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At least 19 recordsLinked to original sources
PubMed2003

Electronic patient records: domain message information model perinatology.

PURPOSE: The Netherlands is developing a set of national domain information models to support electronic information exchange and electronic patient records (EPR). These domain information models aim to support the development, adoption, implementation and maintenance of the EPR in Dutch healthcare practice. This article describes the modelling for a pilot for mother- and childcare (perinatology). METHODOLOGY: Cases' from perinatology are modelled using the Health Level 7 version 3 Reference Information Model (HL7 RIM) as the methodology and tools. RESULTS: Results include descriptions of care processes, communication and information that are broken down into interaction tables and tables with information. Next several domain information models for perinatology are drawn up. These models allow healthcare professionals to recognise their communication, content and work. Currently, the models facilitate discussion and critique by clinician and informaticians. CONCLUSION: The perinatology domain information models facilitate in building implementations because they contain sufficient details for EPR developers and for developers of messages for information exchange. The first results of the project are useful, despite the fact that HL7 RIM modelling methodology is still not finalized. The approach bridges professional content, technical implementation of messages, and future EPR development.

Adult↗
PubMed1989

[Multicenter study of obstetrico-perinatologic quality control in the Rostock district. I. Comparative medical statistics].

Report about outcome-quality assessment in obstetrics and perinatology using an uniform check list for data collection in the district of Rostock. Various possibilities of outprint of the results in 1985 are demonstrated. For daily data collection in obstetrics a special book has been developed. The investigation concerns a data pool of more than 55,000 deliveries. Considering a trend of the results the following optimal criteria in obstetrics and perinatology are postulated: (table; see text) The check list of the Society of Perinatal Medicine of the GDR for obstetrical and neonatal data collection should be generally used. The soft ware for the computed data analyses has been developed by the "Rechenzentrum der Ernst-Moritz-Arndt-Universität Greifswald". Analysis and output of obstetrical and perinatological datas by means of a personal computer are prepared.

Birth Rate↗
PubMed2003

[The main tasks of Czech perinatology at the beginning of the 21st century].

OBJECTIVE: To identify the main goals of the Czech perinatology at the beginning of the 21st century. DESIGN: Retrospective epidemiologic analysis of selected perinatal care quality indicators. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Analysis of selected indicators of perinatal care and their trends in the Czech Republic and comparison with other countries. RESULTS: When we reached the same low level of perinatal mortality as the other most developed countries, we have observed unchanged values for last three years. The priorities established 15 years ago are still important to preserve the current situation, however the further development in perinatology requires now goals related to development of selected indicators of perinatal care and their international comparisons. These are: 1) change of definition of stillbirth including newborns of 500-999 grams (currently registered as spontaneous abortions), 2) termination of the continuous increase of Caesarean section, 3) inclusion of the criteria of quality of perinatal care, especially a) deaths during late neonatal and postneonatal periods with perinatal causes; b) perinatal morbidity (impaired neuro-sensoric and psychological development of the child due to perinatal causes). Both these tasks will require collaboration of professionals from obstetrics and neonatology with specialists from other fields. CONCLUSIONS: The 4 main tasks were established on the basis of development of selected perinatal care quality indicators and their international comparisons: the change of definition of stillbirth, the termination of continuous increase of Caesarean sections, and inclusion of other indicators of perinatal care, first related to mortality after 7th day of life due to perinatal causes, and second the perinatal period related morbidity in later periods of infant life.

Cesarean Section↗
PubMed1996

[The development of perinatology centers in the professional and organizational system of maternal and child care].

The author analyzes the delay in historical development as regards establishment of perinatological centres in the Czech Republic, as compared with other advanced countries, the task of these centres being specialized care of women with the most serious pathological conditions during pregnancy, with premature labour before the 32nd week, and care of there newborn babies. By means of three internationally recognized criteria which evaluate the quality of this care marked improvement of care of these women and neonates was found in 12 officially established centres in the Czech Republic, as compared with other maternity hospitals. This contributed in a major way to the nationwide reduction of the perinatal mortality. At the same time considerable differences were found in the results of this care between different centres and also inadequate centralization of women with the mentioned complications into perinatological centres. The revealed shortcomings will stimulate provisions for the improvement of perinatal care in the Czech Republic.

Czech Republic↗
PubMed2002

Behavioral perinatology: biobehavioral processes in human fetal development.

Behavioral perinatology is as an interdisciplinary area of research that involves conceptualization of theoretical models and conduct of empirical studies of the dynamic time-, place-, and context-dependent interplay between biological and behavioral processes in fetal, neonatal, and infant life using an epigenetic framework of development. The biobehavioral processes of particular interest to our research group relate to the effects of maternal pre- and perinatal stress and maternal-placental-fetal stress physiology. We propose that behavioral perinatology research may have important implications for a better understanding of the processes that underlie or contribute to the risk of three sets of outcomes: prematurity, adverse neurodevelopment, and chronic degenerative diseases in adulthood. Based on our understanding of the ontogeny of human fetal development and the physiology of pregnancy and fetal development, we have articulated a neurobiological model of pre- and perinatal stress. Our model proposes that chronic maternal stress may exert a significant influence on fetal developmental outcomes. Maternal stress may act via one or more of three major physiological pathways: neuroendocrine, immune/inflammatory, and vascular. We further suggest that placental corticotropin-releasing hormone (CRH) may play a central role in coordinating the effects of endocrine, immune/inflammatory, and vascular processes on fetal developmental outcomes. Finally, we hypothesize that the effects of maternal stress are modulated by the nature, duration, and timing of occurrence of stress during gestation. In this paper, we elaborate on the conceptual and empirical basis for this model, highlight some relevant issues and questions, and make recommendations for future research in this area.

Behavior↗
PubMed1989

[Multicenter study of obstetrico-perinatologic quality control in the Rostock district. II. Analysis of results with graphic aids].

Various graphic diagrams of obstetrical and perinatological quality assessment between 1984-1986 in the district of Rostock are demonstrated. The advantages of centralization of premature labors are visible. The prenatal diagnosis of intrauterine growth retardation is still insufficient. With an upper cesarean section rate of 10% good perinatological results are achieved. The cesarean section rate of obstetrical departments without high risk concentration is below 5%. There is a highly subjective influence in vaginal operative decision. A mean rate of prematurity may be combined with a high rate of perinatal mortality caused by an unproportional part of very low birth weight infants. The small number of data of the obstetrical basic-check-list allows different possibilities of comparing quality assessment. Different levels of the results and the reasons are better visible by means of graphs. The preliminary results of outcome control justify a general introduction. By means of further data processing we will get better mathematical and graphical interpretations.

Birth Rate↗
PubMed1998

[Cost-benefit in perinatology--I. General views of western economists].

The mutual cost-benefit relationship of any activity is the main principle of the market mechanism where both these variables are expressed in monetary terms. According to western economists this system cannot be applied, or if so only partly, in the sphere of health services because health benefit can be only in exceptional instances expressed in monetary terms. This is why they recommended for evaluation of health care, incl. perinatal care, other economic models where the health benefit is evaluated by saved lives or improvement of the health status. With this aspect in mind the author described five recommended models for the evaluation of alternative procedures and for evaluation of programmes in perinatology. Each of them is supplemented by examples from clinical practice. Most frequently different views are held on the effectivity of costly screening programmes for early detection of threatened foetuses and intensive care of these neonates, i.e. procedures which are the main cause of rising costs of perinatal care. The author discusses reasons for controversial views on contemporary economic problems in perinatology.

Cost-Benefit Analysis↗
PubMed2006

Informed consent for labor epidurals: a survey of Society for Obstetric Anesthesia and Perinatology anesthesiologists from the United States.

BACKGROUND: Ethicists agree that informed consent is a process rather than just simply the signing of a form. It should provide the patient with needed information and understanding to authorize a procedure. Essential elements of informed consent for women requesting labor epidurals include a description of the procedure, the risks and benefits, and alternative treatments for analgesia including the associated risks and benefits. The purpose of this pilot study was to determine practices and opinions of obstetric anesthesiologists regarding informed consent for parturients. METHODS: Questionnaires were sent to 885 anesthesiologists who were members of the Society of Obstetric Anesthesia and Perinatology based in United States institutions in 2002. RESULTS: Of the 885 questionnaires sent, 448 (51%) were returned with 47% from academic and 47% from private practice institutions. Forty-six percent worked as part of an obstetric anesthesia team; 51% worked in centers where there were >3000 deliveries/year. Sixty-eight percent suggested that "parturients in active labor are able to give informed consent for labor epidural analgesia." Thirteen percent recommend antenatal anesthesia consults for parturients inquiring about labor epidurals and 41% participated in childbirth classes. Responses did not differ significantly between physicians in academic vs. private practice. More obstetric team practices than non-team practices participated in childbirth education (54% vs. 30%, P < 0.0001). CONCLUSION: Despite the painful, stressful circumstances confronted by parturients, many respondents (76% in academic, 64% in private practice) thought that women in active labor are able to give informed consent.

Academic Medical Centers↗
PubMed1987

[Obstetric-perinatologic data collection using a personal computer].

A concept covering the collecting and processing of obstetrical and perinatological data is described. Collecting of patient data is effected on the basis of a case history that has been drawn up in an EDP-adequate manner, which, however, can also be used in the conventional way. This procedure was chosen because for some time to come one cannot do without a document for handwritten notes to avoid duplication of work by "double tracking" and to eliminate transmission errors, and also to continue the present procedure of dealing with the patient. A commercial data base system was chosen for data collection and storage (dBase III by Ashton Tate). This relational data base has its own programming language with very powerful macro calls. Data input is effected by means of programme masks which the user can solicit via menu monitoring. The requisite hardware configuration consists of a computer with a main storage comprising 640 KB, system MS-DOS, and a hard disk of at least 20 MB. This data collection system operates in an obstetric hospital with annually more than 1,600 births and more than 1,200 entries during early pregnancy, to the satisfaction of the users. Besides compiling the usual statistical analyses and formulating research problems, the system automatically prepares the discharge reports. This rationalisation procedure compels the user to collect the data with care and also completely. On the whole, such a data collection system offers to hospitals of any size quick and easy access to data at any time, as well as optimised patient care, without additional effort and at a reasonable cost level.

Computers↗
PubMedDate not supplied

[Quality assurance exemplified by perinatology and surgery].

Quality assurance encompasses all activities which are necessary to obtain a demanded quality of medical care. Typically, a quality assurance process ("monitoring- and evaluation-process") includes the following steps: systematic observation of quality of medical care using quality indicators, assessment of quality by comparison with standards and recognizing problems, analysis of the most important problem, realization of appropriate problem solving strategies and evaluation, if the problem is successfully solved through the corrective action. The quality assurance programs in perinatology and surgery--established in all the states of the Federal Republic of Germany--support the hospitals in the application of this quality assurance process. Uniform documentation and preparation of quality relevant information (lists of complications, profiles, charts, etc.) help the hospitals to perform a self-evaluation, to recognize problems and to verify the elimination of the problems. Hence, comparisons with local results and with results of other hospitals are possible.

Cesarean Section↗
PubMed1999

[History of gynecology and perinatology in Croatia. Midwifery. Clinics and hospitals in Zagreb].

The development of obstetrics in Croatia and the formation of unique discipline of obstetrics and gynecology in Croatia in first ten years of 20th century are presented. The midwifery is mentioned in Croatia for the first time in Dubrovnik in 14th century. The "protomedicus" from Varazdin Johan Baptist Lalangue in 1777 has published the booklet "Brevis institutio de re obstetritia". First public school of midwifery was founded in Zadar on 1820 and the second one in Zagreb in 1877. In Zadar, Ante Kuzmanić, "magister obstetritiae et chirurgiae" published a short textbook "Sixty lessons from midwifery for midwifes", thereafter in 1908 Nikola Lalich "Book for midwifes". In Zagreb, Antun Lobmayer published in 1877 "The midwifery". Gynecology was developing in the second half of 19th century as a part of surgery. On break-time from 19th to 20th century rose the unique medical profession obstetrics and gynecology. In Croatia the unique discipline established Dr Franjo Durst, since he was in 1905 installed for the first head of Royal Country Maternity Hospital in Ilica street and thereafter in 1921 for the first head and university professor of Royal University Clinic for Gynecology and Obstetrics in Petrova street. The evolution of gynecology and obstetrics, respective of perinatology, during last 30 years, in the Zagreb in departments of clinical hospitals "Clinical Hospital Center", "Sestre Milosrdnice", "Merkur" and "Sv. Duh" is presented.

Croatia↗
PubMed2002

Electronic patient records: Dutch domain information model perinatology.

Currently a national domain information model is developed to support information exchange via electronic patient records (EPR), and to support the adoption of the EPR in Dutch healthcare practice. This article describes a pilot for the domain information model for mother- and childcare (perinatology) that serves as a first 'use case'. The 'use case' is modeled using the Health Level 7 version 3 Reference Information Model (HL7 RIM) as the methodology and modeling tool. The first results are promising, despite the fact that HL7 RIM is still in a draft version up to formal vote. The models of the 'use case' are both specific and generic at the same time, allowing professionals to recognize their domain specific content and work, and the EPR developers, or developers of messages for information exchange, to build practical implementations. The approach bridges professional content and technical issues.

Child↗
PubMed2006

[Perinatology for the pediatrician].

From the standpoint of the pediatrician, the new knowledges in perinatology allowed progresses in certain fields (identification of high risk pregnancies, decrease in perinatal mortality, decrease of major handicaps in high risk newborns). However, the new knowledge's did not improve the rate of preterm deliveries. Some aspects of antenatal and intrapartum fetal assessment as well as the postnatal evaluation of the newborn will be discussed. The figures and tables summarize data directly linked to the practitioner's every day's concerns.

Fetal Development↗
PubMedDate not supplied

[Quality circles as a strategy of a medical care quality assurance program at the Perinatology National Institute].

The present article shows the methodology of implantation of a quality guarantee program of medical attention through quality circles at the National Institute of Perinatology and it's results. Among them emphasize the following: organization's structure effects. The optimum on resources in it's own process of attention on the satisfaction of the patients and in the learning implicated in the adaptation of the technology to the hospital environment and the characteristics of a different culture from which that technology emerged. The project, conceived as investigation-action, was advised by Public Health Investigation Center and was created with the purpose to secure that the organized conditions under which the medical attention are given were those permitting to raise the quality as much in the among personal dimension as in the technical, through the participation of the personnel directly responsible of the services given. This led to the use of quality circles as participant technical of quality control and as main quality guarantee program of medical attention. Seven stages can be identified in the implantation of the quality assurance program using the quality circles: 1) to elaborate the proposal document and work protocol; 2) negotiation; 3) drawing of a guide for the elaboration of a quality guarantee manual; 4) selection the point of starting; 5) elaboration of the quality guarantee manual by service; 6) to operate the quality circles; 7) evaluation of the program. This experience has demonstrated it's feasible using the quality circles as fundamental components of a quality guarantee program of medical attention and permits to secure that, in general, it is possible to use this technology in the health services.

Delivery of Health Care↗
PubMed1990

[Birth before 33 weeks gestational age. The significance of in utero-to-birth transfer in the Department of Perinatology].

Systematic transfer of any woman presenting a high risk of delivery before 33 weeks of amenorrhea, for birth within a Perinatology department which was 5 advocated since 1985 (especially at 31 and 32 weeks of amenorrhea) in order to minimize the neurological consequences of the haemodynamic disorders induced by the transfer of these premature babies, has permitted to increase to 40 live newborns without any severe sequelae. This improved management, noticed in three departments (121 PNB in 1988, or a 73 p. cent progression in 4 years), must now take place as early as the 25th week and before the stage of imminent birth, in order for the couple mother-fetus to take advantage, in the same location, of physicians (obstetricians and pediatricians) and technical means suitable for this rare and severe pathology that is prematurity.

Female↗
PubMed1986

Bioethical issues in perinatology--is the future now?

The rapid progress of the science of perinatology has produced a broad range of capabilities in our approach to the fetus. Advances in diagnostic methodology, both invasive and noninvasive, enable early identification and potentially, early correction, of a multitude of disorders. The laboratory correlates of this progress have kept pace, with possibilities in the areas of fetal surgery and genetic manipulation which seemed fantasy only a few years ago. Important moral issues which had been deferred because of our physical limitations must now be addressed. As instigators of the scientific stampede, perinatologists must assume a major role in the ethical inquiry as well.

Bioethics↗
PubMed1977

[ADP system for automatic production of physician's letters as well as statistics analyses in the area of obstetrics and perinatology].

Report about an electronic data processing system for obstetrics and perinatology. The developed data document design and data flowchart are shown. The continuously accumulated data allowed everytime a detailed interpretation record. For all clinical treated patients the computer printed out a final obstetrical report (physician report). By means of this simple system there is an improvement of the information and the typewriting work of medical staff has been reduced. Cost and work-expenditure for this system are limited in relation to our earlier hand made procedure.

Computers↗
PubMed1989

[The prognosis of early-diagnosed twin pregnancies and the modification of their perinatological data using an ultrasonic monitoring system].

We report on the outcome of 129 twin pregnancies, discovered in the first trimenon by ultrasound. 14 (11.9 per cent) of the diagnosed twin pregnancies terminated as an abortus, 10 (8.5 per cent) as births with only one child (twice fetus papyraceus) and in 79.7 per cent as real gemini. Perinatological data of these 94 twin births in 1982-1986 are compared with 103 gemini pregnancies in 1971-78, when sonography and diagnosis ante partum was hardly known. Both groups did not differ with regard to the premature child rate, length of gestation, birth weights and weight differences of both children. The rate of hypotrophic children was reduced to half, especially through reduction of hypotrophic term infants. The number of twins with low birth weight was reduced, but the weight group under 2000 g however was almost constant. Perinatal mortality, still-birth rate and infant-mortality dropped by 50 per cent.

Abortion, Spontaneous↗