings in 18% of residencies. Family physicians were used in the outpatient setting and obstetricians in the delivery room in 27% of programs. The 37% of programs using family physician faculty as preceptors in both outpatient and delivery room settings differed from other programs in four significant ways: they were most likely to be medical school or military residency programs; they were most likely to be located in the north central and mountain states; they reported greater general satisfaction with their preceptors; and more of their graduates practiced obstetrics after residency.

Ambulatory Care Facilities↗
PubMed1987

[Opinion of mothers on continuous peridural obstetrical anesthesia].

The general opinion on epidural anesthesia in obstetrics may be adversely affected by recent public controversies about the mother's situation during childbirth in hospital, which nowadays is often considered to be a highly technological, impersonal, or "unnatural" procedure. This assumption led us to conduct an inquiry on maternal assessment of obstetric epidural anesthesia and its relation to the clinical and social history. The study included 113 parturients, who received epidural anesthesia (on-demand epidural injections of bupivacaine 0.25%) for vaginal delivery. Mothers were asked to answer certain questions about this regimen (e.g. analgetic efficacy; difficulties in deciding on this method; recommendations to other parturients; opinion of the role of epidural anesthesia in obstetrics; choice of analgesic regimen for future childbirth) 1 day after delivery and 2 months later. Additional social and historical factors (e.g. education; profession; family status; preceding pregnancy, childbirth or abortion; complications during pregnancy or childbirth; duration of parturition) were used to reveal relevant statistical correlations. Sixty-five percent of the patients considered pain relief by epidural anesthesia as "good" or even "very good" during the first inquiry immediately after childbirth. Women who had undergone prior interruptions of pregnancy were less satisfied, probably because of their rather ambiguous attitude towards motherhood. With regard to the choice of analgesic regimen for future childbirth (50% of the patients had made a definite decision to have epidural anesthesia under this condition), those women were especially reserved who had suffered from complications during pregnancy and disapproved of it in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMedDate not supplied

Uses of the 1980 National Natality and Fetal Mortality Surveys for the assessment of obstetric technologies.

Because of the multipurpose utility of followback surveys, six Public Health Service (PHS) agencies including the Bureau of Health Care and Delivery Assistance (BHCDA) financially assisted the National Center for Health Statistics (NCHS), which conducted the 1980 National Natality Survey (NNS) and 1980 National Fetal Mortality Survey (NFMS). These are called "followback" surveys because NCHS uses mail questionnaires and telephone to follow back informants (mothers, hospitals, and attendants at delivery) and medical sources of radiation named by informants, identified on Certificates of Live Birth and Reports of Fetal Death from all 52 state and independent registration areas of the United States. Ten basic data applications have emerged from the 1980 NNS/NFMS, and this paper addresses these 10 purposes simultaneously, in relation to NNS/NFMS uses in assessing obstetric technologies. The five obstetric technologies that are the focus of this paper are: cesarean delivery, electronic fetal monitoring, ultrasound, X-ray, and amniocentesis--and are often examined in relation to maternal complications and conditions. Data on these technologies are highlighted with reference to each of the following 10 data applications of followback surveys: produce national estimates of unique information; establish trends; facilitate analytic and epidemiologic research; use followback surveys as anchor data bases; undertake parallel studies; link followback surveys together to calculate new vital rates; conduct comparative studies vis-à-vis other data sets; assess volume of medical care; evaluate quality of information on vital records; and generate synthetic estimates and need assessments. Finally, this paper discusses NCHS plans to measure obstetric technologies in the 1988 National Maternal and Infant Health Survey, which will include natality, fetal mortality, and infant mortality components.

Female↗
PubMed1986

[Dynamics of calving, dystocia and the organization and effectiveness of obstetrical care for cows on commercial farm complexes].

A study was carried out on the organization of the obstetrical aid with cows on the large cow complexes in order to raise its effectiveness. Determined was the dynamic of calvings, dystocia, retentio secundinarum, and puerperal endometritis as affected by the time of calving and the character of obstetrical aid as practised on the farms. It was found that most of the calvings (62.6 per cent) take place at night, and 37.4 per cent--in daytime, while within the working day as fixed by the Labour Code--24.8 per cent only. Directly proportional to these were the cases of laboured delivery--60.4 per cent at night and 39.6 per cent in daytime. It was also established that at night obstetrical aid is chiefly rendered by the attendants on duty and the watchmen, which meant that it was unqualified, with bad results: higher rate of postnatal deaths, higher morbidity rates resulting from puerperal endometritis, prolonged period from calving to the first physiologic estrus and prolonged service period, lower conception rates, and higher economic losses. The authors suggest that the organization of labour of vets should take into consideration the productional and biologic processes on the industrial cow complexes, with night duty or two-shift work. These problems should be settled financially and by means of additional personnel as provided by the Labour Code and the new economic approach and its mechanisms.

Animal Husbandry↗
PubMed1985

Clinical application of a high-risk scoring system on a family practice obstetric service.

A previously described antepartum risk-scoring system was evaluated in 113 consecutive deliveries done by family physicians to determine whether a request for obstetric or pediatric assistance could be predicted. In the defined low-risk group (score less than or equal to 3) assistance was requested in 12 of 72 patients. In the defined high-risk group (score greater than 3) assistance was requested in 23 of 41 patients. Out of 28 requests for obstetric assistance, 22 requests were for a specific skill (cesarean sections, difficult forceps, premature deliveries, shoulder dystocia, and retained placenta). All of the 27 requests for pediatric assistance were for acute resuscitation of the newborn. Reinforced in this study was the finding that a relatively small segment of patients (36 percent of the population) gave rise to most (67 percent) of the morbidity. Knowledge of this simple, reliable method to predict high-risk obstetric patients should help family physicians reduce maternal and infant morbidity.

Family Practice↗
PubMed1979

[Distribution of obstetrical and postnatal risk-factors in 400 randomly selected newborns. A study using Prechtl's concept of optimal conditions (author's transl)].

The distribution of obstetrical and postnatal risk-factors in a population of 400 newborns was investigated. For documentation, an extended list of Prechtl's list of optimal obstetric conditions was used. The newborns had been selected randomly from two populations, born 1972 in two different hospitals (County hospital, University hospital). The reduction of optimal conditions was calculated by percentiles. It was found that the number -3 (of 52 items, representing full optimal conditions) defined the 10th percentile of the population; number -5 the median, and number -10 the 90th percentile. In addition, percentiles were calculated regarding the history of the mother and the history of the infant respectively. Using the distribution of reduced obstetrical and postnatal optimal conditions allows to compare the history of a single newborn or the histories of a population of newborns with defined problems. Newborns with rather low negative numbers of reduced optimal conditions are at lower risk regarding their psychomotor development wheras newborns with high negative numbers carry a much higher irsk in this respect.

Birth Injuries↗
PubMed1983

[Current value, technic and indications for obstetrical operations].

Starting point of this survey is the 1954 paper about obstetrical operations from H. Kraatz. It is demonstrated, that there were and there are defined principles, which continue to exist unchanged. They are the fundamentals of indication and technique of operations in obstetrics. Nevertheless there are distinct changes, too, caused by two factors, progress in medicine (development of antibiotics, anaesthesiology and neonatology) as well as change of aspect in obstetrics (e.g. toxemias of pregnancy, preterm labour). The methods are discussed in detail. Operations by vaginal route come in the foreground in the last years more again. They should be preferred in maternal interest. The enlarged indication for caesarean section was not able to succeed on a large scale. An uniform procedure is proposed both in cephalic and breech presentation, and the new formulated preconditions to these operations are discussed. All three techniques two abdominal ones and one vaginal one) are demanded in caesarean sections, because they come into question in special situations. There is a change in operative indications in cases of bleeding, because of an early diagnosis by ultrasound. The qualification and experience of the obstetrician is more decisive than the selected method of operation or the instrument's type. Therefore there should not be any cut in instruction and training. The versatility of operative technique is a prerequisite to a qualified indication.

Breech Presentation↗