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PubMed2005

Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China.

This study identified the prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among rural obstetrics and gynaecology workers in two poor counties in Anhui, China. A cross-sectional survey was conducted using a self-administered anonymous semi-structured questionnaire. The study population included all health workers in the departments of obstetrics and gynaecology in township hospitals and county health facilities. Among the 137 participants, the rate of non-compliance with glove utilization was 61%, the rate of non-compliance with hand hygiene was 40%, and the rate of non-compliance with both was 67%. 'Unnecessary and inconvenient' accounted for 66% of the reasons for not always using gloves and 71% for not always washing hands. 'Short of gloves or water' accounted for 15% and 22% of reasons, respectively. Two variables were associated with non-compliance: county [odds ratio (OR)=11.56, P<0.001] and knowledge (OR=0.10, P=0.033). After removing county from the regression model, institutional level (OR=2.34, P=0.059), institutional support (OR=3.85, P=0.009) and knowledge (OR=0.05, P=0.007) were associated with non-compliance. The prevalence of non-compliance with glove utilization and hand hygiene was high. The risk factors for non-compliance were institutional level, institutional support and knowledge. These variables incorporated both subjective and objective reasons for non-compliance.

Adult↗
PubMed2004

The towel test: a useful technique for the clinical and electromyographic evaluation of obstetric brachial plexus palsy.

The towel test consists of covering an infant's face with a towel and seeing if he/she can remove it with either arm. In this study it has been used to aid the clinical and electromyographic assessment of 21 infants with obstetric brachial plexus palsy. At 2 to 3 months, none of the 21 infants succeeded in removing the towel, either with their normal or affected arm. At 6 months, all the infants succeeded in removing the towel with their normal arm, but 11 could not with their affected arm, and the same was observed at a further assessment at 9 months. The towel test is a reliable technique for evaluating children with obstetric brachial plexus injuries.

Brachial Plexus↗
PubMed2005

Elbow flexion reconstruction by Steindler flexorplasty in obstetric brachial plexus palsy.

The results of Steindler flexorplasty in nine patients with obstetric brachial plexus palsy are reported. There were 5 girls and 4 boys with a mean age of 6 (range 2-13) years. Selection criteria for the procedure included strong (at least M4) grip strength and wrist and elbow extension, as well as the presence of the "Steindler effect". Pre-operatively, elbow flexion was rated as M0 or M1 in three patients and M2 in the remaining six patients. Intra-operatively, the detached common flexor origin was advanced 5 to 7 cm and fixation was done to the anterior humerus either with direct suture to the periosteum (in younger children) or suturing into a drill hole in the humerus (in older children). Postoperatively, the elbow was immobilized in flexion and supination for 6 weeks. At a mean follow-up of 5 years, the results in eight patients were good with mean active elbow flexion against resistance of 110 degrees and a mean elbow flexion contracture of 35 degrees. The result in the remaining patient was poor (unsuccessful transfer). It is concluded that the results of the Steindler flexorplasty in obstetric brachial plexus palsy patients are good and reliable, provided patient selection is careful.

Adolescent↗
PubMed2005

Obstetric complications in siblings of Japanese schizophrenics: data from the Maternal and Child Health Handbook.

Although the precise etiology of schizophrenia remains unknown, the development of schizophrenia has been associated with a history of obstetric complication (OC). Furthermore, some studies show structural and functional brain abnormalities in the unaffected siblings of schizophrenics. In this study the perinatal histories of 18 unaffected siblings of schizophrenics and 15 unrelated healthy controls, as detailed in their mothers' Maternal and Child Health Handbook records, were retrospectively analyzed. Records were scored for obstetric complication by the method developed by [Parnas, J., Schulsinger, F., Teasdale, T.W., Shulsinger, H., Feldman, P.M., Mednick, S.A., 1982. Perinatal complications and clinical outcome within the schizophrenia spectrum. Br. J. Psychiatry 140, 416-420]. The authors found the sibling group had greater pregnancy and birth complication (PBC) frequency, severity and total scores than the control population.

Female↗
PubMedDate not supplied

Obstetric complications during labor and delivery: assessing ethnic differences in California.

PURPOSE: We sought to compare obstetric complications during labor and delivery among white non-Latina (white), black, Asian, and Latina women who delivered in California hospitals. Many intrapartum complications are preventable. METHODS: We used linked 1996-1998 state hospital discharge and birth certificate data to examine obstetric complications International Classification of Diseases, 9th Revision, Clinical Modification codes considered relevant for population surveillance. We compared the observed and adjusted odds of experiencing a complication among women of color, using white women as the reference group. FINDINGS: One out of 5 deliveries had >or=1 complication. White (21.3%) and Asian women (21.1%) had similar prevalence rates, whereas black women (24.2%) had higher and Latina women (19.6%) had lower rates. After adjusting for covariates, the odds of experiencing >or=1 complication was lower for Asians (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93, 0.96) and Latinas (OR = 0.97; 95% CI = 0.96, 0.98) than whites; the odds for black women remained elevated (OR = 1.25; 95% CI = 1.23, 1.27). Asian women stood a higher risk of deliveries with major lacerations, postpartum hemorrhage, and major puerperal infections. Rates for the latter complication were higher among all women of color. CONCLUSIONS: The burden of morbidity is high for all women, regardless of ethnicity. Yet, compared to white women, blacks suffer more aggregate morbidities, and Asians stand a high risk of all 3 intrapartum care-sensitive conditions. Furthermore, all women of color experience disproportionate rates of puerperal infections. Collective action is needed to reduce these disparities and improve maternal health.

Adult↗
PubMed1992

Experience with mepivacaine paracervical block in an obstetric private practice.

OBJECTIVE: The objective of this study was to determine the efficacy and safety of mepivacaine paracervical block in term, low-risk obstetric patients. STUDY DESIGN: Over a 3-year period all term, low-risk obstetric patients in the author's private practice were offered mepivacaine paracervical block anesthesia. One hundred eighty-two patients received 200 mg mepivacaine with each block. The patients who declined paracervical block were used as a control group to compare Apgar scores, subject to chi 2 analysis. RESULTS: Initial injections were 97.3% successful. Average duration of anesthesia was 59.7 minutes with the first injection. Fetal bradycardia occurred in 13.2% with an average duration of 4.5 minutes. The slightly higher incidence of low Apgar scores at 1 and 5 minutes in the study group was not statistically significant. One neonatal death occurred secondary to group B streptococcal sepsis in the study group. CONCLUSION: Mepivacaine paracervical block remains an anesthetic option in low-risk patients. The high success rate is limited by its short duration of action and the incidence of fetal bradycardia.

Anesthesia, Obstetrical↗
PubMed1975

Training and function of a women's health-care specialist, a physician's assistant, or nurse practitioner in obstetrics and gynecology.

Serious manpower shortages exist in the United States. Proposed corrective measures indicate the need for nonphysicians to provide medical care for well or worried well patients. We have tested this proposed solution in the field of obstetrics and gynecology using allied health personnel to provide health maintenance services to well women, and feel that the experiment has been a success. Using principles of pattern recognition allied health workers recognize normal and abnormal findings. Patients with abnormalities are referred to the supervising physician for diagnosis and therapy. Allied health workers can also perform technical health-maintenance tasks such as inserting intrauterine devices and obtaining Pap smears. This article describes the historical evolution of our allied health personnel workers, called women's health-care specialists (WHCS), the selection and training of students, functions and levels of performance of the specialists, and the future role of such individuals in obstetrics and gynecology. We feel that with appropriate preparation of the physician, co-workers, and patients, the integration of the WHCS into the health-care system is both desirable and appropriate and will offer significant advantages to the patient and the practicing obstetrician-gynecologist in either the clinic or private practice setting.

Allied Health Personnel↗
PubMed1978

Resident training goals in obstetrics and gynecology for the 1980's. Presidential address.

Residency training goals and manpower needs in the 1980's and beyond should bear a consistent relationship. Projections for supply and demand for obstetrics and gynecology and for those medical specialties with overlapping responsibilities, though fraught with uncertainties, suggest that currently approved training programs in obstetrics and gynecology will meet clinical manpower needs for 1990. The role of the obstetrician-gynecologist in the primary care of women will be increasingly shared with others and the trend in urban areas for task delegation seems likely to increase. The popular and pervasive emphasis on primary care carries with it the serious risk that the present shortage of qualified investigators may not be corrected in the next decade. This could seriously hamper our efforts to recruit new faculty and maintain quality in our training programs.

Goals↗
PubMed1984

Obstetric aspects of the use in pregnancy-associated hypertension of the beta-adrenoceptor antagonist atenolol.

The obstetric implications of the use of the beta-adrenoceptor antagonist atenolol have been evaluated in a prospective, randomized, double-blind, and placebo-controlled study involving 120 women with pregnancy-associated hypertension. The clinical interpretation of antenatal and intrapartum cardiotocographs was uninfluenced by atenolol. Human placental lactogen concentration fell in the atenolol group, but this was not an indicator of subsequent fetal distress. Other obstetric indices, such as urinary estriol excretion, were the same in both groups. Spontaneous premature labor occurred in five women receiving placebo but in none who received atenolol. Together with previously reported findings on pregnancy outcome, our study leads us to conclude that beta-blockers such as atenolol can appropriately be used in the management of hypertension during pregnancy.

Atenolol↗
PubMed1985

The use of national board scores in selecting residents for obstetrics and gynecology.

The performance of 29 residents in obstetrics and gynecology on parts 1 and 2 of the national board examinations, which they had taken to graduate from medical school, was compared to their performance on the Council on Resident Education in Obstetrics and Gynecology in-training examination taken during the third year of residency. There was a statistically significant correlation between results of part 1 of the national board and results of the Council on Resident Education examination (r = 0.45, p less than 0.05) and between part 2 of the national board and results of the Council on Resident Education examination (r = 0.67, p less than 0.001). Those scoring "low" (less than fiftieth percentile) on the Council on Resident Education test all had scores less than 500 on part 2 of the national board, whereas those scoring "high" on the Council on Resident Education test (greater than ninetieth percentile) scored about 600 or higher on part 2 of the national board. These data suggest that results of part 2 of the national board can be useful in the resident selection process and that the performance of residents on in-training examinations relates more to resident selection than to the residency educational programs.

Education, Medical, Continuing↗
PubMed1996

Evaluation of postdoctoral physician-scientist training programs in obstetrics and gynecology.

Individuals previously awarded American Association of Obstetricians and Gynecologists Foundation/American Gynecological and Obstetrical Society or Reproductive Scientist Development Program postdoctoral physician-scientist training fellowship in Obstetrics and Gynecology were evaluated for their current status and research support. Forty-two (91%) of the first 44 fellows currently have medical school appointments, 15 at associate or full professor rank, and 75% have received extramural funding. These initial results are encouraging.

Education, Medical, Graduate↗
PubMed1999

Changes and challenges for women in academic obstetrics and gynecology.

In obstetrics and gynecology, more than 60% of current residents and 36% of medical school faculty are women. However, fewer than 10% of professors and only a small number of department chairs and organizational leaders are women. This paper reviews the data on the growing number of women in obstetrics and gynecology, and in medicine in general, during the past 25 years. It reviews some of the challenges that women have faced and some strategies to enhance equitable opportunities.

Data Collection↗
PubMed1996

AN electronic bulletin board for instruction in reproductive endocrinology in a residency in obstetrics and gynecology.

OBJECTIVE: To explore the role of an electronic bulletin board as a means of computer-based learning in reproductive endocrinology for residents in obstetrics and gynecology. DESIGN: An electronic bulletin board was networked to all residents to present a formal lecture series in reproductive endocrinology and an informal question, answer, and discussion session after each lecture. Ten lectures were presented, one each month, throughout the academic year followed by question, answer, and discussion sessions. All lectures could be stored in an electronic file folder or printed as hard copy for review. A questionnaire was distributed at the conclusion of the project to assess previous resident experience with computers, resident response to, and utilization of the bulletin board. SETTING: A residency program in obstetrics and gynecology in a major medical center. PARTICIPANTS: Twenty-four residents in a 4-year program. MAIN OUTCOME MEASURES: Previous computer experience, ease of use, resident participation, and satisfaction with the bulletin board. RESULTS: Sixty-five percent of the residents considered themselves computer literate and 33 percent previously had taken a course in computer technology. Computer experience in word processing, spreadsheet, and database management was related by 55 percent, 40 percent, and 25 percent of the residents, respectively. Ninety-five percent of the residents accessed the bulletin board for the lectures and found this system a convenient means of review. Sixty percent reviewed the lectures and stored them in an electronic file folder for later review. Forty percent printed the lecture on hard copy. On a scale of 1 to 5 (1 = lowest; 5 = highest), overall resident satisfaction was high at 4.5. CONCLUSION: Our data suggest a potential role for electronic bulletin boards as a complement to standard teaching protocols in resident education. The relative ease of use and satisfaction suggest that these techniques are feasible and offer an effective method of on-line instruction.

Computer Communication Networks↗
PubMed1998

Obstetric outcome of singleton pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously.

OBJECTIVE: To compare the obstetric characteristics of singleton pregnancies conceived by IVF and ovulation induction with those conceived spontaneously. DESIGN: Case-control study. SETTING: Tertiary care medical center. PATIENT(S): All singleton pregnancies that were achieved by IVF (n = 169) and ovulation induction (n = 646) and were delivered from January 1989 through December 1994 were evaluated. Each group was compared with a separate control group that conceived spontaneously (n = 469 and n = 1,902 for the IVF and ovulation induction groups, respectively) and delivered during the same period and was matched in terms of maternal age, gestational age, and parity. INTERVENTION(S): Ovulation induction, IVF-ET. MAIN OUTCOME MEASURE(S): Obstetric complications. RESULT(S): Multivariate analysis showed that patients who conceived by IVF and ovulation induction had a significantly higher risk for gestational diabetes mellitus (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.23-3.30 and OR = 1.9, 95% CI = 1.09-1.79, respectively), pregnancy-induced hypertension (OR = 2.1, 95% CI = 1.04-4.10 and OR = 1.5, 95% CI = 1.04-2.02, respectively), and cesarean section (OR = 3.6, 95% CI = 2.44-5.29 and OR = 1.4, 95% CI = 1.09-1.79, respectively) compared with their matched controls. CONCLUSION(S): After controlling for maternal age, gestational age, and parity, we demonstrated that singleton pregnancies conceived by IVF and ovulation induction are at increased risk for maternal gestational diabetes mellitus and pregnancy-induced hypertension, and at greater risk for delivery by cesarean section.

Adult↗
PubMed1998

Post-discharge surveillance and infection rates in obstetric patients.

OBJECTIVE: To study the impact of post-discharge surveillance on the detection of nosocomial surgical site infection (SSI) after cesarean section and vaginal delivery. METHODS: During a 21-month period, all patients attending the obstetrics service in labor were recruited for a observational study on the incidence of SSI. Examinations to detect SSI were performed daily during the hospitalization period and up to 30 days after hospital discharge in an outpatient clinic supervised by the Infection Control Committee. The stratification of risk-factors and the criteria for the diagnosis of SSI were done in accordance with the methods described by the Centers for Disease Control and Prevention. The rates of surgical site infection detected during the hospitalization period were compared with those reported by the Centers for Disease Control and Prevention's National (United States) Nosocomial Infection Surveillance System (CDCNNIS) 'benchmarks'. The incidence of SSI detected by post-discharge outpatient surveillance was compared with that from in-hospital surveillance, for both cesarean section and vaginal delivery. RESULTS: A total of 4463 deliveries were performed during the study period, 2431 (54.5%) by the vaginal route and 2032 (45.5%) by cesarean section. In-hospital surveillance was done on all patients. Post-discharge examinations were done on 951 (46.8%) of the 2032 cesarean section patients. The incidence of SSI in cesarean section detected by in-hospital surveillance was 1.6% (32 cases) and lower than the 3.6% mean rate reported by the CDCNNIS. When SSIs detected by post-discharge surveillance were included, the total number of SSI was 196 cases (9.6%), a value much higher than that for the SSI detected by in-hospital surveillance alone. Only 5 cases (0.21%) of SSI were detected among the 2431 vaginal deliveries. CONCLUSIONS: The results of our study demonstrate that most of SSI following cesarean section were detected only after patient's discharge from the hospital and seems to indicate that failing to do follow-up evaluation of these patients could result in a substantial mis-calculation of the authentic SSIs rates. Therefore data on post-discharge surveillance should be included to realistically estimate the true rates of SSI in obstetric patients and to allow the implementation of measures to reduce post-partum infection.

Brazil↗
PubMed1998

Obstetric outcome of elderly low-risk nulliparae.

OBJECTIVE: To compare referrals and reasons for referral during pregnancy and labor, mode of delivery and obstetric outcome of first births in women 35 years and older with women 20-30 years old. METHODS: A prospective cohort study was performed of 146 elderly and 306 younger nulliparae in seven independent midwives' practices in and around Amsterdam. RESULTS: No significant differences in referrals were found between the two compared groups. After selection during pregnancy, obstetric outcome was not different between the groups. A higher percentage of episiotomies was found in the elderly group, compared to the younger group. CONCLUSIONS: After proper selection during pregnancy, the elderly nullipara under the care of a midwife does not have an increased risk of fetal distress or other emergency factors, compared to the younger nullipara. However, high referral rates during labor - both of younger and older women - were observed in this study.

Adult↗
PubMedDate not supplied

Maternal demographic correlates of increased history of obstetric complications in schizophrenia.

Evidence that history of obstetric complications (OCs) may contribute to the development of schizophrenia has generated renewed focus on characteristics of mothers of preschizophrenics. We studied the relationship between increased history of obstetric complications (OCs) and maternal age, parity, and social class in 70 Research Diagnosis Criteria schizophrenic patients vs 70 demographically matched controls. The sample has previously been studied concerning OC rates in schizophrenic patients, their relationship to other presumptive etiological factors, as well as head circumference at birth. Parity was the only maternal characteristic significantly associated with increased OCs in mothers of preschizophrenics. As compared with nulliparous control mothers, nulliparous mothers of preschizophrenics had significantly increased rates of total OCs and labour/delivery complications, while primi- and multiparous mothers of preschizophrenics (vs parity-matched control mothers) did not have increased rates of OCs. Abnormal labour length was significantly increased in the nulliparous mothers of preschizophrenics. Previous findings of significantly reduced head circumference at birth in preschizophrenic neonates vs controls were reconfirmed selectively in the nulliparous group.

Adolescent↗
PubMed1990

A proposal for obstetric and pediatric management of adolescent pregnancy.

Of the 1 million pregnancies among adolescents in the United States each year, approximately 500,000 result in live births. These pregnancies are at high risk but are amenable to obstetric and pediatric intervention. Medical, social, and economic risks for both the adolescent mother and her infant are substantially decreased by early and comprehensive prenatal care. A combined obstetric and pediatric protocol for the management of adolescent pregnancy can improve both the perinatal and the long-term outcome.

Adolescent↗