Search PubMed⌕ Search

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.

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

At least 1,315 records · Page 73Linked to original sources
PubMed1992

Early and late intraventricular hemorrhage: the role of obstetric factors.

OBJECTIVE: To evaluate the influence of active phase labor and other obstetric factors on the development of periventricular-intraventricular hemorrhage in the neonate. METHODS: A total of 230 infants were studied. Antenatal enrollment was carried out when estimated fetal weight was 1750 g or less. Serial head ultrasound scans were performed to screen for periventricular-intraventricular hemorrhage, with the initial scan performed within minutes of birth. Scan findings and obstetric and neonatal variables collected prospectively at scheduled intervals were analyzed to determine the significant factors that predispose to intraventricular hemorrhage. RESULTS: In 47 infants (20%), intraventricular hemorrhage was detected within 1 hour of birth (early) and in another 49 (21%) at a later age (late). The overall incidence of hemorrhage was similar between vaginal and cesarean deliveries (41 and 44%, respectively). Early hemorrhage was more frequent in vaginal (28%) than cesarean deliveries (11%), whereas late hemorrhage was more frequent in cesarean deliveries. When the role of delivery mode and labor was analyzed by stepwise logistic regression, the odds ratios for development of early intraventricular hemorrhage increased in the following order: cesarean delivery with no labor, cesarean delivery with latent phase labor, vaginal delivery with forceps use, cesarean delivery with active phase labor, and vaginal delivery without forceps use. For late hemorrhage, the odds ratios increased in the following order: vaginal delivery with forceps, vaginal delivery without forceps, cesarean delivery with no labor, cesarean delivery with latent phase labor, and cesarean delivery with active phase labor. CONCLUSIONS: Active phase labor may predispose to early periventricular-intraventricular hemorrhage, but its influence may be attenuated by use of forceps or by abdominal delivery. The protective effect of forceps remains for late periventricular-intraventricular hemorrhage, but abdominal delivery does not seem to protect against late hemorrhage.

Cerebral Hemorrhage↗
PubMed2004

Nighttime call in house vs. out of house: a comparison of obstetric procedure rates.

OBJECTIVE: To evaluate the effect of in-house vs. out-of-house nighttime call coverage on obstetric practice. STUDY DESIGN: A retrospective analysis was performed on nighttime deliveries. Included were deliveries by 2 faculty groups that equally shared in-house and out-of-house call coverage. Included patients had an equal chance of delivering with a physician on call covering in house or out of house. Patient demographics and obstetric outcomes were compared between in-house and out-of-house call status for the delivering physician by ANOVA and chi2. RESULTS: Of eligible nighttime deliveries, 230 were identified, 120 with in-house and 110 with out-of-house call coverage. Demographic features were not statistically different between the groups. A comparison of in-house and out-of-house deliveries yielded rates for episiotomy (28.3% vs. 30.0%), cesarean delivery (26.7% vs. 21.8%), operative vaginal delivery (11.7% vs. 18.2%), total operative delivery (38.4% vs. 40.0%) and nonoperative vaginal delivery (61.7% vs. 60.0%) that did not significantly differ by physician call status. CONCLUSION: The nighttime call status of physicians, whether in house or out of house, did not affect cesarean delivery, operative vaginal delivery, overall (total) operative delivery or episiotomy rates.

Adult↗
PubMed2005

[Enigmas surrounding an obstetric forceps belonging to Albertus Titsingh (1714-1790)].

In the collections of the Society of the Dutch Journal of Medicine there is a small box containing a small obstetric forceps modelled on that of the British physician Smellie and some documents with information about its origin. The instrument belonged to the Amsterdam surgeon-obstetrician Albertus Titsingh and is claimed in the documentation to have been used during the birth of the later King William I (1772-1843) in 1772. However, historical research indicates that this is very unlikely: it is an established fact that the birth of William I was rapid and successful, while Albertus Titsingh was an authoritative obstetrician in an 'obstetric climate' of biding one's time and taking no action until the natural powers have failed.

Female↗
PubMed1991

A randomized comparison of assisted vaginal delivery by obstetric forceps and polyethylene vacuum cup.

The assisted vaginal delivery methods of rigid obstetric forceps and polyethylene vacuum cup extraction were compared in a prospective, randomized study. The 99 women studied had all completed 35 full weeks' gestation, required attempted assisted vaginal delivery, and were randomly assigned to either attempted forceps or vacuum-assisted delivery. All presentations were cephalic, with stations ranging from +1 to +4. Neonates were evaluated at 24 hours by neonatal staff. The infants underwent intracranial ultrasound screening during the first 24 hours of life and ophthalmologic examination within 48 hours. Vaginal delivery was successful with the intended method in 83% of vacuum-assisted deliveries and in 78% of forceps deliveries (not statistically significant). Neonatal retinal hemorrhage was found in 17 and 38% (P less than .043) of the randomized forceps and vacuum deliveries, respectively. No intraventricular hemorrhage was found. Apart from associations between vacuum-assisted delivery and mild hyperbilirubinemia and neonatal retinal hemorrhage (of uncertain clinical significance), and between assisted forceps delivery and an increased potential for facial injury, neonatal outcomes did not differ significantly. Maternal outcomes also did not differ significantly. No significant differences in safety or efficacy were found between polyethylene cup vacuum extraction and rigid obstetric forceps-assisted vaginal delivery in this population of predominantly low-pelvic assisted deliveries. Patients delivered by sequential use of forceps after vacuum or by vacuum after failed forceps application did not suffer significantly increased morbidity relative to those delivered by forceps or vacuum alone. Use of alternate or sequential methods allowed an overall cesarean rate of 3% in this population.

Acid-Base Equilibrium↗
PubMed1991

Rural obstetrics: a 5-year prospective study of the outcomes of all pregnancies in a remote northern community.

OBJECTIVE: To determine whether a small, isolated hospital that has no facilities to perform cesarean section and handles fewer than 50 deliveries annually can provide acceptably safe obstetric and perinatal care. DESIGN: Cohort study. SETTING: Southern region of the Queen Charlotte Islands, BC, served by a 21-bed hospital and medical clinic in Queen Charlotte City. The hospital and clinic are staffed by five family practitioners without local obstetric, pediatric, anesthetic or surgical support. PATIENTS: All women beyond 20 weeks' gestation who gave birth from Jan. 1, 1984, to Dec. 31, 1988; 33% were primiparous and 20% native. Of the 286 women 192 (67%) delivered locally, 33 (12%) were transferred after admission because of antepartum or intrapartum complications, and 61 (21%) delivered elsewhere by choice or on their physician's recommendation. OUTCOME MEASURES: Perinatal mortality rate and adverse perinatal outcome (death, birth weight of less than 2500 g, neonatal transfer or Apgar score of less than 7 at 5 minutes). MAIN RESULTS: There were six perinatal deaths, for a perinatal mortality rate of 20.8 (95% confidence interval [CI] 4.4 to 37.2). The hospital-based rate of adverse perinatal outcome was 6.2% (12 of 193 newborns) (95% CI 2.8% to 9.6%). CONCLUSIONS: The perinatal mortality rate is not a meaningful way to assess small populations; about 85 years of data would be required to decrease the 95% CIs from within 16 to within 4. The rate of adverse perinatal outcome in our study was consistent with the rate in other studies. Collaboration of small, rural hospitals is required to increase cohort size so that the correlation between the currently accepted standard, the perinatal mortality rate, and other outcome measures can be determined.

Apgar Score↗
PubMed1979

[Surgical obstetrics in past and presence (author's transl)].

The history of surgical obstetrics is highlighted by discussing the historical development of forceps delivery, vacuum extraction, forceps vectis (application of a single blade only), embryotomy, and caesarean section operations. Finally present status of operative obstetrics is outlined from a modern point of view.

Cesarean Section↗
PubMed1984

Obstetric management of preterm labour.

In recent years the trends in the obstetric management of preterm labour have moved in the direction of more active policies with greater use of fetal heart monitoring and Caesarean section to avoid traumatic and asphyxial damage to the baby. Conservative management still has an important place, especially in association with extreme prematurity. Following initial enthusiasm, the use of tocolytic drugs and antenatal corticosteroids are going through a phase of re-evaluation and careful assessment is essential in individual cases to avoid their inappropriate use. Future developments in the obstetric management of preterm labour will depend upon careful evaluation studies which examine not only the short-term mortality statistics but also the long-term effects in respect of neurological and developmental handicap. This task is one of the major challenges for obstetricians to tackle over the next two decades.

Adrenal Cortex Hormones↗
PubMed1981

Medical audit. General practitioner obstetrics in a small rural hospital.

A study is made of the outcome of 298 pregnancies supervised by the general practitioners in the Hokianga special area medical service over the six years from January 1974 to December 1979. Of the 87.9 percent delivered at the obstetric unit a Hokianga Hospital 90 percent were normal deliveries, which is a higher than usual proportion. The transfer rates for women in labour and for neonates were acceptably low. The perinatal mortality rte for this period was 10 per 1000 live births which compares well with the 1976 rate for Northland of 17.3 per 1000. It is concluded that, in addition to having a high patient acceptance, general practice obstetrics can provide a very high standard of care. Some of the reasons for this are discussed.

Delivery, Obstetric↗
PubMed1980

Obstetrical care in a prepaid cooperative: a comparison between family practice residents, family physicians, and obstetricians.

The purpose of this study was to compare the obstetrical care provided by three different groups of physicians. Deliveries between July 1975 and July 1977 were tabulated and all 211 deliveries of the family physician (FP) group, and all 199 of the family practice residency (FPR) group were reviewed, as were a randomly selected group of 193 obstetrician (OB) deliveries. All hospital charts were reviewed for 81 variables. The FPR group had more patients who were poor, single, and nulliparous. They presented later in pregnancy, were more often anemic, and had an increased incidence of venereal disease. The FPR and FP groups documented major psychological problems and depression more frequently. The obstetricians used caudal and epidural anesthesia more frequently, whereas the FP and FPR groups used more narcotics. Except for an increased incidence of third degree lacerations in the FP group, total maternal and fetal complications were few and similarly divided among the groups. The FPR and FP groups delivered 78 percent and the OB group 38 percent of their own patients. This paper is an addition to a limited literature base which deals with process and outcome of obstetrical care delivered by various provider groups and is unique in that the study was undertaken in a large prepaid group.

Continuity of Patient Care↗
PubMed1995

[Frequency and determinants of episiotomy in second-line obstetrics in The Netherlands].

OBJECTIVE: To study factors that influence the probability of episiotomy in Dutch gynaecologist-supervised deliveries. SETTING: Obstetric units of Dutch hospitals. DESIGN: Observational study. METHODS: Data of 65,313 gynaecologist-supervised, vaginal deliveries of live-born singletons registered in the Dutch National Obstetric Database of 1990, were used. Firstly, the effect of characteristics of the mother, the child, the pregnancy, and the delivery on the probability of episiotomy were assessed in univariate analyses. Subsequently logistic regression analysis was used to determine the effect of each variable, while adjusting for the other variables. RESULTS: The episiotomy rate in the total group of gynaecologist supervised deliveries was 39%. In the subgroup of vaginal deliveries of live born singletons, the rate was 46%. Besides the well-known risk factors such as parity, instrumental delivery and length of second stage of labour, ethnicity was also found to have an independent effect on the risk of an episiotomy. Mediterranean, Creole and Hindu women had a lower episiotomy risk than Dutch women (OR: 0.47 and 95% CI: 0.44-0.51). Gynaecologists more often performed episiotomy than midwives, after adjusting for possible confounding factors (OR: 1.54; 1.46-1.63). In University hospitals fewer episiotomies were performed than in large non-university hospitals (OR: 0.81; 0.76-0.87. CONCLUSION: The decision to perform episiotomy appears not to depend solely on factors related to perineal rupture or foetal complications. The probability of episiotomy is also influenced by attendant at delivery and type of hospital.

Academic Medical Centers↗
PubMed1994

[Gynecology and obstetrics in ancient Egypt].

We analyzed scriptural and archeologic sources of information concerning gynaecology and obstetrics as practiced in ancient Egypt. Knowledge of anatomy was rudimentary but precocious diagnosis of pregnancy was practiced. An obstetrical chair had been used since the VIth dynasty. The Egyptians were the first to describe prolapsus of the genital organs. The pessary was a known treatment. Spermicidal mixtures were used for contraception.

Delivery, Obstetric↗
PubMed1993

Doing obstetrics and staying alive.

Many family physicians have a love-hate relationship with childbirth care and struggle to balance their personal and family needs with the need to provide high-quality personal care during labour and birth. Many false assumptions undermine family practice obstetrics. Strategies are presented to simplify obstetric care for women and families while promoting reasoned self-care for physicians.

Adaptation, Psychological↗
PubMed1993

Are physicians changing the way they practise obstetrics?

OBJECTIVE: To examine trends in obstetric interventions in women at low risk over approximately 3 years. It was postulated that there would be a general reduction in most intervention rates. DESIGN: Retrospective review of hospital records. SETTING: Three downtown hospitals of the University of Toronto, in which academic and nonacademic family physicians and obstetricians practised. PATIENTS: A total of 2365 women in phase 1 (April 1985 to March 1986) and 1277 in phase 2 (May to September 1988) met the inclusion criteria for grade A (pregnancy at no predictable risk) of the Ontario Antenatal Record at the time of admission to hospital. OUTCOME MEASURES: Rates of artificial rupture of the membranes, induction, augmentation, epidural anesthesia, continuous electronic fetal monitoring (EFM), instrumental delivery, episiotomy and cesarean section. RESULTS: The family physicians and the obstetricians had significant decreases (p < 0.01) over time in the rates of episiotomy, especially mediolateral, and low forceps delivery. The rate of epidural anesthesia decreased significantly in the obstetrician group. The rates of artificial rupture of the membranes, induction and continuous EFM increased in the two physician groups; the increased rate of EFM was significant in the obstetrician group (p < 0.01). There was no significant change in the rates of augmentation, midforceps delivery, vacuum extraction or cesarean section. All of the trends were found to hold when the intervention rates were analysed according to the women's parity. CONCLUSIONS: Some of the findings reflect recommendations and trends reported in the literature, whereas others are not supported by clear medical evidence. The unpredictable nature of the trends suggests that further study is warranted of the reasons for obstetric trends and for the changes in physicians' practice patterns.

Anesthesia, Epidural↗
PubMed1977

[Mechanical action of obstetrical forceps on the fetal skull].

By means of schematic illustrations we demonstrate the working point of the power of labour, obstetrical forceps and vacuum extractor, The bones of the fetal skull are by sutures movable fastened together. Every extraction so will rise the intracranial pressure of the fetus, because the resistance of the birth canal tissues must be overcome. This for the extraction needed power and rising of the intracranial pressure is independent from the instrument with which the extraction is carried out. It is impossible to make a "cage" around the fetal head with the Shute forceps during extraction, to protect the fetal head from the extraction power. Another question is, that some instruments (included vacuum extractor) can limit the used power. By using forcipes with crossed lock without fixation the forces for extraction are not limited and there is a need of better operative technic. By the comparison of the forcipes from Shute, Naegele and Zweifel we can summarize, that for success is decided the indication and good operative technic and not the instrument. Every instrument for vaginal extraction has advantages and disadvantages in different obstetrical situations.

Biomechanical Phenomena↗
PubMed1995

A ten-year review of uterine rupture in modern obstetric practice.

The aim of this paper is to determine the antecedent factors, clinical presentation, complications and management of uterine rupture in the context of modern obstetric practice in Singapore. We conducted a retrospective study of 26 proven cases of uterine rupture in Kandang Kerbau Hospital, Singapore between January 1983 to December 1992. These cases were analysed with regards to their past history, clinical presentation, complications, management and outcome. The incidence of uterine rupture was 1 in 6331 deliveries. The ratio of cases with scarred uteri against those with unscarred uteri was 3:1. The commonest antecedent factor was previous lower segment caesarean section for the scarred group and cephalo-pelvic disproportion in the unscarred group. Overall, 46.2% of the patients had augmentation with oxytocin. The major clinical presentations were abnormal cardiotocogram (25%) and blood-stained amniotic fluid (20%) in the scarred group, and postpartum haemorrhage (50%) and shock (33%) in the unscarred group. Repair of the uterus with or without tubal ligation was performed in 95% of the patients with scarred uteri, whereas 67% of the patients with unscarred uteri underwent total abdominal hysterectomy with or without salpingo-oophorectomy. There was 1 (3.8%) maternal death. Maternal morbidity included bladder injuries, broad ligament haematoma, disseminated intravascular coagulation and gastrointestinal bleeding. The overall incidence of fetal loss was 7.4%. When compared to a previous study on uterine rupture in the same hospital, there was an improvement in obstetric performance.

Adult↗
PubMed1977

An analysis of 3,199 patients booked for delivery in general-practitioner obstetric units.

The outcome of 3,199 women booked for delivery in six general-practitioner obstetric units in one year was analyzed.Five per cent cancelled their bookings, 26 per cent were transferred to a consultant unit after referral for routine problems of pregnancy (mainly postmaturity), and 14 per cent were transferred for problems arising in labour (principally uterine inertia). One per cent were transferred after confinement.Fifty-four per cent were delivered successfully in the general-practitioner units.There were 3,037 live births, 27 stillbirths and 22 neonatal deaths. Nine stillbirths and nine neonatal deaths resulted from congenital abnormalities, while two stillbirths and 11 neonatal deaths were due to immaturity. There were 25 sets of twins and one set of triplets. Seventy-five babies were abnormal, 105 weighed less than 2,500g, and 198 over 4,000g.In this series almost 60 per cent of eventual perinatal deaths were transferred during pregnancy, and over 85 per cent before delivery.The perinatal mortality of all women initially booked for a general-practitioner unit who delivered was 15.. The perinatal mortality of the 1,795 births in the six general-practitioner obstetric units was 3.9.

Delivery, Obstetric↗
PubMed2001

Obstetric complications, parenting, and risk of criminal behavior.

BACKGROUND: The results of studies that have examined the relationship between prenatal and perinatal complications and adult criminality and violence are contradictory. Supporting evidence for this relationship comes from studies of samples drawn from a single cohort. The present study was designed to examine the associations between prenatal and perinatal complications and criminality, defining more precisely than past investigations subject characteristics and the types of offenses. METHODS: The cohort includes the 15 117 persons born in Stockholm, Sweden, in 1953 and followed up to age 30 years. Information was extracted from obstetric files, health, social, work, and criminal records. Obstetric complications were defined as deviations from normal development occurring at any point from conception through the neonatal period. Inadequate parenting was indexed by social intervention. RESULTS: Inadequate parenting was experienced by 19.1% of the men and 18.1% of the women, and was shown to increase the risk of offending (men, 1.39 times [95% confidence interval [CI], 1.28-1.50]; women, 2.09 [95% CI, 1.70-2.56]) and of violent offending (men, 2.02 times [95% CI, 1.67-2.44]; women, 2.09 [95% CI, 1.70-2.56]). Obstetric complications in the absence of family problems did not increase the risk of offending. A combination of pregnancy complications and inadequate parenting affected 3.1% of the men and 4.0% of the women, and increased the risk of offending (1.64 times [95% CI, 1.43-1.89]; 1.79 times [95% CI, 1.16-2.75], respectively) and violent offending (2.86 times [95% CI, 2.09-3.91]; 1.81 times [95% CI, 0.57-5.79]). CONCLUSIONS: A combination of pregnancy complications and inadequate parenting increased the risk of violent and nonviolent offending only slightly more than inadequate parenting alone. However, inadequate parenting was experienced by 5 times more cohort members than was the combination of inadequate parenting and pregnancy complications.

Adult↗
PubMed2006

Flow cytometric assessment of hematopoietic cell subsets in cryopreserved preterm and term cord blood, influence of obstetrical parameters, and availability for transplantation.

OBJECTIVE: The aim of this study was to characterize the lymphocyte and the hematopoietic stem and progenitor cell (HPC) subsets of cryopreserved premature cord blood (PCB) compared to term cord blood (TCB) by flow cytometry, to study the influence of birth conditions, and to assess its availability for transplantation. MATERIALS AND METHODS: Four-color flow cytometric analysis was performed on 43 PCB and 40 TCB cryopreserved samples using a panel of 24 different mAbs, directed against lymphoid and HPC surface markers. The CB volume was estimated by the weight of the newborn to determine the absolute MNC and CD34(+) cell content/CB sample. Clinical and obstetrical data were recovered. Statistical comparisons and a multiple regression analysis were performed. RESULTS: No consistent differences were found in the mononuclear cell (MNC) or CD34(+) cell concentration (x10(6)/L) between PCB and TCB. The percentage of primitive HPC (CD34(+)CD38(-), CD34(+)CD38(-)CD90(-)HLA-DR(-), CD34(+)CD38(-)CD90(-)HLA-DR(+)) and primitive lymphoid progenitors (CD34(+)CD7(+), CD34(+)CD7(+)CD19(-)CD117(-)) were higher in PCB than in TCB. Correspondingly, TCB had an increased percentage of committed HPC. No sample of PCB contained >2 x 10(7) MNC/kg (and only 48% had >1 x 10(5) CD34(+) cells) for a recipient of 20 kg body wt, as the minimum threshold recommended for CB transplantation. Obstetrical factors modulated mainly lymphocyte subsets and fewer HPC subpopulations. Acute fetal distress increased CD34(+) cells, especially the immature subsets. Maternal treatment with dexamethasone and intrauterine growth retardation decreased CD3(+) cells. No other obstetrical factors played a detrimental effect on CB cells if used for transplantation. CONCLUSION: PCB is richer in immature cells both in lymphocyte and HPC populations, and its use for transplantation, at least in special cases, should be reconsidered.

Antigens, Differentiation↗