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At least 1,621 records · Page 90Linked to original sources
PubMed2005

When the stork arrives unannounced - seven years of emergency deliveries in a non-obstetric general hospital.

INTRODUCTION: Emergency department deliveries are uncommon in the Singapore setting, but when they do occur, the emergency physician has to be able to deliver the child safely, perform neonatal resuscitation if needed, and try to prevent any birth trauma to the child or complications of delivery in the mother. We present our experience of emergency room deliveries spanning 7 years in a community hospital without obstetric or neonatal backup. MATERIALS AND METHODS: This is a retrospective case series. A search was made through our electronic medical records system for patients presenting in labour or with deliveries from March 1997 to October 2004. They were studied for demographic and social factors, gravidity and parity, as well as any complications (during birth and in the immediate post-delivery period) in both parent and child. RESULTS: Twenty-three patients presented to our emergency department with labour contractions, and 14 progressed to vaginal deliveries. Twelve were single mothers who had hidden their pregnancies, while another 2 married patients had unsuspected pregnancies. No neonate needed resuscitation or airway support, but there were 4 patients without episiotomy who sustained perineal tears, and another 2 patients in whom the placenta could not be delivered. A child (born to a single mother without antenatal care) had a low Apgar score, but improved with oxygen and suctioning. CONCLUSIONS: An emergency department in a non-obstetric hospital should have in place adequate preparations to cater for the occasional unexpected emergency delivery and the associated need for neonatal resuscitation. In our series, there was a high proportion of concealed (hidden) and "unaware" pregnancies presenting in labour. Prompt referral to a maternity hospital with neonatal care should be made for any complications.

Adolescent↗
PubMed2005

Availability and use of emergency obstetric care services in four districts of West Bengal, India.

Process indicators have been recommended for monitoring the availability and use of emergency obstetric care (EmOC) services. A health facility-based study was carried out in 2002 in four districts of West Bengal, India, to analyze these process indicators. Relevant records and registers for 2001 of all studied facilities in the districts were reviewed to collect data using a pre-designed schedule. The numbers of basic and comprehensive EmOC facilities were inadequate in all the four districts compared to the minimum acceptable level. Overall, 26.2% of estimated annual births took place in the EmOC facilities (ranged from 16.2% to 45.8% in 4 districts) against the required minimum of 15%. The rate of caesarean section calculated for all expected births in the population varied from 3.5% to 4.4% in the four districts with an overall rate of 4%, which is less than the minimum target of 5%. Only 29.9% of the estimated number of complications (which is 15% of all births) was managed in the EmOC facilities. The combined case-fatality rate in the basic/comprehensive EmOC facilities was 1.7%. Major obstetric complications contributed to 85.7% of maternal deaths, and pre-eclampsia/eclampsia was the most common cause. It can be concluded that all the process indicators, except proportion of deliveries in the EmOC facilities, were below the acceptable level. Certain priority measures, such as making facilities fully functional, effective referral and monitoring system, skill-based training, etc., are to be emphasized to improve the situation.

Cesarean Section↗
PubMedDate not supplied

[The prevention of urinary tract injuries in obstetrics].

The aim of this study was to warn young obstetricians of the traumatic injuries to the urinary tract in their daily practice. After a short description of the changes that occur in pregnancy and puerperium at the urinary tract, we present "details" of some methods in order to avoid the urethral, bladder and ureteral injuries during vaginal delivery and some obstetric procedures (caesarean section, hysterectomy). This article represents a small and useful guide for young obstetricians in order to avoid unpleasant situations that can occur in their obstetric practice.

Cesarean Section↗
PubMed2006

Is there gender bias toward male residents in an obstetrics and gynecology training program?

OBJECTIVE: To assess whether male obstetric and gynecologic residents experience gender bias in training for vaginal deliveries. STUDY DESIGN: We compared male and female resident training experiences in vaginal deliveries in a community hospital. Three analyses were performed: (1) total number of deliveries performed by male and female residents, (2) percentage of deliveries that male and female residents performed with female attendings, and (3) percentage of attending deliveries performed by male residents. The main outcome measure was whether male residents had limited training opportunities with female attendings as compared to female residents. RESULTS: There was no difference between male and female residents with regard to total deliveries performed per rotation. Male residents were as likely as female residents to participate in vaginal deliveries by a female attending. Conversely, female attendings were as likely as male attendings to have a male resident attend their patients' deliveries. CONCLUSION: There was no evidence of gender bias regarding male resident training opportunities in vaginal deliveries in an obstetric and gynecologic training program.

Delivery, Obstetric↗
PubMed1991

Charges for comprehensive obstetric care at teaching and nonteaching hospitals. A comparison.

We compared total charges for obstetric care at a major teaching hospital and faculty group practice with those at 3 nonteaching centers in western Washington. The patients were all enrollees of an employee-based health maintenance organization. Charges were used as a proxy for costs and included all outpatient, inpatient, and physician charges. In the teaching system, patients were cared for by faculty and house staff; in the nonteaching settings, they received care from private physicians. No significant differences in total charges were found between the teaching and the nonteaching settings for all deliveries ($4,652 [N = 90] versus $4,530 [N = 335], P greater than .5). In the teaching setting, vaginal deliveries were slightly more expensive ($4,178 [n = 75] versus $3,768 [n = 250], P = .15), as were cesarean deliveries ($7,024 [n = 15] versus $6,771 [n = 85], P greater than .5). The rate of cesarean deliveries was lower in the teaching setting (17% versus 25%, P = .10), partially accounting for the similarity in total charges. The length of stay was similar in the teaching hospital (3.29 versus 3.14 days, P greater than .5). We conclude that the academic medical center as a total system of care can provide obstetric care as cost-effectively as nonteaching systems under the constraints of prepaid care.

Cesarean Section↗
PubMedDate not supplied

Epidural anesthesia for obstetrics after spinal surgery.

The experience of 18 patients with previous spinal surgery who requested epidural anesthesia for obstetric pain was reviewed. Three received epidural anesthetics in two separate pregnancies, producing a total of 21 attempts at epidural anesthesia. All were initiated during labor and three were later extended for Cesarean delivery. Continuous lumbar epidural anesthesia was successfully established in 20 of 21 attempts. Ten were performed easily on the first attempt. There were excessive local anesthetic requirements and/or a patchy block for the remaining 11 attempts. The only complication that could be attributed to the attempts at epidural anesthesia was temporary low back pain in two patients with multiple attempts. No complications were noted on long-term follow-up. Our data, therefore, suggest that epidural anesthesia is safe and generally effective in obstetric patients with previous spinal surgery.

Analgesia, Epidural↗
PubMed1977

The effects of obstetrical medication on the behavior of Israeli newborn infants and some comparisons with Uruguayan and American infants.

The effects of obstetrical medication on neonatal behavior were studied using a sample of Israeli infants from medicated and nonmedicated mothers. Few significant behavioral differences were detected in the first month of life, and there was no difference in Bayley Infant Scale performance at 3 months of age. Comparative analyses using samples of American and Uruguayan infants and additional data from other studies of American newborns led to the conclusion that light levels of obstetrical medication do not appear to have significant effects on neonatal behavior. However, this may well be qualified by some initial population differences, by the measurements commonly used in the studies reviewed, and possibly by critical cutoff points dividing the levels of medication that will and will not affect neonatal behavior.

Analgesics, Opioid↗
PubMedDate not supplied

[The obstetrical bed KA-2].

An obstetric bed is intended for disposition of parturients during labor as well as for performing obstetric non-cavitary operations and manipulations. The new bed is equipped with a small table for a hand to do intravenous injections. It is also fitted out with a detachable pan representing a vessel stamped of stainless steel, designated for liquid collection and with a detachable step for the sake of convenience of parturients' disposition on the bed, which makes it possible to tilt the bed into Trendelenburg's position. The bed is convenient in handling, modern in appearance, enabling one to carry out wet sanitary treatment.

Equipment Design↗
PubMed1989

The relationship between assessed obstetric risk and maternal-perinatal outcome.

The relationship between antepartum risk assessment and subsequent maternal and perinatal outcome was examined in a retrospective study of 430 randomly selected deliveries at the Oregon Health Sciences University during the 1986 calendar year. Antepartum risk scores at the initial prenatal visit and at 37 weeks' gestation were positively correlated with each other. Antepartum risk scores were correlated with maternal length of stay and maternal hospital charges, but not with gestational age, birth weight, or Apgar scores. Increased intrapartum risk scores were strongly correlated with increasing length of stay for mother and baby, lower birth weight, and lower estimated gestational age at birth. The ability of the risk-scoring system to predict selected adverse outcomes was then assessed using a high-risk cutoff score of 5 or greater. Sensitivity and positive predictive value were found to be quite low while specificity and negative predictive value were reasonably high. The results suggest that the risk-scoring system used at this institution is effective in identifying low obstetrical risk and that prenatal care reduces the probability of poor neonatal outcome among infants of women at high obstetrical risk identified through antepartum multivariate assessment. Two antepartum risk assessments, each measuring different factors, may be redundant. Not yet known are which specific factors by their identification result in more effective prenatal care.

Delivery, Obstetric↗
PubMed1989

Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study.

To determine the relation of family physician or specialist care to intrapartum interventions and outcomes, we carried out a historical cohort study of 1456 obstetric patients at low risk admitted between Nov. 15, 1984, and Mar. 15, 1986, to a western Canadian teaching hospital. The patients were classified as being at low risk on admission by means of chart review. Family physicians and specialists were found to have similar rates for most of the interventions measured, although the interventions for which significantly different rates were found suggest a less interventionist style of intrapartum care by family physicians. There were no significant differences in maternal or neonatal outcomes except for a higher proportion of infants weighing less than 2500 g among primigravid women cared for by family physicians compared with those under the care of specialists. Self-selection of physician specialty by patients resulted in differences in the demographic characteristics of the two patient populations. The findings support the continued involvement of family physicians in the provision of obstetric care.

Adolescent↗
PubMed1986

[10 years' obstetric medicine at a district hospital. Methods and results].

Between July 1st, 1975 and June 30th, 1985 9669 deliveries seen were evaluated according to parameters of obstetric efficiency, particular risk factors, perinatological proceedings including a trend analysis. A significant diminuation of perinatal mortality and morbidity could be registered. Since there has been an obvious augmentation of cases with higher obstetrical risks in the time mentioned, these results may be underlined positively. After all, the high taint of the results by preterm deliveries still remains an unsolved problem.

Austria↗
PubMed1986

Obstetric brachial plexus palsy.

This article supplies data related to 11 operated children with obstetric brachial plexus palsy. Discussion of the obstetric background, pathology, pre- and postsurgical testing and of primary and secondary surgical reconstruction also is given. The need for rehabilitation regimen is stressed.

Brachial Plexus↗
PubMed1986

Obstetric and gynecologic problems in women with chondrodystrophies.

Despite the growing body of knowledge on the natural history of various chondrodystrophies, little is known of the associated obstetric and gynecologic problems. The authors have surveyed by questionnaire 150 women with chondrodystrophies after a request by the women of Little People of America and Little People of Canada that a survey of their members be carried out. It was found that some obstetric and gynecologic problems are common to all women with short stature. There is an increased incidence of menstrual complications, problems with certain methods of contraception, and evidence of reduced fertility. In addition, delivery should almost always be by cesarean section under general anesthesia. There are, however, some unique complications in specific chondrodystrophies in the present study group. Women with achondroplasia have premature menopause and an increased incidence of leiomyomata; women with osteogenesis imperfecta have late menarche; and women with pseudoachondroplasia and cartilage hair hypoplasia have long menstrual cycles.

Adolescent↗
PubMed1985

[Peridural obstetrical analgesia using an electronic syringe].

The authors present a study of 20 cases of epidural obstetrical analgesia. A Bupivacaine-Fentanyl mixture was given by continuous flow to bring about this analgesia. After an initial injection of 10 ml (9 ml of 0.25% Bupivacaine and 0.05 mg Fentanyl), a mixture of 45 ml of 0.25% Bupivacaine and 0.25 mg Fentanyl was perfused into the epidural space using an electronic pump syringe, delivering at a rate of 5 ml/hr. The mean time of analgesia until the delivery is 4 h 40 mn and the women in labour received a mean of 31.14 ml of 0.25% Bupivacaine (77.85 mg) and 0.173 mg Fentanyl. It took only 5 1/2 minutes to set up this form of analgesia. Not a single patient had any pain the first stage of labour nor in the second stage, and 95% of them were able to push efficiently. There are no detectable changes in the haemodynamic parameters in either the mothers or the fetuses and no depression of maternal respiration was found. In each case the Apgar score was 10 after 5 minutes. In summary, the use of an electronic pump syringe to deliver a Bupivacaine-Fentanyl mixture in obstetrical labour is a great improvement in analgesia without any secondary effects in the mother and child.

Adult↗
PubMed1978

Obstetric, neonatal, and psychosocial outcome of pregnant adolescents.

Obstetric, neonatal, and psychosocial outcomes were compared for 82 matched adolescents who had been pregnant, been delivered of an infant, and received health care in three sites in Rochester, New York. There were no major differences in obstetric and neonatal outcome of adolescents and their babies according to health site. Differences in outcome were expected in the psychosocial area where a specialized maternity project (Rochester Adolescent Maternity Project [RAMP]) offered more services. On follow-up two years later, school attendance and reliance on full or partial assistance were similar. Repeated pregnancy and postpartum use of contraception favored RAMP.

Adolescent↗
PubMed1984

[Effect of pregnancy and delivery on the function of the cervico-urethral closure. II. Retrospective study on late consequences of obstetrical trauma].

Adding together the obstetric histories and the urodynamic investigations carried out on 178 incontinent women has made it possible for the authors to work out the role that obstetric trauma can play in urinary symptoms. They are able to demonstrate the effects of repeated normal deliveries and also the results of traumata over and above those that occur physiologically and are sometimes undergone by the perineum.

Adult↗
PubMed1981

Obstetric retrospect.

A series of 818 consecutive obstetric patients in a general practice between 1946 and 1970 is analysed in detail. The findings are discussed in relation to other studies from general practice and to current obstetric hospital practice.

Adolescent↗