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At least 1,369 records · Page 76Linked to original sources
PubMed2005

[Obstetrical outcome in 454 women exposed to diethylstilbesterol during their fetal life: a case-control analysis].

OBJECTIVE: To analyze the predictive effect on obstetrical outcome in women with prenatal exposure to diethylstilbestrol (DES) of previous obstetrical history or the specific risk of DES exposure. PATIENTS AND METHODS: We included all in utero DES-exposed women (454 women) followed and delivered at one maternity unit in Paris and compared them with two control women matched for age, parity, number of late fetal losses, number of previous preterm births, number of singleton or twin fetuses, and follow-up, who were managed by the same team or referred for pregnancy complication. RESULTS: DES women had a higher rate of preterm birth (19.2%) than matched controls (10.5%), even when considering women with a previous preterm birth or twin pregnancy. The rate of fetal or neonatal deaths were lower in DES-exposed women than in controls. DES women showed a higher rate of severe post partum bleeding (2.8%) than matched controls (1.5%) or the global population of women delivered in this maternity unit. CONCLUSION: A history of prenatal exposure to DES is a major predictor of preterm birth for primiparous women and for those with an adverse obstetrical history.

Case-Control Studies↗
PubMed2006

[Management of ten patients with complete septate uterus: hystersocopic section of and obstetrical outcome].

INTRODUCTION: Septate uterus is the principal müllerian anomaly, but complete septate uterus is uncommon and often associated with frequent obstetrical complications. Surgical section of the septum is however possible. MATERIAL AND METHOD: We report patients with a complete septum uterus operated in our department between 2002 and 2006. We performed a hysteroscopic section of the cervical, uterine and vaginal septum at discovery of the anomaly. The accuracy of imaging exams, frequency of associated malformations, past obstetrical events and reproductive outcome post surgery were analyzed. RESULTS: The surgical technique was based on section of the cervical part with scissors and hysteroscopic section of the uterine septum; no perforation was noted. Four patients required a second procedure to achieve complete uterine section. Five patients became pregnant after surgery, 8 pregnancies are reported: 2 term delivery, 1 preterm delivery, 4 miscarriages and 1 ectopic pregnancy. CONCLUSION: Complete surgical section of the cervical and uterine septum in case of complete septum uterus is safe. However, we cannot conclude about the obstetrical benefit of this surgical technique. A longer follow-up is needed.

Adult↗
PubMed1983

[Disseminated intravascular coagulation. Retrospective study of 14 acute obstetrical cases].

To test the value of diagnostic and therapeutic data in obstetric DIC, 14 women were selected who presented a severe clotless haemorrhage with fibrin degradation products and/or soluble complexes, decreased fibrinogen (0.87 +/- 0.47 g X 1(-1)), platelet count (75.7 +/- 41 X 10(3) X ml-1) and prothrombin complex (33.7 +/- 12%). The hypovolaemia was treated at the same time as heparin was given in a bolus injection of 0.5 mg X kg-1 followed by a constant flow infusion of 1 mg X kg-1 X day-1 in all patients. Relevant obstetrical treatment was performed in 71.4% of patients. Fibrinogen, fresh frozen plasma, prothrombin complex concentrate and platelet concentrate were given if required. One patient, with severe toxaemia, died. Haemorrhage was stopped in 92.8% of patients after 4.5 +/- 0.8 h. Reversible visceral complications occurred in 28% of cases. The initial data used was easily obtained and seemed to give a reliable diagnosis in acute obstetrical DIC. Substitutive treatment was discussed in correlation with the evolution: PCC seemed pointless; the use of fibrinogen must become exceptional when fresh frozen plasma is available. Heparin remained necessary.

Acute Disease↗
PubMed1997

Correlates and effect of non-response in a postpartum survey of obstetrical care quality.

This study investigated the differences between unprompted respondents, prompted respondents, and non-respondents to a postpartum postal survey, and determined the likely impact of non-response on the accuracy of calculations of patient assessments of obstetrical care quality. Birth certificate and hospital discharge data were obtained for 1664 live births at three hospitals in Washington State between 8/91-10/91 and linked with 1268 completed postpartum maternal postal surveys. Non-white race, public insurance payer, unmarried status, and smoking in pregnancy were independent risk factors for non-participation. Among participants, non-white race, unmarried status, and having an infant who was low birthweight, preterm, or discharged late were independent risk factors for prompted response. The inclusion of prompted respondents did not substantially alter the calculated proportion of women rating obstetrical care quality as low, and these figures were similar to proportions estimated for the entire intended cohort using a modification of Drane's method. A one-time mailing of an obstetrical care quality survey can provide information similar to that obtained with more extensive follow-up even though substantial differences may exist between unprompted and prompted respondents, and with adjustment for factors related to non-participation and timing of response, it may be possible to obtain accurate estimation of outcome prevalences for the entire intended cohort.

Adult↗
PubMed2003

Intensive care use by critically ill obstetric patients: a five-year review.

This is a retrospective analysis of all obstetric admissions to the surgical intensive care unit over the five-year period beginning July 1, 1994. The admission diagnosis, mode of delivery, anaesthetic employed and patient outcome were assessed. There were 43 obstetric admissions during this period, with 38 deliveries. This represents 0.32% of the deliveries in this hospital during the study period. The median duration of stay was three days (range 1-21). Haemorrhage and pregnancy-induced hypertension accounted for the majority of obstetric complications. Anaesthesia may have contributed to the admission of eight patients. Eight patients had more than one admission diagnosis. There were two deaths and one case of major morbidity (hypoxic encephalopathy) in this series. Prolonged ventilation and/or inotropic support were generally not required. In conclusion, approximately 3 per 1000 maternities require intensive care in this institution. The majority are discharged after a short stay with good outcome.

Journal Article↗
PubMed1997

Anaesthesia and the antiphospholipid syndrome: a review of 20 obstetric patients.

The case notes of 20 obstetric patients with antiphospholipid syndrome delivering over a 4-year period were reviewed retrospectively. There were complete details for 22 singleton pregnancies. Obstetric complications in the pregnancies under review were frequent. Nine (47%) of the 19 women whose pregnancies reached the third trimester were delivered by caesarean section. During seven of the pregnancies there was significant prolongation of the phospholipid-dependent coagulation tests secondary to lupus anticoagulant and/or anticardiolipin antibodies. Four of these women received epidural blockade without sequelae. This finding, however, cannot provide valid evidence for the safety or otherwise of epidural placement in this group of patients, since the series is small and the incidence of epidural haematoma is exceedingly rare in the obstetric population. Paradoxically, these patients are hypercoagulable. The estimated blood loss at these deliveries did not exceed 600 ml. Eleven women (55%) had a previous history of thrombosis. Two women had thrombotic episodes during their pregnancies and three had them post partum despite antithrombotic measures.

Journal Article↗
PubMed1997

Obstetric anaesthesia: an approach to improving the standards of services.

There has been considerable discussion about obstetric anaesthesia standards and about the role of peer review in quality improvement. We carried out two postal surveys in 1990 and 1991 in major obstetric departments in Northern England, in order to assess practice and facilities against professionally derived standards, with the aim of stimulating and reviewing change. The reference standards were a local adaptation of those produced by the Obstetric Anaesthetists Association, and covered operating facilities, anaesthetic equipment, management and manpower, training, and protocols. In 1990, considerable variation in practice and facilities was identified with deficiencies in all hospitals. After feedback of the results of the first survey, a further survey conducted in 1991 identified improvement in 23/26 standards. Reference to standards was widely included in business plans and contracts for services. Following further feedback of the second survey and some revision of standards, a third survey was carried out using site visits. This revealed further improvement in 8/26 standards, but apparent deterioration in 11/26. The overall change from the first to the third survey was of apparent improvement in 15/26 standards and deterioration in 6/26. Surveys of practice against professionally derived standards and the targeted feed back of results can lead to improvements in practice and facilities.

Journal Article↗
PubMed1997

A survey of facilities for high risk women in consultant obstetric units.

Reports on Confidential Enquiries into Maternal Deaths and the Obstetric Anaesthetists' Association have made recommendations about the provision of staff and facilities in consultant obstetric units. We have carried out a postal survey of all units in the UK concerning provision of recovery facilities, high dependency and intensive care, and anaesthetic staffing. Replies were received from 232 units (89%). The results show that although many units had achieved recommended standards, this was not universal. In particular, only 62% had a designated and staffed recovery area, only 41% had specific obstetric high dependency beds and there were a number of units with no consultant anaesthetic sessions or trained anaesthetic assistants available around the clock. Despite the practical and financial difficulties in achieving recommended standards, it should be noted that purchasers of health care have been encouraged to ensure that the recommendations are implemented.

Journal Article↗
PubMed2002

[Maternity in adolescence: obstetrical analysis and review of the influence of cultural, socioeconomic and psychological factors in a retrospective study of 62 cases].

OBJECTIVE: To analyse obstetrical outcome of teenage pregnancies and conditions of discharge from the maternity ward. PATIENTS AND METHODS: A retrospective study of 62 deliveries of women 13 to 17 years old, between 1997 and 2000. RESULTS: A majority of patients is aged 16 or 17 (92%); 46.8% of teenagers were born in a sub-Saharan African country. The teenagers do not go to school in 45.2% of the cases. The first visit to hospital is late in the pregnancy (40.3% had their first visit after 30 weeks of amenorrhoea). There was no follow-up at all for 17.7% of the pregnancies. The obstetrical outcome is normal in 66.2% of the cases; 93.5% of the children were born after 37 SA and had a normal weight for gestational age; 93.5% were discharged from the maternity ward with their children. A specific follow-up took place for 36.2% of the women. Compared with women from other origins, teenagers born in sub-Saharan Africa more often live with their boyfriend (P = 0.03), who is likely to be over 25 (P = 0.001). Sub-Saharan African women more often return and live at the father's home (P < 0.001) and a specific follow-up proves less often necessary (P = 0.03). DISCUSSION AND CONCLUSION: In developed countries, obstetrical outcome of teenage pregnancies is generally good if the women are more than 15 years old. In some cases, teenagers want to have a child for socio-economical, cultural or psychological reasons. There is a great variability of interpersonal situations as shown in this study, where a better prognosis was found in sub-Saharan African teenagers. It is recommended to permit an early access to the maternity hospital and to provide economical and psychological support during and after pregnancy.

Adolescent↗
PubMed2005

Neonatal and obstetric outcome of pregnancies conceived by ICSI or IVF.

Intracytoplasmic sperm injection (ICSI) is currently widely used despite concern regarding pregnancy complications and outcome, specifically congenital malformations. The aim of this study was to compare the obstetric and neonatal outcome of pregnancies conceived by IVF and ICSI. Long-term follow-up was achieved through questionnaires sent to women who conceived after IVF/ICSI treatment. Information was obtained regarding 219 pregnancies (322 children) conceived after ICSI and 145 pregnancies (201 children) conceived after IVF. There were no significant differences between the ICSI and regular IVF pregnancies in regard to the couple's characteristics and the obstetric complications. The mean +/- SD birth weight of the singletons conceived after ICSI was similar to that of singletons conceived after IVF: 3001 +/- 703 versus 3059 +/- 643 g respectively. In both groups there was a high incidence of multiple pregnancies, Caesarean sections, prematurity and low birth weights. The incidence of congenital malformations following IVF or ICSI pregnancies was similar, 6.3 and 7.7% respectively, but was increased compared with the general Israeli population. In summary, concern remains regarding the incidence of congenital malformations after IVF and the long-term outcome of ICSI pregnancies. However, the present results are reassuring with regard to the obstetric and neonatal outcome of pregnancies conceived by ICSI compared with those achieved by IVF.

Abnormalities, Multiple↗
PubMed2000

The role of a high-dependency unit in a regional obstetric hospital.

The aim of our study was to review a series of critically ill patients admitted to a high-dependency unit (HDU) in a regional obstetric centre, to assess our HDU utilisation rate and to determine the indications for and rate of transfer to an intensive care unit (ICU) in a tertiary referral centre. A 4-year retrospective review of case notes and HDU/ICU registers was performed. One hundred and twenty-three patients were admitted to the HDU in the 2 years following its inception, representing 1.02% of all deliveries. Obstetric complications accounted for 81.3% of admissions. Seventeen patients were admitted to an ICU during the study period; 12 (0.08%) were transferred before and five (0.04%) after the development of HDU facilities (p = 0.25). The advantages of a HDU within this setting include the concurrent availability of expert obstetric care and critical care management, the avoidance of the hazards of emergency transport and improved continuity of antenatal and postnatal care.

Adult↗
PubMed1998

Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history.

OBJECTIVES: To examine the feasibility of introducing routine measurement of cervical length at 23 weeks of gestation, to establish the distribution of cervical lengths in a routine population of singleton pregnancies and to examine the relation between cervical length and demographic characteristics and previous obstetric history. METHODS: Cervical length was measured by transvaginal sonography at 23 weeks of gestation in women with singleton pregnancies attending for routine antenatal care. The distribution of cervical lengths was established and the significance of differences in median cervical length between subgroups according to maternal age, ethnic origin, maternal ponderal index, cigarette smoking, alcohol drinking, drug abuse and previous obstetric history was calculated. In addition, 100 women were asked to complete a questionnaire aimed to assess the degree of discomfort, pain or embarrassment caused by the scan. In 100 pregnancies, cervical length was measured in each patient by two of four operators to determine intraobserver and interobserver variabilities. RESULTS: During the study period, 2702 (80%) of the 3358 women attending for a 23-week scan agreed to participate in the study and, in all cases, the cervical length was measured successfully. The median cervical length was 38 mm and in 1.6% of cases the length was 15 mm or less. More than 90% of the women reported that the procedure was associated with no or only mild discomfort and embarrassment, whilst 85% found the ultrasound scan to be equally or less uncomfortable than a speculum examination. Measurement of cervical length was highly reproducible and, on 95% of occasions, the difference between two measurements by the same observer and by two observers was < or = 3.5 mm and < or = 4.2 mm, respectively. Cervical length was significantly shorter in women of Afro-Caribbean origin compared to Caucasians, those aged less than 20 years, those with a low ponderal index, those with a history of previous miscarriage or preterm delivery and in drug abusers. CONCLUSIONS: Transvaginal sonographic measurement of cervical length is highly reproducible and it is associated with a minimal degree of discomfort to the patients. At 23 weeks, the median cervical length is 38 mm and, in 1.6% of the population, the length is 15 mm or less. There is an association between cervical length and demographic characteristics and previous obstetric history.

Adult↗
PubMed2003

Management of obstetric hemorrhage.

A reluctance to proceed with hysterectomy for obstetric hemorrhage may be a more likely cause of preventable death in obstetrics than a lack of surgical or medical skills. Every obstetric unit should have protocols available to deal with hemorrhage and, in addition, have specific guidelines for patients who object to blood transfusions for various reasons. Risk factors for hemorrhage should be identified antenatally, using all possible imaging modalities available, and utilizing multidisciplinary resources whenever possible. Novel strategies for prenatal diagnosis of abnormal placentation include advanced sonography and magnetic resonance imaging. Placement and utilization of arterial catheters for uterine artery embolization is becoming more widespread and new surgical technology such as the argon beam coagulator seems promising. When intra or postpartum hemorrhage is encountered, a familiar protocol for dealing with blood loss should be triggered. Timely hysterectomy should be performed for signs of refractory bleeding. Application of medical and surgical principles combined with recent technologic advances will help the obstetrician avoid disastrous outcomes for both mother and fetus.

Abruptio Placentae↗
PubMed2001

Auditing the standard of anaesthesia care in obstetric units.

We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

Journal Article↗
PubMed2001

The management of eclampsia by obstetric anaesthetists in UK: a postal survey.

Eclampsia and pre-eclampsia are major causes of morbidity and mortality in the obstetric population. The latest triennial report on Confidential Enquiries into Maternal Deaths found hypertensive disorders of pregnancy to be the second most common cause of maternal deaths directly attributable to pregnancy. The management of eclampsia includes the control and prevention of further convulsions by pharmacological methods but the choice of drugs may vary. Current evidence supports the use of magnesium sulphate as the drug of first choice for treating eclampsia. Until recently, UK clinicians used other anticonvulsants for this purpose. Questionnaire studies conducted amongst UK obstetricians published in 1991 and 1998 showed that magnesium sulphate was used in the management of severe pre-eclampsia by 2% and 40% of clinicians respectively. We conducted a survey among lead obstetric anaesthetists in 264 obstetric units in the UK to examine their current practice. We also asked how magnesium was used and included a question on the use of nimodipine. The response rate was 86%. Our results show that magnesium sulphate is used for the treatment of eclampsia in 90% of units and for severe pre-eclampsia in 68%. Most administered magnesium for 24-48 h while nimodipine was used by very few units.

Journal Article↗
PubMed2001

Simulation as a training and assessment tool in the management of failed intubation in obstetrics.

Failed intubation has been a serious problem in obstetric anaesthesia in the UK. The current study was designed to assess the use of the 'ACCESS' simulator (Anaesthetic Computer-Controlled Emergency Situation Simulator) to evaluate our trainees' performance in an obstetric failed intubation setting. Using a scoring system based on our department's failed intubation drill in obstetrics, 13 junior anaesthetists were recruited for the study and all took part in the simulation exercise. Six weeks later they were all tutored as a group or individually on the important points raised from their first simulations. Two weeks after that, 12 of the candidates were re-tested, and 11 scored better than their first time. The results were confidential and the authors ensured all feedback was of a positive nature. The study shows that a simulator may be a useful tool for assessment of performance in a simulated emergency situation when combined with practice and formal teaching.

Journal Article↗
PubMed2002

Clinical experience with cell salvage in obstetrics: 4 cases from one UK centre.

We present 4 cases in which cell salvaged blood was used in maternity patients, including three caesarean sections and one post-partum haemorrhage. All patients were monitored for a minimum of 24 h on either a general Intensive Care Unit (ICU) or specialised obstetric High Dependency Unit (HDU). Postoperative complications are discussed, with particular emphasis on whether the transfusion of cell salvaged blood was a contributory factor. Cell salvage in obstetrics is being used in a haphazard and individual manner and our only present outcome indicators are case reports. We consider the argument for and against cell salvage in obstetrics, and suggest guidelines to reflect current best practice in the use of the machine and filters.

Journal Article↗
PubMed2002

Evaluation of varicella immune status in an obstetric population in relation to place of birth.

Obstetric populations born in tropical or subtropical regions are likely to be seronegative for varicella virus; obstetric populations containing a large proportion of women born in tropical or subtropical regions will benefit greatly from being screened for varicella immunity. Physicians should therefore know the geographic origin of the community they serve and should consider testing varicella immunity in their obstetric patients born in tropical or subtropical regions. To ensure that passive immunization is received when indicated, physicians should obtain serostatus without relying on patients' recollection of their exposure to varicella virus.

Adolescent↗