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PubMed1979

Screening for alcohol-related problems in an outpatient obstetric-gynecologic clinic.

Three methods of screening for alcohol-related problems were tested in 499 to 565 consecutive patients in an obstetric-gynecologic outpatient clinic. The methods included a 31 item self-administered questionnaire, a six-item physician-administered questionnaire, and a blood alcohol test. Medical records were reviewed for mention of conditions sometimes associated with alcohol use. Sixteen percent of the women were heavy drinkers, and 18% were found on screening to be probable or potential problem drinkers. In women under age 40 years heavy drinking was associated with a higher incidence of physical problems sometimes associated with excessive alcohol use, and significantly lower birth weights were observed in infants born to obstetric patients who were positive on screening for alcohol-related problems.

Adolescent↗
PubMed1980

The relationship of maternal attitude to pregnancy outcomes and obstetric complications. A cohort study of unwanted pregnancy.

The relationships of maternal attitude to pregnancy outcome and obstetric complications were investigated in a prospective study of a group of 8,000 gravidas, enrolled in the Child Health and Development Studies, who were members of the Kaiser Foundation Health Plan in the San Francisco East Bay Area. Interviews which were conducted early in pregnancy determined the mother's attitude through an open-ended question, "How do you feel about having a baby now?" The responses to this question were categorized as strongly favorable, ambivalent, or negative. Biomedical factors which were related to negative maternal attitude were perinatal death, congenital anomalies, and postpartum infection or hemorrhage. Other factors which were found to be related to maternal attitude toward pregnancy were clinic visits for psychosocial complaints related to anxiety states, and accidental injuries during pregnancy, as well as need for analgesics during labor. Birth weight of the infant, duration of gestation, length of labor, prenatal complications, and intrapartum obstetric complications were not related to maternal attitude. In order to control for the effect of confounding factors, these relationships were analyzed by using a multicontingency table approach and stratifying the data by parity, age of mother, and socioeconomic status.

Adolescent↗
PubMed1983

Survey of men and women residents entering United States obstetrics and gynecology programs in 1981.

In July 1981, questionnaires were distributed to 1,128 residents entering the field of obstetrics and gynecology throughout the United States; 546 (48%) were returned and evaluated, 229 from women (42%) and 317 from men (58%). Factors that related to the choice of the specialty showed a universal interest in the birthing process and the surgical aspects of the specialty, with a large majority also interested in health education, endocrinology, primary care of young people, and achievement of a greater understanding of sexuality. Private partnership practice was favored by most of the respondents. Men attributed a greater importance to income than did women, who were more interested in a salaried practice and less irregularity of hours. Women tended to be more liberal on questions that were related to controversial medical and ethical issues in the field of obstetrics and gynecology. Role models, half of whom were teachers, were equally common to men and women (66%).

Adult↗
PubMed1983

Isolation guidelines for obstetric patients and newborn infants.

Available isolation guidelines for use in hospitals have often overlooked the infectious diseases and unique interactions of obstetric patients and their newborn infants. To help fill this void, we present our hospital's isolation policies for obstetric and neonatal patients and guidelines for maternal-infant contact and breast-feeding. These policies represent a multidisciplinary consensus of opinion and available epidemiologic data and have been found useful and practical in a single large teaching hospital. Other institutions should be able to adapt these guidelines to their own patient populations, personnel, and physical facilities.

Breast Feeding↗
PubMed1987

The role of gender in an obstetrics and gynecology residency program.

A brief historical review of the role of female medical students and female physicians in American medicine is presented. The 1985-1986 Council on Resident Education in Obstetrics and Gynecology Residency Data Bank was analyzed for gender distribution. Questionnaire studies were undertaken to study the possible effect of the increasing number of female residents in an obstetrics and gynecology residency program. Queries were sent to current and former residents, the attending staff, and the nursing and anesthesiology staffs. In order to evaluate the national scene, letters were mailed to directors of programs with 20 or more residents. The overall results indicated female residents have a positive effect on residency training.

Female↗
PubMed1990

A reappraisal of the need for autologous blood donation in the obstetric patient.

There has been recent interest in autologous blood donation in obstetric patients, but little attention has been paid to whether such programs are needed or whether the patients that will require transfusion can be accurately predicted. At the University of California San Diego Medical Center from July 1 to Dec. 31, 1988, there were 2265 deliveries; 13 women (0.57%) received blood transfusions. Traditionally accepted risk factors were identified in 251 patients, with only four (1.6%) requiring transfusion. Among the 150 patients delivered by repeat cesarean section, only one (0.7%) required blood. one of 27 (3.7%) multiple gestations, two of eight (25%) patients with placenta previa, and none of the 66 grandmultiparous women had transfusions. These data suggest that autologous blood donation may not be beneficial or cost effective when the low frequency of blood transfusions in this high-risk obstetric population and the difficulty in accurately predicting those likely to require transfusions are considered.

Blood Donors↗
PubMed1990

Treatment in an obstetric intensive care unit.

A three-bed intensive care unit was opened in the labor and delivery area of a city-county hospital having approximately 7500 deliveries annually. The utilization rate of 0.9% and the severity of illness were sufficient to justify such a unit. Main indications for admission were hypertensive disorders (46%), massive hemorrhage (10%), and medical problems of pregnancy (44%). Identifiable benefits of the unit were as follows: (1) Intensive observation and organization allowed for prevention of early recognition and treatment of complications; (2) familiarity with invasive monitoring permitted personnel to exert prompt, rational treatment of hemodynamically unstable patients; (3) continuity of care was improved before and after delivery; (4) residents and fellows learned a great deal about intensive care and the management of rare medical complications of pregnancy. We conclude not only that critically ill pregnant women can be managed successfully in an obstetric intensive care unit but also that critical care is a bona fide part of obstetric practice and has been incorporated into our training program.

Clinical Competence↗
PubMed1992

Emergency room use of transvaginal ultrasonography by obstetrics and gynecology residents.

OBJECTIVE: The objective of this study was to evaluate the feasibility and diagnostic value of the emergency room use of transvaginal ultrasonography operated by the obstetrics and gynecology residents. STUDY DESIGN: One hundred sixty-eight patients scanned in the emergency room constituted the study group and were compared with 61 patients for whom emergency room scanning was not available. Scanning and no-scanning days alternated for a 6-month period. The Student t test was used in the analysis. RESULTS: By comparing the two patient groups a statistically significant (p less than 0.0001) difference was seen in the time spent by the group of patients scanned in the emergency room (40 minutes) when compared with that of the patients for whom no emergency room scanning was available (215 minutes). The residents expressed high confidence in the scanning procedure. There were six misdiagnosed cases, three of them nonruptured ectopic gestations. However, none of these patients was discharged without adequate treatment. CONCLUSION: The study confirmed our hypothesis that obstetrics and gynecology residents can operate and should have available ultrasonography machines in the emergency departments to render quicker and better patient care.

Education, Medical, Continuing↗
PubMed1993

Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients.

OBJECTIVE: We compared the use of aspirin alone with combined therapy (prednisone plus aspirin) in antiphospholipid antibody-positive obstetric patients with prior adverse pregnancy outcome. STUDY DESIGN: Thirty-nine patients meeting specific laboratory and clinical inclusion criteria were randomized to receive either combined therapy (prednisone plus low-dose aspirin, n = 17) or aspirin alone (n = 22). The daily aspirin dose was 81 mg; prednisone was begun at 20 mg/day and increased or decreased on the basis of observed changes in serial antibody levels. Perinatal outcomes were compared between groups. Evaluation of treatment-related maternal complications and serial antibody titers was also accomplished. RESULTS: Thirty-four randomized subjects were evaluable (prednisone plus low-dose aspirin, n = 12 vs aspirin only, n = 22); no perinatal losses were observed in the study cohort. Preterm delivery was experienced by significantly more patients receiving prednisone plus low-dose aspirin than aspirin only (8/12 vs 3/22, respectively; p = 0.003), and prednisone exposure appeared to be an independent risk factor for preterm birth. CONCLUSIONS: The use of prednisone therapy in conjunction with low-dose aspirin does not appear to improve outcome and may provoke obstetric complications in antiphospholipid antibody-positive patients.

Adult↗
PubMed1994

Trends in an obstetric patient population: an eighteen-year study.

OBJECTIVE: Our goal was to evaluate various trends including gestational age, birth weight, and mode of delivery in an inner-city obstetric patient population delivered at a tertiary medical center. STUDY DESIGN: We used an 18-year computerized perinatal database collected prospectively since 1975 in an inner-city tertiary medical center. More than 63,500 deliveries from 1975 through 1992 were evaluated. Trends in gestational age, birth weight, and mode of delivery were investigated with Cox-Stuart, regression, and other trend analysis methods. RESULTS: The number of deliveries increased from 2682 in 1975 to 4740 in 1991, an increase of 77%. The median maternal age has increased from 20 years in 1975 to 23 years in 1992 (p < 0.001). Overall, the mean gestational age has declined monotonically from 39.2 +/- 2.84 weeks in 1975 to 38.3 +/- 3.17 weeks in 1992 (p = 0.057). While the median and lower percentiles of birth weight for singleton births have declined, the 75th and higher percentiles of birth weight have increased during 18 years. Overall, the proportion of preterm births (< 37 completed weeks gestational age) has increased from 3.3% in 1975 to 7.8% in 1991 (p < 0.001). During this period the proportion of low-birth-weight infants (< 2,500 gm) increased significantly from 12.7% to 17.3% (p < 0.001). The proportion of cesarean section deliveries for private patients has declined from 37% in 1975 to 25% in 1992 (p = 0.025), while this proportion has increased monotonically for staff patients from 10% to 17% during this period (p < 0.001). CONCLUSIONS: Considering the large size of the database and diverse background of the study population, we believe that these trends can provide a realistic characterization of an obstetric patient population for a large inner-city urban population.

Adolescent↗
PubMed1995

Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum alpha-fetoprotein levels.

OBJECTIVE: We hypothesized that in pregnancies complicated by unexplained elevations of maternal serum alpha-fetoprotein, second-trimester uterine artery Doppler findings would detect adverse obstetric outcomes. STUDY DESIGN: One hundred three subjects with unexplained elevations of maternal serum alpha-fetoprotein had uterine artery Doppler velocimetry studies performed at the time of targeted ultrasonographic examination (17 to 22 weeks). A resistance index > 95th percentile or the presence of a uterine notch was considered abnormal. Adverse outcomes included preeclampsia, preterm birth, low birth weight, intrauterine growth restriction, abruptio placentae, and fetal death. Statistical analysis was performed by Student t test, chi 2 analysis, and stepwise logistic regression analysis. RESULTS: An elevated uterine resistance index was associated with an increased relative risk for both preeclampsia (relative risk 41.82, 95% confidence interval 5.36 to 326.13) and low birth weight (relative risk 4.65, 95% confidence interval 1.90 to 11.39). A uterine artery notch was associated with an increased risk of preeclampsia (relative risk 52.22, 95% confidence interval 6.82 to 399.70), preterm birth (relative risk 3.21, 95% confidence interval 1.32 to 7.81), and low birth weight (relative risk 4.18, 95% confidence interval 1.64 to 10.66). When the presence of a uterine notch, vaginal bleeding, and level of maternal serum AFP were analyzed by stepwise logistic regression, the presence of a notch was found to be the only significant factor (odds ratio 6.95, 95% confidence interval 1.24 to 39.10) for the development of an adverse outcome. CONCLUSIONS: Abnormal uterine artery Doppler findings are associated with an increased frequency of adverse obstetric outcomes in women with unexplained elevated maternal serum AFP levels. Abnormal Doppler findings demonstrated high sensitivity for the development of preeclampsia but were less sensitive in predicting other outcomes. The presence of a uterine artery notch is a better independent predictor of adverse outcome than are early vaginal bleeding or maternal serum AFP level.

Adult↗
PubMed1995

Primary and preventive care in a university obstetrics and gynecology group practice.

OBJECTIVE: Our purpose was to determine whether primary and preventive care is practiced by a university obstetrician-gynecologist group practice. STUDY DESIGN: A retrospective chart review spanning 2 years of four academic physicians' private practices was performed. A total of 335 patients were reviewed with 739 patient encounters and 1032 patient problems identified. The definition of a primary care physician according to The American College of Obstetricians and Gynecologists was used to standardize data collection and evaluation. RESULTS: Obstetric complaints accounted for 27.7% of all visits, whereas 65.4% were for gynecologic problems. Almost 7% of all complaints were neither obstetric nor gynecologic, and of those 74.6% were primary care problems completely managed by the obstetrician-gynecologist. Only 19.7% of these were referred for management. More than 89% of all encounters (659/739) involved some element of primary care. CONCLUSION: This study provides evidence that the majority of health care provided by the obstetrician-gynecologist is primary care.

Adolescent↗
PubMed1987

Re-evaluation of the obstetrical risk for the older primipara.

The obstetric data relating to 92 older primiparas (OP) treated as regular obstetric patients and data relating to 92 older multiparas (OM) are compared to a previous study of 98 OP, which led to the conclusion that OP should not be managed as high-risk patients during gestation. No difference was found between the two periods regarding complications of pregnancy, gestational age and birth weight, onset of labor, perinatal morbidity and mortality. Nevertheless, cesarean deliveries were significantly higher in the study group. It seems that the conservative attitude towards OP during pregnancy is justified, but at labor, more rigid indications for cesarean section should be applied to establish objective patient care.

Adult↗
PubMed1982

Elective fetal monitoring and obstetrical operative frequency.

This paper reports on cardiotocographic findings after the introduction of elective fetal monitoring. A classification into the following four groups is recommended: normal, warning, severe functional hemodynamic disorders (SFHD) and hypoxia. This fetal heart frequency (FHF) classification prefers the evaluation of the effects on fetal condition compared with a descriptive classification. SFHD in the first stage of labor can be observed in 4% of parturient women, increasing to nearly 16% in the second stage. Cesarean section rate in this group amounts to 12.5% and forceps rate exceeds 50%. Under the condition of elective fetal monitoring (94% in total) and a reserved application of cesarean section (4.3% in total) and generous forceps delivery (15% in total) a perinatal mortality rate of 13% for obstetrical material with high-risk concentration is achieved. The total acidosis rate (pH less than 7.20) decreases to 2.3%, whereas the rate of severe acidosis (pH less than 7.10) was observed in only 0.4% of the cases. With elective fetal monitoring a low cesarean section rate taking critical evaluation into consideration and using all conservative methods of treatment is obtained. By means of the generous application of the single or repeated bolus injection of 25 micrograms fenoterol and the operative shortening of the second stage of labor in the case of SFHD, the neonatal morbidity can be kept at a low level. The small number of fetal or maternal complications using the direct methods of fetal supervision and the careful operative termination of labor justifies the recommended obstetrical management.

Cesarean Section↗
PubMed1991

Undergraduate education and recruitment in obstetrics and gynaecology.

The extent and quality of exposure to obstetrics and gynaecology that is required in the undergraduate curriculum has bearing on the knowledge, clinical skills and behaviour that are expected from the student. How much involvement should clinical obstetricians and gynaecologists have in teaching human reproduction and basic physiology and related science to the undergraduate? Who should teach sexual medicine? What is the extent of practical experience which students should have? Should the student have an opportunity to study a particular area in the discipline at depth in order to encourage interest and involvement and thereby facilitate recruitment? These issues are being addressed in curricular changes in Manchester, and option teaching is considered to have the potential of enhancing interest in obstetrics and gynaecology as a definitive career.

Curriculum↗
PubMed1995

Obstetrical prognosis for carbon dioxide laser conisation of the uterine cervix.

Carbon dioxide laser conisation is a very reliable surgical technique for cervical intraepithelial dysplasia. As cervical morphology and function are better preserved than with other techniques, obstetrical morbidity should be lower in the often young and pauciparous women who undergo this procedure. In our study comparing the course of 71 pregnancies (55 children) in 54 operated women with that of 82 pregnancies (59 children) in these same women before conisation, the rates for complications at the beginning of pregnancy were similar (respectively, 14.1% and 13.4%, early spontaneous abortions; 2.8% and 2.4%, extrauterine pregnancies; and no late spontaneous abortions). The increased risks of premature delivery (13.2% vs. 8.5%), chorioamnionitis (1.9% vs. 0%), premature rupture of membranes (1.9% vs. 0%) and prematurity (11.3% vs. 1.7%) were not statistically significant. Only the percentage of natural term births was significantly reduced (73.6% vs. 90%; P = 0.025), but this difference was no longer apparent after correction for the prevalence of associated obstetrical pathologies and prematurity and/or cesarean factors which was significantly greater for the 53 pregnancies that developed after carbon dioxide laser conisation.

Abortion, Spontaneous↗
PubMed1995

Adolescent gynecology and obstetrics.

Adolescent gynecology is a subspeciality of obstetrics and gynecology and not broadly known. It deals with many gynecological and obstetrical problems which may be seen during adolescence. The International Federation of Pediatric and Adolescent Gynecology is a branch of FIGO and promotes research and teaching programs on pediatric and adolescent gynecology. Health care professionals should address sex education programs providing accurate information to young people on sexual matters. Prevention of gynecological diseases, undesired pregnancies and sexually transmitted diseases are the goals of physicians working in adolescent gynecology.

Adolescent↗
PubMed1995

Current trends in obstetric and gynecologic academic faculty manpower.

Five prior academic manpower studies were completed by ACOG and the Association of Professors of Gynecology and Obstetrics in 1977-1990. In the current survey, a similar questionnaire was sent to the 130 accredited medical school departments of obstetrics-gynecology; 127 responded. The mean number of full-time faculty members per department is 25.8, an increase of 14% over the last 4 years. Among faculty, women constitute 30.4%, an increase of five percentage points since 1990. Certified subspecialists on faculties have increased 27% in the last 4 years, but decreasing percentages of all subspecialists are in faculty positions compared with private practice settings. Chairmen remain optimistic about continued faculty growth despite the inroads of managed care.

Faculty, Medical↗