21 CFR 884.2660 - Fetal ultrasonic monitor and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Fetal ultrasonic monitor and accessories. 884.2660... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2660 Fetal ultrasonic monitor and accessories. (a) Identification. A fetal ultrasonic...

21 CFR 884.2800 - Computerized Labor Monitoring System.

Code of Federal Regulations, 2013 CFR

2013-04-01

... monitoring system is a system intended to continuously measure cervical dilation and fetal head descent and... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Computerized Labor Monitoring System. 884.2800... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring...

Audit and feedback: effects on professional obstetrical practice and healthcare outcomes in a university hospital.

PubMed

Costa, Maria L; Cecatti, Jose G; Milanez, Helaine M; Souza, Joao P; Gülmezoglu, Metin

2009-01-01

To assess the effects of audit and feedback on the practice of professionals in obstetrics. Before-after intervention study. Obstetric unit of a university hospital in Brazil. Before the intervention the prevalence rates of six evidence-based interventions were assessed. Seminars and workshops were administered, with the baseline results and also the main contents from systematic reviews on the topics studied, followed by detailed discussion of each topic, based on the Reproductive Health Library. After four months, the same practices were measured again and compared with the pre-intervention period. Selective episiotomy; continuous electronic fetal monitoring (EFM) during labor of low-risk pregnant women; antibiotic prophylaxis in cesarean section; active management of third stage of labor; routine induction of labor at 41 weeks for uncomplicated pregnancies; and continuous support for women during childbirth. Both periods showed a similar number and mode of deliveries. There was a significant reduction in episiotomies (RR = 0.84; 0.73-0.97) and an increase in continuous support for women during childbirth by a companion (RR = 1.42; 1.24-1.63). Although there was not a significant change in the use of oxytocin during the third stage of labor, there was a shift to the internationally recommended dosage of 10 IU (p<0.0001). There was no significant change in the use of antibiotic prophylaxis for cesarean section, continuous EFM, or routine induction of labor at 41 weeks for uncomplicated pregnancies. Audit and feedback can be used as a tool to improve obstetrical practice, at least for some interventions and when the medical staff is open and receptive to change.

Obstetrical Practice and Training in Canadian Family Medicine: Conserving an Endangered Species

PubMed Central

Klein, Michael; Reynolds, J. L.; Boucher, Francois; Malus, Michael; Rosenberg, Ellen

1984-01-01

Family practice obstetricians are an endangered species. Our practices and teaching sites must provide the correct attitudinal as well as technical messages to result in a practitioner who will be able to meet the psychosocial and medical needs of the pregnant couple. Family practice obstetrics can be as safe as care given by obstetricians provided that the family practice group functions well, that obstetrical consultants are available and supportive, and assuming that technical approaches are reserved for those truly in need. In rural areas, obstetrical ability is essential, whilst in the urban setting it helps the family physician maintain a practice involving young families. Those trainees who fail to learn basic obstetrical skills (including family centered attitudes and approaches) may in any setting come to feel, belatedly, that their training programs failed in this respect. PMID:21279123

How family influences practice of obstetrics. Do married women family physicians make different choices?

PubMed

Brown, J B; Carroll, J; Reid, A

1996-07-01

To examine the influence of family, past and current, on married women family physicians' and to understand why and how some women continue to practise obstetrics. Purposive sample of nine married women family physicians who currently practise obstetrics. Qualitative in-depth interviews. Analysis identified four main influences of family on participants' practice of obstetrics: family of origin, transitions in the life cycle, children, and the marital relationship. These women described how they combined the roles of wife, mother, daughter, sister, and doctor. Family was a powerful influence throughout their practice lives. Finding a balance between the demands of practice, particularly obstetrics, and family relationships was an ongoing process. The process was also influenced by transitions in the life cycle.

21 CFR 884.2620 - Fetal electroencephalographic monitor.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fetal electroencephalographic monitor. 884.2620 Section 884.2620 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2620 Fetal...

Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition.

PubMed

Minakami, Hisanori; Maeda, Tsugio; Fujii, Tomoyuki; Hamada, Hiromi; Iitsuka, Yoshinori; Itakura, Atsuo; Itoh, Hiroaki; Iwashita, Mitsutoshi; Kanagawa, Takeshi; Kanai, Makoto; Kasuga, Yoshio; Kawabata, Masakiyo; Kobayashi, Kosuke; Kotani, Tomomi; Kudo, Yoshiki; Makino, Yasuo; Matsubara, Shigeki; Matsuda, Hideo; Miura, Kiyonori; Murakoshi, Takeshi; Murotsuki, Jun; Ohkuchi, Akihide; Ohno, Yasumasa; Ohshiba, Yoko; Satoh, Shoji; Sekizawa, Akihiko; Sugiura, Mayumi; Suzuki, Shunji; Takahashi, Tsuneo; Tsukahara, Yuki; Unno, Nobuya; Yoshikawa, Hiroyuki

2014-06-01

The 'Clinical Guidelines for Obstetrical Practice, 2011 edition' were revised and published as a 2014 edition (in Japanese) in April 2014 by the Japan Society of Obstetrics and Gynecology and the Japan Association of Obstetricians and Gynecologists. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction of burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. The number of Clinical Questions and Answers items increased from 87 in the 2011 edition to 104 in the 2014 edition. The Japanese 2014 version included a Discussion, a List of References, and some Tables and Figures following the Answers to the 104 Clinical Questions; these additional sections covered common problems and questions encountered in obstetrical practice, helping Japanese readers to achieve a comprehensive understanding. Each answer with a recommendation level of A, B or C was prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' was weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 104 Clinical Questions and Answers items, with the omission of the Discussion, List of References, and Tables and Figures, are presented herein to promote a better understanding among English readers of the current standard care practices for pregnant women in Japan. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

21 CFR 884.2720 - External uterine contraction monitor and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External uterine contraction monitor and accessories. 884.2720 Section 884.2720 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Monitoring Devices § 884.2720 External...

Improved obstetric safety through programmatic collaboration.

PubMed

Goffman, Dena; Brodman, Michael; Friedman, Arnold J; Minkoff, Howard; Merkatz, Irwin R

2014-01-01

Healthcare safety and quality are critically important issues in obstetrics, and society, healthcare providers, patients and insurers share a common goal of working toward safer practice, and are continuously seeking strategies to facilitate improvements. To this end, 4 New York City voluntary hospitals with large maternity services initiated a unique collaborative quality improvement program. It was facilitated by their common risk management advisors, FOJP Service Corporation, and their professional liability insurer, Hospitals Insurance Company. Under the guidance of 4 obstetrics and gynecology departmental chairmen, consensus best practices for obstetrics were developed which included: implementation of evidence based protocols with audit and feedback; standardized educational interventions; mandatory electronic fetal monitoring training; and enhanced in-house physician coverage. Each institution developed unique safety related expertise (development of electronic documentation, team training, and simulation education), and experiences were shared across the collaborative. The collaborative group developed robust systems for audit of outcomes and documentation quality, as well as enforcement mechanisms. Ongoing feedback to providers served as a key component of the intervention. The liability carrier provided financial support for these patient safety innovations. As a result of the interventions, the overall AOI for our institutions decreased 42% from baseline (January-June 2008) to the most recently reviewed time period (July-December 2011) (10.7% vs 6.2%, p < 0.001). The Weighted Adverse Outcome Score (WAOS) also decreased during the same time period (3.9 vs 2.3, p = 0.001.) Given the improved outcomes noted, our unique program and the process by which it was developed are described in the hopes that others will recognize collaborative partnering with or without insurers as an opportunity to improve obstetric patient safety. © 2014 American Society for Healthcare Risk Management of the American Hospital Association.

Future Career Plans and Practice Patterns of Canadian Obstetrics and Gynaecology Residents in 2011.

PubMed

Burrows, Jason; Coolen, Jillian

2016-01-01

The practice patterns of Obstetricians and Gynaecologists continue to evolve with each new generation of physicians. Diversifying subspecialties, changes in resident duty hours, job market saturation, and desire for work-life balance are playing stronger roles. Professional practice direction and needs assessment may be aided by awareness of future Obstetrics and Gynaecology physician career plans and expectations. The objective of this study was to determine the expected career plans and practice patterns of Canadian Obstetrics and Gynaecology residents following residency. The SOGC Junior Member Committee administered its third career planning survey to Canadian Obstetrics and Gynaecology residents electronically in December 2011. The data collected was statistically analyzed and compared to previous surveys. There were 183 responses giving a response rate of 43%. More than one half of all residents were considering postgraduate training (58%). Projected practice patterns included: 84% maintaining obstetrical practice, 60% locuming, and 50% job-sharing. The majority of residents expected to work in a 6 to 10 person call group (48%), work 3 to 5 call shifts per month (72%), work 41 to 60 hours weekly (69%), and practise in a city with a population greater than 500 000 (45%). Only 18% of residents surveyed were in favour of streaming residency programs in Obstetrics and Gynaecology. Canadian resident career plan and expected practice pattern assessment remains an important tool for aiding in resource allocation and strategic development of care and training in Obstetrics and Gynaecology in Canada. Copyright © 2016 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

Practising obstetrics in the 17th century: François Mauriceau (1637-1709).

PubMed

Karamanou, M; Creatsas, G; Demetriou, T; Androutsos, G

2013-01-01

In 17th century France, the practice of obstetrics passed from female midwives to medical men called accoucheurs. François Mauriceau, a prominent French obstetrician of the 17th century urged the need of an organised obstetrical education, emphasising anatomy. He invented the semi-recumbent or 'French' birthing position, the 'tire-tête' forceps, the 'Mauriceau manoeuvre' in breech delivery, and provided one of the first epidemiological analyses in obstetrics contributing enormously to the development of this specialty. His best-seller, Traité des maladies des femmes grosses revolutionised the practice of obstetrics.

Linkage between Graduate Medical Education Training Practice Profiles in Psychiatry, Obstetrics/Gynecology, and Family Practice. Appendices.

ERIC Educational Resources Information Center

SysteMetrics, Inc., Santa Barbara, CA.

Provided are appendices for a study which examined the relationship between graduate medical education (GME) and practice profiles in three specialties: family practice, psychiatry, and obstetrics/gynecology. Appendix A includes materials related to methodology of the study. Appendices B-D include supplementary materials for family practice,…

Electronic fetal monitoring: family medicine obstetrics.

PubMed

Rodney, John R M; Huntley, Benjamin J F; Rodney, Wm Macmillan

2012-03-01

Electronic fetal monitoring assesses fetal health during the prenatal and intrapartum process. Intermittent auscultation does not detect key elements of fetal risk, such as beat-to-beat variability. Family medicine obstetric fellowships have contributed new knowledge to this process by articulating a method of analysis that builds on evidence-based recommendations from the American College of Obstetrics and Gynecology as well as the National Institute of Child Health and Development. This article summarizes the development, interpretation, and management of electronic fetal heart rate patterns and tracings. Copyright © 2012 Elsevier Inc. All rights reserved.

The malpractice premium costs of obstetrics.

PubMed

Norton, S A

1997-01-01

This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

New Models of Care.

PubMed

Lawrence, Hal C

2017-12-01

The practice of obstetrics and gynecology continues to evolve. Changes in the obstetrician-gynecologists workforce, reimbursement, governmental regulations, and technology all drive new models of care. The advent of the obstetric hospitalist is one new model, and the development of team-based care is another. Increasingly, obstetrician-gynecologists are becoming employees of health care delivery systems, and others are focusing the scope of their practices to subspecialites. As new practice models emerge, the specialty of obstetrics and gynecology will continue to change to meet the health care needs of women.

Linkage between Graduate Medical Education Training Practice Profiles in Psychiatry, Obstetrics/Gynecology, and Family Practice. Deliverable No. 5. Final Report.

ERIC Educational Resources Information Center

Moynihan, Christy; And Others

This study examined the relationship between graduate medical education (GME) and practice profiles in three specialties: family practice, psychiatry, and obstetrics/gynecology. Two analyses were performed, the first assessing the relationship between GME and current practice patterns and the second assessing the relationship between GME and…

Strategies to reduce blood product utilization in obstetric practice.

PubMed

Neb, Holger; Zacharowski, Kai; Meybohm, Patrick

2017-06-01

Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

Simulation laboratories for training in obstetrics and gynecology.

PubMed

Macedonia, Christian R; Gherman, Robert B; Satin, Andrew J

2003-08-01

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

Fundal Height: An Accurate Indicator of Fetal Growth?

MedlinePlus

... antenatal surveillance, diagnosis, and management. American Journal of Obstetrics and Gynecology. 2011;204:288. Peter JR, et ... Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 134: Fetal growth restriction. ...

Prenatal Care: Second Trimester Visits

MedlinePlus

... Cunningham FG, et al. Prenatal care. In: Williams Obstetrics. 24th ed. New York, N.Y.: The McGraw- ... Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. ...

Impact of rural training on physician work force: the role of postresidency education.

PubMed

Acosta, D A

2000-01-01

Many innovative strategies have been developed over the years to improve the recruitment and retention of physicians in the shortage areas of rural America. These strategies have met with varying success. Postresidency education, or fellowship training, for family physicians is yet another strategy that has been developed for the same purpose. Most applicants have been interested in obstetrical and rural health fellowship programs as a means for preparing for rural practice. This paper describes these programs (demographics, funding, applicant pool, curriculum) and reviews their graduate outcomes (practice location after matriculation, clinical privileges). Twenty-nine obstetrical and nine rural health fellowships are currently operational in the United States. Fellows who complete a rural health fellowship have a higher tendency to locate in rural settings. Almost all graduates from obstetrical and rural health programs attain general hospital privileges in family practice, including low-risk obstetrics. A significant number of graduates from both types of programs attain privileges in high-risk and operative obstetrics as well. Fellowship training can play an integral role in the preparation of family physicians for rural practice.

Is the caesarean section rate a performance indicator of an obstetric unit?

PubMed

Singh, Ruchi; Nath Trivedi, Amarendra

2011-02-01

The indications of caesarean section are increasing. The need to respect maternal desire in the decision making has been supported by law and ethics. Some of the other contributors to the increasing caesarean section rate are breech with failed external cephalic version, decreasing rate of trial of scar, increasing induction rate and electronic fetal heart rate monitoring and changing demography. Despite the adverse effects of caesarean section, the incidence of severe morbidity and mortality is low. The strategies put forward to reduce the caesarean section rate (CSR) have not been effective and in no country or province, the CSR has come down. CSR should not be looked at in isolation or as high or low. It is the product of changing obstetric practice and societal norms and demographics. CSR not reflect the performance of a maternity unit.

Obstetric care practice in Birbhum District, West Bengal, India.

PubMed

Bharati, Susmita; Pal, Manoranjan; Bharati, Premananda

2007-08-01

The study area is the Birbhum district of the State of West Bengal in India. It is one of the backward districts in India. The paper investigates the existing pattern of obstetric health care practices and the factors associated with the utilization of such care. The present analysis includes 495 adult married women of both rural and urban areas of nine Blocks of Birbhum district. Besides performing chi2 tests to see the association of the relevant individual and household characteristics, logistic regression was also carried out to measure the effect of these characteristics on the use of obstetric health care. In Birbhum district of West Bengal 65 percent mothers go to doctors for antenatal check-up during their pregnancy, but only 26 percent mothers deliver their babies in institutions and 30 percent mothers get the help of professional health assistants during delivery. Educated women have emphasized role in the practice of obstetric health care. Husband's education and the standard of living of the family also have some effect on the practice of antenatal check up, place of delivery and assistance of health professional. While most of the family background variables have significant effect on the practice of antenatal check up, these variables do not have much effect on the choice of delivery or seeking assistance of health professionals. Contrary to the popular belief the working status of women does not have favourable influence on the obstetric health care practices. In developing countries like India, it is the poverty, which compels the women to take jobs-that too in low paid jobs especially in rural backward areas. The status of literacy of mothers and standard of living of the family are of prime importance in improving the obstetric health care practices.

Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study.

PubMed

Muhumuza Kananura, Rornald; Tetui, Moses; Bua, John; Ekirapa-Kiracho, Elizabeth; Mutebi, Aloysius; Namazzi, Gertrude; Namusoke Kiwanuka, Suzanne; Waiswa, Peter

2017-08-01

Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda. The Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study was implemented in three districts from 2013 to 2015 using a quasi-experimental pre-post comparison design. Data were collected from women who delivered in the last 12 months. Difference-in-differences (DiD) and generalized linear modelling analysis were used to assess the effect of the intervention on BP practices and knowledge of obstetric danger signs. The overall BP practices increased after the intervention (DiD = 5, p < 0.05). The increase was significant in both intervention and comparison areas (7-39% vs. 7-36%, respectively), with a slightly higher increase in the intervention area. Individual savings, group savings, and identification of a transporter increased in both intervention and comparison area (7-69% vs. 10-64%, 0-11% vs. 0-5%, and 9-14% vs. 9-13%, respectively). The intervention significantly increased the knowledge of at least three obstetric danger signs (DiD = 31%) and knowledge of at least two newborn danger signs (DiD = 21%). Having knowledge of at least three BP components and attending community dialogue meetings increased the odds of BP practices and obstetric danger signs' knowledge, respectively. Village health teams' home visits, intervention area residence, and being in the 25+ age group increased the odds of both BP practices and obstetric danger signs' knowledge. The intervention resulted in a modest increase in BP practices and knowledge of obstetric danger signs. Multiple strategies targeting women, in particular the adolescent group, are needed to promote behavior change for improved BP and knowledge of obstetric danger signs.

Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

PubMed Central

Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

2011-01-01

Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care. PMID:19166559

Competency-Based Medical Education: Developing a Framework for Obstetrics and Gynaecology.

PubMed

Caccia, Nicolette; Nakajima, Amy; Scheele, Fedde; Kent, Nancy

2015-12-01

The development of a Canadian competency-based medical education (CBME) curriculum in obstetrics and gynaecology, slated to begin in 2017, must be rooted in, and aligned with, the principles of CanMEDS 2015 and Competence by Design. It must also reflect the unique realities of the practice of the specialty. The Dutch Society of Obstetrics and Gynaecology has been at the forefront of the movement to design and implement competency-based training for obstetrics and gynaecology. The Dutch curriculum represents a practical example of how such a program could be developed. Several CBME curricular initiatives have now also begun across Canada.

Risk management in obstetric care for family physicians: results of a 10-year project.

PubMed

Nesbitt, Thomas S; Hixon, Allen; Tanji, Jeffrey L; Scherger, Joseph E; Abbott, Dana

2003-01-01

Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

Business and Organizational Models of Obstetric and Gynecologic Hospitalist Groups.

PubMed

Garite, Thomas J; Levine, Lisa; Olson, Rob

2015-09-01

The growth of obstetric and gynecologic (OB/GYN) hospitalists throughout the United States has led to different organizational approaches, depending on the perception of what an OB/GYN hospitalist is. There are advantages of OB/GYN hospitalist practices; however, practitioners who do this as just 1 piece of their practice are not fulfilling the promise of what this new specialty can deliver. Because those with office practices have their own business models, this article is devoted to the organizational and business models of OB/GYN hospitalists for physicians whose practice is devoted to inpatient obstetrics with or without emergency room and/or inpatient gynecology coverage. Copyright © 2015 Elsevier Inc. All rights reserved.

[Burnout syndrome in medical and obstetric perception of violence].

PubMed

Pintado-Cucarella, Sheila; Penagos-Corzo, Julio C; Casas-Arellano, Marco Antonio

2015-03-01

Obstetric violence involves a violation of reproductive rights of women during pregnancy, childbirth and postpartum. It has been associated with lack of empathy and emotional discomfort of physicians. To identify the perceptions of obstetric violence and to determine the possible relationship with burnout syndrome. We evaluated 29 physicians whose scope of work relates to obstetrics and gynecology. The evaluation instruments were: a) questionnaire on professional perception that collects demographic information, situations of perceived obstetric violence, major concerns of physicians in their professional work, and includes an scale about level of job satisfaction, b) the Maslach Burnout inventory, and c) Jefferson Scale of Physician Empathy. The most prevalent obstetric violence situations perceived were: medical malpractice and harmful practices (10/29), discrimination (10/29), rude treatment and verbal attacks (11/29). Seventeen participants reported lack of information on obstetric violence and not have tools to cope with this problem. Regarding the burnout syndrome, it was associated with several items of the scale of empathy and with the scale of job satisfaction. This study shows the importance of providing knowledge and tools to deal with obstetric violence and stress management to prevent such situations on medical practices.

Roles, risks, and responsibilities in maternity care: trainees' beliefs and the effects of practice obstetric training.

PubMed Central

Smith, L. F.

1992-01-01

OBJECTIVES--To document the content of practice obstetric vocational training, the beliefs of general practitioner trainees about the roles of midwives and general practitioners in maternity care, and the risks of providing such care; and to ascertain if undergoing such training affects their beliefs. DESIGN--Confidential postal questionnaire survey. SUBJECTS--Random one in four sample of all general practitioner trainees in the United Kingdom on vocational training schemes or in training practices in autumn 1990. MAIN OUTCOME MEASURES--Beliefs scored on seven point Likert scales and characteristics of trainer and training practice. RESULTS--Of 1019 trainees sent questionnaires, 765 (75.1% response rate) replied; 638 (83.3%) had done some part of their practice year. Of their trainers, 224 (35.1%) provided full obstetric care. 749 (99%) and 364 (48%) trainees believed that midwives and general practitioners respectively have an important role in normal labour; 681 (91.7%) trainees believed that general practice intrapartum care is a high risk "specialty." Those trainees whose trainers provide full obstetric care were significantly more likely to believe that both midwives and general practitioners have an important role in abnormal labour and to see the provision of intrapartum care as an incentive to join a practice. CONCLUSION--In this series most general practitioner trainees believed that both midwives and general practitioners have important roles in maternity care. Exposure of trainees to the provision of full obstetric care while in their training practice resulted in a more positive attitude towards the provision of such care by general practitioners. PMID:1628091

Safe delivery and newborn care practices in Sindh, Pakistan: a community-based investigation of mothers and health workers.

PubMed

Hassan, Hamid; Jokhio, Abdul Hakeem; Winter, Heather; Macarthur, Christine

2012-08-01

to determine the prevalence of specific intrapartum practices in Sindh province, Pakistan. a cross-sectional, questionnaire based study. 6 health clinics in Mirpurkhas, Sindh province, rural Pakistan. 225 mothers and 82 health workers. outcome measures were indicators of safe delivery practices and referral following an obstetric complication. Prevalence of unhygienic and unsafe practices in deliveries attended by Traditional Birth Attendants (TBAs) was common. Deliveries by skilled attendants were significantly safer but with some failures in hygienic practices. 29% of women who had experienced an obstetric complication had not received emergency obstetric care. safe delivery practices and newborn care needs to be improved in rural Pakistan. This may be achieved by training health workers and TBAs in safe delivery practices, using safe delivery kits and with an effective referral system. Copyright © 2011 Elsevier Ltd. All rights reserved.

Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness

PubMed Central

Dettinger, Julia; Calkins, Kimberly; Kibore, Minnie; Gachuno, Onesmus; Walker, Dilys

2018-01-01

Background Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. Objective-method We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. Findings Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. Significance Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted. PMID:29474397

Obstetrics and gynaecology as a career choice: a cohort study of canadian medical students.

PubMed

Scott, Ian M; Nasmith, Trudy; Gowans, Margot C; Wright, Bruce J; Brenneis, Fraser R

2010-11-01

to describe the characteristics of medical students interested in obstetrics and gynaecology and to build a model that predicts which of these students will choose obstetrics and gynaecology as their career. students were surveyed in 2002, 2003, and 2004 at the commencement of their medical studies. Data were collected on career choice, attitudes to practice, and demographics at medical school entry and on career choice at medical school exit. three items present at entry to medical school were predictive of students ultimately choosing a career in obstetrics and gynaecology: having this career as one of their first three career choices at entry (having it as their first choice was the strongest predictor), being female, and desiring a narrow scope of practice. students choosing a career in obstetrics and gynaecology have attributes at medical school entry that differentiate them from students interested in other specialties. Identifying these attributes may guide education in and recruitment to obstetrics and gynaecology.

Training in the management of critical problems: teacher's view.

PubMed

van Geijn, H P; Vothknecht, S

1996-03-01

Teaching in critical obstetric problems should have special interest during residency and thereafter. Obstetric emergencies are relatively rare but may occur at any time. The obstetrician at that moment enters a special area requiring a multidisciplinary approach. From experiences in recent years and study of the literature the following recommendations can be summarized; (1) the need to understand (patho)physiologic changes in pregnancy, (2) cultivation of an anticipative attitude towards conditions with elevated risks, (3) adequate knowledge of diagnostic procedures, (4) the discipline to make a differential diagnosis, (5) experience with monitoring of (fetal and) maternal condition, (6) availability of management protocols for emergencies such as shock, eclampsia, uterine rupture, amniotic fluid embolism, thrombo-embolism, sepsis and diabetic ketoacidosis, (7) awareness of pitfalls with inspection of lesions and assessment of blood loss, (8) awareness that caesarean section without prior stabilization can be a life threatening procedure, (9) practice in life-saving measures such as uterine compression, packing, ligation of vessels, postpartum hysterectomy, (10) teaching of postoperative care, (11) insight into the cascade of events finally leading to multi-organ failure. Obstetric emergencies require a disciplined approach, in which teamwork is the cornerstone.

Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

PubMed Central

2014-01-01

Background Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. Methods This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. Results Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). Conclusion The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients. PMID:24725280

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

PubMed

Amodu, Oluwakemi C; Salami, Bukola; Richter, Solina

2017-10-01

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Recommendations for scale-up of community-based misoprostol distribution programs.

PubMed

Robinson, Nuriya; Kapungu, Chisina; Carnahan, Leslie; Geller, Stacie

2014-06-01

Community-based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource-poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community-based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community-based misoprostol program introduction, expansion, or scale-up. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Female family physicians in obstetrics: achieving personal balance.

PubMed Central

Carroll, J C; Brown, J B; Reid, A J

1995-01-01

OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice. PMID:7497390

Obstetric care providers' knowledge, practice and associated factors towards active management of third stage of labor in Sidama Zone, South Ethiopia.

PubMed

Tenaw, Zelalem; Yohannes, Zemenu; Amano, Abdela

2017-09-07

Active management of third stage of labor played a great role to prevent child birth related hemorrhage. However, maternal morbidity and mortality related to hemorrhage is high due to lack of knowledge and skill of obstetric care providers 'on active management of third stage of labor. Our study was aimed to assess knowledge, practice and associated factors of obstetric care providers (Midwives, Nurses and Health officers) on active management of third stage of labor in Sidama Zone, South Ethiopia. An institution based cross sectional study design was conducted from December 1-30 /2015 among midwives, nurses and health officers. Simple random sampling technique was used to get the total of 528 participants. Data entry was done using EPI Info 3.5.1 and exported to SPSS version 20.0 software package for analysis. The presence of association between independent and dependent variables was assessed using odds ratio with 97% confidence interval by applying logistic regression model. Of the 528 obstetric care providers 37.7% and 32.8% were knowledgeable and skilled to manage third stage of labor respectively. After controlling for possible confounding factors, the result showed that pre/in service training, being midwife and graduation year were found to be the major predictors of proper active management of third stage of labor. The knowledge and practice of obstetric care providers towards active management of third stage of labor can be improved with appropriate interventions like in-service trainings. This study also clearly showed that the level of knowledge and practice of obstetric care providers to wards active management of third stage of labor needs immediate attention of Universities and health science colleges better to revise their obstetrics course contents, health institutions and zonal health bureau should arrange trainings for their obstetrics care providers to enhance skill.

Use of Obstetric Practice Web Sites to Distribute Zika Virus Information to Pregnant Women During a Zika Virus Outbreak.

PubMed

Lehnert, Jonathan D; Ellingson, Mallory K; Goryoka, Grace W; Kasturi, Raghuraj; Maier, Emily; Chamberlain, Allison T

To describe the current use of obstetric practice Web sites to disseminate Zika virus information to patients. Review of 913 randomly selected practice Web sites and associated social media accounts in January and August 2016. Obstetric practice Web sites and associated social media accounts, United States of America. N/A. Proportion of obstetric practice Web sites and linked social media accounts providing Zika virus information. Twenty-five percent and 35% of obstetric practice Web sites had information posted about Zika virus in January 2016 and August 2016, respectively. Between the 2 time points, the proportion of practices posting Zika virus content on Facebook and Twitter declined (Facebook: 15% in January, 9% in August; Twitter: 12% in January, 8% in August). In August, the most frequently observed Zika virus-related content themes were the use of insect repellent (14%) and travel advisories (14%). At both time points, practices affiliated with large university hospitals were more likely to have posted information on Zika virus than independent OB/GYN-only practices: January: odds ratio (OR) (95% confidence interval [CI]) = 5.68 (3.50-9.20); August: OR (95% CI) = 8.37 (5.31-13.17). Similarly, practices associated with nonuniversity hospitals were more likely to have posted information than independent OB/GYN-only practices: January: OR (95% CI) = 2.71 (1.88-3.92); August: OR (95% CI) = 6.75 (4.75-9.60). Obstetric care practices are not fully utilizing their practice Web sites to relay Zika virus information to their patients. Since practitioner-sponsored Web sites have the capacity to directly reach the populations at greatest risk for Zika virus complications, public health professionals should consider adapting their materials and provider outreach campaigns to more easily accommodate Web site-based information dissemination during this type of public health emergency. There must be greater recognition of the value information gains in the eyes of the patient when it is validated by their own provider, especially when that patient is part of the highest-risk population for a given emergency. Public health organizations should strive to minimize the burden it takes for providers to relay useful resources to patients in order to maximize the impact that those resources can have.

Obstetric fistula: what about gender power?

PubMed

Roush, Karen; Kurth, Ann; Hutchinson, M Katherine; Van Devanter, Nancy

2012-01-01

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

Review article: practical current issues in perioperative patient safety.

PubMed

Eichhorn, John H

2013-02-01

This brief review provides an overview and, importantly, a context perspective of relevant current practical issues in perioperative patient safety. The dramatic improvement in anesthesia patient safety over the last 30 years was not initiated by electronic monitors but, rather, largely by a set of behaviours known as "safety monitoring" that were then made decidedly more effective by extending the human senses through electronic monitoring, for example, capnography and pulse oximetry. In the highly developed world, this current success is threatened by complacency and production pressure. In some areas of the developing/underdeveloped world, the challenge is implementing the components of anesthesia practice that will bring safety improvements to parallel the overall current success, for instance, applying the World Federation of Societies of Anaesthesiologists (WFSA) "International Standards for A Safe Practice of Anaesthesia". Generally, expanding the current success in safety involves many practical issues. System issues involve research, effective reporting mechanisms and analysis/broadcasting of results, perioperative communication (including "speaking up to power"), and checklists. Monitoring issues involve enforcing existing published monitoring standards and also recognizing the risk of danger to the patient from hypoventilation during procedural sedation and from postoperative intravenous pain medications. Issues of clinical care include medication errors in the operating room, cerebral hypoperfusion (especially in the head-up position), dangers of airway management, postoperative residual weakness from muscle relaxants, operating room fires, and risks specific in obstetric anesthesia. Recognition of the issues outlined here and empowerment of all anesthesia professionals, from the most senior professors and administrators to the newest practitioners, should help maintain, solidify, and expand the improvements in anesthesia and perioperative patient safety.

Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

PubMed

Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

2017-08-01

To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

[Countryside obstetrics--Dr. Franz von Ottenthal and the South Tyrolean Medical Market (1860-1869)].

PubMed

Hilber, Marina

2012-01-01

The paper focuses on the structure of the obstetric market in a rural region of alpine South Tyrol (today: Italy) throughout the 1860s. Besides midwives and parturient women, also male obstetricians are traceable in the actual research area of the Tauferer Ahrntal. Among them was the general practitioner Dr. Franz von Ottenthal, whose medical records (Historiae Morborum, 1847-1899) are used to reconstruct the participation of physicians in the obstetric market. Special emphasis lies on the evaluation of the predominant hierarchies (midwives/surgeons/physicians) and the position of Franz von Ottenthal in this specialized medical sub-segment. Therefore, the quantitative extent of obstetric intervention as well as the qualitative dimension of treatments (medication, surgeries) is investigated. So far, the relevance of Ottenthals obstetric practice as to the gender ratio has been measured as rather high, considering that he generally treated more female than male patients. An attempt will be made to estimate the significance of the obstetric segment within his practice in order to find an explanatory approach for the higher female medical demand.

Future practice of graduates of the New Zealand Diploma of Obstetrics and Gynaecology or Certificate in Women's Health.

PubMed

Miller, Dawn; Roberts, Helen; Wilson, Don

2008-09-22

To determine: why Diploma of Obstetrics (DipObs), Diploma of Obstetrics and Medical Gynaecology (DipOMG), or Certificate in Women's Health graduates enrolled; course usefulness; and subsequent practice. 588 University of Otago DipObs, DipOMG, and Certificate in Women's Health graduates (1992-2006) plus Auckland University graduates (1996-2006) were identified. All were doctors. Questionnaires were sent to the 477 with New Zealand medical registration and responses analysed. 334 of the 477 graduates returned completed questionnaires--70% response rate. 73% had worked as GPs, 10% at family planning clinics, 6% at sexual health clinics; and 13% specialised in OandG. 80% enrolled to further knowledge in women's health, 20% in children's health, and 43% to practise GP obstetrics. Most respondents who enrolled in the 1990s intended to practise GP obstetrics but by 2000 most did not. Of 137 New Zealand-based GP respondents who enrolled to practise GP obstetrics, only 5 (3.6%) currently practise intrapartum obstetric care. Twenty-three GPs still practise shared maternity care. Of 220 primary care practitioners, 90% provide early antenatal care. 93% described the course as useful-extremely useful. The DipObs, Dip OMG and Certificate in Women's Health have continued to provide useful postgraduate training in women's health during a changing time in New Zealand pregnancy care. While many graduates of the 1990s enrolled to practise GP obstetrics, most recent graduates did not, and few GPs still practise intrapartum obstetrics.

Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.

PubMed

Yuill, Gordon; Amroyan, Ashot; Millar, Simon; Vardapetyan, Emil; Habib, Ashraf S; Owen, Medge D

2017-08-01

Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.

Making it work: successful collaborative practice.

PubMed

DeJoy, Susan; Burkman, Ronald T; Graves, Barbara W; Grow, Daniel; Sankey, Heather Z; Delk, Carolyn; Feinland, Julie; Kaplan, Janet; Hallisey, Anastasia

2011-09-01

There are three major examples of collaborative programs between certified nurse-midwives (CNMs) and obstetrician-gynecologists at Baystate Medical Center in Springfield, Massachusetts, within the Department of Obstetrics and Gynecology. One program is a midwifery practice that serves a diverse population in a hospital-based office, four neighborhood health centers, and a correctional facility. Another program provides a triage function for patients who present to the hospital with obstetric or gynecologic problems. The third program introduces a team approach to the education of residents with a CNM having primary responsibility for teaching normal obstetrics to first-year residents and medical students in collaboration with attending physicians. Keys to success include an understanding of the principles of collaborative practice, the use of a detailed practice agreement between midwives and attending physicians, keeping open lines of communication, understanding and accepting differing philosophies of practice, and, most importantly, maintaining trust across all levels of providers.

[Perceiving gender or profession: the practical experience of male nursing students in the obstetrics and gynecology ward].

PubMed

Lee, Ya-Fen; Yang, Yu-O; Tu, Chia-Ling

2013-06-01

The impact of general gender stereotypes on nursing is severe and influential, especially with regard to male nursing students working in obstetrics and gynecology wards. This study examined the experience of male nursing students in obstetrics and gynecology wards. We used a phenomenological qualitative research approach and a sample of 10 male nursing students currently studying at a nursing college in central Taiwan. All participants had obstetrics and gynecology ward experience. Individual interviews were transcribed into the procedural record. Colaizzi content analysis analyzed and categorized research data. Based on participants practical experiences in the obstetrics and gynecology ward, the main stages of participants professional development through their internship experience included: (1) Unbalanced self-role recognition; (2) being defined by the gender framework (gender stereotypes); (3) the difference between male doctor and male nurse; (4) learning appropriate communication techniques; (5) mutual and empathetic understanding of the female psychology during childbirth; (6) gaining sources for positive feedback; (7) releasing the shackles of gender and gaining full insight into and comprehension of nursing functions; and (8) given the opportunity to learn. Through ongoing examination and learning, participant internships in the obstetrics and gynecology wards were significant and essential learning experiences that validated their necessity. Nursing schools and internship institutions alike must realize the importance of gender-equality education to the nursing profession. Medical institutions are encouraged to offer equal learning opportunities to male and female nursing students and provide targeted assistance to males to help them master clinical nursing care practices in the obstetrics and gynecology department.

Cesarean sections, perfecting the technique and standardizing the practice: an analysis of the book Obstetrícia, by Jorge de Rezende.

PubMed

Nakano, Andreza Rodrigues; Bonan, Claudia; Teixeira, Luiz Antônio

2016-01-01

This article discusses the development of techniques for cesarean sections by doctors in Brazil, during the 20th century, by analyzing the title "Operação Cesárea" (Cesarean Section), of three editions of the textbookObstetrícia, by Jorge de Rezende. His prominence as an author in obstetrics and his particular style of working, created the groundwork for the normalization of the practice of cesarean sections. The networks of meaning practiced within this scientific community included a "provision for feeling and for action" (Fleck) which established the C-section as a "normal" delivery: showing standards that exclude unpredictability, chaos, and dangers associated with the physiology of childbirth, meeting the demand for control, discipline and safety, qualities associated with practices, techniques and technologies of biomedicine.

What is an Obstetrics/Gynecology Hospitalist?

PubMed

McCue, Brigid

2015-09-01

The obstetrics/gynecology (OB/GYN) hospitalist is the latest subspecialist to evolve from obstetrics and gynecology. Starting in 2002, academic leaders recognized the impact of such coalescing forces as the pressure to reduce maternal morbidity and mortality, stagnant reimbursements and the increasing cost of private practice, the decrease in applications for OB/GYN residencies, and the demand among practicing OB/GYNs for work/life balance. Initially coined laborist, the concept of the OB/GYN hospitalist emerged. Thinking of becoming an OB/GYN hospitalist? Here is what you need to know. Copyright © 2015 Elsevier Inc. All rights reserved.

'When helpers hurt': women's and midwives' stories of obstetric violence in state health institutions, Colombo district, Sri Lanka.

PubMed

Perera, Dinusha; Lund, Ragnhild; Swahnberg, Katarina; Schei, Berit; Infanti, Jennifer J

2018-06-07

The paper explores how age, social position or class, and linguistic and cultural background intersect and place women in varying positions of control and vulnerability to obstetric violence in state health institutions in Colombo district, Sri Lanka. Obstetric violence occurs during pregnancy, childbirth and the immediate postpartum period; hence, it is violence that directly affects women. The authors aim to break the traditional culture of silence around obstetric violence and bring attention to the resulting implications for quality of care and patient trust in obstetric care facilities or providers. Five focus group discussions were held with 28 public health midwives who had prior experience working in labor rooms. Six focus group discussions were held with 38 pregnant women with previous childbirth experience. Additionally, 10 of the 38 women, whom felt they had experienced excessive pain, fear, humiliation, and/or loss of dignity as patients in labor, participated in individual in-depth interviews. An intersectional framework was used to group the qualitative data into categories and themes for analysis. Obstetric violence appears to intersect with systems of power and oppression linked to structural gender, social, linguistic and cultural inequities in Sri Lanka. In our dataset, younger women, poorer women, and women who did not speak Sinhala seemed to experience more obstetric violence than those with relevant social connections and better economic positions. The women in our study rarely reported obstetric violence to legal or institutional authorities, nor within their informal social support networks. Instead, they sought obstetric care, particularly for childbirth, in other state hospitals in subsequent pregnancies. The quality of obstetric care in Sri Lanka needs improvement. Amongst other initiatives, policies and practices are required to sensitize health providers about the existence of obstetric violence, and repercussions are required for abusive or discriminatory practices. The ethics of care should be further reinforced in the professional training of obstetric health providers.

Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case-Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees.

PubMed

Shaw-Battista, Jenna; Young-Lin, Nichole; Bearman, Sage; Dau, Kim; Vargas, Juan

2015-01-01

Ultrasound is an important aid in the clinical diagnosis and management of normal and complicated pregnancy and childbirth. The technology is widely applied to maternity care in the United States, where comprehensive standard ultrasound examinations are routine. Targeted scans are common and used for an increasing number of clinical indications due to emerging research and a greater availability of equipment with better image resolution at lower cost. These factors contribute to an increased demand for obstetric ultrasound education among students and providers of maternity care, despite a paucity of data to inform education program design and evaluation. To meet this demand, from 2012 to 2015 the University of California, San Francisco nurse-midwifery education program developed and implemented an interprofessional obstetric ultrasound course focused on clinical applications commonly managed by maternity care providers from different professions and disciplines. The course included matriculating students in nursing and medicine, as well as licensed practitioners such as registered and advanced practice nurses, midwives, and physicians and residents in obstetrics and gynecology and family medicine. After completing 10 online modules with a pre- and posttest of knowledge and interprofessional competencies related to teamwork and communication, trainees attended a case-based seminar and hands-on skills practicum with pregnant volunteers. The course aimed to establish a foundation for further supervised clinical training prior to independent practice of obstetric ultrasound. Course development was informed by professional guidelines and clinical and education research literature. This article describes the foundations, with a review of the challenges and solutions encountered in obstetric ultrasound education development and implementation. Our experience will inform educators who wish to facilitate obstetric ultrasound competency development among new and experienced maternity care providers in academic and clinical settings. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

Late Maternal Deaths and Deaths from Sequelae of Obstetric Causes in the Americas from 1999 to 2013: A Trend Analysis.

PubMed

de Cosio, Federico G; Jiwani, Safia S; Sanhueza, Antonio; Soliz, Patricia N; Becerra-Posada, Francisco; Espinal, Marcos A

2016-01-01

Data on maternal deaths occurring after the 42 days postpartum reference time is scarce; the objective of this analysis is to explore the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes in the Americas between 1999 and 2013, and to recommend including these deaths in the monitoring of the Sustainable Development Goals (SDGs). Exploratory data analysis enabled analyzing the magnitude and trend of late maternal deaths and deaths from sequelae of obstetric causes for seven countries of the Americas: Argentina, Brazil, Canada, Colombia, Cuba, Mexico and the United States. A Poisson regression model was developed to compare trends of late maternal deaths and deaths from sequelae of obstetric causes between two periods of time: 1999 to 2005 and 2006 to 2013; and to estimate the relative increase of these deaths in the two periods of time. The proportion of late maternal deaths and deaths from sequelae of obstetric causes ranged between 2.40% (CI 0.85% - 5.48%) and 18.68% (CI 17.06% - 20.47%) in the seven countries. The ratio of late maternal deaths and deaths from sequelae of obstetric causes per 100,000 live births has increased by two times in the region of the Americas in the period 2006-2013 compared to the period 1999-2005. The regional relative increase of late maternal death was 2.46 (p<0.0001) times higher in the second period compared to the first. Ascertainment of late maternal deaths and deaths from sequelae of obstetric causes has improved in the Americas since the early 2000's due to improvements in the quality of information and the obstetric transition. Late and obstetric sequelae maternal deaths should be included in the monitoring of the SDGs as well as in the revision of the International Classification of Diseases' 11th version (ICD-11).

Late Maternal Deaths and Deaths from Sequelae of Obstetric Causes in the Americas from 1999 to 2013: A Trend Analysis

PubMed Central

de Cosio, Federico G.; Sanhueza, Antonio; Soliz, Patricia N.; Becerra-Posada, Francisco; Espinal, Marcos A.

2016-01-01

Background Data on maternal deaths occurring after the 42 days postpartum reference time is scarce; the objective of this analysis is to explore the trend and magnitude of late maternal deaths and deaths from sequelae of obstetric causes in the Americas between 1999 and 2013, and to recommend including these deaths in the monitoring of the Sustainable Development Goals (SDGs). Methods Exploratory data analysis enabled analyzing the magnitude and trend of late maternal deaths and deaths from sequelae of obstetric causes for seven countries of the Americas: Argentina, Brazil, Canada, Colombia, Cuba, Mexico and the United States. A Poisson regression model was developed to compare trends of late maternal deaths and deaths from sequelae of obstetric causes between two periods of time: 1999 to 2005 and 2006 to 2013; and to estimate the relative increase of these deaths in the two periods of time. Findings The proportion of late maternal deaths and deaths from sequelae of obstetric causes ranged between 2.40% (CI 0.85% – 5.48%) and 18.68% (CI 17.06% – 20.47%) in the seven countries. The ratio of late maternal deaths and deaths from sequelae of obstetric causes per 100,000 live births has increased by two times in the region of the Americas in the period 2006-2013 compared to the period 1999-2005. The regional relative increase of late maternal death was 2.46 (p<0.0001) times higher in the second period compared to the first. Interpretation Ascertainment of late maternal deaths and deaths from sequelae of obstetric causes has improved in the Americas since the early 2000’s due to improvements in the quality of information and the obstetric transition. Late and obstetric sequelae maternal deaths should be included in the monitoring of the SDGs as well as in the revision of the International Classification of Diseases’ 11th version (ICD-11). PMID:27626277

Medication errors in the obstetrics emergency ward in a low resource setting.

PubMed

Kandil, Mohamed; Sayyed, Tarek; Emarh, Mohamed; Ellakwa, Hamed; Masood, Alaa

2012-08-01

To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting. This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed. A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts. The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.

Experiences of family physicians who practise primary care obstetrics in groups.

PubMed

Koppula, Sudha; Brown, Judith B; Jordan, John M

2011-02-01

The purpose of this study was to explore the experiences of family physicians in primary care obstetrical groups. Using a qualitative approach, in-depth interviews were conducted with 12 Edmonton family physicians who participated in primary care obstetrical groups. Experiences with respect to several aspects of group obstetrical practice were examined including advantages and challenges of primary care obstetrical groups, provision of patient care by a group, fit with other work commitments, and sustainability of the groups. Study data were audiotaped and transcribed verbatim. Independent and team analysis was iterative and interpretive. Primary care obstetrical groups were found to preserve a family physician's enjoyment of obstetrics and allowed for continuity of care. They afforded work-life balance, allowed for collaboration, and provided support and a social network for group members. Such groups were found to facilitate short-term family physician absences, although long-term absences (such as maternity leaves) were considered challenging. Participants described conflict within primary care obstetrical groups and considered sustainability to be a challenge. Family physicians' continued involvement in obstetrics could be facilitated by their participation in primary care obstetrical groups.

How obstetric settings can help address gaps in psychiatric care for pregnant and postpartum women with bipolar disorder.

PubMed

Byatt, Nancy; Cox, Lucille; Moore Simas, Tiffany A; Kini, Nisha; Biebel, Kathleen; Sankaran, Padma; Swartz, Holly A; Weinreb, Linda

2018-03-13

To elucidate (1) the challenges associated with under-recognition of bipolar disorder in obstetric settings, (2) barriers pregnant and postpartum women with bipolar disorder face when trying to access psychiatric care, and (3) how obstetric settings can identify such women and connect them with mental health services. Structured, in-depth interviews were conducted with 25 pregnant and postpartum women recruited from obstetric practices who scored ≥ 10 on the Edinburgh Postnatal Depression Scale and met DSM-IV criteria for bipolar disorder I, II, or not otherwise specified using the Mini International Neuropsychiatric Interview. Quantitative analyses included descriptive statistics. Interviews were transcribed, and resulting data were analyzed using a grounded theory approach. Most participants (n = 19, 79.17%) did not have a clinical diagnosis of bipolar disorder documented in their medical records nor had received referral for treatment during pregnancy (n = 15, 60%). Of participants receiving pharmacotherapy (n = 14, 58.33%), most were treated with an antidepressant alone (n = 10, 71.42%). Most medication was prescribed by an obstetric (n = 4, 28.57%) or primary care provider (n = 7, 50%). Qualitative interviews indicated that participants want their obstetric practices to proactively screen for, discuss and help them obtain mental health treatment. Women face challenges in securing mental health treatment appropriate to their bipolar illness. Obstetric providers provide the bulk of medical care for these women and need supports in place to (1) better recognize bipolar disorder, (2) avoid inappropriate prescribing practices for women with undiagnosed bipolar disorder, and (3) ensure women are referred to specialized treatment when needed.

A resident conference for systems-based practice and practice-based learning.

PubMed

Sultana, Carmen J; Baxter, Jason K

2011-02-01

Improving patient safety and quality of care is part of systems-based practice and practice-based learning for residents. We expanded our obstetrics and gynecology department's regularly scheduled morbidity and mortality conferences to teach quality assurance concepts based on patient care on obstetrics and gynecology fourth-year resident rotations. Obstetrics and gynecology fourth-year residents on one of the two rotations each presented and analyzed a systems-based problem they encountered during patient care. They used an online learning module and proposed solutions, many of which were effectively implemented. Over 5 years, case presentations from 33 conferences were available with problems identified in emergency preparedness, coordination of care, scheduling and supervision, communication, medical practice, documentation, and lack of equipment or facilities. Twenty-two of the suggested solutions were partially or totally implemented. Barriers to implementation were identified. In conclusion, a conference presentation by fourth-year residents can identify patient safety problems, aid in their resolution, and suggest changes to patient care while teaching the principles of systems-based practice and practice-based learning.

Biopsychosocial obstetrics and gynaecology - a perspective from Australia.

PubMed

Rowe, Heather

2016-01-01

Prior to and throughout the twentieth century, biomedical understandings of health predominated. Australian obstetrician and gynaecologist, Professor Derek Llewellyn-Jones responded to frustrations with the limitations of this narrow approach from both within and beyond the medical profession. His pioneering research, education and writings re-conceptualised the discipline as encompassing the social and psychological contexts and profoundly influenced women's own understanding of their health and the practice of obstetrics and gynaecology. The biopsychosocial model has replaced biological determinism and is now pervasive in education and clinical practice in many parts of the world. Widespread acceptance of the model has until now been associated with under-recognition of the importance of biology. Recent findings from epigenetics and neuroscience are enabling integration of body, mind and society and enhanced understanding and practice of psychosomatic obstetrics and gynaecology.

Cochrane Reviews in Obstetrics and Gynecology: What is the Contribution of Indian Studies?

PubMed

Radhika, A G; Pandey, Garima; Singh, Nilanchali; Sinha, Anju

2016-10-01

Cochrane reviews aim to produce evidence for health care practice globally including India. We wanted to assess the contribution of Indian origin studies in developing these systematic reviews in the field of obstetrics and gynecology. The objective of this study is to determine the number of Indian origin studies in obstetrics and gynecology which provided conclusive data and hence contributed toward formulating Cochrane Reviews in Obstetrics and Gynecology. A total of 910 Cochrane reviews were accessed from gynecology and pregnancy and child birth list from Cochrane health topics. The details of studies included for each review were accessed from references section. Indian origin studies were then identified from this for further analysis. Of the total 910 Cochrane reviews available on the subject of obstetrics and gynecology, 93 reviews had 225 studies of Indian origin. In the subject-wise categorisation, there were 404 and 506 systematic reviews in Gynecology and Obstetrics respectively. Indian studies were included in 32 and 61 systematic reviews of Gynecology and Obstetrics respectively. Regarding the details of 225 Indian studies included for our analysis, 162 were related to Obstetrics and 63 to Gynecology. The place of study could be ascertained in 81 of the 225 studies despite extensive search. Studies published after 1980 are available in the electronic databases while the earlier studies are difficult to access. Studies with duplicate mentions were counted once. There is an urgent continuing need for high quality research and its publication in India in the field of obstetrics and gynecology. Awareness building measures amongst Obstetricians and Gynecologists in this regard need to be addressed. Better quality studies are especially required in specific areas posing a challenge to our country, to improve the health care practices.

Obstetric Complications as Risk Factors for Schizophrenia Spectrum Psychoses in Offspring of Mothers With Psychotic Disorder

PubMed Central

Suvisaari, Jaana M.

2013-01-01

Background: Obstetric complications have predicted future development of schizophrenia in previous studies, but they are also more common in mothers with schizophrenia. The aims of this study were to compare the occurrence of obstetric complications in children of mothers with schizophrenia spectrum psychoses and control children, and to investigate whether obstetric complications predicted children’s psychiatric morbidity. Method: The Helsinki High-Risk (HR) Study monitors females born between 1916 and 1948 and treated for schizophrenia spectrum disorders in Helsinki psychiatric hospitals, their offspring born between 1941 and 1977, and controls. We examined information on obstetric complications and neonatal health of 271 HR and 242 control offspring. We compared the frequency of obstetric complications and neonatal health problems in the HR group vs controls and in HR children who later developed psychotic disorders vs healthy HR children. A Cox regression model was used to assess whether problems in pregnancy or delivery predicted psychiatric morbidity within the HR group. Results: Few differences between HR and control offspring were found in obstetric complications. Within the HR group, infections (hazard rate ratio [HRR] 3.73, 95% CI 1.27–11.01), hypertension during pregnancy (HRR 4.10, 95% CI 1.15–14.58), and placental abnormalities (HRR 4.09, 95% CI 1.59–10.49) were associated with elevated risk of schizophrenia spectrum psychoses. Conclusions: Common medical problems during pregnancy were associated with increased risk of schizophrenia spectrum psychoses in offspring of mothers with schizophrenia spectrum psychoses. These results underline the role of the prenatal period in the development of schizophrenia and the importance of careful monitoring of pregnancies of mothers with psychotic disorder. PMID:23002182

Obstetric complications as risk factors for schizophrenia spectrum psychoses in offspring of mothers with psychotic disorder.

PubMed

Suvisaari, Jaana M; Taxell-Lassas, Virpi; Pankakoski, Maiju; Haukka, Jari K; Lönnqvist, Jouko K; Häkkinen, Laura T

2013-09-01

Obstetric complications have predicted future development of schizophrenia in previous studies, but they are also more common in mothers with schizophrenia. The aims of this study were to compare the occurrence of obstetric complications in children of mothers with schizophrenia spectrum psychoses and control children, and to investigate whether obstetric complications predicted children's psychiatric morbidity. The Helsinki High-Risk (HR) Study monitors females born between 1916 and 1948 and treated for schizophrenia spectrum disorders in Helsinki psychiatric hospitals, their offspring born between 1941 and 1977, and controls. We examined information on obstetric complications and neonatal health of 271 HR and 242 control offspring. We compared the frequency of obstetric complications and neonatal health problems in the HR group vs controls and in HR children who later developed psychotic disorders vs healthy HR children. A Cox regression model was used to assess whether problems in pregnancy or delivery predicted psychiatric morbidity within the HR group. Few differences between HR and control offspring were found in obstetric complications. Within the HR group, infections (hazard rate ratio [HRR] 3.73, 95% CI 1.27-11.01), hypertension during pregnancy (HRR 4.10, 95% CI 1.15-14.58), and placental abnormalities (HRR 4.09, 95% CI 1.59-10.49) were associated with elevated risk of schizophrenia spectrum psychoses. Common medical problems during pregnancy were associated with increased risk of schizophrenia spectrum psychoses in offspring of mothers with schizophrenia spectrum psychoses. These results underline the role of the prenatal period in the development of schizophrenia and the importance of careful monitoring of pregnancies of mothers with psychotic disorder.

Obstetrics in a Time of Violence: Mexican Midwives Critique Routine Hospital Practices.

PubMed

Zacher Dixon, Lydia

2015-12-01

Mexican midwives have long taken part in a broader Latin American trend to promote "humanized birth" as an alternative to medicalized interventions in hospital obstetrics. As midwives begin to regain authority in reproductive health and work within hospital units, they come to see the issue not as one of mere medicalization but of violence and violation. Based on ethnographic fieldwork with midwives from across Mexico during a time of widespread social violence, my research examines an emergent critique of hospital birth as a site of what is being called violencia obstétrica (obstetric violence). In this critique, women are discussed as victims of explicit abuse by hospital staff and by the broader health care infrastructures. By reframing obstetric practices as violent-as opposed to medicalized-these midwives seek to situate their concerns about women's health care in Mexico within broader regional discussions about violence, gender, and inequality. © 2015 by the American Anthropological Association.

STORC safety initiative: a multicentre survey on preparedness & confidence in obstetric emergencies.

PubMed

Guise, Jeanne-Marie; Segel, Sally Y; Larison, Kristine; M Jump, Sarah; Constable, Marion; Li, Hong; Osterweil, Patricia; Dieter Zimmer

2010-12-01

Patient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated with confidence in responding to obstetric emergencies and to evaluate perceptions about the value of team training to improve preparedness. An anonymous survey was administered to all clinical staff members who respond to obstetric emergencies in seven Oregon hospitals from June 2006 to August 2006. 614 clinical staff (74.5%) responded. While over 90% felt confident that the appropriate clinical staff would respond to emergencies, more than half reported that other clinical staff members were confused about their role during emergencies. Over 84% were confident that emergency drills or simulation-based team training would improve performance. Clinical staff who respond to obstetric emergencies in their practice reported feeling confident that the qualified personnel would respond to an emergency; however, they were less confident that the responders would perform well as a team. They reported that simulation and team training may improve their preparedness and confidence in responding to emergencies.

Integrating Prevention into Obstetrics/Gynecology.

ERIC Educational Resources Information Center

Carey, J. Christopher

2000-01-01

Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

In Defense of the Obstetrician and Obstetrics

PubMed Central

Hoffman, Ralph L.

1965-01-01

Changes and advances in obstetrics are emphasized by the comparative study of private and one hospital practice in 1939 and 1964. Education, prenatal care, anesthesia, antibiotics, transfusions have all been instrumental. Old problems—abortion, toxemia, prematurity, developmental abnormalities—remain with us. New developments, both professional and economic, some not desirable, face us and demand that active practicing obstetricians take an active role in helping direct their course. PMID:5847740

Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

PubMed

Fanning, Rebecca A; Briggs, Liam P; Carey, Michael F

2009-03-01

The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

Fifty years of obstetrics and gynaecology.

PubMed

Drife, James O

2016-10-01

The term 'obstetrics and gynaecology' now feels like an outmoded name for women's health care. Since the 1960s the specialty has been transformed by social change, technical innovation and medical subspecialization, although the core values of good clinical practice remain unchanged.

Addressing the third delay: implementing a novel obstetric triage system in Ghana.

PubMed

Goodman, David M; Srofenyoh, Emmanuel K; Ramaswamy, Rohit; Bryce, Fiona; Floyd, Liz; Olufolabi, Adeyemi; Tetteh, Cecilia; Owen, Medge D

2018-01-01

Institutional delivery has been proposed as a method for reducing maternal morbidity and mortality, but little is known about how referral hospitals in low-resource settings can best manage the expected influx of patients. In this study, we assess the impact of an obstetric triage improvement programme on reducing hospital-based delay in a referral hospital in Accra, Ghana. An Active Implementation Framework is used to describe a 5-year intervention to introduce and monitor obstetric triage capabilities. Baseline data, collected from September to November 2012, revealed significant delays in patient assessment on arrival. A triage training course and monitoring of quality improvement tools occurred in 2013 and 2014. Implementation barriers led to the construction of a free-standing obstetric triage pavilion, opened January 2015, with dedicated midwives. Data were collected at three time intervals following the triage pavilion opening and compared with baseline including: referral indications, patient and labour characteristics, waiting time from arrival to assessment and the documentation of a care plan. An obstetric triage improvement programme reduced the median (IQR) patient waiting time from facility arrival to first assessment by a midwife from 40 min (15-100) to 5 min (2-6) (p<0.001) over the 5-year intervention. The triage pavilion enhanced performance resulting in the elimination of previous delays associated with the time of admission and disease acuity. Care plan documentation increased from 51% to 96%. Obstetric triage, when properly implemented, reduced delay in a busy, low-resource hospital. The implementation process was sustained under local leadership during transition to a new hospital.

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

PubMed

Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao

2018-02-01

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

How safe is GP obstetrics? An assessment of antenatal risk factors and perinatal outcomes in one rural practice.

PubMed

Kirke, Andrew B

2010-01-01

Approximately one-fifth of Western Australian women deliver their babies in rural and remote regions of the state. The medical workforce caring for these women is predominantly non-specialist GP obstetricians. This article explores how safe is rural GP obstetrics. It reviews one rural obstetric practice in detail. In particular it asks these questions: What are the antenatal risk factors? What are the obstetric outcomes for the mother? What are the obstetric outcomes for the baby? This study is an audit of the author's obstetric practice over a two-year period from July 2007 to June 2009. The audit criteria included all obstetric patients managed by the author through to delivery and immediate post-partum care. Hospital and practice notes for 195 singleton pregnancies were reviewed. Antenatal risk factors, intrapartum events and immediate post-partum events for all patients cared for by the author through to delivery were recorded and compared with averages for Western Australia from published 2007 figures. The maternal population had mean age of 28.5 years, 2.1% were Aboriginal. Body mass index (BMI) at booking was a mean of 27.1 (range 18-40). Those with a BMI > 40 were referred elsewhere. Significant antenatal risks included smoking (14.9%), previous caesarean section (14.4%), hypertension (13.3%), pre-eclampsia (5.1%) and gestational diabetes (8.2%). Intrapartum there were high rates of induction (33.5%), epidural/spinal (34.7%) and shoulder dystocia (3.6%). Type of delivery was predominantly spontaneous vaginal (65.6%), vacuum (14.9%), forceps (2.6%), elective caesarean (9.7%) and non-elective caesarean (8.7%). Post-partum events included post-partum haemorrhage (10.3%), transfusion (1.5%), retained placenta (2.1%), neonatal jaundice (21.1%), neonatal seizures (1.5%) neonatal sepsis (1.5%) and neonatal special care or intensive care (SCU/NICU) admission (9.8%). The audit population was a group of relatively low risk pregnant women. Despite referral of more complicated patients to specialist services either in Kalgoorlie or to Perth, there remained a significant number of women who developed antenatal risk factors. There was a high rate of induction of labour, which reflected the high rates of hypertension and diabetes, both relative indicators for induction at term. There was a reassuringly high rate of spontaneous vaginal delivery and low rates of elective and non-elective caesarian section. Post-partum clinically significant events still occurred for mother and baby, although not at rates higher than expected elsewhere. The results of this audit show that in a rural setting where options for referral may be less than in an urban setting, it is still possible to practice obstetrics safely. These results support the hypothesis that it is safe to practice GP obstetrics particularly in a rural setting. An unexpected result in this audit was the high rate of gestational diabetes, which is significantly greater than the average published for Western Australia. Further investigation of rates of gestational diabetes in other rural populations is warranted to explore this further.

Obstetrical Forceps

NASA Technical Reports Server (NTRS)

2004-01-01

Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi.

PubMed

Kaplan, Julika Ayla; Kandodo, Jonathan; Sclafani, Joseph; Raine, Susan; Blumenthal-Barby, Jennifer; Norris, Alison; Norris-Turner, Abigail; Chemey, Elly; Beckham, John Michael; Khan, Zara; Chunda, Reginald

2017-06-19

Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women's autonomy and fistula risk undergo further investigation.

German words: still used by Japanese obstetrics and gynecology doctors.

PubMed

Matsubara, Shigeki

2018-03-01

German used to be frequently employed in Japanese obstetric and gynecologic (OBGYN) practice; however, it is now less frequently used. Description and analysis of this situation may shed some light on the change of OBGYN practice and education in Japan, which may at least partly hold true to counties other than Japan. Three eras were classified according to the relationship between German and Japanese OBGYN, with each era characterized. Frequently used German words in Japanese OBGYN practice were described as examples. German words have become less frequently used with each successive generation. Even though English may suffice in practical OBGYN practice, German usage will still be passed on to these new generations.

The fetal heart rate collaborative practice project: situational awareness in electronic fetal monitoring-a Kaiser Permanente Perinatal Patient Safety Program Initiative.

PubMed

MacEachin, S Rachel; Lopez, Connie M; Powell, Kimberly J; Corbett, Nancy L

2009-01-01

Electronic fetal monitoring has historically been interpreted with wide variation between and within disciplines on the obstetric healthcare team. This leads to inconsistent decision making in response to tracing interpretation. To implement a multidisciplinary electronic fetal monitoring training program, utilizing the best evidence available, enabling standardization of fetal heart rate interpretation to promote patient safety. Local multidisciplinary expertise along with an outside consultant collaborated over a series of meetings to create a multimedia instructional electronic fetal monitoring training program. After production was complete, a series of conferences attended by nurses, certified nurse midwives, and physician champions, from each hospital, attended to learn how to facilitate training at their own perinatal units. All healthcare personnel across the Kaiser Permanente perinatal program were trained in NICHD nomenclature, emergency response, interpretation guidelines, and how to create local collaborative practice agreements. Metrics for program effectiveness were measured through program evaluations from attendees, the Safety Attitudes Questionnaire. Program evaluations rendered very positive scores from both physicians and clinicians. Comparing baseline to 4 years later, the perception of safety from the staff has increased over 10% in 5 out of the 6 factors analyzed. Active participation from all disciplines in this training series has highlighted the importance of teamwork and communication. The Fetal Heart Rate Collaborative Practice Project continues to evolve utilizing other educational modalities, such as online EFM education and unit-based interdisciplinary tracing reviews.

FORENSIC OBSTETRICS

PubMed Central

Russell, Keith P.

1959-01-01

Some of the more important and current aspects of forensic obstetrics are, broadly, 1. Fulfillment of basic criteria in all cases of alleged traumatic abortion. 2. Utilization of therapeutic abortion review boards, as well as sterilization committees, in all hospitals, with the active support of such committees by all those physicians interested in advancing the art and practice of obstetrics. 3. Early and active joint study of professional liability problems by combined groups of physicians and lawyers in every community. PMID:14440311

Current obstetrical practice and umbilical cord prolapse.

PubMed

Usta, I M; Mercer, B M; Sibai, B M

1999-01-01

The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

Did the use of chloroform by Queen Victoria influence its acceptance in obstetric practice?

PubMed

Connor, H; Connor, T

1996-10-01

Examination of contemporaneous publications suggests that the use of chloroform by Queen Victoria in 1853 did not result in the major breakthrough in the acceptability of obstetric anaesthesia with which the event has been credited by some later writers.

Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units

PubMed Central

Wyatt, Jeremy C; Paterson-Brown, Sarah; Johanson, Richard; Altman, Douglas G; Bradburn, Michael J; Fisk, Nicholas M

1998-01-01

Objective To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews. Design Randomised single blind controlled trial with obstetric units allocated to an educational visit or control group. Setting 25 of the 26 district general obstetric units in two former NHS regions. Subjects The senior obstetrician and midwife from each intervention unit participated in educational visits. Clinical practices of all staff were assessed in 4508 pregnancies. Intervention Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics, guidance on implementation, and donation of Cochrane database and other materials. Main outcome measures Rates of perineal suturing with polyglycolic acid, ventouse delivery, prophylactic antibiotics in caesarean section, and steroids in preterm delivery, before and 9 months after visits, and concordance of guidelines with review evidence for same marker practices before and after visits. Results Rates varied greatly, but the overall baseline mean of 43% (986/2312) increased to 54% (1189/2196) 9 months later. Rates of ventouse delivery increased significantly in intervention units but not in control units; there was no difference between the two types of units in uptake of other practices. Pooling rates from all 25 units, use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period, but use of steroids in preterm delivery was unchanged. Labour ward guidelines seldom agreed with evidence at baseline; this hardly improved after visits. Educational visits cost £860 each (at 1995 prices). Conclusions There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995. Our educational visits added little to this, despite the informal setting, targeting of senior staff from two disciplines, and donation of educational materials. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic reviews and to clarify leadership and roles of senior obstetric staff in implementing the evidence. Key messagesThere was marked variation in four common obstetric practices known to improve patient outcomes in 25 district general obstetric units across south east England in both 1994 and 1995Labour ward guidelines in the 25 units showed little concordance with Cochrane review evidence in 1994 and 1995The gap between Cochrane review evidence and clinical practice narrowed in 1995, but 46% (1010) of 2196 pregnant women studied were still not managed according to current evidenceEducational visits to senior staff led to a significant but clinically modest uptake of evidence from systematic reviews in only one of the four practices studiedReducing practice variations and improving clinical knowledge management by helping clinicians to locate, select, and implement systematic review evidence remain important challenges for the NHS PMID:9774287

Evaluation of trainees' ability to perform obstetrical ultrasound using simulation: challenges and opportunities.

PubMed

Chalouhi, Gihad E; Bernardi, Valeria; Gueneuc, Alexandra; Houssin, Isabelle; Stirnemann, Julien J; Ville, Yves

2016-04-01

Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Obstetrics and gynaecology residents' self-rated knowledge, motivation, skill, and practice patterns in counselling for contraception, STI prevention, sexual dysfunction, and intimate partner violence and sexual coercion.

PubMed

Garcia, Meivys; Fisher, William A

2008-01-01

This research provides an initial exploration of obstetrics and gynaecology residents' self-rated knowledge base, motivation to practise, skills, and practice patterns with respect to patient counselling concerning contraception, prevention of sexually transmitted infection (STI), sexual dysfunction, and intimate partner violence and sexual coercion. Obstetrics and gynaecology residents (N = 27) at all levels of training at four Ontario postgraduate programs completed self-reports of knowledge, motivation, skills, and practice patterns for counselling concerning four focal issues in women's sexual and reproductive health. Obstetrics and gynaecology residents generally possessed a sound knowledge base in the areas under study, but significant gaps were observed in their knowledge of condom use, abortion, sexual dysfunction, and intimate partner violence and sexual coercion. Residents were well-motivated to provide counselling in these areas, and, with the exceptions of counselling concerning sexual dysfunction and intimate partner violence and sexual coercion, felt that they were well trained to do so. Participants, however, consistently perceived only modest levels of support from their peers and from consultants with respect to counselling in the domains of contraceptive choice and adherence, STI prevention, sexual dysfunction, and intimate partner violence and sexual coercion. These findings suggest the need to review instruction and support for obstetrics and gynaecology resident training in patient counselling in important but clinically neglected areas of women's sexual and reproductive health.

Student and staff experiences of attendance monitoring in undergraduate obstetrics and gynecology: a cross-sectional survey

PubMed Central

Deane, Richard P; Murphy, Deirdre J

2016-01-01

Background Despite the widespread introduction of active learning strategies to engage students across modern medical curricula, student attendance and attendance monitoring remain a challenging issue for medical educators. In addition, there is little published evidence available to medical educators regarding the use of attendance monitoring systems. The aim of this study was to evaluate the opinions of students and staff about the use of a paper-based student logbook to record student attendance across all clinical and classroom-based learning activities within an undergraduate clinical rotation in obstetrics and gynecology (OBGYN). Methods Each student undertaking the clinical rotation in OBGYN was required to complete a paper-based logbook in a booklet format that listed every clinical and classroom-based activity that the student was expected to attend. A cross-sectional survey evaluating the acceptability, practicality, and effect on access to learning opportunities of using the logbook was undertaken. The survey was conducted among all medical students who completed their OBGYN rotation over a full academic year and staff who taught on the program. Results The response rate was 87% (n=128/147) among students and 80% (n=8/10) among staff. Monitoring attendance was widely acceptable to students (n=107/128, 84%) and staff (n=8/8, 100%). Most students (n=95/128, 74%) and staff (n=7/8, 88%) recommended that attendance should be mandatory during rotations. Almost all staff felt that attendance should contribute toward academic credit (n=7/8, 88%), but students were divided (n=73/128, 57%). Students (n=94/128, 73%) and staff (n=6/8, 75%) reported that the use of the logbook to record attendance with tutor signatures was a satisfactory system, although students questioned the need for recording attendance at every classroom-based activity. Most students felt that the logbook facilitated access to learning experiences during the rotation (n=90/128, 71%). Staff felt that the process of signing logbooks improved their interaction with students (n=6/8, 75%). Conclusion The survey showed that the use of a paper-based logbook to record medical student attendance with tutor signatures across all clinical and classroom-based learning activities was acceptable and practical for students and staff and was felt to facilitate access to learning opportunities. The study provides medical educators with evidence to support monitoring of attendance within clinical rotations. PMID:27099545

Student and staff experiences of attendance monitoring in undergraduate obstetrics and gynecology: a cross-sectional survey.

PubMed

Deane, Richard P; Murphy, Deirdre J

2016-01-01

Despite the widespread introduction of active learning strategies to engage students across modern medical curricula, student attendance and attendance monitoring remain a challenging issue for medical educators. In addition, there is little published evidence available to medical educators regarding the use of attendance monitoring systems. The aim of this study was to evaluate the opinions of students and staff about the use of a paper-based student logbook to record student attendance across all clinical and classroom-based learning activities within an undergraduate clinical rotation in obstetrics and gynecology (OBGYN). Each student undertaking the clinical rotation in OBGYN was required to complete a paper-based logbook in a booklet format that listed every clinical and classroom-based activity that the student was expected to attend. A cross-sectional survey evaluating the acceptability, practicality, and effect on access to learning opportunities of using the logbook was undertaken. The survey was conducted among all medical students who completed their OBGYN rotation over a full academic year and staff who taught on the program. The response rate was 87% (n=128/147) among students and 80% (n=8/10) among staff. Monitoring attendance was widely acceptable to students (n=107/128, 84%) and staff (n=8/8, 100%). Most students (n=95/128, 74%) and staff (n=7/8, 88%) recommended that attendance should be mandatory during rotations. Almost all staff felt that attendance should contribute toward academic credit (n=7/8, 88%), but students were divided (n=73/128, 57%). Students (n=94/128, 73%) and staff (n=6/8, 75%) reported that the use of the logbook to record attendance with tutor signatures was a satisfactory system, although students questioned the need for recording attendance at every classroom-based activity. Most students felt that the logbook facilitated access to learning experiences during the rotation (n=90/128, 71%). Staff felt that the process of signing logbooks improved their interaction with students (n=6/8, 75%). The survey showed that the use of a paper-based logbook to record medical student attendance with tutor signatures across all clinical and classroom-based learning activities was acceptable and practical for students and staff and was felt to facilitate access to learning opportunities. The study provides medical educators with evidence to support monitoring of attendance within clinical rotations.

Childbirth care practices in public sector facilities in Jeddah, Saudi Arabia: a descriptive study.

PubMed

Altaweli, Roa F; McCourt, Christine; Baron, Maurina

2014-07-01

to explore reported hospital policies and practices during normal childbirth in maternity wards in Jeddah, Saudi Arabia, to assess and verify whether these practices are evidence-based. quantitative design, in the form of a descriptive questionnaire, based on a tool extracted from the literature. nine government hospitals in Jeddah, Saudi Arabia. These hospitals have varied ownership, including Ministry of Health (MOH), military, teaching and other government hospitals. key individuals responsible for the day-to-day running of the maternity ward. nine interviews using descriptive structured questionnaire were conducted. Data were analysed using SPSS for Windows (version 16.0). the surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. On average, the caesarean section rate was found to be 22.4%, but with considerable variances between hospitals. Some unnecessary procedures that are known to be ineffective or harmful and that are not recommended for routine use, including pubic shaving, enemas, episiotomy, electronic fetal monitoring (EFM) and intravenous (IV) infusion, were found to be frequently practiced. Only 22% of the hospitals sampled reported allowing a companion to attend labour and childbirth. many aspects of recommended EBP were used in the hospitals studied. However, the results of this study clearly indicate that there is wide variation between hospitals in Jeddah, Saudi Arabia in some obstetric practices. Furthermore, the findings suggest that some practices at these hospitals are not supported by evidence as being beneficial for mothers or infants and are positively discouraged under international guidelines. this study has specific implications for obstetricians, midwives and nurses working in maternity units. It gives an overview of current hospital policies and practices during normal childbirth. It is likely to contribute to improving the health and well-being of women, and have implications for service provision. It could also help in the development of technical information for policy-makers, and health care professionals for normal childbirth care. Copyright © 2014 Elsevier Ltd. All rights reserved.

The growth of a culture of evidence-based obstetrics in South Africa: a qualitative case study

PubMed Central

2011-01-01

Background While the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South Africa Methods A qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically. Results The concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health. Conclusion This case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers combined with a readiness by local researchers to receive and actively promote the practice. PMID:21443794

Prone position craniotomy in pregnancy without fetal heart rate monitoring.

PubMed

Jacob, Jean; Alexander, Ashish; Philip, Shoba; Thomas, Anoop

2016-09-01

A pregnant patient in second trimester scheduled for posterior fossa craniotomy in prone position is a challenge for the anesthesiologist. Things to consider are physiological changes during pregnancy, non-obstetric surgery in pregnant patients, neuroanesthetic principles, effects of prone positioning, and need for fetal heart rate (FHR) monitoring. We have described the anesthetic management of this case and discussed intra-operative FHR monitoring including controversies about its role, indications, and various options available as per fetal gestational age. In our case we attempted intermittent intra-operative FHR monitoring to optimize maternal positioning and fetal oxygenation even though the fetus was pre-viable. However the attempt was abandoned due to practical difficulties with prone positioning. Patient made good neurological recovery following the procedure and delivered a healthy term baby 4 months later. Decisions regarding fetal monitoring should be individualized based on viability of the fetus and feasibility of emergency cesarean delivery. Good communication between a multidisciplinary team involving neurosurgeon, anesthesiologist, obstetrician, and neonatologist is important for a successful outcome for mother and fetus. We conclude that prone position neurosurgery can safely be carried out in a pregnant patient with pre-viable fetus without FHR monitoring. Copyright © 2016 Elsevier Inc. All rights reserved.

Childbirth in ancient Rome: from traditional folklore to obstetrics.

PubMed

Todman, Donald

2007-04-01

In ancient Rome, childbirth was a hazardous event for both mother and child with high rates of infant and maternal mortality. Traditional Roman medicine centred on folklore and religious practices, but with the development of Hippocratic medicine came significant advances in the care of women during pregnancy and confinement. Midwives or obstetrices played an important role and applied rational scientific practices to improve outcomes. This evolution from folklore to obstetrics was a pivotal point in the history of childbirth.

[Validity of psychoprophylaxis in obstetrics. Authors' experience].

PubMed

D'Alfonso, A; Zaurito, V; Facchini, D; Di Stefano, L; Patacchiola, F; Cappa, F

1990-12-01

The Authors report the results based on 20 years of practice on obstetric psycho-prophylaxis (PPO). Data on presence at course, on frequency, on primipares/pluripares ratio, on labour, on timing and mode of delivery, are assembled. Moreover, neonatal status at birth and at 10th day of life, are investigated. The data obtained were compared with a control group, constituted by women without any treatment before delivery. The acquired experience confirm the utility of PPO in the ordinary clinical practice.

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

PubMed

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Classification and management of extensive obstetric perineal injuries in the Czech and Slovak Republics.

PubMed

Zahumensky, Jozef; Menzlova, Erika; Korbel, Miroslav; Zmrhalova, Barbora; Vasicka, Ian; Sottner, Oldrich

2010-09-01

To assess the classification, repair, and follow up of extensive obstetric perineal injuries in the Czech and Slovak Republics. A survey conducted in 2009 using questionnaires distributed to obstetric departments regarding classification and management of obstetric perineal injuries. Although 15 centers in the Czech Republic and 2 in the Slovak Republic indicated use of a 4-degree classification system, none of these centers reported using the classification accepted by the Royal College of Obstetricians and Gynaecologists. Use of a 3-degree classification system in accordance with definitions in Czech textbooks was reported by 14 Czech and 3 Slovak maternity hospitals. There was significant heterogeneity in clinical practice regarding techniques to repair extensive obstetric perineal injuries, antibiotic prophylaxis, early postpartum care, and follow up. There is great inconsistency in the classification and management of extensive obstetric perineal injuries. Uniform recommendations should be created and accepted, not only in the Czech and Slovak Republics, but worldwide. Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Measuring unmet obstetric need at district level: how an epidemiological tool can affect health service organization and delivery.

PubMed

Guindo, Gabriel; Dubourg, Dominique; Marchal, Bruno; Blaise, Pierre; De Brouwere, Vincent

2004-10-01

A national retrospective survey on the unmet need for major obstetric surgery using the Unmet Obstetric Need Approach was carried out in Mali in 1999. In Koutiala, the district health team decided to carry on the monitoring of the met need for several years in order to assess their progress over time. The first prospective study, for 1999, estimated that more than 100 women in need of obstetric care never reached the hospital and probably died as a consequence. This surprising result shocked the district health team and the resulting increased awareness of service deficits triggered operational measures to tackle the problem. The Unmet Obstetric Need study in Koutiala district was implemented without financial support and only limited external technical back-up. The appropriation of the study by the district team for solving local problems of access to obstetric care may have contributed to the success of the experience. Used as a health service management tool, the study and its results started a dialogue between the hospital staff and both health centre staff and community representatives. This had not only the effect of triggering consideration of coverage, but also of quality of obstetric care. Copyright 2004 Oxford University Press

A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries.

PubMed

Imamura, Mari; Kanguru, Lovney; Penfold, Suzanne; Stokes, Tim; Camosso-Stefinovic, Janette; Shaw, Beth; Hussein, Julia

2017-01-01

Healthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge. To assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs). Electronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. "audit," "education," "reminder"), and maternal mortality. Randomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included. Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed. Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor-patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies. Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context. CRD42014010310. © 2016 International Federation of Gynecology and Obstetrics.

Obstetrics and gynaecology residents' knowledge of the informed consent process and its practice in their training institutions.

PubMed

Okonta, P I

2015-01-01

The ethical principle of autonomy as expressed in the practice of informed consent is a core tenet of clinical practice and good patient physician relationship. The aim was to identify specific gaps in the knowledge of trainee obstetricians and gynecologists in Nigeria about the informed consent process and its content. It also sought to describe the practice of informed consent in their respective institutions. A survey of Residents in obstetrics and gynecology attending the revision course of the Faculty of obstetrics and gynecology of the national postgraduate medical college was done to determine their knowledge of the informed consent process and its practice in their institutions. None of the residents was able to give responses that contained all five conditions for informed consent to be valid. Furthermore, only 3 (2.22%) Residents mentioned that the name of the surgeon to perform the surgery should be part of the information provided to patients during the informed consent process. Similarly, only 8 (5.93%) mentioned that consequences of not having the surgery should be part of the informed consent process. The concept of the 'emancipated minor' being competent to give consent was known by 38% of the residents. Although Residents in obstetrics and gynecology in Nigeria have some knowledge of the informed consent process, this knowledge is deficient in key areas such as competence to give consent, content and scope of information to be disclosed to patients for surgery. There is a need to teach residents the rudiments of informed consent and bioethics in general.

Critical Appraisal Skills Among Canadian Obstetrics and Gynaecology Residents: How Do They Fare?

PubMed

Bougie, Olga; Posner, Glenn; Black, Amanda Y

2015-07-01

Evidence-based medicine has become the standard of care in clinical practice. In this study, our objectives were to (1) determine the type of epidemiology and/or biostatistical training being given in Canadian obstetrics and gynaecology post-graduate programs, (2) determine obstetrics and gynaecology residents' level of confidence with critical appraisal, and (3) assess knowledge of fundamental biostatistical and epidemiological principles among Canadian obstetrics and gynaecology trainees. During a national standardized in-training examination, all Canadian obstetrics and gynaecology residents were invited to complete an anonymous cross-sectional survey to determine their levels of confidence with critical appraisal. Fifteen critical appraisal questions were integrated into the standardized examination to assess critical appraisal skills objectively. Primary outcomes were the residents' level of confidence interpreting biostatistical results and applying research findings to clinical practice, their desire for more biostatistics/epidemiological training in residency, and their performance on knowledge questions. A total of 301 of 355 residents completed the survey (response rate=84.8%). Most (76.7%) had little/no confidence interpreting research statistics. Confidence was significantly higher in those with increased seniority (OR=1.93), in those who had taken a previous epidemiology/statistics course (OR=2.65), and in those who had prior publications (OR=1.82). Many (68%) had little/no confidence applying research findings to clinical practice. Confidence increased significantly with increasing training year (P<0.001) and with formal epidemiology training during residency (OR=2.01). The mean score of the 355 residents on the knowledge assessment questions was 69.8%. Increasing seniority was associated with improved overall test performance (P=0.02). Poorer performance topics included analytical study method (9.9%), study design (36.9%), and sample size (42.0%). Most (84.4%) wanted more epidemiology teaching. Canadian obstetrics and gynaecology residents may have the biostatistical and epidemiological knowledge to interpret results published in the literature, but lack confidence applying these skills in clinical settings. Most residents want additional training in these areas, and residency programs should include training in formal curriculums to improve their confidence and prepare them for a lifelong practice of evidence-based medicine.

Ethics of infant relinquishment, cultural considerations, and obstetric conveniences.

PubMed

Callister, Lynn Clark

2011-01-01

Ethical issues relating to infant relinquishment, caring for culturally diverse women, the importance of shared power between women and their caregivers, and the provision of evidence-based practice versus reliance on obstetric conveniences are addressed in this article. Respectful care of women relinquishing their infants including use of appropriate language demonstrates moral and ethical nursing practice; providing cultural competent care of multilinguistic, multicultural, and multiethnic childbearing women and their families is an ethical imperative. Nurses practicing ethically will foster adoption of best practices on perinatal and neonatal units, and generate a clearly articulated vision of woman and family centered organizational culture. In ethical terms, this demonstrates respect for others as well as beneficence. Promoting the use of ethical nursing practice and evidence-based practice requires that nurses identify change agents, those who are champions and facilitators of evidence-based practice, and then reward such innovators and make sure that clinical guidelines be developed based on best practices.

Rational selection of antibacterial drugs and postoperative nursing for gynecologic and obstetric surgery patients.

PubMed

Hou, Li; Zhang, Yan; Luan, Yan; Xin, Beibei; Wang, Chunxia

2018-05-01

Infection after gynecologic surgery is very common and frequent. If the control is not good, it will lead to serious consequences. Therefore, it is necessary to use antibiotics in the period of obstetrics and gynecology. This study will explore the use of antimicrobial agents in gynecologic and obstetric surgery, thus standardizing the use of antibiotics in the process of obstetrics and gynecology. Through the analysis of the use of antibacterials, we can see that the highest utilization rate of 5 kinds of antibacterial drugs followed by Cefaclor Sustained Release Tablets (65.7%), metronidazole (32.5%), cefathiamidine (26.8%), enoxacin (22.5%) and cefoperazone tazobactam sodium (11.8%). At the same time, the hospital should improve the consciousness of rational drug use and strengthen the administration of antibacterials in the operative period of obstetrics and gynecology. The application of antibiotics in the operative period of the department of obstetrics and gynecology can improve the current situation of its irrational use. Nursing work must take strict aseptic operation to prevent cross infection. At the same time, we should strengthen the observation of the effect of medication, monitor the body temperature and blood pressure, and identify the side effects of drugs.

Change in practice: a qualitative exploration of midwives' and doctors' views about the introduction of STan monitoring in an Australian hospital.

PubMed

Mayes, M E; Wilkinson, C; Kuah, S; Matthews, G; Turnbull, D

2018-02-17

The present study examines the introduction of an innovation in intrapartum foetal monitoring practice in Australia. ST-Analysis (STan) is a technology that adds information to conventional fetal monitoring (cardiotocography) during labour, with the aim of reducing unnecessary obstetric intervention. Adoption of this technology has been controversial amongst obstetricians and midwives, particularly as its use necessitates a more invasive means of monitoring (a scalp clip), compared to external monitoring from cardiotocography alone. If adoption of this technology is going to be successful, then understanding staff opinions about the implementation of STan in an Australian setting is an important issue for maternity care providers and policy makers. Using a maximum variation purposive sampling method, 18 interviews were conducted with 10 midwives and 8 doctors from the Women's and Children's Hospital, South Australia to explore views about the introduction of the new technology. The data were analysed using Framework Analysis. Midwives and doctors indicated four important areas of consideration when introducing STan: 1) philosophy of care; 2) the implementation process including training and education; 3) the existence of research evidence; and 4) attitudes towards the new technology. Views were expressed about the management of change process, the fit of the new technology within the current models of care, the need for ongoing training and the importance of having local evidence. These findings, coupled with the general literature about introducing innovation and change, can be used by other centres looking to introduce STan technology.

Posttraumatic stress and depression may undermine abuse survivors' self-efficacy in the obstetric care setting.

PubMed

Stevens, Natalie R; Tirone, Vanessa; Lillis, Teresa A; Holmgreen, Lucie; Chen-McCracken, Allison; Hobfoll, Stevan E

2017-06-01

Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors' sense of self-efficacy when communicating their obstetric care needs. Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit. The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences. Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.

Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study.

PubMed

Glasmacher, S A; Bonongwe, P; Stones, W

2016-03-01

To achieve good outcomes in critically ill obstetric patients, it is necessary to identify organ dysfunction rapidly so that life-saving interventions can be appropriately commenced. However, timely access to clinical chemistry results is problematic, even in referral institutions, in the sub-Saharan African region. Reliable point-of-care tests licensed for clinical use are now available for lactate and creatinine. We aimed to assess whether implementation of point-of-care testing for lactate and creatinine is feasible in the obstetric unit at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, by obtaining the opinions of clinical staff on the use of these tests in practice. During a two-month evaluation period nurse-midwives, medical interns, clinical officers, registrars, and consultants were given the opportunity to use StatStrip® and StatSensor® (Nova Biomedical, Waltham, USA) devices, for lactate and creatinine estimation, as part of their routine clinical practice in the obstetric unit. They were subsequently asked to complete a short questionnaire. Thirty-seven questionnaires were returned by participants: 22 from nurse-midwives and the remainder from clinicians. The mean satisfaction score for the devices was 7.6/10 amongst clinicians and 8.0/10 amongst nurse-midwives. The majority of participants stated that the obstetric high dependency unit (HDU) was the most suitable location for the devices. For lactate, 31 participants strongly agreed that testing should be continued and 24 strongly agreed that it would influence patient management. For creatinine, 29 strongly agreed that testing should be continued and 28 strongly agreed that it would influence their patient management. Twenty participants strongly agreed that they trust point-of-care devices. Point-of-care clinical chemistry testing was feasible, practical, and well received by staff, and was considered to have a useful role to play in the clinical care of sick obstetric patients at this referral centre.

Integrating psychology and obstetrics for medical students: shared labour ward teaching.

PubMed

Chalmers, B E; McIntyre, J A

1993-01-01

Two studies relating to the inclusion of psycho-social issues in the training of obstetricians are reported here. The first reports on the extent to which currently practising obstetricians have received training in these aspects. The second explored the value of an innovative teaching approach combining psychological and obstetric training for medical students in the labour ward. A postal survey with responses from 220 obstetricians and paediatricians revealed that little information on psychological aspects of obstetric practice had been included in their undergraduate or postgraduate training or obtained from voluntary continuing education programmes. Experience was the primary source of training in these subjects. The second study explored the impact of joint psychological and obstetric teaching ward rounds for medical students. Students attending these integrated sessions reported being better prepared for the psycho-social aspects of obstetrics and showed a greater awareness of cross-cultural differences in needs of women during birth.

"Womb with a View": The Introduction of Western Obstetrics in Nineteenth-Century Siam.

PubMed

Pearson, Quentin Trais

2016-01-01

This article focuses on the historical confrontation between Western obstetrical medicine and indigenous midwifery in nineteenth-century Siam (Thailand). Beginning with the campaign of medical missionaries to reform Siamese obstetrical care, it explores the types of arguments that were employed in the contest between these two forms of expert knowledge. Missionary-physicians used their anatomical knowledge to contest both particular indigenous obstetrical practices and more generalized notions concerning its moral and metaphysical foundations. At the same time, by appealing to the health and well-being of the consorts and children of the Siamese elite, they gained access to the intimate spaces of Siamese political life. The article contends that the medical missionary campaign intersected with imperial desires to make the sequestered spaces of Siamese political life more visible and accessible to Western scrutiny. It therefore reveals the imbrication of contests over obstetrical medicine and trade diplomacy in the imperial world.

Evidence-based medicine in obstetrics: can levels B and C recommendations be elevated to level A recommendations?

PubMed Central

Chauhan, Suneet P; Chang, Eugene; Brost, Brian; Assel, Barbara; Baxter, Jason; Smith, James A; Grobman, Robert; Berghella, Vincenzo; Scardo, James A; Magann, Everett F; Morrison, John C

2009-01-01

In this study, 65% (132/195) of level B/C obstetric recommendations are amenable to randomized clinical trials (RCTs) and seven were identified as most needed. The purpose of the survey was to evaluate levels B and C recommendations in obstetric practice bulletins (PBs) regarding the feasibility of performing RCT to elevate each subject to level A evidence. Eleven geographically dispersed physicians with experience in research reviewed levels B and C recommendations for the ethical and logistical feasibility of performing an RCT. In the 35 obstetric PBs, 195 level B/C recommendations were reviewed. The majority considered 47 (24%) topics unethical for an RCT and thought 16 (11%) did not need an RCT, thus leaving 132 (67%) levels B and C recommendations available for an RCT. Two-thirds of levels B and C recommendations in obstetric PB are amenable to RCTs and potentially becoming level A evidence. PMID:27582813

Risk Factors for the Development of Obstetric Anal Sphincter Injuries in Modern Obstetric Practice.

PubMed

Ramm, Olga; Woo, Victoria G; Hung, Yun-Yi; Chen, Hsuan-Chih; Ritterman Weintraub, Miranda L

2018-02-01

To characterize the rate of obstetric anal sphincter injuries and identify key risk factors of obstetric anal sphincter injuries, including duration of the second stage of labor. This retrospective cohort study included all singleton, term, cephalic vaginal deliveries within Kaiser Permanente Northern California between January 2013 and December 2014 (N=22,741). Incidence of obstetric anal sphincter injuries, defined as third- or fourth-degree perineal lacerations, was the primary outcome. Multiple logistic regression models were conducted to identify obstetric anal sphincter injury risk factors and high-risk subpopulations. The overall incidence rate of obstetric anal sphincter injuries was 4.9% (3.6% of women who delivered spontaneously vs 24.0% of women who had a vacuum-assisted vaginal delivery, P<.001, CI 18.1-22.6%). In bivariate and multivariate analyses, obstetric anal sphincter injury incidence was higher among women with second stage of labor longer than 2 hours, Asian race, nulliparity, vaginal birth after cesarean delivery, episiotomy, and vacuum delivery. Women with a vacuum-assisted vaginal delivery had four times the odds of obstetric anal sphincter injury (adjusted odds ratio [OR] 4.23, 95% CI 3.59-4.98) and those whose second stage of labor lasted at least 180 minutes vs less than 60 minutes had three times the odds of incurring obstetric anal sphincter injury (adjusted OR 3.20, 95% CI 2.62-3.89). Vacuum-assisted vaginal delivery conferred the highest odds of obstetric anal sphincter injury followed by prolonged duration of the second stage of labor, particularly among certain subpopulations. Understanding these risk factors and their complex interactions can inform antepartum and intrapartum decision-making with the goal of reducing obstetric anal sphincter injury incidence.

Women's recall of obstetric complications in south Kalimantan, Indonesia.

PubMed

Ronsmans, C; Achadi, E; Cohen, S; Zazri, A

1997-09-01

The search for indicators for monitoring progress toward safe motherhood has prompted research into population-based measures of obstetric morbidity. One possible such measure is based on women's reports of their past childbirth experiences. In this prospective study in three hospitals in South Kalimantan, Indonesia, the accuracy of women's reporting of severe birth-related complications was examined. The findings of this study suggest that poor agreement exists between the way women report their experience of childbirth and the way doctors diagnose obstetric problems, although the degree of agreement varies with the type of complication. Questionnaires relying on women's experience of childbirth will tend to overestimate the prevalence of medically diagnosed obstetric problems such as those associated with excessive vaginal bleeding or dysfunctional labor. Questions suggestive of eclampsia may be more promising, although the small number of eclamptic women in this study precludes firm conclusions.

The use of telemedicine in obstetrics: a review of the literature.

PubMed

Magann, Everett F; McKelvey, Samantha S; Hitt, Wilbur C; Smith, Michael V; Azam, Ghazala A; Lowery, Curtis L

2011-03-01

Telemedicine has been advertised for increasing efficiency, extending the scope of obstetric practice, improving pregnancy outcomes, and reducing costs in the healthcare system. The extent of telemedicine use in obstetrics was identified with a literature search. A total of 268 articles were identified of which 60 are the basis for this review. Telemedicine has been used to read ultrasounds, interpret nonstress tests, counsel patients, manage diabetes, manage postpartum depression, and support parents and children postpartum from remote sites. Reductions in time lost from work, transportation costs, more efficiency for the health care providers, and reducing medical costs all have been suggested as benefits of telemedicine. Despite the information published about telemedicine in obstetrics, this technology has not been shown to have adverse effects in obstetrics but neither has it demonstrated unequivocal benefits. Properly structured and powered investigations will be needed to determine the role of telemedicine in the future. Obstetricians & Gynecologists. After completing this CME activity, physicians should be better able to diagnose and treat diabetes using telemedicine techniques; assess the current scope of research in telemedicine in obstetrics; implement clinical telemedicine consultations based on the interaction and the needs of the participants; and the opportunities for further research in telemedicine in obstetrics.

Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review.

PubMed

Kyei-Nimakoh, Minerva; Carolan-Olah, Mary; McCann, Terence V

2017-06-06

Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. PROSPERO 2014 CRD42014015549.

Womens' perceptions regarding obstetric complications and care in a poor fishing community in Karachi.

PubMed

Hasan, I J; Nisar, N

2002-04-01

To assess the knowledge of women about obstetric complications and care. The study was conducted in a remote coastal community in Karachi in 1999, where the Department of Community Health Sciences of Aga Khan University is operating its primary health care project since 1996. The information was collected using a structured questionnaire, interviewing a representative sample of 329 married-women of reproductive age, selected systematically from the community. The mean age of the respondents was 29 years. On average they were married for 11 years and had four living children. Almost half of them had no antenatal care in their last pregnancy and 75% delivered at home. The findings indicate a poor knowledge of common and serious pregnancy related complications based on their perception related to danger signs. Five percent of the women perceived absent/decreased fetal movement as a danger sign of pregnancy. Other reported danger signs included premature uterine contraction by 3%, premature rupture of membranes by 3%, convulsions by 13%, obstructed labor by 23% and bleeding by 39%. Moreover, the women's perception regarding obstetric care suggests that unsafe practices prevail: 86% of women thought that a case of ante-partum hemorrhage should be examined internally and 50% thought that no precaution is required to sterilize the instrument for cutting the cord. There is a clear need to create awareness regarding obstetric complications through a targeted community based health educational intervention aiming to promote early recognition of the obstetric emergency at the household level and also to create a demand of safe obstetric practices.

Field Trial of Methoxyflurane, Nitrous Oxide, and Trichloroethylene as Obstetric Analgesics

PubMed Central

Rosen, M.; Mushin, W. W.; Jones, P. L.; Jones, E. V.

1969-01-01

In a field trial of 1,257 patients receiving methoxyflurane, trichloroethylene, and nitrous-oxide/oxygen for the relief of pain in labour methoxyflurane has been shown to have certain advantages which support its use in midwifery practice. The trial confirms our objective method for screening an inhalational agent as an obstetric analgesic. PMID:4895340

Evaluation of learning from Practical Obstetric Multi-Professional Training and its impact on patient outcomes in Australia using Kirkpatrick's framework: a mixed methods study.

PubMed

Kumar, Arunaz; Sturrock, Sam; Wallace, Euan M; Nestel, Debra; Lucey, Donna; Stoyles, Sally; Morgan, Jenny; Neil, Peter; Schlipalius, Michelle; Dekoninck, Philip

2018-02-17

The aim of this study was to evaluate the implementation of the Practical Obstetric Multi-Professional Training (PROMPT) simulation using the Kirkpatrick's framework. We explored participants' acquisition of knowledge and skills, its impact on clinical outcomes and organisational change to integrate the PROMPT programme as a credentialing tool. We also aimed to assess participants' perception of usefulness of PROMPT in their clinical practice. Mixed methods approach with a pre-test/post-test design. Healthcare network providing obstetric care in Victoria, Australia. Medical and midwifery staff attending PROMPT between 2013 and 2015 (n=508); clinical outcomes were evaluated in two cohorts: 2011-2012 (n=15 361 births) and 2014-2015 (n=12 388 births). Attendance of the PROMPT programme, a simulation programme taught in multidisciplinary teams to facilitate teaching emergency obstetric skills. Clinical outcomes compared before and after embedding PROMPT in educational practice. Assessment of knowledge gained by participants through a qualitative analysis and description of process of embedding PROMPT in educational practice. There was a change in the management of postpartum haemorrhage by early recognition and intervention. The key learning themes described by participants were being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment. Participants reported a positive learning experience and increase in confidence in managing emergency obstetric situations through the PROMPT programme, which was perceived as a realistic demonstration of the emergencies. Participants reported an improvement of both clinical and non-technical skills highlighting principles of teamwork, communication, leadership and prioritisation in an emergency situation. An improvement was observed in management of postpartum haemorrhage, but no significant change was noted in clinical outcomes over a 2-year period after PROMPT. However, the skills acquired by medical and midwifery staff justify embedding PROMPT in educational programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The working status of Japanese female physicians by area of practice: cohort analysis of taking leave, returning to work, and changing specialties from 1984 to 2004.

PubMed

Kodama, Tomoko; Koike, Soichi; Matsumoto, Shinya; Ide, Hiroo; Yasunaga, Hideo; Imamura, Tomoaki

2012-05-01

The percentage of females in the physician workforce is increasing in Japan, as in other countries; however, the working status of female physicians has not been sufficiently investigated. Original data were obtained from the National Survey of Physicians (NSP) conducted by the Ministry of Health, Labour and Welfare, Japan, from 1984 to 2004. We examined the trend of female physicians' areas of practice and analyzed their leave, return to work, and change in areas of practice using cohort data. The percentage of female physicians has increased significantly in recent generations, especially in surgery, surgical subareas of practice, and obstetrics and gynecology. A remarkable increase was found in obstetrics and gynecology among women under 29 years old from 15.4 to 66.2%. The total number of female physicians on leave has been higher than the number of female physicians returning since 1998. The average percentage of those who changed their area of practice was high in surgery (20.7%) and low in pediatrics (5.0%) and obstetrics and gynecology (1.7%). A strategic plan is needed for future health policy to plan for the physician workforce, especially for the areas of practice with increasing proportions of young female physicians. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Current applications of big data in obstetric anesthesiology.

PubMed

Klumpner, Thomas T; Bauer, Melissa E; Kheterpal, Sachin

2017-06-01

The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. Big data has been used to study rare outcomes, to identify trends within the healthcare system, to identify variations in practice patterns, and to highlight potential inequalities in obstetric anesthesia care. Big data studies have helped define the risk of rare complications of obstetric anesthesia, such as the risk of neuraxial hematoma in thrombocytopenic parturients. Also, large national databases have been used to better understand trends in anesthesia-related adverse events during cesarean delivery as well as outline potential racial/ethnic disparities in obstetric anesthesia care. Finally, real-time analysis of patient data across a number of disparate health information systems through the use of sophisticated clinical decision support and surveillance systems is one promising application of big data technology on the labor and delivery unit. 'Big data' research has important implications for obstetric anesthesia care and warrants continued study. Real-time electronic surveillance is a potentially useful application of big data technology on the labor and delivery unit.

Effect of a facility-based multifaceted intervention on the quality of obstetrical care: a cluster randomized controlled trial in Mali and Senegal

PubMed Central

2013-01-01

Background Maternal mortality in referral hospitals in Mali and Senegal surpasses 1% of obstetrical admissions. Poor quality obstetrical care contributes to high maternal mortality; however, poor care is often linked to insufficient hospital resources. One promising method to improve obstetrical care is maternal death review. With a cluster randomized trial, we assessed whether an intervention, based on maternal death review, could improve obstetrical quality of care. Methods The trial began with a pre-intervention year (2007), followed by two years of intervention activities and a post-intervention year. We measured obstetrical quality of care in the post-intervention year using a criterion-based clinical audit (CBCA). We collected data from 32 of the 46 trial hospitals (16 in each trial arm) and included 658 patients admitted to the maternity unit with a trial of labour. The CBCA questionnaire measured 5 dimensions of care- patient history, clinical examination, laboratory examination, delivery care and postpartum monitoring. We used adjusted mixed models to evaluate differences in CBCA scores by trial arms and examined how levels of hospital human and material resources affect quality of care differences associated with the intervention. Results For all women, the mean percentage of care criteria met was 66.3 (SD 13.5). There were significantly greater mean CBCA scores in women treated at intervention hospitals (68.2) compared to control hospitals (64.5). After adjustment, women treated at intervention sites had 5 points’ greater scores than those at control sites. This difference was mostly attributable to greater clinical examination and post-partum monitoring scores. The association between the intervention and quality of care was the same, irrespective of the level of resources available to a hospital; however, as resources increased, so did quality of care scores in both arms of the trial. Trial registration The QUARITE trial is registered on the Current Controlled Trials website under ISRCTN46950658 PMID:23351269

Referral practices and perceived barriers to timely obstetric care among Ugandan traditional birth attendants (TBA).

PubMed

Keri, L; Kaye, D; Sibylle, K

2010-03-01

To assess current beliefs, knowledge and practices of Ugandan traditional birth attendants (TBAs) and their pregnant patients regarding referral of obstructed labors and fistula cases. Six focus groups were held in rural areas surrounding Kampala, the capital city of Uganda. While TBAs, particularly those with previous training, appear willing to refer problematic pregnancies and labors, more serious problems exist that could lessen any positive effects of training. These problems include reported abuse by doctors and nurses, and seeing fistula as a disease caused by hospitals. Training of TBAs can be helpful to standardize knowledge about and encourage timely emergency obstetric referrals, as well as increase knowledge about the causes and preventions of obstetric fistula. However, for full efficacy, training must be accompanied by greater collaboration between biomedical and traditional health personnel, and increased infrastructure to prevent mistreatment of pregnant patients by medical staff.

The Role of Medical Diplomacy in Stabilizing Afghanistan (Defense Horizons, Number 63, May 2008)

DTIC Science & Technology

2008-05-01

initiatives and fail to stem the rising violence in Afghanistan.6 NATO and the international community have been faulted for the lack of a well...National Army Air Corps pilot bled to death during an emer- gency Caesarean section at a civilian women’s hospital in Kabul, an obstetrics mobile...technician on the obstetrics mobile training team quickly became the most sought- after person in town, and he repaired patient monitors, sterilizers

Risky business: framing childbirth in hospital settings.

PubMed

Hausman, Bernice L

2005-01-01

"Risky Business" considers hospital childbirth and the production of the concept of risk in obstetrics. Risk is a defining concept of medicalized childbirth. Approaching obstetrical risk with a goal of challenging its hold on practices demonstrates how risk itself is produced and maintained in particular institutional contexts. The goal here is to imagine new ways of understanding and assessing obstetrical risk, as part of an overall strategy of challenging technocratic approaches to childbirth and mothering. Surveying feminist approaches to childbirth, the essay discusses how the mother's health profile affects both medical education and the construction of childbirth as "risky business."

Introduction of basic obstetrical ultrasound screening in undergraduate medical education.

PubMed

Hamza, A; Solomayer, E-F; Takacs, Z; Juhasz-Boes, I; Joukhadar, R; Radosa, J C; Mavrova, R; Marc, W; Volk, T; Meyberg-Solomayer, G

2016-09-01

Teaching ultrasound procedures to undergraduates has recently been proposed to improve the quality of medical education. We address the impact of applying standardized ultrasound teaching to our undergraduates. Medical students received an additional theoretical and practical course involving hands-on ultrasound screening during their mandatory practical training week in obstetrics and gynecology. The students' theoretical knowledge and fetal image recognition skills were tested before and after the course. After the course, the students were asked to answer a course evaluation questionnaire. To standardize the teaching procedure, we used Peyton's 4-Step Approach to teach the skills needed for a German Society of Ultrasound in Medicine Level 1 ultrasound examiner. The multiple-choice question scores after the course showed statistically significant improvement (50 vs. 80 %; P < 0.001). The questionnaire revealed that students were satisfied with the course, felt that it increased their ultrasound knowledge, and indicated that they wanted more sonographic hands-on training in both obstetrics and gynecology and other medical fields. Using practical, hands-on medical teaching is an emerging method for undergraduate education that should be further evaluated, standardized, and developed.

45 CFR 50.5 - Waivers for the delivery of health care service.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Primary care physicians are defined as: physicians practicing general internal medicine, pediatrics... practice, general pediatrics, obstetrics/gynecology, general internal medicine, or general psychiatry; and...

45 CFR 50.5 - Waivers for the delivery of health care service.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Primary care physicians are defined as: physicians practicing general internal medicine, pediatrics... practice, general pediatrics, obstetrics/gynecology, general internal medicine, or general psychiatry; and...

Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center.

PubMed

Abdulcadir, Jasmine; Dugerdil, Adeline; Yaron, Michal; Irion, Olivier; Boulvain, Michel

2016-02-01

To study the obstetric outcomes of women attending a specialized clinic for women with female genital mutilation (FGM). The medical charts of women with FGM who consecutively attended a specialized clinic between 2010 and 2012 were reviewed retrospectively. The present study focused on women attending for obstetric reasons. The outcome measures were type of delivery, reason for cesarean delivery or assisted delivery, blood loss, episiotomy, perineal tear, duration of the second stage of labor, postpartum complications, weight of the neonate, and Apgar score. Outcomes were compared between women with FGM type III who underwent defibulation, and patients with FGM type I and II. The clinic was attended by 129 women, 84 perinatally. Obstetric outcomes were similar to average outcomes for women without FGM presenting at the same department and in Switzerland generally. Specifically, 20 women had a cesarean delivery. An assisted delivery was performed for 18 patients; among these, only eight had experienced obstructed labor. No statistically significant differences were found for the outcome measures when women with FGM type III were compared to FGM type I and II. Routine obstetric follow-up combined with specialized care for women with FGM, including defibulation, can avoid inappropriate obstetric practices and reduce obstetric complications known to be associated with FGM. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

A survey of Australasian obstetric anaesthesia audit.

PubMed

Smith, S J; Cyna, A M; Simmons, S W

1999-08-01

In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some as priorities for obstetric anaesthesia audit. There was however no consistency as to what data should be collected. Many responses suggested a perceived need to collect clinical data without knowing what to do with it. Our survey has highlighted confusion between three distinct objectives; a dataset for obstetric anaesthesia record keeping, data required for continuing patient management in hospital and, a specific minimal dataset for clinical audit purposes. We conclude that current Australasian obstetric anaesthesia audit strategies are inadequate to develop a minimal dataset for cost-effective clinical audit.

University Gynaecology and Obstetrics, quo vadis? A Department of Women's Health-University Women's Hospital of the future?

PubMed

Simoes, Elisabeth; Brucker, Sara Y; Krämer, Bernhard; Wallwiener, Diethelm

2015-02-01

Numerous changes in society, science and health care challenge gynaecology and obstetrics. These challenges include the maintenance of excellence in research, commercial potential and clinical innovation, as well as the maintenance of adequate human resources, new standards for patient orientation and individualised medicine. Based on a SWOT analysis of the status quo, of local and national quality data, a search regarding national conceptions and of international best practice for women's health centres, the model of a Department of Women's Health was developed. The Department, consisting of a University Hospital and a Research Institute, should interlink clinical care and science. With the establishment of the department, a pool of expertise is achieved which encompasses gynaecology and obstetrics from basic care to the high-technology segments, as well as all the scientific areas relevant to the medical discipline and women's health, including health services research. Preservation and attraction of personnel resources are based on the department's excellence, on reliable perspectives and the flexibility of job profiles, which also result from the close connection between care and research and the expansion of perspectives on women's health. Methodological diversity and inter-professionalism build the appropriate base for the further development of research fields. At the same time, the Department creates space for the consolidation of the core areas and the integration of sub-disciplines (clinical and scientific) to maintain the unity of this discipline. Via the scientific monitoring of the implementation, suitable elements can be highlighted for transfer to other facilities.

Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology.

PubMed

Mikami, Mikio; Nagase, Satoru; Yamagami, Wataru; Ushijma, Kimio; Tashiro, Hironori; Katabuchi, Hidetaka

2017-07-01

Recent evidence has supported the concept that epithelial ovarian cancer (EOC) arises from the cells of the fallopian tube or endometrium. This study investigated current practice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS) during gynecological surgery for benign disease for Ovarian Cancer Prevention. We mailed a questionnaire to 767 hospitals and clinics, comprising 628 accredited training institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Society of Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOE-certified licensed gynecologic laparoscopist. Among the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%) that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88 (19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It was found that awareness and performance of OBS largely depended on the JSGO and/or JSGOE accreditation status. OBS was only performed at 54.0% of responding institutions and just 6.8% of the institutions were willing to participate in randomized controlled trials to validate this method for reducing the incidence of ovarian cancer. The JSOG Gynecologic Tumor Committee will announce its opinion on salpingectomy for ovarian cancer prevention to all JSOG members and will develop a system for monitoring the number of OBS procedures in Japan. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause.

PubMed

AlDakhil, Lateefa O

2016-05-01

The occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine. To identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks. All OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed. Out of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants. Obstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice claims. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A historical examination of the Budin-Pinard phantom: what can contemporary obstetrics education learn from simulators of the past?

PubMed

Owen, Harry; Pelosi, Marco A

2013-05-01

In the 19th and early 20th centuries, obstetric simulators were widely used in medical schools to teach patient assessment skills and to allow students to learn and practice management of a wide range of conditions. Several types of simulators were manufactured, but one, known as the Budin-Pinard phantom, was specifically identified and recommended by J. Whitridge Williams of Johns Hopkins University in a paper he presented to the June 1898 meeting of the Association of American Medical Colleges. Obstetrics simulation became less popular as more women were encouraged to deliver in hospitals, providing trainees the opportunity to learn from actual patients. Today, though, simulation is undergoing a renaissance in obstetrics as a tool to improve learning and patient safety. In light of this shift, the authors examine the origins of simulation in obstetrics training, and specifically why Williams recommended the Budin-Pinard simulator in particular. They investigate the context of simulation in U.S. and Canadian obstetrics training generally up to the early 20th century and provide details about the Budin-Pinard simulator. Finally, the authors offer a discussion of how the Budin-Pinard simulator shaped obstetrics training in the 19th and early 20th centuries and how it can contribute to modern medical education.

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

PubMed Central

Shaylor, Ruth; Weiniger, Carolyn F.; Austin, Naola; Tzabazis, Alexander; Shander, Aryeh; Goodnough, Lawrence T.; Butwick, Alexander J.

2016-01-01

In developed countries, rates of postpartum hemorrhage (PPH) requiring transfusion have been increasing. As a result, anesthesiologists are being increasingly called upon to assist with the management of patients with severe PPH. First responders, including anesthesiologists, may adopt Patient Blood Management (PBM) recommendations of national societies or other agencies. However, it is unclear whether national and international obstetric societies’ PPH guidelines account for contemporary PBM practices. We performed a qualitative review of PBM recommendations published by the following national obstetric societies and international groups: the American College of Obstetricians and Gynecologists; The Royal College of Obstetricians and Gynecologists, United Kingdom; The Royal Australian and New Zealand College of Obstetricians and Gynecologists; The Society of Obstetricians and Gynecologists of Canada; an interdisciplinary group of experts from Austria, Germany, and Switzerland; an international multidisciplinary consensus group; and the French College of Gynaecologists and Obstetricians. We also reviewed a PPH bundle, published by The National Partnership for Maternal Safety. On the basis of our review, we identified important differences in national and international societies’ recommendations for transfusion and PBM. In the light of PBM advances in the nonobstetric setting, obstetric societies should determine the applicability of these recommendations in the obstetric setting. Partnerships among medical, obstetric, and anesthetic societies may also help standardize transfusion and PBM guidelines in obstetrics. PMID:27557476

[Improving the provision of major obstetric interventions by task delegation in Africa: An example from the Bogodogo health district hospital in Ouagadougou, Burkina Faso].

PubMed

Ouédraogo, C M; Ouattara, A; Ouédraogo, A; Bikienga, M; Lankoandé, J

2015-01-01

To describe the role of task delegation in the practice of major obstetric procedures in the Bogodogo health district hospital. This descriptive and analytic prospective study took place in the hospital's department of obstetrics and gynecology from February through October 2013. It included all women undergoing a major obstetric surgical intervention, performed by either by a gynecologist-obstetrician or by a nurse specializing in surgery. Data were collected from individual records and analyzed by SPSS and Epidata software. There were 601 major obstetric interventions during the study period. The women's mean age was 26.7 years. Cesarean deliveries accounted for 90% of these procedures, followed by laparotomy (7.7%). The Misgav-Ladach technique was used for cesareans by 86.5% of the obstetricians and 95.3% of the nurses specialized in surgery. The primary complications were anemia and postpartum hemorrhage. Maternal mortality did not differ significantly between the groups of operators, nor did maternal, fetal, and neonatal outcomes. Task delegation in obstetric surgery at the Bogodogo district hospital is effective. Its extension to the national level would make it possible to overcome the lack of highly qualified human resources to enable adequate availability of major obstetric interventions in rural hospitals.

[Assessment of shoulder dystocia related knowledge among French obstetrics and gynecology residents].

PubMed

Schmitt, A; Heckenroth, H; Cravello, L; Boubli, L; d'Ercole, C; Courbiere, B

2016-09-01

To study the related knowledge of French residents in obstetrics concerning maneuvers for shoulder dystocia (SD). Multicenter descriptive transversal study conducted from June to September 2014. Data collection was performed through questionnaires sent by email to French resident in obstetrics. Among the 1080 questionnaires sent, 366 responses were obtained with a response rate of 33.9%. One hundred and forty-three residents (39.1%) were in the first part of their training (≤5th semester) and 60.9% (n=223) were in the second part of their training. Theoretical training on the SD was provided to 88.2% of resident (n=323). In total, 38.8% (n=142) obtained their French degree in mechanical and technical obstetric and among them 77.5% (n=110) had the opportunity to train on simulators and dummies. Concerning their practical experiences, 31.5% (n=45) residents ≤5th semester reported having experienced SD during their residency vs 58.3% (n=130) amongst oldest residents (P<0.001). In the second part of residency, 40% of residents (n=89) expressed to feel able to manage shoulder dystocia. Only 19.1% (n=70) were satisfied with their residency training program vs 39.1% (n=143) who were unsatisfied. Our study showed that less than one resident out of two (40%) felt able to perform maneuvers for SD in the second part of residency. We think that simulation activities should be mandatory for residency training programs in Obstetrics and Gynecology, which have to develop dependable measures to assess resident competencies to execute practical maneuvers for clinical emergencies in obstetrics. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Effects of obstetric gel on the process and duration of labour in pregnant women: Randomised controlled trial.

PubMed

Seval, Mehmet Murat; Yüce, Tuncay; Yakıştıran, Betül; Şükür, Yavuz Emre; Özmen, Batuhan; Atabekoğlu, Cem; Koç, Acar; Söylemez, Feride

2017-08-01

The present study investigated maternal and neonatal outcomes in pregnant women who used obstetric lubricant gels during active labour. This prospective randomised controlled study included 180 pregnant women. Women were randomly assigned to two groups during the first-stage of labour. Pregnant women in the obstetric gel group received standard antepartum care plus vaginal application of obstetric gel. Women in the control group received standard antepartum care without obstetric gel. Mean duration of the second stage of labour was significantly shorter in the obstetric gel group than control group (45 ± 34 min vs. 58 ± 31 min, respectively; p = .005). Mean APGAR values at 5 min were significantly higher in the obstetric gel group (9.5 ± 0.6 vs. 9.2 ± 0.7; p = .0014). Among nulliparous women, mean duration of the second stage of labour was significantly shorter in the gel group than control group (53 ± 52 min vs. 83 ± 45 min, respectively; p = .003). Using obstetric gel at the beginning of the first stage decreases the length of the second stage of labour, particularly in nulliparous women, and may be associated with an improved APGAR score at 5 min. Impact statement A limited number of studies in the literature have demonstrated that obstetric gels shorten the second stage of labour and are protective for the pelvic floor. The results of this study show that using obstetric gel shortens the second stage of labour in only nulliparous, but not multiparous women. In addition, a significant improvement in the 5 min APGAR score was seen in the neonates of women who used obstetric gel. The application of obstetric gels during the labour of nulliparous women may be a useful clinical practice and may have a widespread use in the future.

A Pilot Study of the Perceptions of Actively Practicing Obstetricians in Puerto Rico: Factors that Influence Decision Making in Cesarean Delivery.

PubMed

Carrera, Alberto M; Sternke, Elizabeth A; Rivera-Viñas, Juana I

2017-03-01

The reported cesarean delivery (CD) rate for 2012 in Puerto Rico was higher than that of the United States (48.5% and 32.8%, respectively). Multiple reasons for and consequences of the high rates of CD exist. The decision to perform a CD is based on multiple factors, some of which are not obstetrical. In order to better understand those factors, the pilot study described in this manuscript analyzed data collected from obstetricians themselves. During 2011, convenience sampling was used to collect data from active obstetric practitioners attending the Caribe Gyn 2011 conference in Ponce, Puerto Rico. A self-administered survey was piloted and analyzed using formative content analysis. Obstetricians were asked to name factors that contribute to their decision to perform a CD and factors they felt influence other obstetricians to make that decision. In general, common maternal and fetal causes for choosing CD were noted. Hypertensive disorders (60%) and abnormal intrapartum fetal tracing (83%) were highly rated, as were non-obstetrical factors, including physician convenience (52%) and concern for medical liability for vaginal delivery (50%). According to the participating obstetricians, many factors associated with the standard practice of obstetrics influence the decision to perform a CD. However, non-obstetrical reasons were also found. Future studies using a larger sample of Puerto Rican obstetricians are required to fully understand these factors in order to both address them through educational interventions for patients, physicians, administrators, and insurers, and inform public policy.

Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.

PubMed

Livingston, Patricia; Evans, Faye; Nsereko, Etienne; Nyirigira, Gaston; Ruhato, Paulin; Sargeant, Joan; Chipp, Megan; Enright, Angela

2014-11-01

High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training.

[Spread of nosocomial infection in obstetric hospitals].

PubMed

Adamyan, L V; Kuzmin, V N; Arslanyan, K N; Kharchenko, E I

2015-01-01

The paper highlights the topical problems of nosocomial infection in the practice of obstetrics and perinatology. It systematizes procedures for controlling the occurrence of nosocomial infection and preventing its spread, such as identification of risk groups and risk factors and prerequisites for complications of epidemiological surveillance, as well as specific diagnosis in pregnant women. Group B streptococcus, one of the major pathogens of nosocomial infection, is described.

Management of obstetric anal sphincter injury: a systematic review & national practice survey

PubMed Central

Fernando, Ruwan J; Sultan, Abdul H; Radley, Simon; Jones, Peter W; Johanson, Richard B

2002-01-01

Background We aim to establish the evidence base for the recognition and management of obstetric anal sphincter injury (OASI) and to compare this with current practice amongst UK obstetricians and coloproctologists. Methods A systematic review of the literature and a postal questionnaire survey of consultant obstetricians, trainee obstetricians and consultant coloproctologists was carried out. Results We found a wide variation in experience of repairing acute anal sphincter injury. The group with largest experience were consultant obstetricians (46.5% undertaking ≥ 5 repairs/year), whilst only 10% of responding colorectal surgeons had similar levels of experience (p < 0.001). There was extensive misunderstanding in terms of the definition of obstetric anal sphincter injuries. Overall, trainees had a greater knowledge of the correct classification (p < 0.01). Observational studies suggest that a new 'overlap' repair using PDS sutures with antibiotic cover gives better functional results. However, our literature search found only one randomised controlled trial (RCT) on the technique of repair of OASI, which showed no difference in incidence of anal incontinence at three months. Despite this, there was a wide variation in practice, with 337(50%) consultants, 82 (55%) trainees and 80 (89%) coloproctologists already using the 'overlap' method for repair of a torn EAS (p < 0.001). Although over 50% of colorectal surgeons would undertake long-term follow-up of their patients, this was the practice of less than 10% of obstetricians (p < 0.001). Whilst over 70% of coloproctologists would recommend an elective caesarean section in a subsequent pregnancy, only 22% of obstetric consultants and 14% of trainees (p < 0.001). Conclusion An agreed classification of OASI, development of national guidelines, formalised training, multidisciplinary management and further definitive research is strongly recommended. PMID:12006105

Obstetric Emergencies: Shoulder Dystocia and Postpartum Hemorrhage.

PubMed

Dahlke, Joshua D; Bhalwal, Asha; Chauhan, Suneet P

2017-06-01

Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage. Copyright © 2017 Elsevier Inc. All rights reserved.

Burnout and Scope of Practice in New Family Physicians.

PubMed

Weidner, Amanda K H; Phillips, Robert L; Fang, Bo; Peterson, Lars E

2018-05-01

Family physicians report some of the highest levels of burnout, but no published work has considered whether burnout is correlated with the broad scope of care that family physicians may provide. We examined the associations between family physician scope of practice and self-reported burnout. Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (N = 1,617). We used bivariate analyses and logistic regression to compare self-report of burnout and measures of scope of practice including: inpatient medicine, obstetrics, pediatric ambulatory care, number of procedures and/or clinical content areas, and providing care outside the principal practice site. Forty-two percent of respondents reported feeling burned out from their work once a week or more. In bivariate analysis, elements of scope of practice associated with higher burnout rates included providing more procedures/clinical content areas (mean procedures/clinical areas: 7.49 vs 7.02; P = .02) and working in more settings than the principal practice site (1+ additional settings: 57.6% vs 48.4%: P = .001); specifically in the hospital (31.4% vs 24.2%; P = .002) and patient homes (3.3% vs 1.5%; P = .02). In adjusted analysis, practice characteristics significantly associated with lower odds of burnout were practicing inpatient medicine (OR = 0.70; 95% CI, 0.56-0.87; P = .0017) and obstetrics (OR = 0.64; 95% CI, 0.47-0.88; P = .0058). Early career family physicians who provide a broader scope of practice, specifically, inpatient medicine, obstetrics, or home visits, reported significantly lower rates of burnout. Our findings suggest that comprehensiveness is associated with less burnout, which is critical in the context of improving access to good quality, affordable care while maintaining physician wellness. © 2018 Annals of Family Medicine, Inc.

A multicenter study on the appropriateness of hospitalization in obstetric wards: application of Obstetric Appropriateness Evaluation Protocol (Obstetric AEP).

PubMed

Mannocci, Alice; Specchia, Maria Lucia; Poppa, Giuseppina; Boccia, Giovanni; Cavallo, Pierpaolo; De Caro, Francesco; Vetrano, Giuseppe; Aleandri, Vincenzo; Capunzo, Mario; Ricciardi, Walter; Boccia, Antonio; Firenze, Alberto; Malvasi, Antonio; La Torre, Giuseppe

2015-09-01

The cross-sectional study has been based on the implementation of the Obstetric Appropriateness Evaluation Protocol (OAEP) in seven hospitals to determine inappropriate hospital admissions and days of stay. The outcomes were: inappropriateness of admission and "percentage of inappropriateness" for one hospitalization. A total number of 2196 clinical records were reviewed. The mean percentage of inappropriateness for hospitalization was 22%. The percentage of inappropriateness for the first 10 d of hospitalization peaked in correspondence of the fourth (42%). The logistic regression model on inappropriated admission reported that emergency admission was a protective factor (OR = 0.4) and to be hospitalized in wards with ≥30 beds risk factor (OR = 5.12). The second linear model on "percentage of inappropriateness" showed that inappropriated admission and wards with ≥30 beds increased the percentage (p < 0.001); whereas the admission in Teaching Hospitals was inversely associated (p < 0.001). The present study suggests that the percentage of inappropriate admission depends especially on the inappropriate admission and the large number of beds in obstetric wards. This probably indicates that management of big hospitals, which is very complex, needs improving the processes of support and coordination of health professionals. The OAEP tool seems to be an useful instrument for the decision-makers to monitor and manage the obstetric wards.

Magnesium in obstetric anesthesia and intensive care.

PubMed

Kutlesic, Marija S; Kutlesic, Ranko M; Mostic-Ilic, Tatjana

2017-02-01

Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

[Noninvasive total hemoglobin monitoring based on multiwave spectrophotometry in obstetrics and gynecology].

PubMed

Pyregov, A V; Ovechkin, A Iu; Petrov, S V

2012-01-01

Results of prospective randomized comparative research of 2 total hemoglobin estimation methods are presented. There were laboratory tests and continuous noninvasive technique with multiwave spectrophotometry on the Masimo Rainbow SET. Research was carried out in two stages. At the 1st stage (gynecology)--67 patients were included and in second stage (obstetrics)--44 patients during and after Cesarean section. The standard deviation of noninvasive total hemoglobin estimation from absolute values (invasive) was 7.2 and 4.1%, an standard deviation in a sample--5.2 and 2.7 % in gynecologic operations and surgical delivery respectively, that confirms lack of reliable indicators differences. The method of continuous noninvasive total hemoglobin estimation with multiwave spectrophotometry on the Masimo Rainbow SET technology can be recommended for use in obstetrics and gynecology.

‘Essential but not always available when needed’ – an interview study of physicians’ experiences and views regarding use of obstetric ultrasound in Tanzania

PubMed Central

Åhman, Annika; Kidanto, Hussein Lesio; Ngarina, Matilda; Edvardsson, Kristina; Small, Rhonda; Mogren, Ingrid

2016-01-01

Background The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries. Objective We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management. Design A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis. Results Use of obstetric ultrasound in the management of complicated pregnancy was much appreciated by participating physicians, although they expressed considerable concern about the lack of ultrasound equipment and staff able to conduct the examinations. These limitations were recognized as restricting physicians’ ability to manage complications adequately during pregnancy and birth. Better availability of ultrasound was requested to improve obstetric management. Concerns were also raised regarding pregnant women's lack of knowledge and understanding of medical issues which could make counseling in relation to obstetric ultrasound difficult. Although the physicians perceived a positive attitude toward ultrasound among most pregnant women, occasionally they came across women who feared that ultrasound might harm the fetus. Conclusions There seems to be a need to provide more physicians in antenatal care in Tanzania with ultrasound training to enable them to conduct obstetric ultrasound examinations and interpret the results themselves. Physicians also need to acquire adequate counseling skills as counseling can be especially challenging in this setting where many expectant parents have low levels of education. Providers of obstetric care and policy makers in Tanzania will need to take measures to ensure appropriate use of the scarce resources in the Tanzanian health care system and prevent the potential risk of overuse of ultrasound in pregnancy. PMID:27452066

Women's experiences of continuous fetal monitoring - a mixed-methods systematic review.

PubMed

Crawford, Alexandra; Hayes, Dexter; Johnstone, Edward D; Heazell, Alexander E P

2017-12-01

Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesized that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability before clinical implementation and to inform clinical studies. Systematic searching of four electronic databases (Embase, PsycINFO, MEDLINE and CINAHL), using key terms defined by initial scoping searches, identified a total of 35 studies. Following title and abstract screening by two independent researchers, five studies met the inclusion criteria. Studies were not excluded based on language, methodology or quality assessment. An integrative methodology was used to synthesize qualitative and quantitative data together. Forms of continuous fetal monitoring used included Monica AN24 monitors (n = 4) and phonocardiography (n = 1). Four main themes were identified: practical limitations of the device, negative emotions, positive perceptions, and device implementation. Continuous fetal monitoring was reported to have high levels of participant satisfaction and was preferred by women to intermittent cardiotocography. This review suggests that continuous fetal monitoring is accepted by women. However, it has also highlighted both the paucity and heterogeneity of current studies and suggests that further research should be conducted into women's experiences of continuous fetal monitoring before such devices can be used clinically. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Knowledge, skills and attitude of evidence-based medicine among obstetrics and gynaecology trainees: a questionnaire survey.

PubMed

Jeve, Yadava Bapurao; Doshani, Angi; Singhal, Tanu; Konje, Justin

2013-12-01

To determine current evidence-based medicine skills and practice among trainees. Questionnaire study. Electronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous. All obstetrics and gynaecology trainees in East Midland South Deanery. Self-reported attitude, skills and knowledge in various components of evidence-based medicine. 69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine. This study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules.

Training residents to be factually accurate and articulate: A case study using foetal heart rate monitoring nomenclature.

PubMed

Stohl, Hindi E; Miller, David A

2016-10-01

Careful communication between members of the obstetric team about intrapartum foetal heart rate is critical for clinical management and patient safety. This study evaluated the benefits of two testing modalities in assessing resident physician knowledge of the 2008 NICHD nomenclature. Multiple-choice (MC) and short-answer (SA) examinations were administered to Obstetrics and Gynecology resident physicians before an educational intervention and then immediately after the training, at 6 months and at 12 months. Test scores on both the MC and the SA examinations improved after the training session. The improvement was sustained over the course of the study. Residents performed higher on the MC examination than on the SA test. This study suggests that formalised teaching in foetal heart rate monitoring improves resident physician knowledge of the NICHD nomenclature and that SA examinations may better discriminate between residents who are and are not able to accurately articulate foetal heart rate monitoring terminology.

Obstetrical Ultrasound

MedlinePlus

... the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of ... by a computer, which in turn creates a real-time picture on the monitor. One or more frames ...

Maternal collapse: Training in resuscitation.

PubMed

Naidoo, Mergan

2015-11-01

The National Committee for the Confidential Enquiries into Maternal Deaths (NCCEMD) of South Africa has recommended in the Sixth Saving Mothers Report that health-care professionals (HCPs) training in managing obstetric emergencies be improved. One such measure is to ensure that the Essential Steps in Managing Obstetric Emergencies (ESMOE) with its Emergency Obstetric Simulation Training (EOST) be rolled out to every HCP working in the obstetric environment. The programme has been strengthened and rolled out in the province of KwaZulu-Natal, South Africa. This review focuses on the various teaching methods used to improve maternal resuscitation training in a South African context. Evidence-based interventions in maternal resuscitation will be highlighted, and recommendations for clinical practice will be suggested. Common causes of maternal collapse will be explored, and measures to improve training in these areas will be outlined. In order to ensure sustainability, quality improvement measures need to be introduced and evaluated. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Essential competencies in training in obstetrics].

PubMed

Duarte, Sebastião Junior Henrique; Machado, Richardson Miranda

2016-11-01

Analyze international reports related to training in obstetrics and present guidelines to help leading educational institutions to develop curriculum guidelines for the teaching of obstetrics and advanced nursing practice in this specialty. A narrative review was conducted of documents from the World Health Organization and the International Confederation of Midwives. The search used the descriptors midwifery and education. All official reports that guide midwife education policies, published from 2009 to 2015 in English and Spanish, and available online, were included. Reports that did not specifically refer to training were excluded. Five reports were selected. Analysis and synthesis of their respective objectives and contents were based on three themes: requirements for professional qualification, continuing education, and guidelines for skilled training in obstetrics, taking into account accepted core competencies for this specialty. Analysis of reports related to training in obstetrics identified that key tasks are being implemented for both educators and midwives. The reports represent a solid basis to develop educational policies that can contribute to universal access and coverage in health and to reducing maternal and neonatal mortality, and potentially can be used to guide international policies.

Compliance with the CONSORT checklist in obstetric anaesthesia randomised controlled trials.

PubMed

Halpern, S H; Darani, R; Douglas, M J; Wight, W; Yee, J

2004-10-01

The Consolidated Standards for Reporting of Trials (CONSORT) checklist is an evidence-based approach to help improve the quality of reporting randomised controlled trials. The purpose of this study was to determine how closely randomised controlled trials in obstetric anaesthesia adhere to the CONSORT checklist. We retrieved all randomised controlled trials pertaining to the practice of obstetric anaesthesia and summarised in Obstetric Anesthesia Digest between March 2001 and December 2002 and compared the quality of reporting to the CONSORT checklist. The median number of correctly described CONSORT items was 65% (range 36% to 100%). Information pertaining to randomisation, blinding of the assessors, sample size calculation, reliability of measurements and reporting of the analysis were often omitted. It is difficult to determine the value and quality of many obstetric anaesthesia clinical trials because journal editors do not insist that this important information is made available to readers. Both clinicians and clinical researchers would benefit from uniform reporting of randomised trials in a manner that allows rapid data retrieval and easy assessment for relevance and quality.

[An Analysis of the Controversy on the Psychoprophylaxis Method in the Japanese Medical Journal "Obstetrics and Gynecology," 1954-1957].

PubMed

Fujihara, Satoko; Tsukisawa, Miyoko

2015-06-01

The methods of painless childbirth are generally divided into two kinds: "with drugs" and "without drugs." In Japan, the full-scale initiation of these two types of painless childbirth methods in clinical practice started in the early 1950s. The practice of the psychoprophylaxis method (PPM)--one of the painless childbirth methods "without drugs"--started in 1953. Japanese obstetricians had discussed the practicability of PPM for painless childbirth and had doubted the scientific nature and originality of PPM as a viable method. Therefore, they published a series of articles in the Japanese medical journal "Obstetrics and Gynecology" from 1954 to 1957. Two representative obstetricians developed this controversy. Naotaro KUJI, the director of the Central Maternity Hospital of the Japanese Red Cross Society and the chief practitioner of PPM, emphasized that PPM was a more practical method, considering the Japanese medical legal situation where midwives were prohibited to use drugs. On the other hand, Kakuichi ANDO, the chief professor of the Department of Obstetrics and Gynecology of Keio University and the team leader of the practitioners of painless childbirth "with drugs," doubted the practicability of PPM. In the course of these discussions, both groups of obstetricians gradually came to a consensus to use the concept of "pain relief" in labor, instead of "painless" childbirth. They also agreed to adopt methods "with drugs" and "without drugs," including PPM, according to the presented case.

Costs and Benefits of Electronic Fetal Monitoring: A Review of the Literature. NCHSR Research Report Series.

ERIC Educational Resources Information Center

Banta, H. David; Thacker, Stephen B.

This report focuses on electronic fetal monitoring (EFM)--a technology that was developed during the 1960s and has rapidly spread into use in clinical obstetrics. The report includes a review of the extensive published literature on EFM and related subjects. It also contains original calculations concerning the technique's specificity and…

Accountability for quality of care: Monitoring all aspects of quality across a framework adapted for action.

PubMed

Hulton, Louise; Matthews, Zoë; Bandali, Sarah; Izge, Abubakar; Daroda, Ramatu; Stones, William

2016-01-01

Quality of care is essential to maternal and newborn survival. The multidimensional nature of quality of care means that frameworks are useful for capturing it. The present paper proposes an adaptation to a widely used quality of care framework for maternity services. The framework subdivides quality into two inter-related dimensions-provision and experience of care-but suggests adaptations to reflect changes in the concept of quality over the past 15years. The application of the updated framework is presented in a case study, which uses it to measure and inform quality improvements in northern Nigeria across the reproductive, maternal, newborn, and child health continuum of care. Data from 231 sampled basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) facilities in six northern Nigerian states showed that only 35%-47% of facilities met minimum quality standards in infrastructure. Standards for human resources performed better with 49%-73% reaching minimum standards. A framework like this could form the basis for a certification scheme. Certification offers a practical and concrete opportunity to drive quality standards up and reward good performance. It also offers a mechanism to strengthen accountability. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth.

PubMed

2017-02-01

Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons. A pregnant woman with term premature rupture of membranes (also known as prelabor rupture of membranes) should be assessed, and the woman and her obstetrician-gynecologist or other obstetric care provider should make a plan for expectant management versus admission and induction. Data suggest that in women with normally progressing labor and no evidence of fetal compromise, routine amniotomy is not necessary. The widespread use of continuous electronic fetal heart-rate monitoring has not improved outcomes when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated nor proscribed. Nulliparous women who have an epidural and no indication for expeditious delivery may be offered a period of rest for 1-2 hours before initiating pushing efforts. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches for the intrapartum management of low-risk women in spontaneous labor.

Quality Indicators for Continuous Monitoring to Improve Maternal and Infant Health in Maternity Departments: A Modified Delphi Survey of an International Multidisciplinary Panel

PubMed Central

Boulkedid, Rym; Sibony, Olivier; Goffinet, François; Fauconnier, Arnaud; Branger, Bernard; Alberti, Corinne

2013-01-01

Objective Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals. Methodology and Main Findings An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators. Conclusion A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units. PMID:23577143

The impact of transmural multiprofessional simulation-based obstetric team training on perinatal outcome and quality of care in the Netherlands

PubMed Central

2014-01-01

Background Perinatal mortality and morbidity in the Netherlands is relatively high compared to other European countries. Our country has a unique system with an independent primary care providing care to low-risk pregnancies and a secondary/tertiary care responsible for high-risk pregnancies. About 65% of pregnant women in the Netherlands will be referred from primary to secondary care implicating multiple medical handovers. Dutch audits concluded that in the entire obstetric collaborative network process parameters could be improved. Studies have shown that obstetric team training improves perinatal outcome and that simulation-based obstetric team training implementing crew resource management (CRM) improves team performance. In addition, deliberate practice (DP) improves medical skills. The aim of this study is to analyse whether transmural multiprofessional simulation-based obstetric team training improves perinatal outcome. Methods/Design The study will be implemented in the south-eastern part of the Netherlands with an annual delivery rate of over 9,000. In this area secondary care is provided by four hospitals. Each hospital with referring primary care practices will form a cluster (study group). Within each cluster, teams will be formed of different care providers representing the obstetric collaborative network. CRM and elements of DP will be implemented in the training. To analyse the quality of care as perceived by patients, the Pregnancy and Childbirth Questionnaire (PCQ) will be used. Furthermore, self-reported collaboration between care providers will be assessed. Team performance will be measured by the Clinical Teamwork Scale (CTS). We employ a stepped-wedge trial design with a sequential roll-out of the trainings for the different study groups. Primary outcome will be perinatal mortality and/or admission to a NICU. Secondary outcome will be team performance, quality of care as perceived by patients, and collaboration among care providers. Conclusion The effect of transmural multiprofessional simulation-based obstetric team training on perinatal outcome has never been studied. We hypothesise that this training will improve perinatal outcome, team performance, and quality of care as perceived by patients and care providers. Trial registration The Netherlands National Trial Register, http://www.trialregister.nl/NTR4576, registered June 1, 2014 PMID:25145317

The Impact and Cost of Scaling up Midwifery and Obstetrics in 58 Low- and Middle-Income Countries

PubMed Central

Bartlett, Linda; Weissman, Eva; Gubin, Rehana; Patton-Molitors, Rachel; Friberg, Ingrid K.

2014-01-01

Background and Methods To guide achievement of the Millennium Development Goals, we used the Lives Saved Tool to provide a novel simulation of potential maternal, fetal, and newborn lives and costs saved by scaling up midwifery and obstetrics services, including family planning, in 58 low- and middle-income countries. Typical midwifery and obstetrics interventions were scaled to either 60% of the national population (modest coverage) or 99% (universal coverage). Findings Under even a modest scale-up, midwifery services including family planning reduce maternal, fetal, and neonatal deaths by 34%. Increasing midwifery alone or integrated with obstetrics is more cost-effective than scaling up obstetrics alone; when family planning was included, the midwifery model was almost twice as cost-effective as the obstetrics model, at $2,200 versus $4,200 per death averted. The most effective strategy was the most comprehensive: increasing midwives, obstetricians, and family planning could prevent 69% of total deaths under universal scale-up, yielding a cost per death prevented of just $2,100. Within this analysis, the interventions which midwifery and obstetrics are poised to deliver most effectively are different, with midwifery benefits delivered across the continuum of pre-pregnancy, prenatal, labor and delivery, and postpartum-postnatal care, and obstetrics benefits focused mostly on delivery. Including family planning within each scope of practice reduced the number of likely births, and thus deaths, and increased the cost-effectiveness of the entire package (e.g., a 52% reduction in deaths with midwifery and obstetrics increased to 69% when family planning was added; cost decreased from $4,000 to $2,100 per death averted). Conclusions This analysis suggests that scaling up midwifery and obstetrics could bring many countries closer to achieving mortality reductions. Midwives alone can achieve remarkable mortality reductions, particularly when they also perform family planning services - the greatest return on investment occurs with the scale-up of midwives and obstetricians together. PMID:24941336

A nationwide descriptive study of obstetric claims for compensation in Norway.

PubMed

Andreasen, Stine; Backe, Bjørn; Jørstad, Rolf Gunnar; Oian, Pål

2012-10-01

To describe causes of substandard care in obstetric compensation claims. A nationwide descriptive study in Norway. All obstetric patients who believed themselves inflicted with injuries by the Health Service and applying for compensation. Data were collected from 871 claims to The Norwegian System of Compensation to Patients during 1994-2008, of which 278 were awarded compensation. Type of injury and cause of substandard care. Of 871 cases, 278 (31.9%) resulted in compensation. Of those, asphyxia was the most common type of injury to the child (83.4%). Anal sphincter tear (29.9%) and infection (23.0%) were the most common types of injury to the mother. Human error, both by midwives (37.1% of all cases given compensation) and obstetricians (51.2%), was an important contributing factor in inadequate obstetric care. Neglecting signs of fetal distress (28.1%), more competent health workers not being called when appropriate (26.3%) and inadequate fetal monitoring (17.3%) were often observed. System errors such as time conflicts, neglecting written guidelines and poor organization of the department were infrequent causes of injury (8.3%). Fetal asphyxia is the most common reason for compensation, resulting in large financial expenses to society. Human error contributes to inadequate health care in 92% of obstetric compensation claims, although underlying system errors may also be present. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates.

PubMed Central

Prual, A.; Bouvier-Colle, M. H.; de Bernis, L.; Bréart, G.

2000-01-01

Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care. PMID:10859853

Obstetricians and violence against women.

PubMed

Charles, Sonya

2011-12-01

I argue that the American Congress of Obstetricians and Gynecologists (ACOG), as an organization and through its individual members, can and should be a far greater ally in the prevention of violence against women. Specifically, I argue that we need to pay attention to obstetrical practices that inadvertently contribute to the problem of violence against women. While intimate partner violence is a complex phenomenon, I focus on the coercive control of women and adherence to oppressive gender norms. Using physician response to alcohol use during pregnancy and court-ordered medical treatment as examples, I show how some obstetrical practices mirror the attitudes of abusive men insofar as they try to coercively control women's behavior through manipulation and violence. To be greater allies in the prevention of violence against women, obstetricians should stop participating in practices that inadvertently perpetuate violence against women.

Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence.

PubMed

Sadler, Michelle; Santos, Mário Jds; Ruiz-Berdún, Dolores; Rojas, Gonzalo Leiva; Skoko, Elena; Gillen, Patricia; Clausen, Jette A

2016-05-01

During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices. Copyright © 2016 Elsevier Inc. All rights reserved.

Perspectives on Procedure Importance: Residents, Faculty, and Community Practitioners.

PubMed

Ludden-Schlatter, Alicia; Wells, Jack; Kruse, Robin L

2018-06-01

Procedural training is integral to family medicine residencies. Although accreditation bodies require that family medicine residency programs train residents in procedures relevant to their practices, there are no standards defining the scope of family medicine. We compared the perceived importance of 31 procedures by faculty, residents, and recent graduates of one institution. An online survey was sent to current residents and faculty of a large academic family medicine residency, as well as community practitioners who had graduated from that residency within the past 5 years. The survey asked participants to rate how important 31 procedures are for family medicine practices. The overall response rate was 37%. Most respondents provided outpatient care, and few provided or intended to provide obstetric care. Dermatologic and musculoskeletal procedures were rated as having high importance by all groups, whereas obstetric and inpatient procedures received lower ratings. Residents ascribed higher importance than faculty or recent graduates for nearly all procedures. Most residents, faculty, and community practitioners provided outpatient care and rated dermatologic and musculoskeletal procedures as important. Inpatient and obstetric care are less common career paths, and related procedures were rated as less important. Resident physicians ascribed greater importance than community practitioners for many procedures, which may be due misperceptions of their future practice needs or imposed requirements for graduation.

Trends in obstetric anal sphincter injuries over 10 years.

PubMed

Tyagi, V; Perera, M; Guerrero, K

2013-11-01

Obstetric anal sphincter injuries (OASIS) is a known complication of vaginal delivery and has significant public health issues, as it can cause both short- and long-term morbidity in women. The most commonly reported complications include different grades of faecal/flatus incontinence, pain and sexual dysfunction. In our study, we found a rising trend in OASIS rates in vaginal deliveries, with the rising rate of forceps and the falling rate of SVD, which is at least partly due to increased awareness and training in OASIS. However, there is an actual increase in the number of such tears at vaginal deliveries. Midwifery and obstetric practices have certainly changed over the last decade and we discuss the possible factors, which might be contributing to such a rise.

[Demography and training of residents in gynaecology and obstetrics: results of a national survey].

PubMed

Bendifallah, S; Hudry, D; Niangoh Timoh, K; Yaribakht, S; Boyon, C; Wafo, E

2012-01-01

To survey French trainees in obstetrics and gynaecology on the general demographic evolution and the quality of training. A questionnaire was sent to the 919 trainees in obstetrics and gynaecology during the academic year 2010-2011. Answer rate was 38.5%. Almost all trainees (99.4%) wish to have a two-year hospital position before applying for consultant or beginning a private practice; 60.4% of these trainees declare this option realistic. Trainees demography is marked by an increasing number of young doctors to train and a feminization. The need of a debate is crucial to assure quality of training after the recent increase in the number of residents and trainees reforms. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Managed care in obstetrics.

PubMed

Devoe, L D

1997-08-01

Managed care has marched relentlessly through all fields of obstetric care: individual and group practices, proprietary hospitals and academic medical centers, and public health systems. Emphasis on cost containment while preserving high quality has driven the redesign of healthcare delivery. A number of models for providing effective and less expensive obstetric care are now being examined in the USA and abroad. Increased market penetration by managed care will also exert profound and possibly harmful effects on traditional academic teaching institutions. These organizations must adapt to this new environment or face the erosion of physician support and training bases. Ultimately, significant moral and ethical dilemmas will arise when patients' best interests for care are being continually brought into conflict with the physician's need to earn a living.

A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia

PubMed Central

Gebresilase, Yenenesh Tadesse

2014-01-01

Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors’ perceptions of their social relationships and health since developing this obstetric complication. In-depth interviews were conducted with eight survivors who were selected based on purposive and snowball sampling techniques. Thematic categorization and content analysis was used to analyze the data. The resultant themes included participants’ understanding of factors predisposing to fistula, challenges they encounter, their coping responses, and the meaning of their experiences. First, the participants had a common understanding of the factors that predisposed them to obstetric fistula. They mentioned poor knowledge about pregnancy, early marriage, cultural practices, and a delay in or lack of access to emergency obstetric care. Second, the participants suffered from powerlessness experienced during their childhood and married lives. They also faced prolonged obstructed labor, physical injury, emotional breakdown, depression, erosion of social capital, and loss of healthy years. Third, to control their negative emotions, participants reported isolating themselves, having suicidal thoughts, positive interpretation about the future, and avoidance. To obtain relief from their disease, the women used their family support, sold their properties, and oriented to reality. Fourth, the participants were struggling to keep going, to accept their changed reality, and to change their perspectives on life. In conclusion, obstetric fistula has significant physical, psychosocial, and emotional consequences. The study participants were not passive victims but rather active survivors of these challenges. Adequate support was not provided by their formal or informal support systems. To prevent and manage obstetric fistula successfully, there should be family-based interventions that improve access to and provision of emergency obstetric care. These initiatives should also ensure men’s participation, women’s empowerment, and the utilization of community-based institutions. PMID:25525395

Midwifery practice and the crisis of modernity: implications for the role of the midwife.

PubMed

Hyde, Abbey; Roche-Reid, Bernadette

2004-06-01

Almost since its inception, the concept of modernity was found to display tensions between its emancipatory potential to liberate the human subject from the manacles of tradition, and the application of reason to co-ordinate and control the natural world through scientific knowledge. This paper presents a qualitative analysis of in-depth interviews with 12 midwives about their role in the Irish maternity services and argues that, in a period of late modernity, these tensions continue to manifest themselves in the context of the midwife's role. Although the contemporary period is marked by a loss of faith in scientific truths, widely contested obstetric knowledge and practices continue to exercise mastery over nature while undermining a central feature of the midwife's role-the liberation of the autonomous subject. Drawing on the theory of communicative action developed by the critical theorist Jürgen Habermas, it is argued that the midwife's role in facilitating the autonomous choices of women through communicative action is impeded by the colonization of the lifeworld of labour and childbirth by the technocratic system of obstetrics. Although participants reported that their role involved empowering women and facilitating choices through dialogue congruent with communicative action, data also suggested that participants used strategic communication with clients aimed at achieving particular ends. The use of strategic communication was linked to the way in which the midwife's role is determined to a large extent by the practices and protocols of obstetrics, and also to the notion of client passivity. The instrumental rationality of obstetrics is linked to an outcome orientation to power and money, and a political economy perspective of medicine. It appears that communicative action between midwives and obstetricians is important in bringing about structural changes to facilitate the conditions for communicative action between midwives and their clients.

A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant Population.

PubMed

Hantsoo, Liisa; Criniti, Stephanie; Khan, Annum; Moseley, Marian; Kincler, Naomi; Faherty, Laura J; Epperson, C Neill; Bennett, Ian M

2018-01-01

This study tested whether a mood tracking and alert (MTA) mobile application (app) improved mental health care delivery in a high-risk obstetric population. Pregnant women with depressive symptomatology at <32 weeks gestation were followed for eight weeks after randomization to a control patient portal (PP) app alone or with the MTA app. The MTA app monitored activity, assessed mood, and alerted obstetric providers of signs of worsening mood. Seventy-two women enrolled (PP, N=24; MTA, N=48). MTA users had significantly more contacts addressing mental health, and as gestational age increased, they rated ability to manage their own health significantly better than women in the control group. Women who received telephone contact from a provider triggered by an MTA app alert were significantly more likely to receive a mental health specialist referral. A mobile MTA app improved service delivery and patient engagement among patients with perinatal depression symptoms.

Impact of a low-technology simulation-based obstetric and newborn care training scheme on non-emergency delivery practices in Guatemala.

PubMed

Walton, Anna; Kestler, Edgar; Dettinger, Julia C; Zelek, Sarah; Holme, Francesca; Walker, Dilys

2016-03-01

To assess the effect of a low-technology simulation-based training scheme for obstetric and perinatal emergency management (PRONTO; Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) on non-emergency delivery practices at primary level clinics in Guatemala. A paired cross-sectional birth observation study was conducted with a convenience sample of 18 clinics (nine pairs of intervention and control clinics) from June 28 to August 7, 2013. Outcomes included implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care. Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labor was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P=0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P<0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P=0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P=0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P=0.012). Use of PRONTO enhanced non-emergency delivery care by increasing evidence-based practice, patient-centered care, and teamwork. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Perinatal Anxiety: Approach to Diagnosis & Management in the Obstetric Setting.

PubMed

Thorsness, Katie R; Watson, Corey; Larusso, Elizabeth M

2018-05-24

Anxiety is common in women during the perinatal period, manifests with various symptomatology and severity, and is associated with significant maternal morbidity and adverse obstetrical and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is optimally positioned to create a therapeutic alliance and manage perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit clinicians' ability to initiate informed risk-benefit discussions. Clear understanding of the role of the obstetric provider in the identification, stabilization, and initiation of medication and/or referral to psychotherapy for women with perinatal anxiety disorders is critical to maternal and neonatal wellbeing. Informed by our clinical practice as perinatal psychiatric providers, we have provided a concise summary of current research on the approach to treatment of perinatal anxiety disorders in the obstetric setting, including psychotherapy and supportive interventions, primary and adjuvant psychiatric medication, and general prescribing pearls. Medications examined include antidepressants, benzodiazepines, sedative-hypnotics, antihistamines, quetiapine, buspirone, propranolol, and melatonin. Further research into management of perinatal anxiety, particularly psychopharmacological management, is warranted. Copyright © 2018 Elsevier Inc. All rights reserved.

Factors associated with adverse clinical outcomes among obstetric trainees

PubMed Central

Aiken PhD, Catherine E.; Aiken, Abigail; Park, Hannah; Brockelsby, Jeremy C.; Prentice, Andrew

2016-01-01

Objective To determine whether UK obstetric trainees transitioning from directly to indirectly-supervised practice have a higher likelihood of adverse patient outcomes from operative deliveries compared to other indirectly supervised trainees and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial indirect practice. Methods We examined all deliveries (13,861) conducted by obstetricians at a single centre over 5 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss, maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly-supervised year with trainees in all other years of indirect practice. Outcomes for trainees in their first indirectly-supervised 3 months were compared to their outcomes for the remainder of the year. Linear regression was used to examine the relationship between number of procedures performed under direct supervision and initial outcomes under indirect supervision. Results Trainees in their first indirectly-supervised year had a higher likelihood of >2 litres estimated blood loss at any delivery (OR 1.32;CI(1.01-1.64) p<0.05) and of failed instrumental delivery (OR 2.33;CI(1.37-3.29) p<0.05) compared with other indirectly-supervised trainees. Other measured outcomes showed no significant differences. Within the first three months of indirect supervision, the likelihood of operative vaginal deliveries with >1litre estimated blood loss (OR 2.54;CI(1.88-3.20) p<0.05) was higher compared to the remainder of the first year. Performing more deliveries under direct supervision prior to beginning indirectly-supervised training was associated with decreased risk of >1litre estimated blood loss (p<0.05). Conclusions Obstetric trainees in their first year of indirectly-supervised practice have a higher likelihood of immediate adverse delivery outcomes, which are primarily maternal rather than neonatal. Undertaking more directly supervised procedures prior to transitioning to indirectly-supervised practice may reduce adverse outcomes, suggesting that experience is a key consideration in obstetric training programme design. PMID:26077215

[Competence development in undergraduate medical schools: a model with entrusted professional activities].

PubMed

Torruco-García, Uri; Ortiz-Montalvo, Armando; Varela-Ruiz, Margarita Elena; Hamui-Sutton, Alicia

2016-01-01

Today´s relevant educational models emphasize that a great part of learning be situated and reflexive; one of those is the Entrusted Professional Activities model. The study objective was to develop a model that integrates Entrusted Professional Activities with a medical school curriculum. From October 2012 a multidisciplinary group met to develop a model with the specialty of obstetrics and gynecology. From two published models of Entrusted Professional Activities and the curriculum of a school of medicine, blocks, units, and daily clinical practice charts were developed. The thematic content of the curriculum was integrated with the appropriate milestones for undergraduate students and the clinical practice needed to achieve it. We wrote a manual with 37 daily clinical practice charts for students (18 of gynecology and 19 of obstetrics) and 37 for teachers. Each chart content was the daily clinical practice, reflection activities, assessment instruments, and bibliography. It is feasible to combine a model of Entrusted Professional Activities with an undergraduate curriculum, which establishes a continuum with postgraduate education.

ACOG Committee Opinion no. 597: Committee on Obstetric Practice: Labor induction or augmentation and autism.

PubMed

2014-05-01

Functional oxytocin deficiency and a faulty oxytocin signaling pathway have been observed in conjunction with autism spectrum disorder (ASD). Because exogenous synthetic oxytocin commonly is administered for labor induction and augmentation, some have hypothesized that synthetic oxytocin used for these purposes may alter fetal oxytocin receptors and predispose exposed offspring to ASD. However, current evidence does not identify a causal relationship between labor induction or augmentation in general, or oxytocin labor induction specifically, and autism or ASD. Recognizing the limitations of available study design, conflicting data, and the potential consequences of limiting labor induction and augmentation, the Committee on Obstetric Practice recommends against a change in current guidance regarding counseling and indications for and methods of labor induction and augmentation.

[Wouter van Doeveren (1730-1783) professor of practical medicine, obstetrics and pathology].

PubMed

Van Heiningen, Teunis Willem

2012-01-01

Between September 1752 and July 1753, Wouter van Doeveren, a student of Gaubius, Albinus and Winter at Leyden University, studied, together with a couple of friends at various Paris hospitals in order to improve his skills in the fields of surgery and obstetrics. After his return to Leyden, he took his doctor's degree in medicine and started his practice in that town. In 1754 he was appointed professor of medicine at Groningen University. In 1770 he was appointed professor of theoretical and practical medicine at Leyden University. He held that office until his death on 31 December 1783. He was a most appreciated foreign member of the Société Royale de Médecine (Paris) and of the Royal Society of Medicine (Edinburgh). He succeeded in improving his medical skills, by doing thorough research in the fields of pathological anatomy and teratology. He laid the foundations for national healthcare regulations for the United Provinces.

No. 347-Obstetric Management at Borderline Viability.

PubMed

Ladhani, Noor Niyar N; Chari, Radha S; Dunn, Michael S; Jones, Griffith; Shah, Prakesh; Barrett, Jon F R

2017-09-01

The primary objective of this guideline was to develop consensus statements to guide clinical practice and recommendations for obstetric management of a pregnancy at borderline viability, currently defined as prior to 25+6 weeks. Clinicians involved in the obstetric management of women whose fetus is at the borderline of viability. Women presenting for possible birth at borderline viability. This document presents a summary of the literature and a general consensus on the management of pregnancies at borderline viability, including maternal transfer and consultation, administration of antenatal corticosteroids and magnesium sulfate, fetal heart rate monitoring, and considerations in mode of delivery. Medline, EMBASE, and Cochrane databases were searched using the following keywords: extreme prematurity, borderline viability, preterm, pregnancy, antenatal corticosteroids, mode of delivery. The results were then studied, and relevant articles were reviewed. The references of the reviewed studies were also searched, as were documents citing pertinent studies. The evidence was then presented at a consensus meeting, and statements were developed. The content and recommendations were developed by the consensus group from the fields of Maternal-Fetal Medicine, Neonatology, Perinatal Nursing, Patient Advocacy, and Ethics. The quality of evidence was rated using criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework (reference 1). The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations, Assessment, Development, and Evaluation methodology framework. The interpretation of strong and weak recommendations is described later. The Summary of Findings is available upon request. A multidisciplinary approach should be used in counselling women and families at borderline viability. The impact of obstetric interventions in the improvement of neonatal outcomes is suggested in the literature, and if active resuscitation is intended, then active obstetric interventions should be considered. Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. This guideline was developed with resources funded by the Society of Obstetricians and Gynaecologists of Canada and the Women and Babies Program at Sunnybrook Health Sciences Centre. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

[Delivery of the IUGR fetus].

PubMed

Perrotin, F; Simon, E G; Potin, J; Laffon, M

2013-12-01

The purpose of this paper is to review available data regarding the management of delivery in intra uterine growth retarded fetuses and try to get recommendations for clinical obstetrical practice. Bibliographic research performed by consulting PubMed database and recommendations from scientific societies with the following words: small for gestational age, intra-uterine growth restriction, fetal growth restriction, very low birth weight infants, as well as mode of delivery, induction of labor, cesarean section and operative delivery. The diagnosis of severe IUGR justifies the orientation of the patient to a referral centre with all necessary resources for very low birth weight or premature infants Administration of corticosteroids for fetal maturation (before 34 WG) and a possible neuroprotective treatment by with magnesium sulphate (before 32-33 WG) should be discussed. Although elective caesarean section is common, there is no current evidence supporting the use of systematic cesarean section, especially when the woman is in labor. Induction of labor, even with unfavorable cervix is possible under continuous FHR monitoring, in favorable obstetric situations and in the absence of severe fetal hemodynamic disturbances. Instrumental delivery and routine episiotomy are not recommended. For caesarean section under spinal anesthesia, an adequate anesthetic management must ensure the maintenance of basal blood pressure. Compared with appropriate for gestational age fetus, IUGR fetus is at increased risk of metabolic acidosis or perinatal asphyxia during delivery. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

[Quality assurance program for pain management after obstetrical perineal injury].

PubMed

Urion, L; Bayoumeu, F; Jandard, C; Fontaine, B; Bouaziz, H

2004-11-01

A quality insurance program has been set up in order to improve the relief of pain in patients with perineal injury after childbirth. The program has been developed according to the French standards of accreditation. After elaboration of a referential, a first study (103 patients) allowed to evaluate the ongoing practices and to appreciate the pain intensities. After analysis of the results, an action strategy has been elaborated, with a brand new therapeutic standard and a pain-monitoring program for nurses. Six months later, a second study (105 patients) measured the efficiency of the accomplished actions. The statistic analysis used chi2 and Kruskal-Wallis tests and a multivariate analyse (p <0.05). Several indicators led to conclude to the success of this program: analgesics prescribed systematically and earlier, best observance, larger utilisation of the NSAI, decrease of the analgesics requests, improvement of the satisfaction referred to the relief of pain. The multivariate analyse showed a risk twice as little as in the second study to have a 36th hour VAS score superior to four (p =0.03). The apply of this quality insurance program allowed to improve the analgesia after obstetric perineal injuries. A few adaptations are needed, and also more formations of the medical and paramedical staff. The durability of the accomplished actions shall be evaluated in the future.

Health care reform: will quality remodeling affect obstetrician-gynecologists in addition to patients?

PubMed

von Gruenigen, Vivian E; Deveny, T Clifford

2011-05-01

The Patient Protection and Affordable Care Act is a federal statute that attempts to address many fundamental problems with the current health care system including the uninsured, rising health care costs, and quality care. Quality metrics have been in development for years (by private and governmental sectors), and momentum is growing. The purpose of this commentary is to explore quality changes in the way practicing obstetricians and gynecologists will be held accountable for quality service. Two new options being explored for health care, both focusing on improving quality and physician metrics, include value-based purchasing and accountable-care organizations. Both will likely consist of universal clinical algorithms and cost monitoring as measures. For obstetrics this will probably include physician's rates of cesarean deliveries and elective inductions. For gynecology this may comprise of indications for hysterectomy with documented failed medical management, minor surgical management, or both medical and minor surgical management. It is anticipated patients will no longer be able to request obstetric testing, pregnancy induction, or hysterectomy. It is imperative we, as obstetrician-gynecologists, are involved in health care reform that inevitably involves the care of women. The expectation is that the American Congress of Obstetricians and Gynecologists (ACOG) will further develop evidenced-based opinions and guidelines, as medical communities embrace ACOG documents and reference these in hospital policies and peer review.

Criterion-based clinical audit in obstetrics: bridging the quality gap?

PubMed

Graham, W J

2009-06-01

The Millennium Development Goal 5 - reducing maternal mortality by 75% - is unlikely to be met globally and for the majority of low-income countries. At this time of heightened concern to scale-up services for mothers and babies, it is crucial that not only shortfalls in the quantity of care - in terms of location and financial access - are addressed, but also the quality. Reductions in maternal and perinatal mortality in the immediate term depend in large part on the timely delivery of effective practices in the management of life-threatening complications. Such practices require a functioning health system - including skilled and motivated providers engaged with the women and communities whom they serve. Assuring the quality of this system, the services and the care that women receive requires many inputs, including effective and efficient monitoring mechanisms. The purpose of this article is to summarise the practical steps involved in applying one such mechanism, criterion-based clinical audit (CBCA), and to highlight recent lessons from its application in developing countries. Like all audit tools, the ultimate worth of CBCA relates to the action it stimulates in the health system and among providers.

The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia.

PubMed

Tiruneh, Gizachew Tadele; Karim, Ali Mehryar; Avan, Bilal Iqbal; Zemichael, Nebreed Fesseha; Wereta, Tewabech Gebrekiristos; Wickremasinghe, Deepthi; Keweti, Zinar Nebi; Kebede, Zewditu; Betemariam, Wuleta Aklilu

2018-05-02

Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose-response relationships between outcome and explanatory variables of interest using regression methods. The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose-response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1-6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need. The BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions.

The start of life: a history of obstetrics.

PubMed

Drife, J

2002-05-01

Obstetric intervention originally consisted of extraction of the baby, usually by the breech, to save the mother's life in obstructed labour. Forceps, introduced in the 17th century, were later refined by men-midwives like William Smellie. In Victorian times, Simpson championed chloroform anaesthesia, Lister pioneered antisepsis, and caesarean section was introduced. In 1935, however, Britain's maternal mortality rate was still around 400/100,000. It fell dramatically after antibiotics appeared and is now 11.4. In the 1960s ultrasound and electronic fetal monitoring became widely used. In 2000 the British caesarean section rate reached 20%. Worldwide, childbirth still causes 600,000 maternal deaths a year.

Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting.

PubMed

Mwanri, Lillian; Gatwiri, Glory Joy

2017-03-14

It is well acknowledged that Female Genital Mutilation/Cutting (FGM/C/C) leads to medical, psychological and sociocultural sequels. Over 200 million cases of FGM/C exist globally, and in Kenya alone, a total of 12,418,000 (28%) of women have undergone FGM/C, making the practice not only a significant national, but also a global health catastrophe. FGM/C is rooted in patriarchal and traditional cultures as a communal experience signifying a transition from girlhood to womanhood. The conversations surrounding FGM/C have been complicated by the involvement of women themselves in perpetuating the practice. A qualitative inquiry employing face-to-face, one-on-one, in-depth semi-structured interviews was used in a study that included 30 women living with obstetric fistulas in Kenya. Using the Social Network Framework and a feminist analysis we present stories of Kenyan women who had developed obstetric fistulas following prolonged and obstructed childbirth. Of the 30 participants, three women reported that health care workers informed them that FGM/C was one of the contributing factors to their prolonged and obstructed childbirth. They reported serious obstetric complications including: the development of obstetric fistulas, lowered libido, poor quality of life and maternal and child health outcomes, including death. Fistula and subsequent loss of bodily functionalities such as uncontrollable leakage of body wastes, was reported by the women to result in rejection by spouses, families, friends and communities. Rejection further led to depression, loss of work, increased sense of apathy, lowered self-esteem and image, as well as loss of identity and communal sociocultural cohesion. FGM/C is practised in traditional, patriarchal communities across Africa. Although the practice aims to bind community members and to celebrate a rite of passage; it may lead to harmful health and social consequences. Some women with fistula report their fistula was caused by FGM/C. Concerted efforts which embrace feminist understandings of society, as well as multi-sectoral, multidisciplinary and community development approaches need to be employed to address FGM/C, and to possibly reduce cases of obstetric fistulas in Kenya and beyond. Both government and non-government organisations need to be involved in making legislative, gender sensitive policies that protect women from FGM/C. In addition, the policy makers need to be in the front line to improve the lives of women who endured the consequences of FGM/C.

Practices and obstetric interventions in women from a state in the Northeast of Brazil.

PubMed

Prado, Daniela Siqueira; Mendes, Rosemar Barbosa; Gurgel, Rosana Queiroz; Barreto, Ikaro Daniel de Carvalho; Bezerra, Felipa Daiana; Cipolotti, Rosana; Gurgel, Ricardo Queiroz

2017-12-01

To describe practices and interventions used during labor and childbirth and factors associated with such practices in puerperae in the state of Sergipe. A cross-sectional study with 768 postpartum women from 11 maternity hospitals interviewed 6 hours after delivery, and hospital records review. The associations between best practices and interventions used during labor and delivery with exposure variables were described using simple frequencies, percentages, crude and adjusted odds ratio (ORa) with the confidence interval. Of the women in the study, 10.6% received food and 27.8% moved during labor; non-pharmacological methods for pain relief were performed in 26.1%; a partogram was filled in 39.4% of the charts; and an accompanying person was present in 40.6% of deliveries. Oxytocin, amniotomy and labor analgesia were used in 59.1%, 49.3% and 4.2% of women, respectively. Lithotomy position during childbirth was used in 95.2% of the cases, episiotomy in 43.9% and Kristeller maneuver in 31.7%. The variables most associated with cesarean section were private financing (ORa=4.27, 95CI 2.44-7.47), higher levels of education (ORa=4.54, 95CI 2.56-8.3) and high obstetric risk (ORa=1.9, 95CI 1.31-2.74). Women whose delivery was funded privately were more likely to have an accompanying person present (ORa=2.12, 95CI 1.18-3.79) and to undergo labor analgesia (ORa=4.96, 95CI 1.7-14.5). Best practices are poorly performed and unnecessary interventions are frequent. The factors most associated with c-section were private funding, greater length of education and high obstetric risk.

Clinicians' practice environment is associated with a higher likelihood of recommending cesarean deliveries.

PubMed

Cheng, Yvonne W; Snowden, Jonathan M; Handler, Stephanie; Tager, Ira B; Hubbard, Alan; Caughey, Aaron B

2014-08-01

Little data exist regarding clinicians' role in the rising annual incidence rate of cesarean delivery in the US. We aimed to examine if clinicians' practice environment is associated with recommending cesarean deliveries. This is a survey study of clinicians who practice obstetrics in the US. This survey included eight clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test and multivariable logistic regression were used for statistical comparison. Of 27 675 survey links sent, 3646 clinicians received and opened the survey electronically, and 1555 (43%) participated and 1486 (94%) completed the survey. Clinicians were categorized into three groups based on eight common obstetric vignettes as: more likely (n = 215), average likelihood (n = 1099), and less likely (n = 168) to recommend cesarean. Clinician environment factors associated with a higher likelihood of recommending cesarean included Laborists/Hospitalists practice model (p < 0.001), as-needed anesthesia support (p = 0.003), and rural/suburban practice setting (p < 0.001). We identified factors in clinicians' environment associated with their likelihood of recommending cesarean delivery. The decision to recommend cesarean delivery is a complicated one and is likely not solely based on patient factors.

No. 247-Antibiotic Prophylaxis in Obstetric Procedures.

PubMed

van Schalkwyk, Julie; Van Eyk, Nancy

2017-09-01

To review the evidence and provide recommendations on antibiotic prophylaxis for obstetrical procedures. Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in obstetrical procedures. Published literature was retrieved through searches of Medline and The Cochrane Library on the topic of antibiotic prophylaxis in obstetrical procedures. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and articles published from January 1978 to June2009 were incorporated in the guideline. Current guidelines published by the American College of Obstetrics and Gynecology were also incorporated. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). Implementation of this guideline should reduce the cost and harm resulting from the administration of antibiotics when they are not required and the harm resulting from failure to administer antibiotics when they would be beneficial. RECOMMENDATIONS. Copyright © 2017. Published by Elsevier Inc.

The obstetric nightmare of shoulder dystocia: a tale from two perspectives.

PubMed

Beck, Cheryl Tatano

2013-01-01

Shoulder dystocia is one of the most terrifying of obstetric emergencies. In this secondary analysis of two qualitative studies, the experiences of shoulder dystocia are compared and contrasted from two perspectives: the mothers and the labor and delivery nurses. In the first study mothers' experiences of shoulder dystocia and caring for their children with obstetric brachial plexus injuries were explored. The second study explored secondary traumatic stress in labor and delivery nurses due to exposure to traumatic births. Krippendorff's content analysis technique of clustering was used to identify data that could be grouped together into themes. It was striking how similar the perspectives of mothers and their nurses were regarding a shoulder dystocia birth. Four themes emerged from the content analysis of these two data sets: (1) in the midst of the obstetric nightmare; (2) reeling from the trauma that just transpired; (3) enduring heartbreak: the heavy toll on mothers; and (4) haunted by memories: the heavy toll on nurses. Providing emotional support to the mother during shoulder dystocia births and afterward in the postpartum period has been acknowledged. What now needs to be added to best practices for shoulder dystocia are interventions for the nurses themselves. Support for labor and delivery nurses who are involved in this obstetric nightmare is critical.

Management of perineal pain among postpartum women in an obstetric and gynecological hospital in China: a best practice implementation project.

PubMed

Zhang, Yu; Huang, Li; Ding, Yan; Shi, Yajing; Chen, Jiaying; McArthur, Alexa

2017-01-01

Perineal pain is a serious condition that may negatively impact a significant number of postpartum women. Healthcare professionals, including midwives and nurses, are available to support women 24 hours a day during this period in hospital and are in an ideal position to assist in the management of perineal pain for postpartum women. The aim of this evidence implementation project was to improve management of perineal pain among postpartum women in Ward 21 of the Obstetric and Gynecological Hospital, Fudan University. This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Six best practice recommendations were used for the audit cycle. A total of 18 nurses, three midwives and 30 female patients participated in the project. A baseline audit was conducted, followed by the implementation of strategies targeted to address the identified barriers. A follow-up audit was then conducted to evaluate change in practice. Improvements in practice were observed for all six criteria. Significant improvements were found for the following: staff education increased compliance by 76% (from 24% to 100%). Education regarding antenatal perineal massage technique increased by 97% (from 3% to 100%). Compliance rates for use of ice packs increased by 63% (from 17 to 80%). Compliance rates for daily perineal pain assessment conducted for three days following childbirth increased by 100%, and analgesia administration rates increased by 27% (from 1% to 40%). Compliance rates for women's acceptance of postnatal perineal care education increased by 70% (from 30 to 100%). The current clinical audit project has made a significant improvement in establishing evidence-based practice of management of perineal pain among postpartum women in the gynecologic and obstetric hospital in Shanghai. It has been effective in increasing staff compliance and reducing the perineal pain among postpartum women.

Signal loss during fetal heart rate monitoring using maternal abdominal surface electrodes between 28 and 42 weeks of pregnancy.

PubMed

Fuchs, Tomasz; Pomorski, Michał; Grobelak, Krzysztof; Tomiałowicz, Marek; Zimmer, Mariusz

2014-01-01

Fetal electrocardiography is one of the methods for monitoring the well-being of the fetus. Signal loss limits the proper interpretation of electrocardiogram traces. The aim of this study was to assess the average signal loss in non-invasive abdominal fetal electrocardiogram (fECG) monitoring using the KOMPOREL fetal monitoring system (ITAM, Zabrze, Poland) in women between 28 and 42 week of pregnancy. The results were compared to FIGO (International Federation of Gynaecology and Obstetric) and DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V.) recommendations concerning fetal heart monitoring. The correlation between fetal ECG signal quality, week of pregnancy and patient BMI was evaluated. 773 pregnant women, hospitalized and diagnosed in the Department of Gynecology and Obstetrics, Wroclaw Medical University, underwent 30 min of abdominal fECG recordings using the KOMPOREL fetal monitoring system. The average signal loss in abdominal fECG monitoring in the study group was 32%. FIGO recommendations describe an acceptable fetal signal loss of 20%. In our study, 46% (357/773) of the recordings were up to FIGO standards, with fetal heart rate success rates above 80%. According to DGGG guidelines, with acceptable fetal signal loss of 15%, only 39% (303/773) of the recordings could be assessed as accurate. No correlation between fECG signal quality, week of pregnancy and patient BMI was proved. The average signal loss in abdominal fECG monitoring in our study group was 32%. Low fECG signal quality may constitute a potentially limiting factor of the described fetal heart monitoring system. No relationship between fECG signal quality, week of pregnancy and patient BMI was proved.

Labor progress indices and dynamics of the individual uterine contraction during the active stage of labor.

PubMed

Ophir, Ella; Bornstein, Jacob; Odeh, Marwan; Kaminsky, Svetlana; Shnaider, Oleg; Megel, Yuri; Barnea, Ofer

2014-03-01

To obtain and study new data on the dynamics of the labor process and to develop a contraction-based index of labor progress. This study was carried out at the Delivery Room, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel, using a new device (Birth Track). We continuously monitored cervical dilatation (CD) and head descent (HD) in 30 nulliparaous women during active labor with (augmented group) and without (study group) oxytocin augmentation. This led to the development and validation of progress indices based on features extracted from continuous monitoring. There were no significant differences between the average of each parameter in the study and augmented groups, except for HD velocity. Average HD velocity was faster in the study group. Linear regression analyses demonstrated that head station (HS) amplitude and Toco amplitude were the best parameters for predicting HD velocity in both groups. In the study group, average HD velocity was also significantly related to Toco rate and contraction efficiency. In the augmented group, only a weak correlation with Toco rate was seen, and no correlation with contraction efficiency. With the assistance of the Birth Track device, we can obtain continuous data on the labor process and indices to estimate the labor progress process without the use of vaginal (manual) examination. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Review of emergency obstetric care interventions in health facilities in the Upper East Region of Ghana: a questionnaire survey.

PubMed

Kyei-Onanjiri, Minerva; Carolan-Olah, Mary; Awoonor-Williams, John Koku; McCann, Terence V

2018-03-15

Maternal morbidity and mortality is most prevalent in resource-poor settings such as sub-Saharan Africa and southern Asia. In sub-Saharan Africa, Ghana is one of the countries still facing particular challenges in reducing its maternal morbidity and mortality. Access to emergency obstetric care (EmOC) interventions has been identified as a means of improving maternal health outcomes. Assessing the range of interventions provided in health facilities is, therefore, important in determining capacity to treat obstetric emergencies. The aim of this study was to examine the availability of emergency obstetric care interventions in the Upper East Region of Ghana. A cross-sectional survey of 120 health facilities was undertaken. Status of emergency obstetric care was assessed through an interviewer administered questionnaire to directors/in-charge officers of maternity care units in selected facilities. Data were analysed using descriptive statistics. Eighty per cent of health facilities did not meet the criteria for provision of emergency obstetric care. Comparatively, private health facilities generally provided EmOC interventions less frequently than public health facilities. Other challenges identified include inadequate skill mix of maternity health personnel, poor referral processes, a lack of reliable communication systems and poor emergency transport systems. Multiple factors combine to limit women's access to a range of essential maternal health services. The availability of EmOC interventions was found to be low across the region; however, EmOC facilities could be increased by nearly one-third through modest investments in some existing facilities. Also, the key challenges identified in this study can be improved by enhancing pre-existing health system structures such as Community-based Health Planning and Services (CHPS), training more midwifery personnel, strengthening in-service training and implementation of referral audits as part of health service monitoring. Gaps in availability of EmOC interventions, skilled personnel and referral processes must be tackled in order to improve obstetric outcomes.

An evaluation of the quality of obstetric morbidity coding using an objective assessment tool, the Performance Indicators For Coding Quality (PICQ).

PubMed

Lamb, Mary K; Innes, Kerry; Saad, Patricia; Rust, Julie; Dimitropoulos, Vera; Cumerlato, Megan

The Performance Indicators for Coding Quality (PICQ) is a data quality assessment tool developed by Australia's National Centre for Classification in Health (NCCH). PICQ consists of a number of indicators covering all ICD-10-AM disease chapters, some procedure chapters from the Australian Classification of Health Intervention (ACHI) and some Australian Coding Standards (ACS). The indicators can be used to assess the coding quality of hospital morbidity data by monitoring compliance of coding conventions and ACS; this enables the identification of particular records that may be incorrectly coded, thus providing a measure of data quality. There are 31 obstetric indicators available for the ICD-10-AM Fourth Edition. Twenty of these 31 indicators were classified as Fatal, nine as Warning and two Relative. These indicators were used to examine coding quality of obstetric records in the 2004-2005 financial year Australian national hospital morbidity dataset. Records with obstetric disease or procedure codes listed anywhere in the code string were extracted and exported from the SPSS source file. Data were then imported into a Microsoft Access database table as per PICQ instructions, and run against all Fatal and Warning and Relative (N=31) obstetric PICQ 2006 Fourth Edition Indicators v.5 for the ICD-10- AM Fourth Edition. There were 689,905 gynaecological and obstetric records in the 2004-2005 financial year, of which 1.14% were found to have triggered Fatal degree errors, 3.78% Warning degree errors and 8.35% Relative degree errors. The types of errors include completeness, redundancy, specificity and sequencing problems. It was found that PICQ is a useful initial screening tool for the assessment of ICD-10-AM/ACHI coding quality. The overall quality of codes assigned to obstetric records in the 2004- 2005 Australian national morbidity dataset is of fair quality.

Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States.

PubMed

Kamali, Amanda; Jamieson, Denise J; Kpaduwa, Julius; Schrier, Sarah; Kim, Moon; Green, Nicole M; Ströher, Ute; Muehlenbachs, Atis; Bell, Michael; Rollin, Pierre E; Mascola, Laurene

2016-07-01

Many of the survivors of the 2014-2015 epidemic of Ebola virus disease (EVD) in western Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women's pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.

Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology.

PubMed

Iavazzo, Christos; Trompoukis, Constantinos; Sardi, Thalia; Falagas, Matthew E

2008-01-01

Pregnancy and labour are holy moments in a woman's life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology.

HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis

PubMed Central

Calvert, Clara; Ronsmans, Carine

2013-01-01

Background Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications. Methods and findings Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00–5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42–13.97). For other obstetric complications the evidence was weak and inconsistent. Conclusions The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women. PMID:24124458

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Pediatric obstetrical ethics: Medical decision-making by, with, and for pregnant early adolescents.

PubMed

Mercurio, Mark R

2016-06-01

Pregnancy in an early adolescent carries with it specific ethical considerations, in some ways different from pregnancy in an adult and from medical care of a non-pregnant adolescent. Obstetrical ethics emphasizes the right of the patient to autonomy and bodily integrity, including the right to refuse medical intervention. Pediatric ethics recognizes the right of parents, within limits, to make medical decisions for their children, and the right of a child to receive medical or surgical interventions likely to be of benefit to her, sometimes over her own objections. As the child gets older, and particularly during the years of adolescence, there is also a recognition of the right to an increasingly prominent role in decisions about her own healthcare. Pediatric obstetrical ethics, referring to ethical decisions made by, with, and for pregnant early adolescents, represents the intersection of these different cultures. Principles and approaches from both obstetrical and pediatric ethics, as well as a unified understanding of rights, obligations, and practical considerations, will be needed. Copyright © 2016. Published by Elsevier Inc.

To press or not to press, and if so, with what? A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics.

PubMed

Biddle, Chuck

2013-08-01

Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. Only the highest quality trials were included. Of 142 studies retrieved, 9 met the defined inclusion criteria. Apgar scores at 1 and 5 minutes in the ephedrine group (served as control) vs the phenylephrine group did not differ at either time epoch; no abnormal values prevailed in either group (relative risk, 0.88; CI, 0.79-1.16). This meta-analysis focused on the most clinically relevant, immediately available information pertinent in the obstetric suite, the Apgar score, and found that ephedrine and phenylephrine did not differ in their effect on this metric. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists' 2007 "Practice Guidelines for Obstetric Anesthesia".

Evaluation of the implementation and effects of an obstetric kit used in the Adamawa region of Cameroon.

PubMed

Cacko, Joachim Aimé; Cissé, Kadari; Pambè, Madeleine Wayack; Compaoré, Rachidatou; Kouanda, Seni

2016-11-01

To assess the implementation and effects of the strategy, introduced in June 2011, of making obstetric kits readily available in health facilities in the Adamaoua region of Cameroon. We conducted a quasi-experimental study using an interrupted time series to assess the effects of the strategy, and a case study to evaluate its implementation. The reviewed data were gathered from 13 health facilities over a period from January 2008 to December 2014. Qualitative data were collected from in-depth interviews. The provision of obstetric kits was effective in the intervention health facilities, although some challenges existed and included lack of staff motivation and rampant illegal practices. The number of deliveries and cesareans increased. There is a need to rethink this strategy, given its gaps and shortcomings. Copyright © 2016. Published by Elsevier Ireland Ltd.

Obstetric violence: A Latin American legal response to mistreatment during childbirth.

PubMed

Williams, Caitlin R; Jerez, Celeste; Klein, Karen; Correa, Malena; Belizán, José M; Cormick, Gabriela

2018-05-04

Over the last several years, a new legal construct has emerged in Latin America that encompasses elements of quality of obstetric care and mistreatment of women during childbirth - both issues of global maternal health import. Termed "obstetric violence," this legal construct refers to disrespectful and abusive treatment that women may experience from health care providers during pregnancy, childbirth, and the postpartum period, as well as other elements of poor quality care, such as failure to adhere to evidence-based best practices. This new legal term emerged out of concerted efforts by women's groups and networks, feminists, professional organizations, international and regional bodies, and public health agents and researchers to improve the quality of care that women receive across the region. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Midwives' experiences of working in an obstetric high dependency unit: A qualitative study.

PubMed

Eadie, Isabelle J; Sheridan, Nicolette F

2017-04-01

to understand the challenges experienced by midwives providing obstetric high dependency care and identify the training they perceive is needed for work in an obstetric high dependency unit. sixteen midwives who worked in the obstetric high dependency unit participated in one of three focus groups. Focus groups lasted 60-90minutes and were conducted in the workplace and facilitated by author (IE). Data were digitally recorded, transcribed and analysed manually by author (IE), specifically using a 'codebook' model to generate codes, categories and themes. a purpose built, two-bed obstetric high dependency unit located in the delivery suite of a large, urban tertiary teaching hospital in New Zealand. five themes were conceptualised: Theme 1: 'high dependency care is not our bread and butter'; the midwives felt that working in the obstetric high dependency work did not constitute 'normal' midwifery work. Theme 2: 'we are family… embracing the baby and partner in HDU'; the midwives recognised that an obstetric high dependency unit enabled the mother and infant to be cared for together, was beneficial for maternal psychosocial wellbeing, and supported mother-infant bonding and breastfeeding. Theme 3: 'primum non nocere; First, do no harm'; the midwives voiced concern that they lacked the skills and training to provide obstetric high dependency care and considered this a potential risk to sick women in their care. Theme 4: 'graceful swans and headless chickens'; the midwives reported feelings of stress, anxiety, fear and of being overwhelmed by the demands of obstetric high dependency care. The more experienced midwives were able to portray calmness and poise despite lots going on beneath the surface. This was in contrast to other, often less experienced midwives, who appeared confused and less organised. Theme 5: 'please sir, can I have some more training?'; the midwives unanimously sought training in the provision of obstetric high dependency care and saw facilitation of training to be a responsibility of the hospital. midwives who are competent in obstetric high dependency care are well placed to provide holistic care to sick women within an obstetric high dependency unit. Midwives found this work challenging and identified the need for specific knowledge and skills beyond those required in the provision of care to well women. The midwives sought post-registration training in obstetric high dependency care. These findings are consistent with other studies reported in the literature. post-registration training must be made available to midwives providing high dependency care to sick women to ensure they have the specialised skills and knowledge for practice. Responsibility to facilitate training rests with hospitals providing this service. Copyright © 2017 Elsevier Ltd. All rights reserved.

Career satisfaction level, mental distress, and gender differences in working conditions among Japanese obstetricians and gynecologists.

PubMed

Sugiura-Ogasawara, Mayumi; Suzuki, Sadao; Kitazawa, Masafumi; Kuwae, Chizuko; Sawa, Rintaro; Shimizu, Yukiko; Takeshita, Toshiyuki; Yoshimura, Yasunori

2012-03-01

Career satisfaction level, degree of mental distress associated with certain work-related factors, and demographics were examined for the first time in obstetricians and gynecologists in Japan. Associations between the score on Kessler 6 screening scale, or the job satisfaction level, and the scores on the job content questionnaire, Social Support Questionnaire (SSQ), working conditions and demographics were examined in 1301 members of the Japan Society of Obstetrics and Gynecology. 8.4% of respondents were speculated to suffer from depression or anxiety disorder. Multivariate linear regression analysis identified a heavier workload, less personal control, lower satisfaction on the SSQ, and longer working hours as being independent risk factors for mental distress. Careful monitoring of the mental state is necessary for obstetricians and gynecologists with lower incomes, heavier workloads, lower degrees of personal control, and lower satisfaction scores on the SSQ. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

Subclinical Hypothyroidism: Impact on Fertility, Obstetric and Neonatal Outcomes.

PubMed

Usadi, Rebecca S; Merriam, Kathryn S

2016-11-01

The incidence of subclinical hypothyroidism (SCH) in pregnancy was classically thought to be low; however, with new definition of normal TSH range in pregnancy, there has been an increase in the percentage of women who meet classification for SCH. The diagnosis of SCH is important not only for monitoring for maternal conversion to overt hypothyroidism, but also for identifying obstetric and neonatal outcomes related to SCH. Although there have been proven associations between maternal overt hypothyroidism and adverse obstetric and neonatal outcomes, there has been conflicting data on the correlation between SCH and these outcomes. Recent data from a meta-analysis found an increased risk of pregnancy loss, placental abruption, premature rupture of membranes, and neonatal death for women with SCH compared to euthyroidism in pregnancy. Research studies have not demonstrated a distinct benefit from treatment of SCH, and the professional societies are divided on their recommendations for treating SCH. Additionally, universal screening of SCH is controversial at present. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

What is needed for taking emergency obstetric and neonatal programmes to scale?

PubMed

Bergh, Anne-Marie; Allanson, Emma; Pattinson, Robert C

2015-11-01

Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to the following: commitment, health systems-strengthening actions, allocation of resources (human, financial and capital/material), dissemination and training, supportive supervision and monitoring and evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Design and Application of High-risk Pregnancy Monitoring & Warning Internet Platform Based on Internet of Things].

PubMed

Lu, Heqing; Zhang, Xiaofeng; Li, Bin

2017-09-30

Through illustrating the designing of high-risk pregnancy maternal-fetal monitoring system based on the internet of things, this paper introduced the specific application of using wearable medical devices to provide maternal-fetal mobile medical services. With the help of big data and cloud obstetrics platform, the monitoring and warning network was further improved, the level-to-level administration of high-risk pregnancy was realized, the level of perinatal health care was enhanced and the risk of critical emergency of pregnancy decreased.

42 CFR 440.165 - Nurse-midwife service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... program for preparing registered nurses to furnish gynecological and obstetrical care to women during pregnancy, delivery, and the postpartum period, and care to normal newborns, and was practicing as a nurse...

42 CFR 440.165 - Nurse-midwife service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... program for preparing registered nurses to furnish gynecological and obstetrical care to women during pregnancy, delivery, and the postpartum period, and care to normal newborns, and was practicing as a nurse...

42 CFR 440.165 - Nurse-midwife service.

Code of Federal Regulations, 2014 CFR

2014-10-01

... program for preparing registered nurses to furnish gynecological and obstetrical care to women during pregnancy, delivery, and the postpartum period, and care to normal newborns, and was practicing as a nurse...

42 CFR 440.165 - Nurse-midwife service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... program for preparing registered nurses to furnish gynecological and obstetrical care to women during pregnancy, delivery, and the postpartum period, and care to normal newborns, and was practicing as a nurse...

Implementation of an Oxytocin Checklist to Improve Clinical Outcomes.

PubMed

Sundin, Courtney; Mazac, Lauren; Ellis, Kathleen; Garbo, Candon

Oxytocin is one of the most common drugs administered in obstetrics. Since its designation as a high-alert medication by the Institute for Safe Medication Practices in 2007, there has been much attention to oxytocin administration during labor. Oxytocin is generally safe when administered correctly, but adverse perinatal outcomes can occur during uterine tachysystole. The purpose of this project was to evaluate and compare results of maternal and fetal outcomes of induction of labor for women at term prior to and after implementation of a newly developed oxytocin checklist. To evaluate the practice change associated with the implementation of the new oxytocin checklist, 200 cases based on retrospective medical record reviews were compared with 200 cases after implementation. Use of the checklist was associated with several significant clinical outcomes, including decreases in tachysystole, decreases in cesarean births for concern about fetal status based on electronic fetal monitoring data, decreases in length of first stage labor, and decreases in maximum dose of oxytocin. Results are similar to previous research. Early physician buy-in, clinical team education, and ongoing evaluation enhanced facilitation of the oxytocin checklist. Clinical outcomes were favorable.

[Training of residents in obstetrics and gynecology: Assessment of an educational program including formal lectures and practical sessions using simulators].

PubMed

Jordan, A; El Haloui, O; Breaud, J; Chevalier, D; Antomarchi, J; Bongain, A; Boucoiran, I; Delotte, J

2015-01-01

Evaluate an educational program in the training of residents in gynecology-obstetrics (GO) with a theory session and a practical session on simulators and analyze their learning curve. Single-center prospective study, at the university hospital (CHU). Two-day sessions were leaded in April and July 2013. An evaluation on obstetric and gynecological surgery simulator was available to all residents. Theoretical knowledge principles of obstetrics were evaluated early in the session and after formal lectures was taught to them. At the end of the first session, a satisfaction questionnaire was distributed to all participants. Twenty residents agreed to participate to the training sessions. Evaluation of theoretical knowledge: at the end of the session, the residents obtained a significant improvement in their score on 20 testing knowledge. Obstetrical simulator: a statistically significant improvement in scores on assessments simulator vaginal delivery between the first and second session. Subjectively, a larger increase feeling was seen after breech delivery simulation than for the cephalic vaginal delivery. However, the confidence level of the resident after breech delivery simulation has not been improved at the end of the second session. Simulation in gynecological surgery: a trend towards improvement in the time realized on the peg-transfer between the two sessions was noted. In the virtual simulation, no statistically significant differences showed, no improvement for in salpingectomy's time. Subjectively, the residents felt an increase in the precision of their gesture. Satisfaction: All residents have tried the whole program. They considered the pursuit of these sessions on simulators was necessary and even mandatory. The approach chosen by this structured educational program allowed a progression for the residents, both objectively and subjectively. This simulation program type for the resident's training would use this tool in assessing their skills and develop learning curves. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Concept of defensive medicine and litigation among Sudanese doctors working in obstetrics and gynecology.

PubMed

Ali, AbdelAziem A; Hummeida, Moawia E; Elhassan, Yasir A M; Nabag, Wisal O M; Ahmed, Mohammed Ahmed A; Adam, Gamal K

2016-02-09

Obstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive medicine. This study was directed to assess the extent and the possible effect of defensive medicine phenomenon (in term of knowledge and prevalence) on medical decision making among different grades of obstetric and gynaecologic Sudanese doctors, and to determine any experience of medical litigations with respect to sources and factors associated with it (in term of area of work, characteristics of the area at which the doctors worked, professionalism, hospitals systems…ect). A total of 117 doctors were approached, their distribution according to job description was as follow: consultants (42.7%, 50\\117) registrars (34.2%, 40\\117) and specialists (23.1%, 27\\117). The majority 89.7% had the impression that litigation against doctors are increasing and 27.6% had a direct experience of litigation. In this study less than one half (42.7%) of the surveyed doctors knew the concept of defensive medicine and 71.8% reported practicing one or another form of defensive medicine. The different sources of the litigations reported by the doctors included: maternal death (n = 15), perinatal death (n = 5), other {misdiagnosis, intra-uterine fetal death, uterine perforation, rupture uterus} (n = 4), fetal distress (n = 3), injury to viscera (n = 3) and shoulder dystocia (n = 2). In this study the experience of medical litigation was significantly observed among those who worked in area of blame culture (90.6% Vs 56.5%, P = 0.000). In logistic regression model, there was no significant difference between those who knew the concept of defence medicine and those who didn't. There should be strategic plan to reduce the practice of defensive medicine and medical litigation against doctors.

Bleeding disorder education in obstetrics and gynecology residency training: a national survey.

PubMed

Dietrich, Jennifer E; Tran, Xuan G; Giardino, Angelo P

2011-04-01

The purpose of this study was to assess the educational approach to the bleeding disorder evaluation in Obstetrics and Gynecology residency training programs in the continental United States. Information was sought from chief residents regarding training experiences and fund of knowledge regarding the evaluation of menorrhagia and diagnosis of bleeding disorders during their residency. A 24-item questionnaire was sent to the chief residents at 241 non-military Obstetrics and Gynecology residency programs. The study was conducted at Texas Children's Health Plan in Houston, Texas. Chief residents at 241 non-military Obstetrics and Gynecology residency programs. Responses to questionnaires. The overall response rate was 30%. Residents reported training in the medical evaluation of menorrhagia during residency with a mean of 9.1 hours per year in the first year of residency and 11.1 hours/year in the 2(nd), 3(rd) and 4(th) years; 67.7% reported they viewed their training in the medical evaluation of menorrhagia and bleeding disorders as sufficient preparation for clinical practice; and over two thirds reported specific training in common bleeding disorders, such as von Willebrand disease. The current state of training in the evaluation of menorrhagia and bleeding disorders appeared to be mixed regarding the evaluation of dysfunctional uterine bleeding. An area for improvement was identified to better approach best clinical practice in the evaluation of women with menorrhagia and underlying bleeding disorders, which can be guided by the thoughtful approach taken in the recent NHLBI von Willebrand disease guidelines. Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Early clinical experience of cell-free DNA-based aneuploidy screening: A survey of obstetric sonologists in Australia and New Zealand.

PubMed

Hui, Lisa; Teoh, Mark; Piessens, Sofie; Walker, Susan P

2015-04-01

Cell-free DNA-based non-invasive prenatal testing for aneuploidy (NIPT) is now established as the most accurate screening test for trisomy 21. This test became clinically available on a patient-funded basis in Australia and New Zealand in 2013. To investigate the clinical implementation of NIPT use by members of the Australian Association of Obstetrical and Gynaecological Ultrasonologists (AAOGU) during its first year of local availability. Email invitations with an embedded link to an anonymous online survey were sent to all 140 members of the AAOGU in December 2013. We received 54 responses to the survey (39% response rate). Two thirds of respondents were subspecialists in obstetric and gynaecological ultrasound or maternal fetal medicine. The majority of respondents had already used NIPT in their practice (94%). There was no significant difference in the proportion of respondents offering NIPT to high-risk women in private versus public practice (95 versus 82%, P = 0.14). However, inequity of access due to cost was the most common ethical issue encountered. The vast majority continued to offer an 11-13 week ultrasound in addition to NIPT. Almost all respondents (96%) were also willing to offer NIPT to low-risk women in December 2013 after appropriate genetic counselling. Non-invasive prenatal testing was introduced into clinical care by obstetric sonologists with confidence and in accordance with the current recommended guidelines. These results may help inform future prenatal screening policy and cost-effectiveness analyses. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The productivity of Washington State's obstetrician-gynecologist workforce: does gender make a difference?

PubMed

Benedetti, Thomas J; Baldwin, Laura-Mae; Andrilla, C Holly A; Hart, L Gary

2004-03-01

To compare the practice productivity of female and male obstetrician-gynecologists in Washington State. The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births. Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P < or =.01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P < or =.05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P <.01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group. Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States. II-3

Utility of proteomics in obstetric disorders: a review

PubMed Central

Hernández-Núñez, Jónathan; Valdés-Yong, Magel

2015-01-01

The study of proteomics could explain many aspects of obstetric disorders. We undertook this review with the aim of assessing the utility of proteomics in the specialty of obstetrics. We searched the electronic databases of MEDLINE, EBSCOhost, BVS Bireme, and SciELO, using various search terms with the assistance of a librarian. We considered cohort studies, case-control studies, case series, and systematic review articles published until October 2014 in the English or Spanish language, and evaluated their quality and the internal validity of the evidence provided. Two reviewers extracted the data independently, then both researchers simultaneously revised the data later, to arrive at a consensus. The search retrieved 1,158 papers, of which 965 were excluded for being duplicates, not relevant, or unrelated studies. A further 86 papers were excluded for being guidelines, protocols, or case reports, along with another 64 that did not contain relevant information, leaving 43 studies for inclusion. Many of these studies showed the utility of proteomic techniques for prediction, pathophysiology, diagnosis, management, monitoring, and prognosis of pre-eclampsia, perinatal infection, premature rupture of membranes, preterm birth, intrauterine growth restriction, and ectopic pregnancy. Proteomic techniques have enormous clinical significance and constitute an invaluable weapon in the management of obstetric disorders that increase maternal and perinatal morbidity and mortality. PMID:25926758

Home Birth: Know the Pros and Cons

MedlinePlus

... these complications, including having: Assistance from a certified nurse-midwife Access to a practicing obstetric doctor A ... health care providers to assist. Choose a certified nurse-midwife, a certified midwife, a midwife whose education ...

Cultural Competence of Obstetric and Neonatal Nurses.

PubMed

Heitzler, Ella T

To measure the cultural competence level of obstetric and neonatal nurses, explore relationships among cultural competence and selected sociodemographic variables, and identify factors related to cultural competence. Descriptive correlational study. Online survey. A convenience sample of 132 obstetric and neonatal registered nurses practicing in the United States. Nurse participants completed the Cultural Competence Assessment (CCA) instrument, which included Cultural Awareness and Sensitivity (CAS) and Cultural Competence Behaviors (CCB) subscales, and a sociodemographic questionnaire. Correlation and regression analyses were conducted. The average CCA score was 5.38 (possible range = 1.00-7.00). CCA scores were negatively correlated with age and positively correlated with self-ranked cultural competence, years of nursing experience, years of experience within the specialty area, and number of types of previous cultural diversity training. CCB subscale scores were correlated positively with age, years of nursing experience, years of experience within the specialty area, and number of types of previous diversity training. CAS subscale scores were positively correlated with number of types of previous diversity training. Standard multiple linear regression explained approximately 10%, 12%, and 11% of the variance in CCA, CAS, and CCB scores, respectively. Obstetric and neonatal registered nurses should continue to work toward greater cultural competence. Exposing nurses to more types of cultural diversity training may help achieve greater cultural competence. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Role of telephone triage in obstetrics.

PubMed

Manning, Nirvana Afsordeh; Magann, Everett F; Rhoads, Sarah J; Ivey, Tesa L; Williams, Donna J

2012-12-01

The telephone has become an indispensable method of communication in the practice of obstetrics. The telephone is one of the primary methods by which the patient makes her appointments and contacts her health care provider for advice, reassurance, and referrals. Current methods of telephone triage include personal at the physicians' office, telephone answering services, labor and delivery nurses, and a dedicated telephone triage system using algorithms. Limitations of telephone triage include the inability of the provider to see the patient and receive visual clues from the interaction and the challenges of obtaining a complete history over the telephone. In addition, there are potential safety and legal issues with telephone triage. To date, there is insufficient evidence to either validate or refute the use of a dedicated telephone triage system compared with a traditional system using an answering service or nurses on labor and delivery. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to analyze the scope of variation in telephone triage across health care providers and categorize the components that go into a successful triage system, assess the current scope of research in telephone triage in obstetrics, evaluate potential safety and legal issues with telephone triage in obstetrics, and identify issues that should be addressed in any institution that is using or implementing a system of telephone triage in obstetrics.

Moral implications of obstetric technologies for pregnancy and motherhood.

PubMed

Brauer, Susanne

2016-03-01

Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a "good" pregnant woman and to be a "good" (future) mother. Activities in the medical field of reproduction contribute to "kinning", that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: (1) informed consent in prenatal care, (2) obstetric sonogram, and (3) birth plan. Their widespread application is supposed to serve the moral (and legal) goal of effecting patient autonomy (and patient right). A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework.

Delivering perinatal depression care in a rural obstetric setting: a mixed methods study of feasibility, acceptability and effectiveness.

PubMed

Bhat, Amritha; Reed, Susan; Mao, Johnny; Vredevoogd, Mindy; Russo, Joan; Unger, Jennifer; Rowles, Roger; Unützer, Jürgen

2017-09-07

Universal screening for depression during pregnancy and postpartum is recommended, yet mental health treatment and follow-up rates among screen-positive women in rural settings are low. We studied the feasibility, acceptability and effectiveness of perinatal depression treatment integrated into a rural obstetric setting. We conducted an open treatment study of a screening and intervention program modified from the Depression Attention for Women Now (DAWN) Collaborative Care model in a rural obstetric clinic. Depression screen-positive pregnant and postpartum women received problem-solving therapy (PST) with or without antidepressants. A care manager coordinated communication between patient, obstetrician and psychiatric consultant. We measured change in the Patient Health Questionnaire 9 (PHQ-9) score. We used surveys and focus groups to measure patient and provider satisfaction and analyzed focus groups using qualitative analysis. The intervention was well accepted by providers and patients, based on survey and focus group data. Feasibility was also evidenced by recruitment (87.1%) and retention (92.6%) rates and depression outcomes (64% with >50% improvement in PHQ 9) which were comparable to clinical trials in similar urban populations. Conclusions for practice: DAWN Collaborative Care modified for treatment of perinatal depression in a rural obstetric setting is feasible and acceptable. Behavioral health services integrated into rural obstetric settings could improve care for perinatal depression.

Prevention of childbirth injuries to the pelvic floor.

PubMed

Heit, M; Mudd, K; Culligan, P

2001-08-01

The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility.

National Partnership for Maternal Safety: Consensus Bundle on Venous Thromboembolism.

PubMed

D'Alton, Mary E; Friedman, Alexander M; Smiley, Richard M; Montgomery, Douglas M; Paidas, Michael J; D'Oria, Robyn; Frost, Jennifer L; Hameed, Afshan B; Karsnitz, Deborah; Levy, Barbara S; Clark, Steven L

2016-10-01

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.

Neither Medicine Nor Health Care Staff Members Are Violent By Nature: Obstetric Violence From an Interactionist Perspective.

PubMed

Briceño Morales, Ximena; Enciso Chaves, Laura Victoria; Yepes Delgado, Carlos Enrique

2018-05-01

This study sought to understand the meaning that women place on the health care practices carried out during labor. We used techniques from Grounded Theory such as coding, categorization, and constant comparison. A total of 18 interviews were conducted with 16 women who had given birth at least once in Colombia. Based on our results, we argue that obstetric violence is an expression of violence during the provision of health care, which occurs in a social environment favoring the development of power relationships between patients and health care staff. Its origin might lie in a health care system whose political and economic foundations encourage inequality on the basis of the patients' purchasing power. We conclude that rethinking and redefining the concept of obstetric violence is essential for understanding its nature and having an impact on it.

[Home childbirth: progress or retrocession?].

PubMed

de Sanfelice, Clara Fróes Oliveira; Shimo, Antonieta Keiko Kakuda

2014-03-01

Giving birth at home represents a rising modality of delivery care in the Brazilian society, although in unrepresentative proportion when compared to the number of hospital childbirths. In Brazil, the topic has been broadly discussed by different professional categories, highlighting the safety issue involved in the process. The aim of this theoretical and reflective study was to present a brief overview of the overall care related to home childbirth, also questioning the reality of the contemporary Brazilian obstetric scenario. The scientific literature presents both obstetric and neonatal outcomes as favorable to home childbirth; similar risks when compared to hospital childbirth and higher rates of maternal satisfaction, and these both factors justify its practice. Therefore, a movement of women who are deeply unhappy with the current model of obstetric care is currently observed and they have been opting for home childbirth as a response to institutional violence,fragmentation and depersonalization of hospital care.

Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy.

PubMed

Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

2016-01-01

The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

[Pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy].

PubMed

Brogly, Nicolas; Schiraldi, Renato; Puertas, Laura; Maggi, Genaro; Yanci, Eduardo Alonso; Maldonado, Ever Hugo Martinez; Arévalo, Emilia Guasch; Rodríguez, Fernando Gilsanz

2016-01-01

The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy. We describe the case of a 28-year-old woman with a congenital heart disease who was submitted to a caesarean section under general anaesthesia for maternal pathology and foetal breech presentation. Intra- and post-operative management was optimized by advanced haemodynamic monitorization obtained by pulse contour wave analysis and thermodilution calibration (Picco Plus(®) monitor). The information about preload, myocardial contractility and postcharge was useful in guiding the fluid therapy and the use of vasoactive drugs. This case report illustrates the importance of advanced haemodynamic monitoring with an acceptably invasive device in obstetric patients with high cardiac risk. The increasing experience in advanced haemodynamic management will probably permit to decrease morbidity and mortality of obstetric patients in the future. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Successes and Challenges of Interprofessional Physiologic Birth and Obstetric Emergency Simulations in a Nurse-Midwifery Education Program.

PubMed

Shaw-Battista, Jenna; Belew, Cynthia; Anderson, Deborah; van Schaik, Sandrijn

2015-01-01

This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

Self-reported practices among traditional birth attendants surveyed in western Kenya: a descriptive study.

PubMed

Bucher, Sherri; Konana, Olive; Liechty, Edward; Garces, Ana; Gisore, Peter; Marete, Irene; Tenge, Constance; Shipala, Evelyn; Wright, Linda; Esamai, Fabian

2016-08-12

The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help inform conversations regarding the roles that traditional birth attendants can play in maternal-newborn health care. A structured questionnaire was used in a survey that included one hundred unskilled birth attendants in western Kenya. Descriptive statistics were employed. Inappropriate or outdated practices were reported in relation to some obstetric complications and newborn care. Encouraging results were reported with regard to positive relationships that traditional birth attendants have with their local health facilities. Furthermore, high rates of referral to health facilities was reported for many common obstetric emergencies and similar rates for reporting of pregnancy outcomes to village elders and chiefs. Potentially harmful or outdated practices with regard to maternal and newborn care among traditional birth attendants in western Kenya were revealed by this study. There were high rates of traditional birth attendant referrals of pregnant mothers with obstetric complications to health facilities. Policy makers may consider re-educating and re-defining the roles and responsibilities of traditional birth attendants in maternal and neonatal health care based on the findings of this survey.

[Obstetricians/gynaecologists and breastfeeding: practice, attitudes, training and knowledge].

PubMed

Simard-Émond, Laurence; Sansregret, Andrée; Dubé, Johanne; Mayrand, Marie-Hélène

2011-02-01

Sole use of breastfeeding is recommended during the first six months of life. The treating physician's opinion influences whether or not the patient will opt for breastfeeding. We wanted to ascertain if obstetricians-gynaecologists and obstetrics and gynaecology residents from Quebec offered counselling on breastfeeding and to examine various aspects of their disposition towards such counselling. A questionnaire evaluating five aspects of physicians' disposition towards breastfeeding was used: practice and confidence, attitudes, training, knowledge. We emailed obstetrics and gynaecology residents from Quebec and members of the Association des obstétriciens et gynécologues du Québec who had a valid email address to invite them to complete the questionnaire, which was offered on a secured website. Only 49% of obstetricians-gynaecologists and 35% of residents periodically offer counselling on breastfeeding. Furthermore, 56% and 35% respectively of both groups have confidence in their ability to meet the needs of breastfeeding patients, while 79% of the former and 93% of the latter believe that such counselling comes under their authority. On average, obstetricians-gynaecologists answered correctly 82% of the questions concerning theoretical knowledge. Only 16% of obstetricians-gynaecologists and 22% of residents believe they have received an "at least adequate" training on how to support breastfeeding women. Respondents have not adequately integrated breastfeeding counselling into their practice, in spite of the fact that they had adequate theoretical knowledge on the matter and that they were convinced that such a role was important and that it came under their authority. A more practical form of training could enhance their confidence level and encourage them to integrate such counselling into the obstetrical follow-up.

Health Occupations Curriculum. Skills and Theory for Practical Nurse. Units 18, 19, and 20.

ERIC Educational Resources Information Center

Arizona State Dept. of Education, Phoenix.

Part of a health occupations program, these instructional units consist of materials for use by those who are studying to become practical nurses. Covered in the units are the following: the nursing care of mothers and newborns (obstetrics, prenatal care and complications, patient needs, care of the newborn, prematurity, medications, and cultural…

Being Well Born: Preventive Health Practices in Pregnancy and Delivery. Matrix No. 6.

ERIC Educational Resources Information Center

Iams, Jay D.

Some of the principal research advances of the 1970s related to pregnancy and newborn infants and consequent changes in obstetrical practice are summarized in this report. The process of infant-parent attachment (bonding), adolescent pregnancy, and the reproductive hazards of tobacco, alcohol, and poor nutrition have been investigated and, in…

Pseudo-outbreak of Penicillium in an outpatient obstetrics and gynecology clinic.

PubMed

Sood, Geetika; Huber, Kerri; Dam, Lisa; Riedel, Stefan; Grubb, Lisa; Zenilman, Jonathan; Perl, Trish M; Argani, Cynthia

2017-05-01

We report an unusual pseudo-outbreak of Penicillium that occurred in patients seen in an outpatient obstetrics and gynecology clinic. The pseudo-outbreak was detected in late 2012, when the microbiology department reported a series of vaginal cultures positive for Penicillium spp. Our investigation found Penicillium spp in both patient and environmental samples and was potentially associated with the practice of wetting gloves with tap water by a health care worker prior to patient examination. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Consent for regional anaesthesia in the United Kingdom: what is material risk?

PubMed

Kelly, G D; Blunt, C; Moore, P A S; Lewis, M

2004-04-01

Legal principles that apply to the process of informed consent have changed in recent years. Patients should now be given the information that they wish to receive, not the information that health professionals may consider reasonable for them. In obstetric practice informed consent is especially important as young, fit patients may request and receive non-essential but potentially life-threatening interventions. The quantity and detail of information parturients desire do not remain static. They vary over time and from country to country. Our paper examines current opinion amongst parturients in the United Kingdom. We asked 100 obstetric patients to choose the complications of regional anaesthesia that they would like to learn about during informed consent. Nearly all women (82-94%) wished to know about common, less severe side effects. A substantial majority (70-77%) also wished to know about rarer but more severe complications, such as permanent neurological deficit, meningitis and high spinal block. Despite the availability of information for patients from sources such as the Obstetric Anaesthetists' Association and the National Electronic Library for Health, there remains little consensus amongst anaesthetists about what information to provide. Frequently some complications that patients would consider important are not discussed. Changing legal and public expectations demand that we adapt our current practice and improve the accuracy and timing of information provided.

Cross-Cultural Obstetric and Gynecologic Care of Muslim Patients.

PubMed

Shahawy, Sarrah; Deshpande, Neha A; Nour, Nawal M

2015-11-01

With the growing number of Muslim patients in the United States, there is a greater need for obstetrician-gynecologists (ob-gyns) to understand the health care needs and values of this population to optimize patient rapport, provide high-quality reproductive care, and minimize health care disparities. The few studies that have explored Muslim women's health needs in the United States show that among the barriers Muslim women face in accessing health care services is the failure of health care providers to understand and accommodate their beliefs and customs. This article outlines health care practices and cultural competency tools relevant to modern obstetric and gynecologic care of Muslim patients, incorporating emerging data. There is an exploration of the diversity of opinion, practice, and cultural traditions among Muslims, which can be challenging for the ob-gyn who seeks to provide culturally competent care while attempting to avoid relying on cultural or religious stereotypes. This commentary also focuses on issues that might arise in the obstetric and gynecologic care of Muslim women, including the patient-physician relationship, modesty and interactions with male health care providers, sexual health, contraception, abortion, infertility, and intrapartum and postpartum care. Understanding the health care needs and values of Muslims in the United States may give physicians the tools necessary to better deliver high-quality care to this minority population.

Update on massive transfusion.

PubMed

Pham, H P; Shaz, B H

2013-12-01

Massive haemorrhage requires massive transfusion (MT) to maintain adequate circulation and haemostasis. For optimal management of massively bleeding patients, regardless of aetiology (trauma, obstetrical, surgical), effective preparation and communication between transfusion and other laboratory services and clinical teams are essential. A well-defined MT protocol is a valuable tool to delineate how blood products are ordered, prepared, and delivered; determine laboratory algorithms to use as transfusion guidelines; and outline duties and facilitate communication between involved personnel. In MT patients, it is crucial to practice damage control resuscitation and to administer blood products early in the resuscitation. Trauma patients are often admitted with early trauma-induced coagulopathy (ETIC), which is associated with mortality; the aetiology of ETIC is likely multifactorial. Current data support that trauma patients treated with higher ratios of plasma and platelet to red blood cell transfusions have improved outcomes, but further clinical investigation is needed. Additionally, tranexamic acid has been shown to decrease the mortality in trauma patients requiring MT. Greater use of cryoprecipitate or fibrinogen concentrate might be beneficial in MT patients from obstetrical causes. The risks and benefits for other therapies (prothrombin complex concentrate, recombinant activated factor VII, or whole blood) are not clearly defined in MT patients. Throughout the resuscitation, the patient should be closely monitored and both metabolic and coagulation abnormalities corrected. Further studies are needed to clarify the optimal ratios of blood products, treatment based on underlying clinical disorder, use of alternative therapies, and integration of laboratory testing results in the management of massively bleeding patients.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-01-01

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality. PMID:27175303

Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology

PubMed Central

Furlow, Mandi L; Patel, Divya A; Sen, Ananda; Liu, J Rebecca

2008-01-01

Background In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care. PMID:18582380

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.

PubMed Central

Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

2000-01-01

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

Antepartum Fetal Monitoring and Spectral Analysis of Preterm Birth Risk

NASA Astrophysics Data System (ADS)

Păsăricără, Alexandru; Nemescu, Dragoş; Arotăriţei, Dragoş; Rotariu, Cristian

2017-11-01

The monitoring and analysis of antepartum fetal and maternal recordings is a research area of notable interest due to the relatively high value of preterm birth. The interest stems from the improvement of devices used for monitoring. The current paper presents the spectral analysis of antepartum heart rate recordings conducted during a study in Romania at the Cuza Voda Obstetrics and Gynecology Clinical Hospital from Iasi between 2010 and 2014. The study focuses on normal and preterm birth risk subjects in order to determine differences between these two types or recordings in terms of spectral analysis.

Implementation and Effects of Risk-Dependent Obstetric Care in the Netherlands (Expect Study II): Protocol for an Impact Study.

PubMed

van Montfort, Pim; Willemse, Jessica Ppm; Dirksen, Carmen D; van Dooren, Ivo Ma; Meertens, Linda Je; Spaanderman, Marc Ea; Zelis, Maartje; Zwaan, Iris M; Scheepers, Hubertina Cj; Smits, Luc Jm

2018-05-04

Recently, validated risk models predicting adverse obstetric outcomes combined with risk-dependent care paths have been made available for early antenatal care in the southeastern part of the Netherlands. This study will evaluate implementation progress and impact of the new approach in obstetric care. The objective of this paper is to describe the design of a study evaluating the impact of implementing risk-dependent care. Validated first-trimester prediction models are embedded in daily clinical practice and combined with risk-dependent obstetric care paths. A multicenter prospective cohort study consisting of women who receive risk-dependent care is being performed from April 2017 to April 2018 (Expect Study II). Obstetric risk profiles will be calculated using a Web-based tool, the Expect prediction tool. The primary outcomes are the adherence of health care professionals and compliance of women. Secondary outcomes are patient satisfaction and cost-effectiveness. Outcome measures will be established using Web-based questionnaires. The secondary outcomes of the risk-dependent care cohort (Expect II) will be compared with the outcomes of a similar prospective cohort (Expect I). Women of this similar cohort received former care-as-usual and were prospectively included between July 1, 2013 and December 31, 2015 (Expect I). Currently, women are being recruited for the Expect Study II, and a total of 300 women are enrolled. This study will provide information about the implementation and impact of a new approach in obstetric care using prediction models and risk-dependent obstetric care paths. Netherlands Trial Register NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143 (Archived by WebCite at http://www.webcitation.org/6t8ijtpd9). ©Pim van Montfort, Jessica PPM Willemse, Carmen D Dirksen, Ivo MA van Dooren, Linda JE Meertens, Marc EA Spaanderman, Maartje Zelis, Iris M Zwaan, Hubertina CJ Scheepers, Luc JM Smits. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 04.05.2018.

Foetal electrocardiograph (ST-analyser or STAN) for intrapartum foetal heart rate monitoring: a friend or a foe?

PubMed

Chandraharan, Edwin

2018-01-01

Cardiotocograph (CTG) is associated with a high false positive rate of up to 60% which may increase the risk of unnecessary intrapartum interventions (emergency caesarean sections or operative vaginal deliveries) without any significant benefits. A recent study on variation of caesarean section rates in England has concluded that there was a very wide variation even in the adjusted rates of caesarean section from 14.9% to 32.1%. Cochrane Systematic Reviews have concluded that the use of FBS does not reduce caesarean section rate or any pre-specified neonatal outcomes. Fetal ECG (ST-Analyser or STAN) has been used in the clinical practice for more than 20 years. Although, initial randomised controlled trials (RCTs) showed great promise regarding the role of STAN in reducing operative delivery rates (instrumental vaginal births and emergency caesarean sections) and neonatal metabolic acidosis, subsequent studies have questioned the role of STAN in clinical practice. A recent meta-analysis which included six randomised controlled trials (a total of 26,446 women) has concluded that there was a 36% reduction in the rate of neonatal metabolic acidosis. Practising clinicians currently face a dilemma as to whether STAN has a place in contemporary obstetric practice or whether it?s use should be discouraged and discontinued.

Touching the high-risk obstetrical patient.

PubMed

Vice, L J

1979-01-01

Nurses are reminded that there is a patient, rather than just an array of technical marvels, in the intensive care labor unit. Practical measures for promoting the patient's physical ease are outlined, and the meaning of support is reviewed.

The Primary Physician

PubMed Central

Sadler, Paul

1969-01-01

Dr Paul Sadler takes another point of view and describes the successful division of his housing-estate practice into four specialist departments: pxediatrics, geriatrics, obstetrics and general medicine. He further details the organization and advantages of his own department, pediatrics. PMID:5816896

[Underwater delivery. Consensus of the Spanish Neonatology Society and the Perinatal Section of the Spanish Obstetrics and Gynecology Society].

PubMed

Iriondo Sanz, M; Sánchez Luna, M; Botet Mussons, F; Martínez-Astorquiza, T; Lailla Vicens, J M; Figueras Aloy, J

2015-02-01

Immersion in water during labor and delivery as an alternative to traditional delivery is a practice that has increased in many countries. This technique is effective in reducing pain and duration of labor. The American Academy of Pediatrics and The American College of Obstetricians and Gynecologists have published a clinical report which indicates the potential maternal benefits during the first stage of labor but, questions the performance of this technique during delivery and birth of the newborn. In this report, the Spanish Society of Neonatology and the Spanish Society of Obstetrics and Gynecology analyze the current scientific evidence on water immersion delivery, and the impact this practice could have in the mother and especially in the wellbeing of newborn. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Perceived Changes to Obstetric Care and the Integration of Personal and Professional Life as a Pregnant Prenatal Genetic Counselor.

PubMed

Rietzler, Jennifer L; Birkeland, Laura E; Petty, Elizabeth M

2018-02-08

The impact of practicing as a prenatal genetic counselor while pregnant is unclear given the limited amount of published literature on this issue. To address this gap in knowledge, a total of 215 current and past prenatal genetic counselors provided insights regarding this personal yet professional juncture through completion of an online survey that allowed for both close-ended and open-ended responses. While participants agreed that experiencing pregnancy affected their perspectives and counseling in several ways, this paper focuses on one particular finding-that of the changes in their own obstetric care perceived by genetic counselors while working within the prenatal setting and being pregnant themselves. As a result of these changes, considerations about when to disclose a pregnancy to colleagues along with how to integrate personal and professional needs as a pregnant prenatal genetic counselor surfaced. Additional findings, practice implications, and research recommendations are discussed.

[The Application of Bryophyllum pinnatum Preparations in Obstetrics and Gynaecology – a Multicenter, Prospective Observational Study].

PubMed

Fürer, Karin; Simões-Wüst, Ana Paula; Winkler, Alice; Amsler, Nadine; Schnelle, Martin; von Mandach, Ursula

2015-01-01

Bryophyllum pinnatum has been introduced in anthroposophic medicine in Europe and is nowadays also widely used in conventional medicine. The aim of this study was to assess the prescriptions in the field of gynaecology and obstetrics in Switzerland and to document potential effects and possible adverse events of B. pinnatum. Private practices and clinics for obstetrics and gynaecology were asked to document each prescription of B. pinnatum for their female patients during 31 months with an online questionnaire. At the University Hospital Zurich, at the Cantonal Hospital Winterthur as well as at 2 private practices, a total of 174 women and 208 prescriptions of B. pinnatum were recorded (several prescriptions per patient were possible). Most of the patients were pregnant (87%). B. pinnatum was prescribed as a tocolytic agent to 83% of all patients and to 95% of all pregnant patients and showed a good or a very good effectiveness. Further, 14% of the patients received B. pinnatum for sedation against their restlessness during the day and 5% for sedation against sleep problems. A decrease of the restlessness was achieved for these 2 indications. 13% of the patients suffered from a hyperactive bladder and in two-thirds of them the effectiveness of the treatment with B. pinnatum was classified as very good. In 92% of the cases, Bryophyllum 50% chewable tablets were prescribed. In conventional gynaecology and obstetrics, B. pinnatum is predominantly prescribed for pregnant women in case of prematurel abour, against restlessness and for hyperactive bladder. B. pinnatum showed a good effectiveness with a high benefit in the treatment of hyperactivity-associated health problems. © 2015 S. Karger GmbH, Freiburg.

Maternal and obstetrical predictors of sudden infant death syndrome (SIDS).

PubMed

Friedmann, Isabel; Dahdouh, Elias M; Kugler, Perlyne; Mimran, Gracia; Balayla, Jacques

2017-10-01

Public Health initiatives, such as the "Safe to Sleep" campaign, have traditionally targeted infants' risk factors for the prevention of Sudden Infant Death Syndrome (SIDS). However, controversy remains regarding maternal and obstetrical risk factors for SIDS. In our study, we sought out to determine both modifiable and non-modifiable obstetrical and maternal risk factors associated with SIDS. We conducted a population-based cohort study using the CDC's Linked Birth-Infant Death data from the United States for the year 2010. The impact of several obstetrical and maternal risk factors on the risk of overall infant mortality and SIDS was estimated using unconditional regression analysis, adjusting for relevant confounders. Our cohort consisted of 4,007,105 deliveries and 24,174 infant deaths during the first year of life, of which 1991 (8.2%) were due to SIDS. Prominent risk factors for SIDS included (OR [95% CI]): black race, 1.89 [1.68-2.13]; maternal smoking, 3.56 [3.18-3.99]; maternal chronic hypertension, 1.73 [1.21-2.48]; gestational hypertension, 1.51 [1.23-1.87]; premature birth <37 weeks, 2.16 [1.82-2.55]; IUGR, 2.46 [2.14-2.82]; and being a twin, 1.81 [1.43-2.29], p < 0.0001. Relative to a cohort of infants who died of other causes, risk factors with a predilection for SIDS were maternal smoking, 2.48 [2.16-2.83] and being a twin, 1.52 [1.21-1.91], p < 0.0001. Conclusions for practice: While certain socio-demographic and gestational characteristics are important risk factors, maternal smoking remains the strongest prenatal modifiable risk factor for SIDS. We recommend the continuation of Public Health initiatives that promote safe infant sleeping practices and smoking cessation during and after pregnancy.

Sources of support for women experiencing obstetric fistula in northern Ghana: A focused ethnography.

PubMed

Sullivan, Ginger; O'Brien, Beverley; Mwini-Nyaledzigbor, Prudence

2016-09-01

we explored how women in northern Ghana who have or have had obstetric fistula and those close to them perceive support. focused ethnography, that includes in-depth interviews, participant observation, and scrutiny of relevant records. a fistula treatment centre in a regional urban centre and three remote villages located in northern Ghana. the sources of data included in-depth interview (n=14), non-participant observation and interaction, as well as scrutiny of relevant health records and documents. Participants for in-depth interviews and observation included women affected by obstetric fistula, their partners, parents, relatives, nurses and doctors. presentation of obstetric fistula information, particularly by Non-Governmental Organisations was not in a format that was readily understandable for many women and their families. Food and other basic requirements for daily living were not necessarily available in the fistula treatment centre. Travelling for care was costly and frequently not easily accessed from their communities. Fistula repair surgery was available at unpredictable times and only for a few days every one to two months. women perceived support from spouses/partner, family members, and other relatives but much of this is limited to tangible support. Perceptions of support were particularly focused on access to information and finances. the implementation of strategies to increase support for women living with obstetric fistula include improving access to fistula repair treatment, directing resources to create a dedicated specialist fistula centre located where most cases of OF occur and providing education to front-line workers. Strategies to prevent fistula as well as identify and support safe motherhood practices are needed for women affected by obstetric fistula. Copyright © 2016 Elsevier Ltd. All rights reserved.

SisPorto 4.0 - computer analysis following the 2015 FIGO Guidelines for intrapartum fetal monitoring.

PubMed

Ayres-de-Campos, Diogo; Rei, Mariana; Nunes, Inês; Sousa, Paulo; Bernardes, João

2017-01-01

SisPorto 4.0 is the most recent version of a program for the computer analysis of cardiotocographic (CTG) signals and ST events, which has been adapted to the 2015 International Federation of Gynaecology and Obstetrics (FIGO) guidelines for intrapartum foetal monitoring. This paper provides a detailed description of the analysis performed by the system, including the signal-processing algorithms involved in identification of basic CTG features and the resulting real-time alerts.

Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

PubMed

Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

2016-08-01

A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit.

PubMed

Kayiga, Herbert; Ajeani, Judith; Kiondo, Paul; Kaye, Dan K

2016-07-11

Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p < 0.001 and 21.7 % vs. 50.5 %; P < 0.001 respectively after the second audit. There was no improvement in vital sign monitoring, delivery within two hours or blood grouping and cross matching. There was a decline in bladder catheterization (94 % vs. 68.9 %; p < 0.001. The overall mean care score in the first and second audits was 55.1 and 48.2 % respectively, p = 0.19. Healthcare factors (negative attitude, low numbers, poor team work, low motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

Optimizing hidden layer node number of BP network to estimate fetal weight

NASA Astrophysics Data System (ADS)

Su, Juan; Zou, Yuanwen; Lin, Jiangli; Wang, Tianfu; Li, Deyu; Xie, Tao

2007-12-01

The ultrasonic estimation of fetal weigh before delivery is of most significance for obstetrical clinic. Estimating fetal weight more accurately is crucial for prenatal care, obstetrical treatment, choosing appropriate delivery methods, monitoring fetal growth and reducing the risk of newborn complications. In this paper, we introduce a method which combines golden section and artificial neural network (ANN) to estimate the fetal weight. The golden section is employed to optimize the hidden layer node number of the back propagation (BP) neural network. The method greatly improves the accuracy of fetal weight estimation, and simultaneously avoids choosing the hidden layer node number with subjective experience. The estimation coincidence rate achieves 74.19%, and the mean absolute error is 185.83g.

Ignorance of electrosurgery among obstetricians and gynaecologists.

PubMed

Mayooran, Zorana; Pearce, Scott; Tsaltas, Jim; Rombauts, Luk; Brown, T Ian H; Lawrence, Anthony S; Fraser, Kym; Healy, David L

2004-12-01

The purpose of this study was to assess the level of skill of laparoscopic surgeons in electrosurgery. Subjects were asked to complete a practical diathermy station and a written test of electrosurgical knowledge. Tests were held in teaching and non-teaching hospitals. Twenty specialists in obstetrics and gynaecology were randomly selected and tested on the Monash University gynaecological laparoscopic pelvi-trainer. Twelve candidates were consultants with 9-28 years of practice in operative laparoscopy, and 8 were registrars with up to six years of practice in operative laparoscopy. Seven consultants and one registrar were from rural Australia, and three consultants were from New Zealand. Candidates were marked with checklist criteria resulting in a pass/fail score, as well as a weighted scoring system. We retested 11 candidates one year later with the same stations. No improvement in electrosurgery skill in one year of obstetric and gynaecological practice. No candidate successfully completed the written electrosurgery station in the initial test. A slight improvement in the pass rate to 18% was observed in the second test. The pass rate of the diathermy station dropped from 50% to 36% in the second test. The study found ignorance of electrosurgery/diathermy among gynaecological surgeons. One year later, skills were no better.

Survey of current practice in clinical transvaginal ultrasound scanning in the UK

PubMed Central

Shaw, Adam; Lees, Christoph

2015-01-01

During transvaginal ultrasound scanning, the fetus and other sensitive tissues are placed close to the transducer. Heating of these tissues occurs by direct conduction from the transducer and by absorption of ultrasound in the tissue. The extent of any heating will depend on the equipment and settings used, the duration of the scan, imaging modes and other aspects of scanning practice. To ensure that scans are performed with minimum risk, staff should have an appropriate knowledge of safety and follow guidelines issued by professional bodies. An online survey aiming to document current practice in transvaginal ultrasound in the UK was created and distributed to individuals performing this type of scanning. The survey posed questions about the respondents, the departments where scans were performed, the equipment used, knowledge of ultrasound safety, scanning practice and the frequency, duration and mode of transvaginal ultrasound scans for gynaecology, obstetrics and fertility applications. In all, 294 responses were obtained, mostly from sonographers (94%). From the analysis of the responses, it was clear that there was a good understanding of the general meaning of thermal and mechanical index and high awareness of guidelines issued by professional bodies. However, 40% of respondents stated that they rarely or never monitor Thermal or Mechanical indices during scanning. Scanning practice was consistent in terms of the duration of scans, scan protocols followed and use of imaging modes. The results highlight the importance of continued ultrasound safety training and promotion of safety guidelines to users. PMID:27433250

Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices.

PubMed

Volmanen, P; Valanne, J; Alahuhta, S

2004-01-01

Various clinical practices have been found to be associated with breast-feeding problems. However, little is known about the effect of pain, obstetrical procedures and analgesia on breast-feeding behaviour. We designed a retrospective study with a questionnaire concerning pain, obstetrical procedures and breast-feeding practices mailed to 164 primiparae in Lapland. Altogether 99 mothers (60%) returned completed questionnaires that could be included in the analysis, which was carried out in two steps. Firstly, all accepted questionnaires were grouped according to the success or failure to breast-feed fully during the first 12 weeks of life. Secondly, an ad hoc cohort study was performed on the sub-sample of 64 mothers delivered vaginally. As many as 44% of the 99 mothers reported partial breast feeding or formula feeding during the first 12 weeks. Older age of the mother, use of epidural analgesia and the problem of "not having enough milk" were associated with the failure to breast-feed fully. Caesarean section, other methods of labour analgesia and other breast-feeding problems were not associated with partial breast feeding or formula feeding. In the sub-sample, 67% of the mothers who had laboured with epidural analgesia and 29% of the mothers who laboured without epidural analgesia reported partial breast feeding or formula feeding (P = 0.003). The problem of "not having enough milk" was more often reported by those who had had epidural analgesia. Further studies conducted prospectively are needed to establish whether a causal relationship exists between epidural analgesia and breast-feeding problems.

Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK

PubMed Central

Al Wattar, Bassel H; Tamblyn, Jennifer A; Parry-Smith, William; Prior, Mathew; Van Der Nelson, Helen

2017-01-01

Background Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. Methods We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients’ demographics, incidence of PPH, estimated blood loss (EBL), prophylactic and treatment measures, onset of labor, and mode of delivery. Results We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500–1000 mL, n=1900/3613, 52.6%) and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4%) and severe PPH (EBL >2000 mL, n=289/3613, 8%). The majority of women received active management of the third stage of labor (3504/3613, 97%) most commonly with Syntometrine intramuscular (1479/3613, 40.9%). More than half required one additional uterotonic agent (2364/3613, 65.4%) most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%). There was a poor involvement of consultant obstetricians and anesthetists in managing PPH cases, which was more prevalent when managing major PPH (p=0.0001). Conclusion There are still variations in managing PPH in the UK against national guidelines. More senior doctor involvement and regular service evaluation are needed to improve maternal outcomes following PPH. PMID:28176919

The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff.

PubMed

Vamos, Cheryl A; Cantor, Allison; Thompson, Erika L; Detman, Linda A; Bronson, Emily A; Phelps, Annette; Louis, Judette M; Gregg, Anthony R; Curran, John S; Sappenfield, William M

2016-10-01

Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.

Non-obstetrical indications for cesarean section: a state-of-the-art review.

PubMed

Venturella, Roberta; Quaresima, Paola; Micieli, Mariella; Rania, Erika; Palumbo, Annarita; Visconti, Federica; Zullo, Fulvio; Di Carlo, Costantino

2018-07-01

To propose an evidence-based review on the most frequent indications for Cesarean section (CS) given by specialists in disciplines other than Obstetrics and Gynecology, with the aim of increasing consciousness about the available data in the literature and the guidelines recommendations about topics that are not frequently managed by obstetricians and gynecologists. We analyzed hospital discharge data regarding deliveries occurred in a 10-year study period in our department to obtain the prevalence and the list of the most recurrent non-obstetrical indications for CS. A search was performed in PubMed, the Cochrane Library, SCOPUS, Web of Science and Ovid MEDLINE and only studies published in English from 1950 to 2017 were included. For indications for which no systematic reviews existed, we included the best available evidence, including guidelines of non-obstetrics scientific societies or organizations, RCTs, non-randomized controlled clinical trials, case-control studies, cohort studies, and case series. The rising rate of CS registered in the recent years is not justified by reduction in maternal--fetal risk or perinatal outcomes and often reflects inappropriate clinical behaviour and a wrong tendency that assimilates CS as a defensive practice. In a relevant percentage of cases, the indication to CS is given by specialists in other disciplines, even when specific guidelines do not give clear recommendation about the route of delivery. To refuse non-obstetrical indications for CS, when scientific support is lacking, could be a useful and safe strategy to further reduce the rate of unnecessary CS.

Nomenclature of primary amenorrhea: A proposal document of the Japan Society of Obstetrics and Gynecology committee for the redefinition of primary amenorrhea.

PubMed

Shozu, Makio; Ishikawa, Hiroshi; Horikawa, Reiko; Sakakibara, Hideya; Izumi, Shun-Ichiro; Ohba, Takashi; Hirota, Yasushi; Ogata, Tsutomu; Osuga, Yutaka; Kugu, Koji

2017-11-01

The aim of this study was to provide medical terms to describe the condition of a girl who should be evaluated for primary amenorrhea in order to facilitate intervention at an appropriate time. We performed a literature and clinical guidelines search for recent practices with regard to menarche and discussed relevant cases that had been experienced by committee members. Additionally, we theoretically reviewed medical terms defined in the Glossary Book of Obstetrics and Gynecology in Japan (Japan Society of Obstetrics and Gynecology, 3rd edition). The committee for the redefinition of primary amenorrhea proposed the introduction of two terms and the deletion of one term that had been defined by the Japan Society of Obstetrics and Gynecology, instead of changing the age definition of primary amenorrhea. 'Delayed menarche' was introduced to describe a condition in which a girl has never experienced cyclic menstruation (menarche) by 15-17 years of age. 'Late menarche' was also introduced to describe a condition in which a girl has experienced menarche at 15 years of age or older. 'Delayed menstruation,' which was defined as a condition in which a girl experiences menarche at 15-18 years of age, was deleted. The new terms 'delayed menarche' and 'late menarche' were introduced, and the term 'delayed menstruation' was deleted. The new system might help in the early detection and appropriate treatment of primary amenorrhea. © 2017 Japan Society of Obstetrics and Gynecology.

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics.

PubMed

Carvalho, Milton Jorge de; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

2016-07-01

Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics

PubMed Central

de Carvalho, Milton Jorge; Pereira, Fernanda Maria Vieira; Gir, Elucir; Lam, Simon Ching; Barbosa, Caio Parente

2016-01-01

OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks. PMID:27464295

Interdisciplinary simulation-based training to improve delivery room communication.

PubMed

Dadiz, Rita; Weinschreider, Joanne; Schriefer, Jan; Arnold, Christine; Greves, Cole D; Crosby, Erin C; Wang, Hongyue; Pressman, Eva K; Guillet, Ronnie

2013-10-01

Poor communication among obstetric and pediatric professionals is associated with adverse perinatal events leading to severe disability and neonatal mortality. This study evaluated the effectiveness of an interdisciplinary simulation-based training (SBT) program to improve delivery room communication between obstetric and pediatric teams. Obstetric and pediatric teams participated in an SBT annually during 3 academic years, 2008-2011 (Y1-Y3), in a prospective, observational study. Eligible participants (n = 228) included attendings, fellows, house staff, midlevel providers, and nurses involved in delivery room care. Simulations were videotaped and evaluated using a validated 20-item checklist of best communication practices. Checklist scores were compared across years with the Kruskal-Wallis test. Providers were also surveyed annually regarding communication during actual deliveries using a standardized questionnaire. Ratings were analyzed using two-way analysis of covariance. At least 60% of eligible providers participated in 1 or more SBT sessions and completed surveys annually. Checklist scores on communication during SBT improved from Y1 (median, 6; interquartile range, 4) to Y3 (median, 11; interquartile range, 6) (P < 0.001). Survey results showed the perception of improvement over time in interteam communication during actual deliveries by obstetric (P < 0.005) and pediatric (P < 0.0001) providers. The obstetric team also perceived improved provider communication with the family (P < 0.05). Communication during SBT as well as the perception of communication during actual deliveries improved across the study period. The potential of a checklist to standardize delivery room communication and improve patient outcomes merits further investigation.

Who will be there when women deliver? Assuring retention of obstetric providers.

PubMed

Anderson, Frank W J; Mutchnick, Ian; Kwawukume, E Y; Danso, K A; Klufio, C A; Clinton, Y; Yun, Luke Lu; Johnson, Timothy R B

2007-11-01

The Safe Motherhood Initiative has highlighted the need for improved health services with skilled attendants at delivery and the provision of emergency obstetric care. "Brain drain" has hampered this process and has been particularly prevalent in Ghana. Between 1993 and 2000, 68% of Ghanaian trained medical school graduates left the country. In 1989, postgraduate training in obstetrics and gynecology was established in Ghana, and as of November 2006, 37 of the 38 specialists who have completed the program have stayed in the country, most working in the public sector providing health care and serving as faculty. Interviews with graduates in 2002 found that the first and single-most important factor related to retention was the actual presence of a training program leading to specialty qualification in obstetrics and gynecology by the West African College of Surgeons. Economic and social factors also played major roles in a graduates' decision to stay in Ghana to practice. This model deserves replication in other countries that have a commitment to sustainable development, human resource and health services capacity building, and maternal mortality reduction. A network of University partnerships between departments of obstetrics and gynecology in developed and developing countries throughout the world sharing internet resources, clinical information, training curriculum and assessment techniques could be created. Grand rounds could be shared through teleconferencing, and faculty exchanges would build capacity for all faculty and enrich both institutions. Through new partnerships, creating opportunity for medical school graduates to become obstetrician-gynecologists may reduce brain drain and maternal mortality.

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations.

PubMed

Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

2009-01-01

We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and the transfer of learning to clinical practice were examined. Participants included senior midwives, obstetricians, and obstetric anesthetists, including course faculty from 4 purposively selected delivery suites in England. Telephone or e-mail interviews with MOSES course participants and facilitators were conducted, and video-recorded debriefings that formed integral parts of this 1-day course were analyzed. The team training was well received. Participants were able to check out assumptions and expectations of others and develop respect for different roles within the delivery suite (DS) team. Skillful facilitation of debriefing after each scenario was central to learning. Participants reported acquiring new knowledge or insights, particularly concerning the role of communication and leadership in crisis situations, and they rehearsed unfamiliar skills. Observing peers working in the simulations increased participants' learning by highlighting alternative strategies. The learning achieved by individuals and groups was noticeably dependent on their starting points. Some participants identified limited changes in their behavior in the workplace following the MOSES course. Mechanisms to manage the transfer of learning to the wider team were weakly developed, although 2 DS teams made changes to their regular update training. Interprofessional, team-based simulations promote new learning.

[Simulation in obstetrics and gynecology - a new method to improve the management of acute obstetric emergencies].

PubMed

Blum, Ronja; Gairing Bürglin, Anja; Gisin, Stefan

2008-11-01

In medical specialties, such as anaesthesia, the use of simulation has increased over the past 15 years. Medical simulation attempts to reproduce important clinical situations to practise team training or individual skills in a risk free environment. For a long time simulators have only been used by the airline industry and the military. Simulation as a training tool for practicing critical situations in obstetrics is not very common yet. Experience and routine are crucial to evaluate a medical emergency correctly and to take the appropriate measures. Nowadays the obstetrician requires a combination of manual and communication skills, fast emergency management and decision-making skills. Therefore simulation may help to attain these skills. This may not only satisfy the high expectations and demands of the patients towards doctors and midwives but would also help to keep calm in difficult situations and avoid mistakes. The goal is a risk free delivery for mother and child. Therefore we developed a simulation- based curricular unit for hands-on training of four different obstetric emergency scenarios. In this paper we describe our results about the feedback of doctors and midwives on their personal experiences due to this simulation-based curricular unit. The results indicate that simulation seems to be an accepted method for team training in emergency situations in obstetrics. Whether patient security increases after the regularly use of drill training needs to be investigated in further studies.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

PubMed

Ng'ang'a, Njoki; Byrne, Mary Woods; Kruk, Margaret E; Shemdoe, Aloisia; de Pinho, Helen

2016-08-08

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Obstetric audit: the Bradford way.

PubMed

Lodge, Virginia; Lomas, Karen; Jaworskyj, Suzanne; Thomson, Heidi

2014-08-01

Ultrasound is widely used as a screening tool in obstetrics with the aim of reducing maternal and foetal morbidity. However, to be effective it is recommended that scanning services follow standard protocols based on national guidelines and that scanning practice is audited to ensure consistency. Bradford has a multi-ethnic population with one of the highest rates of birth defects in the UK and it requires an effective foetal anomaly screening service. We implemented a rolling programme of audits of dating scans, foetal anomaly scans and growth scans carried out by sonographers in Bradford. All three categories of scan were audited using measurable parameters based on national guidelines. Following feedback and re-training to address issues identified, re-audits of dating and foetal anomaly scans were carried out. In both cases, sonographers being re-audited had a marked improvement in their practice. Analysis of foetal abnormality detection rates showed that as a department, we were reaching the nationally agreed detection rates for the Fetal Anomaly Screening Programme auditable conditions. Audit has been shown to be a useful and essential process in achieving consistent scanning practices and high quality images and measurements.

Obstetric interventions during labor and childbirth in Brazilian low-risk women.

PubMed

Carmo Leal, Maria do; Pereira, Ana Paula Esteves; Domingues, Rosa Maria Soares Madeira; Theme Filha, Mariza Miranda; Dias, Marcos Augusto Bastos; Nakamura-Pereira, Marcos; Bastos, Maria Helena; Gama, Silvana Granado Nogueira da

2014-08-01

This study evaluated the use of best practices (eating, movement, use of nonpharmacological methods for pain relief and partograph) and obstetric interventions in labor and delivery among low-risk women. Data from the hospital-based survey Birth in Brazil conducted between 2011 and 2012 was used. Best practices during labor occurred in less than 50% of women and prevalence of the use of these practices was lower in the North, Northeast and Central West Regions. The rate of use of oxytocin drips and amniotomy was 40%, and was higher among women admitted to public hospitals and in women with a low level of education. The uterine fundal pressure, episiotomy and lithotomy were used in 37%, 56% and 92% of women, respectively. Caesarean section rates were lower in women using the public health system, nonwhites, women with a low level of education and multiparous women. To improve the health of mothers and newborns and promote quality of life, a change of approach to labor and childbirth that focuses on evidence-based care is required in both the public and private health sectors.

Obstetric audit: the Bradford way

PubMed Central

Lomas, Karen; Jaworskyj, Suzanne; Thomson, Heidi

2014-01-01

Ultrasound is widely used as a screening tool in obstetrics with the aim of reducing maternal and foetal morbidity. However, to be effective it is recommended that scanning services follow standard protocols based on national guidelines and that scanning practice is audited to ensure consistency. Bradford has a multi-ethnic population with one of the highest rates of birth defects in the UK and it requires an effective foetal anomaly screening service. We implemented a rolling programme of audits of dating scans, foetal anomaly scans and growth scans carried out by sonographers in Bradford. All three categories of scan were audited using measurable parameters based on national guidelines. Following feedback and re-training to address issues identified, re-audits of dating and foetal anomaly scans were carried out. In both cases, sonographers being re-audited had a marked improvement in their practice. Analysis of foetal abnormality detection rates showed that as a department, we were reaching the nationally agreed detection rates for the Fetal Anomaly Screening Programme auditable conditions. Audit has been shown to be a useful and essential process in achieving consistent scanning practices and high quality images and measurements. PMID:27433213

Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study.

PubMed

Edvardsson, Kristina; Ntaganira, Joseph; Åhman, Annika; Sengoma, Jean Paul Semasaka; Small, Rhonda; Mogren, Ingrid

2016-07-01

To explore Rwandan physicians' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Physicians (n = 19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively. Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women's main expectations of ultrasound. Although women's right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician 'protection'. There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women's uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative. © 2016 John Wiley & Sons Ltd.

Knowledge, attitudes, and practices related to uterotonic drugs during childbirth in Karnataka, India: a qualitative research study.

PubMed

Deepak, Nitya Nand; Mirzabagi, Ellie; Koski, Alissa; Tripathi, Vandana

2013-01-01

India has the highest annual number of maternal deaths of any country. As obstetric hemorrhage is the leading cause of maternal death in India, numerous efforts are under way to promote access to skilled attendance at birth and emergency obstetric care. Current initiatives also seek to increase access to active management of the third stage of labor for postpartum hemorrhage prevention, particularly through administration of an uterotonic after delivery. However, prior research suggests widespread inappropriate use of uterotonics at facilities and in communities-for example, without adequate monitoring or referral support for complications. This qualitative study aimed to document health providers' and community members' current knowledge, attitudes, and practices regarding uterotonic use during labor and delivery in India's Karnataka state. 140 in-depth interviews were conducted from June to August 2011 in Bagalkot and Hassan districts with physicians, nurses, recently delivered women, mothers-in-law, traditional birth attendants (dais), unlicensed village doctors, and chemists (pharmacists). Many respondents reported use of uterotonics, particularly oxytocin, for labor augmentation in both facility-based and home-based deliveries. The study also identified contextual factors that promote inappropriate uterotonic use, including high value placed on pain during labor; perceived pressure to provide or receive uterotonics early in labor and delivery, perhaps leading to administration of uterotonics despite awareness of risks; and lack of consistent and correct knowledge regarding safe storage, dosing, and administration of oxytocin. These findings have significant implications for public health programs in a context of widespread and potentially increasing availability of uterotonics. Among other responses, efforts are needed to improve communication between community members and providers regarding uterotonic use during labor and delivery and to target training and other interventions to address identified gaps in knowledge and ensure that providers and pharmacists have up-to-date information regarding proper usage of uterotonic drugs.

Knowledge, Attitudes, and Practices Related to Uterotonic Drugs during Childbirth in Karnataka, India: A Qualitative Research Study

PubMed Central

Deepak, Nitya Nand; Mirzabagi, Ellie; Koski, Alissa; Tripathi, Vandana

2013-01-01

Background and Objectives India has the highest annual number of maternal deaths of any country. As obstetric hemorrhage is the leading cause of maternal death in India, numerous efforts are under way to promote access to skilled attendance at birth and emergency obstetric care. Current initiatives also seek to increase access to active management of the third stage of labor for postpartum hemorrhage prevention, particularly through administration of an uterotonic after delivery. However, prior research suggests widespread inappropriate use of uterotonics at facilities and in communities–for example, without adequate monitoring or referral support for complications. This qualitative study aimed to document health providers’ and community members’ current knowledge, attitudes, and practices regarding uterotonic use during labor and delivery in India’s Karnataka state. Methods 140 in-depth interviews were conducted from June to August 2011 in Bagalkot and Hassan districts with physicians, nurses, recently delivered women, mothers-in-law, traditional birth attendants (dais), unlicensed village doctors, and chemists (pharmacists). Results Many respondents reported use of uterotonics, particularly oxytocin, for labor augmentation in both facility-based and home-based deliveries. The study also identified contextual factors that promote inappropriate uterotonic use, including high value placed on pain during labor; perceived pressure to provide or receive uterotonics early in labor and delivery, perhaps leading to administration of uterotonics despite awareness of risks; and lack of consistent and correct knowledge regarding safe storage, dosing, and administration of oxytocin. Conclusions These findings have significant implications for public health programs in a context of widespread and potentially increasing availability of uterotonics. Among other responses, efforts are needed to improve communication between community members and providers regarding uterotonic use during labor and delivery and to target training and other interventions to address identified gaps in knowledge and ensure that providers and pharmacists have up-to-date information regarding proper usage of uterotonic drugs. PMID:23638148

A questionnaire survey of second year graduate-entry medical students' perception of obstetrics and gynaecology as a future career speciality.

PubMed

Ismail, Sharif I M F; Kevelighan, Euan H

2018-02-12

The aim of this study was to explore the impressions of second year graduate-entry medical students of Obstetrics and Gynaecology, before their attachment in the speciality in the subsequent year, so as to improve its appeal to them and increase their recruitment into it. A total of 74 questionnaires were distributed at the end of the Learning Opportunities in Clinical Setting (LOCS) week in the speciality and 66 (89.19%) completed questionnaires were returned. Over 4% of the respondents were considering the speciality as their career choice and less than half would consider it as a second option. Whilst more than a third perceived some of the demerits of the speciality, more than a third endorsed its merits. This showed the need to explore and address their concerns about training and working in the speciality. Having a health-related primary degree, prior employment and being female were significantly associated with choosing the speciality as a career (p < .001). Barriers for male respondents were flagged, which need to be addressed, and a bias towards Obstetrics was noted, which reflects the narrow focus on the Labour Ward and necessitates a broader exposure to the speciality. Impact statement What is already known on this subject? The perception of third year graduate-entry medical students of Obstetrics and Gynaecology is biased towards Obstetrics, and they have apprehensions about the challenges of training and working in the speciality. What do the results of this study add? The views of second year graduate-entry medical students are consistent with the views of third year graduate-entry medical students, which shows that these views may be formed early. What are the implications of these findings for clinical practice and/or further research? More research is needed to establish and understand the perception of the speciality earlier than second year and explore the value of practical steps that may improve this perception and increase the interest in it and recruitment into its training programmes.

The current crisis in obstetrics.

PubMed

Low, James A

2005-11-01

Of the issues leading to legal actions in obstetrics, the most important are events occurring before delivery that are deemed to account for the birth of a physically or mentally challenged child. In determining causation in the clinical setting, the diagnosis of fetal asphyxia can be made using blood gas and acid-base assessment. However, there are many subsidiary questions that in most cases cannot be answered, including when the asphyxia began, the severity and nature of the asphyxia during the exposure, the quality of the cardiovascular compensation, and when the brain damage occurred. When scientific proof is not available, the dilemma for the court is the requirement to reach a conclusion about the timing of brain damage on the balance of probabilities. Although it is of value, clinical risk scoring using fetal heart rate (FHR) monitoring may result in false positive predictions of fetal asphyxia. The problem in FHR monitoring is the lack of a detailed algorithm for the interpretation of FHR patterns with appropriate recommendations for management. Until such an algorithm is developed, health care workers cannot be expected to respond to fetal heart rate patterns consistently. Responsibility for the crisis in obstetrics must rest with the members of the health care disciplines who provide expert testimony. Progress made in research encourages us to assume that more is known about the causes of brain damage in the clinical setting than in fact is known. Similarly, health care professionals, parents, and lawyers often assume current methods of prediction and diagnosis to be more effective than they actually are.

sFlt-1/PlGF ratio test for pre-eclampsia: an economic assessment for the UK.

PubMed

Vatish, M; Strunz-McKendry, T; Hund, M; Allegranza, D; Wolf, C; Smare, C

2016-12-01

To assess the economic impact of introducing into clinical practice in the UK the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test for guiding the management of pre-eclampsia. We used an economic model estimating the incremental value of information, from a UK National Health Service payer's perspective, generated by the sFlt-1/PlGF ratio test, compared with current diagnostic procedures, in guiding the management of women with suspected pre-eclampsia. The economic model estimated costs associated with the diagnosis and management of pre-eclampsia in pregnant women between 24 + 0 and 36 + 6 weeks' gestation, managed in either a 'test' scenario in which the sFlt-1/PlGF test is used in addition to current diagnostic procedures, or a 'no-test' scenario in which clinical decisions are based on current diagnostic procedures alone. Test characteristics and resource use were derived from PROGNOSIS, a non-interventional study in women presenting with clinical suspicion of pre-eclampsia. The main outcome measure from the economic model was the cost per patient per episode of care, from first suspicion of pre-eclampsia to birth. Introduction of the sFlt-1/PlGF ratio test into clinical practice is expected to result in cost savings of £344 per patient compared with a no-test scenario. Savings are generated primarily through an improvement in diagnostic accuracy and subsequent reduction in unnecessary hospitalization. Introducing the sFlt-1/PlGF ratio test into clinical practice in the UK was shown to be cost-saving by reducing unnecessary hospitalization of women at low risk of developing pre-eclampsia. In addition, the test ensures that those women at higher risk are identified and managed appropriately. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. © 2016 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Assessing the role of case mix in cesarean delivery rates.

PubMed

Lieberman, E; Lang, J M; Heffner, L J; Cohen, A

1998-07-01

Implicit in comparisons of unadjusted cesarean rates for hospitals and providers is the assumption that differences result from management practices rather than differences in case mix. This study proposes a method for comparison of cesarean rates that takes the effect of case mix into account. All women delivered of infants at our institution from December 1, 1994, through July 31, 1995, were classified according to whether they received care from community-based practitioners (N=3913) or from the hospital-based practice that serves a higher-risk population (N=1556). Women were categorized according to both obstetric history (nulliparas, multiparas without a previous cesarean, multiparas with a previous cesarean) and the presence of obstetric conditions influencing the risk of cesarean delivery (multiple birth, breech presentation or transverse lie, preterm, no trial of labor for a medical indication). We determined the percent of women in each parity-obstetric condition subgroup and calculated a standardized cesarean rate for the hospital-based practice using the case mix of the community-based practitioners as the standard. The crude cesarean rate was higher for the hospital-based practice (24.4%) than for the community-based practitioners (21.5%), a rate difference of 2.9% (95% confidence interval=0.4%, 5.4%; P=.02). However, the proportion of women falling into categories conferring a high risk of cesarean delivery (multiple pregnancy, breech presentation or transverse lie, preterm, no trial of labor permitted) was twice as high for the hospital-based practice (24.4% hospital, 12.1% community). The standardization indicates that if the hospital-based practitioners had the same case mix as community-based practitioners, their overall cesarean rate would be 20.1%, similar to the 21.5% rate of community providers (rate difference=-1.4%, 95% confidence interval =-3.1%, 0.3%; P=.11). Standardization for case mix provides a mechanism for distinguishing differences in cesarean rates resulting from case mix from those relating to differences in practice. The methodology is not complex and could be applied to facilitate fairer comparisons of rates among providers and across institutions.

[Nursing care systematization according to the nurses' view: a methodological approach based on grounded theory].

PubMed

de Medeiros, Ana Lúcia; dos Santos, Sérgio Ribeiro; de Cabral, Rômulo Wanderley Lima

2012-09-01

This study was aimed at understanding, from the nurses' perspective, the experience of going through the Systematization of nursing care (SNC) in an obstetric service unit. We used grounded theory as the theoretical and methodological framework. The subjects of this study consisted of thirteen nurses from a public hospital in the city of João Pessoa, in the state of Paraíba. The data analysis resulted in the following phenomenon. "perceiving SNC as a working method that organizes, directs and improves the quality of care by bringing visibility and providing security for the nursing staff" The nurses expressed the extent of knowledge about the SNC experienced in obstetrics as well as considered the nursing process as a decision-making process, which guides the reasoning of nurses in the planning of nursing care in obstetrics. It was concluded that nurses perceive the SNC as an instrument of theoretical-practical articulation leading to personalized assistance.

The public health impact of training physicians to become obstetricians and gynecologists in Ghana.

PubMed

Anderson, Frank W J; Obed, Samuel A; Boothman, Erika L; Opare-Ado, Henry

2014-02-01

We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health.

"Women come here on their own when they need to": prenatal care, authoritative knowledge, and maternal health in Oaxaca.

PubMed

Sesia, P M

1996-06-01

Physiological and anatomical concepts about reproduction held by traditional midwives in Southern Oaxaca differ considerably from those of biomedicine. Government training courses for traditional midwives disregard these deep-seated differences, and also the underlying conceptual rationale of ethno-obstetrics. These courses constantly reinforce and actively promote the biomedical model of care. But rural midwives, despite these training courses, do not substantially change their obstetrical vision and ways. The strength of their own authoritative knowledge, fully shared by the women and men of their communities, allows them to continue their traditional style of care, despite pressures to conform to biomedical values, beliefs, and practices. Suggestions for a mutual accommodation of biomedical and midwifery approaches to prenatal care include training medical personnel in ethno-obstetric techniques and rationales, teaching midwives basic medical interventions, addressing in intervention programs all social actors participating in reproductive decision making, and adopting an interdisciplinary approach that includes nonmedical aspects of maternal care.

Paving the road for a European postgraduate training curriculum.

PubMed

van der Aa, Jessica E; Goverde, Angelique J; Teunissen, Pim W; Scheele, Fedde

2016-08-01

The 'Project for Achieving Consensus in Training' has been initiated by the European Board & College of Obstetrics and Gynaecology to harmonise training in Obstetrics and Gynaecology throughout Europe. In this project called the EBCOG-PACT, a state of the art pan-European training curriculum will be developed. Implementation of a pan-European curriculum will enhance harmonisation of both quality standards of women's healthcare practice and standards of postgraduate training. Secondly, it will assure equal quality of training of gynaecologists, promoting mobility throughout Europe. Thirdly, it will enhance cooperation and exchange of best practices between medical specialists and hospitals within Europe. The project is expecting to deliver (1) a description of the core and electives of the curriculum based on previously defined standards of care, (2) a societally responsive competency framework based on input from societal stakeholders and (3) strategies for education and assessment based on the current literature. Also, the project focuses on implementation and sustainability of the curriculum by delivering (4) a SWOT-analysis for the implementation based on insights into transcultural differences, (5) recommendations for implementation, change management and sustainability based on the SWOT analysis (6) and finally a handbook for other specialties initiating European curriculum development. The development and the implementation of this modern pan-European curriculum in Obstetrics and Gynaecology aims to serve as an example for the harmonisation of postgraduate training in Europe. Copyright © 2016. Published by Elsevier Ireland Ltd.

Domestic violence screening in pregnancy.

PubMed

Bunn, Mikiko Yazawa; Higa, Nicole A; Parker, Willie J; Kaneshiro, Bliss

2009-11-01

Domestic violence is an important health concern that has been shown to have adverse effects on maternal and neonatal outcomes. The objectives of this study were to compare the prevalence of prenatal screening for domestic violence in a hospital-based resident clinic setting with screening practices in private obstetric offices in Honolulu, Hawai'i and to explore physician attitudes towards domestic violence screening during pregnancy. A retrospective chart review was conducted at Queen's Medical Center in Honolulu, Hawai'i in women who delivered between 2003 and 2004. A 6 item written survey was also given to all attending and resident physicians with obstetric privileges. Descriptive statistics including frequency measures were generated and chi square tests were used to compare categorical variables. A total of 270 charts were reviewed. There was a statistically significant difference (p < 0.01) between the number of antepartum patients from the resident clinic (2.4 percent) and antepartum patients from private obstetric practices (39.3 percent) that were screened for domestic violence. While the majority of respondents (77.6%) to the domestic violence survey were aware that the American College of Obstetricians and Gynecologists recommends domestic violence screening in pregnancy most respondents (69.0 percent) indicated that they "never or rarely" screened their patients for domestic violence. Despite professional recommendations and an awareness of these recommendations, between 2003 and 2004, routine prenatal screening for domestic violence was markedly lacking for patients in this study population.

Physician Practice Information: The Practice Expenses and Characteristics of Sleep Medicine as Compared with Other AMA-Recognized Medical Specialties

PubMed Central

Blehart, Caroline

2009-01-01

Summary: This report introduces the Physician Practice Information (PPI) Survey and its findings. Background information on the PPI Survey is explained, as is the Survey's importance to the field of sleep medicine. Statistics reported by the Survey regarding Practice Expenses per Hour (PE/HR) for various specialties are analyzed in comparison with those reported specifically for sleep medicine. The similarities and differences between sleep medicine and all other medical specialties surveyed in terms of practice characteristics are also discussed. Analysis of PE/HR data found that sleep medicine payroll practice expenses are closest to those of obstetrics/gynecology, likely due to the employment of technologists in both fields. Regarding supplies and equipment expenses, sleep medicine is most similar to radiology, cardiology, and spine surgery, probably due to the use of disposable medical supplies. In terms of total PE/HR (less separately billable), sleep medicine is most like obstetrics/gynecology, orthopedic surgery, and otolaryngology. The full cause of this is undeterminable from the PPI Survey. Some areas of dissimilarity in regard to the practice characteristics of sleep physicians and all physicians surveyed across all specialties were found. Most of these fell in the area of “practice size and function of non-physician personnel.” Overall, the results of this section of the PPI Survey show that sleep medicine is practiced in a manner similar to that of the various specialty fields of all physicians surveyed across all specialties but still maintains some unique practice characteristics. Citation: Blehart C. Physician practice information: the practice expenses and characteristics of sleep medicine as compared with other AMA-recognized medical specialties. J Clin Sleep Med 2009;5(6):E1-E11.

Benefit from NASA

NASA Image and Video Library

2004-04-15

Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006-2012: a descriptive study.

PubMed

Varol, Nesrin; Dawson, Angela; Turkmani, Sabera; Hall, John J; Nanayakkara, Susie; Jenkins, Greg; Homer, Caroline S E; McGeechan, Kevin

2016-10-28

Women, who have been subjected to female genital mutilation (FGM), can suffer serious and irreversible physical, psychological and psychosexual complications. They have more adverse obstetric outcomes as compared to women without FGM. Exploratory studies suggest radical change to abandonment of FGM by communities after migration to countries where FGM is not prevalent. Women who had been subjected to FGM as a child in their countries of origin, require specialised healthcare to reduce complications and further suffering. Our study compared obstetric outcomes in women with FGM to women without FGM who gave birth in a metropolitan Australian hospital with expertise in holistic FGM management. The obstetric outcomes of one hundred and ninety-six women with FGM who gave birth between 2006 and 2012 at a metropolitan Australian hospital were analysed. Comparison was made with 8852 women without FGM who gave birth during the same time period. Data were extracted from a database specifically designed for women with FGM and managed by midwives specialised in care of these women, and a routine obstetric database, ObstetriX. The accuracy of data collection on FGM was determined by comparing these two databases. All women with FGM type 3 were deinfibulated antenatally or during labour. The outcome measures were (1) maternal: accuracy and grade of FGM classification, caesarean section, instrumental birth, episiotomy, genital tract trauma, postpartum blood loss of more than 500 ml; and (2) neonatal: low birth weight, admission to a special care nursery, stillbirth. The prevalence of FGM in women who gave birth at the metropolitan hospital was 2 to 3 %. Women with FGM had similar obstetric outcomes to women without FGM, except for statistically significant higher risk of first and second degree perineal tears, and caesarean section. However, none of the caesarean sections were performed for FGM indications. The ObstetriX database was only 35 % accurate in recording the correct FGM type. Women with FGM had similar obstetric outcomes to women without FGM in an Australian metropolitan hospital with expertise in FGM management. Specialised FGM services with clinical practice guideline and education of healthcare professionals may increase the detection rate of FGM and improve obstetric management of women with FGM.

Temperature Pill

NASA Technical Reports Server (NTRS)

1988-01-01

Ingestible Thermal Monitoring System was developed at Johns Hopkins University as means of getting internal temperature readings for treatments of such emergency conditions as dangerously low (hypothermia) and dangerously high (hyperthermia) body temperatures. ITMS's accuracy is off no more than one hundredth of a degree and provides the only means of obtaining deep body temperature. System has additional applicability in fertility monitoring and some aspects of surgery, critical care obstetrics, metabolic disease treatment, gerontology (aging) and food processing research. Three-quarter inch silicone capsule contains telemetry system, micro battery, and a quartz crystal temperature sensor inserted vaginally, rectally, or swallowed.

[Current status and recommendations for intrapartum monitoring of fetal heart rate].

PubMed

Měchurová, A; Velebil, P; Hruban, L; Janků, P

2016-04-01

Monitoring of fetal heart rate is one of the basic components of obstetrical care, in which the cardiotocography remains the gold standard and screening method in early diagnosis of fetal hypoxia, even after introduction of other selective methods of intrauterine monitoring of fetal well-being. The review article is divided into several parts: pathophysiology of fetal oxygenation, fetal heart rate and changes of fetal hemodynamics, and rules for fetal heart rate auscultation. The main principles of cardiotocographic monitoring and evaluation of ante- and intrapartrum recordings according to the FIGO criteria from 1986 and evaluation of intrapartum recordings according to the 2015 FIGO recommendations are mentioned. At the end a comparative table of 1986 FIGO and 2015 FIGO criteria is presented. Review.

The opinions and experiences of Irish obstetric and gynaecology trainee doctors in relation to abortion services in Ireland.

PubMed

Aitken, Kara; Patek, Paul; Murphy, Mark E

2017-11-01

The provision of abortion services in the Republic of Ireland is legally restricted. Recent legislation that has been implemented allows for abortion if there is a real and substantial risk to the woman's life, but in general Irish women must travel abroad for abortion services. The aims of this study were to investigate the clinical experiences of Irish obstetric non-consultant hospital doctors (NCHDs) that work in this environment and to assess their attitudes towards termination of pregnancy (ToP). We conducted an online cross-sectional descriptive survey of 184 Irish obstetric NCHDs. Quantitate and qualitative analysis was performed. There was a 28% response rate. 88% of respondents thought that ToP should be permitted for fatal fetal abnormality if the parents choose, 96% if the woman's health is severely affected and 86% in cases of rape and incest. Over 90% of respondents believed a woman's health suffers because of the need to travel abroad to undergo a ToP. Physical, psychological and social reasons were explored. The research also highlights that obstetric trainees are actively involved in the provision of preabortion and postabortion care. The clinical experiences and opinions of the respondents suggest that the current legal availability of abortion in Ireland is insufficient to guide best clinical practice and does not represent the views of those that provide obstetric care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Applications of and Barriers to Holistic Self-Care in a Low-Income, High-Risk Obstetric Population.

PubMed

Rhoades, Katherine; Telliard, Sarah; Thomas, Tiffany Stanfill; Barkin, Jennifer L

We examined 1) women's perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care. Four focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women's valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied. Although women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money. Socioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Does the "office nurse" level of training matter in the family medicine office?

PubMed

Erickson, Rodney A; Erickson, Richard A; Targonski, Paul V; Cox, Stephen B; Deming, James R; Mold, James W

2012-01-01

The "office nurse" or clinical associate (registered nurse [RN], licensed practical nurse[LPN], or medical assistant [MA]) is a key member of the family medicine care team, but little is known about the influence of their level of training on team performance. The performance of the clinical dyad (clinician and associate) was studied in relation to the level of training of the nurse. The dyad's performance was measured by the performance indicators of diabetes scores, patient satisfaction, and productivity. Dyads with a RN scored higher in meeting all 5 of the diabetes quality indicators (27.8%) than those with a LPN (19.3%) or an MA (14.7%). For patient satisfaction, the RN dyads also scored higher than the other dyad groups (positive responses: RN, 96.8%; LPN, 95.5%; MA, 94.6%). Productivity was the same in all groups. Better diabetes performance was seen in those practices with fewer competing demands: nonrural versus rural (22.2% vs 15.1%, respectively), and those not doing obstetrics versus those doing obstetrics (20.3% vs 15.1%, respectively), and for physicians versus associate providers (18.8% vs 15.1%, respectively). Higher patient satisfaction was observed in those dyads who were nonrural verus rural (96.6 vs 94.1%), among those doing obstetrics (96.0% vs 94.9%), and in physicians verus associate providers (95.7% vs 93.2%). The number of years working with the same clinician was twice as high for RNs (6.63) and LPNs (6.57) than for MAs (3.29). A higher level of education of the clinical associate seems to confer skills that enhance the care team's management of chronic illness such as diabetes. This could potentially decrease the practice burden on other team members while facilitating the team's objectives in meeting quality indicators.

Provision and practice of specialist preterm labour clinics: a UK survey of practice.

PubMed

Sharp, A N; Alfirevic, Z

2014-03-01

To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. Postal survey of clinical practice. All consultant-led obstetric units within the UK. A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Current practice in specialist preterm labour clinics. We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae. © 2013 Royal College of Obstetricians and Gynaecologists.

Clinical peptidomic analysis by a one-step direct transfer technology: its potential utility for monitoring of pathophysiological status in female reproductive system disorders.

PubMed

Araki, Yoshihiko; Nonaka, Daisuke; Hamamura, Kensuke; Yanagida, Mitsuaki; Ishikawa, Hitoshi; Banzai, Michio; Maruyama, Mayuko; Endo, Shuichiro; Tajima, Atsushi; Lee, Lyang-Ja; Nojima, Michio; Takamori, Kenji; Yoshida, Koyo; Takeda, Satoru; Tanaka, Kenji

2013-10-01

To date, numerous studies have searched for candidate molecules or clinical examination methods as potential biomarkers for monitoring intractable diseases, such as carcinomas. Evidence accumulated over the past decade shows that many proteolytic peptides appear in human humoral fluids, including peripheral blood, in association with an individual's health condition. Although an analysis of the whole peptide (the 'peptidome') using mass spectrometry is thought to be one of the most powerful and promising experimental approaches, it has failed to identify biomarkers in the clinical blood samples, presumably due to the methodological limitations. In general, commonly used techniques for proteomic analysis of blood require the removal of large amounts of serum/plasma proteins prior to mass spectrometry analysis, and this step seems to have resulted in the overlooking of important biomarkers during the analytical process. Here, we provide a brief overview of a new quantitative peptidomic analysis by a one-step direct transfer technology without depletion of major blood proteins. Using this technology, we herein report experimental data on serum peptidomic analysis for patients with pregnancy-induced hypertension as a clinical model. In addition, we refer to the potential utility of this approach for the monitoring of pathophysiological status in female reproductive system disorders in general. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Atypical preeclampsia – Gestational proteinuria

PubMed Central

Stevens, Amy B.; Brasuell, Diane M.; Higdon, Rebecca N.

2017-01-01

There are many rural areas where obstetric care is predominately performed by family medicine physicians. As such, it is important for family medicine physicians to stay up to date with the latest obstetric guidelines. Preeclampsia is a well-established disorder and the guidelines for screening and treatment are well known. However, atypical presentations of preeclampsia have been less studied. Notably, what constitutes atypical preeclampsia and when to be concerned for increased morbidity and mortality in the mother and neonate. This report describes a unique case in which a woman with proteinuria of pregnancy developed atypical preeclampsia with severe features. This report discusses the care that was given by a practicing family medicine physician and the reasoning behind it. PMID:29417031

Rapid hypnosis as an anaesthesia adjunct for evacuation of postpartum vulval haematoma.

PubMed

Wong, Lufee; Cyna, Allan M; Matthews, Geoffrey

2011-06-01

Hypnosis can be a useful therapeutic adjunct to pharmacological analgesia or anaesthesia in obstetrics. However, it is rarely considered a primary anaesthetic technique and is seldom employed in the acute surgical setting. Few obstetricians and anaesthetists currently utilise this technique in their clinical practice. We present a case report of a 34-year-old woman who successfully underwent evacuation of a large vulval haematoma using the simple hypnosis technique of 'believed-in imagination' as the principal anaesthetic technique with only minimal adjunctive pharmacological analgesia. © 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Gestational age estimation on United States livebirth certificates: a historical overview.

PubMed

Wier, Megan L; Pearl, Michelle; Kharrazi, Martin

2007-09-01

Gestational age on the birth certificate is the most common source of population-based gestational age data that informs public health policy and practice in the US. Last menstrual period is one of the oldest methods of gestational age estimation and has been on the US Standard Certificate of Live Birth since 1968. The 'clinical estimate of gestation', added to the standard certificate in 1989 to address missing or erroneous last menstrual period data, was replaced by the 'obstetric estimate of gestation' on the 2003 revision, which specifically precludes neonatal assessments. We discuss the strengths and weaknesses of these measures, potential research implications and challenges accompanying the transition to the obstetric estimate.

[A day in the busy obstetric unit from the anesthesiologist point of view, experience at the Cleveland clinic; Cleveland, Ohio].

PubMed

Ootaki, Chiyo; Barsoum, Sabri

2009-10-01

Cleveland Clinic Labor and Delivery Unit is a syntactical delivery facility and comprised of 16 delivery rooms, 3 operating rooms, 3 triage rooms, and 1 recovery room that has a capacity of 6 beds, 43 postpartum rooms, 2 nurseries, and 1 neonatal intensive care unit (NICU). Cleveland Clinic Labor and Delivery Unit (LDU) had 3,691 delivery cases in 2007. The ratio of neuraxial analgesia (NA) during labor is 84.2% (2,348/ 2,787), using epidural anesthesia or combined spinalepidural anesthesia (CSEA). This article introduces the obstetrical (OB) anesthesia practice at the Cleveland Clinic and our novel anesthetic regime as typical of one typical busy day.

Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

PubMed

Sentilhes, Loïc; Sénat, Marie-Victoire; Boulogne, Anne-Isabelle; Deneux-Tharaux, Catherine; Fuchs, Florent; Legendre, Guillaume; Le Ray, Camille; Lopez, Emmanuel; Schmitz, Thomas; Lejeune-Saada, Véronique

2016-08-01

Shoulder dystocia (SD) is defined as a vaginal delivery in cephalic presentation that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed. It complicates 0.5-1% of vaginal deliveries. Risks of brachial plexus birth injury (level of evidence [LE]3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) increase with SD. Its main risk factors are previous SD and macrosomia, but both are poorly predictive; 50-70% of SD cases occur in their absence, and most deliveries when they are present do not result in SD. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of SD. Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for SD (Grade C). In obese women, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (Grade A). Women with gestational diabetes require diabetes care (diabetic diet, glucose monitoring, insulin if needed) (Grade A) because it reduces the risk of macrosomia and SD (LE1). Only two measures are proposed for avoiding SD and its complications. First, induction of labor is recommended in cases of impending macrosomia if the cervix is favorable at a gestational age of 39 weeks or more (professional consensus). Second, cesarean delivery is recommended before labor in three situations and during labor in one: (i) estimated fetal weight (EFW) >4500g if associated with maternal diabetes (Grade C), (ii) EFW >5000g in women without diabetes (Grade C), (iii) history of SD associated with severe neonatal or maternal complications (professional consensus), and finally during labor, (iv) in case of fetal macrosomia and failure to progress in the second stage, when the fetal head station is above +2 (Grade C). In cases of SD, it is recommended to avoid the following actions: excessive traction on the fetal head (Grade C), fundal pressure (Grade C), and inverse rotation of the fetal head (professional consensus). The McRoberts maneuver, with or without suprapubic pressure, is recommended first (Grade C). If it fails and the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, it is preferable to attempt to deliver the posterior arm next (professional consensus). It appears necessary to know at least two maneuvers to perform should the McRoberts maneuver fail (professional consensus). A pediatrician should be immediately informed of SD. The initial clinical examination should check for complications, such as brachial plexus injury or clavicle fracture (professional consensus). If no complications are observed, neonatal monitoring need not be modified (professional consensus). The implementation of practical training with simulation for all care providers in the delivery room is associated with a significant reduction in neonatal (LE3) but not maternal (LE3) injury. SD remains an unpredictable obstetric emergency. All physicians and midwives should know and perform obstetric maneuvers if needed, quickly but calmly. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

PubMed

Jain, Anrudh K; Sathar, Zeba; Salim, Momina; Shah, Zakir Hussain

2013-09-01

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

Contracting in specialists for emergency obstetric care- does it work in rural India?

PubMed

Randive, Bharat; Chaturvedi, Sarika; Mistry, Nerges

2012-12-31

Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India. Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped. Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility. Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.

Contracting in specialists for emergency obstetric care- does it work in rural India?

PubMed Central

2012-01-01

Background Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India. Methods Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped. Results Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility. Conclusions Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration. PMID:23276148

The role of obstetrical rituals in the resolution of cultural anomaly.

PubMed

Davis-Floyd, R E

1990-01-01

To a technological society like that of the United States, the natural process of childbirth presents special conceptual dilemmas, as it calls into perpetual question any boundaries American culture tries to delineate between itself and nature. The author builds on previous works in which she has argued that the American core value system centers around science and technology, the institutions through which these are disseminated into society, and the patriarchal system through which these institutions are managed. A constant reminder that babies come from women and nature, not from technology and culture, childbirth confronts American society with practical, procedural dilemmas: How to create a sense of cultural control over birth, a natural process resistant to such control? How to make birth, a powerfully female phenomenon, reinforce, instead of undermine, the patriarchal system upon which American society is still based? How to turn the natural and individual birth process into a cultural rite of passage which successfully inculcates the dominant core value system into the initiates? In the absence of universal baptism, how to enculturate a non-cultural baby? Some of the dilemmas discussed in this article are universal problems presented by the birth process to all human societies; others are specific to American culture. Each contains within it a fundamental paradox, an opposition which must be culturally reconciled lest the anomaly of its existence undermine the fragile technology-based conceptual system in terms of which American society organizes itself. After a brief discussion of the history of this technological paradigm, the author analyzes eight of the dilemmas presented by childbirth to American society, demonstrating how they have been neatly resolved by obstetrical rituals specifically designed to removed birth's conceptual threat to the technological model by making birth appear, through technological means, to confirm instead of challenge the basic tenets of that model. From this perspective, routinely used obstetrical procedures such as electronic fetal monitoring, episiotomies, the lithotomy position, and even the Cesarean section emerge as rational ritual responses to the conflicts between reality as American society has constructed it, and the physiological realities of birth.

Establishing cross-discipline consensus on contraception, pregnancy and breast feeding-related educational messages and clinical practices to support women with rheumatoid arthritis: an Australian Delphi study

PubMed Central

Jordan, Joanne E; Ackerman, Ilana N; Van Doornum, Sharon

2016-01-01

Objective Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas. Design 3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas. Subsequently, panellists refined and scored the synthesised responses, presented as metathemes, themes and detailed elements. Where ≥5% of panellists did not support a theme in a given round, it was removed. Setting Panel of practicing Australian rheumatologists (n=22), obstetricians/obstetric medicine physicians (n=9) and pharmacists (n=5). Results 34 (94.4%) panellists participated in all 3 rounds. The panel supported 18 themes across the 5 areas (support/strongly support: 88.2–100%) underpinned by 5 metathemes. Metathemes focused on coordination in information delivery, the mode and timing of information delivery, evidence underpinning information, engagement of the right health professionals at the right time and a non-judgemental approach to infant feeding. Themes included practices for primary prevention of chronic disease and their sequelae, the importance of contraception and planning pregnancy and breast feeding, close monitoring of medications, supporting mental well-being, managing disease activity and providing practical support for early parenting. Conclusions A cross-disciplinary clinical panel highly supported key information and clinical practices in the care for women with RA across the continuum of contraception to early parenting within a whole-person, chronic disease management approach. PMID:27633637

John Whitridge Williams' contribution to democracy abroad. (The fetus treated as a patient).

PubMed

Vasicka, A

1999-04-01

The idealism of American pioneers was a driving force in the development of science, democracy, and sociology in the United States. It also served as a model for the development of new democracies abroad. The first American grafted democracy was established in Czechoslovakia in 1918, under Thomas Garrigue Masaryk as President. As a former professor of philosophy, at Charles University in Prague, he built the foundation of Czechoslovakian democracy on the historical principles of Jan Hus' search for the truth (1415), Jan Amos Komensky's use of Science and Humanism (1630), and on the values of American democracy as he conceived it from multiple visits to the United States and from the practical philosophy of his American wife. His major educational means was the use of science. He became a founder of political science. As president he recognized, that democracy, as a state form, does not educate people, they educate themselves through family, school, church, physician and life experience. In the last quarter of the nineteenth century, on the eve of the opening of John Hopkin's University Hospital, a young American scientist by the name John Whitridge Williams came to Prague, Vienna, and other Europeans cities for the purpose of studying scientific obstetrics. He believed in the power of the truth in the power of the truth equally as Masaryk did and used science uncompromisingly in his speciality. He became the founder of American scientific obstetrics. He was shy of political science and ethnic problems. There was no personal connection between Masaryk and Williams. In 1903, John Whitridge Williams published his review of European and American obstetrics: he abolished the craft of obstetrics and worked the science of physiology and pathology into the practice of obstetrics. For Czechoslovaks the political democracy coming out of America through Masaryk was attractive, but of particular interest was native and personal democracy of Americans as a way of life. John Whitridge Williams' book contributed to European families, even though only through obstetricians, the knowledge about American pioneering, optimism, humanism, and a sense of freedom Williams considered the fetus as a patient and thought of education of the physician and patient of equal and fundamental importance: the mother was to participate in the process and the physician to understand the process. He himself understood feto-placental circulation, maternal metabolism, and the need of maternal participation on fetal development. He commanded physicians' respect of the patient and committed the obstetrician to the life long study of his patients. He considered research inseparable from intelligent care, and his book a guide of how and what to study, not a manual of procedures. Williams' greatest contribution to mankind was abolishing the craft of obstetrics and replacing it by sciences that brought to obstetrics humanism, selflessness, and knowledge. He was the first physician in the history of obstetrics who achieved a balance of science and humanism. The second contribution, of equal importance, was his undertaking a scientific review of European and American obstetrics which served the world as a window of the values of America's pioneer civilization. It made obstetrics a scientific discipline, attracted innumerable new students abroad, and through them promoted American democracy in their relations with patients. Williams' impact on European society was considerable. However, subtle at first, it was not included in the literature. He did not participate personally in the establishment of democracy in Czechoslovakia, but strengthened Masaryk's teaching programs through those Czechoslovakian obstetricians who adapted his scientific teachings and made him a model of American democracy as a view on life. Masaryk himself had in his presidential emblem a sign, veritas vincit, and through it, he accomplished twenty years of the most extraordinary democracy in the world.

Measuring facility capability to provide routine and emergency childbirth care to mothers and newborns: An appeal to adjust for delivery caseload of facilities

PubMed Central

Allen, Stephanie M.; Opondo, Charles; Campbell, Oona M. R.

2017-01-01

Background Measurement of Emergency Obstetric Care capability is common, and measurement of newborn and overall routine childbirth care has begun in recent years. These assessments of facility capabilities can be used to identify geographic inequalities in access to functional health services and to monitor improvements over time. This paper develops an approach for monitoring the childbirth environment that accounts for the delivery caseload of the facility. Methods We used data from the Kenya Service Provision Assessment to examine facility capability to provide quality childbirth care, including infrastructure, routine maternal and newborn care, and emergency obstetric and newborn care. A facility was considered capable of providing a function if necessary tracer items were present and, for emergency functions, if the function had been performed in the previous three months. We weighted facility capability by delivery caseload, and compared results with those generated using traditional “survey weights”. Results Of the 403 facilities providing childbirth care, the proportion meeting criteria for capability were: 13% for general infrastructure, 6% for basic emergency obstetric care, 3% for basic emergency newborn care, 13% and 11% for routine maternal and newborn care, respectively. When the new caseload weights accounting for delivery volume were applied, capability improved and the proportions of deliveries occurring in a facility meeting capability criteria were: 51% for general infrastructure, 46% for basic emergency obstetric care, 12% for basic emergency newborn care, 36% and 18% for routine maternal and newborn care, respectively. This is because most of the caseload was in hospitals, which generally had better capability. Despite these findings, fewer than 2% of deliveries occurred in a facility capable of providing all functions. Conclusion Reporting on the percentage of facilities capable of providing certain functions misrepresents the capacity to provide care at the national level. Delivery caseload weights allow adjustment for patient volume, and shift the denominator of measurement from facilities to individual deliveries, leading to a better representation of the context in which facility births take place. These methods could lead to more standardized national datasets, enhancing their ability to inform policy at a national and international level. PMID:29049412

Strategies for preventing group B streptococcal infections in newborns: a nation-wide survey of Italian policies.

PubMed

Tzialla, Chryssoula; Berardi, Alberto; Farina, Claudio; Clerici, Pierangelo; Borghesi, Alessandro; Viora, Elsa; Scollo, Paolo; Stronati, Mauro

2017-11-02

There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations.

[Quantitative assessment of medical students' clinical practical learning in department of obstetrics and gynecology of Brest Hospital University].

PubMed

Muller, M; Monfort, X; Dupré, P-F; Amouroux, P; Tétefort, R; Jaffrelot, M; De Parscau, L; Collet, M

2011-10-01

The main objective of this study was to describe how medical students got progressively trained to perform the most frequent medical procedures in obstetrics and gynecology. The secondary objective was to rationalize and plan the training. The medical students in our University Hospital were contacted either directly or by e-mail. They were given an anonymous simple choice questionnaire relating to eight most important acts in the specialty. Three hundred and eighty-two medical students have been consulted. We got 173 answers which means a participation rate of 45.3%. The survey showed up that the considered procedures were progressively put into practice with the exception of two: the insertion of an intrauterine contraceptive device (coil) and of an implant. The study showed off some insufficiency in the training in two of the considered procedures. An amendment was proposed with simulated performances of the acts and the setting up of a training course booklet. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

There Is No Place Like Home: Imitation and the Politics of Recognition in Bolivian Obstetric Care.

PubMed

Morales, Gabriela Elisa

2018-01-17

This article examines how efforts to "culturally adapt" birthing spaces in a rural Bolivian hospital are generating debates among doctors about what constitutes proper obstetric care. Working at the intersection of national and transnational projects, NGOs in Bolivia have remade the birthing rooms of some public health institutions to look more like a home, with the goal of making indigenous women feel more comfortable and encouraging them to come to the clinic to give birth. Yet narratives of transformation also obscure ongoing conditions of racial and gendered inequality in health services. I demonstrate how doctors' use of culturally adapted technologies enacts shifting affective relations-warm, cold, gentle, harsh-that draws on preoccupations with indigenous culture as a threat to maternal and infant life. In tracing practices of care, I argue that culturally adapted birthing in many ways extends historically rooted practices of doing biomedical work on indigenous bodies. © 2018 by the American Anthropological Association.

Association of Group Prenatal Care in US Family Medicine Residencies With Maternity Care Practice: A CERA Secondary Data Analysis.

PubMed

Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M

2017-03-01

Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.

Multicentre study on factors affecting the gynaecologic oncology career choice of canadian residents in obstetrics and gynaecology.

PubMed

Dodge, Jason E; Chiu, Hannah H; Fung, Sharon; Rosen, Barry P

2010-08-01

The provision of optimal care for women with gynaecologic cancer may be threatened due to the changing demographics of patients and the projected increasing shortage of gynaecologic oncologists in Canada. We evaluated the career plans of Canadian residents in obstetrics and gynaecology to determine the proportion of residents currently considering a career in gynaecologic oncology (GO) and to explore factors that may affect their career decisions. Following institutional ethics approval, all residents at 13 participating Canadian obstetrics and gynaecology residency training programs were contacted by email to complete a 20-item confidential questionnaire examining career plans. Quantitative data were analyzed using SAS v9.1. Qualitative data were coded by theme and grouped into various domains. Of 293 residents, 105 (36%) participated. More than half of these were considering at least one obstetrics and gynaecology subspecialty, but 53% indicated that their most appealing career path was general obstetrics and gynaecology. Although 50% of residents had ever considered a career in GO, only 17% were considering a GO career at the time of the survey. When rated as positive influences, medical school exposure, resident exposure, role models within GO, colleagues, other health care professionals, "my individual life circumstances," "my personal attributes," the clinical, research, and educational components of GO, the GO patient population, and relation with gynaecologic oncologists and other specialists were significant predictors of current GO interest. Themes that emerged from qualitative analysis revealed that the clinical, professional, and research domains were predominant influences among residents currently considering a career in GO. GO is an infrequent career choice for Canadian residents in obstetrics and gynaecology, and a number of factors significantly affect GO career decisions. Modifying factors such as educational experiences, work environment, and current practice models may lead to improved recruitment to the subspecialty, which is crucial for meeting the future needs of women with gynaecologic malignancies in Canada.

Two sides of the same coin--an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management.

PubMed

Åhman, Annika; Persson, Margareta; Edvardsson, Kristina; Lalos, Ann; Graner, Sophie; Small, Rhonda; Mogren, Ingrid

2015-11-20

The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman's reproductive freedom. The purpose of this study was to explore Swedish obstetricians' experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict. A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis. The theme that emerged in the analysis 'Two sides of the same coin' depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman's health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety. The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician's position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.

[Shoulder dystocia: Guidelines for clinical practice--Short text].

PubMed

Sentilhes, L; Sénat, M-V; Boulogne, A-I; Deneux-Tharaux, C; Fuchs, F; Legendre, G; Le Ray, C; Lopez, E; Schmitz, T; Lejeune-Saada, V

2015-12-01

To determine the available evidence to prevent and treat shoulder dystocia to attempt to decrease its related neonatal and maternal morbidity. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Shoulder dystocia, defined as a vaginal delivery that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed, complicates 0.5-1 % of vaginal deliveries. Risks of brachial plexus birth injury (LE3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) are increased after shoulder dystocia. Its main risk factors are previous shoulder dystocia and macrosomia, but they are poorly predictive; 50 % to 70 % of shoulder dystocia cases occur in their absence, and the great majority of deliveries when they are present are not associated with shoulder dystocia. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia (SD). Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for shoulder dystocia (grade C). In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (grade A). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (LE1). In order to avoid shoulder dystocia and its complications, only two measures are proposed. Induction of labor is recommended in case of impending macrosomia if the cervix is favourable and gestational age greater than 39 weeks of gestation (professional consensus). Cesarean delivery is recommended before labor in case of EFW greater than 4500g if associated with maternal diabetes (grade C), EFW greater than 5000g in the absence of maternal diabetes (grade C), history of shoulder dystocia associated with severe neonatal or maternal complications (Professional consensus), and finally during labor, in case of fetal macrosomia and failure to progress in the second stage, when the fetal head is above a +2 station (grade C). In case of shoulder dystocia, it is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts' maneuver, with or without a suprapubic pressure, is recommended in the first line (grade C). In case of failure, if the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver of McRoberts (professional consensus). Pediatrician should be immediately informed in case of shoulder dystocia. The initial clinical examination should search complications such as brachial plexus birth injury or clavicle fracture (professional consensus). In absence of neonatal complication, monitoring of the neonate is not modified (professional consensus). The implementation of a practical training using simulation and concerning all caregivers of the delivery room is associated with a significant reduction in neonatal (LE3) but not maternal (LE3) injury. Shoulder dystocia remains a non-predictable obstetrics emergency. All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation. A training program using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional consensus). Copyright © 2015. Published by Elsevier Masson SAS.

Implementation of effective practices in health facilities: a systematic review of cluster randomised trials.

PubMed

Allanson, Emma R; Tunçalp, Özge; Vogel, Joshua P; Khan, Dina N; Oladapo, Olufemi T; Long, Qian; Gülmezoglu, Ahmet Metin

2017-01-01

The capacity for health systems to support the translation of research in to clinical practice may be limited. The cluster randomised controlled trial (cluster RCT) design is often employed in evaluating the effectiveness of implementation of evidence-based practices. We aimed to systematically review available evidence to identify and evaluate the components in the implementation process at the facility level using cluster RCT designs. All cluster RCTs where the healthcare facility was the unit of randomisation, published or written from 1990 to 2014, were assessed. Included studies were analysed for the components of implementation interventions employed in each. Through iterative mapping and analysis, we synthesised a master list of components used and summarised the effects of different combinations of interventions on practices. Forty-six studies met the inclusion criteria and covered the specialty groups of obstetrics and gynaecology (n=9), paediatrics and neonatology (n=4), intensive care (n=4), internal medicine (n=20), and anaesthetics and surgery (n=3). Six studies included interventions that were delivered across specialties. Nine components of multifaceted implementation interventions were identified: leadership, barrier identification, tailoring to the context, patient involvement, communication, education, supportive supervision, provision of resources, and audit and feedback. The four main components that were most commonly used were education (n=42, 91%), audit and feedback (n=26, 57%), provision of resources (n=23, 50%) and leadership (n=21, 46%). Future implementation research should focus on better reporting of multifaceted approaches, incorporating sets of components that facilitate the translation of research into practice, and should employ rigorous monitoring and evaluation.

Service readiness, health facility management practices, and delivery care utilization in five states of Nigeria: a cross-sectional analysis.

PubMed

Gage, Anastasia J; Ilombu, Onyebuchi; Akinyemi, Akanni Ibukun

2016-10-06

Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15-49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural-urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care.

What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.

PubMed

Bouvier-Colle, M-H; Mohangoo, A D; Gissler, M; Novak-Antolic, Z; Vutuc, C; Szamotulska, K; Zeitlin, J

2012-06-01

To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. Twenty-five countries in the European Union and Norway. Women giving birth in participating countries in 2003 and 2004. Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100,000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist.

PubMed

Chau, Anthony; Tsen, Lawrence C

2014-06-01

In many labor and delivery units, the obstetric anesthesiologist is often responsible for managing and stabilizing the acutely septic parturient. The management of maternal sepsis has been summarized previously; this study will focus on the implications of maternal sepsis on the fetus, and ways to optimize fetal outcomes. Although the complex pathophysiology of sepsis is being better understood, the incidence of maternal severe sepsis and deaths continues to increase. The differential sensitivities of systemic and uterine vasculature to catecholamines during pregnancy and the role of fetal inflammatory responses have recently been further elucidated. Additional investigations on methods of fetal monitoring are needed to assist in early identification of the compromised fetus. Despite decades of research, management of a septic parturient and her fetus, including the most appropriate resuscitation fluids, vasopressors and hemodynamic monitoring systems to maximize maternal and fetal outcomes, remain controversial. In the setting of maternal sepsis, fetal optimization is frequently best accomplished by meeting maternal hemodynamic, oxygenization, and infection treatment goals. Understanding the circulatory and pathophysiologic changes that occur within the uteroplacental unit and fetus is essential to identifying and resolving potential conflicts between maternal and fetal management goals.

User friendly IT Services for Monitoring and Prevention during Pregnancy.

PubMed

Crişan-Vida, Mihaela; Serban, Alexandru; Ghihor-Izdrăilă, Ioana; Mirea, Adrian; Stoicu-Tivadar, Lacramioara

2014-01-01

A healthy lifestyle for a mother and monitoring both mother and fetus activities are crucial factors for a normal pregnancy without hazardous conditions. This paper proposes a cloud computing solution and a mobile application which collect data from the sensors to be used in Obstetrics-Gynecology Department. This application monitors the dietary plan of the pregnant and gives her the possibility to socialize and share pregnancy experience with the rest of women from the social network from the hospital. The physicians can access the information's of the patient in real time and they can alert mothers in some situations. Using this cloud computing device, the health condition of the pregnant women may be improved.

Theoretical considerations to optimize transabdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

NASA Astrophysics Data System (ADS)

Zourabian, Anna; Boas, David A.

2001-06-01

Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are: the first in the range of 670-720nm and the second in the range of 825-925nm. Further we discuss the possible systematic errors during our measurements, and their contribution to the obtained saturation results.

Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? A study from Ecuador.

PubMed

Sánchez Del Hierro, Galo; Remmen, Roy; Verhoeven, Veronique; Van Royen, Paul; Hendrickx, Kristin

2014-07-31

The aim of this study was to assess the possible mismatch of obstetrical skills between the training offered in Ecuadorian medical schools and the tasks required for compulsory rural service. Primary care, rural health centres in Southern Ecuador. A total of 92 recent graduated medical doctors during their compulsory rural year. A web-based survey was developed with 21 obstetrical skills. The questionnaire was sent to all rural doctors who work in Loja province, Southern Ecuador, at the Ministry of Health (n=92). 'importance of skills in rural practice' with a five-point Likert-type scale (1= strongly disagree; 5= strongly agree); and 'clerkship experience' using a nominal scale divided in five levels: level 1 (not seen, not performed) to level 5 (performed 10 times or more). Spearman's rank correlation coefficient (r) was used to observe associations. A negative correlation was found in the skills: 'episiotomy and repair', 'umbilical vein catheterisation', 'speculum examination', 'evaluation of cervical dilation during active labour', 'neonatal resuscitation' and 'vacuum-assisted vaginal delivery'. For instance 'Episiotomy and repair' is important (strongly agree and agree) to 100% of respondents, but in practice, only 38.9% of rural doctors performed the task three times and 8.3% only once during the internship, similar pattern is seen in the others. In this study we have noted the gap between the medical needs of populations in rural areas and training provided during the clerkship experiences of physicians during their rural service year. It is imperative to ensure that rural doctors are appropriately trained and skilled in the performance of routine obstetrical duties. This will help to decrease perinatal morbidity and mortality in rural Ecuador. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Dutch translation of the ICMART-WHO revised glossary on ART terminology.

PubMed

De Neubourg, D; van Duijnhoven, N T L; Nelen, W L D M; D'Hooghe, T M

2012-01-01

A standardized set of definitions was needed in the field of medically assisted reproduction (MAR) to standardize and harmonize international data acquisition and to monitor the availability, efficacy, and safety of assisted reproductive technology (ART) worldwide. In order to provide accurate national data, the use of a terminology list which was composed and negotiated by the International Committee for Monitoring Assisted Reproductive Technology (ICMART) is essential, and a translation into Dutch was crucial for its implementation in Belgium and the Netherlands. The authors of the Dutch article translated the English publication that appeared simultaneously in Human Reproduction and Fertility and Sterility in 2009. A consensus text was obtained after evaluation by experts in the field of MAR both in the Netherlands and in Belgium and then by the board of the respective organizations of obstetrics and gynecology. It was then sent to the World Health Organization (WHO) for approval of publication. A translation into Dutch of the ICMART terminology of 2009 was obtained after consensus was reached on clinical and laboratory procedures, outcome variables, and birth. The availability and use of standardized terminology and its translation into Dutch will add to a more standardized communication between professionals responsible for the practice of ART and for those responsible for national, regional, and international registries. Copyright © 2012 S. Karger AG, Basel.

Cognitive Elements in Clinical Decision-Making

ERIC Educational Resources Information Center

Dunphy, Bruce C.; Cantwell, Robert; Bourke, Sid; Fleming, Mark; Smith, Bruce; Joseph, K. S.; Dunphy, Stacey L

2010-01-01

Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for…

The obstetrical and postpartum benefits of continuous support during childbirth.

PubMed

Scott, K D; Klaus, P H; Klaus, M H

1999-12-01

The purpose of this article is to review the evidence regarding the effectiveness of continuous support provided by a trained laywoman (doula) during childbirth on obstetrical and postpartum outcomes. Twelve individual randomized trials have compared obstetrical and postpartum outcomes between doula-supported women and women who did not receive doula support during childbirth. Three meta-analyses, which used different approaches, have been performed on the results of the clinical trials. Emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula. Labor support by fathers does not appear to produce similar obstetrical benefits. Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding, and increased sensitivity of the mother to her child's needs. The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor.

Fellowship training and board certification in reproductive endocrinology and infertility.

PubMed

Gambone, Joseph C; Segars, James H; Cedars, Marcelle; Schlaff, William D

2015-07-01

Reproductive endocrinology and infertility (REI) is one of the original officially recognized subspecialties in obstetrics and gynecology and among the earlier subspecialties in medicine. Recognized by the American Board of Obstetrics and Gynecology in 1972, fellowship programs are now 3 years in length following an obstetrics and gynecology residency. Originally focused on endocrine problems related to reproductive function, the assisted reproductive technologies (ART) have recently become the larger part of training during REI fellowships. It is likely that the subspecialty of REI strengthens the specialty of obstetrics and gynecology and enhances the educational experience of residents in the field. The value of training and certification in REI is most evident in the remarkable and consistent improvement in the success of ART procedures, particularly in vitro fertilization. The requirement for documented research activity during REI fellowships is likely to stimulate a more rapid adoption (translation) of newer research findings into clinical care after training. Although mandatory reporting of outcomes has been proposed as a reason for this improvement the rapid translation of reproductive research into clinical practice is likely to be a major cause. Looking forward, REI training should emphasize and strengthen education and research into the endocrine, environmental, and genetic aspects of female and male reproduction to improve the reproductive health and fertility of all women. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

[Prevention and detection of obstetric violence: A need in the Spanish delivery rooms?].

PubMed

Freire Barja, Natalia; Luces Lago, Ana María; Mosquera Pan, Lucía; Tizón Bouza, Eva

2016-01-01

The obstetric violence (OV) is the type of violence perpetrated against the pregnant woman through acts such as lack of respect to her autonomy and her freedom to decide. The increasing medicalization of the labour process, seems to be associated to this type of violence. Our objective is to provide health professionals with the necessary knowledge to be able to inform their patients about their rights and recognize those situations that can imply violence during the care process. The literature search was conducted in the following databases: PubMed, Cochrane Database of Systematic Reviews, EMBASE, Joanna Briggs Institute, UpToDate and CUIDEN. The search was limited to articles published during the last five years. The next medical subject heading were used both in English and Spanish: "humanizing delivery", "obstetrics", "medicalization" and "violence". The performance of harmful practices and the unjustified medicalization of the labour process represent a potential damage to pregnant women by action, violating their rights as a result. To prevent and eradicate this, new lines of less interventionist work are being proposed. As health professionals we should promote the humanization of labour and informs women about the existent legislation, protocols and guidelines that offer adequate information based on the latest evidence and promote their advance role as patients. The health institutions are responsible for initiating this change, by implementing protocols to guide the practice of the health professionals involved in the care of women during labour. These protocols should be based on the WHO recommendations.

Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review.

PubMed

Malvasi, Antonio; Zaami, Simona; Tinelli, Andrea; Trojano, Giuseppe; Montanari Vergallo, Gianluca; Marinelli, Enrico

2018-02-21

A significant amount of data concerning maternal-fetal damage arising from the exertion of Kristeller maneuvers (KMs) or fundal pressure (FP) go unreleased due to medicolegal implications. For this reason, the paper gathers information as to the real magnitude of litigation related to FP-induced damages and injuries. The authors have undertaken a research in order to include general search engines (PubMed-Medline, Cochrane, Embase, Google, GyneWeb) and legal databases (De Jure, Italian database of jurisprudence daily update; Westlaw, Thomson Reuters, American ruling database and Bailii, UK Court Ruling Database). Results confirm said phenomenon to be more wide ranging than it appears through official channels. Several courts of law, both in the United States of America (USA) and in European Union (EU) Member States as well, have ruled against the use of the maneuver itself, assuming a stance conducive to a presumption of guilt against those doctors and healthcare providers who resorted to KMs or FP during deliveries. Given how rife FP is in mainstream obstetric practice, it is as if there were a wide gap between obstetric real-life and what official jurisprudence and healthcare institutions-sanctioned official practices are. The authors think that it would be desirable to draft specifically targeted guidelines or recommendations on maneuvers during vaginal delivery, in which to point out exactly what kinds of maneuvering techniques are to be absolutely banned and what maneuvers are to be allowed, and under what conditions their application can be considered appropriate.

The cost of local, multi-professional obstetric emergencies training.

PubMed

Yau, Christopher W H; Pizzo, Elena; Morris, Steve; Odd, David E; Winter, Cathy; Draycott, Timothy J

2016-10-01

We aim to outline the annual cost of setting up and running a standard, local, multi-professional obstetric emergencies training course, PROMPT (PRactical Obstetric Multi-Professional Training), at Southmead Hospital, Bristol, UK - a unit caring for approximately 6500 births per year. A retrospective, micro-costing analysis was performed. Start-up costs included purchasing training mannequins and teaching props, printing of training materials and assembly of emergency boxes (real and training). The variable costs included administration time, room hire, additional printing and the cost of releasing all maternity staff in the unit, either as attendees or trainers. Potential, extra start-up costs for maternity units without established training were also included. The start-up costs were €5574 and the variable costs for 1 year were €143 232. The total cost of establishing and running training at Southmead for 1 year was €148 806. Releasing staff as attendees or trainers accounted for 89% of the total first year costs, and 92% of the variable costs. The cost of running training in a maternity unit with around 6500 births per year was approximately €23 000 per 1000 births for the first year and around €22 000 per 1000 births in subsequent years. The cost of local, multi-professional obstetric emergencies training is not cheap, with staff costs potentially representing over 90% of the total expenditure. It is therefore vital that organizations consider the clinical effectiveness of local training packages before implementing them, to ensure the optimal allocation of finite healthcare budgets. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Awareness Regarding Perineal Protection, Obstetric Anal Sphincter Injury, and Episiotomy Among Obstetrics and Gynecology Residents; Effects of an Educational Workshop.

PubMed

Stecher, Anna M; Yeung, Jennifer; Crisp, Catrina C; Pauls, Rachel N

Appropriate perineal protection may reduce rates of obstetric anal sphincter injuries (OASIS). We sought to investigate the knowledge and attitudes of obstetrics and gynecology residents concerning perineal protection, OASIS, and episiotomy before and after an educational workshop. This was an institutional review board-approved cross-sectional survey study of obstetrics and gynecology residents. Two experts in perineal protection, whose methods have been shown to reduce OASIS by 50%, provided 1 week of education. Residents were taught in hands-on workshops and labor and delivery wards. Residents were surveyed regarding experiences, knowledge, and opinions of perineal protection, OASIS, and episiotomy. Surveys were administered immediately before and after the workshop and at 3 months following. All 31 residents participated. Almost all (97%) felt it was possible to reduce the incidence of OASIS prior to the workshop. Statistically significant increases were noted following training in the number that felt it was "very effective" to use the 2-handed technique taught in the workshop (P = 0.002), as well as those that reported most commonly performing a mediolateral episiotomy (protective against OASIS, if used selectively) when episiotomy was indicated (P = 0.001). The percent that reported feeling "comfortable" or "very comfortable" performing episiotomies increased from 45% to 77% immediately after the workshop (P = 0.002); this declined to 55% at 3 months. A large majority (77%) reported that the workshop was beneficial; 65% described an impact to patient care. A workshop targeting perineal protection improved awareness and changed clinical practice in this group of residents. Ongoing education regarding perineal protection and episiotomy may reinforce behavior modifications.

Special considerations--Induction of labor in low-resource settings.

PubMed

Smid, Marcela; Ahmed, Yusuf; Ivester, Thomas

2015-10-01

Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings. Copyright © 2015 Elsevier Inc. All rights reserved.

The Public Health Impact of Training Physicians to Become Obstetricians and Gynecologists in Ghana

PubMed Central

Obed, Samuel A.; Boothman, Erika L.; Opare-Ado, Henry

2014-01-01

Objectives. We assessed the public health effect of creating and sustaining obstetrics and gynecology postgraduate training in Ghana, established in 1989 to reverse low repatriation of physicians trained abroad. Methods. All 85 certified graduates of 2 Ghanaian university-based postgraduate training programs from program initiation in 1989 through June 2010 were identified and eligible for this study. Of these, 7 were unable to be contacted, inaccessible, declined participation, or deceased. Results. Of the graduates, 83 provide clinical services in Ghana and work in 33 sites in 8 of 10 regions; 15% were the first obstetrician and gynecologist at their facility, 25% hold clinical leadership positions, 50% practice in teaching hospitals, and 14% serve as academic faculty. Conclusions. Creating capacity for university-based postgraduate training in obstetrics and gynecology is effective and sustainable for a comprehensive global approach to reduce maternal and neonatal morbidity and mortality. Policies to support training and research capacity in obstetrics and gynecology are an integral part of a long-term national plan for maternal health. PMID:24354828

Survey of Sexual Education among Residents from Different Specialties

ERIC Educational Resources Information Center

Morreale, Mary K.; Arfken, Cynthia L.; Balon, Richard

2010-01-01

Objective: This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients' sexuality. Methods: An anonymous Internet survey was sent to 195 residents in family practice, internal medicine, obstetrics and gynecology, and psychiatry at a…

The "group" in obstetric psychoprophylaxis.

PubMed

Volpe, B; Tenaglia, F; Fede, T; Cerutti, R

1983-01-01

In the practice of obstetric psychoprophylaxis every method employed considered always the group both from a psychological and a pedagogic point of view. Today the group of pregnant women (or couples) is considered under various aspects: - psychological: the group as a support for members with regard to maternal and parental emotional feelings; - anthropological: the group fills up an empty vital space and becomes a "rite de passage" from a state of social identity to another one; - social: the group is a significative cultural intermediary between health services and the women-patient. The knowledge of these aspects becomes an important methodological support for group conductors. We present an analysis of our experience with groups and how this has affected the Psychoprophylaxis in the last years.

Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?

PubMed Central

Rao, Durga Prasada; Rao, Venkateswara A

2010-01-01

The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with “what is new?” in obstetric anaesthesia. PMID:21224967

Perceived Discrimination During Prenatal Care, Labor, and Delivery: An Examination of Data From the Oregon Pregnancy Risk Assessment Monitoring System, 1998–1999, 2000, and 2001

PubMed Central

Thorburn, Sheryl; Zhao, Weiyi

2008-01-01

Although recent research has examined discrimination in health care, no studies have investigated women's experiences during prenatal or obstetrical care. Analyses of data from the Oregon Pregnancy Risk Assessment Monitoring System showed that 18.53% of mothers reported discrimination by providers during prenatal care, labor, or delivery, most commonly because of age or insurance status. Perceived discrimination was associated with maternal characteristics such as age, marital status, and type of insurance, but not with number of subsequent well-baby visits. PMID:18703444

A collaborative interdisciplinary approach to electronic fetal monitoring: report of a statewide initiative.

PubMed

Miller, Lisa A; Miller, David A

2013-01-01

Intrapartum electronic fetal monitoring (EFM) is one of the most common procedures in obstetrics. Current consensus statements provide clinicians with a common language for EFM as well as provide a basis for a simplified approach to interpretation and management. This article presents a summary of the content and implementation of a statewide initiative in interdisciplinary EFM education and training designed to give clinicians of all backgrounds a shared mental model in EFM. Challenges to implementation at individual institutions may include physician and nursing engagement as well as time and cost constraints.

Developing skills learning in obstetric nursing: approaches between theory and practice.

PubMed

Lima, Maria de Fátima Gomes; Pequeno, Alice Maria Correia; Rodrigues, Dafne Paiva; Carneiro, Cleide; Morais, Ana Patrícia Pereira; Negreiros, Francisca Diana da Silva

2017-01-01

To analyze the development of professional skills in an obstetric nursing graduate course. Qualitative research, applying semi-structured interviews with 11 students in the obstetric nursing specialization at the State University of Ceará. Data was submitted to thematic review. According to the subjects, the course offers the development of skills to strengthen and expand the range of activities in obstetric nursing. Despite relying on previous knowledge and experience acquired by the students, there is a gap between the content taught and internship practice, presented as challenges and difficulties faced by the students. The findings suggest a need for curricular revision, incorporating active teaching-learning methodologies, to overcome the disjunction between theory and practice. Students are part of a corpus that is potentially implicated in the construction and transformation of thoughts and values set forth by educational and health institutions, and it is necessary to make changes in political and social organizations, with a focus on providing comprehensive and egalitarian care to the population. Analisar o desenvolvimento de competências profissionais em curso de pós-graduação em Enfermagem Obstétrica. Pesquisa qualitativa, utilizando entrevista semiestruturada com 11 egressos da especialização em Enfermagem Obstétrica da Universidade Estadual do Ceará. Dados submetidos à análise temática. Na ótica dos sujeitos, o curso confere o desenvolvimento de competências que fortalecem e ampliam o campo de atuação da enfermagem obstétrica. Embora resgate o conhecimento prévio dos discentes e as experiências vivenciadas, há distanciamento entre conteúdos ministrados e a prática de estágios, apresentados como desafios e dificuldades enfrentadas pelos egressos. Os achados sugerem revisão curricular, incorporando as metodologias ativas de ensino-aprendizagem, superando a fragmentação entre teoria e prática. Os egressos se constituem em um corpus potencialmente implicado na construção e transformação de pensamentos e valores das instituições de saúde e ensino, necessários às mudanças nas organizações políticas e sociais, visando atendimento integral e igualitário à população.

Effects of an Interdisciplinary Practice Bundle for Second-Stage Labor on Clinical Outcomes.

PubMed

Garpiel, Susan J

2018-04-09

There is renewed interest in second-stage labor practices as recent evidence has challenged historical perspectives on safe duration of secondstage labor. Traditional practices and routine interventions during second-stage have uncertain benefit for low-risk women and may result in cesarean birth. The purpose of this quality improvement project was to implement an interdisciplinary second-stage practice bundle to promote safe outcomes including method of birth and women's birth experience. Standardized second-stage labor evidence-based practice recommendations structured into a 5 Ps practice bundle (patience, positioning, physiologic resuscitation, progress, preventing urinary harm) were implemented across 34 birthing hospitals in Trinity Health system. Significant improvements were observed in second-stage practices. Association of Women's Health, Obstetric and Neonatal Nurses' perinatal nursing care quality measure Second-Stage of Labor: Mother-Initiated Spontaneous Pushing significantly improved [pre-implementation 43% (510/1,195), post-implementation 76% (1,541/2,028), p < .0001]. Joint Commission Perinatal Care-02: nulliparous, term, singleton, vertex cesarean rate significantly decreased (p = 0.02) with no differences in maternal morbidity, or negative newborn birth outcomes. Unexpected complications in term births significantly decreased in newborns (p < 0.001), and for newborns from vaginal births (p = 0.03). Birth experience satisfaction rose from the 69th to the 81st percentile. Implementing 13 evidence-based second-stage labor practices derived from the Association of Women's Health, Obstetric and Neonatal Nurses and American College of Nurse-Midwives professional guidelines achieved our goals of safely reducing primary cesarean birth among low-risk nulliparous women, and optimizing maternal and fetal outcomes associated with labor and birth. By minimizing routine interventions, nurses support physiologic birth and improve women's birth satisfaction.

External Validation Study of First Trimester Obstetric Prediction Models (Expect Study I): Research Protocol and Population Characteristics.

PubMed

Meertens, Linda Jacqueline Elisabeth; Scheepers, Hubertina Cj; De Vries, Raymond G; Dirksen, Carmen D; Korstjens, Irene; Mulder, Antonius Lm; Nieuwenhuijze, Marianne J; Nijhuis, Jan G; Spaanderman, Marc Ea; Smits, Luc Jm

2017-10-26

A number of first-trimester prediction models addressing important obstetric outcomes have been published. However, most models have not been externally validated. External validation is essential before implementing a prediction model in clinical practice. The objective of this paper is to describe the design of a study to externally validate existing first trimester obstetric prediction models, based upon maternal characteristics and standard measurements (eg, blood pressure), for the risk of pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), small-for-gestational-age (SGA) infants, and large-for-gestational-age (LGA) infants among Dutch pregnant women (Expect Study I). The results of a pilot study on the feasibility and acceptability of the recruitment process and the comprehensibility of the Pregnancy Questionnaire 1 are also reported. A multicenter prospective cohort study was performed in The Netherlands between July 1, 2013 and December 31, 2015. First trimester obstetric prediction models were systematically selected from the literature. Predictor variables were measured by the Web-based Pregnancy Questionnaire 1 and pregnancy outcomes were established using the Postpartum Questionnaire 1 and medical records. Information about maternal health-related quality of life, costs, and satisfaction with Dutch obstetric care was collected from a subsample of women. A pilot study was carried out before the official start of inclusion. External validity of the models will be evaluated by assessing discrimination and calibration. Based on the pilot study, minor improvements were made to the recruitment process and online Pregnancy Questionnaire 1. The validation cohort consists of 2614 women. Data analysis of the external validation study is in progress. This study will offer insight into the generalizability of existing, non-invasive first trimester prediction models for various obstetric outcomes in a Dutch obstetric population. An impact study for the evaluation of the best obstetric prediction models in the Dutch setting with respect to their effect on clinical outcomes, costs, and quality of life-Expect Study II-is being planned. Netherlands Trial Registry (NTR): NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143 (Archived by WebCite at http://www.webcitation.org/6t8ijtpd9). ©Linda Jacqueline Elisabeth Meertens, Hubertina CJ Scheepers, Raymond G De Vries, Carmen D Dirksen, Irene Korstjens, Antonius LM Mulder, Marianne J Nieuwenhuijze, Jan G Nijhuis, Marc EA Spaanderman, Luc JM Smits. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 26.10.2017.

The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training.

PubMed

de Melo, Brena C P; Falbo, Ana R; Muijtjens, Arno M M; van der Vleuten, Cees P M; van Merriënboer, Jeroen J G

2017-04-01

To compare learning outcomes of postpartum hemorrhage simulation training based on either instructional design guidelines or best practice. A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013. The instructional design group included 13 teams, whereas the best practice group included seven teams. A standardized task checklist was used for scenario analysis and the proportion of correctly executed tasks compared (post-test minus pretest). The instructional design group scored higher than the best practice group for total number of tasks completed (median difference 0.46 vs 0.17; P<0.001; effect size [r]=0.72). Similar results were observed for communication (median difference 0.56 vs 0.22; P=0.004; r=0.58), laboratory evaluation (median difference 0.83 vs 0.00; P<0.001; r=0.76), and mechanical management (median difference 0.25 vs -0.15; P=0.048; r=0.39). Speed of learning was also increased. The median differences were 0.20 for the instructional design group compared with 0.05 for the best practice group at 60 seconds (P=0.015; r=0.49), and 0.49 versus 0.26 (P=0.001; r=0.65) at 360 seconds. The use of simulation training for postpartum hemorrhage that was based on instructional design guidelines yielded better learning outcomes than did training based on best practice. © 2016 International Federation of Gynecology and Obstetrics.

Ethiopia's assessment of emergency obstetric and newborn care: setting the gold standard for national facility-based assessments.

PubMed

Keyes, Emily B; Haile-Mariam, Abonesh; Belayneh, Neghist T; Gobezie, Wasihun A; Pearson, Luwei; Abdullah, Muna; Kebede, Henok

2011-10-01

To describe the methods used to implement Ethiopia's 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University's Averting Maternal Death and Disability Program provided technical assistance. Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. Ethiopia's assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Predictors of obstetric intervention rates: case-mix, staffing levels and organisational factors of hospital of birth.

PubMed

Joyce, Rachel; Webb, R; Peacock, Janet

2002-11-01

We performed a cross-sectional study of all Thames maternity units, 1994-96, including 540,834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, which could be a reflection of less experienced management of labour. Caesarean section rates were also associated positively with the levels of delivery beds, which could be a reflection of the closer monitoring of labour that may result from increased bed availability. Both caesarean section and instrumental vaginal delivery rates were associated with epidural rates, which was expected from the literature. Variations in epidural rates were mainly associated with variations in demographic case-mix, due possibly to patient demand. Demographic case-mix was also associated with instrumental vaginal deliveries but not the caesarean section rate.

After a Cesarean…What's a Birth Professional to Do?

PubMed Central

Andrews, Desirre; Humphries, Gretchen

2010-01-01

The discrepancy between the evidence supporting vaginal birth after cesarean and actual medical practice illuminates the larger issues of evidence-based care versus current obstetrical practice. Although the reasons for the disconnect between what we know to be healthy birth practices and what women actually experience are multiple and complex, a commitment to providing accurate education, truly client-centered support, and active patient advocacy will give women the ability to insist on best practice care for themselves and their babies. The International Cesarean Awareness Network believes that all childbirth professionals and advocates share a responsibility to promote change and must work together to be effective. PMID:21358830

[The regional model of three-level system of of medical social monitoring of children and adolescents: the pilot project in the Republic of Tatarstan].

PubMed

Al'bitskii, V Iu; Ustinova, N V; Farrakhov, A Z; Shavaliev, R F; Kulikov O V; Plaksina, L V

2014-01-01

The absence of system of medical social monitoring of children being in difficult life situations is one of main causes of preventable losses of health and life of children and adolescents. The plan of activities of the working group No3 under the Coordination council under the President of the Russian Federation of the national strategy realization of actions in interest of children for 2012-2017 includes a point: "The development and implementation of standard model of medical social monitoring of children and adolescents in the subjects of the Russian Federation". The implementation of this task is assigned to the Department of social pediatrics of The research center of children health of Moscow and the Ministry of Health of the Republic of Tatarstan. The research methods included analysis and generalization of advanced experience of medical social monitoring of children population; expertise technique; modeling. The regional model of three-level system of medical social monitoring of children population is developed and implemented. The model includes level I (consulting rooms of medical social care of children polyclinics, feldsher obstetric stations, first-aid centers), level II--inter-municipal (departments of medical social monitoring in central district hospitals, medical institutions, clinical diagnostic centers) and level III--regional (the Republican center of medical social monitoring of children and adolescents). The immediate tasks necessary for effective functioning of system of medical social monitoring were determined. Within the framework of implementation of the pilot project the legal and normative legislative acts were developed to regulate functioning of regional model of three-level system of medical social care. The other documents necessary for effective functioning of this system were elaborated. The practical significance of this system is in the implementation of effective three-level model of medical social monitoring of children and adolescents supporting decrease of morbidity, mortality and "risk behaviors" suicidal included. The model is to prevent child neglect and homelessness and cruel treatment of children and adolescents.

A Dual-Focus Motivational Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy

ERIC Educational Resources Information Center

Velasquez, Mary M.; Ingersoll, Karen S.; Sobell, Mark B.; Floyd, R. Louise; Sobell, Linda Carter; von Sternberg, Kirk

2010-01-01

Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large…

Comparison of Support Services Offered by Residencies in Six Specialties, 1979-80 and 1988-89.

ERIC Educational Resources Information Center

Kahn, Norman B., Jr.; Addison, Richard B.

1992-01-01

A study investigated the availability of each of 19 medical school support services offered by 493 residencies in 6 specialties: family practice; internal medicine; obstetrics/gynecology; pediatrics; psychiatry; and surgery. Results show many specialties do not offer common, effective support services. It is suggested that programs move to…

Nationwide Practices for Screening and Reporting Prenatal Cocaine Abuse: A Survey of Teaching Programs.

ERIC Educational Resources Information Center

Pelham, Trena L.; DeJong, Allan R.

1992-01-01

A survey of 81 pediatric and 81 obstetric training programs from 42 states determined that respondents favored screening pregnant patients for cocaine abuse by maternal history (81 percent) and urine toxicology (36 percent), though many fewer reported these as established policy. Physicians favored such interventions as voluntary drug…

Information Resources in Clinical Medicine: Family Practice, Pediatrics, Obstetrics and Gynecology, General Surgery, Internal Medicine.

ERIC Educational Resources Information Center

Schwank, Jean; Allen, Joyce

Designed for beginning health science librarians, this continuing education course syllabus presents a guide to information resources for answering physicians' questions about patient care. Sources from standard core lists, such as the Alfred Brandon list, are highlighted and described, along with additional titles. General resources covered…

[The early years of anatomy and obstetrics at the Göttingen University, 1734-1760].

PubMed

Rab, Irén

2014-03-16

In the Age of Enlightenment medical education was based on new fundamentals. According to experts at that time, a medical faculty had to have five branches: anatomy, botany, chemistry, practical and theoretical medicine. Perhaps Göttingen was the most successful university foundation at that time, because a generous financial support was provided, outstanding professors were invited and an education without censorship was warranted. The spirit of Enlightenment affected both the structure and the standards of education of the facultas medicinae. The word-wide reputation of this faculty was earned by Albrecht von Haller. Haller conceived both the still highly regarded botanical garden and the anatomical theatre, which was the first of its kind in the German speaking area. Furthermore, he founded one of the first clinical obstetrics departments in the world. Students gained theoretical knowledge, were trained practically and had the opportunity to make scientific observations and medical experiments. This paper describes the founding era of the medical faculty of University of Göttingen from a historical-cultural view of point, based on contemporary documents from Germany and Hungary.

Restriction of oral intake during labor: whither are we bound?

PubMed

Sperling, Jeffrey D; Dahlke, Joshua D; Sibai, Baha M

2016-05-01

In 1946, Dr Curtis Mendelson suggested that aspiration during general anesthesia for delivery was avoidable by restricting oral intake during labor. This suggestion proved influential, and restriction of oral intake in labor became the norm. These limitations may contribute to fear and feelings of intimidation among parturients. Modern obstetrics, especially in the setting of advances in obstetric anesthesia, does not mirror the clinical landscape of Mendelson; hence, one is left to question if his findings remain relevant or if they should inform current recommendations. The use of general anesthesia at time of cesarean delivery has seen a remarkable decline with increased use of effective neuraxial analgesia as the standard of care in modern obstetric anesthesia. While the American College of Obstetricians and Gynecologists now endorses clear liquids during labor, current recommendations continue to suggest that solid food intake should be avoided. Recent evidence from a systematic review involving 3130 women in active labor suggests that oral intake should not be restricted in women at low risk of complications, given there were no identified benefits or harms of a liberal diet. Aspiration and other adverse maternal outcomes may be unrelated to oral intake in labor and as such, qualitative measures such as patient satisfaction should be paramount. It is time to reassess the impact of oral intake restriction during labor given the minimal risk of aspiration during labor in the setting of modern obstetric anesthesia practices. Copyright © 2016 Elsevier Inc. All rights reserved.

The U.S. Twin Delivery Volume and Association with Cesarean Delivery Rates: A Hospital-Level Analysis.

PubMed

Easter, Sarah Rae; Robinson, Julian N; Carusi, Daniela; Little, Sarah E

2018-03-01

 The objective of this study was to test whether hospitals experienced in twin delivery have lower rates of cesarean delivery for twins.  We divided obstetric hospitals in the 2011 National Inpatient Sample by quartile of annual twin deliveries and compared twin cesarean delivery rates between hospitals with weighted linear regression. We used Pearson's coefficients to correlate a hospital's twin cesarean delivery rate to its overall cesarean delivery and vaginal birth after cesarean (VBAC) rates.  Annual twin delivery volume ranged from 1 to 506 across the 547 analyzed hospitals with a median of 10 and mode of 3. Adjusted rates of cesarean delivery were independent of delivery volume with a rate of 75.5 versus 74.8% in the lowest and highest volume hospitals ( p  = 0.09 across quartiles). A hospital's cesarean delivery rate for twins moderately correlated with the overall cesarean rate ( r  = 0.52, p  < 0.01) and inversely correlated with VBAC rate ( r  =  - 0.42, p  < 0.01).  Most U.S. obstetrical units perform a low volume of twin deliveries with no decrease in cesarean delivery rates at higher volume hospitals. Twin cesarean delivery rates correlate with other obstetric parameters such as singleton cesarean delivery and VBAC rates suggesting twin cesarean delivery rate is more closely related to a hospital's general obstetric practice than its twin delivery volume. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perinatal Illicit Drug and Marijuana Use: An Observational Study Examining Prevalence, Screening, and Disclosure

PubMed Central

Chang, Judy C.; Holland, Cynthia L.; Tarr, Jill A.; Rubio, Doris; Rodriguez, Keri L.; Kraemer, Kevin L.; Day, Nancy; Arnold, Robert M.

2016-01-01

Purpose To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits. Design Observational study that qualitatively assesses provider screening and patient disclosure of substance use. Setting Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania. Participants Pregnant patients and obstetric providers were recruited as participants. Methods We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure. Results Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use. Conclusion Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers. (Am J Health Promot 0000; 00[0]:000–000.) PMID:26559718

Medico-legal litigation in Obstetrics: a characterization analysis of a decade in Portugal.

PubMed

Domingues, Ana Patrícia Rodrigues; Belo, Adriana; Moura, Paulo; Vieira, Duarte Nuno

2015-05-01

It was to analyse the most critical areas in Obstetrics and to suggest measures to reduce or avoid the situations most often involved in these disputes. Obstetrics cases submitted to the Medico-legal Council since the creation of the National Institute of Legal Medicine and Forensic Sciences in 2001 until 2011 were evaluated. A comprehensive characterization, determination of absolute/relative frequencies, hypothesis of a linear trend over the years and the association between each parameter was done. The analysis has shown no significantly linear trend. The most common reasons for disputes were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). Perinatal asphyxia showed no significantly linear trend (p=0.58) and was usually related to perinatal deaths or permanent neurologic sequelae in newborn children. Traumatic injuries of the newborn, mostly related to instrumented deliveries, shoulder dystocia or vaginal delivery in breech presentation, has shown a significantly increased linear trend (p<0.001), especially related to instrumented deliveries. The delay/absence of cesarean section was the clinical procedure questioned in a significantly higher number of cases of perinatal asphyxia (68.7%) and of traumatic lesions of the newborn due to instrumented deliveries (20.5%). It is important to improve and correct theoretical/practical daily clinical performance in these highlighted areas, in order to reduce or even avoid situations that could end up in medico-legal litigations.

Infection control knowledge, attitudes, and practices among healthcare workers at Mulago Hospital, Kampala, Uganda.

PubMed

Sethi, Ajay K; Acher, Charles W; Kirenga, Bruce; Mead, Scott; Donskey, Curtis J; Katamba, Achilles

2012-09-01

Effective implementation of infection control programs and adherence to standard precautions are challenging in resource-limited settings. The objective of this study was to describe infection control knowledge, attitudes, and practices among healthcare workers (HCWs) in Uganda. We conducted a survey of hospital employees who had direct contact with patients or their immediate environment. We also performed an environmental assessment of resource availability and utilization within hospital wards. Surgical, medicine, and obstetrics wards at a national referral hospital in Kampala, Uganda. One hundred eighty-three randomly selected HCWs. Almost all HCWs knew to wash their hands, although nursing and support staff were less likely to perceive that HCWs' hands can be a vector of disease transmission. Hand washing was valued more as a means of self-protection than as a means to prevent patient-to-patient transmission, consistent with the prevailing belief that infection control was important for occupational safety. Sinks were not readily accessible, and soap at sinks was uncommon throughout the medicine and obstetrics wards but more commonly available in the surgery wards. Alcohol gel was rarely available. Changing infection control practices in developing countries will require a multifaceted approach that addresses resource availability, occupational safety, and local understanding and attitudes about infection control.

The changing role of indigenous lay midwives in Guatemala: new frameworks for analysis.

PubMed

Chary, Anita; Díaz, Anne Kraemer; Henderson, Brent; Rohloff, Peter

2013-08-01

to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Kaqchikel Maya-speaking communities in the Guatemalan highlands. the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1)Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2)indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ethical analysis of non-medical fetal ultrasound.

PubMed

Leung, John Lai Yin; Pang, Samantha Mei Che

2009-09-01

Obstetric ultrasound is the well-recognized prenatal test used to visualize and determine the condition of a pregnant woman and her fetus. Apart from the clinical application, some businesses have started promoting the use of fetal ultrasound machines for nonmedical reasons. Non-medical fetal ultrasound (also known as 'keepsake' ultrasound) is defined as using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication. Notwithstanding the guidelines and warnings regarding ultrasound safety issued by governments and professional bodies, the absence of scientifically proven physical harm to fetuses from this procedure seems to provide these businesses with grounds for rapid expansion. However, this argument is too simplistic because current epidemiological evidence is not synchronous with advancing ultrasound technology. As non-medical fetal ultrasound has aroused very significant public attention, a thorough ethical analysis of this topic is essential. Using a multifaceted approach, we analyse the ethical perspective of non-medical fetal ultrasound in terms of the expectant mother, the fetus and health professionals. After applying four major theories of ethics and principles (the precautionary principle; theories of consequentialism and impartiality; duty-based theory; and rights-based theories), we conclude that obstetric ultrasound practice is ethically justifiable only if the indication for its use is based on medical evidence. Non-medical fetal ultrasound can be considered ethically unjustifiable. Nevertheless, the ethical analysis of this issue is time dependent owing to rapid advancements in ultrasound technology and the safety issue. The role of health professionals in ensuring that obstetric ultrasound is an ethically justifiable practice is also discussed.

Practice considerations in providing cancer risk assessment and genetic testing in women's health.

PubMed

Mahon, Suzanne M; Crecelius, Mary E

2013-01-01

Providers of women's health services are often confronted with questions about cancer genetic testing. The provision of these services is complex. The process begins with accurate risk assessment and identification of individuals who might benefit from genetic testing services. There are practice, administrative, legal, and ethical considerations that should be considered when developing policies for the referral of at-risk individuals or before deciding to provide genetic services. © 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

From micro to mainframe. A practical approach to perinatal data processing.

PubMed

Yeh, S Y; Lincoln, T

1985-04-01

A new, practical approach to perinatal data processing for a large obstetric population is described. This was done with a microcomputer for data entry and a mainframe computer for data reduction. The Screen Oriented Data Access (SODA) program was used to generate the data entry form and to input data into the Apple II Plus computer. Data were stored on diskettes and transmitted through a modern and telephone line to the IBM 370/168 computer. The Statistical Analysis System (SAS) program was used for statistical analyses and report generations. This approach was found to be most practical, flexible, and economical.

Practice Bulletin No. 161 Summary: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

Practice Bulletin No. 161: External Cephalic Version.

PubMed

2016-02-01

In the United States, there is a widespread belief that the overall cesarean delivery rate is higher than necessary. Efforts are being directed toward decreasing the number of these procedures, in part by encouraging physicians to make changes in their management practices. Because breech presentations are associated with a high rate of cesarean delivery, there is renewed interest in techniques such as external cephalic version (ECV) and vaginal breech delivery. The purpose of this document is to provide information about ECV by summarizing the relevant evidence presented in published studies and to make recommendations regarding its use in obstetric practice.

Care management and nursing governance in a maternity ward: grounded theory.

PubMed

Copelli, Fernanda Hannah da Silva; Oliveira, Roberta Juliane Tono de; Santos, José Luís Guedes Dos; Magalhães, Aline Lima Pestana; Gregório, Vitória Regina Petters; Erdmann, Alacoque Lorenzini

2017-01-01

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward. Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding. The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care. Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

PubMed

Aradeon, Susan B; Doctor, Henry V

2016-01-01

The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care.

An overview of systematic reviews of normal labor and delivery management

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Elahe; Bahrami, Masoud

2015-01-01

Background: Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. Materials and Methods: The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Results: Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Conclusions: Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care. PMID:26120327

An overview of systematic reviews of normal labor and delivery management.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Elahe; Bahrami, Masoud

2015-01-01

Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care.

A Study to Determine the Most Cost-Effective Method of Delivering Obstetrical Care to All Eligible Beneficiaries within the Kenner Army Community Hospital’s Catchment Area

DTIC Science & Technology

1988-07-05

ONITOR FETAL 10952.72 651501C725660 I MNrITOR OXYGEN 783.92 651501C725692 I PLMP BREAST MECHANICAL 1106.39 651501C725694 I STETHOSCOPE ULTRASOJ’D...TODDLEP 1496.12 651501C725969 I MONITOR, PHYSIOLOGICAL SYST, EMSS 2258.21 651501C726026 I FETAL HEART MCONITOR 9937.20 651501C726162 I OXI ETER, PULSE...THERMWTER FARE𔃾-EIT ELECTRONIC W/-ARGER 303.55 651501C725211 I MONITOR FETAL PULSE 1305.42 651501C725442 2 PUMP INFUSION VOLLUETRIC 1834.71 65150IC725596 I

Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study.

PubMed

Byrne, Abbey; Caulfield, Tanya; Onyo, Pamela; Nyagero, Josephat; Morgan, Alison; Nduba, John; Kermode, Michelle

2016-03-01

Kenya has a high burden of maternal and newborn mortality. Consequently, the Government of Kenya introduced health system reforms to promote the availability of skilled birth attendants (SBAs) and proscribed deliveries by traditional birth attendants (TBAs). Despite these changes, only 10% of women from pastoralist communities are delivered by an SBA in a health facility, and the majority are delivered by TBAs at home. The aim of this study is to better understand the practices and perceptions of TBAs and SBAs serving the remotely located, semi-nomadic, pastoralist communities of Laikipia and Samburu counties in Kenya, to inform the development of an SBA/TBA collaborative care model. This descriptive qualitative study was undertaken in 2013-14. We conducted four focus group discussions (FGDs) with TBAs, three with community health workers, ten with community women, and three with community men. In-depth interviews were conducted with seven SBAs and eight key informants. Topic areas covered were: practices and perceptions of SBAs and TBAs; rewards and challenges; managing obstetric complications; and options for SBA/TBA collaboration. All data were translated, transcribed and thematically analysed. TBAs are valued and accessible members of their communities who adhere to traditional practices and provide practical and emotional support to women during pregnancy, delivery and post-partum. Some TBA practices are potentially harmful to women e.g., restricting food intake during pregnancy, and participants recognised that TBAs are unable to manage obstetric complications. SBAs are acknowledged as having valuable technical skills and resources that contribute to safe and clean deliveries, especially in the event of complications, but there is also a perception that SBAs mistreat women. Both TBAs and SBAs identified a range of challenges related to their work, and instances of mutual respect and informal collaborations between SBAs and TBAs were described. These findings clearly indicate that an SBA/TBA collaborative model of care consistent with Kenyan Government policy is a viable proposition. The transition from traditional birth to skilled birth attendance among the pastoralist communities of Laikipia and Samburu is going to be a gradual one, and an interim collaborative model is likely to increase the proportion of SBA assisted deliveries, improve obstetric outcomes, and facilitate the transition.

'Safe', yet violent? Women's experiences with obstetric violence during hospital births in rural Northeast India.

PubMed

Chattopadhyay, Sreeparna; Mishra, Arima; Jacob, Suraj

2017-11-03

The majority of maternal health interventions in India focus on increasing institutional deliveries to reduce maternal mortality, typically by incentivising village health workers to register births and making conditional cash transfers to mothers for hospital births. Based on over 15 months of ethnographically informed fieldwork conducted between 2015 and 2017 in rural Assam, the Indian state with the highest recorded rate of maternal deaths, we find that while there has been an expansion in institutional deliveries, the experience of childbirth in government facilities is characterised by obstetric violence. Poor and indigenous women who disproportionately use state facilities report both tangible and symbolic violence including iatrogenic procedures such as episiotomies, in some instances done without anaesthesia, improper pelvic examinations, beating and verbal abuse during labour, with sometimes the shouting directed at accompanying relatives. While the expansion of institutional deliveries and access to emergency obstetric care is likely to reduce maternal mortality, in the absence of humane care during labour, institutional deliveries will continue to be characterised by the paradox of "safe" births (defined as simply reducing maternal deaths) and the deployment of violent practices during labour, underscoring the unequal and complex relationship between the bodies of the poor and reproductive governance.

A Contemporary Analysis of Medicolegal Issues in Obstetric Anesthesia Between 2005 and 2015.

PubMed

Kovacheva, Vesela P; Brovman, Ethan Y; Greenberg, Penny; Song, Ellen; Palanisamy, Arvind; Urman, Richard D

2018-05-10

Detailed reviews of closed malpractice claims have provided insights into the most common events resulting in litigation and helped improve anesthesia care. In the past 10 years, there have been multiple safety advancements in the practice of obstetric anesthesia. We investigated the relationship among contributing factors, patient injuries, and legal outcome by analyzing a contemporary cohort of closed malpractice claims where obstetric anesthesiology was the principal defendant. The Controlled Risk Insurance Company (CRICO) is the captive medical liability insurer of the Harvard Medical Institutions that, in collaboration with other insurance companies and health care entities, contributes to the Comparative Benchmark System database for research purposes. We reviewed all (N = 106) closed malpractice cases related to obstetric anesthesia between 2005 and 2015 and compared the following classes of injury: maternal death and brain injury, neonatal death and brain injury, maternal nerve injury, and maternal major and minor injury. In addition, settled claims were compared to the cases that did not receive payment. χ, analysis of variance, Student t test, and Kruskal-Wallis tests were used for comparison between the different classes of injury. The largest number of claims, 54.7%, involved maternal nerve injury; 77.6% of these claims did not receive any indemnity payment. Cases involving maternal death or brain injury comprised 15.1% of all cases and were more likely to receive payment, especially in the high range (P = .02). The most common causes of maternal death or brain injury were high neuraxial blocks, embolic events, and failed intubation. Claims for maternal major and minor injury were least likely to receive payment (P = .02) and were most commonly (34.8%) associated with only emotional injury. Compared to the dropped/denied/dismissed claims, settled claims more frequently involved general anesthesia (P = .03), were associated with delays in care (P = .005), and took longer to resolve (3.2 vs 1.3 years; P < .0001). Obstetric anesthesia remains an area of significant malpractice liability. Opportunities for practice improvement in the area of severe maternal injury include timely recognition of high neuraxial block, availability of adequate resuscitative resources, and the use of advanced airway management techniques. Anesthesiologists should avoid delays in maternal care, establish clear communication, and follow their institutional policy regarding neonatal resuscitation. Prevention of maternal neurological injury should be directed toward performing neuraxial techniques at the lowest lumbar spine level possible and prevention/recognition of retained neuraxial devices.

The development and application of electronic information system for safety administration of newborns in the rooming-in care.

PubMed

Wang, Fang; Dong, Jian-Cheng; Chen, Jian-Rong; Wu, Hui-Qun; Liu, Man-Hua; Xue, Li-Ly; Zhu, Xiang-Hua; Wang, Jian

2015-01-01

To independently research and develop an electronic information system for safety administration of newborns in the rooming-in care, and to investigate the effects of its clinical application. By VS 2010 SQL SERVER 2005 database and adopting Microsoft visual programming tool, an interactive mobile information system was established, with integrating data, information and knowledge with using information structures, information processes and information technology. From July 2011 to July 2012, totally 210 newborns from the rooming-in care of the Obstetrics Department of the Second Affiliated Hospital of Nantong University were chosen and randomly divided into two groups: the information system monitoring group (110 cases) and the regular monitoring group (100 cases). Incidence of abnormal events and degree of satisfaction were recorded and calculated. ① The wireless electronic information system has four main functions including risk scaling display, identity recognition display, nursing round notes board and health education board; ② statistically significant differences were found between the two groups both on the active or passive discovery rate of abnormal events occurred in the newborns (P<0.05) and the satisfaction degree of the mothers and their families (P<0.05); ③ the system was sensitive and reliable, and the wireless transmission of information was correct and safety. The system is with high practicability in the clinic and can ensure the safety for the newborns with improved satisfactions.

Knowledge, attitude, and practice toward cervical cancer among women attending Obstetrics and Gynecology Department: A cross-sectional, hospital-based survey in South India.

PubMed

Narayana, G; Suchitra, M Jyothi; Sunanda, G; Ramaiah, J Dasaratha; Kumar, B Pradeep; Veerabhadrappa, K V

2017-01-01

Cervical cancer-related deaths among women in India are often due to late diagnosis of disease. Knowledge about disease and early screening is the most effective measure for cervical cancer prevention. Lack of awareness, negative attitude, and poor practice about cervical cancer and screening are the major causes to increase the incidence of disease. The study is designed to assess knowledge, attitude, and practice (KAP) toward cervical cancer, screening, and prevention. A cross-sectional, hospital-based survey was conducted in women attending Obstetrics and Gynecology Department of a secondary care referral hospital. A total of 403 subjects were enrolled and subjected for interview using prevalidated KAP questionnaire on cervical cancer. Descriptive statistics were used to represent the sociodemographic characteristics and KAP levels. Association of sociodemographic variables with KAP levels is determined using Chi-square test. Most of (301; 74.6%) the respondents had heard about cervical cancer and majority of them are heard from media (168; 41.6%) and friends (83; 20.5%). Most women knew symptoms (259; 64.2%), risk factors (253; 62.7%), screening methods (310; 76.9%), and preventive measures (249; 61.7%) for cervical cancer. More than half of the women (252; 62.5%) having positive attitude toward screening. More than three-fourth of women (349; 86.6%) are not having practice toward cervical cancer screening. Sociodemographic characteristics are strongly associated with KAP levels. Although women are having good knowledge, positive attitude toward cervical cancer screening and prevention still there is a gap to transform it into practice. There is a need for more educational programs to connect identified knowledge slits and uplift of regular practice of cervical cancer screening.

Tobacco Cessation and Prevention Practices Reported by Second and Fourth Year Students at US Medical Schools

PubMed Central

Brooks, Daniel R.; Powers, Catherine A.; Brooks, Katie R.; Rigotti, Nancy A.; Bognar, Bryan; McIntosh, Scott; Zapka, Jane

2008-01-01

Background Tobacco dependence counseling is recommended to be included as core curriculum for US medical students. To date, there has been little information on students’ self-reported skills and practice opportunities to provide 5A’s (Ask, Advise, Assess, Assist, and Arrange) counseling for tobacco cessation. Methods We conducted anonymous surveys of second year and fourth year students at multiple US medical schools between February 2004 and March 2005 (overall response rate 70%). We report on the tobacco control practices of the 860 second year and 827 fourth year students completing the survey. Measurements and Main Results Fourth year students reported multiple opportunities to learn tobacco counseling in case-based discussions, simulated patient encounters, and clinical skills courses. They reported more instruction in family medicine (79%) and Internal Medicine (70%) than Pediatrics (54%), Obstetrics/Gynecology (41%), and Surgery clerkships (16%). Compared with asking patients about smoking, advising smokers to quit, and assessing patient willingness to quit, fourth year students were less likely to have multiple practice opportunities to assist the patient with a quit plan and arrange follow-up contact. More than half of second year students reported multiple opportunities for asking patients about smoking but far fewer opportunities for practicing the other 4 As. Conclusions By the beginning of their fourth year, most students in this group of medical schools reported multiple opportunities for training and practicing basic 5A counseling, although clear deficits for assisting patients with a quit plan and arranging follow-up care exist. Addressing these deficits and integrating tobacco teaching through tailored specific instruction across all clerkships, particularly in Surgery, Pediatrics, and Obstetrics/Gynecology is a challenge for medical school education. PMID:18612747

Hepatitis C in pregnancy: screening, treatment, and management.

PubMed

Hughes, Brenna L; Page, Charlotte M; Kuller, Jeffrey A

2017-11-01

In the United States, 1-2.5% of pregnant women are infected with hepatitis C virus, which carries an approximately 5% risk of transmission from mother to infant. Hepatitis C virus can be transmitted to the infant in utero or during the peripartum period, and infection during pregnancy is associated with increased risk of adverse fetal outcomes, including fetal growth restriction and low birthweight. The purpose of this document is to discuss the current evidence regarding hepatitis C virus in pregnancy and to provide recommendations on screening, treatment, and management of this disease during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations: (1) We recommend that obstetric care providers screen women who are at increased risk for hepatitis C infection by testing for anti-hepatitis C virus antibodies at their first prenatal visit. If initial results are negative, hepatitis C screening should be repeated later in pregnancy in women with persistent or new risk factors for hepatitis C infection (eg, new or ongoing use of injected or intranasal illicit drugs) (GRADE 1B). (2) We recommend that obstetric care providers screen hepatitis C virus-positive pregnant women for other sexually transmitted diseases, including HIV, syphilis, gonorrhea, chlamydia, and hepatitis B virus (GRADE 1B). (3) We suggest that patients with hepatitis C virus, including pregnant women, be counseled to abstain from alcohol (Best Practice). (4) We recommend that direct-acting antiviral regimens only be used in the setting of a clinical trial or that antiviral treatment be deferred to the postpartum period as direct-acting antiviral regimens are not currently approved for use in pregnancy (GRADE 1C). (5) We suggest that if invasive prenatal diagnostic testing is requested, women be counseled that data on the risk of vertical transmission are reassuring but limited; amniocentesis is recommended over chorionic villus sampling given the lack of data on the latter (GRADE 2C). (6) We recommend against cesarean delivery solely for the indication of hepatitis C virus (GRADE 1B). (7) We recommend that obstetric care providers avoid internal fetal monitoring, prolonged rupture of membranes, and episiotomy in managing labor in hepatitis C virus-positive women (GRADE 1B). (8) We recommend that providers not discourage breast-feeding based on a positive hepatitis C virus infection status (GRADE 1A). Copyright © 2017 Elsevier Inc. All rights reserved.

The use of noninvasive prenatal testing in obstetric care: educational resources, practice patterns, and barriers reported by a national sample of clinicians.

PubMed

Farrell, Ruth M; Agatisa, Patricia K; Mercer, Mary Beth; Mitchum, Ariane G; Coleridge, Marissa B

2016-06-01

The aim of this study was to identify how physicians develop their knowledge base and practice patterns regarding noninvasive prenatal testing (NIPT). A survey was used to assess physicians' informational sources and practice patterns regarding NIPT. While most of the 258 participants acquire knowledge about NIPT from the medical literature or didactic educational programming, 74 (28.7%) cite commercial laboratories as an initial source and 124 (47.8%) as a way to keep current with changes in NIPT. About one-third (n = 94, 36.4%) seek information about ethical issues related to NIPT. Half of the OB/GYN respondents (n = 136, 52.7%) provide pretest counseling; fewer refer to a genetic counselor or maternal fetal medicine specialist (MFM) (n = 94, 34.6%, n = 29, 11.2%, respectively). Pretest counseling content and the comfort with which participants discuss topics pertinent to patients' utilization of NIPT varied between OB/GYNs and MFMs. Advances in cff DNA technology emphasize the need for effective strategies for physicians to develop competency and practice patterns regarding NIPT. Study findings speak to the need for effective educational resources for obstetric providers, not just early adopters of NIPT but also for primary OB/GYNs as they serve in the role of the first point of contact for women considering their prenatal testing options. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

PubMed

Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

2015-11-01

The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training. © 2015 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Family Physicians' Perceived Prevalence, Safety, and Screening for Cigarettes, Marijuana, and Electronic-Nicotine Delivery Systems (ENDS) Use during Pregnancy.

PubMed

Northrup, Thomas F; Klawans, Michelle R; Villarreal, Yolanda R; Abramovici, Adi; Suter, Melissa A; Mastrobattista, Joan M; Moreno, Carlos A; Aagaard, Kjersti M; Stotts, Angela L

2017-01-01

Assess perceptions of prevalence, safety, and screening practices for cigarettes and secondhand smoke exposure (SHSe), marijuana (and synthetic marijuana), electronic nicotine delivery systems (ENDS; eg, e-cigarettes), nicotine-replacement therapy (NRT), and smoking-cessation medications during pregnancy, among primary care physicians (PCPs) providing obstetric care. A web-based, cross-sectional survey was e-mailed to 3750 US physicians (belonging to organizations within the Council of Academic Family Medicine Educational Research Alliance). Several research groups' questions were included in the survey. Only physicians who reported providing "labor and delivery" obstetric care responded to questions related to the study objectives. A total of 1248 physicians (of 3750) responded (33.3%) and 417 reported providing labor and delivery obstetric care. Obstetric providers (N = 417) reported cigarette (54%), marijuana (49%), and ENDS use (24%) by "Some (6% to 25%)" pregnant women, with 37% endorsing that "Very Few (1% to 5%)" pregnant women used ENDS. Providers most often selected that very few pregnant women used NRT (45%), cessation medications (ie, bupropion or varenicline; 37%), and synthetic marijuana (23%). Significant proportions chose "Do not Know" for synthetic marijuana (58%) and ENDS (27%). Over 90% of the sample perceived that use of or exposure to cigarettes (99%), synthetic marijuana (99%), SHS (97%), marijuana (92%), or ENDS (91%) were unsafe during pregnancy, with the exception of NRT (44%). Providers most consistently screened for cigarette (85%) and marijuana use (63%), followed by SHSe in the home (48%), and ENDS (33%) and synthetic marijuana use (28%). Fewer than a quarter (18%) screened consistently for all substances and SHSe. One third (32%) reported laboratory testing for marijuana and 3% reported laboratory testing for smoking status. This sample of PCPs providing obstetric care within academic settings perceived cigarettes, marijuana, and ENDS use to be prevalent and unsafe during pregnancy. Opportunities for increased screening during pregnancy across these substances were apparent. © Copyright 2017 by the American Board of Family Medicine.

Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

PubMed Central

Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

2015-01-01

The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training. PMID:26449292

Obstetrics and Gynecology Resident Interest and Participation in Global Health.

PubMed

Stagg, Amy R; Blanchard, May Hsieh; Carson, Sandra A; Peterson, Herbert B; Flynn, Erica B; Ogburn, Tony

2017-05-01

To evaluate obstetrics and gynecology resident interest and participation in global health experiences and elucidate factors associated with resident expectation for involvement. A voluntary, anonymous survey was administered to U.S. obstetrics and gynecology residents before the 2015 Council on Resident Education in Obstetrics and Gynecology in-training examination. The 23-item survey gathered demographic data and queried resident interest and participation in global health. Factors associated with resident expectation for participation in global health were analyzed by Pearson χ tests. Of the 5,005 eligible examinees administered the survey, 4,929 completed at least a portion of the survey for a response rate of 98.5%. Global health was rated as "somewhat important" or "very important" by 96.3% (3,761/3,904) of residents. "Educational opportunity" (69.2%) and "humanitarian effort" (17.7%) were cited as the two most important aspects of a global health experience. Residents with prior global health experience rated the importance of global health more highly and had an increased expectation for future participation. Global health electives were arranged by residency programs for 18.0% (747/4,155) of respondents, by residents themselves as an elective for 44.0% (1,828/4,155), and as a noncredit experience during vacation time for 36.4% (1,514/4,155) of respondents. Female gender, nonpartnered status, no children, prior global health experience, and intention to incorporate global health in future practice were associated with expectations for a global health experience. Most obstetrics and gynecology residents rate a global health experience as somewhat or very important, and participation before or during residency increases the perceived importance of global health and the likelihood of expectation for future participation. A majority of residents report arranging their own elective or using vacation time to participate, suggesting that residency programs have limited structured opportunities.

Training program for the management of two obstetric emergencies within a French perinatal care network.

PubMed

Noblot, Edouard; Raia-Barjat, Tiphaine; Lajeunesse, Cecile; Trombert, Béatrice; Weiss, Stéphanie; Colombié, Maud; Chauleur, Céline

2015-06-01

To evaluate the effectiveness of an interdisciplinary team training program based on simulated scenarios and focusing on two obstetrical emergency situations: shoulder dystocia and complicated breech vaginal delivery (CBVD). These situations are rare, so there are few opportunities for real-life training, yet their competent and efficient management is crucial to minimizing the risks to mother and child. The target population for training comprised the 450 professionals working in the French regional perinatal care network ELENA. An expert committee defined the topics for the training program, selected the simulated scenarios and developed the evaluation grids. The training sessions were conducted by two qualified and experienced professionals in each maternity unit. They comprised a theoretical introduction followed by practical exercises in management of simulated emergency situations by the participant teams, with the aid of a mannequin. Each team completed the exercises twice, their performances being filmed, reviewed and evaluated in each case. The training sessions took place over 9 months between September 2012 and June 2013. A total of 298 professionals (obstetricians, residents in obstetrics, midwives and nursery nurses) were trained, representing 75% of the staff working in the ELENA perinatal care network. The results showed substantial and significant increases in the overall scores for management of the two emergency situations (from 74.5% to 91.4% for shoulder dystocia [p<0.0001], and from 67.2% to 88.4% [p<0.0001] for CBVD) as well as in the scores for all the specific areas of expertise assessed: safety, know-how, technique, team communication and communication with the patient. This study demonstrated the value of multidisciplinary team training for obstetric emergencies, encouraging the ELENA perinatal care network to implement an annual training program for its staff. Over and above our experience, the future establishment of a national education program to optimize the management of obstetric emergencies seems to be essential. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Non elective cesarean section: use of a color code to optimize management of obstetric emergencies].

PubMed

Rudigoz, René-Charles; Huissoud, Cyril; Delecour, Lisa; Thevenet, Simone; Dupont, Corinne

2014-06-01

The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour.

Prenatal care and counseling of female drug-abusers: effects on drug abuse and perinatal outcome.

PubMed

Kukko, H; Halmesmäki, E

1999-01-01

To evaluate the efficacy of a specific counseling and withdrawal program for drug-abusing pregnant women and its effect on perinatal outcome. An analysis of 120 pregnancies followed in 111 drug-abusing women giving birth at the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, in 1985-95. Personnel responsible for local maternity care in the Helsinki area were trained to identify pregnant drug-abusers and to refer them to our hospital for clinical antenatal care and counseling with psychological and social support. Substance abuse during pregnancy was monitored by self-report and serial urine screenings. Obstetric and perinatal outcome were compared between those who succeeded in quitting totally or reducing drug use, and those who continued their drug use throughout pregnancy. The significance of the differences was tested by Student's unpaired t-test and binomial t-test. Of the women, 62% registered before the 20th week of pregnancy and 32% during the 20th-29th week of pregnancy (mean 18.4+/-6.6 weeks). Twelve women were admitted to an obstetric ward for withdrawal. In 73 of the 120 (61%) pregnancies the woman succeeded either in quitting totally or reducing drug abuse. Among this group, incidence of preterm birth (4.1%) was smaller (p<0.001), and gestational age (39.8+/-2.2 weeks) and birth weight (3393+/-605 gr) higher (p<0.05) than those (19.6%, 38.3+/-3.4 wk and 3049+/-728 gr, respectively) in the group continuing their drug abuse. Additionally, the percentage of normal delivery (80.8%) was higher (p<0.05), and incidence of withdrawal symptoms (19.2%), lower (p<0.001) than for those who continued drug abuse (65.2% and 47.8%, respectively). Carefully monitored counseling program for pregnant drug abusers is effective in reducing the amount of drugs used and improves perinatal outcome.

The quality of free antenatal and delivery services in Northern Sierra Leone.

PubMed

Koroma, Manso M; Kamara, Samuel S; Bangura, Evelyn A; Kamara, Mohamed A; Lokossou, Virgil; Keita, Namoudou

2017-07-12

The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities. The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care. The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

Lumbar ultrasound: useful gadget or time-consuming gimmick?

PubMed

Gambling, D R

2011-10-01

Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. Indeed, obstetric anesthesiologists have managed to do this with great success without using imaging techniques. There is a long learning curve associated with lumbar ultrasound and it is unclear from the literature if the success rates associated with its use are superior to clinical skill alone. Is it only a matter of time before regulators insist that lumbar ultrasound is used before inserting an epidural? Indeed, this has already happened for central vein catheters. The United States spent $2.2 trillion on health care in 2007, nearly twice the average of other developed nations. If rapid health cost growth persists, one out of every four dollars in the US national economy will be tied up in the health system by 2025. Do obstetric anesthesiologists want to add to these costs by using unnecessary and expensive equipment? Although many feel that diagnostic ultrasound in obstetrics is safe, some argue that we have yet to perform an appropriate risk analysis for lumbar ultrasound during pregnancy. The issue of ultrasound bio-safety needs to be considered before we all jump on the ultrasound bandwagon. Copyright © 2010 Elsevier Ltd. All rights reserved.

A measurement tool to assess culture change regarding patient safety in hospital obstetrical units.

PubMed

Kenneth Milne, J; Bendaly, Nicole; Bendaly, Leslie; Worsley, Jill; FitzGerald, John; Nisker, Jeff

2010-06-01

Clinical error in acute care hospitals can only be addressed by developing a culture of safety. We sought to develop a cultural assessment survey (CAS) to assess patient safety culture change in obstetrical units. Interview prompts and a preliminary questionnaire were developed through a literature review of patient safety and "high reliability organizations," followed by interviews with members of the Managing Obstetrical Risk Efficiently (MOREOB) Program of the Society of Obstetricians and Gynaecologists of Canada. Three hundred preliminary questionnaires were mailed, and 21 interviews and 9 focus groups were conducted with the staff of 11 hospital sites participating in the program. To pilot test the CAS, 350 surveys were mailed to staff in participating hospitals, and interviews were conducted with seven nurses and five physicians who had completed the survey. Reliability analysis was conducted on four units that completed the CAS prior to and following the implementation of the first MOREOB module. Nineteen values and 105 behaviours, practices, and perceptions relating to patient safety were identified and included in the preliminary questionnaire, of which 143 of 300 (47.4%) were returned. Among the 220 cultural assessment surveys returned (62.9%), six cultural scales emerged: (1) patient safety as everyone's priority; (2) teamwork; (3) valuing individuals; (4) open communication; (5) learning; and (6) empowering individuals. The reliability analysis found all six scales to have internal reliability (Cronbach alpha), ranging from 0.72 (open communication) to 0.84 (valuing individuals). The CAS developed for this study may enable obstetrical units to assess change in patient safety culture.

Neonatal and maternal outcomes of successful manual rotation to correct malposition of the fetal head; A retrospective and prospective observational study

PubMed Central

Tempest, Nicola; McGuinness, Naomi; Lane, Steven; Hapangama, Dharani K.

2017-01-01

Objective To evaluate the neonatal and maternal outcomes associated with successful operative vaginal births assisted by manual rotation. Design Prospective and retrospective observational study. Setting Delivery suite in a tertiary referral teaching hospital in England. Population A cohort of 2,426 consecutive operative births, in the second stage of labour, complicated with malposition of the fetal head during 2006–2013. Methods Outcomes of all births successfully assisted by manual rotation followed by direct traction instruments were compared with other methods of operative birth for fetal malposition in the second stage of labour (rotational ventouse, Kielland forceps and caesarean section). Main outcome measures Associated neonatal outcomes (admission to the special care baby unit, low cord pH, low Apgar and shoulder dystocia) and maternal outcomes (massive obstetric haemorrhage (blood loss of >1500ml) and obstetric anal sphincter injury). Results Births successfully assisted with manual rotation followed by direct traction instruments, resulted in 10% (36/346) of the babies being admitted to the Special Care Baby Unit, 4.9% (17/349) shoulder dystocia, 2% (7/349) massive obstetric haemorrhage and 1.7% (6/349) obstetric anal sphincter injury, similar to other methods of rotational births. Conclusions Adverse neonatal and maternal outcomes associated with successful manual rotations followed by direct traction instruments were comparable to traditional methods of operative births. There is an urgent need to standardise the practice (guidance, training) and documentation of manual rotation followed by direct traction instrumental deliveries that will enable assessment of its efficacy and the absolute safety in achieving a vaginal birth. PMID:28489924

Neonatal and maternal outcomes of successful manual rotation to correct malposition of the fetal head; A retrospective and prospective observational study.

PubMed

Tempest, Nicola; McGuinness, Naomi; Lane, Steven; Hapangama, Dharani K

2017-01-01

To evaluate the neonatal and maternal outcomes associated with successful operative vaginal births assisted by manual rotation. Prospective and retrospective observational study. Delivery suite in a tertiary referral teaching hospital in England. A cohort of 2,426 consecutive operative births, in the second stage of labour, complicated with malposition of the fetal head during 2006-2013. Outcomes of all births successfully assisted by manual rotation followed by direct traction instruments were compared with other methods of operative birth for fetal malposition in the second stage of labour (rotational ventouse, Kielland forceps and caesarean section). Associated neonatal outcomes (admission to the special care baby unit, low cord pH, low Apgar and shoulder dystocia) and maternal outcomes (massive obstetric haemorrhage (blood loss of >1500ml) and obstetric anal sphincter injury). Births successfully assisted with manual rotation followed by direct traction instruments, resulted in 10% (36/346) of the babies being admitted to the Special Care Baby Unit, 4.9% (17/349) shoulder dystocia, 2% (7/349) massive obstetric haemorrhage and 1.7% (6/349) obstetric anal sphincter injury, similar to other methods of rotational births. Adverse neonatal and maternal outcomes associated with successful manual rotations followed by direct traction instruments were comparable to traditional methods of operative births. There is an urgent need to standardise the practice (guidance, training) and documentation of manual rotation followed by direct traction instrumental deliveries that will enable assessment of its efficacy and the absolute safety in achieving a vaginal birth.

Antenatal Emergency Care Provided by Paramedics: A One-Year Clinical Profile.

PubMed

McLelland, Gayle; McKenna, Lisa; Morgans, Amee; Smith, Karen

2016-01-01

To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor. Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review. Over a 12-month period, paramedics were called to 2,098 women with pregnancy as a primary or non-primary clinical consideration. Women's ages ranged from 14 to 48 years. The majority were multigravidas (86%). There was a greater chance that ambulance services would be required during business hours than any other time of the day. Paramedics noted pregnant women required ambulance services for a range of primary presenting symptoms both obstetric (n = 1137) and non-obstetric (n = 961). Some women had pre-existing conditions including asthma, hypertension, and diabetes potentially complicating their pregnancies. Paramedics administered analgesia to one third of the women. Paired t-tests revealed significant improvement in the pain relief and overall vital signs of the women encountered. Less than half the women (n = 986, 47%) required interventions. This is a unique population wide analysis of ambulance service resource use exploring the clinical profile of pregnant women requiring ambulance services in one calendar year. To manage obstetric and non-obstetric complications in this population safely and effectively, paramedics require an understanding of the unique physiological adaptions during pregnancy. This study therefore has both educational and practice implications.

Trends in the aetiology of urogenital fistula: a case of 'retrogressive evolution'?

PubMed

Hilton, Paul

2016-06-01

It has long been held as conventional wisdom that urogenital fistulae in low-income and middle-income countries are almost exclusively of obstetric aetiology, related to prolonged neglected obstructed labour, whereas those seen in high-income countries are largely iatrogenic in nature. There is, however, a growing perception amongst those working in the field that an increasing proportion of urogenital fistulae in low-income and middle-income countries may be iatrogenic, resulting from caesarean section. Recent studies suggest that adverse patterns of care may also be emerging in high-income countries; an increase in the risk of both vesicovaginal and ureterovaginal fistulae following hysterectomy has been reported, concurrently with the reduction in overall use of the procedure. These apparent secular trends are discussed in the context of evolution of practice, teaching and training in obstetrics and gynaecology.

[Integral obstetrics impeded by history? Midwives and gynaecologists through the ages].

PubMed

van der Lee, N; Scheele, F

2016-01-01

There is a long and complicated history concerning the interprofessional collaboration between midwives and gynaecologists, which is still evident in current practice. Yet, in the analysis of collaborative problems, history and its lessons are often overlooked. Consequently, less effective solutions to problems may be found, because the root cause of a problem is not addressed. In this historical perspective we show how policies of the respective professions have often focused on self-preservation and competition, rather than on effective collaboration. We also highlight how the independent midwives lost and regained authorisation, status and income. Finally, using a theoretical model for interprofessional collaboration, we reflect on where history impedes the development of integral obstetrics. The focus must be averted away from professional self-interest and power struggles, but this proves to be a complex exercise.

What have we learned about vaginal infections and preterm birth?

PubMed

Carey, J Christopher; Klebanoff, Mark A

2003-06-01

Asymptomatic maternal genital tract infection during pregnancy, particularly bacterial vaginosis, has been consistently associated with preterm birth. In response to this evidence, the Maternal-Fetal Medicine Units Network (MFMU) designed and conducted 2 large randomized, placebo-controlled clinical trials of metronidazole treatment of asymptomatic pregnant women with bacterial vaginosis or trichomoniasis in a general obstetrical population. These studies showed that treatment of women with bacterial vaginosis failed to prevent preterm birth, regardless of their history of prior preterm birth. Metronidazole treatment of women with trichomoniasis significantly increased the risk of preterm birth compared to placebo. These results formed the basis of the US Preventive Services Task Force recommendation that screening for bacterial vaginosis not be undertaken in low-risk pregnant women, and show that MFMU network studies can have a direct and immediate impact on obstetrical practice.

The Detour of an Obstetric Technology: Active Management of Labor Across Cultures.

PubMed

Maffi, Irene

2016-01-01

Active management of labor (AML) is an obstetric technology developed in Ireland in the 1970s to accelerate labor in nulliparous women. This technology achieved rapid success in Great Britain and in English-speaking countries outside America, which adopted it before many other states around the world. In this article, I explore AML's technical and social characteristics when it was first designed, and then examine its local inflections in a Jordanian and a Swiss maternity hospital to shed light on the ways its transnational circulation modifies its script. I argue that its application is shaped by local material constraints and specific sociocultural configurations, gender regimes, and hospital cultures. Finally, I make a comparative analysis of AML practices in these two settings and in the foundational textbook to disentangle the technical and sociocultural components modeling its local applications.

[Study on the first translated obstetrics book Tai chan ju yao (Essentials in Obstetrics)].

PubMed

Wu, M

2018-01-28

In 1893, Wan Tsun-mo translated and published Tai chan ju yao ( Essentials in Obstetrics ), the first monograph of western obstetrics in modern China, symbolizing the independence of obstetrics from such maternal and child books as Fu ying xin shuo and Fu ke jing yun tu shuo , which occupies an important position in the history of the development of modern Chinese obstetrics. The book introduced anatomy, physiology, pathology, embryology, diagnostics, surgery, pharmacology and other knowledge of obstetrics in a catechismal form, and had a detailed discussion of such advanced obstetrical technologies as antiseptic, anesthesia, forceps and cesarean section for the first time.Judging from the content and translation of Tai chan ju yao , this book has already possessed the basic knowledge system of modern obstetrics, though the translation appeared to be somewhat jerky and not elegant and the terminology needing to be further improved, it was not only used as an important medium for the introduction of obstetrical knowledge, but also of great clinical value.However, its influence was so weak that later researchers seldom mentioned this book.

Determinants of research engagement in academic obstetrics and gynaecology.

PubMed

Fernandez, Ariadna; Sadownik, Leslie; Lisonkova, Sarka; Cundiff, Geoffrey; Joseph, K S

2016-04-16

To identify the determinants of research engagement among faculty in an academic department of Obstetrics and Gynaecology. All members of the Department of Obstetrics and Gynaecology at the University of British Columbia were mailed an online version of the Edmonton Research Orientation Survey (EROS) in 2011 and in 2014. High scores on overall research engagement and on each of the 4 subscales, namely, value of research, value of innovation, research involvement and research utilization/evidence-based practice were quantified. Analyses were carried out on both surveys combined and on the 2014 survey separately. Logistic regression was used to identify determinants of high levels of research engagement. The overall response rate was 37% (130 responses; 54 respondents in 2011 and 76 respondents in 2014). The average EROS score was 140 (range 54 to 184) and 35% of respondents had a score ≥150. Significant determinants of positive research engagement based on the overall EROS scale included being paid for research work (adjusted odds ratio [AOR] 22.1, 95% confidence interval [CI] 2.47-197.7) and carrying out research during unpaid hours (AOR 6.41, 95% CI 1.97-20.9). Age <50 years (AOR 11.0, 95% CI 1.35-89.9) and clinical experience <20 years (AOR 19.7, 95% CI 2.18-178.8) were positively associated, while journal reading during unpaid hours (AOR 0.21, 95% CI 0.07-0.62) was negatively associated with specific EROS subscales. In a setting with a positive research orientation, research engagement among the faculty was associated with paid research time, research work and journal reading during unpaid hours and more recent entry into clinical practice.

Characteristics Associated With Severe Perineal and Cervical Lacerations During Vaginal Delivery

PubMed Central

Landy, Helain J.; Laughon, S. Katherine; Bailit, Jennifer; Kominiarek, Michelle A.; Gonzalez-Quintero, Victor Hugo; Ramirez, Mildred; Haberman, Shoshana; Hibbard, Judith; Wilkins, Isabelle; Branch, D. Ware; Burkman, Ronald T.; Gregory, Kimberly; Hoffman, Matthew K.; Learman, Lee A.; Hatjis, Christos; VanVeldhuisen, Paul C.; Reddy, Uma M.; Troendle, James; Sun, Liping; Zhang, Jun

2011-01-01

Objective To characterize potentially modifiable risk factors for third- or fourth-degree perineal lacerations and cervical lacerations in a contemporary U.S. obstetric practice. Methods The Consortium on Safe Labor collected electronic medical records from 19 hospitals within 12 institutions (228,668 deliveries from 2002 to 2008). Information on patient characteristics, prenatal complications, labor and delivery data, and maternal and neonatal outcomes were collected. Only women with successful vaginal deliveries of cephalic singletons at 34 weeks of gestation or later were included; we excluded data from sites lacking information about lacerations at delivery and deliveries complicated by shoulder dystocia; 87,267 and 71,170 women were analyzed for third- or fourth-degree and cervical lacerations, respectively. Multivariable logistic regressions were used to adjust for other factors. Results Third- or fourth-degree lacerations occurred in 2,516 women (2,223 nulliparous [5.8%], 293 [0.6%] multiparous) and cervical lacerations occurred in 536 women (324 nulliparous [1.1%], 212 multiparous [0.5%]). Risks for third or fourth-degree lacerations included nulliparity (7.2-fold risk), being Asian or Pacific Islander, increasing birth weight, operative vaginal delivery, episiotomy, and longer second stage of labor. Increasing body mass index was associated with fewer lacerations. Risk factors for cervical lacerations included young maternal age, vacuum vaginal delivery, and oxytocin use among multiparous women, and cerclage regardless of parity. Conclusion Our large cohort of women with severe obstetric lacerations reflects contemporary obstetric practices. Nulliparity and episiotomy use are important risk factors for third- or fourth-degree lacerations. Cerclage increases the risk for cervical lacerations. Many identified risk factors may not be modifiable. PMID:21343766

Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

PubMed

Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

2015-11-01

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

Gestational diabetes mellitus: Confusion among medical doctors caused by multiple international criteria.

PubMed

Agarwal, Mukesh M; Shah, Syed M; Al Kaabi, Juma; Saquib, Shabnam; Othman, Yusra

2015-06-01

The aim of this study was to appraise the current regional practices of screening, diagnosis and follow-up of gestational diabetes mellitus (GDM) because the approach to GDM is frequently inconsistent. A 21-item questionnaire was distributed to physicians taking care of pregnant women in seven hospitals in the United Arab Emirates and one hospital in Oman. Besides assessing their attitudes towards testing for GDM, the questionnaire assessed familiarity with the Hyperglycemia and Pregnancy Outcome study and the International Association of Diabetes in Pregnancy Study Groups GDM guidelines. One hundred and forty-eight (93%) of the 159 questionnaires distributed to the medical doctors (106 [72%] obstetricians and 42 [28%] internists) were returned. For GDM screening, six hospitals used five different tests; two hospitals utilized one single test. For GDM diagnosis, six hospitals employed the 2-h, 75-g oral glucose tolerance test (OGTT) (four different criteria) while two hospitals used the 3-h, 100-g OGTT (single criteria). For post-delivery follow-up, the 2-h, 75-g OGTT and fasting plasma glucose were accepted by 103 (70%) and 38 (26%) of the 148 medical doctors, respectively. Ninety-eight (69%) of 143 responding physicians were aware of the Hyperglycemia and Pregnancy Outcome study, while 85 (61%) of 140 responders were familiar with the guidelines of the International Association of Diabetes in Pregnancy Study Groups; this knowledge was independent of specialty, seniority, academia, years in practice or country trained. Although this study is parochial, its implications are global; that is, further education of caregivers would make the discordant approach to GDM (within and between hospitals) more harmonious and improve the obstetric care of pregnant women. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

What Do Childbearing Women in Your Clinical Practice Look Like?

PubMed

Clark Callister, Lynn

2016-01-01

With cultural diversity increasing, what do the childbearing women in your practice look like? Beliefs about the central role of motherhood and the use of fertility rites in the life of a woman vary. Although individual differences exist because of the uniqueness of each woman, there are wonderfully rich cultural traditions and practices that influence what a woman believes and enacts. What constitutes a satisfying birth experience varies from woman to woman. Perinatal nurses can find many satisfying clinical experiences by being creative, flexible, and resilient in their approach to providing care. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Simulation and Shoulder Dystocia.

PubMed

Shaddeau, Angela K; Deering, Shad

2016-12-01

Shoulder dystocia is an unpredictable obstetric emergency that requires prompt interventions to ensure optimal outcomes. Proper technique is important but difficult to train given the urgent and critical clinical situation. Simulation training for shoulder dystocia allows providers at all levels to practice technical and teamwork skills in a no-risk environment. Programs utilizing simulation training for this emergency have consistently demonstrated improved performance both during practice drills and in actual patients with significantly decreased risks of fetal injury. Given the evidence, simulation training for shoulder dystocia should be conducted at all institutions that provide delivery services.

Standards for midwife practitioners of external cephalic version: A Delphi study.

PubMed

Walker, Shawn; Perilakalathil, Prasanth; Moore, Jenny; Gibbs, Claire L; Reavell, Karen; Crozier, Kenda

2015-05-01

expansion of advanced and specialist midwifery practitioner roles across professional boundaries requires an evidence-based framework to evaluate achievement and maintenance of competency. In order to develop the role of Breech Specialist Midwife to include the autonomous performance of external cephalic version within one hospital, guidance was required on standards of training and skill development, particularly in the use of ultrasound. a three-round Delphi survey was used to determine consensus among an expert panel, including highly experienced obstetric and midwife practitioners, as well as sonographers. The first round used mostly open-ended questions to gather data, from which statements were formed and returned to the panel for evaluation in subsequent rounds. standards for achieving and maintaining competence to perform ECV, and in the use of basic third trimester ultrasound as part of this practice, should be the same for midwives and doctors. The maintenance of proficiency requires regular practice. midwives can appropriately expand their sphere of practice to include ECV and basic third trimester ultrasound, according to internal guidelines, following the completion of a competency-based training programme roughly equivalent to those used to guide obstetric training. Ideally, ECV services should be offered in organised clinics where individual practitioners in either profession are able to perform approximately 30 or more ECVs per year in order to maintain an appropriate level of skill. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical governance in the management of induction of labour.

PubMed

Zuberi, Nadeem Faiyaz; Siddiqui, Salva; Qureshi, Rahat Najam

2003-02-01

To determine whether dissemination of explicit guidelines, developed in consensus with stakeholders, for the processes of induction of labour (IOL), results in reduction of variability in clinical practice. A prospective behaviour modification interventional study. The study was conducted in the department of Obstetrics and Gynaecology at the Aga Khan University, Karachi, between January 1 and August 31, 2002. In a total of 142 conveniently sampled women, undergoing IOL, pre-identified quality assessment indicators were measured. After collection of data from initial 71-women (pre-intervention group) mutually agreed guidelines for clinical practice were disseminated, over a period of time, among consultants, residents and nurses. These indicators were again measured in subsequent 71 women (post-intervention group) to evaluate magnitude of residual non-conformities in these processes. Following behaviour modification interventions, nonconformities in consultants and residents-dependent processes like timely review of patients by consultants (72 vs 1.4%, p value <0.0001), documentation of indication for IOL (66.2 vs 16.9%, p value <0.0001), method of induction for IOL (56.3 vs 28.2%, p value 0.0001), and calculation of Bishop score before IOL (38.0 vs 4.2 %, p value <0.0001) were significantly reduced. Dissemination of explicit guidelines developed in consensus with stakeholders significantly reduces variability in clinical practice. Our model can be used for improving quality of care in other areas of obstetric health care.

Exercise during pregnancy: the role of obstetric providers.

PubMed

May, Linda E; Suminski, Richard R; Linklater, Emily R; Jahnke, Sara; Glaros, Alan G

2013-08-01

Obstetric providers are logical choices for conveying information about physical activity to their pregnant patients. However, research regarding obstetric providers counseling pregnant patients about physical activity is sparse. To investigate the association between obstetric providers discussing exercise with their pregnant patients and patients' exercise behaviors and to explore factors related to obstetric providers discussing exercise and other health behaviors (tobacco use, alcohol use, and nutrition) with their patients. We received completed surveys from 238 pregnant women and 31 obstetric providers at 12 obstetrician offices. The offices were located throughout the United States and were heterogeneous in regards to patient insurance coverage, number of patients treated per month, and percentage of patients with complications. Women who were "more careful about eating healthy" (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.0) and who discussed exercise with their obstetric provider (OR, 2.2; 95% CI, 1.1-4.3) were more likely to "maintain or increase exercise" during pregnancy than those who were not conscientious about their diets and those who did not discuss exercise with their obstetric provider, respectively. The odds of obstetric providers discussing exercise with pregnant patients increased 7-fold (OR, 7.1; 95% CI, 1.4-37.3) for each health behavior the obstetric provider discussed with the patient. Patient discussions with obstetric providers about exercise and patient attention to eating habits are associated with exercising during pregnancy. A more multibehavioral approach by obstetric providers may improve the likelihood that patients exercise during pregnancy.

[Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000].

PubMed

Vincent-Boulétreau, A; Caillat-Vallet, E; Dumas, A M; Ayzac, L; Chapuis, C; Emery, M N; Girard, R; Haond, C; Lafarge-Leboucher, J; Tissot-Guerraz, F; Fabry, J

2005-04-01

In this study we describe the changes in medical practices and nosocomial infection rates in obstetrics observed through a surveillance network in the South East of France. The maternity units which belong to this network participated in voluntary surveillance using the network's methodology. The criteria for the diagnosis of nosocomial infections were in accordance with the methods described by the Centers for Disease Control and Prevention. 101240 pregnancies including 18503 caesareans (18.3%) were included in the network from 1997 to 2000. During the study period, nosocomial infection rates following caesarean section and vaginal delivery decreased respectively from 7.8% to 4.3% (p < 0.001) and from 2.2% to 0.9% (p < 0.001). This evolution was compared with the evolution of collected risk factors. In spite of the methodology limits, general value of surveillance and infection control programs in maternity units has been confirmed by the results of this surveillance network. During the study period, both obstetrics-related risk factors for nosocomial infection and observed hospital-acquired infection rates were dramatically reduced, what prove an improvement of quality of care in maternity units.

Prevalence of illicit drug use in pregnant women in a Wisconsin private practice setting.

PubMed

Schauberger, Charles W; Newbury, Emily J; Colburn, Jean M; Al-Hamadani, Mohammed

2014-09-01

We sought to measure the prevalence of illicit drug use in our obstetric population, to identify the drugs being used, and to determine whether a modified version of the 4Ps Plus screening tool could serve as an initial screen. In this prospective study, urine samples of 200 unselected patients presenting for initiation of prenatal care in a Wisconsin private practice were analyzed for evidence of the use of illicit drugs. Of 200 patients, 26 (13%) had evidence of drugs of abuse in their urine samples. Marijuana (7%) and opioids (6.5%) were the most commonly identified drugs. Adding 5 questions about drug or alcohol use to the obstetric intake questionnaire proved sensitive in identifying patients with high risks of having a positive drug screen. The rate of drug use in our low-risk population was higher than expected and may reflect increasing rates of drug use across the United States. Enhanced screening should be performed to identify patients using illicit drugs in pregnancy to improve their care. Medical centers and communities may benefit from periodic testing of their community prevalence rates to aid in appropriate care planning. Copyright © 2014 Mosby, Inc. All rights reserved.

Utility of the PALM-COEIN classification of abnormal uterine bleeding for Indian gynecologists.

PubMed

Bandi, Nirmala D; Arumugam, Chandrasekharan P; Venkata, Meenakumari R N; Nannam, Lahari

2016-05-01

To study the clinical utility of the PALM-COEIN classification for abnormal uterine bleeding in day-to-day practice in India. Between April and November 2014, a cross-sectional survey was undertaken of gynecologists practicing in Chittoor and Nellore. Doctors possessing a postgraduate degree in gynecology and obstetrics, and postgraduate students in the gynecology department of medical colleges were invited to participate. A validated questionnaire containing 15 questions was distributed, the opinions were collated, and the results analyzed. Among 150 invited gynecologists, 120 agreed to participate, and 119 completed the survey fully. Overall, 95 (79.8%) respondents were aware of the classification, and 56 (47.1%) responded that the PALM-COEIN system is very good, 46 (38.7%) that it is average, and 17 (14.3%) that it is poor. By subgroup, 16 of 20 (80.0%) faculty members, 46 of 56 (82.1%) postgraduate students, and 33 of 43 (76.7%) practitioners responded that the system is useful. Indian doctors generally believe that the PALM-COEIN system is clinically useful and a step forward in the management of abnormal uterine bleeding. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

[Assessment of prophylaxis and treatment of blood loss in patients with pre-eclampsia].

PubMed

Timokhova, S Iu; Golubtsov, V V; Zabolotskikh, I B

2014-01-01

To improve treatment results of women with massive obstetrical blood loss. Subjects and methods: 96 female patients with average and heavy degree preeclampsia worsened massive blood developing were involved into the investigation. The women were divided into two groups: main (n=55) (basic) - it's patients were treated with complex of offered wiays control (n=41) - it's patients were evaluated retrospectively. During the investigation the parameters of hemostasis system and periphery blood values were performed as dynamic evaluations, acidity-basic state and water-electrolyte balance parameters, medical history were monitored. As a result of the investigation it was found out that these offered actions complex application about reducing massive obstetric blood accelerates restoration of clinic, bio-chemical paramnleters during the early post-operating period The application of the offered methods has reduced both inltraoperative blood loss in women with preeclamsia and use of blood components and the time spent on the hemostasis system correction for all the women of the base group.

Reducing the number of obstetrical beds by challenging traditions.

PubMed

Salvig, Camilla Dalby; Storkholm, Marie Højriis; Salvig, Jannie Dalby; Uldbjerg, Niels

2018-05-19

The aim of this commentary is to describe changes in women care at an obstetric department that made it possible to reduce the number of beds from 40 to 29. Patient pathways were reviewed and revised using lean methodology. The mean length of stay was reduced from 70 to 59 hours and the mean numbers of hospitalizations per woman from 1.26 to 1.20. At the organizational level, we introduced a Family Department, home management of newborns, home monitoring of the women with cardiotocography and blood samples, and intrapartum Group B Streptococcus-PCR. Additionally, an After Birth Clinic and network meetings for vulnerable women were established. In patient pathway, we reduced the hospitalization indicated by preterm premature rupture of membranes, preeclampsia and observation after birth laceration. According to National Patient Satisfaction surveys, there was no decrease in women's satisfaction after reducing the number of beds. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Antepartum transabdominal amnioinfusion to facilitate external cephalic version after initial failure.

PubMed

Benifla, J L; Goffinet, F; Darai, E; Madelenat, P

1994-12-01

Transabdominal amnioinfusion can be used to facilitate external cephalic version. Our technique involves filling the uterine cavity with 700 or 900 mL of 37C saline under continuous echographic monitoring. External cephalic version is done the next morning. We have used this procedure in six women, all of whom had previous unsuccessful attempts at external cephalic version. After amnioinfusion, all six patients were converted to cephalic presentation and delivered normally, without obstetric or neonatal complications.

A qualitative assessment of ante-natal care provided by auxillary nurse midwives.

PubMed

Prasad, B; Gupta, V M

1999-01-01

Two hundred sixty eight antenatal mothers were observed for the quality of services provided by Auxillary Nurse Midwives (ANMs). History taking was found to be satisfactory in only 2.6% women. Obstetric examination was done unsatisfactorily in majority (52.6%) of the mothers. General physical examination was not done in 69% women. ANMs in all 31 sub-centres were not performing investigation like haemoglobin estimation, urine testing, foetal heart sound monitoring and blood pressure recording.

An exploration of the effects of clinical negligence litigation on the practice of midwives in England: A phenomenological study.

PubMed

Robertson, Judith H; Thomson, Ann M

2016-02-01

to explore how midwives׳ personal involvement in clinical negligence litigation affects their midwifery practice. descriptive phenomenological study using semi-structured interviews. in 2006-2007 in-depth interviews were conducted in participants׳ homes or at their place of work and focused on participants׳ experience of litigation. Participants were recruited from various regions of England. 22 National Health Service (NHS) midwives who had been alleged negligent. clinical practice affected was an increase in documentation, fear of practising outside clinical guidelines and electronic fetal monitoring of women at low obstetric risk; these changes were not widespread. Changes in practice were sometimes perceived negatively and sometimes positively. Forming a good relationship with childbearing women was judged to promote effective midwifery care but litigation had affected the ability of a minority of midwives to advocate for women if this relationship had not been established. Litigation could result in loss of confidence leading to self-doubt, isolation, increased readiness to seek medical assistance and avoidance of working in the labour ward, perceived as an area with a high risk of litigation. A blame culture in the NHS was perceived by several midwives. In contrast an open non-punitive culture resulted in midwives readily reporting mistakes to risk managers. Litigation lowered midwifery morale and damaged professional reputations, particularly when reported in the newspapers. Some midwives expressed thoughts of leaving midwifery or taking time off work because of litigation but only one was actively seeking other employment, another took sick leave and one had left midwifery and returned to nursing. litigation can have a negative effect on midwives׳ clinical practice and morale and fosters a culture of blame within the NHS. education regarding appropriate documentation, use or non-use of electronic fetal monitoring and the legal status of clinical guidelines will enable midwives to respond proportionately to the threat of litigation. A culture of openness and sharing the problem when adverse events occur would help to extinguish the current blame culture in the National Health Service. Litigation must be recognised by management as capable of inducing loss of confidence and reluctance to work in the labour ward. Promoting teamwork will help support these midwives. The potential for litigation in maternity care could affect retention of the midwifery workforce. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exploring the needs and challenges of women reintegrating after obstetric fistula repair in northern Ghana.

PubMed

Jarvis, Kimberly; Richter, Solina; Vallianatos, Helen

2017-07-01

to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair. a critical ethnographic approach. a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana. ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included. the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair. developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration. Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Outcomes for Gestational Carriers Versus Traditional Surrogates in the United States.

PubMed

Fuchs, Erika L; Berenson, Abbey B

2018-05-01

Little is known about the obstetric and procedural outcomes of traditional surrogates and gestational carriers. Participants included 222 women living in the United States who completed a brief online survey between November 2015 and February 2016. Differences between gestational carriers (n = 204) and traditional surrogates (n = 18) in demographic characteristics, pregnancy outcomes, and procedural outcomes were examined using chi-squared tests, Fisher's exact tests, and t-tests. Out of 248 eligible respondents, 222 surveys were complete, for a response rate of 89.5%. Overall, obstetric outcomes were similar among gestational carriers and traditional surrogates. Traditional surrogates were more likely than gestational carriers to have a Center for Epidemiologic Studies Depression Scale Revised score of 16 or higher (37.5% vs. 4.0%). Gestational carriers reported higher mean compensation ($27,162.80 vs. $17,070.07) and were more likely to travel over 400 miles (46.0% vs. 0.0%) than traditional surrogates. Procedural differences, but not differences in obstetric outcomes, emerged between gestational carriers and traditional surrogates. To ensure that both traditional surrogates and gestational carriers receive optimal medical care, it may be necessary to extend practice guidelines to ensure that traditional surrogates are offered the same level of care offered to gestational carriers.

OB fellowship outcomes 1992-2010: where do they go, who stops delivering, and why?

PubMed

Rodney, W MacMillan; Martinez, Conchita; Collins, Millard; Laurence, Greg; Pean, Carl; Stallings, Joe

2010-01-01

This study describes characteristics and the evolution of the careers of graduates from a 1-year post-residency fellowship program whose primary objectives included clinical skills in Cesarean section. Besides obstetrical practice, rural service and attainment of faculty appointment were used as surrogate measures of fulfilling an underserved need for family medicine obstetrics. For 18 years, the authors maintained contact with all 80 physicians completing 1-year fellowships in family medicine obstetrics in Memphis and Nashville. The founding chair of these programs surveyed each physician and maintained a network of contacts to study outcomes such as graduation, service location, hospital privileges, retention, and career changes. The study tracked 100% of the sample and documented high rates of fellowship completion (74/80 [93%]), Cesarean privileges (71/74 [96%]), and service in a rural community for at least 2 years (47/74 [64%]). The fellowship was also associated with participation as faculty (36/74 [46%]). This paper produces the first and longest-term data describing attrition over time and examines the reasons why fellowship-trained family physicians stop doing maternity care. It is the only series with a 100% response rate and provides longitudinal data on the outcomes of these fellowship programs. Attrition was highest at rural sites. Workforce planners and fellowship designers might benefit from these considerations.

Opportunities and barriers in global women's health training during obstetrics and gynecology residencies in the USA.

PubMed

Eichelberger, Kacey Y; Morse, Jessica E; Connolly, AnnaMarie; Autry, Meg

2015-02-01

To systematically measure the scope and breadth of global women's health (GWH) training opportunities during obstetrics and gynecology residencies in the USA, as described by program directors (PDs). In a questionnaire-based study, PDs were asked to complete a web-based survey between January 1 and March 15, 2013. Information about the residency program and GWH opportunities was obtained. Among 236 PDs contacted, 105 (44.5%) responded. Overall, 82 (78.1%) reported that at least one resident had participated in a GWH rotation during the past 5 years, 36 (34.3%) offered formal didactics, and 29 (27.6%) offered a formal rotation in GWH. Among all respondents, 43 (42.2%) reported having at least one faculty member for whom GWH is a dedicated part of their practice. Programs with dedicated GWH faculty were more likely to offer formal GWH didactics (relative risk [RR] 1.84; 95% confidence interval [CI] 1.07-3.14; P=0.03), but were not significantly more likely to offer a formal GWH rotation (RR 1.91; 95% CI 0.97-3.70; P=0.06). Many residency programs provide opportunities for GWH training, but few offer formal didactics or a formal rotation. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

PubMed Central

Wulff, Verena; Hepp, Philip; Fehm, Tanja; Schaal, Nora K.

2017-01-01

In recent years, the effect of music interventions and music therapy has experienced increased attention in the literature. It has been shown that music has positive effects on cognitive and physical performance, such as concentration and endurance, as well as on psychological parameters, such as anxiety and relaxation. Studies within the context of medicine in particular are increasingly indicating that music may be used as an intervention for relief against anxiety, stress and pain. Music is therefore seen in actual practice as a supplement to conventional pharmacological and non-pharmacological forms of treatment – and the trend is rising. Studies involving music interventions in the field of obstetrics have shown, amongst other things, that music improves the ability to relax during pregnancy and can reduce anxiety. It was also discovered that during childbirth music interventions resulted in a reduction of pain and stress. Music also has the effect of reducing stress, pain and anxiety in expectant mothers during deliveries by caesarean section. This review intends to provide an overview of the literature on music interventions in the field of obstetrics and to give a resume on the current state of research around the topic of music in relation to pregnancy, spontaneous deliveries and caesarean sections. Furthermore, the relevance of music for everyday obstetrics will be illustrated. PMID:28959060

The role of counseling for obstetric fistula patients: Lessons learned from Eritrea

PubMed Central

Johnson, Khaliah A.; Turan, Janet M.; Hailemariam, Letu; Mengsteab, Elsa; Jena, Dirk; Polan, Mary Lake

2013-01-01

Objective The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea. Methods To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling. Results Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem. Conclusion Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem. Practical implications Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair. PMID:20034756

Contemporary Obstetric Triage.

PubMed

Sandy, Edward Allen; Kaminski, Robert; Simhan, Hygriv; Beigi, Richard

2016-03-01

The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. This study is for obstetricians and gynecologists as well as family physicians. After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

Case mix, outcome and activity for obstetric admissions to adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database

PubMed Central

2005-01-01

Introduction Risk prediction scores usually overestimate mortality in obstetric populations because mortality rates in this group are considerably lower than in others. Studies examining this effect were generally small and did not distinguish between obstetric and nonobstetric pathologies. We evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II model in obstetric admissions to critical care units contributing to the ICNARC Case Mix Programme. Methods All obstetric admissions were extracted from the ICNARC Case Mix Programme Database of 219,468 admissions to UK critical care units from 1995 to 2003 inclusive. Cases were divided into direct obstetric pathologies and indirect or coincidental pathologies, and compared with a control cohort of all women aged 16–50 years not included in the obstetric categories. The predictive ability of APACHE II was evaluated in the three groups. A prognostic model was developed for direct obstetric admissions to predict the risk for hospital mortality. A log-linear model was developed to predict the length of stay in the critical care unit. Results A total of 1452 direct obstetric admissions were identified, the most common pathologies being haemorrhage and hypertensive disorders of pregnancy. There were 278 admissions identified as indirect or coincidental and 22,938 in the nonpregnant control cohort. Hospital mortality rates were 2.2%, 6.0% and 19.6% for the direct obstetric group, the indirect or coincidental group, and the control cohort, respectively. Cox regression calibration analysis showed a reasonable fit of the APACHE II model for the nonpregnant control cohort (slope = 1.1, intercept = -0.1). However, the APACHE II model vastly overestimated mortality for obstetric admissions (mortality ratio = 0.25). Risk prediction modelling demonstrated that the Glasgow Coma Scale score was the best discriminator between survival and death in obstetric admissions. Conclusion This study confirms that APACHE II overestimates mortality in obstetric admissions to critical care units. This may be because of the physiological changes in pregnancy or the unique scoring profile of obstetric pathologies such as HELLP syndrome. It may be possible to recalibrate the APACHE II score for obstetric admissions or to devise an alternative score specifically for obstetric admissions.

Enablers and barriers to implementing bedside reporting: insights from nurses.

PubMed

Jeffs, Lianne; Cardoso, Roberta; Beswick, Susan; Acott, Ashley; Simpson, Elisa; Campbell, Heather; Lo, Joyce; Ferris, Ella

2013-09-01

As part of efforts to improve patient safety, quality of care and patient- and family-centred care, there is a growing interest in moving away from traditional taped nursing reports or reporting at the nursing station to reporting at the bedside. Although a body of knowledge exists regarding what nurses view as benefits and challenges experienced in nurse-to-nurse bedside reporting, less is known about the perceptions of nurses who have experienced this change in reporting practice on their unit. In this context, a qualitative study using semi-structured interviews was undertaken to explore nurses' perceptions of a newly implemented nurse-to-nurse bedside reporting practice at one acute care hospital. A total of 43 interviews were conducted on four units with seven nurses from respirology, 10 from obstetrics and gynecology, 10 from nephrology and 16 from general surgery. Data were analyzed using a directed content analysis approach. Three themes emerged that captured nurses' perceptions of the implementation of nurse-to-nurse bedside reporting: (a) being supported to change and embrace bedside reporting, (b) maintaining confidentiality and respecting patients' preferences and (c) experiencing challenges with bedside reporting. Our findings provide insight for other organizations in their efforts to change reporting practices. Specifically, there is a need for multi-pronged initiatives including leadership support, educational opportunities and ongoing monitoring and feedback mechanisms. Future research is required to examine how enablers can be leveraged and barriers mitigated or removed to ensure successful implementation and sustainability of nurse-to-nurse bedside reporting. Copyright © 2013 Longwoods Publishing.

Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence.

PubMed

Jangö, Hanna; Langhoff-Roos, Jens; Rosthøj, Susanne; Sakse, Abelone

2017-06-01

Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997-2005. We performed uni- and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third- or fourth-degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05-2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1.13-3.47], P = .02, respectively). More women with recurrent obstetric anal sphincter injury reported affected the quality of life because of anal incontinence (34.9%, n = 37) compared with women without recurrent obstetric anal sphincter injury (24.2%, n = 335), although this difference did not reach statistical significance after adjustment (adjusted odds ratio, 1.53 [95% confidence interval, 0.92-2.56] P = .10). Women opting for vaginal delivery after obstetric anal sphincter injury should be informed about the risk of recurrence, which is associated with an increased risk of long-term flatal and fecal incontinence. Copyright © 2017 Elsevier Inc. All rights reserved.

Student responses to the introduction of case-based learning and practical activities into a theoretical obstetrics and gynaecology teaching programme

PubMed Central

Massonetto, Júlio Cesar; Marcellini, Cláudio; Assis, Paulo Sérgio Ribeiro; de Toledo, Sérgio Floriano

2004-01-01

Background The fourth-year Obstetrics and Gynaecology course at our institution had previously been taught using theory classes alone. A new teaching model was introduced to provide a better link with professional practice. We wished to evaluate the impact of the introduction of case discussions and other practical activities upon students' perceptions of the learning process. Methods Small-group discussions of cases and practical activities were introduced for the teaching of a fourth-year class in 2003 (Group II; 113 students). Comparisons were made with the fourth-year class of 2002 (Group I; 108 students), from before the new programme was introduced. Students were asked to rate their satisfaction with various elements of the teaching programme. Statistical differences in their ratings were analysed using the chi-square and Bonferroni tests. Results Group II gave higher ratings to the clarity of theory classes and lecturers' teaching abilities (p < 0.05) and lecturers' punctuality (p < 0.001) than did Group I. Group II had greater belief that the knowledge assessment tests were useful (p < 0.001) and that their understanding of the subject was good (p < 0.001) than did Group I. Group II gave a higher overall rating to the course (p < 0.05) than did Group I. However, there was no difference in the groups' assessments of the use made of the timetabled hours available for the subject or lecturers' concern for students' learning. Conclusions Students were very receptive to the new teaching model. PMID:15569385

Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy

PubMed Central

Aradeon, Susan B; Doctor, Henry V

2016-01-01

The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care. PMID:27088844

Leading the rebirth of the rural obstetrician.

PubMed

Campbell, Alison M; Brown, James; Simon, David R; Young, Sari; Kinsman, Leigh

2014-12-11

To understand the factors influencing the decisions of rural general practitioners and GP registrars to practise obstetrics, and to understand the impact on these decisions of an innovative obstetric training and support program in the Gippsland region of Victoria. Qualitative approach using semistructured interviews conducted in July and August 2013 and inductive content analysis. Participants were identified from training records over the previous 5 years for the Gippsland GP obstetric training and support program. Two questions were posed during interviews: What challenges face rural GPs in practising obstetrics? What impact has the Gippsland GP obstetric program had on GP obstetric career decisions? Of 60 people invited to participate, 22 agreed. Interviews ranged in duration from 40 to 90 minutes. The major themes that emerged on the challenges facing rural GPs in practising obstetrics were isolation, work-life balance and safety. The major themes that emerged on the impact of the Gippsland GP obstetric program were professional support, structured training and effective leadership. Rural GP obstetricians are challenged by isolation, the impact of their job on work-life balance, and safety. The support, training and leadership offered by the Gippsland expanded obstetric training program helped doctors to deal with these challenges. The Gippsland model of training offers a template for GP obstetric procedural training programs for other rural settings.

[Posthumous sperm procurement and use--ethical and legal dilemmas].

PubMed

Crha, I; Dostál, J; Ventruba, P; Kudela, M; Záková, J

2004-07-01

To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood. Review article. Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc. Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use. Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.

Lifelong learning in obstetrics and gynaecology: how theory can influence clinical practice.

PubMed

Mukhopadhyay, S; Smith, S; Cresswell, J

2011-08-01

Lifelong learning refers to the systematic acquisition, renewal, updating and completion of knowledge. It is synonymous with the term 'self-directed learning'. This is a new educational strategy meant to consolidate knowledge in a fashion that is reproducible for a lifetime with successful application to both known and unknown clinical exercises. The development of lifelong learning is based on the principles of andragogy (autonomy and independence in one's learning activities), reflection and learning from experience. This paper deals with the development of these theories culminating in the advent of self-directed learning. Evidence to support experiential, reflective and self-directed learning is provided, including the use of rating scales. An example from obstetrics is used to highlight the application of these principles. There are barriers to adopting a new educational paradigm, however, lifelong learning remains an excellent tool for continuous professional development.

Surgical or medical interventions for female genital mutilation.

PubMed

Smith, Helen; Stein, Karin

2017-02-01

Deinfibulation can prevent or treat gynecological and obstetric complications in women living with type III female genital mutilation (FGM), and subsequently improve childbirth outcomes. Recently published WHO guidelines recommend use of deinfibulation in both circumstances. However, to really impact practice, evidence-based guidance needs to be matched with evidence-based implementation strategies. This qualitative evidence synthesis provides information on the factors that facilitate or act as barriers to use of deinfibulation, and the context and conditions that are necessary for implementing the procedure, including healthcare providers' knowledge and experience, the service delivery environment, as well as broader health system contexts. This information is of great value for policy makers and others considering this as an option for better clinical care of women living with FGM. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Novel ways of improving communication with members of health professional associations.

PubMed

Chaudhary, Pushpa; Tuladhar, Heera

2014-10-01

The International Federation of Gynecology and Obstetrics (FIGO) supported the Nepal Society of Obstetricians and Gynaecologists (NESOG) to help influence national health policy and practice through FIGO's Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health. An Organizational Capacity Improvement Framework, developed by the Society of Obstetricians and Gynaecologists of Canada (SOGC), was used to evaluate NESOG's initial baseline organizational capacity in 2010. Communication among NESOG members was rated as moderate (39%). Several initiatives, such as the use of high-speed internet access, group SMS texts and emails for information sharing, member profile updates, use of social media, and regular updates to the NESOG website were examples of interventions that resulted in improved participation of members in NESOG's activities. Members were impressively active in reciprocating via Facebook, and via participation in online voting in the NESOG elections (84%). Copyright © 2014. Published by Elsevier Ireland Ltd.

[Systematization of nursing care in the obstetrical center].

PubMed

dos Santos, Raquel Bezerra; Ramos, Karla da Silva

2012-01-01

This is a descriptive and exploratory study with a quantitative approach, aiming to propose a protocol for the systematization of nursing care to women in the process of giving birth in the Obstetrical Center of a public hospital in Recife, Pernambuco, Brazil. A semi-structured instrument was applied to forty women in the process of giving birth, in order to obtaining the nursing history; from which the nursing diagnoses were identified, having as a basis the International Classification for Nursing Practice (ICNP®), version 1, and their respective results and nursing interventions were established. The protocol consists in two stages: the first one is the nursing consultation, which involves the anamnesis and physical examination; and the second, involves the judicious identification of the nursing diagnoses, which will guide the planning of the nursing care to provide the individualized attention to women in the process of giving birth, using a universal terminology.

Central Fetal Monitoring With and Without Computer Analysis: A Randomized Controlled Trial.

PubMed

Nunes, Inês; Ayres-de-Campos, Diogo; Ugwumadu, Austin; Amin, Pina; Banfield, Philip; Nicoll, Antony; Cunningham, Simon; Sousa, Paulo; Costa-Santos, Cristina; Bernardes, João

2017-01-01

To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm). Fetal blood sampling and electrocardiographic ST waveform analysis were available in both arms. The primary outcome was incidence of newborn metabolic acidosis (pH less than 7.05 and base deficit greater than 12 mmol/L). Prespecified secondary outcomes included operative delivery, use of fetal blood sampling, low 5-minute Apgar score, neonatal intensive care unit admission, hypoxic-ischemic encephalopathy, and perinatal death. A sample size of 3,660 per group (N=7,320) was planned to be able to detect a reduction in the rate of metabolic acidosis from 2.8% to 1.8% (two-tailed α of 0.05 with 80% power). From August 2011 through July 2014, 32,306 women were assessed for eligibility and 7,730 were randomized: 3,961 to computer analysis and online alerts, and 3,769 to visual analysis. Baseline characteristics were similar in both groups. Metabolic acidosis occurred in 16 participants (0.40%) in the experimental arm and 22 participants (0.58%) in the control arm (relative risk 0.69 [0.36-1.31]). No statistically significant differences were found in the incidence of secondary outcomes. Compared with visual analysis, computer analysis of fetal monitoring signals with real-time alerts did not significantly reduce the rate of metabolic acidosis or obstetric intervention. A lower-than-expected rate of newborn metabolic acidosis was observed in both arms of the trial. ISRCTN Registry, http://www.isrctn.com, ISRCTN42314164.

Cost-effectiveness of cardiotocography plus ST analysis of the fetal electrocardiogram compared with cardiotocography only.

PubMed

Vijgen, Sylvia M C; Westerhuis, Michelle E M H; Opmeer, Brent C; Visser, Gerard H A; Moons, Karl G M; Porath, Martina M; Oei, Guid S; Van Geijn, Herman P; Bolte, Antoinette C; Willekes, Christine; Nijhuis, Jan G; Van Beek, Erik; Graziosi, Giuseppe C M; Schuitemaker, Nico W E; Van Lith, Jan M M; Van Den Akker, Eline S A; Drogtrop, Addy P; Van Dessel, Hendrikus J H M; Rijnders, Robbert J P; Oosterbaan, Herman P; Mol, Ben Willem J; Kwee, Anneke

2011-07-01

To assess the cost-effectiveness of addition of ST analysis of the fetal electrocardiogram (ECG; STAN) to cardiotocography (CTG) for fetal surveillance during labor compared with CTG only. Cost-effectiveness analysis based on a randomized clinical trial on ST analysis of the fetal ECG. Obstetric departments of three academic and six general hospitals in The Netherlands. Population. Laboring women with a singleton high-risk pregnancy, a fetus in cephalic presentation, a gestational age >36 weeks and an indication for internal electronic fetal monitoring. A trial-based cost-effectiveness analysis was performed from a health-care provider perspective. Primary health outcome was the incidence of metabolic acidosis measured in the umbilical artery. Direct medical costs were estimated from start of labor to childbirth. Cost-effectiveness was expressed as costs to prevent one case of metabolic acidosis. The incidence of metabolic acidosis was 0.7% in the ST-analysis group and 1.0% in the CTG-only group (relative risk 0.70; 95% confidence interval 0.38-1.28). Per delivery, the mean costs per patient of CTG plus ST analysis (n= 2 827) were €1,345 vs. €1,316 for CTG only (n= 2 840), with a mean difference of €29 (95% confidence interval -€9 to €77) until childbirth. The incremental costs of ST analysis to prevent one case of metabolic acidosis were €9 667. The additional costs of monitoring by ST analysis of the fetal ECG are very limited when compared with monitoring by CTG only and very low compared with the total costs of delivery. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda.

PubMed

Meurice, Marielle; Genadry, Rene; Heimer, Carol; Ruffer, Galya; Kafunjo, Barageine Justus

Obstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. This study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. A descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. Fifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). Study participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

21 CFR 884.5100 - Obstetric anesthesia set.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

21 CFR 884.5100 - Obstetric anesthesia set.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

21 CFR 884.5100 - Obstetric anesthesia set.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Obstetrical and Gynecological Therapeutic Devices...

[Monitoring network for vulnerable children in the Pays de la Loire ("Grandir ensemble" - Cohort LIFT): 10 years of activity 2003-2013].

PubMed

Branger, B; Rouger, V; Berlie, I; Beucher, A; Flamant, C; N'guyen The Tich, S; Garcia, J; Brossier, J-P; Montcho, Y; Hanf, M; Roze, J-C

2015-02-01

Vulnerable children are at-risk newborns including premature infants and some children with pathologies presented by fear anomalies and deficiencies, most particularly neurological. Monitoring is based on the detection of these abnormalities and their early management. The organization of this monitoring system is based on a network of doctors, mostly pediatricians, trained regularly. The objective of this review was to assess the resources, means, and results of 10 years of follow-up. The Pays de la Loire network includes 24 maternity wards and 13 neonatal departments. Annual admissions are around 5000 newborns to approximately 45,000 annual births. Upon discharge of newborns, born prematurely at 34 weeks of gestation (WG) or less, or term infants with neurological problems, parents are asked to have their child monitored by a referring doctor. During the consultation, a reference document is filled out by the doctor and sent to the project manager for data collection and specific compensation for private practitioners. Standardized questionnaires were used such as the ASQ (Ages and Stage Questionnaire) completed by parents, the developmental quotient (DQ) with the Lézine Brunet-Revised test (BLR), the intelligence quotient (IQ) with the Wechsler Preschool and Primary Scale of Intelligence (WIPPSI III) completed by psychologists employed in the network, and a questionnaire completed by the teacher at 5 years of age. The network started on 1st March 2003, and 28th February 2013, after 10 years of inclusion, 10,800 children had been included. This population accounts for 2.4% of all annual births: 1.1% were included for prematurity less than 33 weeks and 0.25% were term-born infants. The characteristics of children are presented with gestational age, birth weight, and obstetric and neonatal pathologies. The percentage of these children followed was 80% at 2 years and 63% at 5 years. At 2 years, the results are presented according to gestational age with approximately 60% of children without disabilities at 25-26 WG, 73% at 27-28 WG, 77% at 29-30 WG, and 86% at 31-32 WG. Absorptions are diverse and vary according to the age of the child with physical therapy, psychomotor skill work, speech therapy, hearing and vision consultations, and psychology/psychiatry. Assessment tools were refined by specific analyses: the ASQ 24 months (completed by parents) was deemed valid and predictive with respect to IQ (abandoned in 2012), and the grid completed by the teacher was found to predict abnormalities in 5 years. The Pays de la Loire monitoring network has met its initial objective, namely to detect disabilities early and provide practical help to parents in a population of vulnerable children. Benefits for professionals and other children not followed in the network were observed, with an increase in pediatricians' skills. The benefits of the evaluation results are more difficult to assess with the care than neonatal care in obstetrics. The sustainability of such a network seems assured for healthcare professionals, provided that funding is maintained by the health authorities. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

PubMed Central

Wilson, Sarah M.; Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.

2016-01-01

Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions. PMID:25670025

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries.

PubMed

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-06-01

Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric services" (≥30% of facility deliveries) were only found in three countries. The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care.

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

PubMed Central

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-01-01

Background Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. Methods We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities “ready to provide obstetric services” had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Results Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and “ready to provide obstetric services” were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and “ready to provide obstetric services”, respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities “ready to provide obstetric services”. Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities “ready to provide obstetric services” (≥30% of facility deliveries) were only found in three countries. Conclusions The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care. PMID:29862026

Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines.

PubMed

Santo, Susana; Ayres-de-Campos, Diogo; Costa-Santos, Cristina; Schnettler, William; Ugwumadu, Austin; Da Graça, Luís M

2017-02-01

One of the limitations reported with cardiotocography is the modest interobserver agreement observed in tracing interpretation. This study compared agreement, reliability and accuracy of cardiotocography interpretation using the International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines. A total of 151 tracings were evaluated by 27 clinicians from three centers where International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines were routinely used. Interobserver agreement was evaluated using the proportions of agreement and reliability with the κ statistic. The accuracy of tracings classified as "pathological/category III" was assessed for prediction of newborn acidemia. For all measures, 95% confidence interval were calculated. Cardiotocography classifications were more distributed with International Federation of Gynecology and Obstetrics (9, 52, 39%) and National Institute for Health and Care Excellence (30, 33, 37%) than with American College of Obstetrics and Gynecology (13, 81, 6%). The category with the highest agreement was American College of Obstetrics and Gynecology category II (proportions of agreement = 0.73, 95% confidence interval 0.70-76), and the ones with the lowest agreement were American College of Obstetrics and Gynecology categories I and III. Reliability was significantly higher with International Federation of Gynecology and Obstetrics (κ = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence (κ = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology (κ = 0.15, 95% confidence interval 0.10-0.21); however, all represent only slight/fair reliability. International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence showed a trend towards higher sensitivities in prediction of newborn acidemia (89 and 97%, respectively) than American College of Obstetrics and Gynecology (32%), but the latter achieved a significantly higher specificity (95%). With American College of Obstetrics and Gynecology guidelines there is high agreement in category II, low reliability, low sensitivity and high specificity in prediction of acidemia. With International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence guidelines there is higher reliability, a trend towards higher sensitivity, and lower specificity in prediction of acidemia. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States.

PubMed

Kozhimannil, Katy B; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle M; Prasad, Shailendra

2018-03-27

Hospital-based obstetric services have decreased in rural US counties, but whether this has been associated with changes in birth location and outcomes is unknown. To examine the relationship between loss of hospital-based obstetric services and location of childbirth and birth outcomes in rural counties. A retrospective cohort study, using county-level regression models in an annual interrupted time series approach. Births occurring from 2004 to 2014 in rural US counties were identified using birth certificates linked to American Hospital Association Annual Surveys. Participants included 4 941 387 births in all 1086 rural counties with hospital-based obstetric services in 2004. Loss of hospital-based obstetric services in the county of maternal residence, stratified by adjacency to urban areas. Primary outcomes were county rates of (1) out-of-hospital births; (2) births in hospitals without obstetric units; and (3) preterm births (<37 weeks' gestation). Between 2004 and 2014, 179 rural counties lost hospital-based obstetric services. Of the 4 941 387 births studied, the mean (SD) maternal age was 26.2 (5.8) years. A mean (SD) of 75.9% (23.2%) of women who gave birth were non-Hispanic white, and 49.7% (15.6%) were college graduates. Rural counties not adjacent to urban areas that lost hospital-based obstetric services had significant increases in out-of-hospital births (0.70 percentage points [95% CI, 0.30 to 1.10]); births in a hospital without an obstetric unit (3.06 percentage points [95% CI, 2.66 to 3.46]); and preterm births (0.67 percentage points [95% CI, 0.02 to 1.33]), in the year after loss of services, compared with those with continual obstetric services. Rural counties adjacent to urban areas that lost hospital-based obstetric services also had significant increases in births in a hospital without obstetric services (1.80 percentage points [95% CI, 1.55 to 2.05]) in the year after loss of services, compared with those with continual obstetric services, and this was followed by a decreasing trend (-0.19 percentage points per year [95% CI, -0.25 to -0.14]). In rural US counties not adjacent to urban areas, loss of hospital-based obstetric services, compared with counties with continual services, was associated with increases in out-of-hospital and preterm births and births in hospitals without obstetric units in the following year; the latter also occurred in urban-adjacent counties. These findings may inform planning and policy regarding rural obstetric services.

Birth weight and obstetric complications determine age at onset in first episode of psychosis.

PubMed

Rubio-Abadal, E; Ochoa, S; Barajas, A; Baños, I; Dolz, M; Sanchez, B; Del Cacho, N; Carlson, J; Huerta-Ramos, E; Usall, J

2015-06-01

Earlier age at onset of psychosis (AOP) has been associated with poor social adjustment and clinical outcome. Genetic and environmental factors such as obstetric complications, parental history of psychosis, advanced paternal age at time of birth, low birth weight and gestational age, and use of drugs have been described as bringing AOP forward. This study aims to evaluate the relationship between AOP and these factors in a sample of first episode of psychosis (FEP) patients. Clinical and sociodemographic data, age at FEP, age of parents at birth, parental history of psychosis, drug-use habits of the mother during pregnancy and of the patient before psychotic onset, and Lewis and Murray obstetric complication scale were obtained from 90 patients with FEP. Statistical analysis was performed by means of Pearson correlations, Chi-square tests, Student T-test analyses and a linear regression model using SPSS version 22. Pre-eclampsia, need for incubator at birth, use of forceps, parental history of psychosis, and low birth weight were associated with an earlier AOP. Use of forceps and birth weight are the variables which best predict AOP in FEP. Stimulant drugs, which were mostly used together with cannabis and cocaine, were the only substances associated with an earlier AOP. Our findings are consistent with previous study results and underline the role of the prenatal period in the development of psychosis and the importance of careful monitoring of pregnancy and delivery, especially in cases with familial history. Copyright © 2015 Elsevier Ltd. All rights reserved.

Team training in obstetrics: A multi-level evaluation.

PubMed

Sonesh, Shirley C; Gregory, Megan E; Hughes, Ashley M; Feitosa, Jennifer; Benishek, Lauren E; Verhoeven, Dana; Patzer, Brady; Salazar, Maritza; Gonzalez, Laura; Salas, Eduardo

2015-09-01

Obstetric complications and adverse patient events are often preventable. Teamwork and situational awareness (SA) can improve detection and coordination of critical obstetric (OB) emergencies, subsequently improving decision making and patient outcomes. The purpose of this study was to assess the effectiveness of a team training intervention in improving learning and transfer of teamwork, SA, decision making, and cognitive bias as well as patient outcomes in OB. An adapted TeamSTEPPS training program was delivered to OB clinicians. Training targeted communication, mutual support, situation monitoring, leadership, SA, and cognitive bias. We conducted a repeated measures multilevel evaluation of the training using Kirkpatrick's (1994) framework of training evaluation to determine impact on trainee reactions, learning, transfer, and results. Data were collected using surveys, situational judgment tests (SJTs), observations, and patient chart reviews. Participants perceived the training as useful. Additionally, participants acquired knowledge of communication strategies, though knowledge of other team competencies did not significantly improve nor did self-reported teamwork on the unit. Although SJT decision accuracy did not significantly improve for all scenarios, results of behavioral observation suggest that decision accuracy significantly improved on the job, and there was a marginally significant reduction in babies' hospital length of stay. These findings indicate that the training intervention was partially effective, but more work needs to be done to determine the conditions under which training is most effective, and the ways in which to sustain improvements. Future research is needed to confirm its generalizability to additional OB units and departments. (c) 2015 APA, all rights reserved).

Pregnancy outcome in 162 women with rheumatic diseases: experience of a university hospital in Turkey.

PubMed

Davutoğlu, Ebru Alici; Ozel, Aysegul; Yılmaz, Nevin; Madazli, Riza

2017-12-01

To evaluate the distribution and the obstetric outcomes of pregnancies with different types of rheumatic diseases managed in our unit. Pregnancies of 162 women with rheumatic diseases, seen for their antenatal care at our department for the period between 2013 and 2017 were included in this retrospective clinical study. Obstetric and perinatal outcomes were main outcome measures. The most encountered rheumatic diseases were SLE (37.7%) followed by Behcet's disease (20.4%) and rheumatoid arthritis (17.3%) in our series. The mean maternal age was 30.6 ± 5.3 and the rate of nulliparity was 38.3% in the overall group. Disease activation occurred in 14.1% of patients. Mean gestational age at delivery was 37.4 ± 3.1 and mean birth weight was 3004 ± 762 g. Stillbirth, neonatal death, fetal growth restriction, preeclampsia and preterm delivery rates were 1.2, 2.4, 17.3, 7.4 and 17.9%, respectively. Antiphospholipid syndrome had the highest incidences for fetal growth restriction (42.9%), preeclampsia (28.6%) and delivery ≤ 34 gestational weeks (42.9%). Pathologic uterine artery Doppler velocimetry was identified in 15 cases (15/162, 9.3%) in which 10 (66.7%) developed preeclampsia and/or fetal growth restriction during follow-up. A majority of women with rheumatic diseases have successful pregnancies and deliver healthy babies, with the close and appropriate rheumatological, obstetric and neonatal monitoring.

Recurrence of obstetric third-degree and fourth-degree anal sphincter injuries.

PubMed

Boggs, Edgar W; Berger, Howard; Urquia, Marcelo; McDermott, Colleen D

2014-12-01

To examine outcomes after primary obstetric anal sphincter injuries in a subsequent pregnancy. This was a retrospective analysis of prospectively collated data from a large perinatal database between 2006 and 2010. Primiparous vaginal deliveries with an obstetric anal sphincter injury were identified and tracked to identify their subsequent delivery characteristics and perineal outcomes. A primary obstetric anal sphincter injury occurred in 5.3% of primiparous vaginal deliveries (9,857/186,239); of those patients, 2,093 had a subsequent delivery, and 91.9% delivered vaginally (1,923/2,093). The recurrent obstetric anal sphincter injury rate was also found to be 5.3% (102/1,923). The adjusted odds ratios (ORs) for primary obstetric anal sphincter injuries were significantly increased in large-for-gestational-age neonates for both third-degree laceration (adjusted OR 2.1, 95% confidence interval [CI] 1.9-2.2) and fourth-degree laceration (adjusted OR 2.7, 95% CI 2.3-3.1) and almost all obstetric interventions studied. The adjusted ORs for recurrent obstetric anal sphincter injuries were significant for large-for-gestational-age (25/102, adjusted OR 2.2, 95% CI 1.3-3.6) and instrumental deliveries (15/102, adjusted OR 2.4, 95% CI 1.2-4.6). In this study population, the incidence of recurrent obstetric anal sphincter injuries was similar to that of primary obstetric anal sphincter injuries, and most patients went on to deliver vaginally for subsequent deliveries. The risk of recurrent obstetric anal sphincter injuries was doubled in those who delivered a large-for-gestational-age neonate and in those who had an instrumental delivery.

Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda.

PubMed

Krause, Hannah G; Natukunda, Harriet; Singasi, Isaac; Hicks, Sylvia S W; Goh, Judith T W

2014-11-01

This study looks at a trilogy of women's health issues including severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistula, all of which can cause significant suffering in the lives of women and their families. Women undergoing surgery for severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistulae, were interviewed to assess their perceptions of what caused their condition, subsequent impact on their social situation and sexual activity, and whether they had sought treatment previously. One hundred fifty women participated in the survey, including 69 undergoing surgery for genito-urinary fistula, 25 with faecal incontinence only (including 24 women with unrepaired 4th degree obstetric tears and 1 woman with an isolated rectovaginal fistula), and 56 women with severe pelvic organ prolapse. All groups of women were exposed to abandonment by their families with 42 % of women with genito-urinary fistula, 21 % with unrepaired 4th degree obstetric tear, and 25 % of women with severe pelvic organ prolapse rejected by their husbands. Most of the women had actively sought treatment for their condition with no success due to unavailability of treatment or misinformation. This study confirms the social stigma associated with obstetric fistula, however also highlights the social stigma faced by women suffering with severe pelvic organ prolapse and unrepaired 4th degree obstetric tears in western Uganda. There is an urgent need for education and training in obstetric management and pelvic organ prolapse management in such areas of limited resources.

Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in Burkina Faso.

PubMed

Richard, F; Ouédraogo, C; Compaoré, J; Dubourg, D; De Brouwere, V

2007-08-01

To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the cost-sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).

21 CFR 884.2050 - Obstetric data analyzer.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

21 CFR 884.2050 - Obstetric data analyzer.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

21 CFR 884.2050 - Obstetric data analyzer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

21 CFR 884.2050 - Obstetric data analyzer.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Obstetric data analyzer. 884.2050 Section 884.2050... § 884.2050 Obstetric data analyzer. (a) Identification. An obstetric data analyzer (fetal status data analyzer) is a device used during labor to analyze electronic signal data obtained from fetal and maternal...

21 CFR 884.5100 - Obstetric anesthesia set.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral, and...

21 CFR 884.5100 - Obstetric anesthesia set.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly of... anesthetic drug. This device is used to administer regional blocks (e.g., paracervical, uterosacral, and...

Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

ERIC Educational Resources Information Center

Freeth, Della; Ayida, Gubby; Berridge, Emma Jane; Mackintosh, Nicola; Norris, Beverley; Sadler, Chris; Strachan, Alasdair

2009-01-01

Introduction: We describe an example of simulation-based interprofessional continuing education, the multidisciplinary obstetric simulated emergency scenarios (MOSES) course, which was designed to enhance nontechnical skills among obstetric teams and, hence, improve patient safety. Participants' perceptions of MOSES courses, their learning, and…

The Current Status and Future of Academic Obstetrics.

ERIC Educational Resources Information Center

Bowers, John Z., Ed.; Purcell, Elizabeth F., Ed.

The state of research in academic obstetrics and its relationship to research in other academic disciplines was addressed in a 1979 conference. Participants included representatives of academic obstetrics, academic pediatrics, and public health. After an introductory discussion by Howard C. Taylor, Jr. on changes in obstetrics in the last 25…

Biotypology, endocrinology, and sterilization: the practice of eugenics in the treatment of Argentinian women during the 1930s.

PubMed

Eraso, Yolanda

2007-01-01

This article looks at medical approaches to women's fertility in Argentina in the 1930s and explores the ways in which eugenics encouraged the reproduction of the fit and attempted to avoid the reproduction of the unfit. The analysis concentrates on three main aspects: biotypology (the scientific classification of bodies), endocrine therapy, and sterilization. The article concludes by suggesting that a eugenically oriented obstetrical and gynecological practice encouraged both endocrine treatments (to achieve the ideal fertile woman) and sterilization, which, in spite of being legally banned, found a subtle application.

ACOG Technology Assessment No. 11: Genetics and molecular diagnostic testing.

PubMed

2014-02-01

Human genetics and molecular testing are playing an increasingly important role in medicine, including obstetric and gynecologic practice. As the genetic basis for reproductive disorders, common diseases, and cancer is elucidated with improved molecular technology, genetic testing opportunities are expanding and influencing treatment options and prevention strategies. It is essential that obstetrician-gynecologists be aware of advances in the understanding of genetic disease and the fundamental principles of genetic screening and molecular testing as genetics becomes a more integral part of routine medical practice. This document reviews the basics of genetic transmission and genetic technologies in current use.

Understanding fetal physiology and second line monitoring during labor.

PubMed

Garabedian, C; De Jonckheere, J; Butruille, L; Deruelle, P; Storme, L; Houfflin-Debarge, V

2017-02-01

Cardiotocography (CTG) is a technique used to monitor intrapartum fetal condition and is one of the most common obstetric procedures. Second line methods of fetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography and to better identify fetuses at risk of intrapartum asphyxia. The acid-base balance of the fetus is evaluated by fetal blood scalp samples, the modification of the myocardial oxygenation by the fetal ECG ST-segment analysis (STAN) and the autonomic nervous system by the power spectral analysis of the fetal heart variability. To correctly interpret the features observed on CTG traces or second line methods, it seems important to understand normal physiology during labor and the compensatory mechanisms of the fetus in case of hypoxemia. Therefore, the aim of this review is first to describe fetal physiology during labor and then to explain the modification of the second line monitoring during labor. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

‘Women think pregnancy management means obstetric ultrasound’: Vietnamese obstetricians’ views on the use of ultrasound during pregnancy

PubMed Central

Edvardsson, Kristina; Graner, Sophie; Thi, Lan Pham; Åhman, Annika; Small, Rhonda; Lalos, Ann; Mogren, Ingrid

2015-01-01

Objective To explore Vietnamese obstetricians’ experiences and views on the role of obstetric ultrasound in clinical management of complicated pregnancy and in situations where maternal and fetal health interests conflict. Design Seventeen obstetricians in northern Vietnam were interviewed as part of the CROss-Country Ultrasound Study (CROCUS) project in 2013. Data were analysed using qualitative content analysis. Results The participants described ultrasound as a central tool in prenatal care, although they called for increased training and resources to prevent inappropriate management. A prevailing overuse driven by women's request and increased commercialisation was described. Other clinical examinations were seen as being disregarded by women in favour of ultrasound, resulting in missed opportunities for identifying potential pregnancy complications. The use of ultrasound for sex selection purposes raised concern among participants. Visualisation of human features or heartbeat during ultrasound was commonly described as the point where the fetus became regarded as a ‘person’. Women were said to prioritise fetal health interests over their own health, particularly if a woman had difficulties becoming pregnant or had undergone assisted fertilisation. The woman's husband and his family were described as having an important role in decision-making in situations of maternal and fetal health conflicts. Conclusions This study provides insight into issues surrounding ultrasound use in contemporary Vietnam, some of which may be specific to this low-income context. It is clear that ultrasound has become a central tool in prenatal care in Vietnam and that it has also been embraced by women. However, there seems to be a need to balance women's demands for obstetric ultrasound with better recognition of the valuable contribution to be made by the full range of clinical examinations in pregnancy, along with a more strategic allocation of resources, that is, use of obstetric ultrasound based on clinical indications. Better regulation of private obstetric practice also appears to be needed. While the root causes of sex selection need to be addressed at societal level, efforts are also required more immediately to find ways to combat the inappropriate use of ultrasound for the purpose of sex selection. PMID:26519131

The 2013 Gerard W. Ostheimer Lecture: What's New in Obstetric Anesthesia?

PubMed

Palanisamy, A

2014-02-01

The "What's New in Obstetric Anesthesia?" lecture is delivered annually in honor of the eminent obstetric anesthesiologist Gerard. W. Ostheimer. This lecture summarizes topics of importance and clinical relevance published in the fields of obstetric anesthesia, obstetrics, and perinatology in the preceding year. The review is a redacted version of the lecture delivered at the Society for Obstetric Anesthesia and Perinatology's Annual Meeting in April 2013. Special emphasis is placed on non-invasive technologies and biomarkers that have the potential to improve clinical care of the pregnant woman. Furthermore, sufficient attention is focused on medical diseases that have their onset or are worsened during pregnancy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania.

PubMed

Dekker, Luuk; Houtzager, Tessa; Kilume, Omary; Horogo, John; van Roosmalen, Jos; Nyamtema, Angelo Sadock

2018-05-15

Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.

WHO Global Survey on Maternal and Perinatal Health in Latin America: classifying caesarean sections

PubMed Central

2009-01-01

Background Caesarean section rates continue to increase worldwide with uncertain medical consequences. Auditing and analysing caesarean section rates and other perinatal outcomes in a reliable and continuous manner is critical for understanding reasons caesarean section changes over time. Methods We analyzed data on 97,095 women delivering in 120 facilities in 8 countries, collected as part of the 2004-2005 Global Survey on Maternal and Perinatal Health in Latin America. The objective of this analysis was to test if the "10-group" or "Robson" classification could help identify which groups of women are contributing most to the high caesarean section rates in Latin America, and if it could provide information useful for health care providers in monitoring and planning effective actions to reduce these rates. Results The overall rate of caesarean section was 35.4%. Women with single cephalic pregnancy at term without previous caesarean section who entered into labour spontaneously (groups 1 and 3) represented 60% of the total obstetric population. Although women with a term singleton cephalic pregnancy with a previous caesarean section (group 5) represented only 11.4% of the obstetric population, this group was the largest contributor to the overall caesarean section rate (26.7% of all the caesarean sections). The second and third largest contributors to the overall caesarean section rate were nulliparous women with single cephalic pregnancy at term either in spontaneous labour (group 1) or induced or delivered by caesarean section before labour (group 2), which were responsible for 18.3% and 15.3% of all caesarean deliveries, respectively. Conclusion The 10-group classification could be easily applied to a multicountry dataset without problems of inconsistencies or misclassification. Specific groups of women were clearly identified as the main contributors to the overall caesarean section rate. This classification could help health care providers to plan practical and effective actions targeting specific groups of women to improve maternal and perinatal care. PMID:19874598

Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression.

PubMed

Tovo, Pier-Angelo; Calitri, Carmelina; Scolfaro, Carlo; Gabiano, Clara; Garazzino, Silvia

2016-01-28

The worldwide prevalence of hepatitis C virus (HCV) infection in children is 0.05%-0.4% in developed countries and 2%-5% in resource-limited settings, where inadequately tested blood products or un-sterile medical injections still remain important routes of infection. After the screening of blood donors, mother-to-child transmission (MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%. Maternal HIV co-infection is a significant risk factor for MTCT and anti-HIV therapy during pregnancy seemingly can reduce the transmission rate of both viruses. Conversely, a high maternal viral load is an important, but not preventable risk factor, because at present no anti-HCV treatment can be administered to pregnant women to block viral replication. Caution is needed in adopting obstetric procedures, such as amniocentesis or internal fetal monitoring, that can favor fetal exposure to HCV contaminated maternal blood, though evidence is lacking on the real risk of single obstetric practices. Mode of delivery and type of feeding do not represent significant risk factors for MTCT. Therefore, there is no reason to offer elective caesarean section or discourage breast-feeding to HCV infected parturients. Information on the natural history of vertical HCV infection is limited. The primary infection is asymptomatic in infants. At least one quarter of infected children shows a spontaneous viral clearance (SVC) that usually occurs within 6 years of life. IL-28B polymorphims and genotype 3 infection have been associated with greater chances of SVC. In general, HCV progression is mild or moderate in children with chronic infection who grow regularly, though cases with marked liver fibrosis or hepatic failure have been described. Non-organ specific autoantibodies and cryoglobulins are frequently found in children with chronic infection, but autoimmune diseases or HCV associated extrahepatic manifestations are rare.

Anesthesia for cesarean delivery in the Czech Republic: a 2011 national survey.

PubMed

Stourac, Petr; Blaha, Jan; Klozova, Radka; Noskova, Pavlina; Seidlova, Dagmar; Brozova, Lucie; Jarkovsky, Jiri

2015-06-01

The purpose of this national survey was to determine current anesthesia practices for cesarean delivery in the Czech Republic. In November 2011, we invited all departments of obstetric anesthesia in the Czech Republic to participate in a prospective study to monitor consecutive peripartum obstetric anesthesia procedures. Data were recorded online in the TrialDB database (Yale University, New Haven, CT). The response rate was 51% (49 of 97 departments); participating centers represented 60% of all births in the country during the study period. There were 1943 cases of peripartum anesthesia care, of which 1166 cases (60%) were anesthesia for cesarean delivery. Estimates were weighted based on population distribution of cesarean delivery among types of participating centers. Neuraxial anesthesia was used in 55.6% (95% confidence interval [CI], 52.8%-58.5%); the distribution of anesthesia techniques differed among type of participating center. The rate of neuraxial anesthesia in university hospitals was 55.6% (95% CI, 51.5%-59.6%), 32.4% (95% CI, 26.4%-39.0%) in regional hospitals, and 60.7% (95% CI, 55.2%-66.0%) in local hospitals. The reasons for cesarean delivery under general anesthesia were emergency procedure (67%), refusal of neuraxial blockade by parturient (30%), failure of neuraxial anesthesia (6%), and preoperative administration of low-molecular-weight heparin (3%). Postcesarean analgesia was primarily provided by systemic opioid (66%) and nonopioid analgesics (61%), solely or in combination. Epidural postoperative analgesia was used in 14% of cases. Compared with national neuraxial anesthesia rate data published in the 1990s (6.7% in 1993), there has been an upward trend in the use of neuraxial anesthesia for cesarean delivery during the 21st century (40.5% in 2000) in the Czech Republic. The rate of neuraxial anesthesia use for cesarean delivery has increased in the Czech Republic in the last 2 decades. However, the current rate of general anesthesia is high compared with other Western countries.

Primitive African Medical Lore and Witchcraft *

PubMed Central

Thompson, Ethel E.

1965-01-01

This article presents a comprehensive study of the methods, practices, equipment, and paraphernalia of African witch doctors in carrying out primitive medical practices. The chief tribes studied are the Azandes of the Sudan, the Manos of Liberia, the Congo tribes, the Bundas of Angola, and the Zulus and other Bantu tribes of South Africa. Primitive beliefs and customs are discussed only insofar as they have a direct bearing on medical practices. The medical practices considered deal mainly with the application of general remedies for ailments and diseases, but certain specialized fields such as obstetrics, surgery, treatment for fractures, and dentistry are also included. Primitive medicaments are presented with reference to their application for various illnesses. An alphabetical list of these medicaments is given at the end of the article. PMID:14223742

Stability and Change of Interest in Obstetrics-Gynecology among Medical Students: Eighteen Years of Longitudinal Data.

ERIC Educational Resources Information Center

Forouzan, Iraj; Hojat, Mohammadreza

1993-01-01

A study investigated, first, the percentage of medical students maintaining interest in obstetrics/gynecology during medical school compared to those maintaining interest in other specialties and, second, changes of interest from obstetrics/gynecology to other specialties and other specialties to obstetrics/gynecology. Results indicate instability…

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders.

PubMed

Coverdale, John; Roberts, Laura Weiss; Balon, Richard; Beresin, Eugene V

2015-08-01

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda.

PubMed

Kasamba, Nassar; Kaye, Dan K; Mbalinda, Scovia N

2013-12-10

Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.

Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

PubMed Central

2013-01-01

Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. Results The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Conclusion Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse. PMID:24321441

Simulation Training in Obstetrics and Gynaecology Residency Programs in Canada.

PubMed

Sanders, Ari; Wilson, R Douglas

2015-11-01

The integration of simulation into residency programs has been slower in obstetrics and gynaecology than in other surgical specialties. The goal of this study was to evaluate the current use of simulation in obstetrics and gynaecology residency programs in Canada. A 19-question survey was developed and distributed to all 16 active and accredited obstetrics and gynaecology residency programs in Canada. The survey was sent to program directors initially, but on occasion was redirected to other faculty members involved in resident education or to senior residents. Survey responses were collected over an 18-month period. Twelve programs responded to the survey (11 complete responses). Eleven programs (92%) reported introducing an obstetrics and gynaecology simulation curriculum into their residency education. All respondents (100%) had access to a simulation centre. Simulation was used to teach various obstetrical and gynaecological skills using different simulation modalities. Barriers to simulation integration were primarily the costs of equipment and space and the need to ensure dedicated time for residents and educators. The majority of programs indicated that it was a priority for them to enhance their simulation curriculum and transition to competency-based resident assessment. Simulation training has increased in obstetrics and gynaecology residency programs. The development of formal simulation curricula for use in obstetrics and gynaecology resident education is in early development. A standardized national simulation curriculum would help facilitate the integration of simulation into obstetrics and gynaecology resident education and aid in the shift to competency-based resident assessment. Obstetrics and gynaecology residency programs need national collaboration (between centres and specialties) to develop a standardized simulation curriculum for use in obstetrics and gynaecology residency programs in Canada.

Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey.

PubMed

Lam, Christy Y Y; Cheung, Charleen S Y; Hui, Annie S Y

2016-04-01

The trend of declining interest of medical graduates in pursuing obstetrics and gynaecology as a career has been observed in many overseas studies. This study aimed to evaluate the career interest of the most recent medical graduates in Hong Kong, especially their level of interest in obstetrics and gynaecology, and to identify key influential factors for career choice and career interest in obstetrics and gynaecology. All medical graduates from the Chinese University of Hong Kong and the University of Hong Kong who attended the pre-internship lectures in June 2015 were invited to participate in this cross-sectional questionnaire survey. The main outcome measures were the level of career interest in obstetrics and gynaecology, the first three choices of specialty as a career, key influential factors for career choice, and key influential factors for career interest in obstetrics and gynaecology. Overall, 73.7% of 323 new medical graduates participated in the study and 233 questionnaires were analysed. The median score (out of 10) for the level of career interest in obstetrics and gynaecology was 3. There were 37 (16.2%) participants in whom obstetrics and gynaecology was among their first three choices, of whom 29 (78.4%) were female. Obstetrics and gynaecology ranked as the eighth most popular career choice. By factor analysis, the strongest key influential factor for career interest in obstetrics and gynaecology was clerkship experience (variance explained 28.9%) and the strongest key influential factor for career choice was working style (variance explained 26.4%). The study confirmed a low level of career interest in obstetrics and gynaecology among medical graduates and a decreasing popularity of the specialty as a career choice. The three key influential factors for career interest in obstetrics and gynaecology and career choice were working style, clerkship experience, and career prospects.

Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District.

PubMed

Ng'anjo Phiri, Selia; Fylkesnes, Knut; Moland, Karen Marie; Byskov, Jens; Kiserud, Torvid

2016-01-01

Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district. A cross-sectional survey was conducted in 2011 as part of the 'Response to Accountable priority setting for Trust in health systems' (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas. A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71-75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60-2.71%) than in rural areas 0.4% (95% CI 0.27-0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55-8.76). Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths.

Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles

PubMed Central

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-01-01

Objective The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. Methods In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Results Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Conclusions Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior. PMID:21976093

Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles.

PubMed

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-09-01

The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.

Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management.

PubMed

Sabiani, Laura; Le Dû, Renaud; Loundou, Anderson; d'Ercole, Claude; Bretelle, Florence; Boubli, Léon; Carcopino, Xavier

2015-12-01

The objective of the study was to evaluate the intra- and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor. A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any. Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15-0.32). The intra- and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court. Copyright © 2015 Elsevier Inc. All rights reserved.

An Assessment of Surgical Experience among Obstetric and Gynaecology SpR Trainees.

PubMed

Gaughan, E; Barry, S; Boyd, W; Walsh, T A

2015-10-01

Changes in gynaecological practice have resulted in a significant reduction in surgical exposure for trainees. We have attempted to assess surgical experience among obstetric and gynaecology SpR's in Ireland using an anonymous on-line questionnaire. Trainees were asked to assess their own ability to perform a variety of general gynaecological procedures. There was a 97% response rate (29/33 trainees). There were 11 trainees who were in the final or penultimate year of the scheme. This group were analysed separately to assess competency rates in those approaching the end of the scheme. They were subdivided in to those who have completed one year in a general hospital doing pure gynaecology and those who have not. Approximately half of this group (6/11) had completed a pure gynaecology year. All of these trainees deemed themselves competent to perform all general gynaecological procedures listed, with the exception of trans-urethral tape procedures, for which 3/6 reported the requirement of direct supervision. Only 2/6 deemed themselves competent to perform a total laparoscopic hysterectomy. Year 4/5 trainees who had not completed a pure gynaecology year displayed significantly lower competency rates for most of the procedures. With the current changes in gynaecological practice, these results highlight the importance of dedicated gynaecological surgical training.

Self-perceived long-term transfer of learning after postpartum hemorrhage simulation training.

PubMed

de Melo, Brena Carvalho Pinto; Rodrigues Falbo, Ana; Sorensen, Jette Led; van Merriënboer, Jeroen J G; van der Vleuten, Cees

2018-05-01

To explore long-term transfer (application of acquired knowledge and skills on the job) after postpartum hemorrhage simulation training based on either instructional design (ID) principles or conventional best practice. In this qualitative study, semi-structured interviews with obstetrics and gynecology healthcare practitioners were conducted between August 7 and September 26, 2015, in Recife, Brazil. The participants were randomly selected from each of two postpartum hemorrhage simulations attended 2 years earlier (one ID and one conventional best practice). Thematic analysis was used to explore (1) residents' perceptions of long-term transfer of learning, (2) ID elements influencing the perceived long-term transfer, and (3) differences in the participants' perceptions according to the type of simulation attended. There were 12 interview participants. After either simulation format, residents perceived long-term transfer effects. Training design factors influencing transfer were, in their opinion, related to trainees' characteristics, simulation design, and workplace environment. Trainees who participated in the ID-based simulation perceived better communication skills and better overall situational awareness: "I didn't do that before." All residents perceived long-term transfer after simulation training for postpartum hemorrhage. Those who attended the ID format additionally perceived improvements in communication skills and situational awareness, which are fundamental factors in the management of postpartum hemorrhage. © 2018 International Federation of Gynecology and Obstetrics.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

PubMed

Lawani, Lucky O; Onyebuchi, Azubuike K; Iyoke, Chukwuemeka A; Okeke, Nwabunike E

2014-05-01

To determine the prevalence of female genital mutilation (FGM), the common forms of FGM, reasons for the practice, associated obstetric outcomes, and how these have affected efforts to achieve Millennium Development Goals (MDGs) 3, 4, and 5 in southeast Nigeria. A prospective descriptive study of parturients in southeast Nigeria was conducted from January to December 2012. All primigravid women attending delivery services at 2 health institutions during the study period were recruited, examined, and classified using the 2008 WHO classification for FGM. The mean age of the 516 participants was 27.24±4.80 years and most (66.3%) had undergone FGM. Type II FGM was the most common form, accounting for 59.6% of cases. Most FGM procedures were performed in infancy (97.1%) and for cultural reasons (60.8%). Women who had undergone FGM had significantly higher risk for episiotomy, perineal tear, hemorrhage, cesarean delivery, neonatal resuscitation, fresh stillbirth/early neonatal death, and longer hospitalization, with higher risk ratios associated with higher degrees of FGM. FGM is still a common practice in southeast Nigeria, where its association with adverse reproductive outcomes militates against efforts to achieve MDGs 3, 4, and 5. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003.

PubMed

Marr, Leslie; Lennox, Christopher; McFadyen, Angus K

2014-06-01

Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.

Towards a new era in fetal medicine in the Nordic countries.

PubMed

Sitras, Vasilis

2016-08-01

Fetal medicine is a subspecialty of obstetrics investigating the development, growth and disease of the human fetus. The advances in fetal imaging (ultrasonography, MRI) and molecular diagnostic techniques, together with the possibility of intervention in utero, make fetal medicine an important, rapidly developing field within women's healthcare. Therefore, a variety of specialists, such as neonatologists, pediatric cardiologists, medical geneticists, radiologists and pediatric surgeons, are necessary to adjunct in the diagnosis and treatment of the fetus as a patient. In this commentary, we provide a description of some organizational and educational aspects of fetal medicine in the Nordic countries, using examples of the management of specific conditions such as aneuploidy screening, red cell allo-immunization and fetal interventions. Clearly, there are several cultural, legal, organizational and practical differences between the Nordic countries; these are not necessarily negative, given the high standards of care in all Nordic countries. The scope of the newly founded Nordic Network of Fetal Medicine is to enhance cooperation in clinical practice, education and research between the participant countries. Hopefully, this initiative will find the necessary political and economic support from the national authorities and bring a new era in the field of fetal medicine in the Nordic region. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Web-based comparison of historical vs contemporary methods of fetal heart rate interpretation.

PubMed

Epstein, Aaron J; Iriye, Brian K; Hancock, Lyle; Quilligan, Edward J; Rumney, Pamela J; Hancock, Judy; Ghamsary, Mark; Eakin, Cortney M; Smith, Cheryl; Wing, Deborah A

2016-10-01

Contemporary interpretation of fetal heart rate patterns is based largely on the tenets of Drs Quilligan and Hon. This method differs from an older method that was championed by Dr Caldeyro-Barcia in recording speed and classification of decelerations. The latter uses a paper speed of 1 cm/min and classifies decelerations referent to uterine contractions as type I or II dips, compared with conventional classification as early, late, or variable with paper speed of 3 cm/min. We hypothesized that 3 cm/min speed may lead to over-analysis of fetal heart rate and that 1 cm/min may provide adequate information without compromising accuracy or efficiency. The purpose of this study was to compare the Hon-Quilligan method of fetal heart rate interpretation with the Caldeyro-Barcia method among groups of obstetrics care providers with the use of an online interactive testing tool. We deidentified 40 fetal heart rate tracings from the terminal 30 minutes before delivery. A website was created to view these tracings with the use of the standard Hon-Quilligan method and adjusted the same tracings to the 1 cm/min monitoring speed for the Caldeyro-Barcia method. We invited 2-4 caregivers to participate: maternal-fetal medicine experts, practicing maternal-fetal medicine specialists, maternal-fetal medicine fellows, obstetrics nurses, and certified nurse midwives. After completing an introductory tutorial and quiz, they were asked to interpret the fetal heart rate tracings (the order was scrambled) to manage and predict maternal and neonatal outcomes using both methods. Their results were compared with those of our expert, Edward Quilligan, and were compared among groups. Analysis was performed with the use of 3 measures: percent classification, Kappa, and adjusted Gwet-Kappa (P < .05 was considered significant). Overall, our results show from moderate to almost perfect agreement with the expert and both between and within examiners (Gwet-Kappa 0.4-0.8). The agreement at each stratum of practitioner was generally highest for ascertainment of baseline and for management; the least agreement was for assessment of variability. We examined the agreement of fetal heart rate interpretation with a defined set of rules among a number of different obstetrics practitioners using 3 different statistical methods and found moderate-to-substantial agreement among the clinicians for matching the interpretation of the expert. This implies that the simpler Caldeyro-Barcia method may perform as well as the newer classification system. Copyright © 2016 Elsevier Inc. All rights reserved.

76 FR 50485 - Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee; Amendment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

...] Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee; Amendment of Notice AGENCY... an amendment to the notice of meeting of the Obstetrics and Gynecology Devices Panel of the Medical... Obstetrics and Gynecology Devices Panel of the Medical Devices Advisory Committee would be held on September...

[The emergence of obstetrical mechanism: From Lucy to Homo sapiens].

PubMed

Frémondière, P; Thollon, L; Marchal, F

2017-03-01

The evolutionary history of modern birth mechanism is now a renewed interest in obstetrical papers. The purpose of this work is to review the literature in paleo-obstetrical field. Our analysis focuses on paleo-obstetrical hypothesis, from 1960 to the present day, based on the reconstruction of fossil pelvis. Indeed, these pelvic reconstructions usually provide an opportunity to make an obstetrical assumption in our ancestors. In this analysis, we show that modern birth mechanism takes place during the emergence of our genus 2 million years ago. References are made to human specificities related to obstetrical mechanism: exclusive bipedalism, increase of brain size at birth, metabolic cost of the pregnancy and deep trophoblastic implantation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Emergency obstetric and neonatal care availability, use, and quality: a cross-sectional study in the city of Lubumbashi, Democratic Republic of the Congo, 2011.

PubMed

Ntambue, Abel Mukengeshayi; Malonga, Françoise Kaj; Cowgill, Karen D; Dramaix-Wilmet, Michèle; Donnen, Philippe

2017-01-19

While emergency obstetric and neonatal care (EmONC) is a proxy indicator for monitoring maternal and perinatal mortalities, in Democratic Republic of the Congo (DRC), data on this care is rarely available. In the city of Lubumbashi, the second largest in DRC with an estimated population of 1.5 million, the availability, use and quality of EmONC are not known. This study aimed to assess these elements in Lubumbashi. This cross-sectional survey was conducted in April and May 2011. Fifty-three of the 180 health facilities that provide maternity care in Lubumbashi were included in this study. Only health facilities with at least six deliveries per month over the course of 2010 were included. The availability, use and quality of EmONC at each level of the health care system were assessed according to the WHO standards. The availability of EmONC in Lubumbashi falls short of WHO standards. In this study, we found one facility providing Comprehensive EmONC (CEmONC) for a catchment area of 918,819 inhabitants. Apart from the tertiary hospital (Sendwe), no other facility provided all the basic emergency obstetric and neonatal care (BEmONC) signal functions. However, all had carried out at least one of the nine signal functions during the 3 months preceding our survey: 73.6% of 53 facilities had administered parenteral antibiotics, 79.2% had systematically offered oxytocics, 39.6% had administered magnesium sulfate, 73.6% had manually evacuated placentas, 81.1% had removed retained placenta products, 54.7% had revived newborns, 35.8% had performed caesarean sections, and 47.2% had performed blood transfusions. Function 6, vaginal delivery assisted by ventouse or forceps, was performed in only two (3.8%) facilities. If this signal function was not taken into account in our assessment of EmONC availability, there would be five facilities providing CEmONC for 918,819 inhabitants, rather than one. In 2010, all the women in the surveyed facilities with obstetric complications delivered in facilities that had carried out at least one signal function in the 3 months before our survey; 7.0% of these women delivered in the facility which provided CEmONC. Mortality due to direct obstetric causes was 3.9% in the health facility that provided CEmONC. The intrapartum mortality was also high in this facility (5.1%). None of the maternity ward managers in any of the facilities surveyed had received training on the EmONC package. Essential supplies and equipment for performing certain EmONC functions were not available in all the surveyed facilities. Audits of maternal and neonatal deaths and near-misses should be established and used as a basis for monitoring the quality of care in Lubumbashi. To reduce maternal and perinatal mortality, it is essential that staff skills regarding EmONC be strengthened, the availability of supplies and equipment be increased, and that care processes be standardized in all health facilities in Lubumbashi.

Labour epidural analgesia in Poland in 2009 - a survey.

PubMed

Furmanik, Jacek

2013-01-01

Labour analgesia in most developed countries is funded by the state, available to every woman in labour, and plays an important role in the everyday activities of most anaesthetists. This paper presents the second part of an Obstetric Anaesthesia Survey which was conducted in 2009. The first part of the Survey, relating to anaesthesia for caesarean sections, was published in 2010. The author sent out 432 questionnaires containing questions about hospital size and location, staffing levels and numbers of deliveries per year. There were also questions regarding regional and other pain relief methods used in labour, ways of administration, drugs used and monitoring of patients. The response rate was 24%. Around 45% of responding hospitals had only 1-3 deliveries per year, which makes it difficult to provide separate obstetric anaesthetic cover. Only ten hospitals (11%) employed an anaesthetist for the labour ward. Epidural analgesia was used in 55% of hospitals but only 20% provided the service for 24 hours per day and free of charge. Entonox was used very occasionally, but the most common means of pain relief was pethidine injection. There were marked differences in the medication used for labour epidurals, with 18% of units using high concentrations of local anaesthetics which could result in motor block. Despite a lack of regulations in Polish law and a lack of proper training in 50% of units, midwives were looking after the patients with established labour epidural which could create medico-legal consequences. There was also a marked variation in the parameters monitored during labour analgesia. Epidural labour analgesia was offered for 24 hours per day and free of charge in only 20% of hospitals. Without public pressure it will be difficult to get more funding from the National Health Fund (NFZ) to enable other hospitals, especially those with small obstetric units, to introduce regional labour analgesia. Although the 2009 guidelines addressed most of the issues regarding the conduct of epidural labour analgesia, changes need to be made in Polish law to allow midwives to be appropriately trained to look after parturients with regional labour analgesia.

A Canadian survey of postgraduate education in Aboriginal women's health in obstetrics and gynaecology.

PubMed

Jumah, Naana Afua; Wilson, Don; Shah, Rajiv

2013-07-01

To assess Canadian obstetrics and gynaecology residents' knowledge of and experience in Indigenous women's health (IWH), including a self-assessment of competency, and to assess the ability of residency program directors to provide a curriculum in IWH and to assess the resources available to support this initiative. Surveys for residents and for program directors were distributed to all accredited obstetrics and gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions in four key areas: general knowledge regarding Indigenous peoples in Canada; the impact of the residential school system; clinical experience in IWH; and a self-assessment of competency in IWH. The program director survey included an assessment of the content of the curriculum in IWH and of the resources available to support this curriculum. Residents have little background knowledge of IWH and the determinants of health, and are aware of their knowledge gap. Residents are interested in IWH and recognize the importance of IWH training for their future practice. Program directors support the development of an IWH curriculum, but they lack the resources to provide a comprehensive IWH curriculum and would benefit from having a standardized curriculum available. A nationwide curriculum initiative may be an effective way to facilitate the provision of education in IWH while decreasing the need for resources in individual programs.

Subchorionic hematomas are increased in early pregnancy in women taking low-dose aspirin.

PubMed

Truong, Ashley; Sayago, M Mercedes; Kutteh, William H; Ke, Raymond W

2016-05-01

To determine the frequency of subchorionic hematomas (SCH) in first-trimester ultrasound examinations of patients with infertility and recurrent pregnancy loss (RPL) and in patients from a general obstetric population. To determine if the method of assisted reproduction utilized or the use of anticoagulants, such as heparin and aspirin (ASA), influenced frequency of SCH. Prospective, cohort study. Fertility clinic and general obstetrics clinic. Five hundred and thirty-three women who were pregnant in the first-trimester. Not applicable. Frequencies of subchorionic hematomas in women based on diagnosis, use of anticoagulants, and fertility treatment. SCH were identified in 129/321 (40.2%) in the study group compared to 23/212 (10.9%) in the control group. Fertility diagnosis and the use of heparin did not appear to affect the frequency of SCH in the first trimester; however, SCH occurred at an almost four-fold increase in patients taking ASA compared to those not taking ASA, regardless of fertility diagnosis or method of fertility treatment. The use of ASA may be associated with an increased risk of developing a SCH during the first trimester. The increased frequencies of SCH in pregnancies of patients attending a fertility clinic compared to women from a general obstetrical practice was highly correlated with the use of ASA. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics.

PubMed

Ananth, Cande V; Schisterman, Enrique F

2017-08-01

Prospective and retrospective cohorts and case-control studies are some of the most important study designs in epidemiology because, under certain assumptions, they can mimic a randomized trial when done well. These assumptions include, but are not limited to, properly accounting for 2 important sources of bias: confounding and selection bias. While not adjusting the causal association for an intermediate variable will yield an unbiased estimate of the exposure-outcome's total causal effect, it is often that obstetricians will want to adjust for an intermediate variable to assess if the intermediate is the underlying driver of the association. Such a practice must be weighed in light of the underlying research question and whether such an adjustment is necessary should be carefully considered. Gestational age is, by far, the most commonly encountered variable in obstetrics that is often mislabeled as a confounder when, in fact, it may be an intermediate. If, indeed, gestational age is an intermediate but if mistakenly labeled as a confounding variable and consequently adjusted in an analysis, the conclusions can be unexpected. The implications of this overadjustment of an intermediate as though it were a confounder can render an otherwise persuasive study downright meaningless. This commentary provides an exposition of confounding bias, collider stratification, and selection biases, with applications in obstetrics and perinatal epidemiology. Copyright © 2017 Elsevier Inc. All rights reserved.

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995-2007.

PubMed

Cook, T M; Bland, L; Mihai, R; Scott, S

2009-07-01

The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

Multidisciplinary In Situ Simulation-Based Training as a Postpartum Hemorrhage Quality Improvement Project.

PubMed

Lutgendorf, Monica A; Spalding, Carmen; Drake, Elizabeth; Spence, Dennis; Heaton, Jason O; Morocco, Kristina V

2017-03-01

Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements. Our objective was to assess participant comfort with managing obstetric hemorrhage following our multidisciplinary in situ simulation training exercise. This was a quality improvement project that utilized a comprehensive multidisciplinary in situ postpartum hemorrhage simulation exercise. Participants from the Departments of Obstetrics and Gynecology, Anesthesia, Nursing, Pediatrics, and Transfusion Services completed the training exercise in 16 scenarios run over 2 days. The intervention was a high fidelity, multidisciplinary in situ simulation training to evaluate hospital protocols, team performance, operational readiness, and system improvements. Structured debriefing was conducted with the participants to discuss communication and team functioning. Our main outcome measure was participant self-reported comfort levels for managing postpartum hemorrhage before and after simulation training. A 5-point Likert scale (1 being very uncomfortable and 5 being very comfortable) was used to measure participant comfort. A paired t test was used to assess differences in participant responses before and after the simulation exercise. We also measured the time to prepare simulated blood products and followed the number of postpartum hemorrhage cases before and after the simulation exercise. We trained 113 health care professionals including obstetricians, midwives, residents, anesthesiologists, nurse anesthetists, nurses, and medical assistants. Participants reported a higher comfort level in managing obstetric emergencies and postpartum hemorrhage after simulation training compared to before training. For managing hypertensive emergencies, the post-training mean score was 4.14 compared to a pretraining mean score of 3.88 (p = 0.01, 95% confidence interval [CI] = 0.06-0.47). For shoulder dystocia, the post-training mean score was 4.29 compared to a pretraining mean score of 3.66 (p = 0.001, 95% CI = 0.41-0.88). For postpartum hemorrhage, the post-training mean score was 4.35 compared to pretraining mean score of 3.86 (p = 0.001, 95% CI = 0.36-0.63). We also observed a decrease in the time to prepare simulated blood products over the course of the simulation, and a decreasing trend of postpartum hemorrhage cases, which continued after initiating the postpartum hemorrhage simulation exercise. Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality in the United States. Comprehensive hemorrhage protocols have been shown to improve outcomes related to postpartum hemorrhage, and a critical component in these processes include communication, teamwork, and team-based practice/simulation. As medicine becomes increasingly complex, the ability to practice in a safe setting is ever more critical, especially for low-volume, high-stakes events such as postpartum hemorrhage. These events require well-functioning teams and systems coupled with rapid assessment and appropriate clinical action to ensure best patient outcomes. We have shown that a multidisciplinary in situ simulation exercise improves self-reported comfort with managing obstetric emergencies, and is a safe and effective way to practice skills and improve systems processes in the health care setting. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

The impact of obstetric gel on the second stage of labor and perineal integrity: a randomized controlled trial.

PubMed

Ashwal, Eran; Aviram, Amir; Wertheimer, Avital; Krispin, Eyal; Kaplan, Boris; Hiersch, Liran

2016-09-01

Dianatal® is a bioadhesive gliding film which reduces the opposing force to vaginal childbirth. We aimed to investigate the safety, applicability, and impact of Dianatal® obstetric gel on second stage of labor and perineal integrity. Low-risk singleton pregnancies at term were prospectively enrolled. Eligible women were randomly assigned to either labor management without using obstetric gel, or labor management using intermittent application of obstetric gel into the birth canal during vaginal examinations, starting at active phase of labor (≥4 cm dilation). The primary measured outcome was the length of second stage of labor. Overall, 200 cases were analyzed. Demographic, obstetrical, and labor characteristics were similar between the groups. Neither adverse events nor maternal or neonatal side effects were observed. The mean lengths of the active and second stages of labor were comparable between the obstetric gel-treated and the control groups (157 versus 219 min and 48 versus 56 min, respectively). None of the women had grade III/IV perineal tears. Maternal and neonatal outcomes were not negatively influenced by using obstetric gel. No difference was found after sub-group analysis for spontaneous vaginal delivery. Dianatal® obstetric gel is safe in terms of maternal or neonatal use. Albeit a trend toward shorter labor stages using Dianatal® obstetric gel, no significant differences were noted among the groups. In order to further investigate the influence of the obstetric gel on labor stage interval, perineal integrity and maternal and neonatal outcomes, larger randomized clinical trials are needed to be carried out.

Career choices for obstetrics and gynaecology: national surveys of graduates of 1974-2002 from UK medical schools.

PubMed

Turner, G; Lambert, T W; Goldacre, M J; Barlow, D

2006-03-01

To report the trends in career choices for obstetrics and gynaecology among UK medical graduates. Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. United Kingdom. All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. Postal questionnaire surveys. Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology. Seventy-four percent (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long-term career choices more for obstetrics and gynaecology than for other careers. The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.