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PubMed1996

Answers to applicant selection from a directory of residency programs in obstetrics and gynecology.

OBJECTIVE: To answer six questions applicants commonly ask of programs, using the data base of a directory of residency programs in obstetrics and gynecology. METHODS: We analyzed data from a directory of 258 civilian residency programs in the United States compiled from a 1994-1995 survey. We expanded the analysis to compare small and large residency programs on the six questions. RESULTS: The average-size program of four residents per year received 50 applications for each position, offered interviews to less than a third of its applicants, and interviewed 15 applicants for each position. An interview gives an applicant a 7% chance of matching with a program. Small programs (fewer than four residents per year) interviewed more of their applicants than did large programs. Programs reported that their residents' scores on part I ranged from the 25th to the 90th percentile, and on part II from the 38th to the 92nd percentile. In general, residents in large programs scored better on these tests than did residents in small programs. Most programs (74%) considered electives beneficial in obtaining a residency position and reported a higher percentage of elective takers than programs without this policy. One in four residents in a program either took a senior elective there, graduated from the same institution, or both. Residents from programs offering fellowship training were twice as likely to pursue fellowship training than residents from programs with no fellowships. Large programs were four times more likely to sponsor fellowships than were small programs. CONCLUSION: Getting an interview in a residency program is a major accomplishment, whereas becoming known in a program may improve the applicant's odds of matching there. Applicants should review a program's policy on electives and selection record. Those considering fellowships should probably apply to programs that offer them. The directory offers a valuable data source for comparing residency programs in obstetrics and gynecology.

Directories as Topic↗
PubMed1985

An obstetric microcomputer information system.

A systems analysis has been done to determine how computer technology can provide an information system to improve the care of the mother and her baby. A minimum data base was established complying with the recommendations of the Körner Committee and designed to meet the needs of the health personnel looking after the mother and baby. An ICL DRS 20/50 network of four microcomputers has been installed in the obstetric unit of a district teaching hospital with a link to the regional mainframe. There have been no significant software or hardware faults since the system became fully operational in January 1984. All women are registered on the system at their first visit allowing the pregnancy to be followed prospectively. Subsequently midwives enter data on line at delivery and at discharge. The on line validation and range checks improves the accuracy of the data allowing a reliable perinatal audit to be obtained routinely. The system has been accepted by the staff since much of the routine pregnancy documentation is produced automatically. This includes booking letters and summaries for general practitioners, admission slips, birth notification forms, registers and forms for the community midwives and health visitors. Immediate production of reports for community health staff allows better communication and improved patient care. No additional staff are needed in the obstetric unit and one job which was mainly of a clerical nature has been saved and the salary transferred to provide one more midwife for the postnatal wards.(ABSTRACT TRUNCATED AT 250 WORDS)

Computers↗
PubMed1991

Obstetrical brachial plexus lesions.

The renewal of interest in brachial plexus surgery has been led by the success of microsurgical techniques in other peripheral nerve repairs. The results in adults remain poor, but in obstetrical palsy the regenerative capacity of babies allows for dramatic recovery after nerve repair or reconstruction. Obstetrical brachial plexus injuries represent a unique group with similar aetiology, age and prognosis.

Birth Injuries↗
PubMed1995

Provider-associated factors in obstetric interventions.

OBJECTIVE: To assess which factors influence provider-associated differences in obstetric interventions. STUDY DESIGN: A survey of obstetricians and co-workers in a sample consisting of 38 Dutch hospitals was taken, using a questionnaire that contained questions about personal and hospital-policy data, and 19 clinical problems with a choice between intervention and non-intervention. From the clinical problems an Intervention Score was assembled. The influence of the personal and hospital-policy items on this Intervention Score was studied by analysis of variance. RESULTS: Overall the Intervention Score was low, with considerable interindividual variation. Four personal/hospital items influenced the Intervention Score: the teacher could affect the score in either direction; the increasing age of the obstetrician and routine electronic fetal monitoring had an increasing effect; employment of midwives had a decreasing effect. Other factors, including litigation, had no effect. CONCLUSION: Supplier-induced differences do exist in obstetric interventions and are influenced by personal and hospital-policy factors.

Adult↗
PubMed1995

In situ human obstetrical ultrasound exposimetry: estimates of derating factors for each of three different tissue models.

A specialized in vivo exposimetry system was developed to acquire transabdominal in situ ultrasound exposure quantities in obstetric patients. Under surgical conditions, the sterilized 7-element calibrated linear array hydrophone was introduced into the uterus under direct ultrasound guidance and placed in direct contact with the products of conception, usually in the saggital midplane of the uterine cavity. Twenty-five patients with empty bladders and 10 patients with full bladders were studied at gestational ages between 7 and 20 weeks. In the empty bladder condition, the sound beam traversed the anterior abdominal wall, uterus, amniotic fluid and fetal parts and in the full bladder condition, the sound beam also traversed the fluid-filled bladder. Each study was conducted with a 3 MHz, mechanical sector transducer in combination with an ATL Ultramark 4 diagnostic ultrasound imaging system. Calibration data were recorded after completion of each in vivo patient study. The acquired exposimetry data from the 35 obstetric patients were used to evaluate the appropriateness of three tissue attenuation models, viz., fixed path, homogeneous and overlying. All three tissue models yield a mean attenuation coefficient value of about a factor of 3 to 4 greater than their respective minimum values. In the case of the overlying and homogeneous tissue models, there was a statistically significant correlation between their calculated attenuation coefficients and total distance for the combined data set whereas there was no such dependency for the calculated fixed-path tissue model. In summary, any one of the three tissue models may be used to estimate in utero acoustic quantities during the first and second trimesters of human pregnancy based on this study.

Adult↗
PubMed1994

Patient-controlled epidural analgesia in obstetric anaesthetic practice.

A randomised single-blind controlled study was made of 60 patients to evaluate the effectiveness of epidural patient-controlled analgesia (PCA) device for obstetric management compared with a continuous infusion system. In both cases 0.125% plain bupivacaine was used. It was found that epidural PCA is at least as effective as an infusion system in producing analgesia and has the advantages of increased satisfaction and reduction of local anaesthetic requirement. Whether there are also advantages resulting from less obstetric intervention at delivery has not been proven.

Analgesia, Epidural↗
PubMedDate not supplied

Postgraduate education in ultrasound diagnosis in obstetrics and gynaecology in Sweden.

The Swedish Society of Obstetrics and Gynaecology has set up principles for systematic postgraduate education in ultrasonography in obstetrics and gynaecology. The education is available at three levels: (1) a basic course; (2) an advanced course; and (3) special courses. The subjects included in each course are described. It is expected that this programme of formal education will lead to improvement in the Swedish gynaecologists' knowledge of ultrasonography.

Education, Medical, Continuing↗
PubMed1995

Obstetric complications and severity of illness in schizophrenia.

A history of obstetric complications (OCs) is common in schizophrenia and may lead to a severe form of the disorder. In order to test this possibility, three questions were identified: (1) Is a history of OCs in schizophrenia common in patients with a severe form of illness? (2) Do patients with OCs have more impaired function, greater severity of illness, and poorer treatment outcome than those with no identified OCs? (3) Are OCs associated with an early age at onset of illness? Obstetric history, clinical indices of functioning, and illness severity were obtained for 83 severely ill patients with schizophrenia. The proportion of patients with a history of OCs was greater in this study than has been reported previously. Subjects with a history of OCs had better functioning than those with no OCs at the time of admission but no group differences were found at discharge. No difference in age at onset of illness was found between patients with and without an OC history.

Activities of Daily Living↗
PubMedDate not supplied

The cardiac, obstetric, and anesthetic management of pregnancy complicated by acute myocardial infarction.

Myocardial infarction (MI) occurring during pregnancy is a rare but potentially lethal event for both mother and fetus, particularly when it occurs in the third trimester or peripartum period. The authors report two cases of MI occurring in the third trimester of pregnancy and review the literature. Management of the acute infarct and the medical, obstetric, and anesthetic considerations in such patients during labor and delivery are discussed. Successful use of percutaneous transluminal coronary angioplasty is described in a patient with evolving MI and ongoing pain. The preferred method of delivery in the pregnant MI patient is addressed, with emphasis on the need for individualization of care and coordination between the cardiac, obstetric, and anesthetic teams. Finally, the authors review the risks of subsequent pregnancy in this patient population.

Adult↗
PubMed2004

Epilepsy and pregnancy: an obstetric perspective.

OBJECTIVE: The purpose of this study was to determine the obstetric and neonatal outcomes of women with prepregnancy diagnoses of epilepsy. STUDY DESIGN: This was a cohort study of women with epilepsy (n=414 women) who were delivered in a tertiary referral center (1978-2000). Outcomes were compared with women who did not have epilepsy (n=81,759 women) who were delivered during the same period, with the use of t tests or contingency table analyses. RESULTS: Comparison showed increased rates of nonproteinuric hypertension (P<.05), induction of labor (P<.001), and fetal cardiovascular malformations (P<.001) among women with epilepsy. Rates of other antenatal, intrapartum, and neonatal complications and congenital malformations were similar to those of control subjects. There were fewer instrumental vaginal deliveries. There were no live births with neural tube defects. The occurrence of major antepartum seizures did not increase the rate of adverse outcomes significantly. Major congenital malformations increased in proportion to the number of anticonvulsants that were prescribed. CONCLUSION: Women with epilepsy are not at increased risk for obstetric complications, provided that appropriate care is available during preconception, pregnancy, labor, delivery, and after delivery.

Abnormalities, Drug-Induced↗
PubMed2004

Variation in medical student grading criteria: a survey of clerkships in obstetrics and gynecology.

OBJECTIVE: Our purpose was to assess how obstetrics/gynecology clerkships incorporate methods of student assessment into grades. STUDY DESIGN: A survey that included a broad range of assessment methods was distributed to obstetrics/gynecology clerkship directors registered with the Association of Professors of Gynecology and Obstetrics. Respondents were asked to indicate the methods used for assessment and to indicate the weight assigned to these methods in determining a student grade. RESULTS: Of the 146 surveys distributed, there were 53 respondents (36.4%). The most common methods of subjective assessment included evaluation of patient presentation skills and performance on ward rounds. The 2 most commonly used objective methods, general assessment of cognitive knowledge and the National Board of Medical Examiners Subject Examination in Obstetrics and Gynecology, generally accounted for 75% of the final grade, although these same 2 components also had the widest range of assigned weights reported. CONCLUSION: Assessment methods and incorporation into a final grade vary widely across obstetrics/gynecology clerkships.

Adult↗
PubMed2004

The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria.

OBJECTIVE: The purpose of this study was to describe the characteristics of women with obstetric vesicovaginal fistulas at a hospital in north central Nigeria. STUDY DESIGN: A retrospective record review was conducted of all women who were seen with vesicovaginal fistulas at Evangel Hospital in Jos, Plateau State, Nigeria, between January 1992 and June 1999. RESULTS: A total of 932 fistula cases were identified, of which 899 cases (96.5%) were associated temporally with labor and delivery. The "typical patient" was small and short (44 kg and <150 cm); had been married early (15.5 years) but was now divorced or separated; was uneducated, poor, and from a rural area; had developed her fistula as a primigravida during a labor that lasted at least 2 days and which resulted in a stillborn fetus. CONCLUSION: Obstetric vesicovaginal fistula is extremely common in north central Nigeria. A complex interaction that involves multiple biologic and socioeconomic factors appears to predispose young women to this devastating childbirth injury.

Adolescent↗
PubMed2005

Board certification in obstetrics and gynecology: associations with physicians' demographics and performances during medical school.

OBJECTIVE: This study was undertaken to investigate the relationship of demographics, medical school performance, and licensing examination scores to board certification. STUDY DESIGN: A longitudinal follow-up study of graduates of Jefferson Medical College between 1968 and 1994 identified in the AMA Physicians' Professional Data (AMA-PPD) file as practicing obstetrics and gynecology in 2003. Demographics, grades, and licensing examination scores had been collected prospectively. Board certification status was obtained from the AMA-PPD in 2003. Bivariate differences were evaluated with t tests. Logistic regression was used to evaluate multivariate relationships to board certification status. RESULTS: Of 310 physicians in obstetrics and gynecology, 291 (94%) were board certified. Those without certification were more likely to be underrepresented minorities, to have been older in medical school, and to have weaker academic records. Logistic regression indicated that scores on step 2 of the United States Medical Licensing Examination were the single most important predictor of achieving board certification. Those with scores of 200 or higher were 7 times more likely to achieve certification than those below 200. CONCLUSION: Age, gender, and minority status are not independent predictors of achieving board certification. A low score on United States Medical Licensing Examination step 2 is a risk factor for not achieving certification.

Adult↗
PubMed2005

Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up.

OBJECTIVES: This study was undertaken to evaluate the advantages and disadvantages of a program of early obstetric-pediatric discharge (24 hours postpartum) with domiciliary follow-up, compared with the traditional postpartum hospital stay (more than 48 hours), according to the criteria described by reviewers of the subject. STUDY DESIGN: A randomized controlled trial of early obstetric discharge for healthy mothers and term infants, with postpartum randomization, with no prenatal preparation and with observational and clinical follow-up was performed. The participants were mothers with healthy, term neonates (37-42 weeks) weighing more than 2500 g and produced via vaginal delivery and with a verified normal evolution before discharge. The sample consisted of 430 cases (213 cases with early discharge, and 217 control cases) in which the following variables were evaluated: existence of complications in the mother and/or child that required rehospitalization or a medical consultation, existence of maternal problems of fatigue or anxiety/depression after the birth, continuity of lactation and its problems, satisfaction of the mother and family, and relative costs. CONCLUSION: After demonstrating the homogeneity of the groups, no significant differences were found in the rates of maternal rehospitalization (1.9% in the early discharge group vs 2.3% in the control group, relative risk 0.81, 95% CI 0.21-3.03) or in the rates of rehospitalization of the neonates (1.4% in the early discharge group vs 2.3% in the control group, relative risk 0.16, 95% CI 0.15-2.56). No increases were observed in maternal or neonatal disease, puerperal fatigue, or maternal anxiety/depression. A prolongation of maternal lactation to 3 months was observed in the early discharge group (P=.016 <.05 Fisher exact test). When the cost of early discharge is compared with that of traditional discharge with a minimum of 48 hours hospital stay, we find a saving of 18% to 20%. The level of maternal satisfaction with early discharge is better than 90%.

Adult↗
PubMed2005

Improved performance and student satisfaction after implementation of a problem-based preclinical obstetrics and gynecology curriculum.

OBJECTIVE: This study was undertaken to assess student performance and satisfaction as a preclinical obstetrics and gynecology course changed from a didactic to a problem-based format. STUDY DESIGN: We prospectively compared examination scores and course evaluations given to 162 second-year medical students over 4 years: 2 years before and 2 years after the curricular change, to assess student performance and satisfaction with learning. We used analysis of variance for the analysis of student performance and likelihood-ratio test for analysis of student satisfaction. RESULTS: Mean examination scores increased from 79.1% to 84% after implementation of the problem-based curriculum (P < .0001). The data showed statistically significant improvement in satisfaction with course content, learning objectives, learning resources, instructional methods, and course examinations. CONCLUSION: Students' satisfaction and performance in a preclinical obstetrics and gynecology course improved significantly when problem-based learning methods were introduced.

Curriculum↗
PubMed2005

Obstetrics-Gynecology resident satisfaction.

OBJECTIVE: The objective of the study was to identify factors associated with satisfaction in the Indiana University School of Medicine Obstetrics-Gynecology residency program and the residents' and faculty's perception of whether these factors were extant in our program. STUDY DESIGN: Residents and faculty at the Indiana University School of Medicine Obstetrics-Gynecology program were surveyed using an instrument based on prior primary care specialty investigations. Multivariate regression evaluated the impact of various factors on resident satisfaction. RESULTS: Seventy-seven percent (44 of 57) and 100% (35 of 35) of faculty and residents, respectively, completed the survey. Relevant training, collegiality, adequate resources, workload, care continuity, supportive coworkers, learning environment, autonomy, role ambiguity, and supportive faculty were significantly associated with resident satisfaction. Care continuity, role ambiguity, and learning environment were the areas of largest faculty/resident disagreement. CONCLUSION: Relevant training and collegiality were most strongly linked to resident satisfaction. Three areas of dissatisfaction were identified, and we will seek to remedy these areas.

Gynecology↗
PubMed2005

Measurement of endometrial stripe thickness by obstetrics and gynecology residents.

OBJECTIVE: How well do obstetrics and gynecology residents measure the endometrial stripe by transvaginal sonography? STUDY DESIGN: Three obstetrics and gynecology residents at the University of Texas Medical Branch from each year level were tested for their ability to perform endometrial stripe measurements. Measurements of endometrial stripe thickness within 1 mm of the reference value that was obtained by an expert sonographer were deemed to be correct. RESULTS: Residents correctly measured the endometrial stripe in 14 of 24 cases (58%). Postgraduate year-4 residents correctly measured endometrial stripe thickness in 5 of 6 cases (83%); lower level residents were correct in 9 of 18 cases (50%). The most common error that was noted was an incorrect image plane in 25 of 47 attempts (53%). Fewer errors were committed by upper level as compared with lower level residents (P < .05). CONCLUSION: By the end of residency, residents can accurately measure the endometrial stripe using transvaginal sonography. Emphasis should be placed on the improvement of the measurement skills.

Endometrium↗
PubMed2006

Accuracy of obstetric diagnoses and procedures in hospital discharge data.

OBJECTIVE: The objective of the study was to estimate the validity of obstetric procedures and diagnoses in California patient discharge data. STUDY DESIGN: We randomly sampled 1611 deliveries from 52 of 267 California hospitals that performed more than 678 eligible deliveries in 1992 to 1993. We compared hospital-reported procedures and diagnoses against our recoding of the same records. RESULTS: Cesarean, forceps, and vacuum delivery were accurately reported, with sensitivities and positive predictive values exceeding 90%. Episiotomy was underreported (70% sensitivity). Cesarean indications were reported with at least 60% sensitivity, except uterine inertia, herpes, and long labor. Among comorbidities, sensitivity exceeded 60% for chorioamnionitis, diabetes, premature labor, preeclampsia, and intrauterine death. Sensitivity was poor (less than 60%) for anemia, asthma, thyroid disorders, mental disorders, drug abuse, genitourinary infections, obesity, fibroids, excessive fetal growth, hypertension, premature rupture, polyhydramnios, and postdates. CONCLUSION: The validity of hospital-reported obstetric procedures and diagnoses varies, with moderate to high accuracy for some codes but poor accuracy for others.

Female↗