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PubMed2000

Course and outcome of obstetric patients in a general intensive care unit.

BACKGROUND: To characterize the course, interventions required to achieve predetermined end-points and outcome of obstetric patients admitted to a general intensive care unit. METHODS: A retrospective case series study was performed including all pregnant patients admitted to an 8-bed general intensive care unit at a tertiary care university-affiliated hospital over a 4-year period. All patients referred by the obstetricians were admitted. Patients were divided into two groups: group 1, (n = 19) those requiring mechanical ventilatory support and group 2, (n = 27) those requiring intensive monitoring. Data collected included demographics, reason for admission, admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) and Therapeutic Intervention Scoring System (TISS) scores, intensive care unit course, types of interventions used and outcome. End-points of therapy included systolic blood pressure 110-150 mmHg, urine output > or = 1 cc/kg/h and oxygen saturation > 95%. RESULTS: Over the study period, 46 obstetric patients were admitted to the intensive care unit, representing 0.2% of all deliveries and an intensive care unit utilization rate of 2.3%. Commonest admission diagnoses were pregnancy-induced hypertension and hemorrhage. Reason for admission was mechanical ventilation in 41% while 59% were admitted for monitoring. Median length of stay was 25 +/- 80.9 (mean 48.8) hours. The median APACHE II score was 6 +/- 3.9 (mean 7.24) and the TISS score was > 20 in both groups. Only one patient died (mortality rate 2.3%). CONCLUSION: Despite a short length of stay and low APACHE score, the high TISS score in obstetric patients admitted for both ventilation and monitoring suggests that these patients require a level of intervention and care typically provided by a general intensive care unit.

Adult↗
PubMed2000

[Obstetrical outcome of pregnancy on in vitro fertilization and embryo transfer 128 cases analysis].

OBJECTIVE: To evaluate the obstetrical outcome of in vitro fertilization and embryo transfer (IVF-ET) pregnancy. METHODS: This study compared the obstetrical outcome of 128 cases of IVF-ET pregnancy with that of 11,372 natural pregnancies as control group. RESULTS: There were 20.3%(26/128) multiple pregnancy, 20.3%(26/128) premature birth, 14.8%(19/128) pregnancy induced hypertension, 25.5%(41/161) small for gestational age, 88.3% (113/128) cesarean section rate and 31.1@1000(5/161) perinatal mortality in the IVF-ET group. However, these data in the control group were 3.3%(380/11,372), 1.0%(119/11,372), 7.6%(863/11,372), 3.6%(416/11,492), 34.7%(3,946/11,372) and 8.9@1000 (102/11,492), respectively. CONCLUSION: The incidence of obstetrical complications was significantly higher in IVF-ET pregnancy. Multiple pregnancy is a high risk factor.

Adult↗
PubMed2001

[For and against non-obstetrical indications for cesarean section].

The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.

Adult↗
PubMed2002

[Training midwives in developing countries in obstetric ultrasonography: goals and application].

Obstetric ultrasonography is one of the most important advances in antenatal and obstetric emergency care. As part of the program designed to reduce maternal and perinatal mortality, it can provide real patient benefit and should become a standard procedure in developing countries. The midwife is the ideal health worker to practice first level obstetric ultrasonography. Appropriate material can be procured and of specific training can be organized at a moderate cost. Several difficulties are encountered, but there is a solution for each. The concept of the training program is particularly important.

Developing Countries↗
PubMed2002

Obstetric morbidity and socio-demographic factors in rural West Bengal, India.

The impact of selected socio-demographic factors on reported obstetric morbidity during antepartum and postpartum periods was studied through a cross-sectional retrospective survey carried out in rural areas of three districts of West Bengal, India. During their most recent live births, 56.6% of mothers reported at least one morbid condition. Mothers with higher levels of education reported fewer overall problems. Factors such as age and pregnancy order affect obstetric morbidity differently in different religious groups. More mothers reported postpartum than antepartum problems, and very few sought treatment. The present study provides an insight into various factors affecting obstetric morbidity in a developing country.

Adolescent↗
PubMedDate not supplied

[Analysis of epileptic pregnant women delivering between 1992-1998 in obstetric departments of the University Medical School in Lublin].

Pregnancy in woman with epilepsy arouses several serious medical problems and always belongs to the group of high obstetric risks. The aim of the present clinical study was the evaluation of the antiepileptic treatment efficiency during pregnancy, including risk factor, effects on pregnancy and delivery in epileptic patients. The study group consisted of 84 epileptic pregnant women which delivered between 1992-1998 in Obstetric Departments of University Medical School of Lublin. A randomised group 80 healthy pregnant women constituted the control group. The mean age of the analysed patients was 25 years. 51 epileptic patients were pregnant for the first time, 23 patients for the second time and 10 patients for the third time or more. The mean duration time of the disease was 8.6 years. In our study group: 45 (53.8%) patients experienced primary generalized tonic-clonic seizures and 39 (46.6%) patients experienced partial seizures. 26 patients were treated with monotherapy and the rest with polytherapy methods. The estimation of the seizure frequency during pregnancy in 52 (61.9%) patients did not change, in 13 (15.4%) patients increased. Among obstetric complications: urinary tract infections, hypertonia (EPH-gestosis) were observed. In 4 newborn congenital defects have been noted. Mothers of three of them were treated with Phenydantin (heart lesion, developmental anomaly of fingers). The fourth mother used Convulex (meningoarachnided hernia, hydrocephalus).

Abnormalities, Drug-Induced↗
PubMed1975

[Modern results and old-established methods in obstetrics (author's transl)].

More than 20.000 obstetric cases were attended to during the years 1965 to 1974 at the Semmelweis-Klinik in Vienna. The perinatal maternal mortality rate was 0.1% and the perinatal infant mortality rate was finally 15%. The cases were treated according to oldfashioned obstetric principles. Hence, although the more modern obstetric methods might be of some scientific value, their importance appears to have been overestimated from a practical point of view. A return to the conscientious implementation of simple, long-established methods of pernatal care appears to be called for, even with the most modern monitoring machines at hand.

Adult↗
PubMed2002

[The impact of some factors on obstetrical management in women with previous cesarean section].

Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.

Attitude of Health Personnel↗
PubMed2002

[Effect of some factors on obstetrical care of women with previous cesarean section].

Considering obstetrical management we should have always in mind advantages and disadvantages of vaginal birth after cesarean (VBAC) and elective cesarean section after a previous one, financial part of the elected mode of delivery in the particular case, psychological aspect of the matter (especially after an unsuccessful trial of labour--TOL) and not on the last position-patient's right to choose the way how to deliver. We performed an inquiry of 3-year-period and 50 women with a prior cesarean section, by which we studied the factors contributed in different extent to the choice of the following approach to delivery: patient's preliminary choice, the impact of medical staff during pregnancy and when entering the Department of Obstetrics, the impact of non-medical persons, complications after the previous cesarean section, patient's acquaintance with complications and consequences associated with the operative mode of delivery, as well as doctor's personal attitude to the different modes of delivery. The aim of our research is to show that by careful selection (according to the established indices) of women, who have a high probability (more than 80%) to deliver their babies vaginally and offering adequate information by educational literature and including the woman in the decision making process, the patient resistance to vaginal delivery will be reduced. In this way, the growing rate of cesarean section will be decreased by increasing the number of VBAC--undoubtedly one of the most important issue in modern obstetrics.

Attitude of Health Personnel↗
PubMed2003

Antinuclear antibody testing in obstetric patients.

OBJECTIVES: To assess possible associations between the presence of antinuclear antibodies (ANAs) and pregnancy outcome in order to determine the significance of this test in obstetric practice. METHODS: A case-control study was performed on 408 patients admitted to an obstetric high care unit and on whom ANA testing was consecutively performed. The study group consisted of 46 patients who tested positive for ANAs and a control group of 92 patients who tested negative for ANAs. In addition to demographic data, indications for admission and pregnancy outcome were compared between the two groups. RESULTS: Of the 46 patients with a positive ANA result, 28 had an antinuclear pattern, 13 an anticytoplasmic pattern and 5 an antinuclear and an anticytoplasmic pattern. No significant differences were observed between the two groups (ANA-positive and negative) with regard to demographic data, indication for admission, clinical and laboratory data, and pregnancy outcome. The patients were also tested for anticardiolipin antibodies, and significantly more patients with severe pre-eclampsia tested positive (24% versus 4.7%, p = 0.01). No difference in HIV status and presence of autoantibodies was found between the two groups. CONCLUSION: The presence of ANAs was not associated with adverse pregnancy outcome. Therefore routine patient testing for ANAs in an obstetric high-care unit is not recommended.

Adult↗
PubMedDate not supplied

[Preventing adverse obstetric outcome in women with thrombophilia].

Thrombophilia may represent a new risk factor for placental vascular disorders. Thromboprophylaxis with low doses of heparin and aspirin may be discussed in order to reduced adverse obstetric outcomes. No randomized controlled trials are currently published in the literature. Thromboprophylaxis may be unwarranted in asymptomatic women because of the lack for an association between thrombophilia and pregnancy outcome. Women with antiphospholipid syndrome are at high risk for pregnancy loss and maternal complications. Pregnancy in women with antiphospholipid syndrome appears to be improved by thromboprophylaxis, but adverse obstetric outcome may occur despite treatment. Thromboprophylaxis is recently reported in women with previous poor obstetric outcomes. These preliminary observational studies are still insufficient to recommend a large diffusion for thromboprophylaxis. Prevention for adverse outcomes with a low fixed dose of heparin may only be discussed in women with previous late fetal loss or intrauterine fetal death.

Anticoagulants↗
PubMed1992

[Fundamental study on levofloxacin in the field of obstetrics and gynecology].

We performed a fundamental study on levofloxacin (LVFX, DR-3355), a new synthetic antimicrobial agent, in the field of obstetrics and gynecology. Concentrations in serum and intrapelvic genital organs (various regions in the uterus, ovary and oviduct) were determined following single oral administration. The transport of LVFX into genital tissues was found to be good, with the tissue levels of 0.64-2.13 micrograms/g after oral administration of 100 mg and 0.77-4.86 micrograms/g after administration of 200 mg. These tissue levels of LVFX were higher than those in serum and exceeded the MIC90 values against most causative organisms isolated from the lesions of obstetric and gynecological infections. These data indicate that LVFX should be useful in the field of obstetrics and gynecology.

Administration, Oral↗
PubMed1992

[Pharmacokinetic and clinical evaluation of levofloxacin in obstetrics and gynecology].

Levofloxacin (LVFX, DR-3355), a new synthetic quinolone derivative antibacterial agent, was evaluated for its pharmacokinetics and clinical efficacy in obstetric and gynecological infections, and the following results were obtained. Concentrations of LVFX in serum and intrapelvic genital organs such as uterine and adnexal tissues were determined following oral administration of 100 mg. Tissue penetration of LVFX was found to be good, with its tissue levels (Cmax) of 1.17-2.16 micrograms/ml or g after inhalation anaesthesia and 1.15-2.17 micrograms/ml or g after lumbar spinal anaesthesia. LVFX was given to 22 cases of obstetric and gynecological infections with a daily dose of 200-600 mg for 3-14 days and its clinical efficacy was 95% and bacteriological response was 100%. No side effect was observed. From these findings, we consider that LVFX will be a useful antibacterial agent against obstetric and gynecological infections.

Administration, Oral↗
PubMed2004

[Clinical analysis of pregnancy complicated by hypertension in the material of the Department of Obstetrics and Perinatology of the Pomeranian Academy of Medicine].

OBJECTIVES: The aim of this study was retrospective analysis of arterial hypertension during pregnancy in the Department of Obstetrics and Perinatology of Pomeranian Academy of Medicine in Szczecin, and severe PIH intensive obstetrical care optimization. DESIGN: The retrospective analysis of 81 pregnancies complicated by arterial hypertension in the years 1995-2000 was performed. MATERIAL AND METHODS: The retrospective analysis of 81 pregnancies was performed. Patients were divided into two groups. In the first pregnancy was ended by caesarean section (n = 43), in the second by vaginal delivery. The mean gestational age, the way of delivery, accompanying diseases, uric acid levels, short term variability, Dawes - Reedman's criteria, presence of decelerations in CTG, Doppler PI, S/D, RI parameters in umbilical artery and cerebral arteries, presence of AEDVF and REDVF in umbilical artery were analyzed. RESULTS: Caesarean section was performed in 53.1% of all cases, in 46.9% vaginal delivery took place. Absolute range of short-term variability was more often less than 6 ms in caesarean section group (41.9%). Uric acid level was also higher in caesarean section group (p = 0.000194) CONCLUSIONS: 1. The caesarean rate in pregnancies complicated by arterial hypertension is over 50% and during severe PIH is approximately 100%. 2. Caesarean section takes place before estimated delivery date and indications to it are in most cases connected with a main disease 3. Short-term variability is lower among patients from caesarean section group. 4. Uric acid level is a relevant parameter of a degree of arterial hypertension, and the level is higher in first group. 5. Doppler velocimetry of umbilical artery and middle cerebral artery are valid part of obstetrical care among patients with PIH.

Adult↗
PubMed1992

[Presence of inhibitors of activated partial thromboplastin time (TTPA). Clinical repercussion in obstetric patients].

Partial thromboplastin time, activated with kaolin (TTPA) is a qualitative test used to find defects of some factor of intrinsic via of coagulation or to rule out the presence of some circulating inhibitor. The lupus anticoagulant (LA) is part of a group of several auto-antibody with pathogenic potential in several branches of medicine, mainly rheumatology, hematology and gyneco-obstetrics. In this last area the LA has been associated with different obstetrical repercussions. The purpose of this study was to determine the main obstetrical events associated with patients with circulating anticoagulants identified by TTPA with kaolin. Ninety six patients were included in cases-control study. Group I (n = 48) cases and Group II (n = 48) controls, were selected from the same population and information source. The cases were included when presenting prolongation of more than 4 seconds of TTPA activated with kaolin regarding a control with lack of correction with normal plasma. A registration sheet for data captation, was designed specially for this study. The comparability of both groups was established, as there were no differences (significant) among the variable considered as basal. The group of cases presented with a greater frequency of habitual abortion, neonatal death and thrombotic phenomena. This relationship of autoimmunological pictures with recurrent fetal loss and thromboembolic incidents has been consistently described in literature. To this respect, several immunological abnormalities. Including positive anticardiolipin antibodies and VDRL falsely positive. The incidence, in this country of these entities, is unknown. These observations show the need of a methodologic superation.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Habitual↗
PubMed2004

Evaluation of nine pilot obstetric ultrasound education workshops for Australian rural and remote doctors.

INTRODUCTION: This article describes the evaluation of nine pilot obstetric ultrasound education workshops for Australian rural and remote doctors developed in response to an educational needs assessment that showed a large unmet need in this area. METHOD: Data from pre- and post-knowledge tests were analysed in SPSS. Data from the follow-up sonographer assessment visits were analysed in an EXCEL spreadsheet. RESULTS: In all, 141 doctors attended one of the nine pilot obstetric ultrasound workshops and reported an increase in their confidence in obstetric ultrasound. The overall workshop pre- and post-knowledge test mean improved from a score of 13.9 to 15.5 (p = 0.001) and the RANZCOG pre- and post-knowledge test mean improved from 9.56 to 15.12 (p = <0.001). Data from the follow-up competency assessment visits showed doctors were competent in some areas but required further practice in others. CONCLUSION: An intensive educational intervention can successfully address the pre-determined needs of rural and remote doctors. However, this intervention should be followed by ongoing practice-based education and assessment.

Journal Article↗
PubMedDate not supplied

[Changes in pelvic anatomy in 8 decades--computerized tomography study of obstetrically relevant pelvic measurements].

An increasing proportion of obstetric operative procedures due to cephalopelvic disproportion gave raise to the question, whether there has been a change in pelvic anatomy during the past decades. In a retrospective evaluation of 467 computerized pelvic tomograms of patients aged between 18 and 88 years relevant parameters of pelvic proportion were determined. As these parameters are not subject to age-conditioned changes, the values may be viewed as representative for the time of patients' birth or fertility period respectively. Changes in pelvic anatomy turned out to be complex: The transverse elliptic shape of pelvic inlet changed into sagittal elliptic form, the pelvic midplane is contracted progressively, sacral concavity is reduced. Obviously, this obstetrically adverse development is influenced by the fact, that unfavourable pelvic conformation can be transmitted more intensively by the generous indication for cesarean section. This development is contrasted by the circumstance of fetal acceleration. Therefore, an increase in cephalopelvic disproportion has to be expected. For the sake of a safe obstetrical management in these situations the generous use of ante partum pelvimetric diagnosis seems to be advisable.

Adolescent↗
PubMed1992

Deep vein thrombosis in obstetric patients: diagnosis and risk factors.

This study was performed to assess the prevalence of deep vein thrombosis (DVT) in consecutive obstetric patients with clinical symptoms of DVT, using impedance plethysmography (IPG) as the diagnostic method and to establish the safety of withholding anticoagulant therapy in patients with a repeatedly normal IPG. In addition, in patients with DVT the prevalence of coagulation and fibrinolytic disorders, which may explain the occurrence of venous thrombosis was investigated. Of the 77 obstetric patients with symptoms of DVT, 32 (42%) had an abnormal IPG. The remaining 45 patients had a repeatedly normal IPG and showed no venous thromboembolism during a 6 months follow-up period. Twenty percent (six patients) of the patients with an abnormal IPG had a coagulation or fibrinolytic abnormality. These observations suggest that serial IPG can be used effectively in the management of obstetric patients with clinically suspected DVT and that hemostatic abnormalities are frequently found in those patients with DVT.

Adolescent↗