WorldWideScience

Sample records for clinical commentary obstetric

  1. Clinical proteomics in obstetrics and neonatology.

    Science.gov (United States)

    Klein, Julie; Buffin-Meyer, Benedicte; Mullen, William; Carty, David M; Delles, Christian; Vlahou, Antonia; Mischak, Harald; Decramer, Stéphane; Bascands, Jean-Loup; Schanstra, Joost P

    2014-02-01

    Clinical proteomics has been applied to the identification of biomarkers of obstetric and neonatal disease. We will discuss a number of encouraging studies that have led to potentially valid biomarkers in the context of Down's syndrome, preterm birth, amniotic infections, preeclampsia, intrauterine growth restriction and obstructive uropathies. Obtaining noninvasive biomarkers (e.g., from the maternal circulation, urine or cervicovaginal fluid) may be more feasible for obstetric diseases than for diseases of the fetus, for which invasive methods are required (e.g., amniotic fluid, fetal urine). However, studies providing validated proteomics-identified biomarkers are limited. Efforts should be made to save well-characterized samples of these invasive body fluids so that many valid biomarkers of pregnancy-related diseases will be identified in the coming years using proteomics based analysis upon adoption of 'clinical proteomics guidelines'.

  2. Obstetrical staff nurses experiences of clinical learning.

    Science.gov (United States)

    Veltri, Linda M

    2015-01-01

    The clinical learning experience is used in nursing programs of study worldwide to prepare nurses for professional practice. This study's purpose was to use Naturalistic Inquiry to understand the experiences of staff nurses in an obstetrical unit with undergraduate nursing students present for clinical learning. A convenience sample of 12 staff nurses, employed on a Family Birth Center, participated in semi-structured interviews. The constant comparative method as modified by Lincoln and Guba was used to analyze data. Five themes related to staff nurses experiences of clinical learning were identified: Giving and Receiving; Advancing Professionally and Personally; Balancing Act; Getting to Know and Working with You; and Past and Present. This research highlights staff nurses' experiences of clinical learning in undergraduate nursing education. Staff nurses exert a powerful, long lasting influence on students. A need exists to prepare and judiciously select nurses to work with students. Clinical agencies and universities can take joint responsibility providing tangible incentives, financial compensation, and recognition to all nurses working with nursing students. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Commentary

    DEFF Research Database (Denmark)

    Skytte, Marianne

    2012-01-01

    Commentary on a case about child abuse discussing the dilemma between recognition of professional discretion and the decire for further democratic development of society.......Commentary on a case about child abuse discussing the dilemma between recognition of professional discretion and the decire for further democratic development of society....

  4. Commentary

    DEFF Research Database (Denmark)

    Skytte, Marianne

    2012-01-01

    Commentary on a case about child abuse discussing the dilemma between recognition of professional discretion and the decire for further democratic development of society.......Commentary on a case about child abuse discussing the dilemma between recognition of professional discretion and the decire for further democratic development of society....

  5. COMMENTARY

    African Journals Online (AJOL)

    2007-03-01

    Mar 1, 2007 ... 41. COMMENTARY. Is climate change influencing the decline of Cape ... two of the larger, montane vulture species present in the region: the two northern- most colonies of .... distribution should be first affected. In vultures, we ...

  6. Inconsistencies in clinical guidelines for obstetric anaesthesia for Caesarean section

    DEFF Research Database (Denmark)

    Winther, Lars; Mitchell, A U; Møller, Ann

    2013-01-01

    Anaesthetists need evidence-based clinical guidelines, also in obstetric anaesthesia. We compared the Danish, English, American, and German national guidelines for anaesthesia for Caesarean section. We focused on assessing the quality of guideline development and evaluation of the guidelines...

  7. Commentary

    DEFF Research Database (Denmark)

    Otrel-Cass, Kathrin

    2015-01-01

    ’s lives. However there has been primarily focus on its life accelerating attributes. Slowing down the process of production may open up possibilities for sustainable ICT development. The commentary combined with Patrignani and Whitehouse's article may provide a resource for those responsible in training...... technology. Connecting resource production, use and disposal and its affect on climate change will require those who are in the position to make changes to come up with solutions that consider also values, beliefs and norms that lead to particular types of behaviour. ICT has had an enormous impact on people...

  8. Commentary

    DEFF Research Database (Denmark)

    Marchuk, Iryna

    2016-01-01

    This commentary addresses a number of important evidentiary issues that arose during cross-examination of Charles Taylor, the former President of Liberia, who who stood trial and was convicted of crimes against humanity and war crimes committed during Sierra Leone’s brutal civil war before the UN......-backed Special Court for Sierra Leone (SCSL). At the core of cross-examination was the Prosecution’s strategy to challenge Taylor’s self-portrayal as a peacemaker and to demonstrate a pattern of conduct of the accused in Liberia similar to the one pursued by war-mongering leaders of various rebel groups....... A large part of the Prosecution’s strategy was to impeach the credibility of the accused through the introduction of documentary evidence that unravelled inconsistencies in his prior testimony. This, however, proved on many occasions to be impossible, as the judges treated these documents with great...

  9. Commentary

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Interventional therapy for congenital heart disease (CHD)was introduced in the 1960s following animal experiments and clinical studies using transluminal technique. However,it was not widely accepted in clinical applications until the 1990s because of the limitations of interventional devices and catheter technique. Interventional therapy is now well developed as a result of successful animal studies and clinical trials. It has a higher success rate than that of surgery in some CHD cases such as patent ductus arteriosus (PDA), pulmonary valve stenosis (PS), atrial septial defect (ASD) and coarctation of the aorta (CoA), and it may palliate some CHDs by atrial septostomy and interventional embolization of the pulmonary arteriovenous fistula.

  10. DRY NEEDLING FOR MYOFASCIAL TRIGGER POINT PAIN: A CLINICAL COMMENTARY.

    Science.gov (United States)

    Unverzagt, Casey; Berglund, Kathy; Thomas, J J

    2015-06-01

    Sports and orthopaedic physical therapists have long used a multitude of techniques in order to address pain and dysfunction associated with myofascial trigger points. One technique in particular has recently received overwhelming attention: trigger point dry needling (DN). Despite its efficacy and low risk, questions remain as to its effectiveness, safety, and whether the technique is within the scope of practice of physical therapists. Therefore, the purpose of this clinical commentary is to summarize the current literature related to the associated mechanisms of action of DN, the safety of DN, as well as to discuss relevant scope of practice concerns. 5.

  11. Development of an obstetrics triage tool for clinical pharmacists.

    Science.gov (United States)

    Covvey, J R; Grant, J; Mullen, A B

    2015-06-25

    Obstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services. A retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service (NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development). One hundred and seventy-five cases were reviewed with a median age of 29 years old. Eighty-six patients (49·1%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (66·9%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (75·6 vs. 58·4%, P = 0·017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (55·4 vs. 80·8%, P = 0·015), but numerically higher rates of clinical (26·2 vs. 9·6%, p=NS) and mixed clinical/administrative (18·5 vs. 9·6%, p=NS) missed opportunities, although this failed to reach statistical significance. Evaluation of a triage tool for obstetric services demonstrated potential for prioritizing

  12. Clinical Boot Camp: An Innovative Simulation Experience to Prepare Nursing Students for Obstetric and Pediatric Clinicals.

    Science.gov (United States)

    Hogewood, Connie; Smith, Tedra; Etheridge, Sherita; Britt, Sylvia

    2015-01-01

    Obstetric and pediatric patients require unique specialized care not included in traditional adult health education. To prepare nursing students for clinical rotations beginning the second week of class, faculty developed an innovative one-day simulation seminar, the OB/PEDS Boot Camp, in which groups of students rotated through six stations of obstetric and pediatric simulation exercises. This article provides insight on the development and implementation of the OB/PEDS Boot Camp.

  13. Utilization of Clinical Trials Registries in Obstetrics and Gynecology Systematic Reviews.

    Science.gov (United States)

    Bibens, Michael E; Chong, A Benjamin; Vassar, Matt

    2016-02-01

    To evaluate the use of clinical trials registries in published obstetrics and gynecologic systematic reviews and meta-analyses. We performed a metaepidemiologic study of systematic reviews between January 1, 2007, and December 31, 2015, from six obstetric and gynecologic journals (Obstetrics & Gynecology, Obstetrical & Gynecological Survey, Human Reproduction Update, Gynecologic Oncology, British Journal of Obstetrics and Gynaecology, and American Journal of Obstetrics & Gynecology). All systematic reviews included after exclusions were independently reviewed to determine whether clinical trials registries had been included as part of the search process. Studies that reported using a trials registry were further examined to determine whether trial data were included in the analysis of these systematic reviews. Our initial search resulted in 292 articles, which was narrowed to 256 after exclusions. Of the 256 systematic reviews meeting our selection criteria, 47 (18.4%) used a clinical trials registry. Eleven of the 47 (23.4%) systematic reviews found unpublished data and two included unpublished data in their results. A majority of systematic reviews in clinical obstetrics and gynecology journals do not conduct searches of clinical trials registries or do not make use of data obtained from these searches. Failure to make use of such data may lead to an inaccurate summary of available evidence and may contribute to an overrepresentation of published, statistically significant outcomes.

  14. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    Science.gov (United States)

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. Participants The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. Outcome measures An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. Results 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. Conclusions The process established a new network of opinion leaders and researchers for further

  15. Brucellosis in pregnancy: clinical aspects and obstetric outcomes

    Directory of Open Access Journals (Sweden)

    Gustavo Vilchez

    2015-09-01

    Conclusions: This is the largest series of brucellosis in pregnancy reported in the literature. Brucella presents adverse obstetric outcomes including fetal and maternal/neonatal death. Cases with unexplained spontaneous abortion should be investigated for brucellosis. Prompt treatment is paramount to decrease the devastating outcomes.

  16. Factors associated with adverse clinical outcomes among obstetrics trainees.

    Science.gov (United States)

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

    2015-07-01

    This study was conducted to determine whether UK obstetrics trainees transitioning from directly to indirectly supervised practice have a higher likelihood of recording adverse patient outcomes in operative deliveries compared with other indirectly supervised trainees, and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial practice under indirect supervision. We examined all deliveries (13 856) conducted by obstetricians at a single centre over 6 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss (EBL), maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly supervised year with those for trainees in all other years of indirect supervision. Outcomes for trainees in their first indirectly supervised 3 months were compared with 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. Trainees in their first indirectly supervised year had a higher likelihood of recording EBL of > 2 L at any delivery (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.01-1.64; p  1 L (OR 2.54, 95% CI 1.88-3.20; p  1 L (p Obstetrics trainees in their first year of indirectly supervised practice have a higher likelihood of recording 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, which suggests that experience is a key consideration in obstetrics training programme design. © 2015 John Wiley & Sons Ltd.

  17. Birth Rates Among Hispanics and Non-Hispanics and their Representation in Contemporary Obstetric Clinical Trials.

    Science.gov (United States)

    Kahr, Maike K; De La Torre, Rosa; Racusin, Diana A; Suter, Melissa A; Mastrobattista, Joan M; Ramin, Susan M; Clark, Steven L; Dildy, Gary A; Belfort, Michael A; Aagaard, Kjersti M

    2016-10-01

    Objective Our study aims were to establish whether subjects enrolled in current obstetric clinical trials proportionately reflects the contemporary representation of Hispanic ethnicities and their birth rates in the United States. Methods Using comprehensive source data over a defined interval (January 2011-September 2015) on birth rates by ethnicity from the Centers for Disease Control and Prevention (CDC), we evaluated the proportional rate by ethnicity, then analyzed the observed to expected relative ratio of enrolled subjects. Results Hispanic women comprise a significant contribution to births in the United States (23% of all births). Systematic analysis of 90 published obstetric clinical trials showed a correlation between inclusion of Hispanic gravidae and the corresponding state's birth rates (r = 0.501, p < 0.001). While the mean was strongly correlated, individual clinical trials may have relatively over-enrolled (n = 31, or 34%) or under-enrolled (n = 33, or 37%) relative to their regional population. In 48% of obstetric clinical trials the Hispanic proportion of the study population was not reported. Conclusion Hispanic gravidae represent a significant number of contemporary U.S. births, and are generally adequately represented as obstetric subjects in clinical trials. However, this is trial-dependent, with significant trial-specific under- and over-enrollment of Hispanic subjects relative to the regional birth population.

  18. A commentary on the 2015 Canadian Clinical Practice Guidelines in glutamine supplementation to parenteral nutrition.

    Science.gov (United States)

    Leguina-Ruzzi, Alberto

    2016-01-08

    Glutamine is one of the conditionally essential free amino acids with multiple biological functions. Its supplementation to parenteral nutrition has been widely used for the management of complications in intensive care. However, controversial clinical reports have generated reluctance in the use of this pharmaco-nutrient. In this commentary, we address the impact of four studies that influenced the recommendations on glutamine supplementation by the Canadian Clinical Practice Guide 2015. Because of the importance of this guideline in clinical practice, we strongly believe that a more rigorous and critical evaluation is required to support recommendations in future guidelines.

  19. Commentary: the postdoctoral residency match in clinical neuropsychology.

    Science.gov (United States)

    Bodin, Doug; Grote, Christopher L

    2016-07-01

    Postdoctoral recruitment in clinical neuropsychology has evolved significantly over the past two decades. Prior to 1994, there were no organized recruitment guidelines for the specialty. From 1994 to 2001, the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) facilitated a uniform notification date where member programs agreed to not make offers prior to a specified date. In 2001, APPCN partnered with National Matching Services to administer a computerized match recruitment system. Presently, not all programs participate in the match. This often results in students applying to 'match' and 'non-match' programs which can lead to significant stress on the part of applicants and program directors. This issue has recently become the focus of journal articles and public discussions. The goals of this paper were to review the history of postdoctoral recruitment in clinical neuropsychology, review the benefits of coordinated recruitment systems, review the structure and function of the computerized match, and explain why the computerized match for postdoctoral recruitment in clinical neuropsychology is beneficial for the specialty of clinical neuropsychology.

  20. Obstetrical Antiphospholipid Syndrome: From the Pathogenesis to the Clinical and Therapeutic Implications

    Directory of Open Access Journals (Sweden)

    T. Marchetti

    2013-01-01

    Full Text Available Antiphospholipid syndrome (APS is an acquired thrombophilia with clinical manifestations associated with the presence of antiphospholipid antibodies (aPL in patient plasma. Obstetrical APS is a complex entity that may affect both mother and fetus throughout the entire pregnancy with high morbidity. Clinical complications are as various as recurrent fetal losses, stillbirth, intrauterine growth restriction (IUGR, and preeclampsia. Pathogenesis of aPL targets trophoblastic cells directly, mainly via proapoptotic, proinflammatory mechanisms, and uncontrolled immunomodulatory responses. Actual first-line treatment is limited to low-dose aspirin (LDA and low-molecular weight heparin (LMWH and still failed in 30% of the cases. APS pregnancies should be a major field in obstetrical research, and new therapeutics are still in progress.

  1. Attitudes towards abortion among trainees in obstetrics/gynecology and clinical genetics

    DEFF Research Database (Denmark)

    Ingerslev, Marie Diness; Diness, Birgitte Rode; Norup, Michael Slott

    2012-01-01

    This study aimed to provide knowledge about attitudes towards abortion among Danish physicians in training in the specialties of obstetrics/gynecology and clinical genetics. The study was a questionnaire survey among trainees in these specialties. Ninety-six responded. Trainees in clinical genetics...... were more pro-abortion than those in obstetrics/gynecology (p=0.04). Of the respondents, 30 versus 48% found working with early and late abortions unpleasant. Nearly half agreed that they had chosen their specialty despite having to counsel and treat women having abortions. Twenty-one percent agreed...... that working with late abortion affected their job satisfaction negatively. Those agreeing with the above statements had a tendency towards lower pro-abortion scores than those who were indifferent or who disagreed but the differences were not significant. A substantial fraction of physicians in training have...

  2. Profile of pregnancy in adolescence and related clinical-obstetric occurrences

    OpenAIRE

    Maria Veraci Oliveira Queiroz; Eysler Gonçalves Maia Brasil; Caroline Magalhães de Alcântara; Maria da Glória Oliveira Carneiro

    2014-01-01

    The objective was to characterize the profile of adolescence pregnancy and its clinical and obstetric events. Descriptive, cross-sectional study, with quantitative approach, developed in a tertiary hospital in Fortaleza, CE, Brazil, with one hundred adolescent mothers, through interviews and registers from the medical records, from February to May, 2011. Data were analyzed by Statistical Package for the Social Science software, version 17.0. The majority lived with a partner who earned up to ...

  3. [Incidence and indications for cesarean section in the Obstetrics Clinic in the University Hospital of Obstetrics and Gynecology "Maichin Dom" in Sofia].

    Science.gov (United States)

    Asenova, D; Stambolov, B

    2005-01-01

    The incidence and the indications for Cesarean section in the Obstetric Clinic of the University Hospital of Obstetrics and Gynecology were analysed and compared to a study carried out 20 years ago In 2003 - 2004 there were 2700 pregnant women treated in the clinic 558 had Cesarean section (incidence 20.7%). For comparison the incidence of Cesarean section in 1985 was 6.67% (160 Cesarean sections for 2096 patients) and for 1986 the incidence was 7.63% (131 Cesarean Sections for 1865 patients. The leading indication for the both studies was "previous Cesarean section" the indication "contracted pelvis" was the second and infertility and breech presentation were on the third and forth place. There was no change in the indications for Cesqarean section in the present study and the study carried out 20 years ago. There was a relative increase of the indications 'contracted pelvis' and 'increased age in a nulliparous patiet' compared to the previous years.

  4. A commentary on the disparate perspectives of clinical microbiologists and surgeons

    Science.gov (United States)

    O’Connell, Nuala H; O’Connor, Ciara; O’Mahony, Jim; Lobo, Ronstan; Hayes, Maria; Masterson, Eric; Larvin, Michael; Coffey, J Calvin; Dunne, Colum

    2014-01-01

    Prosthetic joints and other orthopedic implants have improved quality of life for patients world-wide and the use of such devices is increasing. However, while infection rates subsequent to associated surgery are relatively low (<3%), the consequences of incidence are considerable, encompassing morbidity (including amputation) and mortality in addition to significant social and economic costs. Emphasis, therefore, has been placed on mitigating microbial risk, with clinical microbiologists and surgeons utilizing rapidly evolving molecular laboratory techniques in detection and diagnosis of infection, which still occurs despite sophisticated patient management. Multidisciplinary approaches are regularly adopted to achieve this. In this commentary, we describe an unusual case of Actinomyces infection in total hip arthroplasty and, in that context, describe the perspectives of the clinical microbiology and surgical teams and how they contrasted. More specifically, this case demonstrates an ad hoc approach to structured eradication of biofilms and intracellular bacteria related to biomaterials, as reflected in early usage of linezolid. This is a complex topic and, as described in this case, such accelerated treatment can be effective. This commentary focuses on the merits of such inadvisable use of potent antimicrobials amid the risk of diminishing valuable antimicrobial efficacy, albeit resulting in desirable patient outcomes. PMID:25122489

  5. Obstetrical Ultrasound

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Obstetric Ultrasound Obstetric ultrasound uses sound waves to produce pictures ... limitations of Obstetrical Ultrasound Imaging? What is Obstetrical Ultrasound Imaging? Ultrasound is safe and painless, and produces ...

  6. A commentary on the role of molecular technology and automation in clinical diagnostics

    Science.gov (United States)

    O’Connor, Ciara; Fitzgibbon, Marie; Powell, James; Barron, Denis; O’Mahony, Jim; Power, Lorraine; O’Connell, Nuala H; Dunne, Colum

    2014-01-01

    Historically, the identification of bacterial or yeast isolates has been based on phenotypic characteristics such as growth on defined media, colony morphology, Gram stain, and various biochemical reactions, with significant delay in diagnosis. Clinical microbiology as a medical specialty has embraced advances in molecular technology for rapid species identification with broad-range 16S rDNA polymerase chain reaction (PCR) and matrix-assisted laser desorption and/or ionization time of flight (MALDI-TOF) mass spectrometry demonstrated as accurate, rapid, and cost-effective methods for the identification of most, but not all, bacteria and yeasts. Protracted conventional incubation times previously necessary to identify certain species have been mitigated, affording patients quicker diagnosis with associated reduction in exposure to empiric broad-spectrum antimicrobial therapy and shortened hospital stay. This short commentary details such molecular advances and their implications in the clinical microbiology setting. PMID:24658184

  7. Physical therapy guideline for children with malnutrition in low income countries: clinical commentary

    Science.gov (United States)

    Bekele, Abey; Janakiraman, Balamurugan

    2016-01-01

    Physical therapy intervention along with nutritional rehabilitation has recently become an inevitable combo after recent evidences suggesting a strong interaction between malnutrition and neuro-muscular disabilities which contribute to a significant burden in global settings. Recent studies confirm that appropriate physical assessment of neuro-musculo skeletal system, developmental assessment or cognitive tools along with nutritional assessments followed by exercise rehabilitation will yield positive results in children with malnutrition. There is an obvious need to make available a simple physical therapy exercise guidelines with simple measure and exercise to be used in resource limited settings of developing countries. The purpose of this clinical commentary is to summarize simple assessment tools to evaluate activity impairment, participation restriction, gross motor activity and simple physical therapy intervention program for children with disability secondary to malnutrition. PMID:27656622

  8. Effect of a multi-modal intervention on immunization rates in obstetrics and gynecology clinics.

    Science.gov (United States)

    Mazzoni, Sara E; Brewer, Sarah E; Pyrzanowski, Jennifer L; Durfee, M Josh; Dickinson, L Miriam; Barnard, Juliana G; Dempsey, Amanda F; O'Leary, Sean T

    2016-05-01

    There is increasing attention on immunizations by obstetrician-gynecologists and a need to improve vaccination rates for all women. To evaluate the effect of a multimodal intervention on rates of immunization with tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); and influenza in outpatient obstetrics and gynecology clinics. Immunization rates at 2 clinics were compared pre- and post-implementation of multiple interventions at a public integrated health-care system. Study interventions began on June 6, 2012 and concluded on May 31, 2014; the preimplementation time period used was June 6, 2010 to June 5, 2012. Interventions included stocking of immunizations in clinics, revision and expansion of standing orders, creation of a reminder/recall program, identification of an immunization champion to give direct provider feedback, expansion of a payment assistance program, and staff education. All women aged 15 and older who made a clinic visit during influenza season were included in the influenza cohort; women who delivered an infant during the study time period and had at least 1 prenatal visit within 9 months preceding delivery were included in the Tdap cohort; each clinic visit by a nonpregnant woman aged 15-26 years was assessed and included in the HPV analysis as an eligible visit if the patient was lacking any of the 3 HPV vaccines in the series. The primary outcome was receipt of influenza and Tdap vaccine per current American College of Obstetricians and Gynecologists guidelines and receipt of HPV vaccine during eligible visits. Influenza and Tdap were assessed with overall coverage rates at the institutional level, and HPV was assessed at the visit level by captured opportunities. All analyses included generalized estimating equations and the primary outcome was assessed with time as a covariate in all models. A total of 19,409 observations were included in the influenza cohort (10,231 pre- and 9178 post-intervention), 2741 in

  9. Prescribing errors intercepted by clinical pharmacists in paediatrics and obstetrics in a tertiary hospital in Spain.

    Science.gov (United States)

    Fernandez-Llamazares, Cecilia M; Calleja-Hernández, Miguel-Ángel; Manrique-Rodríguez, Silvia; Pérez-Sanz, Cristina; Durán-García, Esther; Sanjurjo-Sáez, María

    2012-09-01

    To assess the main differences in clinical significance of the prescribing errors intercepted by clinical pharmacists in paediatrics and obstetrics and the reasons for these prescribing errors, as well as the differences in pharmacists' activity indicators. The was a cross-sectional epidemiological study analysing the activities of paediatric pharmacists in a maternity and children's hospital with 180 paediatric beds and 138 obstetrics and gynaecology beds between January 2007 and December 2009. The following variables were analysed: clinical significance of prescribing errors intercepted, reason for the error, impact of the intervention by pharmacist, acceptance rate of the recommendation made, medication involved, intervention detection date and observations. A total of 2,449 interventions in medical orders were recorded. Interventions that were not accepted by doctors were excluded, leaving 43 cases (2.1%) of extremely significant interventions and 170 (8.4%) very significant interventions. Interventions in what were deemed to be error-free situations were excluded. Significance testing (based on 2,035 errors detected) showed that 1.7% of the detected errors were potentially lethal (35 cases), while 10.2% (210 cases) were clinically serious. The main reason for the interventions was the detection of a dosage between 1.5- and tenfold higher than the recommended dosage. The overall rate of acceptance of the pharmacist's suggestions was 92.2%. Pharmacists carried out an average of 0.016 interventions/patient-day throughout the study period. Paediatric patients had a fourfold higher risk of serious errors than the maternity population. Pharmacist intervention had a major impact on reducing prescribing errors in the study period, thus improving the quality and efficiency of care provided.

  10. Student attendance and academic performance in undergraduate obstetrics/gynecology clinical rotations.

    Science.gov (United States)

    Deane, Richard P; Murphy, Deirdre J

    2013-12-04

    Student attendance is thought to be an important factor in the academic performance of medical students, in addition to having important regulatory, policy, and financial implications for medical educators. However, this relationship has not been well evaluated within clinical learning environments. To evaluate the relationship between student attendance and academic performance in a medical student obstetrics/gynecology clinical rotation. A prospective cohort study of student attendance at clinical and tutorial-based activities during a full academic year (September 2011 to June 2012) within a publicly funded university teaching hospital in Dublin, Ireland. Students were expected to attend 64 activities (26 clinical activities and 38 tutorial-based activities) but attendance was not mandatory. All 147 fourth-year medical students who completed an 8-week obstetrics/gynecology rotation were included. Student attendance at clinical and tutorial-based activities, recorded using a paper-based logbook. The overall examination score (out of a possible 200 points) was obtained using an 11-station objective structured clinical examination (40 points), an end-of-year written examination comprising 50 multiple-choice questions (40 points) and 6 short-answer questions (40 points), and an end-of-year long-case clinical/oral examination (80 points). Students were required to have an overall score of 100 points (50%) and a minimum of 40 points in the long-case clinical/oral examination (50%) to pass. The mean attendance rate was 89% (range, 39%-100% [SD, 11%], n = 57/64 activities). Male students (84% attendance, P = .001) and students who failed an end-of-year examination previously (84% attendance, P = .04) had significantly lower rates. There was a positive correlation between attendance and overall examination score (r = 0.59 [95% CI, 0.44-0.70]; P attendance (r = 0.50 [95% CI, 0.32-0.64]; P attendance (r = 0.57 [95% CI, 0.40-0.70]; P

  11. Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study

    Science.gov (United States)

    Grote, Nancy K.; Bledsoe, Sarah E.; Swartz, Holly A.; Frank, Ellen

    2004-01-01

    Objective: To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression, we conducted a pilot study to assess the feasibility of providing brief interpersonal psychotherapy (IPT-B) to depressed, pregnant patients on low incomes in an obstetrics and gynecological (OB/GYN) clinic. Method: Twelve pregnant,…

  12. Medical student self-reported confidence in obstetrics and gynaecology: development of a core clinical competencies document

    Science.gov (United States)

    2013-01-01

    Background Clinical competencies in obstetrics and gynaecology have not been clearly defined for Australian medical students, the growing numbers of which may impact clinical teaching. Our aim was to administer and validate a competencies list, for self-evaluation by medical students of their confidence to manage common clinical tasks in obstetrics and gynaecology; to evaluate students’ views on course changes that may result from increasing class sizes. Methods A draft list of competencies was peer-reviewed, and discussed at two student focus groups. The resultant list was administered as part of an 81 item online survey. Results Sixty-eight percent (N = 172) of those eligible completed the survey. Most respondents (75.8%) agreed or strongly agreed that they felt confident and well equipped to recognise and manage most common and important obstetric and gynaecological conditions. Confidence was greater for women, and for those who received a higher assessment grade. Free-text data highlight reasons for lack of clinical experience that may impact perceived confidence. Conclusions The document listing competencies for medical students and educators is useful for discussions around a national curriculum in obstetrics and gynaecology in medical schools, including the best methods of delivery, particularly in the context of increasing student numbers. PMID:23634953

  13. Tocilizumab and multiple sclerosis: a causal relationship? Clinical Commentary on the case report entitled--MS arising during Tocilizumab therapy for rheumatoid arthritis.

    Science.gov (United States)

    Comabella, Manuel

    2016-02-01

    This clinical commentary discusses on the potential relationship between multiple sclerosis (MS) and tocilizumab in a patient with rheumatoid arthritis who developed MS while on treatment with this anti-interleukin-6 agent.

  14. Are the Endocrine Society's Clinical Practice Guidelines on Androgen Therapy in Women misguided? A commentary.

    Science.gov (United States)

    Traish, Abdulmaged; Guay, Andre T; Spark, Richard F

    2007-09-01

    The Endocrine Society Clinical Guidelines on Androgen Therapy in Women (henceforth referred to as the Guidelines) do not necessarily represent the opinion held by the many health-care professionals and clinicians who are specialized in the evaluation, diagnosis, and treatment of women's health in androgen insufficiency states. The recommendations provided in the published Guidelines are neither accurate nor complete. We disagree with the therapeutic nihilism promoted by these Guidelines. The members of the Guidelines Panel (henceforth referred to as the Panel), in their own disclaimer, stated that the Guidelines do not establish a standard of care. Based on data available in the contemporary literature, on the role of androgens in women's health, we provide in this commentary a point-by-point discussion of the arguments made by the Panel in arriving at their recommendations. It is our view that the Guidelines are not based on the preponderance of scientific evidence. Health-care professionals, physicians, and scientists often disagree when determining how best to address and manage new and emerging clinical issues. This is where we stand now as we endeavor to understand the role of androgens in a woman's health and welfare. Indeed, some basic facts are not in contention. All agree that dehydroepiandrosterone sulfate (DHEA-S) production from the adrenal gland begins during the preteen years, peaks in the mid 20s, then declines progressively over time. In contrast, ovarian androgen (i.e., testosterone) secretion commences at puberty, is sustained during a woman's peak reproductive years and declines as a woman ages, with a more rapid and steep decrease after surgical menopause. However, there are ample data to suggest that adrenal androgens play a role in the development of axillary and pubic hair, and that testosterone is critical for women's libido and sexual function. We take this opportunity to invite members of the Panel on Androgen Therapy in Women to discuss

  15. The impact of a longitudinal curriculum on medical student obstetrics and gynecology clinical training.

    Science.gov (United States)

    Melo, Juliana; Kaneshiro, Bliss; Kellett, Lisa; Hiraoka, Mark

    2014-05-01

    Clinical training in most medical schools consists of separate rotations, based out of tertiary-care facilities, across the core medical disciplines. In addition to a traditional clinical curriculum, the University of Hawai'i offers a longitudinal clinical curriculum as an option to medical students. The longitudinal curriculum provides students with an innovative, alternative educational track to achieve their educational goals in clinical medicine. The objective of this study was to describe the obstetrics and gynecology procedural experiences of third-year medical students who participated in a longitudinal curriculum versus a traditional block clerkship. The number of procedures reported by third-year medical students who participated in a non-traditional, longitudinal clerkship was compared with the number of procedures reported by students who participated in the traditional block third-year curriculum between July 2007 and June 2009. National Board of Medical Examiners (NBME) subject scores, clerkship grade and chosen residency specialty were also compared. The mean number of pelvic exams (longitudinally-trained 36 [SD 33] versus block-trained 8 [SD 6], [t=4.3, P<.01]) and pap smears (longitudinally-trained 28 [SD 26] versus block-trained 7 [SD 3] [t=4.4, P<.01]) was significantly higher for longitudinally-trained students compared to block-trained students. No significant differences in overall clerkship grades or NBME shelf scores emerged.

  16. The Impact of a Longitudinal Curriculum on Medical Student Obstetrics and Gynecology Clinical Training

    Science.gov (United States)

    Melo, Juliana; Kaneshiro, Bliss; Kellett, Lisa

    2014-01-01

    Clinical training in most medical schools consists of separate rotations, based out of tertiary-care facilities, across the core medical disciplines. In addition to a traditional clinical curriculum, the University of Hawai‘i offers a longitudinal clinical curriculum as an option to medical students. The longitudinal curriculum provides students with an innovative, alternative educational track to achieve their educational goals in clinical medicine. The objective of this study was to describe the obstetrics and gynecology procedural experiences of third-year medical students who participated in a longitudinal curriculum versus a traditional block clerkship. The number of procedures reported by third-year medical students who participated in a non-traditional, longitudinal clerkship was compared with the number of procedures reported by students who participated in the traditional block third-year curriculum between July 2007 and June 2009. National Board of Medical Examiners (NBME) subject scores, clerkship grade and chosen residency specialty were also compared. The mean number of pelvic exams (longitudinally-trained 36 [SD 33] versus block-trained 8 [SD 6], [t=4.3, P<.01]) and pap smears (longitudinally-trained 28 [SD 26] versus block-trained 7 [SD 3] [t=4.4, P<.01]) was significantly higher for longitudinally-trained students compared to block-trained students. No significant differences in overall clerkship grades or NBME shelf scores emerged. PMID:24843837

  17. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

  18. Preserving knee function following osteoarthritis diagnosis: a sustainability theory and social ecology clinical commentary.

    Science.gov (United States)

    Nyland, J; Wera, J; Henzman, C; Miller, T; Jakob, R; Caborn, D N M

    2015-02-01

    To sustain natural systems, there must be an ongoing balance between environmental, social, and economic considerations. A key element of sustainability theory is to identify the most vulnerable surroundings. The most vulnerable knee tissue is the articular cartilage as it is the last line of osteoarthritis (OA) defense. This tissue has a poor capacity for healing. Based on sustainability theory and social ecology concepts we propose that several key factors contribute to knee function preservation. Factors include health history, genetic predisposition, personal behaviors, and socio-environmental factors in addition to local-regional-global physiological system function. Addressing only some of these factors or any one factor in isolation may lead to less than optimal treatment effectiveness. The purpose of this commentary is to introduce a medical, surgical and rehabilitation management approach for patients with knee OA that considers more than physical function improvement. This approach also considers social, emotional, and environmental factors to better ensure patient satisfaction, fulfilled expectations and successful outcomes. A clinical care pathway is presented for a 57-year-old patient with medial compartment knee OA who is contemplating early arthroplasty versus a knee function preservation treatment approach. Early arthroplasty refers to high revision likelihood based on a minimum 15 year prosthesis life-expectancy.

  19. Clinical, parasitological and obstetric observations in pregnant bitches with experimental toxoplasmosis

    Directory of Open Access Journals (Sweden)

    Bresciani Katia Denise Saraiva

    2001-01-01

    Full Text Available Eight pregnant mixed breed bitches, serologically negative for Toxoplasma gondii, were divided into three groups. Group I : bitches 01 and 02 (1.0 x 10(7 tachyzoites of Toxoplasma gondii, subcutaneous route; Group II: bitches 03, 04 and 05 (1.5 x 10(4 oocysts, oral route; Group III: bitches 06, 07 and 08 (as control. Clinical and obstetric examinations were conducted twice a day on each bitch, and weekly ultra-sonografic evaluations were performed until the end of pregnancy. From the 2nd day the bitches presented clinical alterations such as fever, nasal flowing, lachrymation, prostration, lymphadenopathy, premature parturition, abortion and fetal death. In Group I, Toxoplasma gondii was isolated from the bitches urine (day 10 and saliva (day 18. The bitches inoculated with oocysts showed milk samples collected on day 07and day 16 after inoculation positive for Toxoplasma gondii. Saliva collected on day 13 and urine samples collected on days 1, 3, 7 and 16 from these bitches also showed positive. All inoculated bitches reacted positively to antigenic stimulus, with production of Toxoplasma gondii antibodies from day 3 on, with highest titers detected on day 11. Antibodies were detected by Indirect fluorescent antibody test (IFAT and Enzyme linked immunosorbent assay (ELISA tests.

  20. Clinical skills training in obstetrics - a descriptive survey of current practice in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Mathilde Maagaard; Johansen, Marianne; Lottrup, Pernille

    2012-01-01

    The Danish National Board of Health has recommended that labor wards establish regular obstetric emergency skills training programs. The aim of this study was to describe current practice in Denmark. A questionnaire was sent to all obstetric departments in Denmark in 2008. All responded. Simulation......-based training was conducted in 26/28 obstetrical departments. Settings for the training programs were mainly local. Training was provided for shoulder dystocia, postpartum bleeding and basic neonatal resuscitation in almost all the departments, but was not organized in a uniform way. Neither the program itself...... nor the participants' performance was evaluated in a structured or validated way. Obstetric emergency skills training is being actively conducted in the majority of the Danish labor wards. However, it still remains a challenge to ensure the uniform organization and evaluation of the current training...

  1. Profile of pregnancy in adolescence and related clinical-obstetric occurrences

    Directory of Open Access Journals (Sweden)

    Maria Veraci Oliveira Queiroz

    2014-09-01

    Full Text Available The objective was to characterize the profile of adolescence pregnancy and its clinical and obstetric events. Descriptive, cross-sectional study, with quantitative approach, developed in a tertiary hospital in Fortaleza, CE, Brazil, with one hundred adolescent mothers, through interviews and registers from the medical records, from February to May, 2011. Data were analyzed by Statistical Package for the Social Science software, version 17.0. The majority lived with a partner who earned up to one minimum wage, had low education and unpaid occupational activity. Most of them also reported early sexual activity, and were primiparas. All of them had complete prenatal care, with an average number of 5.91 consultations. The percentage of uncomplicated births of newborns was 48.9%, being prematurity the most frequent (56.3%. It is necessary to have more encouragement to young mothers attending postnatal consultation and family planning, and to have access and learning contraceptive matters, making prevention to early pregnancy more effective.

  2. KDOQI US commentary on the 2013 KDIGO Clinical Practice Guideline for Lipid Management in CKD.

    Science.gov (United States)

    Sarnak, Mark J; Bloom, Roy; Muntner, Paul; Rahman, Mahboob; Saland, Jeffrey M; Wilson, Peter W F; Fried, Linda

    2015-03-01

    The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

  3. Hypertensıon Prevalance in Pregnant Women Refered to the Gynecology and Obstetrics Clinic of a Faculty of Medicine

    OpenAIRE

    Haydar ERSOY; Oktay Sarı; Aydoğan, Ümit

    2011-01-01

    OBJECTIVE: Hypertension is one of the most common reason of mother and fetus mortality in pregnancy. In our study, we investigated the prevalence of hypertension in pregnant women. MATERIAL and METHODS: Sample of the study is composed of those who apply because of pregnancy between November 2007 to March 2008 to obstetrics and gynecology clinic. Measurement of blood pressure was carried out as 2 measurements at 6-hour intervals, during 3 days. Data of the patients including age, height, we...

  4. Reliability and Validity of Objective Structured Clinical Examination for Residents of Obstetrics and Gynecology at Kermanshah University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Nasrin Jalilian

    2012-11-01

    Full Text Available Introduction: Objective structured clinical examination (OSCE is used for the evaluation of the clinical competence in medicine for which it is essential to measure validity and reliability. This study aimed to investigate the validity and reliability of OSCE for residents of obstetrics and gynecology at Kermanshah University of Medical Sciences in 2011.Methods: A descriptive-correlation study was designed and the data of OSCE for obstetrics and gynecology were collected via learning behavior checklists in method stations and multiple choice questions in question stations. The data were analyzed through Pearson correlation coefficient and Cronbach's alpha, using SPSS software (version 16. To determine the criterion validity, correlation of OSCE scores with scores of resident promotion test, direct observation of procedural skills, and theoretical knowledge was determined; for reliability, however, Cronbach's alpha was used. Total sample consisted of 25 participants taking part in 14 stations. P value of less than 0.05 was considered as significant.Results: The mean OSCE scores was 22.66 (±6.85. Criterion validity of the stations with resident promotion theoretical test, first theoretical knowledge test, second theoretical knowledge, and direct observation of procedural skills (DOPS was 0.97, 0.74, 0.49, and 0.79, respectively. In question stations, criterion validity was 0.15, and total validity of OSCE was 0.77.Conclusion: Findings of the present study indicated acceptable validity and reliability of OSCE for residents of obstetrics and gynecology.

  5. [Various aspects of voluntary abortion at the Obstetrical and Gynecological Clinic of the University of Modena].

    Science.gov (United States)

    Lucchi, M G; Masellis, G; Colombarini, M P; Barbanti-Silva, C; Citti, V; Trianni, G

    1980-01-01

    Abortion became legal in Italy in May 1978. At the Obstetrical and Gynecological Clinic of the University of Modena, Italy, 2029 interventions were done between June 1978 and August 1979. During the same period of time there was a constant decrease in the number of deliveries and in the number of spontaneous abortions, in reality, illegally induced abortions. The abortion method used within the 1st 90 days of pregnancy was vacuum aspiration under local anesthesia. The largest group of abortion seekers was between 21-26 years of age, and about 46.3% came from the city of Modena itself. 55.9% of women were professionals, and 44.1% nonprofessionals; of these 71.8% were housewives, mostly married to factory workers. About 63% of women were married; 31.8% were nulliparous, 27.7% were primiparous, 40.5% were multiparous; 79.9% had never had an abortion before. 74.6% of certificates for abortion had been given by one of the public family health centers. 73.4% of patients were hospitalized for 1 day only; 22.9% for 2 days. There were 40 cases of complications, or 1.98%, mostly bleeding. There were only 17 cases of interruption of pregnancy after the 90th day, or 0.83% of the total; 10 cases were for eugenic reasons, and 7 because of the psychological health of the mother. Of all the other instances 35.9% of causes for abortion were of a socioeconomic order, 36.2% because of family reasons, 20.9% because of health reasons. Method of contraception used was coitus interruptus in 88.9% of patients, spermicidal agents in 2.7% of cases, and the condom for 1.9%.

  6. Proposed learning strategies of medical students in a clinical rotation in obstetrics and gynecology: a descriptive study

    Directory of Open Access Journals (Sweden)

    Deane RP

    2016-08-01

    Full Text Available Richard P Deane, Deirdre J Murphy Department of Obstetrics and Gynecology, Trinity College Dublin, University of Dublin, Coombe Women & Infants University Hospital, Dublin, Republic of Ireland Background: Medical students face many challenges when learning within clinical environments. How students plan to use their time and engage with learning opportunities is therefore critical, as it may be possible to highlight strategies that optimize the learning experience at an early stage in the rotation. The aim of the study was to describe the learning drivers and proposed learning strategies of medical students for a clinical rotation in obstetrics and gynecology. Methods: A descriptive study of personal learning plans completed by students at the start of their clinical rotation in obstetrics and gynecology was undertaken. Data relating to students’ learning strategies were obtained from the personal learning plans completed by students. Quantitative and qualitative analyses were used. Results: The desire to obtain a good examination result was the most significant reason why the rotation was important to students (n=67/71, 94%. Students struggled to create a specific and practical learning outcome relevant to their career interest. Target scores of students were significantly higher than their reported typical scores (P<0.01. Textbooks were rated as likely to be the most helpful learning resource during the rotation. Bedside tutorials were rated as likely to be the most useful learning activity and small group learning activities were rated as likely to be more useful than lectures. Most students intended to study the course material linked to their clinical program rather than the classroom-based tutorial program. Conclusion: The main learning driver for medical students was academic achievement, and the proposed learning strategy favored by medical students was linking their study plans to clinical activities. Medical educators should

  7. Pathologic examination of the placenta and its clinical utility: a survey of obstetrics and gynecology providers.

    Science.gov (United States)

    Odibo, Imelda; Gehlot, Ashita; Ounpraseuth, Songthip T; Magann, Everett F

    2016-01-01

    To determine provider awareness of the College of American Pathologists (CAP) recommended guidelines for examination of placenta and evaluate the Obstetrician -Gynecologist's perception of the clinical utility of placenta pathology reports. An anonymous survey of Obstetrician Gynecologists who attended the national conference of The Central Association of Obstetricians and Gynecologists (CAOG) in 2013 assessing their knowledge of the CAP guidelines and utilization of information obtained from pathology reports. Chi-square or Fisher's exact test were used to evaluate association between specialists and non-specialist providers as related to survey questions and multivariable logistic regression used to explore factors associated with utilization and awareness of the guidelines. A total of 218 providers attended the conference and 111 surveys were completed. Only 36% of participants were aware of the CAP guidelines for pathologic examination of the placenta. The odds that a physician with more than 15 years of experience will send a placenta for examination was 0.210 times that of physicians with less than 15 years of experience (CI 0.084, 0.521). The odds for awareness of the CAP guideline among subspecialists who participated in the study were 3.630 times the odds for non-specialist (CI 1.44, 9.147). In addition, the odds of sending a placenta for those physicians in a community hospital are 0.300 times that of physicians in a University hospital (CI 0.110, 0.820). The presence of a pathologist skilled in obstetrics and gynecology did not seem to affect awareness of the CAP guidelines, perception of the usefulness of the guidelines and likelihood of sending a placenta for examination. Only 21% of participants reported understanding the nomenclature used in pathology reports "all the time". Participants ranked the explanation of adverse pregnancy outcome as the most useful clinical application of placenta pathologic examination and most advocated for continued

  8. Psychosocial Characteristics and Obstetric Health of Women Attending a Specialist Substance Use Antenatal Clinic in a Large Metropolitan Hospital

    Directory of Open Access Journals (Sweden)

    Lucy Burns

    2011-01-01

    Full Text Available Objective. This paper reports the findings comparing the obstetrical health, antenatal care, and psychosocial characteristics of pregnant women with a known history of substance dependence (n=41 and a comparison group of pregnant women attending a general antenatal clinic (n=47. Method. Face-to-face interviews were used to assess obstetrical health, antenatal care, physical and mental functioning, substance use, and exposure to violence. Results. The substance-dependent group had more difficulty accessing antenatal care and reported more obstetrical health complications during pregnancy. Women in the substance-dependent group were more likely to report not wanting to become pregnant and were less likely to report using birth control at the time of conception. Conclusions. The profile of pregnant women (in specialised antenatal care for substance dependence is one of severe disadvantage and poor health. The challenge is to develop and resource innovative and effective multisectoral systems to educate women and provide effective care for both women and infants.

  9. Proposed learning strategies of medical students in a clinical rotation in obstetrics and gynecology: a descriptive study.

    Science.gov (United States)

    Deane, Richard P; Murphy, Deirdre J

    2016-01-01

    Medical students face many challenges when learning within clinical environments. How students plan to use their time and engage with learning opportunities is therefore critical, as it may be possible to highlight strategies that optimize the learning experience at an early stage in the rotation. The aim of the study was to describe the learning drivers and proposed learning strategies of medical students for a clinical rotation in obstetrics and gynecology. A descriptive study of personal learning plans completed by students at the start of their clinical rotation in obstetrics and gynecology was undertaken. Data relating to students' learning strategies were obtained from the personal learning plans completed by students. Quantitative and qualitative analyses were used. The desire to obtain a good examination result was the most significant reason why the rotation was important to students (n=67/71, 94%). Students struggled to create a specific and practical learning outcome relevant to their career interest. Target scores of students were significantly higher than their reported typical scores (Plectures. Most students intended to study the course material linked to their clinical program rather than the classroom-based tutorial program. The main learning driver for medical students was academic achievement, and the proposed learning strategy favored by medical students was linking their study plans to clinical activities. Medical educators should consider strategies that foster more intrinsic drivers of student learning and more student-oriented learning resources and activities.

  10. Experience of a comprehensive infertility clinic in the Department of Obstetrics and Gynaecology, University of Singapore.

    Science.gov (United States)

    Ratnam, S S; Chew, P C; Tsakok, M

    1976-09-01

    The diagnosis, treatment, and pregnancy outcome for 709 infertile couples who attended the comprehensive infertility clinic of the University of Singapore's Department of Obstetrics and Gynecology from 1970-1974 are presented. Investigations for most of the couples were completed within 3 months. This short investigative period was attributable primarly to the use of laparoscopy to diagnose female infertility. In 22.5% of the 709 cases infertility was due to ovulation problems. After treatment eith either clomiphene, human pituitory gonadotrophin, or a combination of clomiphene and human chorinic gonadotrophin, pregnancy was achieved in 30.6% of the cases. 11.7% or 83 of the 709 infertility cases were attributed to blocked tubes. 28 of these patients received tubal surgery, but only 14.3% or 4 of these cases resulted in pregnancy. In 14.7% of the 709 cases, infertility was attributed to endometriosis. 90% of the patients with endometriosis were asymptomatic, and the liesons discovered by laparoscopy, were very small. Pregnancy eventually occurred in 27.6% of the cases treated for endometriosis. In 5.8% of the 709 cases infertility was due to mixed gynecological problems, and after treatment, conception occurred among 31.7% of the cases. For 23.1%, or 147 of the 709 couples, infertility was attributed to either oligospermia or azoospermia. 85 of the 147 patients were given hormone therapy and in 12.9% of these cases pregnancy was achieved. 14 of the 147 patients were treated with antibotics for 3-6 months and in 14.3% of these cases pregnancy was achieved. 9 of the 147 patients were surgically treated and in 4 of these cases pregnancy later occurred. 20 of the 147 couples were treated with artifical insemination of donor semen and in 25.0% of these cases pregnancy occurred. Another 19 of the 147 cases were treated with artificial insemination with the husband's semen and conception occurred in 26.8% of these cases. The remaining 22.1% of the 709 couples were

  11. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of glomerulonephritis in adults.

    Science.gov (United States)

    Cybulsky, Andrey V; Walsh, Michael; Knoll, Greg; Hladunewich, Michelle; Bargman, Joanne; Reich, Heather; Humar, Atul; Samuel, Susan; Bitzan, Martin; Zappitelli, Michael; Dart, Allison; Mammen, Cherry; Pinsk, Maury; Muirhead, Norman

    2014-03-01

    The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for management of glomerulonephritis was recently released. The Canadian Society of Nephrology convened a working group to review the recommendations and comment on their relevancy and applicability to the Canadian context. A subgroup of adult nephrologists reviewed the guideline statements for management of glomerular disease in adults and agreed with most of the guideline statements developed by KDIGO. This commentary highlights areas for which there is lack of evidence and areas in need of translation of evidence into clinical practice. Areas of controversy or uncertainty, including the choice of second-line agents, are discussed in more detail. Existing practice variation also is addressed. The relevance of treatment recommendations to the Canadian practitioner is discussed.

  12. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children.

    Science.gov (United States)

    Samuel, Susan; Bitzan, Martin; Zappitelli, Michael; Dart, Allison; Mammen, Cherry; Pinsk, Maury; Cybulsky, Andrey V; Walsh, Michael; Knoll, Greg; Hladunewich, Michelle; Bargman, Joanne; Reich, Heather; Humar, Atul; Muirhead, Norman

    2014-03-01

    The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for management of glomerulonephritis was recently released. The Canadian Society of Nephrology convened a working group to review the recommendations and comment on their relevancy and applicability to the Canadian context. A subgroup of pediatric nephrologists reviewed the guideline statements for management of childhood nephrotic syndrome and agreed with most of the guideline statements developed by KDIGO. This commentary highlights areas in which there is lack of evidence and areas in need of translation of evidence into clinical practice. Areas of controversy or uncertainty, including the length of corticosteroid therapy for the initial presentation and relapses, definitions of steroid resistance, and choice of second-line agents, are discussed in more detail. Existing practice variation is also addressed.

  13. Obstetrical paralysis.

    Science.gov (United States)

    Chung, S M; Nissenbaum, M M

    1975-04-01

    Most patients with obstetrical paralysis have some useful functional return, and early recognition and treatment help prevent rapidly developing shoulder contractures. Initial physical therapy includes passive range of motion exercises. Fixed contractures must be released prior to reconstructive surgery designed to improve funtion. An approach to the diagnosis, evaluation, and treatment of obstetrical paralysis is given.

  14. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit

    Directory of Open Access Journals (Sweden)

    Sunanda Gupta

    2011-01-01

    Full Text Available A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II at admission for predicting maternal mortality was also assessed.During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries. There were 24 ICU admissions (ICU utilization ratio 0.14% with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05 with more patients presenting with obstetric complications (91.66%, n=22, P<0.01 as compared to medical complications (8.32% n=2. Obstetric haemorrhage (n=15, 62.5% and haemodynamic instability (n=20, 83.33% were considered to be significant risk factors for ICU admission (P=0.000. Inotropic support was required in 22 patients (91.66% while 17 patients (70.83% required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h and ICU stay (39.42±33.70 h were of significantly longer duration in survivors (P=0.01, P=0.00 respectively versus non-survivors. The observed mortality (n=10, 41.67% was significantly higher than MPM II predicted death rate (26.43%, P=0.002. We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

  15. Clinical outcome of shoulder muscle transfer for shoulder deformities in obstetric brachial plexus palsy: A study of 150 cases

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

    Full Text Available Background: Residual muscle weakness, cross-innervation (caused by misdirected regenerating axons, and muscular imbalance are the main causes of internal rotation contractures leading to limitation of shoulder joint movement, glenoid dysplasia, and deformity in obstetric brachial plexus palsy. Muscle transfers and release of antagonistic muscles improve range of motion as well as halt or reverse the deterioration in the bony architecture of the shoulder joint. The aim of our study was to evaluate the clinical outcome of shoulder muscle transfer for shoulder abnormalities in obstetric brachial plexus palsy. Materials and Methods: One hundred and fifty patients of obstetric brachial plexus palsy with shoulder deformity underwent shoulder muscle transfer along with anterior shoulder release at our institutions from 1999 to 2007. Shoulder function was assessed both preoperatively and postoperatively using aggregate modified Mallet score and active and passive range of motion. The mean duration of follow-up was 4 years (2.5-8 years. Results: The mean preoperative abduction was 45° ± 7.12, mean passive external rotation was 10° ± 6.79, the mean active external rotation was 0°, and the mean aggregate modified Mallet score was 11.2 ± 1.41. At a mean follow-up of 4 years (2.5-8 years, the mean active abduction was 120° ± 18.01, the mean passive external rotation was 80° ± 10.26, while the mean active external rotation was 45° ± 3.84. The mean aggregate modified Mallet score was 19.2 ± 1.66. Conclusions: This procedure can thus be seen as a very effective tool to treat internal rotation and adduction contractures, achieve functional active abduction and external rotation, as well as possibly prevent glenohumeral dysplasia, though the long-term effects of this procedure may still have to be studied in detail clinico-radiologically to confirm this hypothesis. Level of evidence: Therapeutic level IV

  16. Clinical profile and obstetric outcome in pregnancies complicated by heart disease: a five year Indian rural experience

    Directory of Open Access Journals (Sweden)

    Nilajkumar D. Bagde

    2013-02-01

    Full Text Available Background: Cardiac diseases are a major cause of morbidity and mortality in pregnant women in the developing world. This study illustrates the problem in rural India focusing on patterns of diseases, clinical features, and pregnancy outcome in these women. Methods: A retrospective analysis of five year data, from 2006 to 2010 for all patients admitted with cardiac disease in pregnancy. Results: Past history of heart disease was present in 70%. Rheumatic heart disease was predominant type in 83% and the chief complaint at admission was breathlessness in 44%. Mitral stenosis was the commonest lesion in 55% and mitral regurgitation with or without stenosis in 48%. Preeclampsia was seen in 20% and preterm labor in 10%. Spontaneous vaginal delivery was seen in 41% and cesarean in 20.6%. Conclusions: Heart disease in pregnancy is a high risk condition has a major impact on pregnancy. Associated obstetric complications along with lack of knowledge and ignorance regarding the pathology lead to unpleasant obstetric outcomes. [Int J Reprod Contracept Obstet Gynecol 2013; 2(1.000: 52-57

  17. Obstetrical disseminated intravascular coagulation score.

    Science.gov (United States)

    Kobayashi, Takao

    2014-06-01

    Obstetrical disseminated intravascular coagulation (DIC) is usually a very acute, serious complication of pregnancy. The obstetrical DIC score helps with making a prompt diagnosis and starting treatment early. This DIC score, in which higher scores are given for clinical parameters rather than for laboratory parameters, has three components: (i) the underlying diseases; (ii) the clinical symptoms; and (iii) the laboratory findings (coagulation tests). It is justifiably appropriate to initiate therapy for DIC when the obstetrical DIC score reaches 8 points or more before obtaining the results of coagulation tests. Improvement of blood coagulation tests and clinical symptoms are essential to the efficacy evaluation for treatment after a diagnosis of obstetrical DIC. Therefore, the efficacy evaluation criteria for obstetrical DIC are also defined to enable follow-up of the clinical efficacy of DIC therapy.

  18. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit.

    Science.gov (United States)

    Gupta, Sunanda; Naithani, Udita; Doshi, Vimla; Bhargava, Vaibhav; Vijay, Bhavani S

    2011-03-01

    A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, Pobstetric complications (91.66%, n=22, PObstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

  19. [Obstetric emergency and non-emergency transfers to the university teaching hospital Yalgado ouedraogo of Ouagadougou: A 3-year study of their epidemiologic, clinical, and prognostic aspects].

    Science.gov (United States)

    Ouattara, A; Ouedraogo, C M; Ouedraogo, A; Lankoande, J

    2015-01-01

    to describe the epidemiologic, clinical, and prognostic aspects of the emergency and non-emergency transfers of obstetric patients to Yalgado Ouédraogo University Hospital Center (UHC-YO) in Ouagadougou. this retrospective descriptive study looked at the outcomes of women transferred, on an emergency basis or not, to the obstetrics department of the UHC-YO. The study population comprised all women transferred to the department during 2010, 2011, and 2012. during the study period, there were 9,806 admissions for obstetric disorders: 43% were transfers. The patients' mean age was 26.11 years [(13-49]. Women transferred from health care facilities within the city of Ouagadougou accounted for 96% of the sample. The leading reason for these transfers - emergency or not - was preeclampsia and eclampsia (24.57%). We recorded a total of 161 maternal deaths, for a mortality rate of 3.9%. Approximately 26.55% of the newborns received immediate intensive care and were then transferred to the neonatology department. maternal and neonatal prognosis is always poor in cases transferred to UHC-YO, despite increased funding for emergency obstetric and neonatal care. Increased population awareness of the importance of prenatal consultation and adequate funding for health care facilities to provide equipment for emergency transfers and staff training in the management of obstetric and neonatal emergencies would probably improve these mortality and morbidity rates.

  20. Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

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    Sparić Radmila

    2007-01-01

    Full Text Available Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections and 91 postpartum hysterectomies (70 or 76.92% after cesarean section in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections and 64 hysterectomies (39 or 60.94 % after cesarean section. The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .

  1. Commentary: a practical guide for translating basic research on affective science to implementing physiology in clinical child and adolescent assessments.

    Science.gov (United States)

    Aldao, Amelia; De Los Reyes, Andres

    2015-01-01

    The National Institute of Mental Health recently launched the Research Domain Criteria (RDoC). RDoC is a framework that facilitates the dimensional assessment and classification of processes relevant to mental health (e.g., affect, regulation, cognition, social affiliation), as reflected in measurements across multiple units of analysis (e.g., physiology, circuitry, genes, self-reports). A key focus of RDoC involves opening new lines of research examining patients' responses on biological measures, with the key goal of developing new therapeutic techniques that effectively target mechanisms of mental disorders. Yet applied researchers and practitioners rarely use biological measures within mental health assessments, which may present challenges in translating RDoC-guided research into improvements in patient care. Thus, if RDoC is to result in research that yields clinical tools that reduce the burden of mental illness and improve public health, we ought to develop strategies for effectively implementing biological measures in the context of clinical assessments. In this special issue, we sought to provide an initial step in this direction by assembling a collection of articles from leading research teams carrying out pioneering work on implementing multimodal assessments (biological, subjective, behavioral) of affective processes in applied settings. In this commentary, we expand upon the work presented in this special issue by making a series of suggestions for how to most parsimoniously conduct multimodal assessments of affective processes in applied research and clinical settings. We hope that this approach will facilitate translations of the RDoC framework into applied research and clinic settings.

  2. Ultrasonogram in obstetric field

    Energy Technology Data Exchange (ETDEWEB)

    Joo, K. B.; Song, C. H.; Lee, H. B. [Eul-Ji General Hospital, Seoul (Korea, Republic of)

    1980-06-15

    The clinical evaluation of 535 cases of sonogram from Mar. 1, 1979 to Oct. 30, 1979 in obstetric field at Department of Radiology and Ob. and Gy. Eul-Ji General Hospital. We present these cases: normal pregnancy, missed abortion, twin pregnancy, hydatidiform mole and ectopic pregnancy, with brief review of literature.

  3. Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital

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    Hadiza A Agbo

    2016-01-01

    Full Text Available Background: Hypertensive disease in pregnancy (HDP accounts for high mother and child morbi-mortality and predict future cardiometabolic diseases. This study aimed to identify obstetric predictors of HDP needing preventive action to reduce its consequences; when women present to antenatal clinic (ANC. Materials and Methods: Cross-sectional descriptive this was an Interviewer-administered semi-structured questionnaire-based study of the anthropometric, and blood pressure measurementsin attendees at the postnatal clinic (PNC of Jos University with ANC records. Setting: Six weeks postnatal clinic (PNC of Jos University Teaching Hospital (JUTH. Results: The following indices proved predictive of HDP and subsequent hypertension: weight (P = 0.009, hip circumference (P = 0.018, parity (P = 0.043, waist circumference (P = 0.00, abdominal height (P = 0.040, waist/height (P = 0.020, history of developing hypertension in previous pregnancy (P = 0.000, birth weight of baby (P = 0.02, and mode of delivery (P = 0.05. Conclusion: To initiate preventive action on ANC registration in mitigating effects of or outrightly preventing HDP, careful check on anthropometry as well as history of hypertension or operative/preterm delivery in a previous pregnancy is necessary

  4. A harmonized and efficient clinical research environment would benefit patients and enhance European competitiveness. Commentary.

    Science.gov (United States)

    Amato, Antonino; Aringhieri, Eugenio; Boccia, Stefania; Buccella, Filippo; Gorini, Barbara; Gramaglia, Donatella; Masetti, Riccardo; Rossi, Paolo; Pelicci, Pier Giuseppe

    2017-01-01

    The forthcoming implementation of the European Clinical Trial Regulation (Regulation (EU) No. 536/2014), which is expected to facilitate the conduct of clinical trials across the European Union, will require National Authorities to create the best conditions for the implementation of the new Regulation through national guidelines, so that sponsors may reconsider Europe as a prime location for planning clinical trials. During a meeting titled "Innovation in Clinical Research", an expert panel discussed potential local advances fostering competitiveness of European clinical research with representatives of the pharmaceutical industry, patient organisations and Italian regulatory agency in view of the forthcoming implementation of (EU) No. 536/2014 on clinical trials of medicinal products. In this article we summarise the findings of the meeting, describe features characterising clinical research patterns and offer some suggestions on the possible involvement of all stakeholders in order to foster research innovation and allow the timely access to novel medicines for patients.

  5. Test of Integrated Professional Skills: Objective Structured Clinical Examination/Simulation Hybrid Assessment of Obstetrics-Gynecology Residents' Skill Integration

    Science.gov (United States)

    Winkel, Abigail Ford; Gillespie, Colleen; Hiruma, Marissa T.; Goepfert, Alice R.; Zabar, Sondra; Szyld, Demian

    2014-01-01

    Background Assessment of obstetrics-gynecology residents' ability to integrate clinical judgment, interpersonal skills, and technical ability in a uniform fashion is required to document achievement of benchmarks of competency. An observed structured clinical examination that incorporates simulation and bench models uses direct observation of performance to generate formative feedback and standardized evaluation. Methods The Test of Integrated Professional Skills (TIPS) is a 5-station performance-based assessment that uses standardized patients and complex scenarios involving ultrasonography, procedural skills, and evidence-based medicine. Standardized patients and faculty rated residents by using behaviorally anchored checklists. Mean scores reflecting performance in TIPS were compared across competency domains and by developmental level (using analysis of variance) and then compared to standard faculty clinical evaluations (using Spearman ρ). Participating faculty and residents were also asked to evaluate the usefulness of the TIPS. Results Twenty-four residents participated in the TIPS. Checklist items used to assess competency were sufficiently reliable, with Cronbach α estimates from 0.69 to 0.82. Performance improved with level of training, with wide variation in performance. Standard faculty evaluations did not correlate with TIPS performance. Several residents who were rated as average or above average by faculty performed poorly on the TIPS (> 1 SD below the mean). Both faculty and residents found the TIPS format useful, providing meaningful evaluation and opportunity for feedback. Conclusions A simulation-based observed structured clinical examination facilitates observation of a range of skills, including competencies that are difficult to observe and measure in a standardized way. Debriefing with faculty provides an important interface for identification of performance gaps and individualization of learning plans. PMID:24701321

  6. Clinical Analysis of 31 Cases with Obstetric Disseminated Intravascular Coagulation%产科急性DIC 31例临床分析

    Institute of Scientific and Technical Information of China (English)

    阮焱; 张为远

    2009-01-01

    Objective Discuss the etiology and treatment of obstetric disseminated intravascular coagulation.Methods The clinic materials of 31 patients with obstetric disseminated intravaacular coagulation were analyzed retrospectively.Results 29 patients with obstetric disseminated intravascular coagulation were cured and leaved hospital.2case was dead.13 cases were hysterectomy.Conclusion Prevention and treatment of primary diseases should be focused on such as postpartum hemorrhage and severe pre-eclampsia,the critical treatment of obstetric DIC consists of early diagnosis of DIC,elimination of the cause promptly,anti-shock,supplement coagulation factors in time and the application of hysterectomy decidedly.%目的 探讨产科弥漫性血管内疑血(DIC)的病因及治疗.方法 对31例产科DIC患者的临床资料进行回顾性分析.结果 31例产科DIC患者中有29例抢救成功,痊愈出院,2例死亡.13例行子宫切除.结论 重视产后出血、重度子痫前期等原发病的防治,早期诊断,及时去除病因,抗休克,补充血容量、及时补充凝血因子、果断行子宫切除术是产科DIC治疗的关键.

  7. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury.

    Science.gov (United States)

    Palevsky, Paul M; Liu, Kathleen D; Brophy, Patrick D; Chawla, Lakhmir S; Parikh, Chirag R; Thakar, Charuhas V; Tolwani, Ashita J; Waikar, Sushrut S; Weisbord, Steven D

    2013-05-01

    In response to the recently released 2012 KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for acute kidney injury (AKI), the National Kidney Foundation organized a group of US experts in adult and pediatric AKI and critical care nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The first portion of the KDIGO guideline attempts to harmonize earlier consensus definitions and staging criteria for AKI. While the expert panel thought that the KDIGO definition and staging criteria are appropriate for defining the epidemiology of AKI and in the design of clinical trials, the panel concluded that there is insufficient evidence to support their widespread application to clinical care in the United States. The panel generally concurred with the remainder of the KDIGO guidelines that are focused on the prevention and pharmacologic and dialytic management of AKI, although noting the dearth of clinical trial evidence to provide strong evidence-based recommendations and the continued absence of effective therapies beyond hemodynamic optimization and avoidance of nephrotoxins for the prevention and treatment of AKI. Published by Elsevier Inc.

  8. Commentary: Compliance education and training: a need for new responses in clinical research.

    Science.gov (United States)

    Steinberg, Mindy J; Rubin, Elaine R

    2010-03-01

    Increasing regulatory mandates, heightened concerns about compliance, accountability, and liability, as well as a movement toward organizational integration are prompting assessment and transformation in education and training programs at academic health centers, particularly with regard to clinical research compliance. Whereas education and training have become a major link between all research and compliance functions, the infrastructure to support and sustain these activities has not been examined in any systematic, comprehensive fashion, leaving many critical interrelated issues unaddressed. Through a series of informal interviews in late 2008 with chief compliance officers and other senior leadership at 10 academic health centers, the authors studied the organization, management, and administration of clinical research compliance education and training programs. The interviews revealed that while clinical research compliance education and training are undergoing growth and expansion to accommodate a rapidly changing regulatory environment and research paradigm, there are no strategies or models for development. The decentralization of education and training is having serious consequences for leadership, resources, and effectiveness. The authors recommend that leaders of academic health centers conduct a comprehensive analysis of clinical research compliance education and training as clinical trials administration undergoes change, focusing on strategic planning, communication, collaboration across the institution, and program evaluation.

  9. Maximizing clinical revenues of psychiatric consultation-liaison services. An economic commentary.

    Science.gov (United States)

    Koran, L M; Foley, T

    1994-01-01

    Clinical revenues rarely suffice to support an academic psychiatric consultation-liaison (C-L) service. Nonetheless, the revenue provides a major source of financial support. The authors describe ten steps that can help maximize the financial return from the C-L service's clinical efforts. The steps range from establishing a reasonable fee schedule and creating an efficient charge document, through educating residents and faculty physicians about documentation requirements, to billing quickly and insisting on meaningful monthly reports from the faculty practice plan. A number of "magic phrases" (proper and key wording for reimbursement) are described in detail that can markedly reduce documentation requirements.

  10. Aplicações das dosagens de inibinas em Ginecologia e Obstetrícia Clinical usefulness of inhibin assays in Gynecology and Obstetrics

    Directory of Open Access Journals (Sweden)

    Fernando Marcos dos Reis

    2009-12-01

    Full Text Available Na mulher, a principal fonte de inibina B são as células da granulosa de folículos em crescimento, enquanto a inibina A é secretada principalmente pelo corpo lúteo e pela placenta. Em mulheres inférteis submetidas a terapias de reprodução assistida, a inibina B se mostrou útil para predizer má resposta ovulatória, embora não tenha superado o desempenho de outros marcadores. No rastreamento pré-natal da síndrome de Down, a utilidade da inibina A foi repetidamente confirmada no segundo trimestre e começa a ser considerada também na bateria de testes do primeiro trimestre. Além das duas aplicações acima, a dosagem de inibina total pode contribuir para a identificação de casos de insuficiência ovariana autoimune. A inibina total também pode ser um marcador auxiliar no diagnóstico de tumores epiteliais do ovário, enquanto a dosagem de inibina B auxilia no diagnóstico de tumores de células da granulosa. O uso da inibina A pode se estender à avaliação de gestantes com ameaça de abortamento, com história de abortamento de repetição, com risco aumentado de pré-eclâmpsia, ou ainda nos primeiros dias de seguimento pós-esvaziamento de mola hidatiforme. Todas essas aplicações continuam em estudo, mas com possibilidade real de virem a ampliar o espectro diagnóstico das dosagens de inibinas em Ginecologia e Obstetrícia.The main source of inhibin B in women is the growing follicle granulosa cells, while inhibin A is mainly produced by the corpus luteum and the placenta. In infertile women submitted to therapies of assisted reproduction, inhibin B has shown to be useful to predict a poor ovulatory response, though it has not yet overcome the performance of other markers. In the pre-natal screening of the Down syndrome, inhibin A has been repeatedly confirmed as useful in the second trimester and has also started to be considered in the first trimester test battery. Besides the two applications above, the dosage of total

  11. Definitions of Obstetric and Gynecologic Hospitalists.

    Science.gov (United States)

    McCue, Brigid; Fagnant, Robert; Townsend, Arthur; Morgan, Meredith; Gandhi-List, Shefali; Colegrove, Tanner; Stosur, Harriet; Olson, Rob; Meyer, Karenmarie; Lin, Andrew; Tessmer-Tuck, Jennifer

    2016-02-01

    The obstetric hospitalist and the obstetric and gynecologic hospitalist evolved in response to diverse forces in medicine, including the need for leadership on labor and delivery units, an increasing emphasis on quality and safety in obstetrics and gynecology, the changing demographics of the obstetric and gynecologic workforce, and rising liability costs. Current (although limited) research suggests that obstetric and obstetric and gynecologic hospitalists may improve the quality and safety of obstetric care, including lower cesarean delivery rates and higher vaginal birth after cesarean delivery rates as well as lower liability costs and fewer liability events. This research is currently hampered by the use of varied terminology. The leadership of the Society of Obstetric and Gynecologic Hospitalists proposes standardized definitions of an obstetric hospitalist, an obstetric and gynecologic hospitalist, and obstetric and gynecologic hospital medicine practices to standardize communication and facilitate program implementation and research. Clinical investigations regarding obstetric and gynecologic practices (including hospitalist practices) should define inpatient coverage arrangements using these standardized definitions to allow for fair conclusions and comparisons between practices.

  12. Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

    Institute of Scientific and Technical Information of China (English)

    Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

    2016-01-01

    Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre.Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond’s medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator.Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays(76.9%) and the remaining were Chinese(15.1%), Indians(2.2%)and other ethnic groups(5.8%). One hundred and thirty eight(99.3%) of the women were married and 98.6% had less than 6 children. More than half(75.5%) of the women’s last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge.Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

  13. Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

    Institute of Scientific and Technical Information of China (English)

    Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

    2016-01-01

    Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre. Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator. Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays (76.9%) and the remaining were Chinese (15.1%), Indians (2.2%) and other ethnic groups (5.8%). One hundred and thirty eight (99.3%) of the women were married and 98.6%had less than 6 children. More than half (75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge. Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

  14. [Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research and commentary].

    Science.gov (United States)

    Shichinohe, Toshiaki; Kondo, Satoshi; Ide, Chizuka; Higuchi, Norio; Aiso, Sadakazu; Sakai, Tatsuo; Matsumura, George; Yoshida, Kazunari; Kobayashi, Eiji; Tatsumi, Haruyuki; Yaginuma, Hiroyuki; Hishikawa, Shuji; Sugimoto, Maki; Izawa, Yoshimitsu; Imanishi, Nobuaki

    2011-07-01

    This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.

  15. [Draft of guidelines for human body dissection for clinical anatomy education and research and commentary].

    Science.gov (United States)

    Shichinohe, Toshiaki; Kondo, Satoshi; Ide, Chizuka; Higuchi, Norio; Aiso, Sadakazu; Sakai, Tatsuo; Matsumura, George; Yoshida, Kazunari; Kobayashi, Eiji; Tatsumi, Haruyuki; Yaginuma, Hiroyuki; Hishikawa, Shuji; Sugimoto, Maki; Izawa, Yoshimitsu; Imanishi, Nobuaki

    2011-06-01

    This article analyses the Draft of Guidelines for Human Body Dissection for Clinical Anatomy Education and Research drawn by the Study Group for Future Training Systems of Surgical Skills and Procedures established by the Fiscal Year 2010 research program of the Ministry of Health, Labor and Welfare. The purpose of the Draft of Guidelines is: First, to lay out the required basic guidelines for human cadaver usage to allow medical and dental faculty to conduct clinical education and research in accordance with existing regulations. Second, the guidelines are expected to give physicians a regulatory framework to carry out cadaver training in accordance with the current legal framework. This article explains the Draft of Guidelines in detail, outlines the future of cadaver training, and describes issues which must still be solved.

  16. A commentary on randomized clinical trials: How to produce them with a good level of evidence

    Directory of Open Access Journals (Sweden)

    Olga Dumont Flecha

    2016-01-01

    Full Text Available Randomized clinical trial (RCT is the gold standard study for the evaluation of health interventions and is considered the second level of evidence for clinical decision making. However, the quality of the evidence produced by these studies is dependent on the methodological rigor employed at every stage of their execution. The purpose of randomization is to create groups that are comparable independent of any known or unknown potential confounding factor. A critical evaluation of the literature reveals that, for many years, RCTs have been developed based on inaccurate methodological criteria, and empirical evidence began to accumulate. Thus, guidelines were developed to assist authors, reviewers, and editors in the task of developing and assessing the methodological consistency of this type of study. The objective of this article is to review key aspects to design a good-quality RCT, supporting the scientific community in the production of reliable evidence and favoring clinical decision making to allow the patient to receive the best health care.

  17. Identification and description of controlled clinical trials published in Spanish Gynaecology and Obstetrics journals and risk of bias assessment of trials on assisted reproductive techniques.

    Science.gov (United States)

    Gutarra-Vilchez, Rosa B; Pardo-Hernandez, Hector; Arévalo-Rodríguez, Ingrid; Buitrago, Diana; Bonfill, Xavier

    2016-08-01

    To identify and describe controlled clinical trials (CCTs) published in Spanish Gynaecology and Obstetrics journals. In addition, to assess the quality of the CCTs on Assisted Reproduction Techniques (ART) identified in this project. In order to identify eligible CCTs, all Spanish Gynaecology and Obstetrics journals were handsearched. Handsearching was conducted following the guidelines provided by the Cochrane Collaboration, which state that each journal article must be carefully reviewed, including original articles and other types of studies, letters to the editor, abstracts, and conference presentations. The results of the handsearching process were compared with an electronic search conducted in MEDLINE (PubMed). A descriptive analysis of the main characteristics of the identified CCTs was performed, as well as a methodological assessment of CCTs on ART. Sixteen Gynaecology and Obstetrics journals were identified, four of which have been indexed in MEDLINE at some point, although not currently. The journal with the most CCTs was "Progresos de Obstetricia y Ginecología". A total of 235 CCTs were published in these journals, of which 29 were on ART. Most CCTs (216, 91.9%) were carried out in a hospital setting; 201 (89.4%) were unicentric. Obstetrics was the most studied subspecialty (46.4%). Among CCTs on ART, the risk of bias was predominantly high. The number of CCTs published in Spanish Gynaecology and Obstetrics journals is limited. CCTs on ART present deficiencies in the report of results and low methodological quality. It is advised that authors and journals adhere to the CONSORT statement and to the Cochrane Collaboration recommendations to reduce risk of bias when designing and disseminating research projects. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Invited Commentary: Biological and Clinical Insights From Epidemiologic Research Into HIV, HPV, and Anal Cancer

    Science.gov (United States)

    Engels, Eric A.; Madeleine, Margaret M.

    2013-01-01

    Anal cancer is common among people infected with human immunodeficiency virus (HIV). This cancer is caused by human papillomavirus, and immunosuppression likely contributes to its development. In this issue of the Journal, Bertisch et al. (Am J Epidemiol. 2013;178(6):877–884) present the results of a case-control study of anal cancer among HIV-infected people in Switzerland. They demonstrate that anal cancer risk is increased in association with a low CD4+ cell count (a clinical measurement of immune status). In particular, HIV-induced immunosuppression was most severe among cases approximately 6–7 years prior to the diagnosis of anal cancer. A plausible biological interpretation is that immunosuppression is important at an early stage of the development of anal cancer, but that the neoplastic process becomes irreversible over time with persistent human papillomavirus infection and genetic damage. With current efforts to provide earlier combination antiretroviral therapy to HIV-infected people, anal cancer incidence may start to decline. Bertisch et al. also demonstrate a strong association between serum antibodies against the human papillomavirus type 16 protein E6 and anal cancer risk, highlighting the role of this viral oncoprotein in carcinogenesis. Additional biomarkers could help refine clinical approaches to anal cancer screening and prevention for the HIV-infected population. PMID:23900552

  19. [Fundamental and clinical studies of imipenem/cilastatin sodium in the field of obstetrics and gynecology].

    Science.gov (United States)

    Nakanishi, A; Hino, K; Shimamoto, I; Ichijo, M

    1986-05-01

    Imipenem (MK-0787), a new carbapenem antibiotic, combined with cilastatin sodium (MK-0791), was studied clinically and microbiologically. The following results were obtained: Concentrations of MK-0787 in the plasma and internal genital tissues were measured at 1 hour after an intravenous drip infusion of MK-0787/MK-0791 (500 mg/500 mg) for 30 minutes. Mean plasma levels higher than 11.8 micrograms/ml and mean tissue levels higher than 2.3 micrograms/g were observed. When its MIC values are considered, MK-0787/MK-0791 appeared to be bactericidal against many Gram-positive and Gram-negative bacteria except some Pseudomonas sp. and Enterococcus faecium. Clinical effects of the therapy with MK-0787/MK-0791 (500 mg/500 mg) using a drip infusion twice daily were evaluated in 3 patients with pyometra and 3 patients with Bartholin's gland abscess. Clinical responses were good in 5 of the 6 patients. One patient with pyometra due to E. coli didn't respond to the therapy. No side effects or abnormal laboratory findings due to the drug were noted.

  20. Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

    Directory of Open Access Journals (Sweden)

    Håkan Alfredson

    2015-10-01

    Full Text Available ABSTRACTThe chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.

  1. Teamwork in obstetric critical care

    OpenAIRE

    Guise, Jeanne-Marie; Segel, Sally

    2008-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  2. Pertussis as health care workers infectious disease – The clinical case with a commentary

    Directory of Open Access Journals (Sweden)

    Ernest Kuchar

    2013-10-01

    Full Text Available We discuss the changing epidemiological situation of pertussis observed in recent years, with a focus on the shift of cases from young children to older age groups, teenagers and adults. Whooping cough may affect healthcare workers who belong to a high-risk group and cause hospital infections. We present a case report of pertussis in a nurse and the recommended prophylactic measures in healthcare workers. The current definition and diagnosis of pertussis is also discussed. The clinical course of pertussis can be significantly alleviated and highly non-specific, with no typical coughing and vomiting in people vaccinated against whooping cough a few years earlier. Pertussis should be considered in the differential diagnosis of cough lasting more than fourteen days. Improvement of the epidemiological situation requires, besides immunization of infants, regular and universal booster immunization for adolescents and adults. Vaccinations for health care workers of neonatal and pediatric wards are recommended in the National Program of Immunization for 2013. It seems that booster vaccination of health care workers with a triple vaccine against diphtheria, tetanus and acellular pertussis (dTpa of the reduced quantity of antigens, particularly of health workers caring for infants, children and the elderly, may be the most effective way to reduce the risk of pertussis transmission in the health care environment. Med Pr 2013;64(5:731–739

  3. Invited commentary: Personality phenotype and mortality--new avenues in genetic, social, and clinical epidemiology.

    Science.gov (United States)

    Chapman, Benjamin P

    2013-09-01

    In this issue of the Journal, Jokela et al. (Am J Epidemiol. 2013;178(5):667-675) scrutinize the association between personality phenotype and all-cause mortality in remarkable detail by using an "individual-participant meta-analysis" design. Across 7 large cohorts varying in demographics and methods of personality measurement, they find varying prospective associations for 4 dimensions of the five-factor (or "Big Five") model of personality, but robust and consistent prospective associations for Big Five dimension of "conscientiousness." Jokela et al. place an important exclamation point on a long era of study of this topic and hint directly and indirectly at new avenues for this line of research. I consider the following 3 areas particularly rife for further inquiry: the role of genetics in personality and health studies; the role of personality in social inequalities in health; and the health policy and clinical implications of work like that of Jokela et al., including the potential role of personality phenotype in the evolution of personalized medicine.

  4. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management.

    Science.gov (United States)

    Akbari, Ayub; Clase, Catherine M; Acott, Phil; Battistella, Marisa; Bello, Aminu; Feltmate, Patrick; Grill, Allan; Karsanji, Meena; Komenda, Paul; Madore, Francois; Manns, Braden J; Mahdavi, Sara; Mustafa, Reem A; Smyth, Andrew; Welcher, E Sohani

    2015-02-01

    We congratulate the KDIGO (Kidney Disease: Improving Global Outcomes) work group on their comprehensive work in a broad subject area and agreed with many of the recommendations in their clinical practice guideline on the evaluation and management of chronic kidney disease. We concur with the KDIGO definitions and classification of kidney disease and welcome the addition of albuminuria categories at all levels of glomerular filtration rate (GFR), the terminology of G categories rather than stages to describe level of GFR, the division of former stage 3 into new G categories 3a and 3b, and the addition of the underlying diagnosis. We agree with the use of the heat map to illustrate the relative contributions of low GFR and albuminuria to cardiovascular and renal risk, though we thought that the highest risk category was too broad, including as it does people at disparate levels of risk. We add an albuminuria category A4 for nephrotic-range proteinuria and D and T categories for patients on dialysis or with a functioning renal transplant. We recommend target blood pressure of 140/90mm Hg regardless of diabetes or proteinuria, and against the combination of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors. We recommend against routine protein restriction. We concur on individualization of hemoglobin A1c targets. We do not agree with routine restriction of sodium intake to 3.3g/d). We suggest screening for anemia only when GFR is 60mg/mmol or proteinuria with protein excretion > 1g/d as the referral threshold for proteinuria.

  5. Clinical Analysis of Nosocomial Infection in 1496 Cases from Obstetrical Department%1496例产妇医院感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    岳灵英; 王玲玲

    2013-01-01

      Objective To explore the clinical features of nosocomial infection of inpatients in obstetrical department, the causes and prevention of infection. Methods The clinical data of 1496 cases from obstetrical department were reviewed. Results The prevalence rate of nosocomial infection in obstetrical department was 2.21%. the prevalence rate of obstetric infection was the highest, followed by urinary infection. The prevalence rate of nosocomial infection in parturition using vacuum extraction was at a high level;and the prevalence rate of nosocomial infection in parturition by spontaneous delivery was low. Conclusion Choosing the right mode of delivery, using vaginal delivery as far as possible, mastering aseptic technique strictly, and reasonable application of antibiotics is the key of preventing nosocomial infection in dobstetrical department.%  目的探讨产科医院感染的临床特点,感染原因及其防治。方法对产科1496例出院病历进行回顾性分析。结果产科的医院感染发生率为2.21%,产科感染居首位,其次为泌尿道感染。胎头吸引术分娩医院感染发生率高;阴道顺产的医院感染发生率最低。结论选择正确的分娩方式,尽可能阴道顺产,严格掌握无菌操作技术,合理应用抗生素是预防产科医院感染的关键。

  6. Prevalence of Trichomonas vaginalis in Women Visiting 2 Obstetrics and Gynecology Clinics in Daegu, South Korea.

    Science.gov (United States)

    Goo, Youn-Kyoung; Shin, Won-Sik; Yang, Hye-Won; Joo, So-Young; Song, Su-Min; Ryu, Jae-Sook; Lee, Won-Myung; Kong, Hyun-Hee; Lee, Won-Ki; Lee, Sang-Eun; Lee, Won-Ja; Chung, Dong-Il; Hong, Yeonchul

    2016-02-01

    This study explored epidemiological trends in trichomoniasis in Daegu, South Korea. Wet mount microscopy, PCR, and multiplex PCR were used to test for Trichomonas vaginalis in vaginal swab samples obtained from 621 women visiting 2 clinics in Daegu. Of the 621 women tested, microscopy detected T. vaginalis in 4 (0.6%) patients, PCR detected T. vaginalis in 19 (3.0%) patients, and multiplex PCR detected T. vaginalis in 12 (1.9%) patients. Testing via PCR demonstrated high sensitivity and high negative predictive value for T. vaginalis. Among the 19 women who tested positive for T. vaginalis according to PCR, 94.7% (18/19) reported vaginal signs and symptoms. Notably, more than 50% of T. vaginalis infections occurred in females younger than 30 years old, and 58% were unmarried. Multiplex PCR, which simultaneously detects pathogens from various sexually transmitted infections, revealed that 91.7% (11/12) of patients were infected with 2 or more pathogens. Mycoplasma hominis was the most prevalent co-infection pathogen with T. vaginalis, followed by Ureaplasma urealyticum and Chlamydia trachomatis. Our results indicate that PCR and multiplex PCR are the most sensitive tools for T. vaginalis diagnosis, rather than microscopy which has been routinely used to detect T. vaginalis infections in South Korea. Therefore, clinicians should take note of the high prevalence of T. vaginalis infections among adolescent and young women in order to prevent persistent infection and transmission of this disease.

  7. THE "VANISHING TWIN" SYNDROME - A MYTH OR CLINICAL REALITY IN THE OBSTETRIC PRACTICE?

    Directory of Open Access Journals (Sweden)

    Emil Kovachev

    2015-09-01

    Full Text Available Background: A case of triplets pregnancy after IVF ET, ended with a spontaneous reduction of one of the fetuses. The patient was with secondary infertility, with two unsuccessful preceding IVF Procedures and reduced ovarian reserve. A short flare up protocol with recombinant FSH was performed and three embryos were transferred on day three. An intrauterine pregnancy and three gestational sacs with CA (cardiac activity were visualized via transvaginal ultrasonography by the twenty-first day. After the patient refused to go through an embrioreduction, during a routine sonography by the fourteenth week, the death of one fetus was reported. The pregnancy was finalized with the Cesarean delivery of two newborn in good health by thirty- seventh week. During the regular examination of the placentas, a mummified fetus -fetus papyraceus was found Objective: To report a case of "Vanishing Twin" syndrome. Design: Case report. Methods: Clinical presentation, examination and ultrasound were consistent with diagnosis “Vanishing Twin” syndrome. Conclusion: The frequency of multi fetal births considerably increased after ART.

  8. Obstetric medicine

    Directory of Open Access Journals (Sweden)

    L. Balbi

    2013-05-01

    Full Text Available BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004. DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

  9. [Sheehan's syndrome after obstetric hemorrhage].

    Science.gov (United States)

    Ramos-López, L; Pons-Canosa, V; Juncal-Díaz, J L; Núñez-Centeno, M B

    2014-12-01

    Sheehan's syndrome is described as panhypopituitarism secondary to a pituitary hypoperfusion during or just after obstetric hemorrhage. Advances in obstetric care make this syndrome quite unusual, but some cases are reported in underdeveloped countries. Clinical presentation may change depending on the severity of the hormone deficiencies. The diagnosis is clinical, but abnormalities are observed in the magnetic resonance in up to 70% of patients. We present a case of a woman with hypotension, hypothermia and edemas in relation to a previous massive postpartum hemorrhage. Failure in lactation was the clue to the diagnosis. A review of its main features, its diagnosis and treatment in the current literature is also presented.

  10. Obstetric controversies in thyroidology

    Directory of Open Access Journals (Sweden)

    Ambika Gopalakrishnan Unnikrishnan

    2013-01-01

    Full Text Available It is well known that thyroid disorders commonly affect women. The care of pregnant women affected by thyroid disease is an important clinical challenge for endocrinologists. Hypothyroidism is the commonest problem, and maternal hypothyroxinemia has been linked to adverse feto-maternal outcomes. This article would discuss the controversy regarding first-trimester thyroid hormone deficiency and fetal brain development. Certain obstetric controversies in the management of hyperthyroidism in pregnancy, including the indications of TSH receptor antibody measurements and fetal thyroid status monitoring would also be discussed.

  11. Clinical Observation of 16 Cases of Obstetric Diffuse Intravascular Coagulation%16例产科弥漫性血管内凝血的临床观察

    Institute of Scientific and Technical Information of China (English)

    刘宝红; 李瑞英

    2012-01-01

      Objective Clinical study of obstetric disseminated intravascular coagulation (DIC) in the diagnosis and treatment of symptoms. Methods The selection in recent years in our hospital of clinical data of 16patients with DIC were retrospectively analyzed. Results In this group of12patients, 12patients after the treatment effect is good (75%);in 1 cases newborn fetal abortion and stillbirth in 1 cases of placental abruption patients at the time of admission fetaldead. Conclusion The clinical cause of obstetric DIC has many etiologies, current clinical mainly adopts the comprehensive treatment method, i.e. removing etiology, coagulation factors, massive blood transfusion and auxiliary clinical treatment simultaneously, thus effectively enhance the success rate of clinical DIC.%  目的临床研究产科弥漫性血管内凝血(DIC)的诊治方法。方法本文选取近十几年收治的16例DIC患者的临床资料进行回顾分析。结果本组16例患者中,12例患者经治疗后效果良好(75%);胎儿中有1例死胎引产,2例胎盘早剥患者在入院时胎儿已死。结论临床引起产科DIC的病因较多,目前临床主要采用综合治疗法,即去除病因、补充凝血因子、大量输血及辅助临床治疗同时进行,进而有效提高临床DIC的抢救成功率。

  12. Pregnancies in women with hyperprolactinaemia: clinical course and obstetric complications of 41 pregnancies in 27 women. [Yttrium 90

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, W.F.; Doyle, F.H.; Mashiter, K.; Banks, L.M.; Gordon, H.; Joplin, G.F.

    1979-09-01

    Observations are reported on 41 pregnancies in 27 patients who initially had infertility and raised serum prolactin concentrations. Associated symptoms were secondary amenorrhoea and galactorrhoea. All patients were at risk of pituitary expansion during pregnancy, especially these 19 (70 per cent) with radiological evidence of pituitary tumors. Fifteen patients had 21 pregnancies after pituitary implantation with 90 yttrium; 14 patients had 20 pegnancies without prior pituitary implantation or any other attempt to prevent tumor expansion. The induction and Cesarean section rates were about 30 per cent in 32 term pregnancies in 25 patients. Details of how pregnancy was achieved and the associated obstetric problems are given.

  13. Antiphospohlipid syndrome in obstetrics.

    Science.gov (United States)

    Danza, Alvaro; Ruiz-Irastorza, Guillermo; Khamashta, Munther

    2012-02-01

    Antiphospholipid syndrome is characterised by a variety of clinical and immunological manifestations. The clinical hallmarks of this syndrome are thrombosis and poor obstetric outcomes, including miscarriages, fetal loss and severe pre-eclampsia. The main antiphospholipid antibodies include lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein I. The combination of aspirin and heparin is considered the standard of care for women with antiphospholipid syndrome and embryo-fetal losses; however, aspirin in monotherapy may have a place in women with recurrent early miscarriage. A good benefit-risk ratio of low-molecular-weight heparin in pregnancy thrombosis treatment has been reported. Warfarin must be avoided if possible throughout the first trimester of pregnancy. Adequate pregnancy management of women with antiphospholipid syndrome should include co-ordinated medical-obstetrical care, a close follow-up protocol and a good neonatal unit. Close blood pressure control and early detection of proteinuria, together with Doppler studies of the utero-placental circulation should be included in the management protocol.

  14. Application of scene action in clinical obstetric nursing teaching%情景剧表演在产科临床护理教学中的应用

    Institute of Scientific and Technical Information of China (English)

    嵇秀明; 夏珊敏

    2011-01-01

    Objective To explore the effect of scene action on clinical obstetric nursing teaching.Methods In our hospital 50 obstetric student nurses were selected to be taught by the way of scene action in clinical teaching.After activity,questionnaires were distributed to analyze and summarize the results.Results More than 90% of the student nurses thought thai scene action was helpful for their learning interests,communication skills,abilities of clinical treatment.Conclusions Scene action is fit for clinical teaching,student nurses can improve interpersonal communication skills,develop team spirits,humanistic quality and comprehensive analysis and skills of solving problem.%目的 探讨情景剧表演在产科临床护理教学中的效果.方法 选取在我院产科临床实习护生50名,在临床带教中采用情景剧表演教学,活动结束后发放调查表,进行统计分析总结.结果 90%以上的护生认为情景剧表演对自己的学习兴趣、沟通能力、临床处理能力等方面提高有较大帮助.结论 情景剧表演适合临床护理带教,可提高护生的沟通能力,培养护生的团队协作精神、提高人文素质和综合分析与解决问题的能力.

  15. Commentary on Pharmacometrics for Immunotherapy

    Science.gov (United States)

    Garrido, MJ; Berraondo, P

    2017-01-01

    This commentary provides an overview of recent examples of pharmacometrics applied during the clinical development of two antagonists of the programmed death‐1 (PD‐1) cell surface receptor, pembrolizumab and nivolumab. Despite the remarkable achievements obtained in predicting the correct dosing schedule from different quantitative approaches, data indicated a great degree of heterogeneity in tumor response. To achieve therapeutic goals the search for predictive biomarkers associated with a lack of response and mechanism‐based combination studies are warranted. PMID:27997736

  16. 产科腹部手术切口液化的临床诊断探讨%Clinical Diagnosis of Obstetric Abdominal Incision Liquefied

    Institute of Scientific and Technical Information of China (English)

    邓培香

    2013-01-01

      目的:分析妇产科腹部手术切口液化的病因、诊断以及治疗措施.方法:回顾性分析来笔者所在医院妇产科就诊的32例手术腹部切口脂肪液化患者的临床资料.结果:通过对两组患者采用不同的处理方式,患者伤口愈合时间、总有效率均有显著差异(P<0.05).结论:通过分析发现妇产科腹部切口液化与患者的肥胖、贫血以及糖尿病等具有密切的关系,因此早期预防、及时发现并采取有效的处理方法可以缩短切口愈合时间,提高治愈率.%Objective:Analysis of obstetric and gynecologic abdominal operation incision in the etiology,diagnosis and treatment of liquefaction measures. Methods:A retrospective analysis to my courtyard department of gynaecology and obstetrics clinic of the implementation of operation in 32 patients with abdominal incision fat liquefaction in patients with clinical data.Results:The group of patients treated in different ways,the wound healing time,the total effective rate were significant difference (P<0.05).Conclusion:The discovery of abdominal incision liquefaction and in patients with obesity,anemia and diabetes have a close relationship,therefore,the early prevention,timely find and take effective processing method can shorten the wound healing time,improve the cure rate.

  17. Is personalized medicine achievable in obstetrics?

    Science.gov (United States)

    Quinney, Sara K; Patil, Avinash S; Flockhart, David A

    2014-12-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic makeup of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy, a woman's body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor, and discuss the impediments of bringing personalized medicine to the obstetrical clinic.

  18. Is Personalized Medicine Achievable in Obstetrics?

    Science.gov (United States)

    Quinney, Sara K; Flockhart, David A; Patil, Avinash S

    2014-01-01

    Personalized medicine seeks to identify the right dose of the right drug for the right patient at the right time. Typically, individualization of therapy is based on the pharmacogenomic make-up of the individual and environmental factors that alter drug disposition and response. In addition to these factors, during pregnancy a woman’s body undergoes many changes that can impact the therapeutic efficacy of medications. Yet, there is minimal research regarding personalized medicine in obstetrics. Adoption of pharmacogenetic testing into the obstetrical care is dependent on evidence of analytical validity, clinical validity, and clinical utility. Here, we briefly present information regarding the potential utility of personalized medicine for treating the obstetric patient for pain with narcotics, hypertension, and preterm labor and discuss the impediments of bringing personalized medicine to the obstetrical clinic. PMID:25282474

  19. 产科医源性心衰18例临床分析%A clinical analysis on 18 obstetric patients with iatrogenic heart failure

    Institute of Scientific and Technical Information of China (English)

    张群; 林惠文

    2013-01-01

    目的 探讨产科医源性心衰的原因和预防.方法 回顾性分析2007至2011年在我院发生的医源性心衰18例临床资料,同期随机选取20例分娩无发生心衰的孕产妇作为对照组,寻找产科医源性心衰的发病原因及预防措施.结果 妊娠期高血压疾病9例(50%),产后大出血8例(44.4%),妊娠合并贫血9例(50%),低蛋白血症12例(66.7%);心衰发生的时间,产前2例,产时2例,产后14例.结论 产科医源性心衰的主要病因是产科医务人员对孕产妇的病情评估不足够,静脉补液的量及速度控制不恰当,护理观察不够细致.%Objective To investigate the etiologies and prevention of iatrogenic heart failure in obstetric patients.Methods The clinical data on 18 ptients who had occurred iatrogenic heart failure during the period of 2007 to 2011 were retrospectively analyzed.20 puerperas without heart failure were used as control.The pathogenesis of iatrogenic heart failure and and the relevant measures for prevention were determined.Results 9 of the 18 (50%) patients were due to pregnancy-induced hypertension,8 (44.4%)due to postpartum hemorrhage,9 (50%) due to anemia,and 12 (66.7%) due to hypoalbuminemia.2 patients developed heart failure prenatally,2 intrapartally,and 14 postpartally.Conclusions Underestimation of disease course by obstetric staff,inappropriate control of volume and speed of intravenous infusion,and careless observation by nurses are the major causes of iatrogenic heart failure in obstetric patients.

  20. [Recent standards in management of obstetric anesthesia].

    Science.gov (United States)

    van Erp, Maximiliaan; Ortner, Clemens; Jochberger, Stefan; Klein, Klaus Ulrich

    2017-07-25

    The following article contains information not only for the clinical working anaesthesiologist, but also for other specialists involved in obstetric affairs. Besides a synopsis of a German translation of the current "Practice Guidelines for Obstetric Anaesthesia 2016" [1], written by the American Society of Anesthesiologists, the authors provide personal information regarding major topics of obstetric anaesthesia including pre-anaesthesia patient evaluation, equipment and staff at the delivery room, use of general anaesthesia, peridural analgesia, spinal anaesthesia, combined spinal-epidural anaesthesia, single shot spinal anaesthesia, and programmed intermittent epidural bolus.

  1. 产科多器官功能衰竭17例临床分析%Clinical analysis of 17 cases of multiple organ failure in obstetrics

    Institute of Scientific and Technical Information of China (English)

    朱旭雯; 黎平; 张燕玲; 陈绮雯

    2009-01-01

    Objective To explore the clinical diagnosis and treatment of multiple organ failure(MOF)in obstetrics.Methods 17 cases of MOF in obstetrics were studied retrospectively.Results Postpartum hemorrhage,severe regnancy-induced hypertension syndrome(PIH),amniotic fluid embolism,and placental abruption were the major factors leading to MOF from the 17 cases.The blood coagulation dysfunction and the renal failure were the most common organ dysfunction.8 cases died and the fatality rate was 47.06%.Conclusion The key to lowering the fatality rate of MOF is to prevent and treat the primary diseases,diagnose and treat blood coagulation dysfunction and renal failure early.%目的 探讨产科患者多器官功能衰竭(MOF)的临床诊断及处理.方法 对17例MOF病例的临床资料进行回顾性分析.结果 17例多器官功能衰竭的主要诱因是产后出血、重度妊娠期高血压疾病、羊水栓塞、胎盘早剥.器官功能障碍以凝血功能障碍及肾功能衰竭为最多见.8例死亡,病死率47.06%.结论 预防和治疗原发病,积极去除病因,早期诊断及治疗凝血功能障碍及肾功能衰竭,是降低MOF病死率的关键.

  2. Evidence-based obstetrics in four hospitals in China: An observational study to explore clinical practice, women's preferences and provider's views

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2001-05-01

    Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

  3. Application of Clinical Nursing Path of Obstetric care%临床护理路径在产科护理中的应用

    Institute of Scientific and Technical Information of China (English)

    李燕

    2014-01-01

    目的:探讨临床护理路径在产科护理中的应用效果。方法以本院200例产妇为研究对象,分实验组和对照组进行试验,每组10O例,实验组按照预先制定的临床护理路径表实施护理,对照组按产科常规护理实施护理。结果两组产妇在住院天数、住院费用、产妇护理满意度及护理知识认知达标率等方面都差异有统计学意(<0.01)。结论临床护理路径的程序化和标准化能使临床护理由被动变为主动,并能增强患者自我护理意识和能力,提升护理服务满意度,使患者获得最佳护理服务。%Objective To investigate the ef ect of the application of clinical nursing path of obstetric care.Methods In our hospital 200 cases of women for the study,divided into experimental and control groups were tested,each 10O cases,the experimental group received care in accordance with pre-established clinical nursing path table,the control group received routine care by obstetric care. Results Two groups of mothers in terms of length of stay,hospital costs,nursing satisfaction and nursing mothers'knowledge of standard rate dif erences are statistical y significant ( <0.01).Conclusion Procedures and standardization of clinical nursing path enables clinical care from passive to active,self-care and to enhance patient awareness and ability to improve nursing service satisfaction,so that patients get the best care.

  4. Improving the Utilization of Human Papillomavirus and Cervical Cytology Co-testing for Cervical Cancer Screening in an Obstetrics and Gynecology Resident Clinic.

    Science.gov (United States)

    Yoshino, Kurt; Karimoto, Maxine; Marzo, Christina; Kaneshiro, Bliss; Hiraoka, Mark

    2015-08-01

    Human Papillomavirus (HPV) testing in combination with cervical cytology (HPV co-testing) has been recommended for cervical cancer screening for women 30 to 65 years of age. In several studies, HPV co-testing increased sensitivity for detecting high grade dysplasia and resulted in cost-savings. This retrospective cohort study assessed the prevalence of HPV co-testing in an obstetrics and gynecology resident clinic before and after a brief educational intervention which was designed to reinforce current cervical cancer screening recommendations. The intervention consisted of a short presentation that was given to all residents and medical assistants in October 2011. The proportion of women age 30-65 years of age who had cervical cancer screening with HPV co-testing as compared to cervical cytology alone was compared before and after the intervention using chi-square tests. The goal of the intervention was to increase the percentage of patients receiving co-testing from 0.5% to 7.8%. Each arm (pre- and post-intervention) required 130 subjects to achieve 80% power with a significance of P = .05. No significant differences in demographics including age, insurance type, and cytology were noted. HPV co-testing increased from 0% to 55% (P cervical cancer screening for another 5 years. HPV co-testing represents an underutilized cervical cancer screening modality for women 30 years and older. This brief educational intervention, adaptable to any clinical setting, significatnly increased co-testing at the clinical site.

  5. Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary.

    Science.gov (United States)

    Culbert, Timothy

    2017-04-04

    It has been well-established that a variety of mind-body (MB) techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice) for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges.

  6. Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary

    Directory of Open Access Journals (Sweden)

    Timothy Culbert

    2017-04-01

    Full Text Available It has been well-established that a variety of mind-body (MB techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges.

  7. Tocolytic Drugs for Use in Veterinary Obstetrics

    OpenAIRE

    Ménard, L

    1984-01-01

    The author presents a literature review of two tocolytic agents used in veterinary obstetrics: isoxsuprine and clenbuterol. The medical background from which these drugs emerged for human use and to which is linked their application in animal medicine is described. Each drug is reviewed according to its pharmacology, basic considerations for its clinical use and the reports on its application in the treatment and management of obstetrical disorders in veterinary medicine.

  8. Teamwork in obstetric critical care.

    Science.gov (United States)

    Guise, Jeanne-Marie; Segel, Sally

    2008-10-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  9. Teaching primary care obstetrics

    Science.gov (United States)

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

    2014-01-01

    Abstract Objective To explore the experiences and recommendations for recruitment of family physicians who practise and teach primary care obstetrics. Design Qualitative study using in-depth interviews. Setting Six primary care obstetrics groups in Edmonton, Alta, that were involved in teaching family medicine residents in the Department of Family Medicine at the University of Alberta. Participants Twelve family physicians who practised obstetrics in groups. All participants were women, which was reasonably representative of primary care obstetrics providers in Edmonton. Methods Each participant underwent an in-depth interview. The interviews were audiotaped and transcribed verbatim. The investigators independently reviewed the transcripts and then analyzed the transcripts together in an iterative and interpretive manner. Main findings Themes identified in this study include lack of confidence in teaching, challenges of having learners, benefits of having learners, and recommendations for recruiting learners to primary care obstetrics. While participants described insecurity and challenges related to teaching, they also identified positive aspects, and offered suggestions for recruiting learners to primary care obstetrics. Conclusion Despite describing poor confidence as teachers and having challenges with learners, the participants identified positive experiences that sustained their interest in teaching. Supporting these teachers and recruiting more such role models is important to encourage family medicine learners to enter careers such as primary care obstetrics. PMID:24627402

  10. Clinical Commentary by Barbara Segal, a Consultant Child and Adolescent Psychotherapist Working in University College London Hospitals

    Science.gov (United States)

    Segal, Barbara

    2010-01-01

    This moving clinical account describes the psychotherapeutic work of a child psychotherapist undertaken in a hospital room with 13-year-old Maya, after the sudden onset of a terrifying and serious illness, Guillain-Barre syndrome, leaving her with paralysis and extreme weakness. The first session takes place almost three weeks after Maya's…

  11. Clinical Commentary by Barbara Segal, a Consultant Child and Adolescent Psychotherapist Working in University College London Hospitals

    Science.gov (United States)

    Segal, Barbara

    2010-01-01

    This moving clinical account describes the psychotherapeutic work of a child psychotherapist undertaken in a hospital room with 13-year-old Maya, after the sudden onset of a terrifying and serious illness, Guillain-Barre syndrome, leaving her with paralysis and extreme weakness. The first session takes place almost three weeks after Maya's…

  12. Clinical Effect of Risk Management for Obstetrics and Gynecology Nursing%风险管理在妇产科护理中的应用

    Institute of Scientific and Technical Information of China (English)

    王艳君

    2015-01-01

    Objective To study the Clinical effect of risk management for nursing care in gynecology and obstetrics department.Methods From 2011 January to 2014 December,360 cases with various diseases were treated in Hunnan District Central Hospital, they were randomly divided into the observation group (180 cases) and the control group(180 cases), the observation group were carried out the nursing risk management , and the control group received the general nursing, nursing effect was compared between the two groups .Results Satisfaction of the observation group and the con-trol group is respectively 93.33%and 71.11%, the observation group was significantly better than the control group , P<0.05 , the difference has statistical significance .Conclusions The application of risk management for obstetrics and gynecology nursing , which can not only improve the risk awareness and the level of nursing of nursing staff , and can im-prove the satisfaction of patients , reduce nurse-patient disputes , is worth popularizing and applying in hospital′s nursing management.%目的:研究风险管理在妇产科护理中的应用效果。方法选取2011年1月~2014年12月收治的360例妇产科患者,分为观察组180例和对照组180例,观察组实施护理风险管理,对照组未实施风险管理,对比观察两组的护理效果。结果观察组满意度为93.33%,对照组满意度为71.11%,观察组显著优于对照组,P<0.05,差异具有统计学意义。结论妇产科护理中应用风险管理,不仅可提高护理人员的风险意识和护理水平,且可提高患者满意度,减少护患纠纷,值得在医院护理管理工作中推广应用。

  13. 产科失血性休克的临床特点及急救探讨%The clinical characteristics and first aid of obstetrical hemorrhagic shock

    Institute of Scientific and Technical Information of China (English)

    黄宜红

    2014-01-01

    Objective To investigate the clinical characteristics and first aid of obstetrical hemorrhagic shock .Methods Forty-six patients with obstetrical hemorrhagic shock and other patients without obstetrical hemorrhagic shock were investigated retrospectively .The placenta previa , placental abruption, placenta accreta or placenta remnants , Uterine Atony, laceration of birth canal , coagulation disorder dysfunction , postpartum hemorrhage were analyzed .The main risk factors for hemorrhagic shock were analyzed , and the effect of comprehensive emergency measures were discussed .Results The rate of placenta previa , placental abruption , placenta accreta or placenta remnants , Uterine Atony, laceration of birth canal, coagulation disorder dysfunction were higher than those of the control group (P2000 mL compared with the control group (P <0.05).All of the patients were out of danger , and the rate of rescue success was 100%.Conclusion The main risk factors for hemorrhagic shock include placenta previa , placental abruption , placenta accreta or placenta remnants, Uterine Atony, laceration of birth canal , coagulation disorder dysfunction , postpartum hemorrhage .It helps to increase the rate of rescue success by effective rescue measures and prevention complications .%目的:探讨产科失血性休克(hemorrhagic shock, HS)的临床特点及急救方法。方法回顾性分析我院收治的46例产科HS危急重症产妇(试验组)和同期未发生HS的产妇(对照组)胎盘前置、胎盘早剥、胎盘残留或粘连、宫缩乏力、产道裂伤及产后出血等的发生情况,分析HS的主要危险因素,并探讨综合急救措施的救治效果。结果试验组胎盘前置、胎盘残留或粘连、胎盘早剥、宫缩乏力、产道裂伤及凝血机制障碍发生率均明显高于对照组(P<0.05);试验组出血量在800~1500 mL和1500~2000 mL HS患者明显低于对照组,当出血量>2000 mL时,HS

  14. Clinical characteristics of obstetric merging hospital infections%产科合并医院感染临床特点观察

    Institute of Scientific and Technical Information of China (English)

    项秀琴

    2012-01-01

    OBJECTIVE To discuss the characteristics of nosocomial infections in obstetric department. METHODS The clinical data of 2460 pregnant women were retrospectively analyzed; the infection sites, distribution of pathogens, and related factors for infection were observed. RESULTS Nosocomial infections occurred in 120 of 2460 pregnant women, accounting for 4. 9%; 46(38. 3%)cases were urinary tract infection, 40 (33. 3%) cases were incision infection, 15 (12. 5%) cases were genital tract infection, 8 (6. 7%)cases were gastrointestinal tract infection, and 6(5. 0%) cases were oral infection of the 164 strains of bacteria cultured from 120 patients with nosocomial infections included 82 strains(50. 0%) of gram-negative bacilli, 68 strains(41. 5%) of gram-positive cocci, and 12 strains (7. 3%) of fungi. Complications during the pregnancy, invasive operation, prophylactic antibiotics, and long hospital stay were the risk factors for nosocomial infections. CONCLUSION Nosocomial infections in obstetric patients are characterized by high incidence, diversity in infection sites, complex pathogens, and many impact factors. The awareness of nosocomial infections in obstetric department should be strengthened and intervention of the impact factors should be carried out.%目的 探讨产科合并医院感染的特点.方法 回顾性分析2460例孕产妇的临床资料;观察医院感染发生部位、病原菌构成及相关因素.结果 2460例孕产妇发生医院感染120例占4.9%;感染部位泌尿道46例占38.3%、切口感染40例占33.3%、生殖道感染15例占12.5%、胃肠道8例占6.7%、口腔感染6例占5.0%;120例医院感染患者共培养出病原菌164株,革兰阴性杆菌82株占50.0%、革兰阳性球菌68株占41.5%、真菌12株占7.3%;医院感染因素为妊娠并发症及合并症、侵入性操作、预防性应用抗菌药物、住院时间长.结论 产科患者医院感染发生率高、感染部位多、病原菌复杂、

  15. 产科出血性休克主要原因及临床处理措施分析%Analysis of main factors and clinical treatment of obstetric hemorrhage shock

    Institute of Scientific and Technical Information of China (English)

    陈文娟

    2015-01-01

    Objective:To investigate the main factors and clinical treatment of obstetric hemorrhage shock.Methods:100 cases of obstetric hemorrhage shock patients were selected from August 2012 to August 2013.We retrospectively analyzed the medical records of them,and we summarized and analysed its causes and clinical treatment.Results:In 100 cases of obstetric hemorrhagic shock patients,the main factors of prenatal bleeding were placenta previa,placental abruption.The main factors of postpartum hemorrhage were the weakness of uterine contraction,placental factors and reproductive tract laceration and so on.100 cases were all successful rescue,in the postpartum hemorrhage patients,2 cases underwent abdominal hysterectomy.Conclusion:In order to do a good job in the prevention of obstetric hemorrhagic shock,and reduce maternal mortality,we should strengthen perinatal health efforts,popularize the standardized diagnosis and treatment of obstetric hemorrhagic shock,improve the treatment level of perinatal health care personnel and obstetric medical staff.The treatment of obstetric hemorrhagic shock requires teamwork,obstetrical medical staff should have excellent professional and technical treatment of obstetric hemorrhagic shock,to form a standardized processes and referral process,to achieve the timely rescue,referral and timely,so that it can further reduce the maternal mortality rate and severe complications caused by obstetric hemorrhage.%目的:探讨产科出血性休克主要原因和临床处理措施.方法:2012年8月-2013年8月收治产科出血性休克患者 100 例,对其病历资料进行回顾性分析,总结分析其原因和临床处理措施.结果:100 例产科出血性休克患者中,产前出血的主要原因为前置胎盘、胎盘早剥.产后出血的主要原因有子宫收缩乏力、胎盘因素以及生殖道裂伤等.100 例患者全部抢救成功,产后出血患者中 2 例进行了经腹子宫全切术.结论:要做好产科出血性休克的

  16. Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions.

    Science.gov (United States)

    Suetterlin, Karen Joan; Sayer, Avan Aihie

    2014-05-01

    Proprioception, the sense of where one is in space, is essential for effective interaction with the environment. A lack of or reduction in proprioceptive acuity has been directly correlated with falls and with reduced functional independence in older people. Proprioceptive losses have also been shown to negatively correlate with functional recovery post stroke and play a significant role in other conditions such as Parkinson's disease. However, despite its central importance to many geriatric syndromes, the clinical assessment of proprioception has remained remarkably static. We look at approaches to the clinical assessment of proprioception, changes in proprioception across the life course, functional implications of proprioception in health and disease and the potential for targeted interventions in the future such as joint taping, and proprioception-specific rehabilitation and footwear.

  17. The incidental pulmonary nodule in a child. Part 2: Commentary and suggestions for clinical management, risk communication and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Westra, Sjirk J. [Massachusetts General Hospital, Division of Pediatric Radiology, Boston, MA (United States); Thacker, Paul G. [Medical University of South Carolina, Department of Radiology, Charleston, SC (United States); Podberesky, Daniel J. [Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Lee, Edward Y. [Boston Children' s Hospital, Department of Pediatric Radiology, Boston, MA (United States); Iyer, Ramesh S. [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Hegde, Shilpa V. [Arkansas Children' s Hospital, Department of Radiology, Little Rock, AR (United States); Guillerman, R.P. [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Mahani, Maryam Ghadimi [University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States)

    2015-05-01

    The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers' individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine. (orig.)

  18. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

    Science.gov (United States)

    Taler, Sandra J.; Agarwal, Rajiv; Bakris, George L.; Flynn, Joseph T.; Nilsson, Peter M.; Rahman, Mahboob; Sanders, Paul W.; Textor, Stephen C.; Weir, Matthew R.; Townsend, Raymond R.

    2014-01-01

    In response to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for blood pressure management in patients with chronic kidney disease not on dialysis, the National Kidney Foundation organized a group of US experts in hypertension and transplant nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The overriding message was the dearth of clinical trial evidence to provide strong evidence-based recommendations. For patients with CKD with normal to mildly increased albuminuria, goal blood pressure has been relaxed to ≤140/90 mm Hg for both diabetic and nondiabetic patients. In contrast, KDIGO continues to recommend goal blood pressure ≤130/80 mm Hg for patients with chronic kidney disease with moderately or severely increased albuminuria and for all renal transplant recipients regardless of the presence of proteinuria, without supporting data. The expert panel thought the KDIGO recommendations were generally reasonable but lacking in sufficient evidence support and that additional studies are greatly needed. PMID:23684145

  19. Nigerian obstetric patients

    African Journals Online (AJOL)

    combination of Mallampati and Thyro-mental distance had values of ... difficult tracheal intubation is not precisely known but failed ... predictive values in a sample of Nigeria Obstetric Patients. ... the mentum to the thyroid notch was measured.

  20. Critically ill obstetric patients

    Directory of Open Access Journals (Sweden)

    Kirti Rajesh Bendre

    2015-04-01

    Methods: This is a retrospective study carried out in a medical college with tertiary hospital facility in Mumbai. The ICU admissions for a period of 5 years from October 2005 to October 2010 were reviewed. Results: Over 5 years, 48 out of 10800 obstetric patients were admitted in ICU (0.4%. Most common reasons for admissions were obstetric hemorrhage and preeclampsia. The most common intervention done was transfusion of blood and blood products. Conclusions: We need better information about high risk obstetrics in order to improve maternal care. The study identifies the risk factors for maternal mortality and severe maternal morbidity, most significant being obstetric hemorrhage. Lack of antenatal care and delay in referral to intensive care unit adversely affect the maternal outcome. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 370-372

  1. Transforming Clinical Education in Obstetrics and Gynecology: Gone Is the Day of the Sage on the Stage.

    Science.gov (United States)

    Smith, Marshall L; Foley, Michael R

    2016-04-01

    Many traditional approaches to clinical education today are outdated and inefficient with disruptive changes on the horizon. Millennials are the new wave of learners in health care and do not learn the same way as their older faculty. Merging health care systems are moving to standardizations of care and reduction of errors, and health care providers are going to be increasingly held more accountable for their clinical outcomes. Computers, digitalization, and connectivity are revolutionizing learning environments, and simulation learning in the form of trainers, mannequins, and team training is already widespread. Newer technologies like virtual and augmented reality are beginning to be used for clinical education and will be a more efficient and standardized way of providing simulation learning. Emerging technologies like holograms and head-mounted displays will follow soon after and be even more disruptive. Faculty and mentors will always be crucial to learning in health care but will be empowered to teach in more focused and comprehensive ways. The educational model of the future will be a hybrid model of experienced faculty, interactive learning, and innovative and emerging technology. It is time we start to train health care providers for their future, not our past.

  2. Obstetrics and Ernest Hemingway.

    Science.gov (United States)

    King, C R

    1989-07-01

    Ernest Hemingway is one of the most popular and important American writers of the 20th century. His fiction, ranging from the short story to the novel, is well known, but his medical knowledge, and in particular his knowledge of obstetrics, often is not recognized. To achieve the realistic depiction of the childbirth scenes in A Farewell to Arms required that Hemingway acquire special knowledge of obstetrics practice.

  3. Obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Esteve-Valverde, E; Ferrer-Oliveras, R; Alijotas-Reig, J

    2016-04-01

    Obstetric antiphospholipid syndrome is an acquired autoimmune disorder that is associated with various obstetric complications and, in the absence of prior history of thrombosis, with the presence of antiphospholipid antibodies directed against other phospholipids, proteins called cofactors or PL-cofactor complexes. Although the obstetric complications have been related to the procoagulant properties of antiphospholipid antibodies, pathological studies of human placenta have shown the proinflammatory capacity of antiphospholipid antibodies via the complement system and proinflammatory cytokines. There is no general agreement on which antiphospholipid antibodies profile (laboratory) confers the greatest obstetric risk, but the best candidates are categories I and IIa. Combined treatment with low doses of aspirin and heparin achieves good obstetric and maternal outcomes. In this study, we also review the therapeutic possibilities in refractory cases, although the likelihood of progressing to other autoimmune diseases is low. We briefly comment on incomplete obstetric antiphospholipid syndrome, also known as antiphospholipid antibody-mediated pregnancy morbidity syndrome. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline group's clinical recommendations.

    Science.gov (United States)

    Lamont, Ronald F; Keelan, Jeffrey A; Larsson, Per G; Jørgensen, Jan S

    2017-02-01

    Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. 21st European Congress of Obstetrics and Gynaecology

    DEFF Research Database (Denmark)

    Hornnes, Peter

    2010-01-01

    The 21st European Congress of Obstetrics and Gynaecology took place in Antwerp 5-8 May 2010. The congress provided the participants with an overview of recent scientific and clinical developments throughout the field of obstetrics and gynaecology, and these are summarized in this article....

  6. 21st European Congress of Obstetrics and Gynaecology

    DEFF Research Database (Denmark)

    Hornnes, Peter

    2010-01-01

    The 21st European Congress of Obstetrics and Gynaecology took place in Antwerp 5-8 May 2010. The congress provided the participants with an overview of recent scientific and clinical developments throughout the field of obstetrics and gynaecology, and these are summarized in this article....

  7. [Human papillomavirus infection and its correlates with clinically relevant gynecological and obstetric conditions: A cross-sectional study].

    Science.gov (United States)

    López-Hernández, Daniel; Beltrán-Lagunes, Luis; Brito-Aranda, Leticia; López-Hernández, Maria de la Luz

    2016-08-05

    To analyze the prevalence of human papillomavirus (HPV) infection and the possible epidemiological association with conditions of clinical relevance in women. A cross-sectional study from Mexico City was conducted from January 2012 to December 2014. HPV molecular detection was performed on cervical samples. Data were analyzed with appropriated statistic tests. A total of 1,604 females (median 47, interquartile range 38-54) were analyzed. Global prevalence of infection for any HPV is 9.91% (95% CI 8.6-11.3). An association between infection with 16-HPV and number of abortions (NA) (OR=1.427; 95% CI 1.091-1.866), by univariate regression model (UVRM) was estimated. Moreover, menarche (OR=1.566; 95% CI 1.079-2.272), NA (OR=1.570; 95% CI 1.106-2.227) and number of pregnancies (NP) (OR=0.461; 95% CI 0.260-0.818) have a direct and inverse association with infection by genotype 18 of HPV, respectively. Also, infection with HR-HPV genotypes has an inverse association with NP (OR=0.791; 95% CI 0.707-0.884) by normal labor (OR=0.867; 95% CI 0.767-0.979) and NA (OR=0.715; 95% CI 0.534-0.959) (UVRM), and a direct association with number of sexual partners (OR=1.082; 95% CI 1.015-1.154). Onset of sexual activity has an inverse association with infection by genotype 16- (UVRM: OR=0.814; 95% CI 0.715-0.926; multinomial regression model (MNRM): OR=0.803; 95% CI 0.702-0.918) and HR-HPV (UVRM: OR=0.933; 95% CI 0.889-0.980, and MNRM: OR=0.912; 95% CI 0.867-0.959), all P values were lower than .03. Prevalence of HPV cervical infection is different according to age and it is associated with several medical conditions of clinical relevance in women. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  8. Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

    Science.gov (United States)

    Cetinel, Bulent; Demirkesen, Oktay; Tarcan, Tufan; Yalcin, Onay; Kocak, Taner; Senocak, Mustafa; Itil, Ismail

    2007-06-01

    The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.

  9. 产科临床护理带教中的相关危险因素及风险管理%The related risk factors and risk management of obstetric clinical nursing teaching

    Institute of Scientific and Technical Information of China (English)

    胡巧; 吴淑芬; 洪士璇

    2015-01-01

    目的::探讨产科临床护理带教中的相关危险因素及风险管理方法。方法:分析产科临床护理带教中的相关危险因素,实施相应的风险管理措施,考核护生护理风险知识、理论知识及操作情况。结果:护生护理风险知识的掌握水平较好,优秀人数(评分超过80分)60名,占95.24%;理论知识优秀人数(评分超过80分)58名,占92.06%;操作技能优秀人数(评分超过80分)50名,占79.37%。结论:产科临床护理带教工作中存在产科环境复杂、产科专业性强、带教老师因素、实习护生因素、患者不配合等危险因素,给予风险管理后,有效提高了护生的临床护理综合能力。%Objective:To explore the related risk factors and risk management effect of obstetric clinical nursing teaching. Methods:To analyze the fisk factors in obstetric clinical nursing teaching,and implements the risk management. To assess the results of nursing risk knowledge,theoretical knowledge and opera-tion for nurse students. Results:Among the nurse students,excellent knowledge of nursing risk of 60 cases (95. 24% ),excellent theoretical knowledge ex-amination 58 cases (92. 06% ),and excellent operation skill 50 cases (79. 37% ). Conclusion:The obstetric environment complex,obstetrics professional strong,teaching teachers,practice nurses,and patients incompatibility were with risk factors in obstetric clinical nursing teaching. Risk management could improve nurse student′s clinical comprehensive ability effectively.

  10. 产科镜像综合征12例临床分析%Clinical study of 12 cases with obstetric mirror syndrome

    Institute of Scientific and Technical Information of China (English)

    吴琳琳; 王晨虹; 李智泉

    2012-01-01

    后出血行子宫动脉栓塞术.结论 产科镜像综合征患者既具有子痫前期的临床特点,又常表现出血液稀释、胎盘水肿和羊水过多等异于子痫前期的发病特点.一旦导致产科镜像综合征的原因不能被纠正,需果断终止妊娠.%Objective To discuss the clinical features,management,pregnancy outcome and prognosis of obstetric mirror syndrome.Methods The clinical data of 12 cases with obstetric mirror syndrome at Shenzhen Maternity and Child Healthcare Hospital from April 2008 to December 2010 were collected to retrospectively analyze the clinical features, management,pregnancy outcome and prognosis.Results ( 1 ) Etiology:12 cases with obstetric mirror syndrome included 9 cases of Bart's hydrops fetalis,2 cases with fetal complicated congenital cardiac anomalies,and 1 case of unknown etiology.(2)Gestational age at diagnosis and at delivery:gestational age at diagnosis ranged from 28 to 36 weeks [ mean (31.5 ±4.7) weeks],and gestational age at delivery ranged from 28+3 to 38 weeks [ mean (32.9 ±2.9)weeks].There were no significant differences between the gestational age at diagnosis and at delivery in consistented with severe preeclampsia group and mild preeclampsia group [ (31.8 ± 2.3 ) weeks vs.(30.9 ± 7.2) weeks,(32.5 ± 2.3 ) weeks vs.(33.5 ± 3.9 ) weeks,P > 0.05 ].( 3 ) The patients with obstetric mirror syndrome can present a preeclampsia-like syndrome:maternal extremity edema in 12 cases,headache and visual disturbance in 1 case,proteinuria in 11 cases,elevated blood pressure in 5 cases,elevated uric acid in 9 cases,hypoproteinemia in 12 cases,elevated creatinine in 3 case,elevated liver enzyme in 1 case,thrombocytopenia in 2 cases.The major complications included 1 case of HELLP syndrome,acute pulmonary edema,placental abruption,amnionic fluid embolism,DIC respectively,3 cases of acute kidney failure and 6 cases of postpartum hemorrhage.(4) Sonographic findings:① Hydrops fetalis:fetal ultrasound revealed pleural fluid

  11. Clinical effects on tubal infertility in obstetrics and gynecology%妇产科输卵管性不孕症的临床疗效探析

    Institute of Scientific and Technical Information of China (English)

    郑阳

    2016-01-01

    目的:探讨妇产科输卵管性不孕症的临床治疗。方法:30例采用输卵管通液术治疗,作为对照组,30例采用腹部B 超联合输卵管通液术治疗,作为研究组,对两种治疗方法的效果做出评价。结果:研究组单侧通畅率为30.0%,双侧通畅率为70.0%,宫内妊娠率为76.7%;对照组分别为43.3%、26.7%、50.0%,P<0.05,比较有统计学意义。结论:腹部 B超联合输卵管通液显影术治疗输卵管性不孕症安全无辐射,通畅率高,多数患者治疗后当月就可妊娠,具有临床推广和应用的价值。%Objective: To investigate the clinical treatment of tubal infertility in obstetrics and gynecology department. Methods: 30 cases were treated by hydrotubation, as the control group; 30 cases were treated by abdominal ultrasound more, as the research group. The effects were evaluated. Results: The patency rate was 30%; the bilateral patency rate was 70%; the intrauterine pregnancy rate was 76.7% in the study group; those in the control group were 43.3%,26.7%,50.0% (P<0.05). Conclusion: Abdominal B ultrasound with hydrotubation on tubal infertility is safe and effective, with no radiation and higher patency rate. The majority of patients can be pregnant after treatment , with the value of clinical popularization and application.

  12. Clinical Analysis of Tubal Infertility Obstetrics and Gynecology%妇产科输卵管性不孕症的临床探析

    Institute of Scientific and Technical Information of China (English)

    赵丽岩

    2015-01-01

    目的:对妇产科输卵管性不孕症的临床治疗效果进行探讨。方法随机抽取我院在2012年1月~2014年12月治疗的80例输卵管性不孕症患者,分为两组:观察组与对照组,观察组患者使用联合腹部B超进行输卵管通液显影术进行治疗,对照组患者使用输卵管通液术进行治疗,对两组患者的治疗效果进行对比和分析。结果观察组患者的宫内受孕率、输卵管通畅率均优于对照组,存在差异,具备统计学意义(P<0.05)。结论联合腹部B超进行输卵管通液显影术在输卵管性不孕症患者治疗中具有应用价值。%Objective Clinical therapeutic effect on obstetrics and Gynecology tubal infertility were discussed.Methods Randomly selected from our hospital in January 2012--December 2014, treated 80 cases of oviduct infertility patients, divided into two groups: observation group and control group, patients in the observation group using combined abdominal B ultrasound imaging of hydrotubation treatment, patients in the control group use hydrotubation treatment, comparison and analysis of two groups of patients treatment effect. ResultsIn the observation group, patients with intrauterine insemination rate of fallopian tube patency rate was better than the control group, there was significant difference, with statistical significance (P< 0.05). Conclusion Combined abdominal B ultrasound for tubal imaging tube infertility patients in falopian, worthy of promotion and application in large range in clinical treatment.

  13. Integrating Prevention into Obstetrics/Gynecology.

    Science.gov (United States)

    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…

  14. Integrating Prevention into Obstetrics/Gynecology.

    Science.gov (United States)

    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…

  15. Controversies concerning the antiphospholipid syndrome in obstetrics.

    Science.gov (United States)

    Camarena Cabrera, Dulce María Albertina; Rodriguez-Jaimes, Claudia; Acevedo-Gallegos, Sandra; Gallardo-Gaona, Juan Manuel; Velazquez-Torres, Berenice; Ramírez-Calvo, José Antonio

    Antiphospholipid antibody syndrome is a non-inflammatory autoimmune disease characterized by recurrent thrombotic events and/or obstetric complications associated with the presence of circulating antiphospholipid antibodies (anticardiolipin antibodies, anti-β2 glycoprotein-i antibodies, and/or lupus anticoagulant. Antiphospholipid antibodies are a heterogeneous group of autoantibodies associated with recurrent miscarriage, stillbirth, fetal growth restriction and premature birth. The diversity of the features of the proposed placental antiphospholipid antibodies fingerprint suggests that several disease processes may occur in the placentae of women with antiphospholipid antibody syndrome in the form of immune responses: inflammatory events, complement activation, angiogenic imbalance and, less commonly, thrombosis and infarction. Because of the disparity between clinical and laboratory criteria, and the impact on perinatal outcome in patients starting treatment, we reviewed the aspects of antiphospholipid antibody syndrome related to obstetric complications and seronegative antiphospholipid antibody syndrome, and their treatment in obstetrics.

  16. [Airway management in obstetrics].

    Science.gov (United States)

    Boutonnet, M; Faitot, V; Keïta, H

    2011-09-01

    Reviewing problems related to the airway management in obstetrics, taking into account the recent evolutions of the anaesthetic practices in obstetrics. A review of the literature in English and French was performed in the Pumed database in April 2010. The first research used the following MeshTerms: "Anesthesia, Obstetrical" [Mesh] AND "Intubation, Intratracheal" [Mesh]. Complementary research used alone or in combination the following keywords: difficult tracheal intubation; failed tracheal intubation; airway; prediction of difficult tracheal intubation; maternal mortality; maternal morbidity; liability; aspiration pneumonia and obstetrical anesthesia. All the publications were retained excluding the correspondence. Data analysis for the airway management in obstetrics, the prediction of difficult intubation, the prevention of pulmonary inhalation of gastric fluid, but also on maternal morbi-mortality in link with general anesthesia in obstetrics. Airway management in obstetrics remains a true challenge for various reasons. The physiological and anatomical modifications related to pregnancy are responsible for a faster hypoxemia, a reduction of the diameter of the pharyngolaryngal tract, as well as an increase of the risk of inhalation of gastric contents after 16 weeks of amenorrhea. The emergency or extreme emergency context and the presence of diseases like obesity or preeclampsia raise the risks of difficulties with airway management. The logical evolution of the practices, with the considerable rise of the regional anesthesia/analgesia limits the training and the maintenance of competences for intratracheal intubation in obstetrics. The training per simulation appears particularly interesting on the subject and this approach needs to be developed. The literature indicates that the incidence of difficult intubation is of one per 30. The impossible intubation is one per 280 in obstetrics, eight times greater than in the general population. No criterion of

  17. Diagnosis and management of non-criteria obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Arachchillage, Deepa R Jayakody; Machin, Samuel J; Mackie, Ian J; Cohen, Hannah

    2015-01-01

    Accurate diagnosis of obstetric antiphospholipid syndrome (APS) is a prerequisite for optimal clinical management. The international consensus (revised Sapporo) criteria for obstetric APS do not include low positive anticardiolipin (aCL) and anti β2 glycoprotein I (aβ2GPI) antibodies (pregnancy morbidity, particularly recurrent pregnancy loss, suggest that elimination of aCL and/or IgM aβ2GPI, or low positive positive aCL or aβ2GPI from APS laboratory diagnostic criteria may result in missing the diagnosis in a sizeable number of women who could be regarded to have obstetric APS. Such prospective and retrospective studies also suggest that women with non-criteria obstetric APS may benefit from standard treatment for obstetric APS with low-molecular-weight heparin plus low-dose aspirin, with good pregnancy outcomes. Thus, non-criteria manifestations of obstetric APS may be clinically relevant, and merit investigation of therapeutic approaches. Women with obstetric APS appear to be at a higher risk than other women of pre-eclampsia, placenta-mediated complications and neonatal mortality, and also at increased long-term risk of thrombotic events. The applicability of these observations to outcomes in women with non-criteria obstetric APS remains to be determined.

  18. The 2013 Gerard W. Ostheimer Lecture: What's New in Obstetric Anesthesia?

    Science.gov (United States)

    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.

  19. Is obstetric triage necessary?

    Directory of Open Access Journals (Sweden)

    Seetha Panicker

    2014-02-01

    Conclusions: Obstetric triage would improve efficiency of care and reduce waiting time. The suggestions for improvement were also discussed. There should be clear guidelines and protocols for the initial assessment and action for each level of severity. [Int J Reprod Contracept Obstet Gynecol 2014; 3(1.000: 44-47

  20. Obstetric hysterectomy: a retrospective study at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Anjali Kanhere

    2013-08-01

    Conclusions: Obstetric hysterectomy is a lifesaving procedure. The outcome depends on timely decision, good clinical judgement and professional surgical technique. It reduces maternal morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 562-565

  1. Obstetrical brachial plexus palsy (OBPP) outcome with conservative management

    NARCIS (Netherlands)

    Eng, GD; Binder, H; Getson, P; ODonnell, R

    1996-01-01

    Resurgence of neurosurgical intervention oi obstetrical brachial plexus palsy prompted our review of 186 patients evaluated between 1981 and 1993, correlating clinical examination, electrodiagnosis, and functional outcome with conservative management. Eighty-eight percent had upper brachial plexus p

  2. Misdiagnosis of obstetrical cases and the clinical and cost consequences to patients: a cross-sectional study of urban providers in the Philippines

    Directory of Open Access Journals (Sweden)

    Riti Shimkhada

    2016-12-01

    Full Text Available Background: Misdiagnosis may be a significant and under-recognized quality of care problem. In birthing facilities located in anurban Philippine setting, we investigated the diagnostic accuracy for three obstetric conditions: cephalopelvic disproportion (CPD, post-partum hemorrhage (PPH, and pre-eclampsia. Design: Identical simulated cases were used to measure diagnostic accuracy for every provider (n=103. We linked misdiagnosis – identified by the simulated cases – to obstetrical complications of the patients at the participating facilities. Patient-level data on health outcomes and costs were obtained from medical records and follow-home in-person interviews. Results: The prevalence of misdiagnosis among obstetric providers was 29.8% overall, 25% for CPD, 33% for PPH, and 31% for pre-eclampsia. Linking provider decision-making to patients, we found those who misdiagnosed the simulated cases were more likely to have patients with a complication (OR 2.96; 95% CI 1.39–3.77 compared with those who did not misdiagnose. Complicated patients were significantly less likely to be referred to a hospital immediately, were more likely to be readmitted to a hospital after delivery, had significantly higher medical costs, and lost more income than non-complicated patients. Conclusion: Diagnosis is arguably the most important task a clinician performs because it determines the subsequent course of evaluation and treatment, with the direct and indirect costs of diagnostic error, placing large financial burdens on the patient.

  3. 产瘫患儿Horner征的临床观察%Clinical observation of concurrent Horner's sign in infants with obstetric brachial plexus palsy

    Institute of Scientific and Technical Information of China (English)

    李清; 陈亮; 胡韶楠

    2012-01-01

    Objective To discuss the diagnostic value of concurrent Horner's sign in infants with obstetric brachial plexus palsy and discover the clinical characteristics of Horner's syndrome caused by C7 nerve root avulsion alone.Methods From January 2009 to July 2009,39 infants with OBPP were identified with concurrent Horner' s syndrome.Clinical signs of Homer's syndrome were recorded which include ipsilateral blepharoptosis,pupillary miosis and facial anhidrosis.Lesions of brachial plexus nerve roots were confirmed during the surgery by direct visualization and electrophysiology.After a period of 6-month follow-up,these signs were recorded again.Results The initial age of Horner's sign evaluation of these OBPP patients was(3.58 ±0.87)months.Average postoperative follow-up interval was(6.19 ± 1.10)months.C7 nerve root avulsion alone was confirmed in 11 patients(case group),while the other 28 patients(control group)lind avulsion of at least one root of C8 and T1 nerve roots.There were not significant differences in anisocoria and blepharoptosis between the two groups(P > 0.05).Facial gland secretary function was recovered more rapidly among patients in case group than their counterparts(P < 0.05).Conclusion In newborns with OBPP,Horner' s syndrome can be correlated with C7 nerve root avulsion alone.No unique feature of Horner's syndrome which caused by C7 nerve root avulsion was found among patients of 3 months old.%目的 探讨Horner征在产瘫中的诊断意义,寻找单纯C7神经根撕脱导致Horner征的特异性临床体征.方法 对2009年1月至7月在我院接受手术治疗的39例Horner征阳性的产瘫患儿,术前记录患侧Horner征3项临床体征:瞳孔大小,睑裂大小及面部汗腺分泌功能.术中通过直视观察联合神经电生理检查明确患儿神经根损伤程度,并在患儿术后首次随访时再次记录Horner征的各项体征.结果 产瘫患儿平均首次评估Horner征时间为(3.58±0.87)个月.

  4. 产科急性心力衰竭28例临床分析%Clinical analysis of acute heart failure in department of obstetrics

    Institute of Scientific and Technical Information of China (English)

    何爱芬

    2015-01-01

    目的 回顾性查阅产科急性心力衰竭的临床病例资料,总结相关治疗经验及注意事项.方法 对2011年9月至2014年9月我院收治的28例妊娠合并急性心力衰竭患者的临床诊治资料进行回顾性分析.结果 产科急性心力衰竭的常见危险因素主要包括:妊娠高血压疾病(10.71%)、多胎妊娠(10.71%)、羊水过多并巨大儿(7.14%)、妊娠合并急性上呼吸道感染(7.14%)、妊娠合并心脏病(32.14%)、妊娠合并贫血(35.71%)、产前检查不完善(21.43%)、既往心脏病病史(7.14%)等.同时10例(35.71%)患者由于早期心力衰竭未及时干预而致患者病情加重,入院心功能大多数为NYHA I级或Ⅱ级;15例患者心力衰竭发生于产前,13例发生于产后.8例经阴道顺产,20例剖宫产,两种分娩方式的围生儿窒息情况比较差异未见统计学意义.结论 为降低产科急性心力衰竭的发病率和病死率,及早发现和控制早期心力衰竭十分重要,同时应重视产前检查及诱发心力衰竭相关因素,心力衰竭的治疗强调早期干预,根据患者病情制定治疗方案,必要时终止妊娠,可改善患者的病情,降低死亡风险.%Objective Retrospectively checking the obstetric acute heart failure cases,to summarize the relevant therapy experience and precautions.Methods From September 2011 to September 2014,the clinical data of 28 pregannt patient with acute heart failure treated in wuyang people' s hospital were retrospectively analyzed.Results The common risk factors of pregannt patient with acute heart failure were gestational hypertension (10.71%),multiple pregnancy (10.71%),polyhydramnios and overweight children (7.14%),acute upper respiratory tract infection (7.14%),pregnant with heart disease (32.14%),pregnant with anemia (35.71%),inadequate prenatal care (21.43%),previous history of heart disease (7.14%).The diesease aggravated in 10 cases (35.71%) due to the neglection of

  5. Commentary: statistics for biomarkers.

    Science.gov (United States)

    Lovell, David P

    2012-05-01

    This short commentary discusses Biomarkers' requirements for the reporting of statistical analyses in submitted papers. It is expected that submitters will follow the general instructions of the journal, the more detailed guidance given by the International Committee of Medical Journal Editors, the specific guidelines developed by the EQUATOR network, and those of various specialist groups. Biomarkers expects that the study design and subsequent statistical analyses are clearly reported and that the data reported can be made available for independent assessment. The journal recognizes that there is continuing debate about different approaches to statistical science. Biomarkers appreciates that the field continues to develop rapidly and encourages the use of new methodologies.

  6. Obstetric anal sphincter injuries

    Institute of Scientific and Technical Information of China (English)

    Remon Keriakos; Deepa Gopinath

    2015-01-01

    Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  7. Obstetric anal sphincter injuries

    Directory of Open Access Journals (Sweden)

    Remon Keriakos

    2015-10-01

    Full Text Available Obstetric anal sphincter injuries can be associated with significant short and long term consequences causing devastating impacts on the quality of lives of young, otherwise healthy women. The major consequence is anal incontinence which may be short or long term and vary in severity. The other consequences include pain, infection, dyspareunia and sexual dysfunction. This may in turn result in considerable economic burden to health care providers and patients. It also has an implication on future deliveries. Although it can never be eliminated, it can be reduced by improving practice, training and provision of high quality multidisciplinary care in order to reduce long-term morbidity. Obstetric anal sphincter injuries are also a source of litigation which can be distressing to both patients and clinicians. The aim of this review article is to explore the available evidence on epidemiology, strategies for preventions, prognosis and also how to deal with governance issues.

  8. Obstetric antiphospholipid syndrome.

    Science.gov (United States)

    Galarza-Maldonado, Claudio; Kourilovitch, Maria R; Pérez-Fernández, Oscar M; Gaybor, Mariana; Cordero, Christian; Cabrera, Sonia; Soroka, Nikolai F

    2012-02-01

    Antiphospholipid syndrome (APS) in pregnancy has a serious impact on maternal and fetal morbidity. It causes recurrent pregnancy miscarriage and it is associated with other adverse obstetric findings like preterm delivery, intrauterine growth restriction, preeclampsia, HELLP syndrome and others. The 2006 revised criteria, which is still valid, is used for APS classification. Epidemiology of obstetric APS varies from one population group to another largely due to different inclusion criteria and lack of standardization of antibody detection methods. Treatment is still controversial. This topic should include a multidisciplinary team and should be individualized. Success here is based on strict control and monitoring throughout pregnancy and even in the preconception and postpartum periods. Further research in this field and unification of criteria are required to yield better therapeutic strategies in the future.

  9. Obstetric Safety and Quality.

    Science.gov (United States)

    Pettker, Christian M; Grobman, William A

    2015-07-01

    Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.

  10. 产科弥漫性血管内凝血的临床诊治分析%Clinical Analysis of Diagnosis and Treatment of Obstetric Disseminated Intravascular Coagulation

    Institute of Scientific and Technical Information of China (English)

    熊炜

    2014-01-01

    目的:探讨产科弥漫性血管内凝血(DIC)的发病原因、临床诊断及治疗措施。方法:回顾性分析本院21例产科DIC患者的临床资料。结果:产科DIC的发病原因依次为重度胎盘早剥者(8例,38.1%)、子痫和先兆子痫(4例,19.0%)、羊水栓塞(3例,14.3%)、产后出血(2例,9.5%)、前置胎盘(1例,4.8%)、死胎(1例,4.8%)、子宫破裂(1例,4.8%)、妊娠合并重症肝炎(1例,4.8%)。21例患者中,抢救成功18例,成功率85.7%,行子宫切除术6例。结论:早期诊断DIC,尽快清除致病因素,及时终止妊娠或切除子宫,大量补充凝血因子和合理使用肝素均为产科DIC的有效治疗措施。%Objective:To investigate the pathogenesis,clinical diagnosis and the treatment measures of obstetrics disseminated intravascular coagulation(DIC).Methods:The clinical data of 21 obstetric patients with DIC were retrospective analyzed.Results:The incidence causes of obstetric DIC were severe placental abruption(8 cases,38.1%),preeclampsia and eclampsia(4 cases,19.0%),amniotic fluid embolism(3 cases,14.3%),postpartum hemorrhage(2 cases,9.5%),placenta previa(1 cases,4.8%),uterine rupture(1 cases,4.8%),stillbirth(1 cases,4.8%),pregnancy complicated with severe hepatitis(1 cases,4.8%).In 21 patients,18 cases were rescued successfully,the success rate was 85.7%,6 cases underwent hysterectomy.Conclusion:The effective treatment of obstetric DIC were the early diagnosis of DIC,as soon as possible to remove pathogenic factors,timely termination of pregnancy or removal of the uterus,supplement of blood coagulation factor and rational use of heparin.

  11. Clinical analysis of 28 cases with obstetric disseminated intravascular coagulation%产科弥漫性血管内凝血28例临床分析

    Institute of Scientific and Technical Information of China (English)

    侯桂玉; 郭跃文

    2014-01-01

    Objective To explore the cause, treatment programs and prognostic factors of obstetric disseminated intravascular coagulation. Methods 28 pregnant women with disseminated intravascular coagulation in our hospital from January 2006 to January 2014 were selected, the cause and clinical manifestations of the pregnant women with disseminated intravascular coagulation were retrospectively analyzed. Results 28 pregnant women were all rescued successfully, no maternal deaths;3 cases had total hysterectomy, 1 case had subtotal hysterectomy, 6 cases had uterine arterial embolization. Fetal condition, 27 neonatal survived, 1 case was intrauterine death, 4 cases were stillbirth, neonatal mortality rate was 15.62%. Patients' coagulation function had significant differences before and after the treatment of disseminated intravascular coagulation. After the treatment, patients' coagulation function had been significantly improved. Conclusion In the treatment of disseminated intravascular coagulation, it is main to remove the cause of disseminated intravascular coagulation, while to give effective hemostasis, add volume and other related symptomatic treatment. It plays a very important role for reservations uterus of uterine arterial embolization and plus line B-Lynch suture uterus when Laparotomy again.%目的:探讨产科弥漫性血管内凝血的发生原因、治疗方案及其预后的影响因素。方法选择2006年1月~2014年1月在我院妇产科收治的28例发生弥漫性血管内凝血的孕妇作为本次临床观察的研究对象,回顾性分析孕妇发生弥漫性血管内凝血的原因及其临床表现,探讨弥漫性血管内凝血的临床治疗效果。结果28例孕妇均抢救成功,无产妇死亡病例;子宫全切除的患者有3例,次全子宫切除患者1例,子宫动脉灌注栓塞术患者6例。胎儿情况,新生儿存活27例,宫内死亡1例,死胎4例,新生儿死亡率为15.62%。患者在弥漫性血管内凝血

  12. 选择性动脉栓塞治疗在产科的临床应用价值%Clinical application value of selective arterial embolism in obstetric department

    Institute of Scientific and Technical Information of China (English)

    刁震; 陈香娟; 陈云琴; 张文淼; 黄引平

    2012-01-01

    Objective: To observe the clinical application value of selective arterial embolism in obstetric department. Methods: Nineteen patients who underwent selective arterial embolism in obstetric department of the hospital were analyzed retrospectively, all the patients underwent right femoral artery puncture and intubation, bilateral internal iliac artery angiography via Seldinger technique, after defining the positions, stopping blood supply by super - selective bilateral uterine artery intubation and infusion of gel foam uterine artery embolism or internal iliac artery embolism were performed. Results: After embolism, bleeding was stopped among the patients with hemorrhage, induced abortion succeeded among the patients with placenta previa, no recurrent bleeding and severe complications occurred. Conclusion: Selective artery embolism is a minimally invasive and effective method for obstetric patients.%目的:观察选择性动脉栓塞治疗在产科的临床应用价值.方法:回顾性分析19例接受选择性动脉栓塞的产科患者,所有病例均采用Seldinger技术行右股动脉穿刺插管双侧髂内动脉造影,明确部位后,超选择双侧子宫动脉插管注入明胶海绵颗粒,阻断供血,行子宫动脉或髂内动脉栓塞.结果:栓塞术后,产后出血患者出血停止,前置胎盘患者成功引产,所有患者均无复发出血及严重并发症发生.结论:选择性动脉栓塞是治疗产科患者微创、有效的方法.

  13. OBSTETRIC RENAL FAILURE

    Directory of Open Access Journals (Sweden)

    Rajeshwari

    2015-11-01

    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  14. Obstetric Care Specialist Nursing Experience and Experience of Clinical Teaching%产科护理专科临床带教的护理经验与体会

    Institute of Scientific and Technical Information of China (English)

    崔莹

    2015-01-01

    目的:探讨产科护理专科临床带教的护理经验与体会。方法针对《妇产科护理学》中的教材内容,按照整体护理的步骤对妇科产科进行护理教学;在授课过程中把妇科产科的护理和诊断、护理的措施、护理评估的方法作为重点;在实验课堂中,结合基础护理的操作技能和妇科产科的护理技能进行操作,达到了统一分类的目标。结果护理专业技能加强训练,从而妇科产科护理质量提高。给护理人员带来先进的护理理念,更好的提高服务质量。掌握产妇及家属的心理,适应和患者沟通。注重管理和考核,护士的产科护理技能要提高。因为产科护理的要求特殊,所以老师要认真教学和实际操作来传授技能。护士需要各方面能力的培养来符合现代护理的要求。老师带动护理人员熟悉她们的工作环境,消除压力。对于产科护理而言,尤为重要的是护理人员和孕产妇以及家属的沟通交流。带教老师要亲身示范表现奉献的精神,对护理人员的职业道德教育要加强。要教育护生既然选择了护士职业就应该全身投入。加强护生法律法规教育,提高护生法律意识。举事例,鸣警钟,在实习中自觉约束自己。结论护理学中最重要的环节就是临床实践,护理人员在临床实践中不仅要学会理论知识和技能,还要加强职业道德和人文素养,让实习护士能够更好的成为一名合格的护士。%Objective To investigate the obstetric nursing specialty nursing experience and experience of clinical teaching. Methods In the gynecology and obstetrics nursing teaching material content, according to the steps of general nursing for gynecology obstetrics nursing teaching; In the process of teaching the obstetric nursing diagnosis, nursing and measures of department of gynaecology, nursing assessment method as the key, In the experimental class

  15. Ultrasound in obstetric anaesthesia: a review of current applications.

    LENUS (Irish Health Repository)

    Ecimovic, P

    2010-07-01

    Ultrasound equipment is increasingly used by non-radiologists to perform interventional techniques and for diagnostic evaluation. Equipment is becoming more portable and durable, with easier user-interface and software enhancement to improve image quality. While obstetric utilisation of ultrasound for fetal assessment has developed over more than 40years, the same technology has not found a widespread role in obstetric anaesthesia. Within the broader specialty of anaesthesia; vascular access, cardiac imaging and regional anaesthesia are the areas in which ultrasound is becoming increasingly established. In addition to ultrasound for neuraxial blocks, these other clinical applications may be of value in obstetric anaesthesia practice.

  16. Obstetric medical care in Canada.

    Science.gov (United States)

    Magee, Laura A; Cote, Anne-Marie; Joseph, Geena; Firoz, Tabassum; Sia, Winnie

    2016-09-01

    Obstetric medicine is a growing area of interest within internal medicine in Canada. Canadians continue to travel broadly to obtain relevant training, particularly in the United Kingdom. However, there is now a sufficient body of expertise in Canada that a cadre of 'home-grown' obstetric internists is emerging and staying within Canada to improve maternity care. As this critical mass of practitioners grows, it is apparent that models of obstetric medicine delivery have developed according to local needs and patterns of practice. This article aims to describe the state of obstetric medicine in Canada, including general internal medicine services as the rock on which Canadian obstetric medicine has been built, the Canadian training curriculum and opportunities, organisation of obstetric medicine service delivery and the future.

  17. Potential Impact of Obstetrics and Gynecology Hospitalists on Safety of Obstetric Care.

    Science.gov (United States)

    Srinivas, Sindhu K

    2015-09-01

    Staffing models are critical aspects of care delivery. Provider staffing on the labor and delivery unit has recently received heightened attention. Based on the general medicine hospitalist model, the obstetrics and gynecology hospitalist or laborist model of obstetric care was introduced more than a decade ago as a plausible model-of-care delivery to improve provider satisfaction, with the goal of also improving safety and outcomes through continuous coverage by providers whose sole focus was on the labor and delivery unit without other competing clinical duties. It is plausible that this model of provider staffing and care delivery will increase safety.

  18. [Selective embolization to treat obstetric hemorrhage].

    Science.gov (United States)

    Ferrer Puchol, M D; Lanciego, C; Esteban, E; Ciampi, J J; Edo, M A; Ferragud, S

    2014-01-01

    To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  19. To the point: obstetrics and gynecology global health experiences for medical students.

    Science.gov (United States)

    Hampton, Brittany S; Chuang, Alice W; Abbott, Jodi F; Buery-Joyner, Samantha D; Cullimore, Amie J; Dalrymple, John L; Forstein, David A; Hueppchen, Nancy A; Kaczmarczyk, Joseph M; Page-Ramsey, Sarah; Pradhan, Archana; Wolf, Abigail; Dugoff, Lorraine

    2014-07-01

    This article, from the To the Point series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides educators with an overview of considerations for obstetrics and gynecology global health experiences for the medical student. Options for integration of obstetrics and gynecology global health into undergraduate medical curricula are discussed. Specific considerations for global health clinical experiences for medical students, including choosing a clinical location, oversight and mentorship, goals and objectives, predeparture preparation, and evaluation, are reviewed.

  20. 对妇产科患者术后疼痛行综合护理干预的临床观察%Observation Clinical Comprehensive Nursing Intervention of Patients With Postoperative Pain in Gynaecology and Obstetrics

    Institute of Scientific and Technical Information of China (English)

    王祯

    2015-01-01

    目的:探讨妇产科患者术后疼痛行综合护理干预的临床效果。方法随机将340例妇产科术后疼痛患者分为两组,对照行常规护理,观察组行护理干预。结果观察组护理第3 d VAS评分优于治疗前、对照组,P<0.05,差异具有统计学意义。结论采用护理干预措施,可改善术后症状。%Objective To explore the gynecology and obstetrics patients with postoperative pain the clinical effect of comprehensive nursing intervention. Methods 340 cases of gynecology and obstetrics patients with postoperative pain randomly divided into two groups, routine nursing care, nursing intervention group. Results Observation group care before 3 d VAS score was signiifcantly superior to treatment and control group (P<0. 05). Conclusion The nursing intervention measures, can obviously improve the symptoms.

  1. 八年制医学生妇产科实习中综合能力的培养%Construction of mixed ability in eight-year program clinical teaching of obstetrics and gynecology

    Institute of Scientific and Technical Information of China (English)

    李科珍; 孙文君; 刘蔚; 何晓峰; 刘丽江

    2012-01-01

    华中科技大学是首批试办八年制医学教育的5所学校之一.2010年同济医学院八年制学生进入妇产科实习后,教研室根据八年制医学教育的培养目标和妇产科的教学特点,综合运用PBL教学、全病程管理、典型病例集中讨论、参与临床诊疗操作、参加学术讲座、参与科研报告会、参与实验设计、参与科研实验等多种措施,对现有的实习教学模式进行了改革;圆满地完成了实习带教任务,取得了较好的教学效果.%Huazhong University of Science and Technology is one of the five schools that trial implementing eight-year program medical education of first batch.Eight-year program medical students in Tongji college came into obstetrics and gynecology clinical contact in 2010.According to the characteristics of students and discipline,obstetrics and gynecology department used multiple teaching methods and means as PBL teaching,integrated case management,typical clinical case conference,clinical diagnosis and treatment,academic lecture,research report,experimental design,scientific research and experi-ment,etc.Available practice mode was reformed.Those students accomplished clinical practice,and achieved expected effect.

  2. Obstetric risk indicators for labour dystocia in nulliparous women

    DEFF Research Database (Denmark)

    Kjaergaard, Hanne; Olsen, Jørn; Ottesen, Bent

    2008-01-01

    In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often...... do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria....

  3. Continuous Renal Replacement Therapy for Severe Obstetric Sepsis

    Directory of Open Access Journals (Sweden)

    D. L. Shukevich

    2010-01-01

    Full Text Available Objective: to improve the results of treatment for severe obstetric sepsis by pathogenetically founded continuous renal replacement therapies as extracorporeal homeostatic correction. Subjects and methods. Forty-two women with severe abdominal sepsis were divided into 3 groups: 1 14 women with severe extragenital abdominal sepsis who received standard intensive care (a control group; 2 12 women with severe obstetric sepsis who had standard intensive care (a study group; 3 16 with severe obstetric sepsis who had the standard intensive care supplemented with continuous renal replacement therapy (an intervention group. Results. In Group 2, endogenous intoxication and multiple organ dysfunction were controlled later than in Group 1, mortality rates being 41.7 and 7.1%, respectively. Clinical laboratory differences were due to gestosis recorded in 100% of the patients with severe obstetric sepsis. When continuous renal replacement therapy was incorporated into the complex therapy of severe obstetric sepsis, there was a prompter regression of endogenous intoxication and multiple organ dysfunction, mortality was decreased by an average of 35% as compared with that during standard therapy. Conclusion. The inclusion of continuous renal replacement therapy into the complex treatment program for severe obstetric sepsis made it possible to reduce control time _ for endogenous intoxication and multiple organ dysfunction and to decrease mortality by an average of 35% as compared with that during standard intensive care. Key words: obstetric sepsis, abdominal sepsis, gestosis, endogenous intoxication, multiple organ dysfunction, renal replacement therapy.

  4. Commentary on measuring disability.

    Science.gov (United States)

    Goldman, Howard H

    2013-09-01

    This is a commentary on 5 articles in this issue of Archives of Physical Medicine and Rehabilitation that report on several related studies of new approaches to measuring disability. The project was grounded in theory, beginning with the development of a conceptual framework enhanced by a literature review and expert consultation within and outside of the Social Security Administration. The investigators then used item response theory to develop test items, which they organized into computer adaptive testing instruments and tested them for their psychometric properties. All in all, it is a groundbreaking set of studies and an enormously valuable contribution to the field. Hopefully it will also be tested as an alternative approach to assessing disability in the Social Security Administration disability benefits programs.

  5. Developing obstetric medicine training in Latin America.

    Science.gov (United States)

    Rojas-Suarez, José; Suarez, Niza; Ateka-Barrutia, Oier

    2017-03-01

    Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care. The impact of nonobstetric and medical pathologies on maternal mortality in Latin America is largely unknown. In Latin America, two educational initiatives have been proposed to improve skills in maternity care. The Advanced Life Support in Obstetrics (ALSO®) was first started to address obstetric emergencies, and subsequently adapted for low-middle-income country settings as the Global ALSO®. In parallel, the Latin American obstetric anesthesia community has progressively focused on improvement of several intrapartum/intraoperative issues, which has secondarily taken them to embrace the obstetric medicine area on interest and join the former initiatives. In the present review, we summarize the available data regarding medical morbidity and mortality in pregnancy in Latin America, as well as the challenges, achievements, issues, initiatives, and future directions encouraging maternal health educators, health care trainers, and physicians in middle- and low-income countries, such as many Latin American ones, to improve and/or change attitudes, if needed, on current clinical practice.

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

    Science.gov (United States)

    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.

  7. 产科急性弥漫性血管内凝血的临床表现及治疗措施分析%Acute Disseminated Intravascular Coagulation in Obstetrics Clinical Manifestations and Treatment Measures

    Institute of Scientific and Technical Information of China (English)

    黄意锋

    2013-01-01

    目的:分析产科急诊弥漫性血管内凝血的临床表现及治疗措施。方法:抽取本院治疗的18例急性弥漫性血管内凝血孕妇的临床资料进行回顾性分析。结果:经分析,这些患者的临床中表现主要为:大出血,并且血液不凝。经过积极治疗,其中包括治疗原发病、补充血液以及手术等,15例成功抢救,3例死亡,其中12例切除子宫,其抢救成功率高达83.3%。结论:产科患者一旦发现出血症状,应立即采取措施进行治疗。%Objective:Analysis of emergency obstetric disseminated intravascular coagulation in the clinical presentation and treatment measures.Methods: Collected from this hospital treatment of 18 cases of acute disseminated intravascular coagulation in pregnant women were retrospectively reviewed the clinical data analysis.Results:Through analysis, these patients in the clinical manifestations are mainly:bleeding, and blood coagulation.After active treatment, including treatment of primary disease, supplement blood as well as operation, 15 cases of successful rescue, 3 patients died, including 12 cases of hysterectomy, rescue success rate as high as 83.3%.Conclusion: Obstetric patients once found bleeding symptoms, immediate measures should be taken for treatment.

  8. More Accurate Definition of Clinical Target Volume Based on the Measurement of Microscopic Extensions of the Primary Tumor Toward the Uterus Body in International Federation of Gynecology and Obstetrics Ib-IIa Squamous Cell Carcinoma of the Cervix

    Energy Technology Data Exchange (ETDEWEB)

    Xie, Wen-Jia [Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Wu, Xiao [Department of Pathology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Xue, Ren-Liang; Lin, Xiang-Ying [Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Kidd, Elizabeth A. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Yan, Shu-Mei [Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province (China); Zhang, Yao-Hong [Department of Radiation Oncology, Chaozhou Hospital of Chaozhou City, Guangdong Province (China); Zhai, Tian-Tian; Lu, Jia-Yang; Wu, Li-Li; Zhang, Hao [Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Huang, Hai-Hua [Department of Pathology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Chen, Zhi-Jian; Li, De-Rui [Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China); Xie, Liang-Xi, E-mail: xieliangxi1@qq.com [Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province (China)

    2015-01-01

    Purpose: To more accurately define clinical target volume for cervical cancer radiation treatment planning by evaluating tumor microscopic extension toward the uterus body (METU) in International Federation of Gynecology and Obstetrics stage Ib-IIa squamous cell carcinoma of the cervix (SCCC). Patients and Methods: In this multicenter study, surgical resection specimens from 318 cases of stage Ib-IIa SCCC that underwent radical hysterectomy were included. Patients who had undergone preoperative chemotherapy, radiation, or both were excluded from this study. Microscopic extension of primary tumor toward the uterus body was measured. The association between other pathologic factors and METU was analyzed. Results: Microscopic extension toward the uterus body was not common, with only 12.3% of patients (39 of 318) demonstrating METU. The mean (±SD) distance of METU was 0.32 ± 1.079 mm (range, 0-10 mm). Lymphovascular space invasion was associated with METU distance and occurrence rate. A margin of 5 mm added to gross tumor would adequately cover 99.4% and 99% of the METU in the whole group and in patients with lymphovascular space invasion, respectively. Conclusion: According to our analysis of 318 SCCC specimens for METU, using a 5-mm gross tumor volume to clinical target volume margin in the direction of the uterus should be adequate for International Federation of Gynecology and Obstetrics stage Ib-IIa SCCC. Considering the discrepancy between imaging and pathologic methods in determining gross tumor volume extent, we recommend a safer 10-mm margin in the uterine direction as the standard for clinical practice when using MRI for contouring tumor volume.

  9. Major obstetric hemorrhage.

    Science.gov (United States)

    Mercier, Frederic J; Van de Velde, Marc

    2008-03-01

    Major obstetric hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, and is associated with a high rate of substandard care. A well-defined and multidisciplinary approach that aims to act quickly and avoid omissions or conflicting strategies is key. The most common etiologies of hemorrhage are abruptio placenta, placenta previa/accreta, uterine rupture in the antepartum period and retained placenta, uterine atony, and genital-tract trauma in the postpartum period. Basic treatment of postpartum hemorrhage relies on manual removal of the placenta or manual exploration of the uterus plus bladder emptying and oxytocin administration. If this does not arrest bleeding, or if there is any suspicion of genital-tract trauma, examination of the vagina and cervix with appropriate valves and analgesia/anesthesia must follow quickly. Postpartum uterine atony resistant to oxytocin must be treated with prostaglandin within 15 to 30 minutes; uterine balloon tamponade can be also useful at this stage. Aggressive transfusion therapy and resuscitation are mandatory in major obstetric hemorrhage. Specific invasive treatment must be considered within no more than 30 to 60 minutes, if previous measures have failed -- and even earlier in some particular etiologies. The two main options are radiologic embolization and surgical artery ligations. Recombinant factor VIIa may also be considered, but should not delay the performance of a life-saving procedure such as embolization or surgery. Hysterectomy must be implemented when all other interventions have failed.

  10. 产科弥散性血管内凝血患者的诱发因素和治疗效果探讨%Discussion on the predisposing factors and clinical efficacy of obstetric patients with disseminated intravascular coagulation

    Institute of Scientific and Technical Information of China (English)

    吴玲

    2015-01-01

    Objective:To investigate the clinical efficacy and predisposing factors of obstetric patients with disseminated intravascular coagulation.Methods:100 patients with disseminated intravascular coagulation were selected.They were randomly divided into two equal groups according to the order of admission.Patients in the control group were given routine treatment. Patients in the experimental group received supportive treatment on the basis of the control group.We observed the predisposing factors of obstetric patients with disseminated intravascular coagulation,and observed the clinical therapeutic effect of the two groups after treatment and the amount of bleeding.Results:Predisposing factors included amniotic fluid embolism,placental abruption,fetal death,postpartum hemorrhage and pregnancy induced hypertension.The amount of bleeding within 24 hours after treatment of the experimental group was significantly lower than the control group,the rescue efficiency was higher than the control group,the differences between the groups were statistically significant(P<0.05).Conclusion:Strengthen support for treatment on the basis of conventional therapy had significant effect on the treatment of obstetric disseminated intravascular coagulation and reduce the bleeding.%目的:探讨产科弥散性血管内凝血患者的诱发因素和临床疗效。方法:收治弥散性血管内凝血患者100例,按照入院顺序随机均分为两组,对照组予以常规治疗,试验组在对照组的基础上予以支持治疗,观察产科弥散性血管内凝血患者的诱发因素,治疗后观察两组的临床治疗效果与出血量。结果:诱发因素包括羊水栓塞、胎盘早剥、死胎、产后出血及妊娠期高血压。试验组患者治疗的24 h 内出血量明显少于对照组,抢救有效率也明显高于对照组,组间差异具有统计学意义(P<0.05)。结论:常规治疗基础上加强支持治疗对治疗产科弥散性血管内凝

  11. Improving the Ability of Medical Students ’ Doctor-patient Communication of Gynecology and Obstetrics in Clinical Practice%提高妇产科医学生在临床实践中的医患沟通能力

    Institute of Scientific and Technical Information of China (English)

    安闻; 卢美松

    2014-01-01

    With the improvement of living standards ,the demand for health care ,legal consciousness and concept of human rights has increased .The requirements for public medical services provided by the medical staff get higher and individual expectancy become more and more high .Sensitive and com-plex doctor-patient relationship become the focus of society .In the process of the clinical diagnosis and treatment of obstetrics and gynecology ,the complexity and its ow n privacy highlights the importance of the doctor-patient relationship .The lack of doctor-patient communication often leads to high inci-dence of medical disputes .As a result ,improving the ability of doctor-patient communication of medi-cal students is a necessary measures to prevent medical disputes .This study explores the importance of the doctor-patient communication skills in the work of obstetrics and gynecology and expounds the communication skills in front of different situation of communication in obstetrics and gynecology clin-ical work .%随着居民生活水平的不断提高,人们对医疗保健的要求也随之提高,法律意识和维权观念愈发增强。社会对医务人员的要求越来越严格,期望也越来越高。敏感而复杂的医患关系成为人们关心的重点问题。在妇产科的整个临床诊疗过程中,因为它自身的隐私性及其复杂性,更加突显了医患关系的重要意义。医患沟通能力的短缺常常是引起高发生率医患纠纷的导火索。因此,增强医患沟通能力是有效避免发生医疗纠纷的必要措施。本文探讨在妇产科工作中提高医学生医患沟通能力的重要意义,着重阐述了在妇产科临床工作中不同情境下的医患沟通要点以及沟通技巧。

  12. Obstetric outcome with low molecular weight heparin therapy during pregnancy.

    LENUS (Irish Health Repository)

    Donnelly, J

    2012-01-01

    This was a prospective study of women attending a combined haematology\\/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6\\/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.

  13. [110 years--University Obstetrics and Gynecology Hospital "Maichin dom"].

    Science.gov (United States)

    Zlatkov, V

    2014-01-01

    The first specialized Obstetrics and Gynecology Hospital in Bulgaria was founded based on the idea of Queen Maria Luisa (1883). Construction began in 1896 and the official opening of the hospital took place on November 19, 1903. What is unique about the University Obstetrics and Gynecology Hospital "Maichin dom" is above all the fact that the Bulgarian school of obstetrics and gynecology was founded within its institution. Currently, the hospital has nearly 400 beds and 600 employees who work at nine clinics and six laboratories, covering the entire spectrum of obstetric and gynecological activities. Its leading specialists still continue to embody the highest level of professionalism and dedication. The future development of the hospital is chiefly associated with the renovation of facilities, resources and equipment and with the enhancement of the professional competence of the staff and of the quality of hospital products to improve the health and satisfaction of the patients.

  14. A COMPARATIVE STUDY ABOUT THE INCIDENCE OF CONGENITAL ABNORMALITIES OF THE NEW BORN CHILDREN AT OBSTETRICS AND GYNAECOLOGY CLINICAL HOSPITAL OF ORADEA, BIHOR COUNTY, IN THE YEARS OF 1987 AND 2002

    Directory of Open Access Journals (Sweden)

    Ioana Mihaela Tomulescu

    2003-01-01

    Full Text Available This study is about the incidence of congenital abnormalities in two populations of new born children at Obstetrics and Gynaecology Clinical Hospital of Oradea. First population is represented by the children that were born in the year of 1987. The second population is represented by the children that were born in the year of 2002. We selected these years for this study, because the policy about births is different in the two mentined years. Comparatively with 1987, the abortion is legal. The results are meaningful, because we observed that number of children with congenital abnormalities is bigger in 2002 comparatively with 1987. In spite of all this, the birth rate is smaller in 2002 comparatively with 1987. also, we obtained a significant increased frequency of digestive apparatus congenital abnormalities in comparison with 1987.

  15. Early Course in Obstetrics Increases Likelihood of Practice Including Obstetrics.

    Science.gov (United States)

    Pearson, Jennifer; Westra, Ruth

    2016-10-01

    The Department of Family Medicine and Community Health Duluth has offered the Obstetrical Longitudinal Course (OBLC) as an elective for first-year medical students since 1999. The objective of the OBLC Impact Survey was to assess the effectiveness of the course over the past 15 years. A Qualtrics survey was emailed to participants enrolled in the course from 1999-2014. Data was compiled for the respondent group as a whole as well as four cohorts based on current level of training/practice. Cross-tabulations with Fisher's exact test were applied and odds ratios calculated for factors affecting likelihood of eventual practice including obstetrics. Participation in the OBLC was successful in increasing exposure, awareness, and comfort in caring for obstetrical patients and feeling more prepared for the OB-GYN Clerkship. A total of 50.5% of course participants felt the OBLC influenced their choice of specialty. For participants who are currently physicians, 51% are practicing family medicine with obstetrics or OB-GYN. Of the cohort of family physicians, 65.2% made the decision whether to include obstetrics in practice during medical school. Odds ratios show the likelihood of practicing obstetrics is higher when participants have completed the OBLC and also are practicing in a rural community. Early exposure to obstetrics, as provided by the OBLC, appears to increase the likelihood of including obstetrics in practice, especially if eventual practice is in a rural community. This course may be a tool to help create a pipeline for future rural family physicians providing obstetrical care.

  16. [Centralization in obstetrics: pros and cons].

    Science.gov (United States)

    Roemer, V M; Ramb, S

    1996-01-01

    Possible advantages and disadvantages of a general centralization of German obstetric facilities are analysed in the study. The need for centralization of risk cases, especially premature births (regionalization) is pointed out. Centralization appears appropriate, since every fifth maternity unit in Germany (19.78%) has 300 or fewer deliveries per year. This one fifth of perinatal clinics accounts for 6.3% of all deliveries (N = 49450). There are appreciable differences between the old and new federal states (Bundesländer): in the recently acceded federal states, 48.7% of all perinatal clinics have deliveries of 300 and less per year. This group of perinatal clinics accounts for 29% of all deliveries in the new federal states. We have carried out a survey of the mother's attitude to centralization: out of 416 patients in the Detmold women's hospital whose mean age was 29.0 +/- 4.2 years, 90.4% were not in favor of general centralization of obstetrics. 43% were also against a centralization of risk cases (regionalization). 75% of the women surveyed objected to centralized obstetrics because of the 'possible absence of the family', the 'possible absence of students and trainees' (44.9%), the 'unfamiliarity with staff and premises' (41.8%) and 'fear of anonymity' (44.5%). The majority of all women (84.1%) did not want to have a drive more than 20 km to an obstetrics center. Fear of 'delivery in a taxi'(78.6%), the 'fear that the husband will come too late to the delivery' (65.4%) and that the 'overall course of the delivery might not be adequate for reasons of time'. The presence of a pediatrics department in conjunction with the perinatal clinic was rated very positively (93%). It is concluded from the data and further juridical considerations that centralization of risk cases (regionalization) is indispensable in the near future and that somewhat more further into the future decentralization should be carried out by closing obstetrics departments with substantially

  17. Medawar's legacy to cellular immunology and clinical transplantation: a commentary on Billingham, Brent and Medawar (1956) 'Quantitative studies on tissue transplantation immunity. III. Actively acquired tolerance'.

    Science.gov (United States)

    Simpson, Elizabeth

    2015-04-19

    'Quantitative studies on tissue transplantation immunity. III. Actively acquired tolerance', published in Philosophical Transactions B in 1956 by Peter Medawar and his colleagues, PhD graduate Leslie Brent and postdoctoral fellow Rupert Billingham, is a full description of the concept of acquired transplantation tolerance. Their 1953 Nature paper (Billingham RE et al. 1953 Nature 172, 603-606. (doi:10.1038/172603a0)) had provided initial evidence with experimental results from a small number of neonatal mice, with mention of similar findings in chicks. The Philosophical Transactions B 1956 paper is clothed with an astonishing amount of further experimental detail. It is written in Peter Medawar's landmark style: witty, perceptive and full of images that can be recalled even when details of the supporting information have faded. Those images are provided not just by a series of 20 colour plates showing skin graft recipient mice, rats, rabbits, chickens and duck, bearing fur or plumage of donor origin, but by his choice of metaphor, simile and analogy to express the questions being addressed and the interpretation of their results, along with those of relevant published data and his prescient ideas of what the results might portend. This work influenced both immunology researchers and clinicians and helped to lay the foundations for successful transplantation programmes. It led to the award of a Nobel prize in 1960 to Medawar, and subsequently to several scientists who advanced these areas. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.

  18. Defining Functions of Danish Political Commentary

    DEFF Research Database (Denmark)

    Bengtsson, Mette

    2011-01-01

    In Denmark political commentary is still a relatively new phenomenon. This paper analyzes the metadiscourse in relation to political commentary to identify the different understandings that have coalesced around political commentary as a genre. I argue that people in different positions (e.g. cit...

  19. Clinical characteristics of critically ill obstetric patients in intensive care unit: analysis of 476 cases%476例入住重症监护病房的危重孕产妇的临床特征

    Institute of Scientific and Technical Information of China (English)

    汤雯婷; 龚景进; 匡丽云; 李秀英; 李晓梅; 潘燕梅; 杜丽丽; 苏春宏; 陈敦金

    2015-01-01

    Objective To explore the clinical characteristics of critically ill obstetric patients in intensive care unit (ICU) and the short-term perinatal outcomes.Methods The clinical data of 476 critically ill obstetric patients in ICU, who delivered in the Third Affiliated Hospital of Guangzhou Medical University from June 2009 to June 2014, were retrospectively analyzed.All subjects were divided into obstetric related diseases group (Group 1) and non-obstetric related diseases group (Group 2) according to the reasons for ICU admission.The perinatal outcomes of the two groups were compared by Wilcoxon-test and Chi-square test.Results Totally, 476 critically ill obstetric patients were transferred to ICU accounting for 1.71% of all deliveries during the 5-year period (476/27 836), with the mean age of (29.04±5.77) years and the mean gestational age of (32.00±5.63) weeks.Among them, 261 women were assigned to Group 1 (54.83%) and 215 to Group 2 (45.17%).The first three reasons for ICU admission in Group 1 were hypertensive disorder complicating pregnancy (35.29%, 168/476), postpartum hemorrhage (11.97%, 57/476) and acute fatty liver of pregnancy (2.31%, 11/476) and those in Group 2 were pregnancy with acute severe hepatitis (7.56%, 36/476), pregnancy with severe pneumonia 5.67%(27/476) and pregnancy with congenital heart disease (3.57%, 17/476) and pregnancy with acute severe pancreatitis (3.57%, 17/476) tie for the third place.The average age and the proportion of irregular prenatal care of the patients in Group 1 were both higher than those in Group 2 [(30.02± 5.62) vs (27.85± 5.75) years, Z=4.198, P=0.000;75.86% (198/261) vs 61.40% (132/215), x2=11.603, P=0.001].More than half of the pregnant women ended in emergency cesarean section (56.71%,148/261) in Group 1, while the most common delivery mode was elective cesarean section in Group 2 when patients were clinically stable (45.58%, 98/215) (x2=21.990, P=0.000).The mortality rate in Group

  20. Non-haemorrhagic obstetric shock.

    Science.gov (United States)

    Thomson, A J; Greer, I A

    2000-02-01

    The causes of non-haemorrhagic obstetric shock (pulmonary thromboembolism, amniotic fluid embolism, acute uterine inversion and sepsis) are uncommon but responsible for the majority of maternal deaths in the developed world. Clinically suspected pulmonary thromboembolism should be treated initially with heparin and objective testing should be performed. If the diagnosis is confirmed, heparin is usually continued until delivery, following which anticoagulation in the puerperium is achieved with either warfarin or heparin. Amniotic fluid embolism is a rare complication of pregnancy, occurring most commonly during labour. The management of amniotic fluid embolism involves maternal oxygenation, the maintenance of cardiac output and blood pressure, and the management of any associated coagulopathy. Acute uterine inversion arises most commonly following mismanagement of the third stage of labour. The shock in uterine inversion is neurogenic in origin, although there may also be profound haemorrhage. The management of this condition includes maternal resuscitation and replacement of the uterus either manually, surgically or by hydrostatic pressure. Genital tract sepsis remains a significant cause of maternal death, the most common predisposing factor being prolonged rupture of the fetal membranes. The management of septic shock in pregnancy includes resuscitation, identification of the source of infection and alteration of the systemic inflammatory response.

  1. SERVQUAL评价法在产科护理服务质量评价中的应用效果%THE CLINICAL EFFECT OF SERVQUAL EVALUATING METHOD IN OBSTETRICAL DE-PARTMENT NURSING QUALITY MANAGEMENT

    Institute of Scientific and Technical Information of China (English)

    陈晓芳; 钟丽红; 郑雪珍; 付清梅; 涂晋梅

    2015-01-01

    目的:探讨SERVQUAL测评法的管理理念与方法在产科护理质量管理中对提高护理质量与病人满意度中的效果。方法利用SERVQUAL测评法根据五个维度的标准制定调查问卷,了解病人的感受-期望差异,对服务质量测量范围的界定,依据SERVQUAL方法找存在问题的方面,提出相应整改措施。结果除SQC值,五维度的服务质量SQ值( SQA、SQB、SQD、SQE)得分均为负值,说明我科的总体服务质量不太乐观,服务质量有待提高。通过针对性地改进及护士主动服务后,患者的护理满意度较前明显提高,差异具有显著性( p<0.05)。结论实施SERVQUAL测评法有助于护理人员更确切体会到“感受-期望”的差异,有利于提高管理效力和护理质量,提高患者对护理工作的满意度。%Objective To investigate the measure for conducting the SERVQUAL evaluating method in ob-stetrical department nursing quality management , and then to evaluate the nursing quality and patients'satisfaction rate of SERVQUAL evaluating method .Methods SERVQUAL investigating questionnaire was established based on five dimensionalities standard in order to investigate feeling -expectation difference and the range of service quality measuring from patients .According to questionnaire results , we find out problems and improve nursing quality ac-cording to SERVQUAL method.Results Except the SQC value , the SQA, SQB, SQD and SQE values of SE-RVQUAL evaluating method were negative , which showed that the overall service quality was not very optimistic in our obstetrical department and had yet to be improved .Through corresponding targeted improvements , the satisfaction rate of patients in obstetrical nursing was improved and the difference was statistically significant (p<0.05).Con-clusion The SERVQUAL evaluating method in obstetrical department is valuable for the nurses to realize the differ -ence between feeling and

  2. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan.

    Directory of Open Access Journals (Sweden)

    Junichi Hasegawa

    Full Text Available The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP after 33 weeks' gestation in Japan.This retrospective case cohort study (1:100 cases and controls used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks.One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%, umbilical cord abnormalities (15%, maternal complications (10%, and neonatal complications (1%. A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028-69.032, uterine rupture (RR: 24.770, 95% CI: 6.006-102.160, placental abruption (RR: 20.891, 95% CI: 11.817-36.934, and preterm labor (RR: 3.153, 95% CI: 2.024-4.911, whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088-0.450 and elective cesarean section (RR: 0.236, 95% CI: 0.067-0.828.CP after 33 weeks' gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption.

  3. Relevant Obstetric Factors for Cerebral Palsy: From the Nationwide Obstetric Compensation System in Japan

    Science.gov (United States)

    Hasegawa, Junichi; Toyokawa, Satoshi; Ikenoue, Tsuyomu; Asano, Yuri; Satoh, Shoji; Ikeda, Tomoaki; Ichizuka, Kiyotake; Tamiya, Nanako; Nakai, Akihito; Fujimori, Keiya; Maeda, Tsugio; Masuzaki, Hideaki; Suzuki, Hideaki; Ueda, Shigeru

    2016-01-01

    Objective The aim of this study was to identify the relevant obstetric factors for cerebral palsy (CP) after 33 weeks’ gestation in Japan. Study design This retrospective case cohort study (1:100 cases and controls) used a Japanese national CP registry. Obstetric characteristics and clinical course were compared between CP cases in the Japan Obstetric Compensation System for Cerebral Palsy database and controls in the perinatal database of the Japan Society of Obstetrics and Gynecology born as live singleton infants between 2009 and 2011 with a birth weight ≥ 2,000 g and gestation ≥ 33 weeks. Results One hundred and seventy-five CP cases and 17,475 controls were assessed. Major relevant single factors for CP were placental abnormalities (31%), umbilical cord abnormalities (15%), maternal complications (10%), and neonatal complications (1%). A multivariate regression model demonstrated that obstetric variables associated with CP were acute delivery due to non-reassuring fetal status (relative risk [RR]: 37.182, 95% confidence interval [CI]: 20.028–69.032), uterine rupture (RR: 24.770, 95% CI: 6.006–102.160), placental abruption (RR: 20.891, 95% CI: 11.817–36.934), and preterm labor (RR: 3.153, 95% CI: 2.024–4.911), whereas protective factors were head presentation (RR: 0.199, 95% CI: 0.088–0.450) and elective cesarean section (RR: 0.236, 95% CI: 0.067–0.828). Conclusion CP after 33 weeks’ gestation in the recently reported cases in Japan was strongly associated with acute delivery due to non-reassuring fetal status, uterine rupture, and placental abruption. PMID:26821386

  4. Determinants of health-related quality of life in the postpartum period after obstetric complications

    NARCIS (Netherlands)

    Prick, Babette W.; Bijlenga, Denise; Jansen, A. J. Gerard; Boers, Kim E.; Scherjon, Sicco A.; Koopmans, Corine M.; van Pampus, Marielle G.; Essink-Bot, Marie-Louise; van Rhenen, Dick J.; Mol, Ben W.; Duvekot, Johannes J.

    2015-01-01

    Objective: To determine the influence of socio-demographic, clinical parameters and obstetric complications on postpartum health-related quality of life (HRQoL). Study design: We used data of three randomized controlled trials to investigate HRQoL determinants in women after an obstetric complicatio

  5. Commentary: Biochemistry Re-Natured

    Science.gov (United States)

    White, Harold B.

    2010-01-01

    In his last commentary on "Biochemistry Denatured," this author dealt with his perception that college students today have spent too little of their childhood years playing outside in nature and as a consequence have not learned basic things about the world from personal experience. This "nature-deficit disorder" removes many opportunities for…

  6. A tale of three blind men on the proper subject matter of clinical science and practice: commentary on Plaud's behaviorism vs. Ilardi and Feldman's cognitive neuroscience.

    Science.gov (United States)

    Forsyth, J P; Kelly, M M

    2001-09-01

    Plaud (J Clin Psychol 57, 1089-1102, 1109-1111, 1119-1120) and Ilardi and Feldman (J Clin Psychol 57, 1067-1088, 1103-1107, 1113-1117, 1121-1124) argue for two very different approaches to clinical science and practice (i.e., behavior analysis and cognitive neuroscience, respectively). We comment on the assets and liabilities of both perspectives as presented and attempt to achieve some semblance of balance between the three protagonists embroiled in this current debate. The vision of clinical science we articulate is more ecumenical and evolutionary, rather than paradigmatic and revolutionary. As we see it, the problem clinical psychology faces is much larger than the authors let on; namely, how best to make clinical science meaningful and relevant to practitioners, consumers, the general public, and the behavioral health-care community. Clinical psychology's immediate internal problem is not pluralism with regard to subject matter, worldview, methodology, or school of thought, but pluralism in clinical psychologists' adherence to a scientific epistemology as the only legitimate form of clinical psychology. On this latter point, we still have a very long way to go. Copyright 2001 John Wiley & Sons, Inc.

  7. Quality of Care and Disparities in Obstetrics.

    Science.gov (United States)

    Howell, Elizabeth A; Zeitlin, Jennifer

    2017-03-01

    Growing attention is being paid to obstetric quality of care as patients are pressing the health care system to measure and improve quality. There is also an increasing recognition of persistent racial and ethnic disparities prevalent in obstetric outcomes. Yet few studies have linked obstetric quality of care with racial and ethnic disparities. This article reviews definitions of quality of care, health disparities, and health equity as they relate to obstetric care and outcomes; describes current efforts and challenges in obstetric quality measurement; and proposes 3 steps in an effort to develop, track, and improve quality and reduce disparities in obstetrics. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Cross-Cultural Obstetric and Gynecologic Care of Muslim Patients.

    Science.gov (United States)

    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.

  9. Validity of a hospital-based obstetric register using medical records as reference

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed;

    2015-01-01

    and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... as having given birth in 2013 to the National Patient Register with coverage of all births in 2013. Validity of eleven selected indicators from the Obstetric Database was assessed using medical records as a golden standard. Using a random sample of 250 medical records, we calculated proportion of agreement......, sensitivity, specificity, and positive and negative predictive values for each indicator. Two assessors independently reviewed medical records and inter-rater reliability was calculated as proportion of agreement and Cohen's κ coefficient. RESULTS: We found 100% completeness of the Obstetric Database when...

  10. Obstetric Thromboprophylaxis: The Swedish Guidelines

    Directory of Open Access Journals (Sweden)

    Pelle G. Lindqvist

    2011-01-01

    Full Text Available Obstetric thromboprophylaxis is difficult. Since 10 years Swedish obstetricians have used a combined risk estimation model and recommendations concerning to whom, at what dose, when, and for how long thromboprophylaxis is to be administrated based on a weighted risk score. In this paper we describe the background and validation of the Swedish guidelines for obstetric thromboprophylaxis in women with moderate-high risk of VTE, that is, at similar or higher risk as the antepartum risk among women with history of thrombosis. The risk score is based on major risk factors (i.e., 5-fold increased risk of thromboembolism. We present data on the efficacy of the model, the cost-effectiveness, and the lifestyle advice that is given. We believe that the Swedish guidelines for obstetric thromboprophylaxis aid clinicians in providing women at increased risk of VTE with effective and appropriate thromboprophylaxis, thus avoiding both over- and under-treatment.

  11. The Nordic Obstetric Surveillance Study

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Petersen, Kathrine B; Jakobsson, Maija

    2015-01-01

    OBJECTIVE: To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. DESIGN: Prospective, Nordic collaboration. SETTING: The Nordic Obstetric Surveillance Study...... (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. SAMPLE AND METHODS: Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases...... hysterectomy was 3.5/10 000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35 years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. CONCLUSION: The studied obstetric complications are rare...

  12. Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

    Directory of Open Access Journals (Sweden)

    Eckmann C

    2011-03-01

    Full Text Available Abstract Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates. From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Further-more, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or

  13. 重症监护室联合产科抢救危重孕产妇26例临床护理%Intensive care unit joint critical maternal obstetric rescue 26 cases of clinical nursing

    Institute of Scientific and Technical Information of China (English)

    曾毅

    2013-01-01

      目的探讨重症监护室联合产科抢救危重产妇的监测与护理,从中找出危重孕产妇的临床护理方法。方法针对我科收治的26例危重孕产妇的患者,采取急救措施,密切的监测病情变化,出现症状及时给予处理,做好呼吸。循环功能的监护,掌握患者抽搐、子痫、DIC的症状与护理措施。结果26例患者中经过及时救治和密切的监护与护理,1例临床死亡,其余25例均治愈出院。结论危重孕产妇在重症监护联合产科的治疗与护理下明显的提高了产妇的抢救成功率,降低了死亡率,提高患者的生存质量。%Objective monitoring and nursing of critically ill ICU with maternal obstetrics,clinical nursing method to find the critical pregnant women from the. Methods the patients in 26 cases of critically ill pregnant women admitted to our depart-ment,take emergency measures,monitoring the condition of close change,symptomatic treatment,do breathing. Monitoring of circulatory function,master the symptoms and the nursing measures for the patients with convulsions,eclampsia,DIC. Results in 26 patients after timely treatment and close monitoring and nursing of 1 cases,death,the other 25 cases were cured and dis-charged. Conclusion critically ill pregnant women in the treatment and nursing of intensive care and obstetric conditions sig-nificantly improved maternal rescue success rate,reduce the mortality rate,improve the quality of life of patients.

  14. A CLINICAL STUDY OF EFFECTS OF POLY AND OLIGOHY DROMNIOS ON OBSTETRIC OUTCOME WITH A SP E C I AL REF ERENCE TO PERINATAL MORTALITY AND MORBI D ITY

    Directory of Open Access Journals (Sweden)

    Sunanda Bai

    2015-08-01

    Full Text Available OBJECTIVES: To study the obstetric outcome in pregnancies with oligohydramnios and polyhydramnios. To determine the perinatal outcome in pregnancies complicated with oligohydramnios and polyhydramnios. METHODS: This study is conducted on pregnant woman with abnormal liquor volume who attended the antenatal clinic at Institute of obstetrics and gynecology , Bowring and Lady curzon Hospital attached to BMCRI Bengaluru January 2013 to January 2014 , 150 cases of oligohydramnios and 50 cases of polyhydramnios were selected for the study. A detailed history was taken. Detailed examination was done. Routine investigation was done. USG was done. Patient was followed up for timely and post - natal period. T he values obtained so far was tabulated, analyzed, compared with other studies and concluded. RESULTS: Majority of the oligohydramnios cases were primigavida and polyhydramnios cases were multigravida. Mild polyhydramnios was the most common type. Isolated oligohydramnios (37.33% was the most common cause followed by postdated pregnancy (28.67% and third being the hypertensive diseases of pregnancy (17.34% in oligohydramnios group. Incidence of congenital anomalies was high in polyhydramnios (22% than i n oligohydramnios (4%. Induction of labour was high in oligohydramnios group (65.33% than in polyhydramios (20% group. 59.33% were underwent cesarean section in oligohydramnios group compared to 18% in polyhydramnios group. Fetal distress (76.4% was th e leading cause of cesarean in oligohydramnios, CPD (33.33% was the common cause in polyhydramnios group. In oligohydramnios group, the alive babies’ rate was 92.7% and perinatal death was 7.3%. In polyhydramnios group, the alive and perinatal death rate was 72%, and 28% respectively. In the oligohydramnios group, congenital anomaly was not the cause of any perinatal death but in polyhydramnios group majority of the death was due to lethal congenital anomalies. Birth weight <2.5kg were high in

  15. [Prognosis and intensive care for massive obstetric blood loss].

    Science.gov (United States)

    Sadchikov, D V; Marshalov, D V

    2005-01-01

    The study covered 235 obstetric patients having varying blood loss (1.8 to 55.7%) at labor. Their constitutional, history, clinical, functional, and biochemical data were studied, which allowed the authors to develop a strategic and tactic line of prediction of the development of massive blood loss at labor. The algorithm of preventive intensive care, developed on the basis of predictive criteria, was found to significantly improve the results of treatment and to reduce the frequency and severity of obstetric hemorrhagic complications.

  16. Current applications of big data in obstetric anesthesiology.

    Science.gov (United States)

    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.

  17. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    Science.gov (United States)

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

  18. Obstetrics Patients' Assessment of Medical Students' Role in Their Care.

    Science.gov (United States)

    Magrane, Diane

    1988-01-01

    Obstetric patients rated the skills and assessed the roles of students caring for them during a clinical clerkship. They rated skills and attitudes high, generally, with lower ratings for their ability to answer questions and preparation to participate in care. Most felt students improved their care, primarily in supportive ways. (Author/MSE)

  19. A National Survey of Undergraduate Teaching in Obstetrics and Gynecology.

    Science.gov (United States)

    And Others; Stenchever, Morton A.

    1979-01-01

    A survey of academic departments of obstetrics and gynecology was designed to assess undergraduate educational programs and the impact of efforts made to improve teaching in the specialty. It focuses on instructional patterns, the clinical clerkship, student evaluation, and program administration and evaluation. Prior surveys are noted.…

  20. Obstetric complications in Marfan syndrome

    NARCIS (Netherlands)

    Meijboom, LJ; Drenthen, W; Pieper, PG; Groenink, M; Van der Post, JAM; Timmermans, J; Voors, AA; Roos-Hesselink, JW; van Veldhuisen, DJ; Mulder, BJM

    2006-01-01

    Objective: To investigate the obstetric maternal and neonatal outcome of pregnancy in women with Marfan syndrome. Methods: Retrospective observational multi-center study based on congenital heart disease registry. Results: Sixty-three of the 122 enrolled women with Marfan syndrome had been pregnant

  1. 多元化教育实习模式在产科临床带教中的创建研究%The creation and research of diverse education practice mode on clinical obstetric ' s guidance and teaching

    Institute of Scientific and Technical Information of China (English)

    尚剑; 罗清平; 章兰萍; 黄春华

    2016-01-01

    Objective To study the creation and effect of diverse education practice model in obstetric's clini-cal guidance and teaching. Methods A total of 240 obstetric practice nurses in our hospital form January 2013 to De-cember 2014 were selected as the research objects, and the intern students in the group were all women. 120 interns in the hospital in 2013 were taken as a control group, receiving traditional education during the internship and 120 interns in 2014 as the observation group, receiving diverse education during the internship. Results Practice self-assessment, evaluation from teachers and evaluation and satisfaction from patients of the students in the two groups were compared and analyzed, and it was found that the self-evaluation satisfaction of the observation group was up to 96. 67%, the clin-ical teacher gave the students (93. 47±4. 92) marks, and patient satisfaction was 95. 00%. The difference was statisti-cally significant ( P<0. 05 ) . This study analyzed and compared the assessments of the clinical teachers from the two groups of students, and found that the students in the observation group were more satisfied with the clinical teacher's re-sponsibility, service attitude, medical ethics, concern for students, theoretical knowledge, teaching level, operating a-bility, teaching methods and student satisfaction scores had a higher satisfaction than that of the control group, the differ-ence was statistically significant ( P<0. 05 ) . Conclusions Diverse educational practice mode intern can not only im-prove interns with the phenomenon of culture shock, but also help students adapt to the environment quickly and improve their theoretical knowledge and operating skills. Students, clinical teachers and patients were quite satisfied with the ap-plication of the model, for it enables interns to adapt to obstetric care, worthy of clinical reference.%目的:研究多元化教育实习模式在产科临床带教中的创建及

  2. Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznań, Poland.

    Science.gov (United States)

    Sobkowski, Maciej; Opala, Tomasz

    2014-01-01

    Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.

  3. Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznań, Poland

    Directory of Open Access Journals (Sweden)

    Maciej Sobkowski

    2014-06-01

    Full Text Available introduction and objectives. Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. material and methods. The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. results. After implementation of the restructuring program all clinics apart from one – Surgical Gynecology Clinic – reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20% increase in the revenues from selling healthcare services and a simultaneous decrease (2% of the operating cost was observed. conclusions. Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.

  4. The effect of concentrating obstetrics services in fewer hospitals on patient access: a simulation.

    Science.gov (United States)

    Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kashima, Saori; Atarashi, Hidenao; Yasunaga, Hideo

    2016-01-22

    In Japan, the number of obstetrics facilities has steadily decreased and the selection and concentration of obstetrics facilities is progressing rapidly. Obstetrics services should be concentrated in fewer hospitals to improve quality of care and reduce the workload of obstetricians. However, the impact of this intensification of services on access to obstetrics hospitals is not known. We undertook a simulation to examine how the intensification of obstetrics services would affect access to hospitals based on a variety of scenarios, and the implications for health policy. The female population aged between 15 and 49 living within a 30-min drive of an obstetrics hospital was calculated using a Geographic Information System for three possible intensification scenarios: Scenario 1 retained facilities with a higher volume of deliveries without considering the geographic boundaries of Medical Service Areas (MSAs, zones of healthcare administration and management); Scenario 2 prioritized retaining at least one hospital in each MSA and then retained higher delivery volume institutions, while Scenario 3 retained facilities to maximize population coverage using location-allocation modeling. We also assessed the impact of concentrating services in academic hospitals and specialist perinatal medical centers (PMCs) alone. In 2011, 95.0% of women aged 15-49 years lived within a 30-min drive of one of 1075 obstetrics hospitals. This would fall to 82.7% if obstetrics services were intensified into academic hospitals and general and regional PMCs. If 55.0% of institutions provided obstetrics services, the coverage would be 87.6% in Scenario 1, whereas intensification based on access would achieve over 90.5% coverage in Scenario 2 and 93.9% in Scenario 3. Intensification of obstetrics facilities impairs access, but a greater caseload and better staffing have the potential advantages of better clinical outcomes and reduced costs. It is essential to consult residents of hospital

  5. Utility of proteomics in obstetric disorders: a review

    Directory of Open Access Journals (Sweden)

    Hernández-Núñez J

    2015-04-01

    Full Text Available Jónathan Hernández-Núñez,1 Magel Valdés-Yong21Department of Obstetrics and Gynecology, Hospital Alberto Fernández-Valdés, Santa Cruz del Norte, Mayabeque, 2Department of Obstetrics and Gynecology, Hospital Luis Díaz Soto, Habana del Este, La Habana, CubaAbstract: 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.Keywords: proteomic techniques, obstetrics, diagnosis, prediction

  6. Unified Modern Mathematics, Course 3, Teachers Commentary.

    Science.gov (United States)

    Secondary School Mathematics Curriculum Improvement Study, New York, NY.

    This commentary is to be used with "Unified Modern Mathematics, Course III." Statements of specific purposes and goals of each section of every chapter of Course III are included in the "Commentary." Also included are suggestions for teaching concepts presented in each section; time estimates for each section; suggested instructional aids for…

  7. Unified Modern Mathematics, Course 1, Teachers Commentary.

    Science.gov (United States)

    Secondary School Mathematics Curriculum Improvement Study, New York, NY.

    This commentary is designed for use with "Unified Modern Mathematics, Course I," Parts 1 and 2. Included in the commentary are statements of the specific purposes and goals of each section of every chapter, suggestions for teaching the concepts presented in each section, time estimates for each section, suggested instructional aids for presenting…

  8. Unified Modern Mathematics, Course 2, Teachers Commentary.

    Science.gov (United States)

    Secondary School Mathematics Curriculum Improvement Study, New York, NY.

    This commentary is designed for use with "Unified Modern Mathematics, Course II," Parts 1 and 2. As in the commentary for "Course I," statements of the specific purposes and goals of each section of every chapter are presented. Also included are suggestions for teaching the concepts presented in each section, time estimates for each section,…

  9. Radulphus Brito's Commentary on Aristotle's De anima

    NARCIS (Netherlands)

    de Boer, Sander W.

    2012-01-01

    In 1974, Winfried Fauser published his edition of Radulphus Brito's commentary on the third book of Aristotle's De anima. This contribution continues his project by providing an edition of Brito's commentary on the first book and the first third of the second book. An analysis of this part of the co

  10. Pathology of Commentary in Persian Literary Texts

    Directory of Open Access Journals (Sweden)

    احمد رضی

    2011-10-01

    Full Text Available Today commentary work has a significant role and place among the readers of Persian literary texts and those interested in them. The growing importance of commentary works in helping the readers understand and popularity of commentary works, notably in recent decades, has caused different commentators with different knowledge level and abilities to write comments and foster this disorganized market. This study intends to investigate the published commentary works in the past decades, analyze their week points. To do so, over 250 works, which have been written and published between 1300 AP (circa 1921 AD and 1387 AP (circa2008 AD and an attempt has been made to classify, describe, and analyze their most important problems and week points, and at the end, the most important items of best commentary and best commentators have been explained. This article intends to analyz the most important problems and week points of commentary works, which can be summarized in seven broad categories: 1 content shortcomings; 2 inappropriate approach; 3 incongruence between the structure of commentary work and type of the work and the commentator's objective; 4 lack of attention towards the readership; 5 carelessness and incompetency of the commentator; 6 complex statement and insensible language; 7 inaudibility of introductions. Key words: research methodology, commentary works, pathology, literary works

  11. Commentary: Toward Convergence in Creativity Inquiry

    Science.gov (United States)

    Tan, Ai-Girl; Wong, Meng-Ee

    2015-01-01

    This commentary is about reflection in the new language of creativity and the meanings of inquiry into creative life. The authors of the commentary adopt the cultural paradigm of psychology of creativity. They praise effortful creativity of the authors who submitted the articles to this special issue. Their studies employed diverse methods of…

  12. Commentary: Toward Convergence in Creativity Inquiry

    Science.gov (United States)

    Tan, Ai-Girl; Wong, Meng-Ee

    2015-01-01

    This commentary is about reflection in the new language of creativity and the meanings of inquiry into creative life. The authors of the commentary adopt the cultural paradigm of psychology of creativity. They praise effortful creativity of the authors who submitted the articles to this special issue. Their studies employed diverse methods of…

  13. Analysis on the Application of Psychological Nursing in Obstetrics and Gynecology in Clinical Nursing%浅谈心理护理在妇产科临床护理中的应用

    Institute of Scientific and Technical Information of China (English)

    桂春; 王新芳; 牛金凤

    2015-01-01

    探讨心理护理在妇产科护理工作中的应用,通过运用适当的心理护理手段,解决了妇产科患者的心理问题,从而提高了护理质量。%The application of psychological nursing in obstetrics and gynecology nursing,psychological nursing through the use of appropriate means to solve the psychological problems of obstetrics and gynecology patients,thereby improving the quality of nursing.

  14. Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Diavolitsis, V. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Rademaker, A. [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Lurain, J.; Hoekstra, A. [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Strauss, J. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Small, W., E-mail: wsmall@nmff.org [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)

    2012-10-01

    Purpose: To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). Methods and Materials: All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Results: Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. Conclusions: The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

  15. 对新生儿产伤性疾病的临床探讨%The clinical study of the obstetric disease of the newborn

    Institute of Scientific and Technical Information of China (English)

    罗桂芬

    2014-01-01

    Objective:To explore the high risk factors and coping methods of neonatal birth injury diseases.Methods:35 cases with birth injury were selected from February 2011 to February 2014.The clinical data were retrospectively analyzed.Results:Cranial hematoma,intracranial hemorrhage,soft tissue injury,clavicle fracture were the main aspects of birth injury.Cranial hematoma was the most,and clavicle fracture was the least.In the normal birth weight,birth injury rate was significantly lower than the giant infants and low birth weight infants.Natural parturition injury rate was lower than the forceps and breech extraction childbirth, which was higher than that of cesarean section.Conclusion:Maternal prenatal must do comprehensive examination.According to the specific situation of maternal and fetal,doctors can choose the different modes of delivery.We should closely monitor the delivery process,so that it can effectively prevent neonatal injury,and reduce the incidence of neonatal injury.%目的:探讨新生儿产伤性疾病的高危因素和应对手段。方法:2011年2月-2014年2月收治产伤患儿35例,对其临床资料进行回顾性分析。结果:头颅血肿、颅内出血、软组织损伤、锁骨骨折是新生儿产伤的几个主要方面,其中头颅血肿最多,最少的是锁骨骨折;正常体重新生儿的产伤率明显低于巨大儿和低出生体重儿;自然分娩的产伤发生率低于产钳助产和臀位助产分娩,高于剖宫产。结论:产妇产前必须做综合检查,依据产妇和胎儿的具体情况选择不同的分娩方式,严密监测分娩过程,这样能够有效预防新生儿产伤,降低新生儿产伤发生率。

  16. Cluster randomized trial of an active, multifaceted information dissemination intervention based on The WHO Reproductive health library to change obstetric practices: methods and design issues [ISRCTN14055385

    OpenAIRE

    Lumbiganon Pisake; Grimshaw Jeremy; Piaggio Gilda; Villar José; Gülmezoglu A; Langer Ana

    2004-01-01

    Abstract Background Effective strategies for implementing best practices in low and middle income countries are needed. RHL is an annually updated electronic publication containing Cochrane systematic reviews, commentaries and practical recommendations on how to implement evidence-based practices. We are conducting a trial to evaluate the improvement in obstetric practices using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library (RHL)....

  17. Disseminated intravascular coagulation in obstetric and gynecologic disorders.

    Science.gov (United States)

    Montagnana, Martina; Franchi, Massimo; Danese, Elisa; Gotsch, Francesca; Guidi, Gian Cesare

    2010-06-01

    Disseminated intravascular coagulation (DIC) is a syndrome characterized by a massive, widespread, and ongoing activation of the coagulation system, secondary to a variety of clinical conditions. Many obstetric complications, such as abruptio placentae, amniotic fluid embolism, endotoxin sepsis, retained dead fetus, post-hemorrhagic shock, hydatidiform mole, and gynecologic malignancies, might trigger DIC. In these gynecologic and obstetric settings, DIC is usually associated with high mortality and morbidity rates. No single laboratory test is sensitive or specific enough to diagnose DIC definitively, but it can be diagnosed by using a combination of multiple clinical and laboratory tests that reflect the pathophysiology of the syndrome. At present, the therapeutical approach to pregnancy- and gynecologic-related DIC comprises the specific and aggressive treatment of the underlying disease, eventually followed by a supportive blood product replacement therapy and restoration of physiological anticoagulant pathways. This article reviews the etiopathogenesis, clinical manifestations, laboratory diagnosis, and therapy of pregnancy- and gynecologic-related DIC.

  18. Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial.

    Science.gov (United States)

    Fransen, A F; van de Ven, J; Merién, A E R; de Wit-Zuurendonk, L D; Houterman, S; Mol, B W; Oei, S G

    2012-10-01

    To determine whether obstetric team training in a medical simulation centre improves the team performance and utilisation of appropriate medical technical skills of healthcare professionals. Cluster randomised controlled trial. The Netherlands. The obstetric departments of 24 Dutch hospitals. The obstetric departments were randomly assigned to a 1-day session of multiprofessional team training in a medical simulation centre or to no such training. Team training was given with high-fidelity mannequins by an obstetrician and a communication expert. More than 6 months following training, two unannounced simulated scenarios were carried out in the delivery rooms of all 24 obstetric departments. The scenarios, comprising a case of shoulder dystocia and a case of amniotic fluid embolism, were videotaped. The team performance and utilisation of appropriate medical skills were evaluated by two independent experts. Team performance evaluated with the validated Clinical Teamwork Scale (CTS) and the employment of two specific obstetric procedures for the two clinical scenarios in the simulation (delivery of the baby with shoulder dystocia in the maternal all-fours position and conducting a perimortem caesarean section within 5 minutes for the scenario of amniotic fluid embolism). Seventy-four obstetric teams from 12 hospitals in the intervention group underwent teamwork training between November 2009 and July 2010. The teamwork performance in the training group was significantly better in comparison to the nontraining group (median CTS score: 7.5 versus 6.0, respectively; P = 0.014). The use of the predefined obstetric procedures for the two clinical scenarios was also significantly more frequent in the training group compared with the nontraining group (83 versus 46%, respectively; P = 0.009). Team performance and medical technical skills may be significantly improved after multiprofessional obstetric team training in a medical simulation centre. © 2012 The Authors BJOG An

  19. Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders.

    Science.gov (United States)

    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.

  20. Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

    Science.gov (United States)

    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

  1. Clinical analysis of 13 cases of unplanned reoperation in obstetrics and gynecology department%妇产科非计划再次手术13例临床分析

    Institute of Scientific and Technical Information of China (English)

    王相岩; 干宁

    2016-01-01

    目的 分析妇产科非计划再次手术的原因,为提高医疗质量、降低非计划再次手术的发生率提供依据.方法 对安徽医科大学附属巢湖医院妇产科13例非计划再次手术患者的临床资料进行回顾分析.结果 2012年1月至2013年12月安徽医科大学附属巢湖医院妇产科住院手术共4193例,非计划再次手术13例(0.31%).13例全部治愈出院,术后切口愈合不良,泌尿系损伤、肠管损伤、肠梗阻、出血、感染是发生非计划再次手术的主要原因.结论 加强围手术期的管理,充分医患沟通,加强专业学习,提高临床技能,规范手术操作,提高快速病理诊断准确率可减少非计划再次手术的发生.%Objective To analyze the causes of non-planned reoperation in Obstetrics and Gynecology Department ,in order to pro-vide evidence for improving the quality of medical care and reducing the incidence of unplanned reoperation .Methods The clinical data of 13 cases unplanned reoperation in our department were retrospectively analyzed .Results There were 4193 cases of hospitalization from Jan-uary 2012 to December 2013,and the rate of non-planned reoperation was 0.31%.Thirteen cases of patients were cured and discharged .The postoperative poor wound healing ,urinary system injury ,intestinal injury ,intestinal obstruction ,bleeding and infection were the reasons for the occurrence of non-planned reoperation .Conclusion We should strengthen the preoperative management ,strengthen the communication be-tween doctors and patients ,strengthen professional learning ,improve clinical skills,standardize operation,and improve the accuracy of rapid pathological diagnosis so as to decrease the incidence of non-planed reoperation .

  2. Obstetrics and gynecology multi-resistant infections in patients with high risk factors and clinical measures%妇产科多重耐药菌感染的高危因素分析及临床对策

    Institute of Scientific and Technical Information of China (English)

    陈伟梅; 范先伟

    2012-01-01

      Objective To investigate the high risk factors of multiple drug-resistant infections of patients in gynecologi-cal and clinical measures. Methods From Jul 2006 to Sep 2011 in our hospital 26 cases of obstetrics and gynecology multi-resistant infection were retrospectively analyzed the patient's age,length of stay,number of joint use of antibiotics,antibiotic use of time,after surgery white blood cell count,albumin,postoperative hemoglobin and other information for quantitative multivariate regression analysis. Results The joint use of a variety of antibiotics and prolonged antimicrobial drugs were risk factors for multiple drug-resistant infection(P<0.05). Conclusion The rational clinical use of antibiotics,strict aseptic technique,are the important measures to prevent multiple drug-resistant infections.%  目的探讨在妇产科引起多重耐药菌感染的高危因素及临床对策.方法对2006年7月~2011年9月我院妇产科收治的26例多重耐药菌感染患者临床资料进行回顾性分析,将患者的年龄、住院天数、联合使用抗生素数量,抗生素使用时间、术后白细胞数、白蛋白、血色素等资料作量化进行多因素回归分析.结果多种抗生素的联合使用和长时间使用抗菌药物是多重耐药菌感染的高危因素(P<0.05).结论临床应注意抗生素的合理使用,严格无菌技术操作,是预防多重耐药菌感染的重要措施.

  3. Delivering quality care: what can emergency gynaecology learn from acute obstetrics?

    Science.gov (United States)

    Bika, O H; Edozien, L C

    2014-08-01

    Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient flow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology.

  4. Secondary repair of severe chronic fourth-degree perineal tear due to obstetric trauma.

    Science.gov (United States)

    Weledji, Elroy P; Elong, Adolphe; Verla, Vincent

    2014-05-13

    Obstetric injury is the commonest cause of anal incontinence. We report a case of anal incontinence as a result of severe chronic fourth-degree perineal tear secondary to birthing with complete disruption of the perineum. Secondary repair consisting of an anterior sphincter repair and levatorplasty in a poor resourced area rendered excellent immediate clinical result. The outcome of anterior sphincter repair following obstetric trauma is good but long-term follow-up is required because of the underlying complexity of obstetric injury. As prevention is not always possible, immediate recognition and adequate primary treatment is of importance.

  5. OBSTETRIC PATIENTS IN MULTIDISIPLINARY INTENSIVE CARE UNIT: RETROSPECTIVE ANALYSIS

    Directory of Open Access Journals (Sweden)

    Semih ARICI

    2014-03-01

    The aim of this study is to retrospectively evaluate the obstetric cases who referred to intensive care unit, and define the frequency, cause and clinic outcomes of the patients. Demographic data, causes of reference, interventions in the intensive care and the outcomes of 15 obstetric cases in the pregnancy and postpartum period, whose referred to Gaziosmanpasa University Hospital Intensive Care Unit between 2007 and 2013 were included and retrospectively evaluated. The frequency of patients who referred from another center to our intensive care unit was 10 (%66.6. The mean age of the patients was 28.80 +/- 5.74. The mean hospital stay time was 3.20 +/- 2.51. The most cause to refer into intensive care unit was postpartum hemorrhage. One of the cases was resulted in death. The mortality ratio was found as %6.7. In conclusion, the frequent cause of intensive care requirement of the obstetric cases were obstetric bleeding and uncontrolled hypertension. The maternal morbidity and mortality will be substantially decreased with advanced treatment modalities and maternal care before pregnancy. [J Contemp Med 2014; 4(1.000: 14-17

  6. The role of obstetric complications in schizophrenia.

    Science.gov (United States)

    Heun, R; Maier, W

    1993-04-01

    The importance of obstetric complications in sporadic and familial psychoses was analyzed in 43 schizophrenic and 28 chronic schizoaffective patients. Patients and first-degree relatives were diagnosed using Research Diagnostic Criteria and the best-estimate procedure. Mothers of patients were interviewed for histories of pregnancy and obstetric complications in their offspring. Patients had more often suffered perinatal complications (42%) than their siblings (29%). The risk for obstetric complications and secondary cases of psychosis was enhanced in relatives of patients with a history of obstetric complications. Siblings with obstetric complications had a low incidence of psychoses; therefore, obstetric complications could not explain the occurrence of secondary cases of psychosis in siblings. Patients with familial psychoses had a higher incidence of obstetric complications than did sporadic cases (without reaching statistical significance). There was no inverse relationship between the history of obstetric complications in patients and the morbid risk of first-degree relatives for psychoses. The familial versus sporadic distinction revealed no subgroups where obstetric complications were of special relevance.

  7. Commentary: Osler in a brave new world.

    Science.gov (United States)

    Humphrey, Holly J

    2008-10-01

    The current issue of Academic Medicine includes a proposal to reform internal medicine residency education by returning to the Oslerian ideal of an internist as a consultant-generalist. To meet this goal, the proposed model focuses on a traditional inpatient learning experience with outpatient learning structured in blocks rather than continuity clinics. In this commentary, the author contends that today's learning environment is significantly different from the learning environment of the 1890s when the Oslerian ideal was conceived. Inpatient wards are often filled with patients who arrive to the hospital ward with a diagnosis already made. Residency education needs to take into account the technological and scientific advances of today's age to ensure that residents are learning the fundamental skills required of all physicians--delivering a precise differential diagnosis which leads to the ultimate evaluation and treatment plan. Meaningful experience with patients who cover the full spectrum of health and illness will bring the most robust learning for our residents. To attain these experiences, our residents must practice in a variety of environments, including in inpatient services, intensive care units, and outpatient clinics. Just as in designing a well-balanced financial portfolio, educational programs must be equally well balanced to achieve the learning and patient outcomes that residents expect and patients deserve.

  8. Maternity Hospital Obstetric Interns of Clinical Pathway Teaching Mode Construction and Effect Analysis%妇产医院产科实习生临床路径带教模式构建及效果探析

    Institute of Scientific and Technical Information of China (English)

    孙雪

    2016-01-01

    Objective To evaluate the effectiveness of clinical pathway model in nursing practice teaching of obstetrics nursing students. Methods In our hospital in the period of time during June July 2014 to 2015 interns of 98 to randomly di_vided into two groups, namely control group and observation group, each group 49 control group of interns to take is the tra_ditional teaching, and the observation group of interns to take is clinical pathway with teaching mode, the two groups of nurses of operation skills and theoretical knowledge assessment, and to understand the two groups of nurses with a teaching job satisfaction. Results By statistics that, observation group of interns in the scores of knowledge and practical skills of the skilled ratio respectively (91.2±3.7) and 87.76%, significantly higher than that of the control group observed group of interns for the teaching job satisfaction rate is 89.80%, significantly higher than that of the control group, two group of interns on to teach job satisfaction rate comparison, also has obvious difference (P< 0.05), there is statistical significance. Conclusion The application of clinical pathway model has excellent effectiveness in nursing practice teaching. This method can greatly enhance the enthusiasm of nursing students, and can make the interns and nurses with the formation of a good interaction. Interns have a high degree of satisfaction with the teaching work, so it is necessary to popularize and apply the clinical pathway model in the teaching process of obstetric nursing practice.%目的:全面评价临床路径模式在产科护生护理实习带教中进行应用的有效性。方法将该院在2014年7月—2015年6月这段期间内的实习生98人以随机方式分成两组,即对照组和观察组,每组各49人,对照组实习生采取的是传统带教,而观察组实习生采取的是临床路径带教模式,对两组护士的操作技能与理论知识进行考核,并了解两组护士对带

  9. OBSTETRICAL MORBIDITIES IN GENITAL TRACT INFECTION S

    Directory of Open Access Journals (Sweden)

    Sapna

    2013-05-01

    Full Text Available ABSTRACT: INTRODUCTION- Sub clinical ascending infections through the lower female genital tract are predominant worldwide. Important morbidit ies related to poor perinatal outcome both for the mother and for the fetus and new born compr ise preterm birth, prelabor rupture of membranes, post partum sepsis and maternal anaemia. In the fetus, sepsis and intrauterine growth retardation are suspected to be the consequences of ascending maternal infection. Both the direct effect of the infection and the maternal immune r esponse contribute to these eventualities. This study was done to identify antenatal women with va rious genital infections and to know the outcome of pregnancy in presence of these infection s. OBJECTIVES- Diagnosis treatment and preventive measures in genital infections in Antena tal period to improve the pregnancy out come . MATERIAL AND METHODS- One thousand women were studied for lower genital tract infection by ELISA KITS for chlamydia trachomatis, hanging dr op preparation of vaginal discharge for trichomoniasis and mycelia of candida albicans can be seen by wet mount of vaginal dischage in 10% KOH. Gardnerella vaginal infection was diagnose d by Amsel's criteria . RESULT- out of thousand women 53% were positive for single or mult iple infections (gp-1, 47% women had no infection (gp-11 . Labour outcome was studied in 4 15 antenatal women of gp -1 &395 antenatal women of gp -11 . In gp-1 51.80% had no effect ,7.7 1% had abortions and 40.48% had pre term labour and/or PROM .Which was significantly higher than in non infected group . IN INFECTED GROUP- 41.92% neonates had no effect others had some effec t in terms of LBW, birth asphyxia, neonatal death & IUD. Which was significantly highe r than in non infected group. P=0.00 CONCLUSION- The study showed significantly higher incidence of obstetrical morbidities in women with lower genital tract infection,since geni tal infections are the root cause of these obstetrical

  10. Secondary repair of severe chronic fourth-degree perineal tear due to obstetric trauma

    OpenAIRE

    Weledji, Elroy P; Elong, Adolphe; Verla, Vincent

    2014-01-01

    Obstetric injury is the commonest cause of anal incontinence. We report a case of anal incontinence as a result of severe chronic fourth-degree perineal tear secondary to birthing with complete disruption of the perineum. Secondary repair consisting of an anterior sphincter repair and levatorplasty in a poor resourced area rendered excellent immediate clinical result. The outcome of anterior sphincter repair following obstetric trauma is good but long-term follow-up is required because of the...

  11. Commentary.

    Science.gov (United States)

    Power, F. Clark

    1994-01-01

    Comments on revision of Piagetian theory of reciprocity in forgiveness by Enright (PS 522 365) in this issue. Reviews relationship of Enright theory to previous research. Suggests that forgiveness may require moral insights in addition to reciprocity, but reciprocity appears central to children's and adults' understanding of forgiveness. Provides…

  12. Commentary

    Directory of Open Access Journals (Sweden)

    Jason W. Moore

    2015-08-01

    Full Text Available Alf Hornborg says many useful things in his article, “Ecosystems and World Systems: Accumulation as an Ecological Process.” His effort to “ground the notion of capital accumulation in the physical realities of ecology and thermodynamics” is a much-needed corrective to nature-blind studies of capitalism. At a more paradigmatic level, his dismay at the “analytical disjuncture of ecology and economics” in modern social science is right on target (1998: 169. Yet, despite the article’s laudable intent, Hornborg goes astray by imputing to Marx a focus on labor that excludes the “physical realities” of labor reproduction, world trade, or imperialism. Hornborg is right to urge a synthesis of ecological and economic studies, but wrong in his call to “supplement” the labor theory of value with a “resource-oriented…concept of exploitation” (1998: 173. Even if Marx did not grapple with a global ecological crisis of contemporary standards, he was remarkably sensitive to ecological processes as they shaped, and were shaped by, capital accumulation; indeed, Marx studied intensively the works of the leading soil chemists of his day, foremost among them Justus von Liebig. Particularly in the ?rst and third volumes of Capital, Marx provides a compelling framework for comprehending the nature-society dialectic under capitalism.

  13. COMMENTARY

    African Journals Online (AJOL)

    User

    also constitute a critical block of health systems as they affect the ... Based on the above estimates, the projected total requirements for all ... The total estimated cost for the strategic plan is projected ..... this activity is also not budgeted for. Costs ...

  14. Commentary

    DEFF Research Database (Denmark)

    Langsted, Lars Bo

    2013-01-01

    Konkluderer at Højesteret har accepteret at Cyberspace har sin egen jurisdiktion - men samtidig er en del af dansk efterforskninsgmæssig jurisdiktion: Accept af at politiet ved hjælp af brugernavn og password skaffer sig adgang til Facebook og Messenger-profiler, der fysisk befinder sig på server...

  15. Commentary.

    Science.gov (United States)

    Northway, Ruth

    2003-01-01

    When I facilitate sessions that explore ethical aspects of research, one of the first activities I ask group members to do is to consider the rights which they believe they should have as potential research participants. Very quickly, and without exception, they are able to identify a range of issues from the right to confidentiality, through to freedom from harm and the right to know why the research is being undertaken. Given that these issues can so easily be identified, it could be tempting to assume that all research would be conducted in an ethical manner. Unfortunately, history reveals many horror stories of actions carried out in the name of research. Even today, questionable aspects of research are brought to light. The focus on research ethics within this edition of Nurse Researcher is thus a timely reminder of the key issues that need to be addressed.

  16. Commentary

    African Journals Online (AJOL)

    abp

    2015-11-26

    Nov 26, 2015 ... for all; (9) To build resilient infrastructure, promote inclusive and sustainable ... health system is weak, and rapid response is needed which allows economies ... health system destroys structural walls and dismantle all stand-.

  17. Commentary

    African Journals Online (AJOL)

    ebutamanya

    2015-03-10

    Mar 10, 2015 ... Funding for health care programs has over the years been an important challenge for health and ... and governance, justice and human rights, and several other ... data obtained from funded projects in the developing world.

  18. Commentary

    African Journals Online (AJOL)

    abp

    2016-04-08

    Apr 8, 2016 ... Management, and Master in Hospital and Healthcare ... (Global Health, Health Financing, and Supply Chain Management); partnerships with ... research programmes is inspiring through close interactions between main stakeholders. .... GRD), and a Research Screening and Ethics Clearance Committee.

  19. Commentary

    Science.gov (United States)

    Heller, Monica

    2014-01-01

    The subject of multilingualism in institutions has long been a central interest in sociolinguistics, and it is worth asking why. The answer lies in the role of institutions in the modern nation state, a point made over and over again by Michel Foucault. Institutions control access to all the resources a state can distribute; it distributes them…

  20. Commentary

    DEFF Research Database (Denmark)

    Rasmussen, Jens

    1993-01-01

    basically to understand the cognitive process and cooperative patterns of the actors in work, and to develop a framework for design of advanced information systems. The work contributed to a CEC basic research action project; MOHAWC; modeling human activities in work context (Rasmussen et al., 1991...... in the research paradigms than to extend the scope of the human factors profession to encompass total socio-technical systems. This conclusion is not in contradiction to the arguments in the articles reviewed, but calls for a substantial extension....

  1. Commentary.

    Science.gov (United States)

    Izard, Carroll E.

    1995-01-01

    Discusses the article by Lewis in this issue in the context of complex systems theory. Reviews several concepts of complex systems theory, including self-organization, entropy, phase transitions, stochastic processes, nonlinearity, and attractors. Notes that Lewis highlights the need for psychological models to treat nonlinear processes, chaotic…

  2. Commentary

    African Journals Online (AJOL)

    Ramakantb

    with 30 day outcome in acute ischemic stroke in. Nigerians. ... Kahn K, Tollman S. Stroke in rural South Africa- contributing to the little ... Metange J. Stroke incidence rate among black residents of Harare - A .... year review. West Afr J Med 2000 ...

  3. Commentary

    African Journals Online (AJOL)

    abp

    2017-06-01

    Jun 1, 2017 ... Unfortunately, pharmaceuticals have left their industrial and household confines and leaked into the environment. ... In Europe, a study of 40 households in rural Greece found 557 ... wells, and effluent from wastewater treatment plants for drug ... are present in the environment, their biological effects are.

  4. COMMENTARY

    African Journals Online (AJOL)

    2007-03-01

    Mar 1, 2007 ... Summary. Traditionally, the decline of vulture populations in southern Africa has been explained ... showing expansion; the lowland breeding sites of the Cape and Bearded Vulture .... face human pressure or food reduction.

  5. Commentary.

    Science.gov (United States)

    Smetana, G. Judith

    1994-01-01

    Comments on the issues introduced by Saltzstein (PS 522 554) in this issue. Elaborates on Saltzstein's proposed social cognitive factors that may account for discrepancies between moral reasoning and action, highlighting strengths and weaknesses. (AA)

  6. Commentary

    Science.gov (United States)

    Heller, Monica

    2014-01-01

    The subject of multilingualism in institutions has long been a central interest in sociolinguistics, and it is worth asking why. The answer lies in the role of institutions in the modern nation state, a point made over and over again by Michel Foucault. Institutions control access to all the resources a state can distribute; it distributes them…

  7. PBL 教学法在妇产科护理教学中的应用*%Application of problem-based learning in clinical nursing teaching in obstetrical and gynecological department

    Institute of Scientific and Technical Information of China (English)

    章雪玲; 黄美凌; 邓燕红; 杨敏玲; 谢健; 梁慧贤

    2013-01-01

    Objective To investigate the feasibility of using problem-based learning in nursing clinical teaching in the obstetrics and gynecology department.Methods Sixty-six nursing students were randomly divided into PBL group and lecture-based learning(LBL)group .At the end of their internship,the two groups were compared in terms of examination performance,learning attitude and aptitude,and their feedback on the two learning modes.Results The students in the PBL group were significantly better than those in the control group in terms of examination performance,learning attitude and aptitude,and their feedback on the learning mode(P<0.001).Conclusions PBL may be effective in the improvement of their attitude to learning and aptitude,the comprehensive ability.It can provide an environment to promote internal learning motivation for students.%  目的探讨 PBL 教学法在妇产科护理教学中的应用效果。方法将66名护理实习学生按不同的教学法分为以问题为基础的教学法(problem-based learning,PBL)的 PBL 组33名和以讲授为基础的教学法(lecture-based learning,LBL)的 LBL 组33名,实习结束后对两组学生进行考核,评估学生学习态度和能力和对教学方法反馈情况。结果PBL 组学生考核成绩、学习态度和能力、教学效果均优于 LBL 组,两组比较,均 P<0.01,差异具有统计学意义。结论PBL 教学法可提高学生学习态度和能力及整体综合能力,且为学生提供一个促进内在学习动机的环境,其教学方法更符合学生的临床学习需求。

  8. Case notes and clinicians: Galen's "Commentary" on the Hippocratic "Epidemics" in the Arabic tradition.

    Science.gov (United States)

    Pormann, Peter E

    2008-01-01

    Galen's "Commentaries" on the Hippocratic "Epidemics" constitute one of the most detailed studies of Hippocratic medicine from antiquity. The Arabic translation of the "Commentaries" by Ḥunayn ibn Isḥāq (d. c. 873) is of crucial importance because it preserves large sections now lost in Greek, and because it helped to establish an Arabic clinical literature. The present contribution investigate the translation of this seminal work into Syriac and Arabic. It provides a first survey of the manuscript tradition, and explores how physicians in the medieval Muslim world drew on it both to teach medicine to students, and to develop a framework for their own clinical research.

  9. Preventing obstetric fistulas in low-resource countries: insights from a Haddon matrix.

    Science.gov (United States)

    Wall, L Lewis

    2012-02-01

    An obstetric fistula is classically regarded as an "accident of childbirth" in which prolonged obstructed labor leads to destruction of the vesicovaginal/rectovaginal septum with consequent loss of urinary and/or fecal control. Obstetric fistula is highly stigmatizing and afflicted women often become social outcasts. Although obstetric fistula has been eliminated from advanced industrialized nations, it remains a major public health problem in the world's poorest countries. Several million cases of obstetric fistula are currently thought to exist in sub-Saharan Africa and south Asia. Although techniques for the surgical repair of such injuries are well known, it is less clear which strategies effectively prevent fistulas, largely because of the complex interactions among medical, social, economic, and environmental factors present in those countries where fistulas are prevalent. This article uses the Haddon matrix, a standard tool for injury analysis, to examine the factors influencing obstetric fistula formation in low-resource countries. Construction of a Haddon matrix provides a "wide angle" overview of this tragic clinical problem. The resulting analysis suggests that the most effective short-term strategies for obstetric fistula prevention will involve enhanced surveillance of labor, improved access to emergency obstetric services (particularly cesarean delivery), competent medical care for women both during and after obstructed labor, and the development of specialist fistula centers to treat injured women where fistula prevalence is high. The long-term strategies to eradicate obstetric fistula must include universal access to emergency obstetric care, improved access to family planning services, increased education for girls and women, community economic development, and enhanced gender equity. Successful eradication of the obstetric fistula will require the mobilization of sufficient political will at both the international and individual country levels to

  10. Obstetrics and Gynecology Hospitalist Fellowships.

    Science.gov (United States)

    Vintzileos, Anthony M

    2015-09-01

    This article establishes the rationale and development of an obstetrics and gynecology (OB/GYN) hospitalist fellowship program. The pool of OB/GYN hospitalists needs to be drastically expanded to accommodate the country's needs. Fellowship programs should provide extra training and confidence for recent resident graduates who want to pursue a hospitalist career. Fellowships should train physicians in a way that aligns their interests with those of the hospital with respect to patient care, teaching, and research. Research in the core measures should be a necessary component of the fellowship so as to provide long-term benefits for all stakeholders, including hospitals and patients.

  11. Obstetrics Hospitalists: Risk Management Implications.

    Science.gov (United States)

    Veltman, Larry

    2015-09-01

    The concept of having an in-house obstetrician (serving as an obstetrics [OB] hospitalist) available 24 hours a day, 7 days a week provides a safety net for OB events that many need immediate intervention for a successful outcome. A key precept of risk management, that of loss prevention, fits perfectly with the addition of an OB hospitalist role in the perinatal department. Inherent in the role of OB hospitalists are the patient safety and risk management principles of improved communication, enhanced readiness, and immediate availability.

  12. Proteomics in obstetrics and gynecology

    Directory of Open Access Journals (Sweden)

    Seema Lekhwani

    2011-01-01

    Full Text Available Proteomics helps to understand the basic biological processes critical to normal cellular functions as well as the development of diseases. It identifies the essential components of these processes and exploits these components as targets in the development of new methods to prevent or treat diseases. Proteomics, although in an infancy stage in India, has the potential to complement and further enlarge the wealth of information in medicine, especially in the field of cancer. This article reviews the recent progress in proteomic techniques and their applications in the field of obstetrics and gynecology.

  13. Developmental evidence for obstetric adaptation of the human female pelvis.

    Science.gov (United States)

    Huseynov, Alik; Zollikofer, Christoph P E; Coudyzer, Walter; Gascho, Dominic; Kellenberger, Christian; Hinzpeter, Ricarda; Ponce de León, Marcia S

    2016-05-10

    The bony pelvis of adult humans exhibits marked sexual dimorphism, which is traditionally interpreted in the framework of the "obstetrical dilemma" hypothesis: Giving birth to large-brained/large-bodied babies requires a wide pelvis, whereas efficient bipedal locomotion requires a narrow pelvis. This hypothesis has been challenged recently on biomechanical, metabolic, and biocultural grounds, so that it remains unclear which factors are responsible for sex-specific differences in adult pelvic morphology. Here we address this issue from a developmental perspective. We use methods of biomedical imaging and geometric morphometrics to analyze changes in pelvic morphology from late fetal stages to adulthood in a known-age/known-sex forensic/clinical sample. Results show that, until puberty, female and male pelves exhibit only moderate sexual dimorphism and follow largely similar developmental trajectories. With the onset of puberty, however, the female trajectory diverges substantially from the common course, resulting in rapid expansion of obstetrically relevant pelvic dimensions up to the age of 25-30 y. From 40 y onward females resume a mode of pelvic development similar to males, resulting in significant reduction of obstetric dimensions. This complex developmental trajectory is likely linked to the pubertal rise and premenopausal fall of estradiol levels and results in the obstetrically most adequate pelvic morphology during the time of maximum female fertility. The evidence that hormones mediate female pelvic development and morphology supports the view that solutions of the obstetrical dilemma depend not only on selection and adaptation but also on developmental plasticity as a response to ecological/nutritional factors during a female's lifetime.

  14. Commentary: is CIT today's lobotomy?

    Science.gov (United States)

    Geller, Jeffrey L

    2008-01-01

    Birthed in Memphis, Tennessee, in 1988, Crisis Intervention Teams (CITs) have had remarkable growth spurts with few, if any, developmental milestones to document their progress. Compton and colleagues investigated the evidence basis for CIT and found very little. They perhaps found even more than there actually is. There are contributions to CIT outcomes that are rooted in local variations in mental health services and regional culture. These are considered in this commentary, using Memphis as the example. None of us should be surprised that reform is evidence-absent. The mental illness delivery system and the criminal justice system have been instituting reform, and these reforms have had reverberating changes between the two systems, with little or no data to support the changes, for centuries. That there would be unexpected consequences should be obvious. But apparently not so evident that we don't continue to take one blind step after another. Is CIT on firm footing, or just another fool's journey?

  15. Patient Satisfaction with Virtual Obstetric Care.

    Science.gov (United States)

    Pflugeisen, Bethann Mangel; Mou, Jin

    2017-02-07

    Introduction The importance of patient satisfaction in US healthcare is increasing, in tandem with the advent of new patient care modalities, including virtual care. The purpose of this study was to compare the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference ("Virtual-care") compared to those who received 12-14 face-to-face visits in-clinic with their physician/midwife ("Traditional-care"). Methods We developed a four-domain satisfaction questionnaire; Virtual-care patients were asked additional questions about technology. Using a modified Dillman method, satisfaction surveys were sent to Virtual-care (N = 378) and Traditional-care (N = 795) patients who received obstetric services at our institution between January 2013 and June 2015. Chi-squared tests of association, t-tests, logistic regression, and ANOVA models were used to evaluate differences in satisfaction and self-reported demographics between respondents. Results Overall satisfaction was significantly higher in the Virtual-care cohort (4.76 ± 0.44 vs. 4.47 ± 0.59; p Virtual-care selection (OR = 2.4, 95% CI: 1.5-3.8; p Virtual-care respondents was not significantly impacted by the incorporation of videoconferencing, Doppler, and blood pressure monitoring technology into their care. The questionnaire demonstrated high internal consistency as measured by domain-based correlations and Cronbach's alpha. Discussion Respondents from both models were highly satisfied with care, but those who had selected the Virtual-care model reported significantly higher mean satisfaction scores. The Virtual-care model was selected by significantly more women who already have children than those experiencing pregnancy for the first time. This model of care may be a reasonable alternative to traditional care.

  16. The Effect of Student Gender on the Obstetrics and Gynecology Clerkship Experience

    Science.gov (United States)

    Odrobina, Michele R.; McIntyre-Seltman, Kathleen

    2010-01-01

    Abstract Objectives To explore the effects of the students' gender on their perception of quality and quantity of teaching, the amount of experiential learning, and their interest in obstetrics and gynecology. Methods Anonymous, self-administered surveys to third-year medical students rotating on the obstetrics and gynecology clerkship. Results Eighty-one of 91 students participated (89% response rate): 33 men, 46 women, 2 declined to reveal their gender. No significant gender differences existed regarding number of interactions with residents and faculty; number of deliveries, surgeries, or examinations performed; perceived quality of teaching; or feeling included as part of the clinical team. Male students were more likely to report performing specific surgical procedures, such as operating the bovie cautery during gynecological surgeries (p = 0.005). More men experienced patients refusing to allow them to participate in the clinical interview (p obstetrics and gynecology, male students were more likely to report that their interest increased at the end of the clerkship. Conclusions Male students were more likely to experience gender bias from patients on the obstetrics and gynecology service. Male students also described feeling socially excluded from female-dominated clinical teams. Obstetrics and gynecology educators need to consider methods of encouraging patients to accept medical student participation regardless of gender. Obstetrics and gynecology faculty and residents need to be sensitive to subtle forms of gender bias and ensure equal inclusion for both male and female medical students. PMID:20088663

  17. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  18. Obstetric Provider Maldistribution: Georgia, USA, 2011.

    Science.gov (United States)

    Spelke, Bridget; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In 2010, Georgia had the nation's highest maternal mortality rate, sixteenth highest infant mortality rate, and a waning obstetrician/gynecologist (ob/gyn) workforce. Statewide ob/gyn workforce data, however, masked obstetric-specific care shortages and regional variation in obstetric services. The Georgia Maternal and Infant Health Research Group thereby assessed each Georgia region's obstetric provider workforce to identify service-deficient areas. Methods We identified 63 birthing facilities in the 82 Primary Care Service Areas (PCSAs) outside metropolitan Atlanta and interviewed nurse managers and others to assess the age, sex, and expected departure year of each delivering professional. Using accepted annual delivery rates of 155 per obstetrician (OB), 100 per certified nurse midwife (CNM), and 70 per family medicine physician (FP) we converted obstetric providers into "OB equivalents" to standardize obstetric services available in any given area. Using facility births and computed OB equivalents (contemporary and 2020 estimates), we calculated current and projected average annual births per provider (AABP) for each PCSA, categorizing its obstetric provider workforce as "adequate" (AABP  166). We mapped results using ArcGIS. Results Of 82 surveyed PCSAs, 52 % (43) were deficient in obstetric care; 16 % (13) had a shortage and 37 % (30) lacked obstetric providers entirely. There were no delivering FPs in 89 % (73) of PCSAs and no CNMs in 70 % (56). If Georgia fails to recruit delivering providers, 72 % (58/77) of PCSAs will have deficient or no obstetric care by 2020. Conclusions Obstetric provider shortages in Georgia hinder access to prenatal and delivery services. Care-deficient areas will expand if recruitment and retention of delivering professionals does not improve.

  19. A Clinical Practice Guidelines for the Management of Obstetric Patients with Heart Disease: an Alternative for the Anesthesiologist’s Practice. Guía de práctica clínica para la asistencia a la paciente obstétrica con cardiopatía: una alternativa de actuación para el anestesiólogo.

    Directory of Open Access Journals (Sweden)

    Maritza Rodríguez Alvárez

    2011-10-01

    Full Text Available Background: The appropriate anesthetic management of the obstetric patient with heart disease, either congenital or acquired, poses a complex problem to the anesthesiologist, whose scientific knowledge and clinical experience are deeply challenged. Objective: To outline a clinical practice guidelines for the management of obstetric patients with heart disease. Methods: A qualitatively approached study with a descriptive and exploratory projection was conducted in such a way that the qualitative and quantitative methodologies were complemented. The following scientific methods were used: document analysis, observation, expert criteria and surveys to specialists. Results: The theoretical systematization allowed evidencing that the difficulties in managing obstetric patients with heart disease constitute a challenge to the practice of the anesthesiologist. In this sense, the specialist must master the anatomy and physiology of the obstetric patient and the particularities of each pregnancy-related heart disease and its anesthetic management. A clinical practice guidelines for the anesthetic management of the obstetric patient with heart disease was designed. It was developed from a needs assessment in the practice of the anesthesiology and resuscitation specialist. Conclusions: The appropriate implementation of the present guidelines should result in a more efficient anesthetic management of the obstetric patient with heart disease.Fundamento: el adecuado manejo anestésico de la paciente obstétrica que presenta cardiopatía, ya sea congénita o adquirida, plantea un problema complejo al anestesiólogo, reta sus conocimientos científicos y su experiencia clínica en toda profundidad. Objetivo: diseñar una guía de práctica clínica para la asistencia a la paciente obstétrica con cardiopatía. Métodos: estudio

  20. Comparisons of clinical and hormonal characteristics of Sheehan′s syndrome between different diagnosis duration after obstetrical event%希恩综合征不同诊断时限间的临床对比分析

    Institute of Scientific and Technical Information of China (English)

    杜国利; 苏银霞; 杨梅; 刘中华; 陈敏; 艾比拜·玉素甫; 朱筠

    2016-01-01

    收集1999年1月至2014年5月于新疆医科大学第一附属医院确诊的72例希恩综合征患者的临床资料,根据诊断时限即自末次产科事件至初次诊断希恩综合征时长,≤5年组纳入38例,>5年组纳入34例。对于入组患者进行病史、临床表现、激素水平进行回顾性分析,并对组间差异进行比较。72例希恩综合征患者的平均确诊年龄为(42.5±11.8)岁,距离产科事件的平均时间为(9.0±9.3)年。其中产后大出血71例(98.6%),52例(72.2%)产后无乳,59例(81.9%)产后闭经,61例(84.7%)有腋毛、阴毛脱落。黄体生成素( LH)降低63例、卵泡刺激素( FSH)降低58例,雌二醇降低54例,TSH降低59例,TT3降低58例,TT4降低57例,ACTH降低37例,血皮质醇降低60例。与诊断时限>5年组相比,≤5年组产后行子宫切除比例(13.1%对0,P=0.029)、低血钠比例(52.6%对23.5%,P=0.016)、低血糖比例(42.1%对14.7%,P=0.018)均明显增高。2组间低血压发生率、产后无乳、产后闭经、低体温比例、低体重比例差异无明显统计学意义。≤5年组下丘脑-垂体-肾上腺轴受损比例高于>5年组(92.1%对73.5%,P=0.036),2组间下丘脑-垂体-甲状腺轴(81.6%对82.4%)及下丘脑-垂体-性腺轴(92.1%对91.2%)轴受损比例差异无明显统计学意义。%[Summary] Seventy-two cases diagnosed as Sheehan’s syndrome in our hospital from January 1999 to May 2014 were divided into two groups according to the diagnosis duration from the obstetrical event to diagnosis:≤5 years (n=38)and >5 years(n=34). The medical history, physical examination findings, and hormonal profiles were retrospectively reviewed and analyzed. The mean age at diagnosis was(42. 5 ± 11. 8) years, with a mean diagnostic duration of(9.0±9.3)years. 71(98.6%)of these patients had a history of obstetric hemorrhage. The most common clinical presentation included amenorrhea(59/72, 81. 9%), agalactia(52/72, 72. 2%), and loss of axillary or pubic hair(61

  1. Proceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology.

    Science.gov (United States)

    Benacerraf, Beryl R; Minton, Katherine K; Benson, Carol B; Bromley, Bryann S; Coley, Brian D; Doubilet, Peter M; Lee, Wesley; Maslak, Samuel H; Pellerito, John S; Perez, James J; Savitsky, Eric; Scarborough, Norman A; Wax, Joseph; Abuhamad, Alfred Z

    2017-07-06

    The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Cystic fibrosis and pregnancy: counseling, obstetrical management and perinatal outcome.

    Science.gov (United States)

    Grigoriadis, Charalampos; Tympa, Aliki; Theodoraki, Kassiani

    2015-03-01

    The progress in research of in vitro fertilization and fetal-maternal medicine allows more women and men, with fertility problems due to cystic fibrosis, to have a baby. In the majority of cases, pregnancy in women with cystic fibrosis results in favorable maternal and fetal outcomes. However, the incidence of preterm delivery, intrauterine growth restriction, caesarean section and deterioration of the maternal health are increased. Pre-pregnancy counseling is a crucial component of overall obstetric care, especially in women with poor pulmonary function. Additionally, closer monitoring during pregnancy with a multidisciplinary approach is required. The value of serial ultrasound scans and fetal Doppler assessment is important for the control of maternal and fetal wellbeing, as well as for the definition of the appropriate timing of delivery. In this article, clinical issues of pregnant women with cystic fibrosis are reviewed; counseling, obstetrical management and perinatal outcomes are being discussed.

  3. On use of ultrasonography in obstetrics and gynecology

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Kwang Suk; Lee, Yong Woo [Seoul National University Hospital, Seoul (Korea, Republic of)

    1984-08-15

    Ultrasonography is playing an very important in diagnosis of normal pregnancy and the other diseases in the fields of obstetrics and gynecology. It is mainly used B-mode and Real time linear scan for pregnancy such as fetal movement during its early stage, fetal position, placenta location and biparietal diameter during its middle stage, and amniotic fluid and placenta previa during its late stage, as well as tumor accompanying pregnancy. Ultrasonography has been extensively used in the fields of obstetrics and gynecology for obtaining detailed images of soft tissues without hazard to the fetus and pregnant woman. In view of the need for its professionalism of high degree of skill, this treatise will introduce clinical instances and images obtained in the sonography room of the Seoul National University Hospital.

  4. Biopsychosocial obstetrics and gynaecology - a perspective from Australia.

    Science.gov (United States)

    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.

  5. The vanishing mother: Cesarean section and "evidence-based obstetrics".

    Science.gov (United States)

    Wendland, Claire L

    2007-06-01

    The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.

  6. A bill of rights for patients with obstetric fistula.

    Science.gov (United States)

    Wall, L Lewis

    2014-12-01

    According to the seven categories of vulnerability proposed by Kipnis (cognitive, juridical, deferential, medical, allocational, social, and infrastructural), and the four generally accepted principles of biomedical ethics (respect, beneficence, non-maleficence, and fairness), women with obstetric fistulas are an exceptionally vulnerable population. Therefore, they merit special consideration in both clinical care and research settings. Adoption of a formal bill of rights for patients with fistula similar to the one proposed in the present report should be encouraged at all facilities where these women are treated. Acknowledgment of their rights would help to improve their care and end the abuses they are exposed to in institutional settings. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  7. Commentary on the use of acupuncture in chronic pediatric pain.

    Science.gov (United States)

    Waterhouse, Michael; Tsao, Jennie C I; Zeltzer, Lonnie K

    2009-02-01

    The use of acupuncture for pain in pediatrics is a long-standing practice in Eastern cultures. Despite growing interest in the West, there has been relatively little systematic research on acupuncture for chronic pediatric pain. In particular, there is a paucity of randomized clinical trials testing the efficacy of acupuncture for chronic pain problems in pediatric populations. This commentary briefly reviews the history of acupuncture for pain and includes a summary of extant findings regarding potential mechanisms of its analgesic effects. Key areas for future research to advance the application of acupuncture to chronic pediatric pain problems are outlined.

  8. Commentary on Becoming a Daughter: Trauma is a powerful teacher.

    Science.gov (United States)

    Veach, Patricia McCarthy

    2006-06-01

    Personal life crises profoundly impact genetic counselor practice. In this commentary, themes from Matloff's (in press) article, Becoming a Daughter are highlighted and expanded upon. These themes include: personal impact of a life crisis, and professional impact vis a vis empathy countertransference, self-disclosure, nondirectiveness, and self-confidence. Strategies that help genetic counselors manage personal life crises within their clinical practice and also promote their professional development are emphasized, including normalization of life crises, self-reflection, boundary-setting, and use of peer supervision and consultation.

  9. [HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

    Science.gov (United States)

    Rabinerson, David; Yeoshua, Effi; Gabbay-Ben-Ziv, Rinat

    2015-05-01

    Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

  10. Haemostatic management of obstetric haemorrhage.

    Science.gov (United States)

    Collis, R E; Collins, P W

    2015-01-01

    The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause. This review examines areas such as possible intervention points, describes evidence for over-transfusion of fresh frozen plasma in some situations and challenges conventional thinking on formulaic management. It also examines the rationale for other therapeutic options, including fibrinogen concentrate and tranexamic acid.

  11. The "group" in obstetric psychoprophylaxis.

    Science.gov (United States)

    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.

  12. Clinical Effect of Cefoperazone Sodium and Sulbactam Sodium in the Treatment of Infection in Obstetrics and Gynecol-ogy Department%头孢哌酮钠舒巴坦钠治疗妇产科感染的临床研究

    Institute of Scientific and Technical Information of China (English)

    周磊清

    2014-01-01

    Objective To explore the clinical effect of cefoperazone sodium and sulbactam sodium in the treatment of infection in obstetrics and gynecology department. Methods A total of 120 infection patients in Obstetrics and Gynecology de-partment in our hospital were selected from March 2012 to January 2014,and they were randomly divided into observation group and control group,60 cases in each group. Control group was treated with amoxicillin and clavulanate potassium,while observa-tion group was treated with cefoperazone sodium and sulbactam sodium. Clinical effect and incidence of adverse reactions between two groups were compared. Results There was no significant differences of total effective rate between two groups(P>0. 05). The incidence of adverse reactions of observed group was 1. 7%(1/60),was lower than that of control group of 10. 0%(6/60),the difference was statistically significantly different(P0.05)。观察组不良反应发生率为1.7%(1/60),低于对照组的10.0%(6/60),差异有统计学意义( P<0.05)。结论头孢哌酮钠舒巴坦钠治疗妇科感染疗效可靠,并能较好地减少不良反应发生率。

  13. Prognostic models in obstetrics: available, but far from applicable.

    Science.gov (United States)

    Kleinrouweler, C Emily; Cheong-See, Fiona M; Collins, Gary S; Kwee, Anneke; Thangaratinam, Shakila; Khan, Khalid S; Mol, Ben Willem J; Pajkrt, Eva; Moons, Karel G M; Schuit, Ewoud

    2016-01-01

    Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the process of developing and validating models. Important aspects to consider when assessing a prognostic model are discussed and recommendations on how to proceed on this within the obstetric domain are given. We searched MEDLINE (up to July 2012) for articles developing prognostic models in obstetrics. We identified 177 papers that reported the development of 263 prognostic models for 40 different outcomes. The most frequently predicted outcomes were preeclampsia (n = 69), preterm delivery (n = 63), mode of delivery (n = 22), gestational hypertension (n = 11), and small-for-gestational-age infants (n = 10). The performance of newer models was generally not better than that of older models predicting the same outcome. The most important measures of predictive accuracy (ie, a model's discrimination and calibration) were often (82.9%, 218/263) not both assessed. Very few developed models were validated in data other than the development data (8.7%, 23/263). Only two-thirds of the papers (62.4%, 164/263) presented the model such that validation in other populations was possible, and the clinical applicability was discussed in only 11.0% (29/263). The impact of developed models on clinical practice was unknown. We identified a large number of prognostic models in obstetrics, but there is relatively little evidence about their performance, impact, and usefulness in clinical practice so that at this point, clinical implementation cannot be recommended. New efforts should be directed

  14. Clinical Using of Combined Remifentanil with Mivacurium in Obstetric General Anesthesia%联合瑞芬太尼和米库氯铵在产科全麻中的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    刘丹; 王冬娜; 王靖宇; 付颖

    2014-01-01

    目的:探讨瑞芬太尼与米库氯铵联合应用于产科全麻的临床效果,评价其可行性和安全性。方法:以38例因椎管内麻醉禁忌症而行全麻剖宫产的产妇为研究对象,随机分为 A、B两组,每组各19例。 A 组:给予丙泊酚+氯胺酮+维库溴铵组合,B 组:给予丙泊酚+瑞芬太尼+米库氯铵组合。观察两组产妇麻醉前、插管后即刻、手术10、20 min 时的 HR、DBP、SBP,记录两组手术开始至胎儿娩出时间、术毕至拔管时间、产妇完全苏醒时间、Steward 评分、新生儿出生后1、5、10 min Apgar 评分、新生儿处理情况以及不良反应等。结果:A 组产妇 HR、SBP、DBP 在麻醉各个节点上有较明显的波动,各个节点之间差异均有统计学意义(P0.05)。两组胎儿娩出时间,新生儿1、5、10 min 时 Apgar 评分以及使用面罩吸氧的新生儿例数均大体相当,组间差异均无统计学意义(P>0.05)。 B 组产妇拔管时间、完全清醒时间较 A 组短,Steward 评分比 A 组高,三个指标组间比较差异均有统计学意义(P0.05). Fetal childbirth time, neonatal Apgar scores at 1min, 5min and 10min, and the cases of neonatal using oxygen masks between the two groups were roughly the same, the differences were not statistically significant (P >0.05). The extubation time, maternal awake time of Group B were shorter than those of group A, the Steward score was higher in Group B than in Group A, the three indexes between the two groups had statistically significant differences (P<0.05). Conclusion: By combining propofol, remifentanil and mivacurium in general anesthesia of obstetrics, the maternal hemodynamics is apt to maintain stable with fast recovery, small fetal/neonatal effects, good feasibility and high security, which needs to be confirmed by further clinical studies.

  15. Commentary: The practice of empathy.

    Science.gov (United States)

    Spiro, Howard

    2009-09-01

    In response to the articles in this issue about measuring physician empathy by Hojat and colleagues, Di Lillo and colleagues, and Kataoka and colleagues, this commentary further explores the concept of empathy. It is posited that empathy is an emotion important to medical care, but it is emphasized that it really doesn't matter whether empathy is a thought or an emotion. Retaining or enhancing it in medical care givers is worth doing and may be achieved through (1) the selection of medical students and others who will care for the sick, (2) the training caretakers receive, and more fundamentally even, (3) reconsideration of what doctors do in a world so much changed and so diverse.Empathy is the foundation of patient care, and it should frame the skills of the profession. It may be that empathy can be taught by example, but the minds of students, like soil, must be prepared before they can nourish seeds of knowledge, and in some soils little grows. Physicians must have the time to listen to their patients. Listening can create empathy--if physicians remain open to be moved by the stories they hear. Empathy has always been and will always be among a physician's most essential tools of practice.

  16. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced...... obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Elizabeth Echoka1,&, Anselimo Makokha2, Dominique Dubourg3, Yeri Kombe1, Lillian Nyandieka1, Jens Byskov4 Results: Findings indicate that pregnant women experienced delays in making...

  17. A multi disciplinary obstetric emergency training programme.

    LENUS (Irish Health Repository)

    Whelan, Mary

    2012-09-01

    The Rotunda Hospital (Dublin) obstetric emergency training programme (RHOET) was designed, in 2008, to meet the ongoing education and training needs of the local multidisciplinary team. Prior to its implementation, senior midwives attended the advanced life support in obstetrics (ALSO) course, and many of the obstetricians attended the Management of obstetric emergencies and trauma (MOET) and\\/or ALSO courses. Attendance at these off site courses meant that the only opportunity for team training was the informal and ad hoc \\'drills and skills\\' that took place in the birthing suite. This paper documents our journey since RHOET was implemented.

  18. Non-physician providers of obstetric care in Mexico: Perspectives of physicians, obstetric nurses and professional midwives

    Science.gov (United States)

    2012-01-01

    Background In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health’s 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric nurses and professional midwives. This study compares and contrasts these two provider types with the medical model, analyzing perspectives on their respective training, scope of practice, and also their perception and/or experiences with integration into the public system as skilled birth attendants. Methodology This paper synthesizes qualitative research that was obtained as a component of the quantitative and qualitative study that evaluated three models of obstetric care: professional midwives (PM), obstetric nurses (ON) and general physicians (GP). A total of 27 individual interviews using a semi-structured guide were carried out with PMs, ONs, GPs and specialists. Interviews were transcribed following the principles of grounded theory, codes and categories were created as they emerged from the data. We analyzed data in ATLAS.ti. Results All provider types interviewed expressed confidence in their professional training and acknowledge that both professional midwives and obstetric nurses have the necessary skills and knowledge to care for women during normal pregnancy and childbirth. The three types of providers recognize limits to their practice, namely in the area of managing complications. We found differences in how each type of practitioner perceived the concept and process of birth and their role in this process. The barriers to incorporation as a model to attend birth faced by PMs and ONs are at the individual, hospital and system level. GPs question their ability and training to handle deliveries, in particular those that become complicated, and the professional midwifery model particularly as it relates to a clinical setting, is

  19. Measuring stress before and during pregnancy: a review of population-based studies of obstetric outcomes.

    Science.gov (United States)

    Witt, Whitney P; Litzelman, Kristin; Cheng, Erika R; Wakeel, Fathima; Barker, Emily S

    2014-01-01

    Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n = 10); three examined stress during both the preconception and pregnancy periods (n = 3). Most studies examined the environmental domain (e.g. life events) only (n = 9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.

  20. Osteopathic manipulative treatment in gynecology and obstetrics: A systematic review.

    Science.gov (United States)

    Ruffini, Nuria; D'Alessandro, Giandomenico; Cardinali, Lucia; Frondaroli, Franco; Cerritelli, Francesco

    2016-06-01

    The aim of the review was to evaluate the effects of the osteopathic manipulative treatment (OMT) on women with gynaecological and obstetric disorders. An extensive search from inception to April 2014 was conducted on MEDLINE, Embase, the Cochrane library using MeSH and free terms. Clinical studies investigating the effect of OMT in gynaecologic and obstetric conditions were included as well as unpublished works. Reviews and personal contributions were excluded. Studies were screened for population, outcome, results and adverse effects by two independent reviewers using an ad-hoc data extraction form. The high heterogeneity of the studies led to a narrative review. 24 studies were included (total sample=1840), addressing back pain and low back functioning in pregnancy, pain and drug use during labor and delivery, infertility and subfertility, dysmenorrhea, symptoms of (peri)menopause and pelvic pain. Overall, OMT can be considered effective on pregnancy related back pain but uncertain in all other gynaecological and obstetrical conditions. Only three studies (12.5%) mentioned adverse events after OMT. Although positive effects were found, the heterogeneity of study designs, the low number of studies and the high risk of bias of included trials prevented any indication on the effect of osteopathic care. Further investigation with more pragmatic methodology, better and detailed description of interventions and systematic reporting of adverse events are recommended in order to obtain solid and generalizable results. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Transfusion practice in major obstetric haemorrhage: lessons from trauma.

    Science.gov (United States)

    Saule, I; Hawkins, N

    2012-01-01

    The management of massive haemorrhage with blood products is changing as evidence arrives from civilian and military trauma. Rapid early replacement of coagulation factors and platelets is now becoming central to improving outcome, usually given in higher ratios with respect to red cell units than previously recommended and using empiric transfusion based on clinical rather than laboratory parameters. The management of three cases of major obstetric haemorrhage based on these principles is presented. Packed red blood cells, fresh frozen plasma, platelets and cryoprecipitate were transfused in the ratios 5:2:2:1, 4.5:1:1:1 and 4.5:2:1:1. Each patient had acceptable full blood count and coagulation results after surgery and all made an uneventful recovery. These outcomes support the opinion that major obstetric haemorrhage can be managed in a similar fashion to blood loss in trauma. Recommendations from the Association of Anaesthetists of Great Britain and Ireland, and the UK National Patient Safety Agency should be considered during major obstetric haemorrhage.

  2. Utility of proteomics in obstetric disorders: a review

    Science.gov (United States)

    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

  3. The critically ill obstetric patient - Recent concepts

    Directory of Open Access Journals (Sweden)

    Anjan Trikha

    2010-01-01

    Full Text Available Obstetric patients admitted to an Intensive Care Unit (ICU present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.

  4. Botulinum A toxin utilizations in obstetric palsy

    Directory of Open Access Journals (Sweden)

    Atakan Aydin

    2012-12-01

    Conclusion: We conclude that with the help of botulinum A toxin and physyotherapy, obstetrical palsy patient with cocontractions can significantly improve movements and may have less surgery. [Hand Microsurg 2012; 1(3.000: 89-94

  5. common laboratory investigations in obstetrics and gynaecology

    African Journals Online (AJOL)

    Enrique

    tice have much in common with those in other medical disci- ... Vitamin B12 and folate ... hypertensive disorders of ... antenatal full blood count screening ... and Low Platelets). ... be of value in detecting obstetrically .... The cut-off at 2 hours.

  6. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... by a reduction in the discretion of obstetric decision making rather than by patient cream skimming.Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified...... that these results are robust to the different methodologies and can be explained by a reduction in the discretion of obstetric decision making rather than by patient cream skimming....

  7. Design of a Serious Game for Handling Obstetrical Emergencies.

    Science.gov (United States)

    Jean Dit Gautier, Estelle; Bot-Robin, Virginie; Libessart, Aurélien; Doucède, Guillaume; Cosson, Michel; Rubod, Chrystèle

    2016-12-21

    The emergence of new technologies in the obstetrical field should lead to the development of learning applications, specifically for obstetrical emergencies. Many childbirth simulations have been recently developed. However, to date none of them have been integrated into a serious game. Our objective was to design a new type of immersive serious game, using virtual glasses to facilitate the learning of pregnancy and childbirth pathologies. We have elaborated a new game engine, placing the student in some maternity emergency situations and delivery room simulations. A gynecologist initially wrote a scenario based on a real clinical situation. He also designed, along with an educational engineer, a tree diagram, which served as a guide for dialogues and actions. A game engine, especially developed for this case, enabled us to connect actions to the graphic universe (fully 3D modeled and based on photographic references). We used the Oculus Rift in order to immerse the player in virtual reality. Each action in the game was linked to a certain number of score points, which could either be positive or negative. Different pathological pregnancy situations have been targeted and are as follows: care of spontaneous miscarriage, threat of preterm birth, forceps operative delivery for fetal abnormal heart rate, and reduction of a shoulder dystocia. The first phase immerses the learner into an action scene, as a doctor. The second phase ask the student to make a diagnosis. Once the diagnosis is made, different treatments are suggested. Our serious game offers a new perspective for obstetrical emergency management trainings and provides students with active learning by immersing them into an environment, which recreates all or part of the real obstetrical world of emergency. It is consistent with the latest recommendations, which clarify the importance of simulation in teaching and in ongoing professional development.

  8. Design of a Serious Game for Handling Obstetrical Emergencies

    Science.gov (United States)

    Bot-Robin, Virginie; Libessart, Aurélien; Doucède, Guillaume; Cosson, Michel; Rubod, Chrystèle

    2016-01-01

    Background The emergence of new technologies in the obstetrical field should lead to the development of learning applications, specifically for obstetrical emergencies. Many childbirth simulations have been recently developed. However, to date none of them have been integrated into a serious game. Objective Our objective was to design a new type of immersive serious game, using virtual glasses to facilitate the learning of pregnancy and childbirth pathologies. We have elaborated a new game engine, placing the student in some maternity emergency situations and delivery room simulations. Methods A gynecologist initially wrote a scenario based on a real clinical situation. He also designed, along with an educational engineer, a tree diagram, which served as a guide for dialogues and actions. A game engine, especially developed for this case, enabled us to connect actions to the graphic universe (fully 3D modeled and based on photographic references). We used the Oculus Rift in order to immerse the player in virtual reality. Each action in the game was linked to a certain number of score points, which could either be positive or negative. Results Different pathological pregnancy situations have been targeted and are as follows: care of spontaneous miscarriage, threat of preterm birth, forceps operative delivery for fetal abnormal heart rate, and reduction of a shoulder dystocia. The first phase immerses the learner into an action scene, as a doctor. The second phase ask the student to make a diagnosis. Once the diagnosis is made, different treatments are suggested. Conclusions Our serious game offers a new perspective for obstetrical emergency management trainings and provides students with active learning by immersing them into an environment, which recreates all or part of the real obstetrical world of emergency. It is consistent with the latest recommendations, which clarify the importance of simulation in teaching and in ongoing professional development. PMID

  9. Commentary on Sources of Ostracism Research.

    Science.gov (United States)

    Grahe, Jon E

    2015-01-01

    This article briefly introduces and provides commentary on this special issue, "Investigating How Individuals Feel Ostracizing Others" in the Journal of Social Psychology. This commentary uses first-person recollections from early ostracism studies to help frame the special issue in the larger scope of ostracism research. Modern ostracism research started in the early 1990s and hundreds of studies have advanced our understanding of this phenomenon. However, the preponderance of research has focused on the target of ostracism (those being ostracized) and relied primarily on a single method in experimental studies. The present special issue includes articles that employed a variety of research approaches and focused exclusively on the sources (those who do the ostracism). Finally, this commentary invites researchers to more fully investigate this understudied aspect of a common phenomenon that people are likely to engage in regularly.

  10. Approaches to Political Commentary in Scandinavia

    DEFF Research Database (Denmark)

    Bengtsson, Mette

    2015-01-01

    Political commentary is a contested genre that has attracted a great deal of attention in the Scandinavian public debate, whereas the scholarly literature on it is still in an initial phase. In order to strengthen future research, the present paper suggests a two-dimensional matrix indexing...... the research on Scandinavian political commentary along the dimensions text/context and descriptive/evaluative. The matrix enables us to see more clearly what we already know and where we lack knowledge. It enables us to see how each category can be developed, the interplay among them, and the obvious lack...

  11. Neurotrophin in obstetrics and gynaecology.

    Science.gov (United States)

    Bose, Chinmoy K

    2009-01-01

    Since Rita Levi Montalcini and Stanley Cohen received Nobel Prize for their pioneering work on nerve growth factor (NGF), its role in female reproductive system has been reinforced in last two decades. The neurotrophins (NT) including nerve growth factor (NGF) are a family of related growth factors and their respective receptor tyrosine kinases that are of major importance in the regulation of neuronal survival and differentiation. While role of NGF in mast cell-mediated egg implantation and inhibition of rejection were primary concern at their time, in the ovary NGF can help in the differentiation process by which ovarian follicles become responsive to gonadotrophins. They help in follicular maturation, steroid secretion and ovulation in the ovary, by inducing the FSH receptor (FSHR). Due to the pleiotropism, NGF is mandatory for the success of pregnancy, while progesterone helping to maintain local levels of NGF in utero. In endometriosisi and polycystic ovarian disease it has major role to play. An autocrine role of NGF in breast cancer and epithelial ovarian cancer (EOC) is evident now. Thus its study will infuse new insight in diseases of both obstetrics and gynaecology.

  12. Identifying Obstetrical Emergencies at Kintampo Municipal Hospital: a perspective from Pregnant Women and Nursing Midwives

    National Research Council Canada - National Science Library

    Oiyemhonlan, Brenda; Udofia, Emilia; Punguyire, Damien

    2013-01-01

    .... The most common obstetric emergencies were hemorrhage, eclampsia and anemia. Potential obstetric complications were poorly understood by antenatal women and known barriers limited access to emergency obstetric care...

  13. The "virtual" obstetrical intensive care unit: providing critical care for contemporary obstetrics in nontraditional locations.

    Science.gov (United States)

    Leovic, Michael P; Robbins, Hailey N; Foley, Michael R; Starikov, Roman S

    2016-12-01

    Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness. The health care needs of the critically ill obstetric patient calls for clinicians to move beyond the traditional definition of the intensive care unit and develop a well-rounded, quickly responsive, and communicative interdisciplinary team that can provide high-quality, unique, and versatile care that best meets the needs of each particular patient. We propose a model in which a virtual intensive care unit team composed of preselected specialists from multiple disciplines (maternal-fetal medicine, neonatology, obstetric anesthesiology, cardiology, pulmonology, etc) participate in the provision of individualized, precontemplated care that is readily adapted to the specific patient's clinical needs, regardless of setting. With this team-based approach, an environment of trust and familiarity is fostered among team members and well thought-out patient care plans are developed through routine prebrief discussions regarding individual clinical care for parturients anticipated to required critical care services. Incorporating debriefings between team members following these intricate cases will allow for the continued evolution of care as the medical needs of this patient population change as well.

  14. Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromes

    Directory of Open Access Journals (Sweden)

    Salvatore Andrea Mastrolia

    2014-11-01

    Full Text Available Obstetrical complications including preeclampsia, fetal growth restriction, preterm labor, preterm prelabor rupture of membranes and fetal demise are all the clinical endpoint of several underlying mechanisms (i.e., infection, inflammation, thrombosis, endocrine disorder, immunologic rejection, genetic, and environmental, therefore, they may be regarded as syndromes. Placental vascular pathology and increased thrombin generation were reported in all of these obstetrical syndromes. Moreover, elevated concentrations of thrombin-anti thrombin III complexes and changes in the coagulation as well as anticoagulation factors can be detected in the maternal circulation prior to the clinical development of the disease in some of these syndromes. In this review, we will assess the changes in the hemostatic system during normal and complicated pregnancy in maternal blood, maternal–fetal interface and amniotic fluid, and describe the contribution of thrombosis and vascular pathology to the development of the great obstetrical syndromes.

  15. Local health workers’ perceptions of substandard care in the management of obstetric hemorrhage in rural Malawi

    Directory of Open Access Journals (Sweden)

    Beltman Jogchum Jan

    2013-02-01

    Full Text Available Abstract Background To identify factors contributing to the high incidence of facility-based obstetric hemorrhage in Thyolo District, Malawi, according to local health workers. Methods Three focus group discussions among 29 health workers, including nurse-midwives and non-physician clinicians (‘medical assistants’ and ‘clinical officers’. Results Factors contributing to facility-based obstetric hemorrhage mentioned by participants were categorized into four major areas: (1 limited availability of basic supplies, (2 lack of human resources, (3 inadequate clinical skills of available health workers and (4 substandard referrals by traditional birth attendants and lack of timely self-referrals of patients. Conclusion Health workers in this district mentioned important community, system and provider related factors that need to be addressed in order to reduce the impact of obstetric hemorrhage.

  16. The professional responsibility model of obstetrical ethics: avoiding the perils of clashing rights.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L

    2011-10-01

    Obstetric ethics is sometimes represented by polarized views. One extreme asserts the rights of the fetus as the overwhelming ethical consideration. Another extreme asserts the pregnant woman as the overwhelming ethical consideration. Both assertions are overly simplistic. Such oversimplification is called reductionism. This article explains the fallacy of rights-based reductionism and 2 models of obstetric ethics based on it and explains why the fetal rights reductionism model and the pregnant woman's rights reductionism model result in conceptual and clinical failure and therefore should be abandoned. The article argues for the professional responsibility model of obstetric ethics, which emphasizes the importance of medical science and compassionate clinical care of both the pregnant and fetal patient. The result is that responsible medical care overrides the extremes of clashing rights. Copyright © 2011 Mosby, Inc. All rights reserved.

  17. Geometry in the Early Years: A Commentary

    Science.gov (United States)

    Dindyal, Jaguthsing

    2015-01-01

    The primary goal of this paper is to provide a commentary on the teaching and learning of geometry in the early years of schooling with the set of papers in this issue as a guiding factor. It is structured around issues about geometry education of young learners, such as: what should we teach in geometry and why; representation of geometrical…

  18. Kidney research national dialogue overview and commentary.

    Science.gov (United States)

    Rys-Sikora, Krystyna E; Ketchum, Christian J; Star, Robert A

    2013-09-01

    The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) asked the scientific community to formulate and prioritize research objectives to improve understanding of kidney function and disease. The Kidney Research National Dialogue welcomed all interested parties to submit, discuss, and prioritize ideas via an interactive website. More than 1600 participants posted approximately 300 ideas and assigned them to 12 topic areas (AKI, CKD, diabetic nephropathy, National Kidney Disease Education Program/translation, ESRD/dialysis, GN/inflammation, hypertension, normal biology/development/physiology, polycystic kidney disease, training, transplantation, other). This commentary provides an overview of the NIDDK's first experience with web-based strategic planning and addresses the broader issues of open access and cloud-sourcing technologies to capture input from a large, heterogeneous group of contributors. Discussions and findings for each topic will be published as separate, forthcoming commentaries. A final commentary will present cross-cutting themes and concluding remarks. The hope is that this series of commentaries constitutes a cohesive, integrated vision of future research opportunities to be pursued by the kidney research community and supported by the NIDDK.

  19. Language interpretation and generation for football commentary

    NARCIS (Netherlands)

    Nijholt, A.; Akker, op den H.J.A.; Jong, de F.M.G.; Miyares, L. R.; Alvarez, C. E.; Silva Alvarez, M. R.

    2003-01-01

    Our interest in the computer processing of football commentary was at first given in by the EU/IST funded project MUMIS (Multimedia Indexing and Searching) that started in 2000 [11, 18, 19]. This project's objective is to develop technology for automatic indexing of multimedia programme material (te

  20. A Response to Andrea R. Halpern's Commentary

    Directory of Open Access Journals (Sweden)

    Freya Bailes

    2007-05-01

    Full Text Available The author responds to points raised in Andrea Halpern’s commentary, which appeared in Vol. 2, No. 1 of Empirical Musicology Review. Discussion focuses on the apparent contradiction between self-reports of veridical mental imagery of musical timbre, and cognitive constraints on temporal memory for multidimensional sound.

  1. Conscientiousness in Life Course Context: A Commentary

    Science.gov (United States)

    Costanzo, Philip R.

    2014-01-01

    In this commentary, the common themes from the interesting articles in this special section of "Developmental Psychology" are considered as they illuminate the potential ontogenetic sources of the conscientiousness-well-being-longevity interconnections that have emerged in recent research. In particular, consideration is given to the…

  2. Conscientiousness in Life Course Context: A Commentary

    Science.gov (United States)

    Costanzo, Philip R.

    2014-01-01

    In this commentary, the common themes from the interesting articles in this special section of "Developmental Psychology" are considered as they illuminate the potential ontogenetic sources of the conscientiousness-well-being-longevity interconnections that have emerged in recent research. In particular, consideration is given to the…

  3. Geometry in the Early Years: A Commentary

    Science.gov (United States)

    Dindyal, Jaguthsing

    2015-01-01

    The primary goal of this paper is to provide a commentary on the teaching and learning of geometry in the early years of schooling with the set of papers in this issue as a guiding factor. It is structured around issues about geometry education of young learners, such as: what should we teach in geometry and why; representation of geometrical…

  4. Little house of oxymorons with commentaries

    CERN Document Server

    Carter, Steven

    2010-01-01

    This volume features well over 200 fresh and original oxymorons with commentaries-all with a satirical twist. As a satire, Little House of Oxymorons complements Steven Carter's The New Devil's Dictionary, a two-volume 'sequel' to Ambrose Bierce's notorious The Devil's Dictionary of a century ago.

  5. Toward a phenomenology of forensic psychotherapy: a commentary on Polizzi and Draper.

    Science.gov (United States)

    Aanstoos, Christopher M

    2013-06-01

    This piece is a commentary on the article by Polizzi and Draper (2013), elaborating a phenomenological hermeneutic of clinical forensics. First, it analyzes their depiction of the concepts of reduction, the given and the manifest, and the event. Second, it discusses their application of these ideas to clinical forensics, particularly with respect to issues of the openness/closedness of the client and therapist and their context.

  6. Machine learning, medical diagnosis, and biomedical engineering research - commentary.

    Science.gov (United States)

    Foster, Kenneth R; Koprowski, Robert; Skufca, Joseph D

    2014-07-05

    A large number of papers are appearing in the biomedical engineering literature that describe the use of machine learning techniques to develop classifiers for detection or diagnosis of disease. However, the usefulness of this approach in developing clinically validated diagnostic techniques so far has been limited and the methods are prone to overfitting and other problems which may not be immediately apparent to the investigators. This commentary is intended to help sensitize investigators as well as readers and reviewers of papers to some potential pitfalls in the development of classifiers, and suggests steps that researchers can take to help avoid these problems. Building classifiers should be viewed not simply as an add-on statistical analysis, but as part and parcel of the experimental process. Validation of classifiers for diagnostic applications should be considered as part of a much larger process of establishing the clinical validity of the diagnostic technique.

  7. Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics.

    Science.gov (United States)

    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.

  8. Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile.

    Science.gov (United States)

    Sáez-López, Emma; Guiral, Elisabet; Fernández-Orth, Dietmar; Villanueva, Sonia; Goncé, Anna; López, Marta; Teixidó, Irene; Pericot, Anna; Figueras, Francesc; Palacio, Montse; Cobo, Teresa; Bosch, Jordi; Soto, Sara M

    2016-01-01

    Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (pcoli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001). The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the aetiological link between maternal carriage and obstetric and subsequent puerperal infections.

  9. Vaginal versus Obstetric Infection Escherichia coli Isolates among Pregnant Women: Antimicrobial Resistance and Genetic Virulence Profile.

    Directory of Open Access Journals (Sweden)

    Emma Sáez-López

    Full Text Available Vaginal Escherichia coli colonization is related to obstetric infections and the consequent development of infections in newborns. Ampicillin resistance among E. coli strains is increasing, which is the main choice for treating empirically many obstetric and neonatal infections. Vaginal E. coli strains are very similar to extraintestinal pathogenic E. coli with regards to the virulence factors and the belonging to phylogroup B2. We studied the antimicrobial resistance and the genetic virulence profile of 82 E. coli isolates from 638 vaginal samples and 63 isolated from endometrial aspirate, placental and amniotic fluid samples from pregnant women with obstetric infections. The prevalence of E. coli in the vaginal samples was 13%, which was significant among women with associated risk factors during pregnancy, especially premature preterm rupture of membranes (p<0.0001. Sixty-five percent of the strains were ampicillin-resistant. The E. coli isolates causing obstetric infections showed higher resistance levels than vaginal isolates, particularly for gentamicin (p = 0.001. The most prevalent virulence factor genes were those related to the iron uptake systems revealing clear targets for interventions. More than 50% of the isolates belonged to the virulent B2 group possessing the highest number of virulence factor genes. The ampicillin-resistant isolates had high number of virulence factors primarily related to pathogenicity islands, and the remarkable gentamicin resistance in E. coli isolates from women presenting obstetric infections, the choice of the most appropriate empiric treatment and clinical management of pregnant women and neonates should be carefully made. Taking into account host-susceptibility, the heterogeneity of E. coli due to evolution over time and the geographical area, characterization of E. coli isolates colonizing the vagina and causing obstetric infections in different regions may help to develop interventions and avoid the

  10. Trends in the obstetric features and management of twin pregnancies.

    LENUS (Irish Health Repository)

    Smith, K E

    2010-03-01

    There are no reports outlining the trends in obstetric features and clinical management of twin pregnancies in an Irish obstetric population. The aim of this study was to investigate these factors for all twin pregnancies delivered during the 19 year period between 1989 and 2007, at Galway University Hospital (GUH). There were 52,199 infants delivered at GUH, of which 1594 infants (3.05% of births) were twins, related to 797 twin pregnancies. The overall incidence of twin pregnancies was 1.52%, increasing from 0.8%-1.0% in the early years of the study to 1.7-1.8% in the latter years of the study (P<0.001). There was a significant increase in incidence of twins born to mothers aged 30-39 years, alongside a significant reduction to mothers aged 20-29 years (P<0.01). The caesarean section rate overall was 41.5% (331\\/797), of which 54% (n=179) were elective, and 46% (n=152) were emergency, representing an emergency caesarean section rate of 19.1% of all twin pregnancies, and of 24.6% after exclusion of elective caesarean sections. The caesarean section rate for twins increased from 30% in 1989 to greater than 50% in the latter years of the study (P<0.01), related largely to a significant increase in elective caesarean sections (P<0.01). The combined vaginal-caesarean delivery rate was remarkably low at 0.75% of all twin pregnancies, and 1% after exclusion of elective caesarean sections. The preterm delivery rates were 4.1% (<32 weeks), and 16.3% (<36 weeks), with an overall perinatal mortality rate of 37 per 1000. These findings highlight the altered demographic and clinical aspects of twin pregnancies in an Irish obstetric population.

  11. Acute myocardial infarction in the obstetric patient.

    Science.gov (United States)

    Firoz, Tabassum; Magee, Laura A

    2012-06-01

    Acute myocardial infraction (AMI) in the obstetric patient is a rare event, although the incidence is rising due to advancing maternal age and pre-existing cardiac risk factors and medical co-morbidities. While atherosclerotic disease is the leading cause of AMI, coronary artery dissection is an important consideration in pregnancy and in the postpartum period. The physiological changes of pregnancy as well as pregnancy-specific risk factors can predispose the obstetric patient to AMI. Diagnosis of AMI can be challenging as symptoms may be atypical. Furthermore, diagnostic tests must be interpreted in the context of pregnancy. While the overall management of the obstetric patient with AMI is similar to that outside of pregnancy, drug therapy requires modification as some medications may be contraindicated in pregnancy and breastfeeding. There is limited information about prognosis and risk stratification but it is anticipated that future studies will address this issue.

  12. Obstetrics and Gynecology: Considerations in Career Selection

    Science.gov (United States)

    Stephen Petrilli, Edmund

    1981-01-01

    Current training programs in obstetrics and gynecology are not producing an excess of specialists in view of future manpower needs. In addition to being specialists and consultants, obstetrician-gynecologists also function as providers of primary care for women. During the last decade, three formal sub-specialties of obstetrics and gynecology have evolved: gynecologic oncology, maternal-fetal medicine and reproductive endocrinology. These have improved patient care and have altered the structure of resident education. With more American medical school graduates entering this specialty, the quality of resident applicants has improved, creating intense competition for desirable training positions. Those inclined toward a career in obstetrics and gynecology can be assured that it will provide an increasingly favorable and challenging environment for professional activity in the future. PMID:7210670

  13. Obstetrical violence: activism on social networkin

    Directory of Open Access Journals (Sweden)

    Lia Hecker Luz

    2015-12-01

    Full Text Available Normal birth in contemporaneity is discussed and the three models of birth care are presented, accordingly to categorization proposed by the north-American anthropologist Davis-Floyd, pointing out the consequences of the technocratic model, which has become hegemonic in contemporary societies, naturalizing obstetrical violence. The problematic is contextualized to Brazilian reality, with the analyses of the blog Cientista que virou mãe making it evident that Brazilian women on social media are articulating themselves in order to defend and give visibility to initiatives of natural and humanized birth, acting against obstetrical violence. It is concluded that Internet tools have allowed a pioneer mobilization in respecting women’s reproductive rights in Brazil, turning blogs into a potential hegemonic alternative way to reach more democratic forms of social organization. In addition to denaturalize the obstetrical violence, the bloggers also act aiming to pave the way for the humanistic approach and to motivate planned home birth initiatives.

  14. Considerations about our approach to obstetric psychoprophylaxis.

    Science.gov (United States)

    Cerutti, R; Volpe, B; Sichel, M P; Sandri, M; Sbrignadello, C; Fede, T

    1983-01-01

    Usually the term "obstetric psychoprophylaxis" refers to a specific method or technique. We prefer to consider it as a procedure that involves on one side the woman, the child and its family, and on the other the services entitled to give pre- and post-natal assistance. In order to realize this, a reformation of our methodological parameters and a critical analysis of the results obtained are required. In the courses of obstetric psychoprophylaxis that are held in the Department of Obstetrics and Gynaecology of the University of Padua we take into consideration the following themes: - Methodological approach - Professional training of the staff - Significance of psychosocial culture in the management of the pregnancy by the health services.

  15. What is an Obstetrics/Gynecology Hospitalist?

    Science.gov (United States)

    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.

  16. Freestanding midwifery units versus obstetric units

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Fenger-Grøn, Morten; Sandall, Jane

    2012-01-01

    women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage Methods The study was designed as a cohort study with a matched control group. It included 839 lowrisk women intending to give birth in an FMU, who were...... prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat. Results Women intending to give birth in an FMU had a significantly higher...

  17. Residents as Role Models: The Effect of the Obstetrics and Gynecology Clerkship on Medical Students' Career Interest

    Science.gov (United States)

    Chang, Judy C.; Odrobina, Michele R.; McIntyre-Seltman, Kathleen

    2010-01-01

    Background Medical students' choice of residency specialty is based in part on their clerkship experience. Postclerkship interest in a particular specialty is associated with the students' choice to pursue a career in that field. But, many medical students have a poor perception of their obstetrics and gynecology clerkships. Objective To determine whether fourth-year medical students' perceptions of teaching quality and quantity and amount of experiential learning during the obstetrics-gynecology clerkship helped determine their interest in obstetrics-gynecology as a career choice. Methods We distributed an anonymous, self-administered survey to all third-year medical students rotating through their required obstetrics and gynecology clerkship from November 2006 to May 2007. We performed bivariate analysis and used χ2 analysis to explore factors associated with general interest in obstetrics and gynecology and interest in pursuing obstetrics and gynecology as a career. Results Eighty-one students (N  =  91, 89% response rate) participated. Postclerkship career interest in obstetrics and gynecology was associated with perceptions that the residents behaved professionally (P obstetrics and gynecology as a career both before (P  =  .027) and after (P  =  .014) the clerkship, men were more likely to increase their level of career interest during the clerkship (P  =  .024). Conclusions Clerkship factors associated with greater postclerkship interest include higher satisfaction with resident professional behavior and students' sense of inclusion in the clinical team. Obstetrics and gynecology programs need to emphasize to residents their role as educators and professional role models for medical students. PMID:21976080

  18. low birthweight babies: socio-demographic and obstetric ...

    African Journals Online (AJOL)

    2002-10-01

    Oct 1, 2002 ... mothers (aged below 20 years) and older mothers of low birthweight ( ... have unfavourable socio-demographic and obstetric factors like ... having less formal education, being unemployed and having obstetric risks for poor.

  19. What Role Does Obstetrical Care Play in Childbirth?

    Science.gov (United States)

    ... Research Planning Scientific Resources Research A-Z Topics Obstetrics Overview Condition Information What medical care is provided? ... during labor and delivery. 4 American Board of Obstetrics and Gynecology. (n.d.). Frequently asked questions . Retrieved ...

  20. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study

    DEFF Research Database (Denmark)

    Kjaergaard, H.; Olsen, J.; Ottesen, Bent Smedegaard

    2008-01-01

    BACKGROUND: In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors...... for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. METHODS: A multi-centre population based cohort study with prospectively collected data from 2810......: The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix

  1. Crew Resource Management for Obstetric and Neonatal Teams to Improve Communication During Cesarean Births.

    Science.gov (United States)

    Mancuso, Mary P; Dziadkowiec, Oliwier; Kleiner, Catherine; Halverson-Carpenter, Katherine; Link, Terri; Barry, James

    2016-01-01

    To assess the effectiveness of crew resource management training and interventions on the quality and quantity of communication during cesarean births in a tertiary academic hospital's labor and birthing services. A prospective pre-post crew resource management training intervention. Tertiary academic hospital in the Western United States. All members of obstetric and neonatal teams that participated in cesarean births. Over a 5-month time period, all obstetric and neonatal staff were required to participate in team training in crew resource management critical language, communication, and team structure. Trained observers collected baseline data (n = 52) for 3 months on the quantity and quality of communications that occurred during cesarean births. Postintervention data (n = 50) were gathered for 3 months after team training. Analysis approach included use of Fisher's exact test, independent-samples t test, and multilevel generalized linear regression models with Poisson distribution. There was a statistically significant increase in quantity and quality of communication from pre- to postintervention assessment for obstetric and neonatal staff. Although the increase in quality was similarly great between both types of teams, increase in quantity was more substantial in obstetric staff. Principles of team communication training shown to be effective in increasing communication among team members in a variety of clinical areas were also effective in improving communication in the labor and birth setting during cesarean births. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  2. Use of an Information Retrieval Service in an Obstetrics/Gynecology Residency Program.

    Science.gov (United States)

    And Others; Gunning, John E.

    1980-01-01

    A program that uses the clinical librarian as a member of the patient care team has been developed by an obstetrics and gynecology department of a university medical center to keep faculty and hospital house staff knowledgeable about current developments and research. Program objectives, methodology, costs, evaluation, and information utilization…

  3. [METROPLASTY FOR OBSTETRIC PERITONITIS, ARISING IN THE BACKGROUND SUTURE FAILURE OF THE UTERUS].

    Science.gov (United States)

    Tussupkaliyev, A; Daribay, Zh; Saduov, M; Dossimbetova, M; Rakhmetullina, G

    2016-12-01

    Improving treatment outcomes obstetric peritonitis after cesarean section on the basis of organ-preserving treatment and reasonable intensive care in the postpartum period. Fifteen clinical cases in which on the background of peritonitis were made conserving surgery, which included: excision of necrotic areas on the uterus, uterine cavity curettage, metroplasty. Nasointestinal bowel intubation and drainage of the abdominal cavity. It is discussed tactics of postpartum women with obstetric peritonitis on the background of insolvency seams on the uterus, currently existing criteria for evaluation and treatment of patients data. The necessity of using in the algorithm survey postpartum women with obstetric peritonitis diagnostic criteria SIRS, leukocyte index of intoxication, integrated scales organ dysfunctions. Modern approaches to surgical treatment, the starting antibiotic therapy antibiotics ultra wide spectrum of action, combined with early intensive treatment in an intensive care unit avoids removal of the uterus as a primary focus.

  4. EVALUATION OF UNDERGRADUATE TEACHING CURRICULUM FOR OBSTETRICS AND GYNECOLOGY

    Directory of Open Access Journals (Sweden)

    Suniti

    2015-10-01

    Full Text Available The ultimate controlling process of education is evaluation which not only monitors the progress and achievements of students but also provides important feedback towards modification and improvement of teaching learning process. Present study was conducted to evaluate the undergraduate curriculum in Obstetrics and Gynecology. Ninety one students of final MBBS students participated in the study. Student feedback was taken by preparing a questionnaire. The opinions were recorded and analyzed. In the present stud y 94.50% felt that the classes in the final year should be taken regularly by the senior faculty. In the clinical postings 14.28% had seen MTP and method of taking Pap smear was seen by 19.78% of student’s .At the end of the clinical posting the students w ere confident about conducting normal delivery and suturing episiotomy. They were not confident in seeing cross matching (9.89% and management of PPH (28.57%. The areas to be strengthened in the present curriculum are: More practical sessions in taking p ap smears, seeing cross matching and management of emergencies in Obstetrics and Gynecology.

  5. Asymptomatic bacteriuria and antibacterial susceptibility patterns in an obstetric population.

    Science.gov (United States)

    Celen, Sevki; Oruç, Ayla Sargin; Karayalçin, Rana; Saygan, Sibel; Unlü, Serpil; Polat, Belgin; Danişman, Nuri

    2011-01-01

    Introduction. Asymptomatic bacteriuria (ASB), occurring in 2-11% of pregnancies, is a major predisposition to the development of pyelonephritis, which is associated with obstetrical complications, such as preterm labor and low birth weight infants. The aim of this study was to determine the prevalence of ASB, the antibacterial susceptibilities of the isolated microorganisms and the associated risk factors in an outpatient clinical setting in Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey. Material and Methods. Between December 2009 and May 2010, pregnant women admitted to the antenatal outpatient clinic were included in this study. The results of a complete urine analysis, midstream urine culture and antibacterial susceptibility were evaluated. Results. Of the 2011 pregnant women included, 171 had ASB (8.5%). E. coli was the most frequently isolated microorganism (76.6%), followed by Klebsiella pneumonia (14.6%). Both microorganisms were highly sensitive to fosfomycin, sensivity being 99.2% for E. coli and 88% for Klebsiella pneumonia. Conclusions. In this certain geographical region, we found E. coli as the most common causative agent of ASB in the obstetric population and it is very sensitive to fosfomycin. We recommend fosfomycin for ASB in pregnant women due to its high sensitivity, ease of administration and safety for use in pregnancy.

  6. The Current Status and Future of Academic Obstetrics.

    Science.gov (United States)

    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…

  7. The Current Status and Future of Academic Obstetrics.

    Science.gov (United States)

    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…

  8. Commentary: Pursuing justice in death penalty trials.

    Science.gov (United States)

    Watson, Clarence; Eth, Spencer; Leong, Gregory B

    2012-01-01

    The capital trial, by its nature, is fraught with emotionally disturbing elements that jurors must face when deciding the ultimate fate of a guilty defendant. A confluence of mitigating and aggravating factors influences a capital jury's decision to impose a sentence of death. The presence or absence of defendant remorse in these cases may make all the difference in whether a capital defendant's life is spared. This commentary examines the onerous emotional toll encountered by capital jurors in light of the findings of Corwin and colleagues regarding defendant remorse and juror's need for affect. The commentary also presents practical and ethics-related considerations that should be kept in mind when reflecting on their study.

  9. [Neurologic vigor of term newborns according to the type of delivery and obstetric maneuvers].

    Science.gov (United States)

    Riesgo, Rudimar dos Santos; Ohlweiler, Lygia; Winckler, Maria Isabel Bragatti; Ranzan, Josiane; Riesgo, Itamar Dos Santos; Rotta, Newra Tellechea

    2009-06-01

    to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic

  10. Urban Forms and Future Cities: A Commentary

    Directory of Open Access Journals (Sweden)

    Shlomo Angel

    2017-02-01

    Full Text Available The commentary reflects on the critical ways in which the proliferation of private property rights and local planning powers constrain and delimit the changes in the forms of cities that will be required in the coming years to ensure that they remain productive, inclusive, and sustainable. It argues that the effective management of the coming disruptions now require a shift of power from the private and the local to the metropolitan and the regional.

  11. Obstetric outcome of women with uterine anomalies in China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan; ZHAO Yang-yu; QIAO Jie

    2010-01-01

    Background Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.Methods This retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student's t test and analysis of variance (ANOVA) were used to compare means for normally distributed variables. The analysis was carried out using the SPSS.Results Among 21 961 deliveries in Peking University Third Hospital, 116 (0.45%) were in women with uterine anomalies. A septate uterus was present in 43 (37.1%) and the uterus didelphys in 28 (24.2%) of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 (10.3%), 18 (15.5%) and 15 (12.9%) patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation (38.8%), preterm delivery (19.8%), and cesarean section (78.5%) compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage (SGA) neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies (P <0.001). The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns (P <0.05).Conclusions Women with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.

  12. Commentary: ambiguity and uncertainty: neglected elements of medical education curricula?

    Science.gov (United States)

    Luther, Vera P; Crandall, Sonia J

    2011-07-01

    Despite significant advances in scientific knowledge and technology, ambiguity and uncertainty are still intrinsic aspects of contemporary medicine. To practice confidently and competently, a physician must learn rational approaches to complex and ambiguous clinical scenarios and must possess a certain degree of tolerance of ambiguity. In this commentary, the authors discuss the role that ambiguity and uncertainty play in medicine and emphasize why openly addressing these topics in the formal medical education curriculum is critical. They discuss key points from original research by Wayne and colleagues and their implications for medical education. Finally, the authors offer recommendations for increasing medical student tolerance of ambiguity and uncertainty, including dedicating time to attend candidly to ambiguity and uncertainty as a formal part of every medical school curriculum.

  13. [Propanidid-ketamine combination in obstetrical anesthesia].

    Science.gov (United States)

    Purita, N; Lisardi, S; Bilotta, F; Accorinti, L

    1979-09-01

    The A. have introduced a new technique in obstetrical, anaesthesia for short and long term intervention, included caesarean section, inducing anaesthesia with a mixture in the same syringe of propanidid and ketamin. The A. exhibit the results they have got treating the first 100 patients in this way and conclude with an extremely positive judgement.

  14. Cultural Competence of Obstetric and Neonatal Nurses.

    Science.gov (United States)

    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.

  15. knowledge about obstetric danger signs among preg

    African Journals Online (AJOL)

    user

    about knowledge level of pregnant women on obstetric danger signs. The objective of this ... deficiencies in awareness should be addressed through maternal and child health services by designing an appro- ..... demographic, cultural, and health interventions as well as ... Baby Package: Implementing Safe Motherhood.

  16. Acute Respiratory Distress Syndrome in Obstetric Patients

    Directory of Open Access Journals (Sweden)

    S. V. Galushka

    2007-01-01

    Full Text Available Objective: to define the specific features of the course of acute respiratory distress syndrome (ARDS in puer-peras with a complicated postpartum period. Subjects and methods. Sixty-seven puerperas with ARDS were examined. Group 1 included 27 puerperas with postpartum ARDS; Group 2 comprised 10 puerperas who had been treated in an intensive care and died; Group 3 consisted of nonobstetric patients with ARDS of various genesis (a control group. Results. In obstetric patients, the baseline oxygenation index was significantly lower than that in the control group. However, Group 1 patients showed a rapid increase in PaO2/FiO2 on days 3—4 of treatment. In the control group, the changes occurred later — on days 5—6. The baseline alveolar-arterial oxygen difference was significantly higher in the obstetric patients than that in the controls. In Group 1, AaDpO2 drastically decreased on days 3—4, which took place in parallel with an increase in the oxygenation index. At the beginning of the study, pulmonary shunting was high in the group of survivors, deceased, and controls. In Group 1, the shunting decreased on days 3—4 whereas in the control group this index normalized later — only by days 6—7. In Group 1, compliance remained lower throughout the observation, but on day 7 there was a significant difference in this index between the deceased, survivors, and controls. Conclusion. Thus, more severe baseline pulmonary gas exchange abnormalities are observed in obstetric patients than in general surgical and traumatological patients; the oxygenation index, alveolar-arterial oxygen difference, and pulmonary shunting index more rapidly change in patients with severe obstetric disease in its favorable course than in general surgical and traumatological patients; throughout the observation, thoracopulmonary compliance was less in obstetric patients than in the controls. Key words: acute respiratory distress syndrome, puerperium.

  17. Midwifery and obstetrics: twenty years of collaborative academic practice.

    Science.gov (United States)

    Angelini, Diane J; O'Brien, Barbara; Singer, Janet; Coustan, Donald R

    2012-09-01

    This review describes a collaborative educational practice model partnering midwifery and obstetrics within a department of obstetrics and gynecology. For more than 20 years, the authors' model has demonstrated sustainability and influence on medical education. The focus is on resident education in obstetrics, using midwifery faculty as teachers in the obstetric and obstetric triage settings. This noncompetitive and integrated educational practice model has achieved sustainability and success using midwives in a collaborative approach to medical education. The continuing collaboration and innovation within medical and resident education are important elements for the future of collaborative practice.

  18. Evaluation of ethics education in obstetrics and gynecology residency programs.

    Science.gov (United States)

    Byrne, John; Straub, Heather; DiGiovanni, Laura; Chor, Julie

    2015-03-01

    The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. A cross-sectional, web-based survey was designed in conjunction with a professional survey laboratory at the University of Chicago. The survey was piloted with a convenience sample of clinical medical ethics fellows to assess question content and clarity. The survey was deployed by e-mail to all obstetrics-gynecology residency program directors. Descriptive statistics were used to analyze participant responses. The University of Chicago's Institutional Review Board deemed this study exempt from institutional review board formal review. Of 242 eligible obstetrics-gynecology residency program directors, 118 (49%) completed the survey. Most respondents were from university-based programs (n = 78, 66%) that were not religiously affiliated (n = 98, 83%) and trained 4-6 residents per postgraduate year (n = 64, 70%). Although 50% of program directors (n = 60) reported having ethics as part of their core curriculum, most programs teach ethics in an unstructured manner. Fifty-seven percent of respondents (n = 66) stated their program dedicated 5 or fewer hours per year to ethics. The majority of program directors (n = 80, 73%) responded they would like more to a lot more ethics education and believed that ethics education should be required (n = 93, 85%) for residents to complete their training. Respondents identified that crowding in the curriculum was a significant barrier to increased ethics training (n = 50, 45%) and two-thirds (n = 74, 67%) reported a lack of faculty expertise as a moderate barrier to providing ethics education in the residency curriculum. This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics

  19. Commentary: Lowly interns, more is merrier, and the Casablanca Strategy.

    Science.gov (United States)

    Croskerry, Pat

    2011-01-01

    Test ordering is an integral part of clinical decision making. Variation in test-ordering behavior appears to reflect uncertainty in the clinical reasoning and decision-making process. Among decision makers, novices function mostly in the analytic mode of reasoning, experiencing high levels of uncertainty and, therefore, account for the most variance. While less discriminate test ordering has both economical and clinical downsides, it nevertheless remains a rite of passage along the road toward expertise. In response to the article by Iwashyna and colleagues, the author of this commentary reflects on the implications of test-ordering behavior in the academic medicine setting. The process of ordering tests can serve purposes other than the obvious, not the least of which allows the decision maker additional time for reflection in the decision-making process, perhaps leading to a less mindless and more mindful approach. The author observes that test-ordering behavior of novitiates might be optimized through a variety of strategies that improve both active and passive learning in the clinical environment. In addition to specific education around costs, as well as Bayesian considerations, active learning importantly requires exposure to those processes that may subvert clinical reasoning, notably cognitive biases. Passive learning is enhanced in supportive environments. Throughout, those who supervise and teach should provide effective models.

  20. Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

    Directory of Open Access Journals (Sweden)

    Jalana N. Lazar

    2013-01-01

    Full Text Available Background. This pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers’ experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC. Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

  1. Metformin in obstetric and gynecologic practice: a review.

    Science.gov (United States)

    McCarthy, Elizabeth A; Walker, Susan P; McLachlan, Kylie; Boyle, Jacqui; Permezel, Michael

    2004-02-01

    Metformin is a common treatment for women who have insulin resistance manifesting as type 2 diabetes or polycystic ovarian syndrome (PCOS). With an increasing number of these patients conceiving, it is expected that the use of metformin in and around the time of pregnancy will increase. This article reassesses the mechanisms, safety, and clinical experience of metformin use in obstetrics and gynecology. Metformin is an attractive therapeutic option because administration is simple, hypoglycemia rare, and weight loss promoted. There is a large volume of research supporting the use of metformin treatment in diabetes mellitus, androgenization, anovulation, infertility, and recurrent miscarriage. Although metformin is known to cross the placenta, there is, as yet, no evidence of teratogenicity. Metformin has an array of complex actions, accounting for the varied clinical roles, many of which are still to be fully evaluated. Much research is still needed.

  2. Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training.

    Science.gov (United States)

    Moran, Neil F; Naidoo, Mergan; Moodley, Jagidesa

    2015-11-01

    Training programmes to improve health worker skills in managing obstetric emergencies have been introduced in various countries with the aim of reducing maternal mortality through these interventions. In South Africa, based on an ongoing confidential enquiry system started in 1997, detailed information about maternal deaths is published in the form of regular 'Saving Mothers' reports. This article tracks the recommendations made in successive Saving Mothers reports with regard to emergency obstetric training, and it assesses the impact of these recommendations on reducing maternal mortality. Since 2009, South Africa has had its own training package, Essential Steps in the Management of Obstetric Emergencies (ESMOE), which the last three Saving Mothers reports have specifically recommended for all doctors and midwives working in maternity units. A special emphasis has been placed on the need for the simulation training component of ESMOE, also called obstetric 'fire drills', to be integrated into the clinical routines of all maternity units. The latest Saving Mothers report (2011-2013) suggests there has been little progress so far in improving emergency obstetric skills, indicating a need for further scale-up of ESMOE training in the country. The example of the KwaZulu-Natal province of South Africa is used to illustrate the process of scale-up and factors likely to facilitate that scale-up, including the introduction of ESMOE into the undergraduate medical training curriculum. Additional factors in the health system that are required to convert improved skills levels into improved quality of care and a reduction in maternal mortality are discussed. These include intelligent government health policies, formulated with input from clinical experts; strong clinical leadership to ensure that doctors and nurses apply the skills they have learnt appropriately, and work professionally and ethically; and a culture of clinical governance.

  3. [An update of the obstetrics hemorrhage treatment protocol].

    Science.gov (United States)

    Morillas-Ramírez, F; Ortiz-Gómez, J R; Palacio-Abizanda, F J; Fornet-Ruiz, I; Pérez-Lucas, R; Bermejo-Albares, L

    2014-04-01

    Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  4. Changes in the Practice of Obstetrics and Gynecology.

    Science.gov (United States)

    Rayburn, William F; Tracy, Erin E

    2016-01-01

    A projected shortage of obstetrician-gynecologists (OB-GYNs) is a result of both the increasing US population and the relatively static number of residency graduates. In addition, generational changes have contributed to increasing subspecialization, more desiring part-time employment, and earlier retirement. This article reviews data regarding changes in the practice of obstetrics and gynecology. Residency education is focusing more on a core curriculum in general obstetrics and gynecology, while subspecialty fellowship training has grown in popularity. There are no recent data to describe whether OB-GYNs are working fewer hours, yet more are employed in larger practices at mostly metropolitan locations. A team-based care model that incorporates nonphysician clinicians and digital conversion of clinical data has been encouraged to increase accessibility, improve comprehensiveness, commit to more continuity of care, and reduce redundancy. Compared with other medical specialists, OB-GYNs retire slightly earlier, especially females who will represent the field more. The specialty is moving toward a more comprehensive women's health care practice model that is more patient-centered, efficient, cost controlling, team-based, and adaptable to the needs of a diverse population. Implications from these changes for our practices and improving patient care are currently unclear and await more reported experience.

  5. [Modification of the obstetric hysterectomy in placental acretism].

    Science.gov (United States)

    Ortiz-Villalobos, Roberto Carlos; González-Gómez, Israel Alejandro; Luna-Covarrubias, Edith Esmeralda; Bañuelos-Franco, Alberto; Serrano-Enríquez, Raymundo Felipe

    2014-03-01

    Acretismo is a condition of abnormal placentation, in which the villi invade the myometrium at the implantation site, Representing a risk of massive obstetric hemorrhage with possible alterations of the coagulation, besides to the damage to other organs. Moving forward even to his death, so it is a challenge for the obstetric services, to make a correct diagnosis and in a timely manner, along with the programming of the interruption of pregnancy, as well as the utilization of proper surgical techniques and the involvement of a multidisciplinary team to the possible complications. The following describes a surgical technique modified for patients with a diagnosis of acretismo placentario, used in the Hospital General de Occidente in Jalisco, Mexico from 1 year ago, presenting two clinical cases of patients who underwent surgery with this technique, considering it necessary to present up to the moment a significant decrease in the amount of bleeding, zero days stay of patients in intensive care, any complications in the mother as well as in the product, and more importantly, it has remained at the hospital with no maternal death by this pathology in the last year, considering the nature of being a referral hospital for the whole entity by the Servicios de Salud Jalisco. It is necessary to consider the risks/benefits in the short, medium and long term for the institution, the mother and the product, allowing present good practices that will impinge on the permanent reduction of the maternal death by this pathology.

  6. Menopause education: needs assessment of American obstetrics and gynecology residents.

    Science.gov (United States)

    Christianson, Mindy S; Ducie, Jennifer A; Altman, Kristiina; Khafagy, Ayatallah M; Shen, Wen

    2013-11-01

    This study aims to understand the current teaching of menopause medicine in American obstetrics and gynecology residency programs. A Web-based survey was e-mailed to all American obstetrics and gynecology residency directors, with a request that they forward it to their residents. Of 258 residency program directors contacted, 79 (30.6%) confirmed forwarding the survey. In all, 1,799 people received the survey, with 510 completions, for a response rate of 28.3%. Most residents reported that they had limited knowledge and needed to learn more about these aspects of menopause medicine: pathophysiology of menopause symptoms (67.1%), hormone therapy (68.1%), nonhormone therapy (79.0%), bone health (66.1%), cardiovascular disease (71.7%), and metabolic syndrome (69.5%). Among fourth-year residents who will be entering clinical practice soon, a large proportion also reported a need to learn more in these areas: pathophysiology of menopause symptoms (45.9%), hormone therapy (54.2%), nonhormone therapy (69.4%), bone health (54.2%), cardiovascular disease (64.3%), and metabolic syndrome (63.8%). When asked to rate the most preferred modalities for learning about menopause, the top choice was supervised clinics (53.2%), followed by case presentations (22.2%), formal lectures (21.3%), small groups (14.7%), Web-based learning (7.8%), and independent reading (5.2%). Only 20.8% of residents reported that their program had a formal menopause medicine learning curriculum, and 16.3% had a defined menopause clinic as part of their residency. It seems that some American residency programs do not fulfill the educational goals of their residents in menopause medicine. A curriculum would be beneficial for increasing knowledge and clinical experience on menopause issues.

  7. Medical Device Approvals Through the Premarket Approval Pathway in Obstetrics and Gynecology From 2000 to 2015: Process and Problems.

    Science.gov (United States)

    Walter, Jessica R; Hayman, Emily; Tsai, Shelun; Ghobadi, Comeron W; Xu, Shuai

    2016-06-01

    Recent controversies surrounding obstetrics and gynecology devices, including a permanent sterilization device, pelvic meshes, and laparoscopic morcellators, highlight the need for deeper understanding of obstetrics and gynecology medical device regulation. The U.S. Food and Drug Administration premarket approval database was queried for approvals assigned to the obstetrics and gynecology advisory committee from January 2000 to December 2015. Eighteen device approvals occurred in the time period studied. The most common clinical indications included endometrial ablation (33%), contraception (28%), and fetal monitoring (17%). The median approval time was 290 days (range 178-1,399 days). Regarding the pivotal trials leading to approval, there were 11 randomized controlled trials, one randomized crossover study, five nonrandomized prospective studies, and two human factor studies. Fourteen devices (78%) met their primary clinical efficacy endpoint. Only 12 of 18 devices were required to conduct postmarket surveillance. A significant proportion of devices (42%) were approved on the basis of nonrandomized controlled trials. Three devices have been withdrawn after approval, all of which were either not referred or not recommended for approval by the obstetrics and gynecology advisory committee. Of the three devices withdrawn from the market, two failed to demonstrate clinical benefit in their pivotal trials. One device was not required to undergo postmarketing surveillance and was subsequently withdrawn as a result of patient safety concerns. Our results reveal significant weaknesses in the preapproval and postapproval regulation of high-risk obstetrics and gynecology devices. Greater specialty group involvement is necessary to ensure the development of safe and clinically effective devices.

  8. Response to Erich Loewy: commentary.

    Science.gov (United States)

    Thomasma, David C

    1991-01-01

    The capacity to suffer, the vulnerability with respect to suffering, confers on all animals with that capacity (not just human beings) a prima facie right not to be caused suffering. Nurturing in order to stave off such suffering is the first act of the community toward the individual, primarily in infancy. Hence for Loewy, autonomy, the gradual growth of self-determination in individuals, is grounded in a broader moral commitment of the community, that of beneficence. This is the critical point in his argument, for it represents a wholesale critique of modern libertarianism. Libertarians, in contrast to Loewy's argument, seem to ground the nature of the community in the prima facie right of autonomy. For Loewy, the community not only has an obligation to refrain from harming individuals (nonmaleficence), but it also has an active duty to ameliorate and prevent, as far as possible, the suffering of its members. Thus, if there is a social contract, it is one of nurturing one another to overcome the vulnerability of suffering, not primarily one of protecting autonomy. This is most significant for clinical ethics as well. Once the primary obligation to ameliorate suffering is no longer necessary, when the individual loses or does not have the primary moral worth prompted by the capacity to suffer, then secondary and symbolic obligations emerge. Loewy is thereby able to suggest a "calculus" of moral worth, wherein our obligations to individuals in a permanent vegetative state or to anencephalics (almost always the individual will have lost the capacity to suffer through some cerebral event) must be weighed against other primary obligations. Although Loewy admits that grounding clinical ethics in the capacity to suffer might be "thin," it nevertheless prompts serious discussion about the nature of the "good" in good clinical ethics decisions.

  9. Risk for obstetric complications and schizophrenia.

    Science.gov (United States)

    Preti, A; Cardascia, L; Zen, T; Marchetti, M; Favaretto, G; Miotto, P

    2000-10-30

    The goal of this study was to determine whether cases with schizophrenia or related disorders show a history of obstetric complications significantly more often than control subjects and, if so, whether the enhanced risk of a negative pregnancy outcome also extends to the non-schizophrenic offspring of cases. Data based on the obstetric birth case-notes of patients with diagnosed schizophrenia or related disorders were compared to those of normal 'healthy' control subjects; each case/control pair was individually matched by gender, time and parity of birth, maternal age and marital status. Forty-four case/control pairs born in Padova (Italy) between 1964 and 1978 were assessed for prenatal and perinatal complications, including abnormal gestational age or birthweight. No significant differences were observed between cases and control subjects in the general characteristics of birth; gestational age and birthweight in particular were strictly comparable between cases and control subjects. The schizophrenia spectrum patients (75%) were more likely than control subjects (59%) to have experienced at least one definite obstetric complication: odds ratio=2.07 (95% CI: 0.83-5. 15). Cases also suffered more complications per birth than control subjects (average 2:1). In particular, obstetric complications involving a clear damaging potential were seen significantly more often among cases than control subjects: 34% vs. 9%, Fisher's exact test, P=0.008 (odds ratio=5.17, 95% CI: 1.55-17.21). Moreover, severe obstetric complications were noted more often among males (n=13, 41%) than females (n=2, 15%). When any previous pregnancies of the mothers of patients were compared with those of the mothers of control subjects, mothers of cases were seen to have suffered unfavorable pregnancy outcomes significantly more often. In particular mothers of cases were seen to have had more miscarriages (OR=4.66), and pre-term births (OR=2.58) than control subects' mothers. Severe, brain

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  12. Why clinical trials of vitamin E and cardiovascular diseases may be fatally flawed. Commentary on "The Relationship Between Dose of Vitamin E and Suppression of Oxidative Stress in Humans"

    Science.gov (United States)

    Many investigators have pondered the apparent paradox in the conflicting evidence about the cardiovascular benefits of vitamin E suggested by experimental and observational studies versus that reported from randomized clinical trials. In the light of recent evidence, particularly a new clinical tria...

  13. Assessing teamwork performance in obstetrics: A systematic search and review of validated tools.

    Science.gov (United States)

    Fransen, Annemarie F; de Boer, Liza; Kienhorst, Dieneke; Truijens, Sophie E; van Runnard Heimel, Pieter J; Oei, S Guid

    2017-09-01

    Teamwork performance is an essential component for the clinical efficiency of multi-professional teams in obstetric care. As patient safety is related to teamwork performance, it has become an important learning goal in simulation-based education. In order to improve teamwork performance, reliable assessment tools are required. These can be used to provide feedback during training courses, or to compare learning effects between different types of training courses. The aim of the current study is to (1) identify the available assessment tools to evaluate obstetric teamwork performance in a simulated environment, and (2) evaluate their psychometric properties in order to identify the most valuable tool(s) to use. We performed a systematic search in PubMed, MEDLINE, and EMBASE to identify articles describing assessment tools for the evaluation of obstetric teamwork performance in a simulated environment. In order to evaluate the quality of the identified assessment tools the standards and grading rules have been applied as recommended by the Accreditation Council for Graduate Medical Education (ACGME) Committee on Educational Outcomes. The included studies were also assessed according to the Oxford Centre for Evidence Based Medicine (OCEBM) levels of evidence. This search resulted in the inclusion of five articles describing the following six tools: Clinical Teamwork Scale, Human Factors Rating Scale, Global Rating Scale, Assessment of Obstetric Team Performance, Global Assessment of Obstetric Team Performance, and the Teamwork Measurement Tool. Based on the ACGME guidelines we assigned a Class 3, level C of evidence, to all tools. Regarding the OCEBM levels of evidence, a level 3b was assigned to two studies and a level 4 to four studies. The Clinical Teamwork Scale demonstrated the most comprehensive validation, and the Teamwork Measurement Tool demonstrated promising results, however it is recommended to further investigate its reliability. Copyright © 2017

  14. Obstetrics risk of HIV infection among antenatal women in a rural Nigerian hospital

    Directory of Open Access Journals (Sweden)

    E A Etukumana

    2011-01-01

    Full Text Available Background: Obstetrics risk and practices can lead to the spread of HIV/AIDS. Identification of such obstetrics risk of HIV infection is a useful step in the prevention of transmission of the virus. Objective: We sought to determine obstetrics risk of HIV infection in pregnant women attending antenatal clinic in a rural Northern Nigerian hospital. Methods: We conducted a cross-sectional descriptive study of pregnant women attending antenatal clinic of a rural mission hospital in northern Nigeria between June and October 2005. Data were collected using structured questionnaire. HIV screening and confirmation was carried out on pregnant women after voluntary counseling. Results: 350 pregnant women were enrolled with a mean age (±SD of 26.8± 6.4years. The highest number of HIV infected women was observed in those who had their first coitus between 16 and 20 years. The age at first coitus was not significantly related to the HIV infection (P=0.41. Neither parity (P=0.13 nor past history of abortion (P=0.42 was associated with HIV infection. None of the 41 women who had their last delivery at home had HIV infection compared with 9.8% of the 194 women who delivered in the hospital or clinic (P=0.008. Forty percent of those who had their last delivery in primary health centre had HIV infection while 22.2% of those who delivered under the care of traditional birth had HIV infection. Conclusion: Obstetrics practices may encourage transmission of HIV infection. This calls for re-examination of the obstetrics practices especially in our primary health centers in order to prevent transmission of HIV infection.

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

    Science.gov (United States)

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

    2017-03-21

    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.

  16. Obstetric performance following an induced abortion.

    Science.gov (United States)

    Lowit, Alison; Bhattacharya, Sohinee; Bhattacharya, Siladitya

    2010-10-01

    Abortion has been legalised in most of the Western world for the past four decades. In areas where abortion practices are legal and easy to access, the risk of short-term complications is very low. As most women requesting induced abortion (IA) are young, potential adverse effects on subsequent reproductive function are important to them. This review investigates obstetric performance following IA and highlights methodological problems associated with research in this area. Some data suggest that IA may be linked with an increased risk of low birth weight, miscarriage and placenta previa but could be protective for pre-eclampsia. Current evidence also suggests an association between IA and pre-term birth. Large prospective cohort studies, which permit meaningful subgroup analyses, are needed to provide definitive answers on outcomes following alternative methods of IA and the impact of gestational age at abortion on future obstetric outcomes. Copyright 2010 Elsevier Ltd. All rights reserved.

  17. Myokymia in obstetrically related brachial plexopathy.

    Science.gov (United States)

    Sclar, Gary; Maniker, Allen; Danto, Joseph

    2004-06-01

    Myokymic discharges are spontaneous bursts of semirhythmic potentials that are sometimes correlated with rippling movements of skin and muscle. They have been reported in limb muscles in patients with Guillain-Barré syndrome, spinal stenosis, nerve root and nerve compression, and envenomations. They commonly occur with radiation induced plexopathies (approximately 60% of patients), but have not been reported in obstetrically related brachial plexopathies. We report 2 instances of myokymia in children with obstetric brachial plexus palsies. Each child was studied twice, and it was only at the later study, when the child was 10 or 11 months of age, that these potentials were noted. This could represent ongoing recovery from lesions incurred at birth or developmental changes. The final common pathway of all causes of myokymia could be to generate axonal membrane hyperexcitability.

  18. Blood transfusion practices in obstetric anaesthesia

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2014-01-01

    Full Text Available Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

  19. Obstetric care for women with thalassemia.

    Science.gov (United States)

    Lao, Terence T

    2017-02-01

    Thalassemia is the commonest monogenic disease and manifests as severe anemia. It is increasingly encountered outside the Mediterranean region, Africa, Middle East, and Southeast Asia because of immigration. Pregnancy, previously uncommon in patients with homozygous β-thalassemia, is encountered increasingly because of improved management and assisted reproduction technology; however, preconceptional problems that include anemia, iron overload, cardiac dysfunction, thromboembolism, alloimmunization, infections, and endocrine and bone disorders, could influence maternal and obstetric outcome. Although, successful pregnancy in thalassemia trait carriers and women with hemoglobin H disease is more common, there is still increased risk of obstetric and perinatal complications. Prenatal diagnosis to exclude fetal homozygous thalassemia and other congenital anomalies, together with close monitoring of the pregnancy, would optimize outcome. Further research is warranted to elucidate the fetal safety of iron chelation therapy and potential effect of pregnancy on long-term maternal health outcome, especially following occurrence of maternal complications. Copyright © 2016. Published by Elsevier Ltd.

  20. Magnesium in obstetric anesthesia and intensive care.

    Science.gov (United States)

    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.

  1. Barriers to emergency obstetric care services

    DEFF Research Database (Denmark)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique

    2014-01-01

    Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore...... decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay...... was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching...

  2. Investigation and analysis of clinical obstetrics and gynecology clinicians' mastery of basic skills and its influencing factors%妇产科临床医师对临床基本技能掌握情况及其影响因素的调查分析

    Institute of Scientific and Technical Information of China (English)

    孙成光; 甘晓玲; 刘帅斌; 胡丽娜; 董晓静; 蔡一玲; 罗丽

    2015-01-01

    目的 调查分析妇产科临床医师对于临床基本技能的掌握程度及其影响因素,以寻找提高临床医师熟练掌握妇产科临床基本技能的可行方法.方法 2015年2月至3月,采用自行设计调查问卷,以现场调查和函调方式随机对重庆市、四川、贵州、云南省等地的16所医院、共计320名妇产科临床医师进行调查,运用SPSS 19.0统计软件对结果进行描述性分析和秩和检验分析. 结果:有效问卷310份,33.7%(98人)认为自己妇产科基本技能掌握较差;23.1%(81人)认为自己掌握中等;43.1%(131人)认为自己掌握较好. 妇产科基本技能熟练程度均与操作次数、工作年限、职称有关(P<0.05). 基本技能学习途径来源主要为:工作医院87%(270人)、书籍82%(254人)、学术会议56%(174人);94.6%(293)的临床医师希望参加单独技能培训. 对于培训方式,临床医师更青睐于临床带教和模具训练. 结论 妇产科基本技能熟练程度与实际操作机会密切相关,需加强对临床医师基本技能培训的重视力度;增加其参加学术会议、进修、培训班等的机会;建立临床技能培训中心;构建区域性医学资源共享平台.%Objective To investigate and analyze clinical obstetrics and gynecology clinicians' mastery of basic skills, and then find the way to help clinicians master basic clinical skills. Methods A self-designed questionnaire survey was conducted among 310 clinicians working in 1-3 grade hospital from Chongqing, Sichuan, Guizhou, Yunnan provinces anonymously by spot field investigation and letter-investigations from February 1, 2015 and to March 31, 2015. The data were analyzed by descriptive analysis, using SPSS 19.0 software package for rank sum test analysis. Result Among 310 valid questionnaires, 31.6% (98) clinicians considered having inadequate clinical skills, 26% (81) average and 42.3%(131) expert. All the basic skills obtained had a relationship with the number of

  3. Obstetrical and perinatal outcomes in patients with or without obstetric analgesia during labor

    Directory of Open Access Journals (Sweden)

    Piedrahíta-Gutiérrez, Dany Leandro

    2016-07-01

    Full Text Available Objective: To describe and compare the obstetric and perinatal outcomes in patients with or without obstetric analgesia during labor, and to determine whether such analgesia is associated with adverse maternal or perinatal outcomes. Methodology: Comparative, retrospective, descriptive study, between January and November 2014, that included 502 healthy patients with normal pregnancies, out of which 250 received obstetric analgesia. The groups were compared as to maternal and perinatal outcomes. Results: Young, single and nulliparous mothers predominated; delivery was vaginal in 86 % of the cases, and by caesarean section in 14 %. Obstetric analgesia was associated with longer duration of the second stage of labor, instrumental delivery and cesarean section due to arrest of dilatation or fetal bradycardia; however, it was not related with higher incidence of postpartum hemorrhage or adverse perinatal outcomes such as meconium-stained amniotic fluid, Apgar under 5 at one minute or under 7 at 5 minutes, the need for neonatal resuscitation or for admission to NICU. Conclusion: Obstetric analgesia increases the duration of the second stage of labor and can increase the rate of caesarean sections and instrumental delivery, but it is not associated with adverse maternal or perinatal outcomes. Therefore, its use in labor is justified.

  4. Cutaneous pseudovasculitis, antiphospholipid syndrome and obstetric misadventure.

    Science.gov (United States)

    Thayaparan, A S; Lowe, S A

    2015-09-01

    We present two women with severe obstetric complications from antiphospholipid (aPL) syndrome associated with a rare dermatological manifestation, cutaneous pseudovasculitis. Both of these women developed a rash on the palmar aspect of the hands during the post partum period, with histology consistent with microthrombotic disease, despite anticoagulation. Cutaneous pseudovasculitis appears to be a maternal manifestation of aPL coagulopathy, possibly reflecting the severity of the underlying pregnancy pathology.

  5. Concepts of humanistic theory in obstetric care

    OpenAIRE

    Isolda Pereira da Silveira; Ana Fátima Carvalho Fernandes

    2012-01-01

    This study reflects the concepts of Paterson’s and Zderad’s humanistic theory, applied to daily nursing care during labor and childbirth. The objective of the study is to understand the importance of their application to attendant care. We take into account that the application of such concepts in obstetric nursing provides to the nurse and the expectant mother interaction and also a sense of being properly cared on behalf of the patient.

  6. Improved obstetric safety through programmatic collaboration.

    Science.gov (United States)

    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.

  7. Commentary: Situated learning in the Network society

    Directory of Open Access Journals (Sweden)

    Rune Krumsvik

    2008-07-01

    Full Text Available There is a need to develop a broader view of knowledge for dealing with the way in which new digital trends influence the underlying conditions for schools, pedagogy and subjects. This short commentary article, based on my paper at the NVU-conference 2008, will therefore highlight whether a broader view of knowledge - situated learning, digital literacy and the digital revolution can generate new ways of how we perceive pedagogy within the new educational reform in Norway in particular and the digitized school in general. The focus is particularly angled towards the implications this may have for developing new practises for teachers and students.

  8. A pilot structured resident orientation curriculum improves the confidence of incoming first-year obstetrics and gynecology residents.

    Science.gov (United States)

    Hiraoka, Mark; Kamikawa, Ginny; McCartin, Richard; Kaneshiro, Bliss

    2013-11-01

    A prospective, observational study was performed to evaluate a pilot orientation curriculum which involved all 7 incoming obstetrics and gynecology residents in June 2012. The objective of this study was to assess how a structured orientation curriculum, which employs an evaluation of baseline competency, affects the confidence of incoming first-year obstetrics and gynecology residents. The curriculum included didactic lectures, online modules, simulation, and mock clinical scenarios. Pre- and post-course surveys were conducted online via SurveyMonkey™ and were sent to all incoming obstetrics and gynecology residents. All seven incoming obstetrics and gynecology residents completed the orientation curriculum which included evaluations at the end of the orientation to assess baseline competency prior to taking part in clinical care. Confidence levels improved in all 27 elements assessed. Statistically significant improvement in confidence levels occurred in cognitive skills such as obstetric emergency management (2.9 vs 3.9, P< .05) and technical skills such as knot tying (3.9 vs. 4.6, P< .05). Certain teaching skills also demonstrated statistically significant improvements. A structured orientation program which improves resident self-confidence levels and demonstrates baseline competencies in certain clinical areas can be valuable for many residency training programs.

  9. Maternal morbid obesity and obstetric outcomes.

    LENUS (Irish Health Repository)

    Farah, Nadine

    2012-02-01

    OBJECTIVE: The purpose of this retrospective cohort study was to review pregnancy outcomes in morbidly obese women who delivered a baby weighing 500 g or more in a large tertiary referral university hospital in Europe. METHODS: Morbid obesity was defined as a BMI > or =40.0 kg\\/m2 (WHO). Only women whose BMI was calculated at their first antenatal visit were included. The obstetric out-comes were obtained from the hospital\\'s computerised database. RESULTS: The incidence of morbid obesity was 0.6% in 5,824 women. Morbidly obese women were older and were more likely to be multigravidas than women with a normal BMI. The pregnancy was complicated by hypertension in 35.8% and diabetes mellitus in 20.0% of women. Obstetric interventions were high, with an induction rate of 42.1% and a caesarean section rate of 45.3%. CONCLUSIONS: Our findings show that maternal morbid obesity is associated with an alarmingly high incidence of medical complications and an increased level of obstetric interventions. Consideration should be given to developing specialised antenatal services for morbidly obese women. The results also highlight the need to evaluate the effectiveness of prepregnancy interventions in morbidly obese women.

  10. Our experience and commentaries on improving clinical laboratory services in China%有关提高我国临床分子医学检验水平的探索和感想

    Institute of Scientific and Technical Information of China (English)

    包黎明

    2006-01-01

    @@ The Sino-US Joint Clinical and Molecular Laboratory (JCML) is a comprehensive clinical research laboratory with main focus on study of hematopoetic diseases including myelodysplastic syndrome, leukemias and lymphomas. The JCML is located in the Shanghai Medical College of Fudan University (formerly Shanghai Medical University) in Shanghai, China and was established as part of a large multi-center, international study of benzene health effect in China that is sponsored by the international consortium on benzene health effect.

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

    Directory of Open Access Journals (Sweden)

    Annika Åhman

    2016-07-01

    Full Text Available 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

  12. What's new in obstetric anesthesia? Focus on preeclampsia.

    Science.gov (United States)

    Leffert, L R

    2015-08-01

    Recent advances in the diagnosis, pathogenesis, and understanding of preeclampsia-related morbidity provide opportunities to optimize clinical management of the mother and fetus. These discoveries are timely, as contemporary data suggest that the prevalence of preeclampsia, affecting 7.5% of pregnancies globally and 2-5% in the USA, has increased by up to 30% over the last decade. Managing pregnant patients with preeclampsia can be challenging for all members of the obstetric care team due to the disease's multi-organ system maternal and fetal effects. This review presents recent updates in the definition of preeclampsia, etiology, comorbidities and therapeutic interventions and discusses how they impact the care of these high-risk patients.

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

    Science.gov (United States)

    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.

  14. Availability, utilisation and quality of basic and comprehensive emergency obstetric care services in Malawi.

    Science.gov (United States)

    Kongnyuy, Eugene J; Hofman, Jan; Mlava, Grace; Mhango, Chisale; van den Broek, Nynke

    2009-09-01

    To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.

  15. Obstetric Provider Trainees in Georgia: Characteristics and Attitudes About Practice in Obstetric Provider Shortage Areas.

    Science.gov (United States)

    Smulian, Elizabeth A; Zahedi, Leilah; Hurvitz, Julie; Talbot, Abigail; Williams, Audra; Julian, Zoë; Zertuche, Adrienne D; Rochat, Roger

    2016-07-01

    Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia.

  16. Study of role of blood transfusion in obstetric emergencies

    Directory of Open Access Journals (Sweden)

    Vibhuti Pravinbhai Patel

    2014-08-01

    Full Text Available Background: Blood Transfusion is recognized as one of the eight essential component of comprehensive emergency obstetric care which has been shown to reduce the maternal mortality.1,2 In developing country like India, efforts should be done to make blood and transfusion services well maintained and quickly available to reduce maternal morbidity from haemorrhage and thus decrease the incidence of maternal mortality. Aims and objectives: (1 To study clinical status of the patients at time of admission. (2 To study the role of antenatal visits in all patients required blood transfusion. (3 To study the effect of blood components on the patients' health. (4 To screen out the patients of high risk pregnancy and treat them safely. (5 To study causes of maternal mortality. Methods: Retrospective study of requirement of blood transfusion in antenatal and postnatal patients who came in labour room during last 3 month period at tertiary care Centre, Ahmedabad. Results: during the whole study out of 2200 patients 440 patients required blood transfusion among which 70% required due to obstetric hemorrhage and 30% due to severe anemia (less than 7 gm/dl. Major associated complications in the transfused patients were anemia (34% and PPH (36%. 4 patients expired among them 2 were due to development of DIC and septicemia, 1 due to severe anemia and 1 due to severe PPH. Conclusions: Ensuring a safe supply of blood and blood products and the appropriate and rational clinical use of blood. Strategies made to maximize the haemoglobin (Hb level at the time of delivery as well as to minimize blood loss. Active management of the third stage of labour is required to prevent avoidable morbidities, such as PPH, Retained product of conception, and vaginal lacerations. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1002-1005

  17. Determinants of research engagement in academic obstetrics and gynaecology.

    Science.gov (United States)

    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.

  18. Provision of critical care services for the obstetric population.

    Science.gov (United States)

    Sultan, P; Arulkumaran, N; Rhodes, A

    2013-12-01

    Management of the peripartum patient is a challenging aspect of critical care that requires consideration of both the physiological changes associated with pregnancy as well as the well-being of the foetus. In the UK, for every maternal death, approximately 118 near-miss events or severe acute maternal morbidities (SAMMs) occur. While a dedicated anaesthetic cover is usually provided on larger labour wards in the UK and US, a close communication with intensive care and other medical specialties must still be maintained. Medical outreach teams and early warning scores may help facilitate the early identification of clinical deterioration and prompt treatment. Ultimately level of care is allocated according to the clinical need, not the location, which may be a designated room, a normal labour room or a recovery area. Specialist obstetric units that provide high-dependency care facilities show lower rates of maternal transfer to critical care units and improved continuity of care before and after labour. The benefits of obstetric high-dependency units (HDUs) are likely to be determined by a number of logistic aspects of the hospital organisation, including hospital size and available resources. There remains a striking contrast in the burden of maternal mortality and morbidity and intensive care unit (ICU) resources between high- and low-income countries. The countries with the highest maternal mortality rates have the lowest number of ICU beds per capita. In under-resourced countries, patients admitted to ICUs tend to have higher illness severity scores, suggesting delayed admission to the ICU. The appropriate training of midwives is essential for successful HDUs located within labour wards.

  19. The maternal venous system: the ugly duckling of obstetrics.

    Science.gov (United States)

    Tomsin, K

    2013-01-01

    In pregnancy, both maternal vascular tone and cardiac function are considered key players to reach a normal outcome for both mother and child. This complex story of maternal hemodynamics is intensely discussed in current scientific literature, however the role of the maternal veins has been strongly underestimated. We developed and evaluated a set of measurable objective parameters which give an indication of venous function, i.e. the venous impedance index and the venous pulse transit time. These parameters turned out to be subject to changes throughout normal pregnancy and in preeclampsia enabling their use in gestational hemodynamic -studies. From our studies, we concluded that the venous system is a crucial determinant of cardiac output, which can be estimated by impedance cardiography. The introduction of these non-invasive techniques in obstetrics enables profiling the maternal cardiovascular system, integrating both arteries and veins, as well as maternal cardiac -function. Studying the cascade of cardiovascular changes throughout pregnancy using such non-invasive, easily applicable, and highly accessible methods opens perspectives to introduce this maternal cardiovascular profile in several -clinical settings. The early discrimination between low and high risk patients, together with the classification of different pregnancy disorders may help guiding the clinical work-up of the pregnant population regarding both prevention and treatment, as well as follow-up. We illustrate that the venous system, being an "ugly duckling" at first neglected by the medical world, transforms and matures into a beautiful swan, accepted by the obstetric world. We are confident that this is the beginning of many other studies regarding the maternal venous system, an important piece of the gestational physiology puzzle.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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 (PObstetrics 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.

  3. An open source software project for obstetrical procedure scheduling and occupancy analysis.

    Science.gov (United States)

    Isken, Mark W; Ward, Timothy J; Littig, Steven J

    2011-03-01

    Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the resulting occupancy on inpatient obstetrical units such as labor and delivery and postpartum. The models capture numerous important characteristics of inpatient obstetrical patient flow such as time of day and day of week dependent arrivals and length of stay, multiple patient types and clinical interventions, and multiple patient care units with inter-unit patient transfers. We have used these models in several projects at different hospitals involving design of procedure scheduling templates and analysis of inpatient obstetrical capacity. In the development of these models, we made heavy use of open source software tools and have released the entire project as a free and open source model and software toolkit.

  4. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: A retrospective study

    Directory of Open Access Journals (Sweden)

    Mariano Mascarenhas

    2014-01-01

    Full Text Available Objectives : The overwhelming numbers of twins following assisted reproductive technology (ART are dichorionic twins, but monochorionic twins account for around 0.9% of post ART pregnancies. The data for post ART-monochorionic pregnancy outcomes are scarce due to the rarity of this condition. Hence, we evaluated the obstetric outcomes of monochorionic and dichorionic pregnancies conceived on ART. Settings : University teaching hospital. Study Design : A case-control study of monochorionic diamniotic (MCDA and dichorionic diamniotic (DCDA pregnancies conceived following ART treatment. Charts of all women who conceived following ART from 2008 to 2013 were screened. Among them, the monochorionic twins diagnosed in the first trimester were included and their obstetric outcome was followed-up. For comparison, an equal number of dichorionic twin pregnancies from age and body mass index matched mothers was selected. Results : The baseline clinical characteristics were similar between the two groups. MCDA group had a higher miscarriage rate (50% than the DCDA group (10%, with three seconds trimester miscarriages in the MCDA group. The live birth rates were lower in the MCDA versus DCDA group (40% vs. 90%. Among triplet pregnancies with a monochorionic component, the live birth rate was only 25%. Conclusions : Monochorionic pregnancies following ART have poorer obstetric outcomes when compared to dichorionic pregnancies. For monochorionic pregnancies following ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome.

  5. Evaluation of an education day for families of children with obstetrical brachial plexus palsy.

    Science.gov (United States)

    Ho, Emily S; Ulster, Alissa A

    2011-09-01

    Children with obstetrical brachial plexus palsy may have chronic physical impairment in their affected upper extremity. Affected children and their families may benefit from psychosocial interventions including therapeutic relationships with health professionals, meeting other families living with obstetrical brachial plexus palsy, support groups, and social work. One method of addressing psychosocial needs is through a support and education day. The purpose of this quality improvement project is to evaluate parental perceptions of a support and education day called the "Brachial Plexus Family Day." Families of children with obstetrical brachial plexus palsy who attended the Brachial Plexus Family Day completed a questionnaire to evaluate the different programs offered during the day. The families also ranked the importance of different psychosocial supports offered in the clinic. Sixty-three out of 69 families completed the questionnaire. Each program of the Brachial Plexus Family Day was rated as good or excellent by the respondents. Ninety-seven percent of respondents rated meeting other families and children with obstetrical brachial plexus palsy as helpful supports. Attending a Brachial Plexus Family day event (86%), followed by connecting with a doctor (60%), and physical or occupational therapist (59%) were the highest ranked supports reported by the families. The parents and caregivers that attended the Brachial Plexus Family Day rated the program highly. This group also valued the opportunity to connect with other families and children affected with the same condition.

  6. High proportions of obstetric referrals in Addis Ababa: the case of term premature rupture of membranes.

    Science.gov (United States)

    Mirkuzie, Alemnesh H; Sisay, Mitike Molla; Bedane, Mulu Muleta

    2016-01-25

    The Public Health Centers (HCs) provide basic obstetric and neonatal care to about 80% of the eligible population in Addis Ababa. Hospitals provide comprehensive services and are referral centers for complications that cannot be managed at the HCs. This study assessed the proportion of obstetric referrals in general and referrals due to premature rupture of membranes (PROM) at term in particular, from the HCs in Addis Ababa and explored its appropriateness and management in hospitals. The study used a sequential explanatory mixed methods design. Routine retrospective data were collected from ten randomly selected HCs in 2012. Key informant interviews were conducted using a guide developed following a preliminary analysis of the quantitative data. Ten head midwives, one from each health center participated in the interviews. Of the 9340 mothers who sought skilled birth care in the ten HCs in 2012, 2820 (30.3%) were diagnosed with obstetric complications and referred to hospital. Term PROM accounted for 557 (19.7%) of the referrals and it was widely varied across the HCs. Fifteen (7.8%) mothers who were referred for PROM, had intact membranes upon hospital examinations. Forty-two (77.8%) of the referred mothers who had spontaneous labour and delivery could have been misclassified as not having labour upon referral. In the interviews, variations in diagnosing and managing term PROM were identified as themes. Three HCs relayed solely on mothers' self reports of amniotic fluid leakage to diagnose, two HCs did complementary speculum/vaginal examination, three HCs monitored sign of labour on top of confirming the leakage. Regarding management, two HCs practiced expectant management, three referred mothers after 30 min of observation while others issued referral right away. All providers reported the lack of clinical guidelines for most common obstetric problems in their HC. The study reported large proportion of obstetric referrals in general and PROM referrals in

  7. Auditing the standard of anaesthesia care in obstetric units.

    Science.gov (United States)

    Mörch-Siddall, J; Corbitt, N; Bryson, M R

    2001-04-01

    We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

  8. Pregnancy in patients with rheumatic diseases: obstetric management and monitoring.

    Science.gov (United States)

    Branch, D W

    2004-01-01

    The obstetric management of the pregnant rheumatic patient is largely dictated by the specific disease and the degree to which it is associated with recognizable and treatable adverse obstetric outcomes, maternal or fetal. This review will cover the obstetric management of women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), rheumatoid arthritis (RA) and systemic sclerosis (SSc). Most experts agree that a co-ordinated management effort on the part of obstetricians and rheumatologists will likely yield the optimal achievable results.

  9. Association study of obstetrical complication and depressive disorder

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To investigate the correlation between obstetrical complications and depressive disorder.Methods:Depressive disorder probands and their adult sibling were diagnosed using CCMD-3 criteria.Obstetrical data from maternal reports were scored,applying published scales that take into account number and severity of complication.Results:The scores of obstetric complication and prenatal complications and low birth weight were significantly worse in probands than siblings without depressive disorders.Conclusion:Results suggest obstetric complications are etiologically significant in depressive disorder.

  10. Targeted doctors, missing patients: obstetric health services and sectarian conflict in northern Pakistan.

    Science.gov (United States)

    Varley, Emma

    2010-01-01

    The spectre of exclusionary medical service provision, restricted clinic access and physician targeting in sectarian-divided Iraq underscores the crucial and timely need for qualitative research into the inter-relationship between conflict, identity and health. In response, this paper provides a critical ethnography of obstetric service provision and patient access during Shia-Sunni hostilities in Gilgit Town, capital of Pakistan's Northern Areas (2005). I analyse how services were embedded in and constrained by sectarian affiliation in ways that detrimentally impacted Sunni women patients and hospital staff, resulting in profoundly diminished clinic access, reduced physician coverage and a higher observed incidence of maternal morbidity and mortality. The paper first situates obstetric medicine at the interstices of contested sectarian terrain and competing historical projects of sectarian identity. Gilgiti Sunnis' high clinical reliance is argued to be a response to and consequence of, inter-sectarian dissonance and the ascendance of biomedicine during three decades of regional development. In 2005, conflict-incurred service deprivations and the enactment and strategic use of sectarian identity in clinical settings were associated with differential treatment and patient-perceived adverse health outcomes, leading Sunnis to generate alternative sect-specific health services. Obstetric morbidity and mortality during sectarian conflict are analyzed as distinctive manifestations of the wide range of direct harms routinely associated with violence and political strife.

  11. Commentary on an Innovative Interprofessional Dental Practice for 2026.

    Science.gov (United States)

    Guyton, Brad; LeBeau, Jan; Sorci, Rebecca; Doneen, Amy

    2016-06-01

    An innovative interprofessional model is described for the delivery of dental care in the year 2026 to optimize efficiency and profitability while enhancing quality of care. The dental practice of tomorrow may look different than today. Although not broken, the current system can be improved in efficiency and effectiveness. Although traditional private practices will continue to exist and many will thrive over the next decades, they may not present the optimal model for dental practice. To manage complex patient needs, a more collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively has been suggested by the authors. They explore an alternative model of practice that may be possible in the next 10 years to better serve patients and improve outcomes while honoring the role of practitioners. Landmark publications and reviews are used to examine evidence showing the potential benefits of an innovative interprofessional approach to the delivery of care in the oral health care setting. By examining key studies, the authors provide commentary on the potential for enhanced efficiency, profitability, and quality of care in the oral health care setting through a collaborative model of multidisciplinary, interprofessional clinical teams capable of treating patients comprehensively. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2009-01-01

    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…

  13. Training in motivational interviewing in obstetrics

    DEFF Research Database (Denmark)

    Lindhardt, Christina L; Rubak, Sune Leisgaard Mørck; Mogensen, Ole

    2014-01-01

    : The Region of Southern Denmark. METHODS: Eleven obstetric healthcare professionals working with obese pregnant women underwent a three day course in motivational interviewing techniques and were assessed before- and after training to measure the impact on their overall performance as well as the effect......-adherent interventions). Furthermore, the participants asked fewer closed and more open questions before training in motivational interview. In the assessment of proficiency and competency, most of the participants scored higher after the training in motivational interviewing. CONCLUSIONS: Training in motivational...

  14. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    2015-01-01

    Using inpatient discharge records from the Italian region of Piedmont, we estimate the impact of an increase in malpractice pressure brought about by experience-rated liability insurance on obstetric practices. Our identification strategy exploits the exogenous location of public hospitals in court...... districts with and without schedules for noneconomic damages. We perform difference-in-differences analysis on the entire sample and on a subsample which only considers the nearest hospitals in the neighborhood of court district boundaries. We find that the increase in medical malpractice pressure...

  15. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identied by the introduction of experience-rated malpractice liability insurance. Our identication...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...

  16. An obstetric emergency called peripartum cardiomyopathy!

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. The etiology of PPCM is still not known. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. The only way to prevent PPCM is to avoid further pregnancies.

  17. Fistulas secondary to gynecological and obstetrical operations

    Directory of Open Access Journals (Sweden)

    Jakovljević Branislava N.

    2003-01-01

    Full Text Available The authors present urogenital and rectogenital fistulas treated at the Department of Obstetrics and Gynecology in Novi Sad in the period from 1976 to 1999. The study comprised 28 cases of fistula out of which 17 were vesicovaginal, 3 ureterovaginal, 1 vesicorecto vaginal and 7 recto vaginal. During the investigated period there were 182 Wertheim operations, 3864 total abdominal hysterectomies, 1160 vaginal hysterectomies and 7111 cesarean sections. The vesicovaginal fistulas were most frequent with the incidence of 0.33%, whereas the tocogenic fistulas did not occur. Urogenital fistulas secondary to radical hysterectomy are extremely rare thanks to the administered measures of prevention during the surgical procedure.

  18. 危重症产妇妊娠相关性急性肾损伤的病因、临床特点及预后分析%Etiology, clinical profile and prognosis of pregnancy-related acute kidney injury in critically ill obstetric patients

    Institute of Scientific and Technical Information of China (English)

    宁耀贵; 张民伟; 陈金龙; 郭晶; 吴焱琼; 余剑华; 李娜; 徐颢

    2015-01-01

    Objective To investigate the etiology,clinical profile and prognosis of pregnancyrelated acute kidney injury (PR-AKI) in critically ill obstetric patients.Methods Data of the critically ill obstetric patients admitted to ICU from January 2011 to March 2014 were collected and analyzed retrospectively.PR-AKI patients were screened according to the clinical diagnostic criteria of AKI.The etiological diseases,laboratory indicators,urine output,length of ICU stay,prognosis of PR-AKI were documented and analyzed;and the risk factors of PR-AKI was assessed with logistic regression analysis.Results A total of 124 critically ill obstetric patients were enrolled,and AKI occurred in 46 of them (37.1%) under kidney disease:Improving Global Outeomes Acute kidney injury (KDIGO-AKI) criteria.The main causes of PR-AKI included pre-eclampsia (41.3 %,19/46),hemorrhagic shock (21.7 %,10/46),hemolysis,elevated liver enzymes and low platelet (HELLP) syndrome (17.4%,8/46),acute fatty liver of pregnancy (AFLP) (15.2%,7/46).Of the 46 PR-AKI patients,3 died (6.5%),and the causes of death was cerebral hemorrhage,cerebral venous sinus thrombosis and multiorgan failure (MOF).There were 23 cases in stage 1,13 cases in stage 2 and 10 cases in stage 3 according to KIDGO-AKI stage criteria.Ten patients received renal replacement treatment:1 in stage 1,2 in stage 2 and 7 in stage 3.Complete,partial and no renal recovery was observed in 73.9% (34/46),17.4% (8/46) and 8.7% (4/ 46) of the patients,respectively.Complete renal recovery was observed 91.3% (21/23) in stage 1,9/13 in stage 2,4/10 in stage 3,respectively.On logistic regression,pregnancy-induced hypertension,hemorrhagic shock and HELLP syndrome were risk factors of PR-AKI.Conclusions The incidence of PR-AKI in critically ill obstetric patients is high.A variety of etiological factors and risk factors are related to PRAKI.Early detection and effective therapeutic measures are important to PR-AKI.The prognosis of PR-AKI is

  19. Comparison of Women in Department Leadership in Obstetrics and Gynecology With Other Specialties

    Science.gov (United States)

    Hofler, Lisa G.; Hacker, Michele R.; Dodge, Laura E.; Schutzberg, Rose; Ricciotti, Hope A.

    2016-01-01

    Objective To compare the representation of women in Obstetrics and Gynecology department-based leadership to other clinical specialties, while accounting for proportions of women in historical residency cohorts. Methods This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of Anesthesiology, Diagnostic Radiology, General Surgery, Internal Medicine, Neurology, Obstetrics and Gynecology, Pathology, Pediatrics, and Psychiatry. Each specialty's representation ratio—proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women—and 95% confidence interval (CI) were calculated. A ratio of one indicates proportionate representation. Results Women were significantly under-represented among chairs for all specialties (ratios ≤0.60, P≤0.02) and division directors for all specialties except Anesthesiology (ratio: 1.13, 95% CI: 0.87–1.46) and Diagnostic Radiology (ratio: 0.97, 95% CI: 0.81–1.16). The representation ratio for vice chair was below 1.0 for all specialties except Anesthesiology; this finding reached statistical significance only for Pathology, Pediatrics, and Psychiatry. Women were significantly over-represented as residency program directors in General Surgery, Anesthesiology, Obstetrics and Gynecology, and Pediatrics (ratios >1.19, P≤0.046). Obstetrics and Gynecology and Pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Conclusion Despite having the largest proportion of leaders who were women, representation ratios demonstrate Obstetrics and Gynecology is behind other specialties in progression of women to departmental leadership. Women's over-representation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles. PMID

  20. Comparison of Women in Department Leadership in Obstetrics and Gynecology With Those in Other Specialties.

    Science.gov (United States)

    Hofler, Lisa G; Hacker, Michele R; Dodge, Laura E; Schutzberg, Rose; Ricciotti, Hope A

    2016-03-01

    To compare the representation of women in obstetrics and gynecology department-based leadership to other clinical specialties while accounting for proportions of women in historical residency cohorts. This was a cross-sectional observational study. The gender of department-based leaders (chair, vice chair, division director) and residency program directors was determined from websites of 950 academic departments of anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics, and psychiatry. Each specialty's representation ratio-proportion of leadership roles held by women in 2013 divided by proportion of residents in 1990 who were women-and 95% confidence interval (CI) were calculated. A ratio of 1 indicates proportionate representation. Women were significantly underrepresented among chairs for all specialties (ratios 0.60 or less, P≤.02) and division directors for all specialties except anesthesiology (ratio 1.13, 95% CI 0.87-1.46) and diagnostic radiology (ratio 0.97, 95% CI 0.81-1.16). The representation ratio for vice chair was below 1.0 for all specialties except anesthesiology; this finding reached statistical significance only for pathology, pediatrics, and psychiatry. Women were significantly overrepresented as residency program directors in general surgery, anesthesiology, obstetrics and gynecology, and pediatrics (ratios greater than 1.19, P≤.046). Obstetrics and gynecology and pediatrics had the highest proportions of residents in 1990 and department leaders in 2013 who were women. Despite having the largest proportion of leaders who were women, representation ratios demonstrate obstetrics and gynecology is behind other specialties in progression of women to departmental leadership. Women's overrepresentation as residency program directors raises concern because education-based academic tracks may not lead to major leadership roles.

  1. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    Directory of Open Access Journals (Sweden)

    Dennis AC

    2016-09-01

    Full Text Available Alexis C Dennis1 Sarah M Wilson1–3 Mary V Mosha4 Gileard G Masenga4 Kathleen J Sikkema1,5,6 Korrine E Terroso1 Melissa H Watt1 1Duke Global Health Institute, Duke University, 2Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Kilimanjaro Christian Medical Center, Moshi, Tanzania; 5Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; 6Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa Objective: An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.Patients and methods: The study used a mixed-methods design to analyze cross-sectional surveys (n=59 and in-depth interviews (n=20.Results: Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.Conclusion: Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic

  2. Mental Health Screening Among Newly-Arrived Refugees Seeking Routine Obstetric and Gynecologic Care

    OpenAIRE

    Johnson-Agbakwu, Crista E.; Allen, Jennifer; Nizigiyimana, Jeanne F.; Ramirez, Glenda; Hollifield, Michael

    2014-01-01

    Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multi-ethnic, newly-arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women’s health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally-responsive, ...

  3. Mental Health Screening Among Newly-Arrived Refugees Seeking Routine Obstetric and Gynecologic Care

    OpenAIRE

    Crista E. Johnson-Agbakwu; Allen, Jennifer; Nizigiyimana, Jeanne F.; Ramirez, Glenda; Hollifield, Michael

    2014-01-01

    Posttraumatic stress disorder (PTSD), anxiety, and depression are the most common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multi-ethnic, newly-arrived refugee women receiving routine obstetric and gynecologic care in a dedicated refugee women’s health clinic is described. The Refugee Health Screener-15 (RHS-15) is a culturally-responsive, ...

  4. Flatland an edition with notes and commentary

    CERN Document Server

    Abbott, Edwin A; Banchoff, Thomas F

    2010-01-01

    Flatland, Edwin Abbott Abbott's story of a two-dimensional universe, as told by one of its inhabitants who is introduced to the mysteries of three-dimensional space, has enjoyed an enduring popularity from the time of its publication in 1884. This fully annotated edition enables the modern-day reader to understand and appreciate the many "dimensions" of this classic satire. Mathematical notes and illustrations enhance the usefulness of Flatland as an elementary introduction to higher-dimensional geometry. Historical notes show connections to late-Victorian England and to classical Greece. Citations from Abbott's other writings as well as the works of Plato and Aristotle serve to interpret the text. Commentary on language and literary style includes numerous definitions of obscure words. An appendix gives a comprehensive account of the life and work of Flatland's remarkable author.

  5. Commentary: grading: what is it good for?

    Science.gov (United States)

    Durning, Steven J; Hemmer, Paul A

    2012-08-01

    Grading students is a necessary but challenging activity. In this commentary, the authors respond to the compelling national data about clerkship grading in U.S. medical schools presented by Alexander and colleagues. They present perspectives and cautions for how the medical education community might perceive these findings and examine how the community can act to address them. The authors discuss several aspects of normative versus criterion-based grading, reliability, and educational theory to provide context for the results reported by Alexander and colleagues. To address variability among and within schools with regard to grading systems and terminology, the authors argue for more credible and transparent interpretation of what grades mean rather than inflexible regulation of grade distributions.

  6. Commentary on Huovinen's "Varieties of Musical Empiricism"

    Directory of Open Access Journals (Sweden)

    Eric F. Clarke

    2006-06-01

    Full Text Available Erkki Huovinen’s “Varieties of Musicological Empiricism” provides a valuable analysis of some of the theoretical predicaments raised by pursuing an empirical musicology. But in this commentary, I argue for a less programmatic, and more pragmatic, approach to the term than he does. Empirical approaches in musicology have been around in one form or another for a long time, and the purpose of the label is less to identify a new ‘brand’ of musicology than to bring together a diversity of approaches that in different ways capitalise on the opportunities that data collection (in the broadest sense of the term may provide. If programme is set aside in favour of pragmatism, and a looser relationship between theory and observation accepted, then empirical musicology can be a productive way to rub ideas up against a stimulatingly resistant world.

  7. Commentary: Jail-based competency restoration.

    Science.gov (United States)

    Kapoor, Reena

    2011-01-01

    Many factors influence restoration of competence to stand trial: age, IQ, severity of mental illness, criminal history, treatment history, and others. This commentary poses the question of whether competency to stand trial is also influenced by the setting in which restoration treatment occurs. Jail-based competency-restoration programs, which are in their infancy and have yet to produce large-scale data demonstrating their efficacy, are examined. Several factors related to jail-based restoration are considered: choosing the right candidates for the program, impact of treatment in a punitive setting, ability to maintain separation between treaters and forensic evaluators, procedures for involuntary medication, aggregation of incompetent defendants in regional jails, effect on malingering, and cost savings.

  8. Commentary on a framework for multicultural education.

    Science.gov (United States)

    Hammerich, Karin F

    2014-09-01

    Today's changing demographics require that multicultural factors be considered in the delivery of quality patient-centred health care in chiropractic. Yet minimal training in cultural competency in chiropractic education leaves graduates ill-equipped to treat a diverse population. This commentary examines cultural competency training in current literature, demonstrates frameworks for curriculum integration, and suggests how cultural competency might be included in a chiropractic college curriculum. A database search yielded little evidence that cultural competency is integrated into curricula of chiropractic schools. Some journal articles note that promoting multicultural education and cultural sensitivity is an important goal. However, they provide no mechanisms as to how this can be achieved within training programs. Thus, although an undeniable need exists for all healthcare practitioners to develop cultural competency in the face of an increasingly diverse population, cultural competency education has not kept pace. Chiropractic schools must review their curricula to develop the cultural competencies of their graduates and a basic framework is suggested.

  9. Vaginal delivery simulation in the Obstetrics and Gynaecology clerkship.

    Science.gov (United States)

    Nitsche, Joshua; Morris, Dana; Shumard, Kristina; Akoma, Ugochi

    2016-10-01

    Although simulation is now used in other areas of obstetrics and gynaecology, its utility in the training of an uncomplicated vaginal delivery is surprisingly under-explored. Here we describe our experience integrating simulation into the third-year Obstetrics and Gynaecology (OB/GYN) clerkship. In 2013/14, at the start of each 4-week OB/GYN clerkship, each third-year student participated in a 90-minute vaginal delivery simulation session using the Noelle(®) simulator. Upon completion of the clerkship, they were surveyed using a five-point Likert scale questionnaire (1, inferior; 5, superior) to assess self-perceived training adequacy, clinical preparedness and number of deliveries performed during the clerkship. Students who completed the clerkship in 2012/13, before the introduction of the simulation, were also surveyed to serve as a comparison group. Survey scores and number of deliveries performed were compared between the two cohorts of students. The 2013/14 cohort (n = 98) who received simulation training gave their training in vaginal deliveries an average rating of 4.1, versus 2.7 for the 2012/13 cohort that did not receive the simulation (n = 80; p < 0.001). Self-perceived preparedness to perform a vaginal delivery was 4.0 in the 2013/14 cohort, versus 3.0 in the 2012/13 cohort (p < 0.001). There was no difference in the number of deliveries performed between the cohorts. Students that received simulation rated their training adequacy and readiness to perform a vaginal delivery higher than students that did not receive training. Simulation did not increase participation in real-life deliveries. The utility of simulation in the training of an uncomplicated vaginal delivery is under-explored. © 2015 John Wiley & Sons Ltd.

  10. Antibiotic susceptibility patterns of uropathogens in obstetric patients

    Directory of Open Access Journals (Sweden)

    Ekadashi R Sabharwal

    2012-01-01

    Full Text Available Background: Urinary tract infections (UTI are the most commonly encountered infections in obstetric patients. Although a variety of etiology is involved, Escherichia coli and other coliforms account for a large majority of these naturally acquired infections. The estimation of local etiology and susceptibility profile could support the most effective empirical treatment. Aim: The current study was undertaken to find the spectrum of micro-organisms responsible for causing UTI in obstetric patients and to find out the most appropriate antibiotic. Materials and Methods: Consecutive patients in different stages of pregnancy with or without symptoms of UTI attending the antenatal clinic during November 2011 to March 2012 were screened for significant bacteriuria. The bacterial uropathogens isolated were then subjected to antimicrobial susceptibility testing and screened for ESBL production and methicillin resistance. Results: During the 5-month study period, out of the 250 samples screened, a total of 60 (24% samples of urine from pregnant females, in different stages of pregnancy were found to be positive on culture. The Enterobacteriaceae accounted for nearly two-thirds of the isolates and E. coli alone accounted for 63% of the urinary isolates followed by Klebsiella pneumonia 8%. Among the Gram-positive cocci, coagulase-negative Staphylococcus (15% were more frequently isolated than Staphylococcus aureus (8.3%. A significantly high resistance was noted to the beta-lactam group of antimicrobials, fluoroquinolones and cotrimoxazole, both by the Gram-negative bacilli as well as Gram-positive cocci. Resistance was quite low against the aminoglycosides and nitrofurantoin and virtually absent against imipenem. Conclusion: The susceptibility patterns seen in our study seem to suggest that it is absolutely necessary to obtain sensitivity reports before initiation of antibiotic therapy in cases of suspected UTI.

  11. [To rescue a vanishing obstetric skill--vaginal breech delivery].

    Science.gov (United States)

    Glezerman, Marek

    2011-02-01

    In 2000, a large randomized controlled trial was published (Term Breech Trial - TBT). The authors concluded that cesarean section (CS) was safer for newborns in breech presentation than vaginal breech delivery (VBD). This conclusion was endorsed by major professional institutions, was adopted almost immediately by the medical community and led to a wholesale abandonment of planned VBD in the western world, including Israel. In past years, serious criticism has been voiced related to the methodology applied in the TBT and numerous studies have contradicted the recommendations. Subsequently, the professional institutions published revised guidelines with the recommendation that pregnant women with breech presentation should, under certain circumstances, be given the choice between CS and VBD. Yet, in most delivery wards, following a decade of abandonment of VBD, the expertise for this technique had almost vanished. An unbearable situation had materialized: CS increases maternal mortality and morbidity when compared to vaginal delivery but most obstetricians are no longer capable of offering women the choice of VBD. Recently, and with the support of the Israel Societies of Obstetrics and Gynecology and Feto-Maternal Medicine, representatives of 17 obstetrical departments convened and decided on urgent steps to revive VBD, including updating the relevant clinical guidelines and informed consent forms and, most importantly, to issue a call to train obstetricians in VBD. In March 2010, a workshop dedicated to breech delivery was conducted at the Beilinson Hospital, with the representatives of most Israeli hospitals and specialists from abroad. Subsequently, and at the same hospital, a week-long program for VBD was conducted at which approximately 30 obstetricians received hands-on training. Time will show if "turning back the tide" will help to progress into a safer future for women with breech presentation and to annually avoid between 1000 and 2000 needless cesarean

  12. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.

    Science.gov (United States)

    Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

    2015-12-18

    Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

  13. 客观结构化临床考试在妇产科实习出科考试中的应用%Application of Objective Structured Clinical Examination in Internship Examination of Obstetrics and Gynecology Department

    Institute of Scientific and Technical Information of China (English)

    李静; 张晓静

    2013-01-01

    笔者借鉴客观结构化临床考试(Objective Structured Clinical Examination,简称OSCE)先进理念,在每轮实习同学出科前1周按照OSCE考核方案组织考试,有效检验医学生在我科临床实习的效果,同时又可以在一定程度上督促实习科室的临床带教质量,发现问题能够及时处理.

  14. Application of small lecture nursing teaching method in obstetrics and gynecology clinic%小讲课护理教学法在妇产科门诊临床带教中的应用和体会

    Institute of Scientific and Technical Information of China (English)

    左艳; 刘芯如; 张建军; 付金兰; 刘德荣; 钟英静; 黄燕

    2014-01-01

    Objective To explore the effects of the small lectures in clinical nursing teaching in department of gynaecology clinic. Methods 86 students who practiced from January 2011 to February 2012 in our hospital clinic were enrolled as control group, and 88 students from March 2012 to April 2013 as experimental group. The control group was given routine teaching, and on this basis, the experimental group carried out small lectures. Compare the grades of theory, operation and pacific performance between the two groups.Results The grades of theory, operation and pacific performance in experimental group were superior to control group, and the difference was statistically significant (P<0.05). And most students praised this kind of teaching methods.Conclusion Small lectures can improve the comprehensive ability of nursing students, arouse the enthusiasm of the nursing students in active learning and to en-hance the communication between teachers and students,which is worthy of reference for clinical nursing teaching.%目的:探讨小讲课护理教学法在妇产科门诊临床带教中的应用效果。方法选择2011年1月~2012年2月在本院妇产科门诊实习的护生86名作为对照组,2012年3月~2013年4月的88名护生作为实验组,对照组常规带教,实验组在常规带教的基础上进行护生小讲课。比较2组护生出科时的理论成绩、操作成绩及平时成绩。结果实验组出科时理论成绩、操作成绩、平时成绩及总成绩都优于对照组,差异有统计学意义(P<0.05)。且大多数护生对该教学方法给予了肯定。结论小讲课教学法提高了护生综合能力,调动了护生主动学习的积极性,增强了师生间的沟通和感情,值得临床护理教学借鉴运用。

  15. Commentary: PhDs in biochemistry education-5 years later.

    Science.gov (United States)

    Offerdahl, Erika G; Momsen, Jennifer L; Osgood, Marcy

    2014-01-01

    In this commentary, the discussion of PhDs in biochemistry education research is expanded to explore a number of diverse pathways leading to a competitive research program in biochemistry education research.

  16. Commentary: PhDs in Biochemistry Education--5 Years Later

    Science.gov (United States)

    Offerdahl, Erika G.; Momsen, Jennifer L.; Osgood, Marcy

    2014-01-01

    In this commentary, the discussion of PhDs in biochemistry education research is expanded to explore a number of diverse pathways leading to a competitive research program in biochemistry education research.

  17. A research proposal for a new commentary on John

    Directory of Open Access Journals (Sweden)

    Charles Landon

    2000-01-01

    Full Text Available The author offers a research proposal for a new commentary on the Gospel of John, provisionally entitled An Internal Textual Commentary on John, Part I: A Commentary on the Apparatus to NA27; Part J/: A Selective Commentary on the Apparatus to Tischendorf and Elliott & Parker. In the proposal, he responds to criticism of his previous work on Jude offered by Peter Head in Novum Testamentum 61(2 181-185. The proposed work on John will not exemplify thorough-going eclecticism in practice, but will instead measure (1 the internal strength of three major text-types, and (2 the internal strength of two editions of the Greek New Testament, NA27 and Westcott & Hort (1881.

  18. Experiences of family medicine residents in primary care obstetrics training.

    Science.gov (United States)

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

    2012-03-01

    Obstetrical practice by family physicians has been declining rapidly for many reasons over the past number of decades. One reason for this trend is family medicine residents not considering intrapartum care as part of their future careers. Decisions such as this may be related to experiences during obstetrical training. This study explored the experiences of family medicine residents in core primary care obstetrics training. Using qualitative approaches, focus groups of family medicine residents were conducted. The resulting data were audiotaped and transcribed verbatim. Independent and team analysis was both iterative and interpretive. Data obtained from the focus groups revealed findings relating to the following categories: (1) perceived facilitators to practicing primary care obstetrics, (2) perceived barriers to practicing primary care obstetrics, and (3) learner experiences at the fulcrum of career decision making. Family medicine residents were encouraged by favorable learning experiences and group shared-call arrangements by their primary care obstetrics preceptors. Some concerns about a career including obstetrics persisted; however, positive experiences, including influential fulcrum points, may inspire family medicine residents to pursue a career involving primary care obstetrics.

  19. Obstetrical Complications and Violent Delinquency: Testing Two Developmental Pathways.

    Science.gov (United States)

    Arseneault, Louise; Tremblay, Richard E.; Boulerice, Bernard; Saucier, Jean-Francois

    2002-01-01

    Assessed interaction between obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence among 849 boys from low SES areas. Found that elevated scores on scale of obstetrical complications (preeclampsia, umbilical cord prolapse, induced labor) increased risk of being violent at 6 and 17…

  20. Determining Optimal Allocation of Naval Obstetric Resources with Linear Programming

    Science.gov (United States)

    2013-12-01

    NHCP Naval Hospital Camp Pendleton NICU neonatal intensive care unit NMCP Naval Medical Center Portsmouth NMCSD Naval Medical Center San Diego... obstetric care that meets the delivery volume of specific facilities as well as the standards and vision of BUMED. Furthermore, optimum staffing... obstetric care to include, but not limited to, the following services: hospitalization for labor, delivery, and postpartum care ; anesthesia; cesarean

  1. Obstetric emergencies in primary midwifery care In The Netherlands

    NARCIS (Netherlands)

    Smit, Marrit

    2014-01-01

    In this thesis, the primary aim was to gain insight into management of obstetric emergencies occurring in primary midwifery care in the Netherlands. Secondly, we aimed to develop preventative strategies and tools to optimise care in case of an obstetric emergency. From 2008-2010, a unique dataset of

  2. Brazilian Social Psychology in the international context: a commentary

    OpenAIRE

    Valentim, Joaquim Pires

    2013-01-01

    The present paper is a commentary on the talks given by Torres and Álvaro and by Krüger regarding Brazilian Social Psychology in the international context. Starting with a brief contrast with the situation in Portugal, this commentary next approaches, in a synthetic way, questions that cut across social psychology in the international setting, namely, those related with the recurrent dichotomy individual/collective, the great advances in social neuroscience, the study of minorities, the scarc...

  3. Obstetric patients requiring intensive care: a one year retrospective study in a tertiary care institute in India.

    Science.gov (United States)

    Ashraf, Niyaz; Mishra, Sandeep Kumar; Kundra, Pankaj; Veena, P; Soundaraghavan, S; Habeebullah, S

    2014-01-01

    Background and Objectives. Critically ill obstetric patients are a particularly unique cohort for the intensivist. The objective of this study was to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted to intensive care unit of a medical college hospital in southern India and to identify conditions associated with maternal mortality. Design. Retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a 1-year result. We studied 55 patients constituting 11.6% of mixed ICU admissions during the study period. Results. The mean APACHE (acute physiology and chronic health evaluation) II score of patients at admission was 11.8. Most of the patients (76%) were admitted in the antepartum period. The commonest indications for ICU admission were obstetric haemorrhage (51%) and hypertensive disorders of pregnancy (18%). 85% of patients required mechanical ventilation and 78% required inotropic support. Conclusions. Maternal mortality was 13%, and the majority of the deaths were due to disseminated intravascular coagulation and multiorgan failure, following an obstetric haemorrhage. A dedicated obstetric ICU in tertiary hospitals can ensure that there is no delay in patient management and intensive care can be instituted at the earliest.

  4. Obstetric Patients Requiring Intensive Care: A One Year Retrospective Study in a Tertiary Care Institute in India

    Directory of Open Access Journals (Sweden)

    Niyaz Ashraf

    2014-01-01

    Full Text Available Background and Objectives. Critically ill obstetric patients are a particularly unique cohort for the intensivist. The objective of this study was to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted to intensive care unit of a medical college hospital in southern India and to identify conditions associated with maternal mortality. Design. Retrospective analysis of pregnant/postpartum (up to 6 weeks admissions over a 1-year result. We studied 55 patients constituting 11.6% of mixed ICU admissions during the study period. Results. The mean APACHE (acute physiology and chronic health evaluation II score of patients at admission was 11.8. Most of the patients (76% were admitted in the antepartum period. The commonest indications for ICU admission were obstetric haemorrhage (51% and hypertensive disorders of pregnancy (18%. 85% of patients required mechanical ventilation and 78% required inotropic support. Conclusions. Maternal mortality was 13%, and the majority of the deaths were due to disseminated intravascular coagulation and multiorgan failure, following an obstetric haemorrhage. A dedicated obstetric ICU in tertiary hospitals can ensure that there is no delay in patient management and intensive care can be instituted at the earliest.

  5. The reliability and validity of self-reported reproductive history and obstetric morbidity amongst birth to ten mothers in Soweto

    Directory of Open Access Journals (Sweden)

    GTH Ellison

    2000-09-01

    Full Text Available Objective: To assess whether self-reports of reproductive history and obstetric morbidity provide an accurate basis for clinical decision-making. Setting, participants and methods: Self-reports of maternal age and reproductive history, together with clinical measurements of five medical disorders, were abstracted from the obstetric notes of 517 mothers whose children were enrolled in the Birth to Ten study. These data were compared to self-reported information collected by interview during the Birth to Ten study. Findings: The reliability of self-reported age and gravidity was high (R=0.810-0.993, yet self-reports of previous miscarriages, terminations, premature- and stillbirths were only fairly reliable (Kappa=0.48-0.50. Self-reported diabetes and high blood pressure had specificities of more than 95% for glycosuria, hypertension and pre-eclampsia. However, the specificity of self-reported oedema for hypertensive disorders and the specificity of self-reported urinary tract infection for STD seropositivity were only around 65%. Conclusions: The modest reliability and limited validity of self-reported obstetric morbidity undermines the clinical utility of this information. Recommendations: These results strengthen the case for providing mothers with “Home-based Maternal Records” to facilitate access to accurate obstetric information during subsequent clinical consultations.

  6. The Changing Scenario of Obstetrics and Gynecology Residency Training

    Science.gov (United States)

    Gupta, Natasha; Dragovic, Kristina; Trester, Richard; Blankstein, Josef

    2015-01-01

    Background Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. Objective We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. Methods We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002–2003 and 2012–2013. Results The average number of cesarean sections per resident increased from 191.8 in 2002–2003 to 233.4 in 2012–2013 (17%; P obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills. PMID:26457146

  7. Diagnosis summary and coding of obstetric conditions in the government hospitals in Pattalung Province, the effects of audit and feedback.

    Science.gov (United States)

    Wittayawarawat, Worapin; Liabsuetrakul, Tippawan; Tassee, Sathana

    2007-02-01

    Assess the effects of audit and feedback through a seminar on the obstetric summary and coding system with respect to the International Classification of Diseases, Tenth Revision (ICD-10) and to determine factors associated with the error of summary and coding audit. The medical records of 1,629 and 1,337 women with obstetric conditions admitted to one provincial and nine district hospitals in Pattalung Province, Southern Thailand, were evaluated before and after a seminar, respectively. The error of coding audit among cases with normal conditions and those with abnormal conditions after the seminar was reduced significantly from 40.7 to 13.0% and from 81.8% to 61.2%, respectively (p audit and feedback was moderately effective on summary and coding audit but the clinical significance of error reduction in abnormal obstetric conditions was marginal, thus intensive intervention, evaluation, and monitoring are necessary.

  8. The economic impact of rural family physicians practicing obstetrics.

    Science.gov (United States)

    Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M

    2014-01-01

    The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.

  9. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    Science.gov (United States)

    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…

  10. Multidisciplinary Obstetric Simulated Emergency Scenarios (MOSES): Promoting Patient Safety in Obstetrics with Teamwork-Focused Interprofessional Simulations

    Science.gov (United States)

    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…

  11. Rural-urban inequity in unmet obstetric needs and functionality of emergency obstetric care services in a Zambian district

    DEFF Research Database (Denmark)

    Phiri, Selia Ng'Anjo; Fylkesnes, Knut; Moland, Karen Marie;

    2016-01-01

    Background: 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....... Method: 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...

  12. Beta-Carotene in Prevention of Cow’s Obstetric- Gynecological Diseases

    Directory of Open Access Journals (Sweden)

    Taisiia DMITRIEVA

    2015-07-01

    Full Text Available The intensification of the livestock industry is the decisive role of healthy reproduction. The aim of this study was to use "Carofertin" for the preventive purpose of obstetric pathology in high-productive cows (every 10 days and compare with the action of vitamin A. Prophylactic effectiveness of "Carofertin" was defined for prevention of obstetric pathology of high-productive cows whose were predisposed to diseases of parturient (the incidence of retention placenta: 21.7±0.4%, 43.5±0.41%, 65.2±0.38% (P<0.01 and postnatal periods too. The incidence of uterus subinvolution was 13.0±0.34% in the first group, 43.48±0.5% in the second group and 56.5±0.49% in the third group (P<0.001. The incidence of acute puerperal endometritis was 26.0±0.44% in the first group, 34.78±0.49% in the second group and 52.0±0.49% in the third group (P<0.001. We used biochemical and clinical analysis of blood samples to assess the impact of the drug on the functional metabolism and general methods of clinical examination (including rectal and vaginal examination for control over the parturition and puerperal period. It is important to study the problems of obstetric pathology in cows especially during the late stall period and to improve preventive measures.

  13. Promoting accountability in obstetric care: use of criteria-based audit in Viet Nam.

    Science.gov (United States)

    Bailey, P E; Binh, H T; Bang, H T

    2010-01-01

    Audits can improve clinical and managerial practices, enhance the rational use of limited resources, and improve staff morale and motivation. Staff at five hospitals in Thanh Hoa and Quang Tri provinces (Viet Nam) used criteria-based audit (CBA) as a tool to improve the quality of emergency obstetric and newborn care. CBA compares current practice with standards based on the best available evidence and the local context. The audit cycle begins with a known problem, proceeds with an initial assessment and data collection, analysis of those data, formulation and implementation of an action plan, and a re-evaluation of the topic initially assessed. Teams found that clinical protocols for treating major obstetric complications were not followed, although, national guidelines had been issued in 2002. In an audit of facility organisation, staff addressed obstacles to the timely treatment of obstetric emergencies during off hours. In each audit, teams devised mechanisms to correct problems that resulted in significant improvements when the audit cycle was repeated. CBA improved adherence to national guidelines, improved record-keeping, heightened teamwork, and showed staff that they could identify and solve many of their own problems.

  14. [Coeliac disease as a possible cause of some gynecological and obstetric abnormalities].

    Science.gov (United States)

    Fiolková, K; Biringer, K; Hrtánková, M; Fiolka, R; Danko, J

    To bring a review of available literature sources on the prevalence of coeliac disease and its possible impact on gynecological and obstetric disorders. Review article. Gynecology and Obstetrics Clinic, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia. Analysis of literary sources. Coeliac disease is an autoimmune enteropathy caused by abnormal immune system response to gluten. Over the last decade when the prevalence of the disease increases rapidly confirming the relationship between coeliac disease and a range of reproductive disorders. Problems in this area are mostly confirmed in untreated women. Among the atypical symptoms of coeliac disease also include infertility such as delayed onset of menstruation, early menopause, secondary amenorrhea, infertility and pregnancy complications, such as recurrent abortions, intrauterine fetal growth restriction, small fetus for gestational age, low birth weight and premature birth.

  15. The need to include obstetric nurses in prenatal care visits in the public health system

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-06-01

    Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

  16. Update on the management of non-obstetric acute abdomen in pregnant patients.

    Science.gov (United States)

    Barber-Millet, Sebastián; Bueno Lledó, José; Granero Castro, Pablo; Gómez Gavara, Immaculada; Ballester Pla, Neus; García Domínguez, Rafael

    2016-05-01

    Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Doppler ultrasound in obstetrics and gynecology. 2. rev. and enl. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Maulik, D. [Winthrop Univ. Hospital, Mineola, NY (United States). Dept. of Obstetrics and Gynecology; Zalud, I. (eds.) [Kapiolani Medical Center for Women and Children, Honolulu, HI (United States)

    2005-07-01

    The second edition of Doppler Ultrasound in Obstetrics and Gynecology has been expanded and comprehensively updated to present the current standards of practice in Doppler ultrasound and the most recent developments in the technology. Doppler Ultrasound in Obstetrics and Gynecology encompasses the full spectrum of clinical applications of Doppler ultrasound for the practicing obstetrician-gynecologist, including the latest advances in 3D and color Doppler and the newest techniques in 4D fetal echocardiography. Written by preeminent experts in the field, the book covers the basic and physical principles of Doppler ultrasound; the use of Doppler for fetal examination, including fetal cerebral circulation; Doppler echocardiography of the fetal heart; and the use of Doppler for postdated pregnancy and in cases of multiple gestation. Chapters on the use of Doppler for gynecologic investigation include ultrasound in ectopic pregnancy, for infertility, for benign disorders and for gynecologic malignancies. (orig.)

  18. The Role of Ultrasound Simulation in Obstetrics and Gynecology Training: A UK Trainees' Perspective.

    Science.gov (United States)

    Patel, Hersha; Chandrasekaran, Dhivya; Myriokefalitaki, Eva; Gebeh, Alpha; Jones, Kate; Jeve, Yadava B

    2016-10-01

    Ultrasonography is a core skill required by all obstetrics and gynecology trainees; however, training opportunities in clinical ultrasound are declining. Simulation ultrasound training has been proposed as a strategy to overcome this.The study aims were to determine the current availability of clinical and simulation ultrasound training in obstetrics and gynecology in the United Kingdom and to explore the trainees' perspective on the role of ultrasound simulation. All obstetrics and gynecology trainees within the East Midlands Local Education Training Board in the United Kingdom were asked to complete an anonymous web-based survey in July 2014. Of 140 trainees, 70 (50%) responded to the survey, and 69% reported rarely having dedicated clinical ultrasound sessions. Fifty percent had failed to achieve ultrasound competencies required for their stage of training, and 83% felt that the pressures of service provision limited their exposure to clinical ultrasound.Seventy-three percent of the trainees considered ultrasound simulation to be an essential component of training, and 69% agreed that it would help improve their clinical skills. Only 50% had access to an ultrasound simulator. Seventy-seven percent of the trainees thought that it would be useful to have ultrasound simulation integrated into training. Trainees are struggling to achieve minimal ultrasound competences with clinical ultrasound training alone. They believe that ultrasound simulation will shorten the learning curve and improve their clinical skills and knowledge. Despite the cost implications of simulation training, we propose that consideration is given to formal integration of ultrasound simulation into the curriculum as a possible way forward.

  19. A response to Dubler's commentary on "surmounting elusive barriers: the case for bioethics mediation".

    Science.gov (United States)

    Bergman, Edward J

    2013-01-01

    Dubler's commentary focuses on knowledge of clinical medicine and "institutional savvy" as pieces of the skill set required of bioethics mediators. Here, I describe why, as a practical matter, such requirements are unlikely to be achieved by a meaningful number of aspirants. Simultaneously, I examine the reasons why Dubler's criteria are inherently risk-laden and would be better addressed as a dialogue among experienced practitioners regarding the merits of alternative stylistic approaches, rather than as universal threshold criteria for the practice of bioethics mediation.

  20. Common misconceptions about cognitive mediation of treatment change: a commentary to Longmore and Worrell (2007).

    Science.gov (United States)

    Hofmann, Stefan G

    2008-01-01

    The article by Richard J. Longmore and Michael Worrell [Clinical Psychology Review, Volume 27, 2007, pp. 173-187] reviews a selection of studies showing no significant difference between treatment conditions that include formal cognitive restructuring techniques and other behavioral treatment modalities that do not include techniques to directly challenge cognitions. Based on this literature, Longmore and Worrell question the validity of the cognitive behavioral treatment model and argue that changes in symptoms are not mediated by changes in cognitions. Longmore and Worrell's arguments are based on common misconceptions about mediation models of treatment change. This commentary discusses and clarifies these misconceptions.

  1. 无创产前基因检测在产科门诊的应用研究%Applicative research of noninvasive prenatal gene checking in the obstetrical clinics

    Institute of Scientific and Technical Information of China (English)

    徐彬; 余元勋; 章小琳; 李建平; 刘萍

    2015-01-01

    Objective:To study the sensitivity and specificity of using new gene DNA sequencing method to check the cffDNA in their mother's plasma for the chromosome abnormality,and to compare the results with the re-sults of amniotic fluids karyotyping.Methods:The bloods of 2596 pregnant women from the clinic of the Anhui Province Hospital from January 2013 to July 2014 were screened applying DS serelogical screening method,12-plex high rate Hiseq 2000 checking,we found the cffDNA positive samples that were analyzed by amniotic fluids kary-otyping again.Results:From the 2596 pregnant women,we found 197 high riskers(7.59%),from 176 high riskers were cffDNA positive (24.43%),from 176 high riskers,we found that 42 high riskers were abnormal karyotype (23.86%),The two methods can get nearly same result.Conclusion:Checking the cffDNA from their mother's plas-mas is the noninvasive prenatal diagnostic method with high sensitivity.%目的:应用新的基因DNA测序方法研究其对孕中期孕母血浆中胎儿游离DNA(cffDNA)进行染色体非整倍体检测的灵敏度和特异性,并与羊水核型分析结果比较.方法:收集2013年1月~2014年7月在安徽省立医院产科门诊2596例孕妇的血样本,进行唐氏综合症血清学筛查、12-plex高通量Hiseq2000平台检查;对血清学筛査中的cffDNA检测阳性者,进行羊水细胞遗传学诊断.结果:孕中期血清学筛查共2596例,发现高危孕妇197例,占7.59%;对高危孕妇176例进行cffDNA检测发现43例阳性,阳性率为24.43%;同时进行羊水染色体核型分析发现42例核型异常,阳性率为23.86%;两种方法结果基本一致.结论:孕妇血的胎儿cffDNA检测,是无创产前诊断方法;检测灵敏度较高.

  2. Manejo clínico e obstétrico em gestantes portadoras de hepatite autoimune complicada pela plaquetopenia moderada ou grave Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia

    Directory of Open Access Journals (Sweden)

    Roseli Mieko Yamamoto Nomuras

    2013-02-01

    Full Text Available OBJETIVO: O presente trabalho tem como objetivo descrever o manejo do pré-natal e do parto em pacientes portadoras de hepatite autoimune associada à plaquetopenia moderada ou grave. MÉTODOS: Este trabalho foi realizado em hospital universitário, de nível terciário. Foram analisadas, retrospectivamente, 13 gestações em dez pacientes com diagnóstico de hepatite autoimune complicadas pela plaquetopenia. Os critérios de inclusão foram: diagnóstico clínico de hepatite autoimune, plaquetopenia moderada ou grave (contagem de plaquetas OBJECTIVE: To describe the management of prenatal care and delivery in patients bearing autoimmune hepatitis associated with moderate or severe thrombocytopenia. METHODS: This study was performed in a tertiary level university hospital. Thirteen pregnancies in ten patients diagnosed with autoimmune hepatitis, complicated by thrombocytopenia, were retrospectively analyzed. The inclusion criteria were as follows: clinical diagnosis of autoimmune hepatitis, moderate or severe thrombocytopenia (platelet count < 100 x 103/mm3, gestational age at birth over 22 weeks, and patient followed-up by a specialized team at the institution. The variables studied were: maternal age, parity, treatment regimen, platelet count, examinations for investigation of hepatic function, type of delivery, weight at birth, and gestational age at the time of delivery. RESULTS: The average maternal age was 24.5 years (SD = 5.3 and six (50% occurred in nulliparous women. During pregnancy, monotherapy with prednisone was adopted in 11 cases (92%. According to the autoantibody profiles, seven pregnancies (58% had the autoimmune hepatitis type I diagnosis, two pregnancies had type II (17%, and three pregnancies (25% had cryptogenic chronic hepatitis (undetectable titers of autoantibodies. Portal hypertension was featured in 11 pregnancies (92%. The average gestational age at delivery was 36.9 weeks (SD = 1.5 weeks, with an average weight at

  3. Analysis of the Clinical Value of Interventional Therapy in Gynecologic and Obstetric Hemorrhage Diseases%介入治疗在妇产科出血性疾病临床应用中的价值

    Institute of Scientific and Technical Information of China (English)

    付忠连

    2011-01-01

    [目的]探讨介入治疗方法在剖宫产术后瘢痕妊娠、宫颈妊娠、产后出血中的应用价值.[方法]对2008年7月以来本院收治的25例剖宫产术后瘢痕妊娠、14例宫颈部妊娠、6例产后出血患者.采用Seldinger技术,将明胶海绵颗粒均匀悬混于碘佛醇中,透视下经导管缓慢注入子宫动脉应用于清宫或产后出血.[结果]瘢痕妊娠者行介入治疗后出血明显减少.宫颈妊娠者及产后出血介入治疗后即刻止血.[结论]介入治疗手术时间短、疗效显著、创伤小、保留了子宫,在妇产科出血性疾病的治疗中具有推广价值.%[Objective] To explore the value of interventional therapy in cesarean scar pregnancy, cervical gestation and postpartum hemorrhage in order to provide the new methods for the treatment of above diseases. [Methods] Twenty five patients with cesarean scar pregnancy, 14 patients with cervical gestation and 6 pa tients with postpartum hemorrhage in our hospital from July 2008 to now were analyzed retrospectively. Gelat in sponge granules were evenly mixed to iovensol by Seldinger technique and infused into uterine artery under fluoroscopy for the treatment of post curettage or postpartum hemorrhage. [Results] The hemorrhage in pa tients with cesarean scar pregnancy decreased obviously after interventional therapy. Patients with cervical ges tation and postpartum hemorrhage stopped bleeding immediately after interventional therapy. [Conclusion] In terventional therapy has advantages such as short operation time, obvious effect, less trauma and the reserva tion of the uterine. Therefore, it has the value of clinical promotion in the treatment of gynecologic and obstet ric hemorrhage diseases.

  4. Obstetric use of nitroglycerin: Anesthetic implications

    Science.gov (United States)

    Saroa, Richa; Sachan, Shikha; Palta, Sanjeev; Gombar, Satinder; Sahai, Nitika

    2013-01-01

    Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min) used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration. PMID:24015145

  5. Obstetric use of nitroglycerin: Anesthetic implications

    Directory of Open Access Journals (Sweden)

    Richa Saroa

    2013-01-01

    Full Text Available Nitroglycerin has been used in anesthetic practice for induced hypotension and managing perioperative hypertension and myocardial ischemia. Contrary to the continuous low dose infusions (5-20 mcg/min used for the same, intravenous bolus dosages are sometimes administered at the behest of obstetricians for removal of retained placenta. Use of nitroglycerine in managing retained placenta is undertaken as a last resort when other measures fail to relax the uterine smooth muscles. Intravenous nitroglycerine relaxes smooth muscle cells by releasing nitric oxide thus causing prompt cervico-uterine relaxation. However, administration of nitroglycerine in this manner is not without risks which should be kept in mind while using it for obstetric purposes. We hereby report a case of 22-year-old female scheduled for manual removal of placenta where unpredictable and unexpected hypoxemia was observed following nitroglycerine administration.

  6. Does Experience Rating Improve Obstetric Practices?

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Bertoli, Paola; Grembi, Veronica

    Using data from 2002 to 2009 inpatient discharge records on deliveries in the Italian region of Piedmont, we assess the impact of an increase in malpractice pressure on obstetric practices, as identified by the introduction of experience-rated malpractice liability insurance. Our identification...... in the probability of performing a C-section from 2.3 to 3.7 percentage points (7% to 11.6% at the mean value of C-section) with no consequences for a broadly defined measure of complications or neonatal outcomes. We show that these results are robust to the different methodologies and can be explained...... by the introduction of experience-rated malpractice liability insurance. Our identification strategy exploits the exogenous location of public hospitals in court districts with and without schedules for noneconomic damages. We perform difference-in-differences and difference-in-discontinuities analyses. We find...

  7. [Obstetrical handbook in comic strip form].

    Science.gov (United States)

    1998-04-01

    An obstetric handbook was created in comic strip form in cooperation with the Ministry of Health in the region of Segou, Mali, for training of traditional midwives living far from community health centers. The drawings illustrate pregnancies at risk that the midwife should be able to identify in order to advise women to stay near the health facility before onset of labor. Drawings indicate pregnancies that are at risk because of the following: small stature, limping as a result of polio or sciatic paralysis, high parity, prior cesarean delivery, heart disease, overly large uterus, or prior stillbirth. Serious complications requiring referral to a health service are also illustrated and include severe anemia, genital bleeding, and signs of toxemia and edema. The midwife should accompany the woman during transport.

  8. Obstetric hysterectomy, still a life saving tool in modern day obstetrics: a five year study

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2014-06-01

    Results: During the study period, 105 emergency obstetric hysterectomies were performed giving an incidence of 0.54% .The incidence of hysterectomy following vaginal delivery was 0.54% and that of caesarean hysterectomy was 2.08%. It was most common in the age group 26-35 years (66.66% and in women of parity 3-4 (71.42%.Rupture uterus was the most common indication accounting for 59.04% cases followed by Atonic PPH (18.09%. Febrile illness and wound infection were the two most common co-morbidities. Maternal mortality was 5.71%. Conclusions: Emergency obstetric hysterectomy is potentially a life saving procedure which every obstetrician must be familiar with in cases of catastrophic rupture uterus and intractable haemorrhage. With the help of prostaglandins, modern policies of active management of labor, timely performance of caesarean section, internal iliac artery ligation, compression sutures etc. obstetric hysterectomy should be made a more rare procedure. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 540-543

  9. OBSTETRICS AND PSYCHOSOCIAL OUTCOME OF TEENAGE PREGNANCY

    Directory of Open Access Journals (Sweden)

    Seetesh

    2013-11-01

    Full Text Available Teenage pregnancy is defined as pregnancies which occur in a female below the age of 20 i.e. when the pregnancy ends. A female can become pregnant as early as two weeks before menarche, although rare, but usually occurs after menarche. In healthy, well - nourished girls, menarche normally takes place around the ages 12 or 13. A number of personal and social factors are responsible for the onset of biological fertility in a teenage. Teenage pregnanc y rates vary between countries because of differences in socio - economic status, traditional culture of early marriage, besides levels of sexual activity, general sex education provided and access to affordable contraceptive options. Worldwide, teenage preg nancy rates range from 143 per 1000 in some sub - Saharan African countries to 2.9 per 1000 in South Korea. ( 1(2 The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than for those between the ages of 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as sub - Saha ran Africa (3 In our country teenage marriages does take place and pregnancy usually occur after marriage, despite a law against early marriage. Teenage pregnancy is considered to be high - risk due to many reasons because during this period a woman is physio logically and psychologically as well not mature. Their body itself is in growing stage. So to support the growth of the foetus exposes them to additional challenges. Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in deve loping countries each year. Complications they develop can be grouped into medical, obstetrical, psychological and social. This chapter will highlight obstetrical, psychological and social impact of the teenage pregnancy

  10. Clinical effect of venaflow compression method in the prevention of deep vein thrombosis for the high risk patients in gynaecology and obstetrics department%Venaflow法预防妇产科高危患者深静脉血栓形成的临床效果

    Institute of Scientific and Technical Information of China (English)

    刘小雅; 林芳; 翟剑

    2013-01-01

    Objective To study and observe the clinical effect of venaflow compression method in the prevention of deep vein thrombosis(DVT) for the high risk patients in gynaecology and obstetrics department. Methods Eighty high risk patients with DVT in our department were randomly divided into two groups, the patients in the experimental group used calf inflatable venaflow compression method, while the patients in the control group used conventional calf massage with sequential compression stockings, and did double lower limbs isometric exercise, ate balanced diet and implemented symptomatic treatment. The symptoms and signs, lower limbs venous color Doppler ultrasonography and plasma D-dimer of all patients were examined and determined respectively at 1th, 7th day, and were judged according to DVT diagnosis process. Results The two groups had no severe lower limbs DVT and pulmonary embolism(PE). In the experimental group, the incidence of lower limbs DVT was 7.5%, 1 case happened double lower limbs thrombosis, 2 cases happened single limb thrombosis; In the control group, the incidence of lower limbs DVT was 25%, 2 cases happened double lower limbs thrombosis, 8 cases happened single limb thrombosis; The patients in the experimental group significantly reduced the risk of vein thrombosis. In addition, there was a statistically significant difference in the seventh days venous velocity between two groups (P<0.05). Conclusion The venaflow compression method can significantly accelerate the vein blood velocity, and contribute to the prevention of DVT for the high risk patients in gynaecology and obstetrics department, and reduce the risk of vein thrombosis.%目的:研究观察venaflow压迫法预防妇产科高危患者深静脉血栓形成(DVT)的临床效果。方法将我科80例DVT高危风险患者随机分为两组:实验组采用venaflow的小腿充气压迫法,对照组采用常规小腿按摩法加序贯加压袜,配合双下肢等长收缩运动、平

  11. Invited commentary: the testimony of Dr. Snow.

    Science.gov (United States)

    Vandenbroucke, J P

    2000-07-01

    This paper presents a commentary on the testimony delivered by Dr. John Snow before the British Parliamentary Committee in 1855. It is noted that in Snow's testimony was highlighted his extremely strong belief in germ theory and contagion and his consequent contempt for anything close to the rivaling theory that miasmatic emanations cause disease. Snow's unreasonableness may have been because he already held his germ theory and drinking water convictions before he made his observations. In addition, based on his published books it has become apparent that even his data analysis was guided by such preconceptions. Although Snow's opinion on germ theory created contemporaries, it is noted however, that Snow did not truly sway contemporary opinion, and his theories were not agreed as a complete breakthrough in the way that they are often presented as being in epidemiological textbooks. Overall, the fundamental problem with the miasma and contagion theories at the time was that both failed to answer certain questions, including transmission of diseases, development of diseases, and the issue of temporary carriers of causative germs.

  12. Mending the gap: Introduction to the invited commentaries on Dinger, Strack, Sachsse, and Schauenburg (2009).

    Science.gov (United States)

    Samstag, Lisa Wallner

    2009-09-01

    Introduces several commentaries on an article by U. Dinger et al (see record 200913603-002) entitled "Therapists' attachment, patients' interpersonal problems and alliance development over time in inpatient psychotherapy." This article represents an ambitious effort on the part of the researchers to map a number of interrelated relational variables, over the course of treatment, in a relatively understudied patient population. "Attachment," "interpersonal problems," and "alliance" are variables that capture core components of the therapeutic relationship and psychotherapy process that have been reliably linked to patient improvement in many previous studies of mostly outpatient psychotherapy. Jeremy Holmes (see record 2009-13603-003) and George Silbershatz (see record 2009-13603-004) were invited to comment on this study while wearing their clinical hats. They were asked about how they made sense of the research results as practicing psychotherapists, the ways in which the findings were useful to them as clinicians, and where they considered the research to be of more limited value from a clinical point of view. Following the commentaries is a final word from the authors of the study (see record 2009-13603-005). It is hoped that this format of dialogue will have an impact on how clinical research is presented in the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  13. Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms.

    Science.gov (United States)

    Raz, Iris; Novack, Lena; Yitshak-Sade, Maayan; Shahar, Yemima; Wiznitzer, Arnon; Sergienko, Ruslan; Warshawsky-Livne, Lora

    2015-10-01

    In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours. We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits. The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR=1.22) and in non-urgent OER visits (IRR=1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home. We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications.

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

    Science.gov (United States)

    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

  15. [The EbM Commentary at the Annual Meeting of the German Congress of Orthopaedics and Traumatology (DKOU): background, aims and vision].

    Science.gov (United States)

    Dubs, L; Kirschner, S; Neugebauer, E; Hassenpflug, J

    2011-08-01

    The critical appraisal of clinical and scientific work to assure the effectiveness and to balance the risks of treatment are mandatory today. Recent innovations in medicine often lead only to minor improvement in patient benefit. For the better understanding of the presented study results, the EbM commentary was introduced in 2007 at the Annual Meeting of the German Society of Orthopaedics and Traumatology. The EbM commentary was developed within the Swiss Orthopaedic Society and is a vital part of the Annual Meetings. The EbM commentary is a carefully prepared critical appraisal of an orally presented study by a specially trained colleague. The commentary consists of three components and begins with a systematic analysis following the SPION principle. What kind of study was carried out? Which patients were enrolled in the investigation? What kind of interventions were compared? How was the outcome measured? What is the benefit of the study for my own practice and what is the benefit for the patient? The reporting and the evaluation of the patient benefit is of great interest. In the second step the strengths and weaknesses of the study were discussed and the study will be rated for their evidence. For the best case the presented study implies direct changes in the usual treatment of patients. In the worst case no changes are necessary and the study is rated "so what" because of methodological weaknesses making the drawn conclusions invalid. For the audience the EbM commentary may support their rating of the quality of the presented study. The congress team selects interesting presentations for the EbM commentary. The EbM commentators receive the oral presentation and in most cases additional information from the selected studies four weeks in advance of the meeting. The EbM commentary is focused on a precise analysis of the presented data in an open and pleasant discussion. The aim of the EbM commentary is to clearly point out the patient benefit and to disclose

  16. 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.

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

  18. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database.

    Science.gov (United States)

    Carle, C; Alexander, P; Columb, M; Johal, J

    2013-04-01

    We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to

  19. Obstetric prognosis in sisters of preeclamptic women – implications for genetic linkage studies

    Directory of Open Access Journals (Sweden)

    Heinonen Seppo

    2003-02-01

    Full Text Available Abstract Background To investigate obstetric prognosis in sisters of preeclamptic women. Methods We identified consecutive 635 sib pairs from the Birth Registry data of Kuopio University Hospital who had their first delivery between January 1989 and December 1999 in our institution. Of these, in 530 pairs both sisters had non-preeclamptic pregnancies (the reference group, in 63 pairs one of the sisters had preeclampsia and the unaffected sisters were studied (study group I. In 42 pairs both sister's first delivery was affected (study group II. Pregnancy outcome measures in these groups were compared. Results Unaffected sisters of the index patients had uncompromised fetal growth in their pregnancies, and overall, as good obstetric outcomes as in the reference group. The data on affected sisters of the index patients showed an increased prematurity rate, and increased incidences of low birth weight and small-for-gestational age infants, as expected. Conclusion Unaffected sisters of the index patients had no signs of utero-placental insufficiency and they were at low risk with regard to adverse obstetric outcome, whereas affected sisters were high-risk. Clinically, affected versus unaffected status appears to be clear-cut in first-degree relatives regardless of their genetic susceptibility and unaffected sisters do not need special antepartum surveillance.

  20. Obstetric Complications Tied to Slightly Upped Risk for Autism

    Science.gov (United States)

    ... Obstetric Complications Tied to Slightly Upped Risk for Autism Study suggests link, but one expert stressed that most complicated pregnancies result in babies without autism To use the sharing features on this page, ...

  1. Knowledge and Utilization of the Partograph among obstetric care ...

    African Journals Online (AJOL)

    elearning

    This cross-sectional study assessed knowledge and utilization of the ... Correspondence: Dr. Fawole AO Department of Obstetrics & Gynaecology, University College Hospital, Ibadan,. Nigeria. .... was 0% while modal score for Physicians was.

  2. Old primips and big babies; Changing the art of obstetrics

    LENUS (Irish Health Repository)

    Flood, K

    2011-02-01

    Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting Junior Obstetrics & Gynecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Matenity Hospitals Report Meeting Friday 26th Nov 2010

  3. Uterine rupture an obstetrics catastrophy; incidence, risk factors ...

    African Journals Online (AJOL)

    Uterine rupture an obstetrics catastrophy; incidence, risk factors, management ... at Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria. ... is 0.35% and the common risk factors include high parity, exposure to oxytocin in ...

  4. Screening for Chlamydia trachomatis in Low-Risk Obstetric Patients

    Directory of Open Access Journals (Sweden)

    Robert K. Gribble

    1994-01-01

    Full Text Available Objective: The purpose of this study was to evaluate the prevalence of Chlamydia trachomatis in our rural obstetric population and assess the appropriateness of selective vs. universal prenatal screening.

  5. male knowledge of danger signs of obstetric complications

    African Journals Online (AJOL)

    and cultural status in society. In addition to ... Keywords: Danger Signs in Pregnancy, Obstetric Complications, Male Knowledge ... documentation of this would be useful in designing ... Package for the Social Sciences version 16 with analysis.

  6. Guest Editorial The Obstetric Anaesthesia Special Interest Society ...

    African Journals Online (AJOL)

    , Z Farina, ... courses, educating the public on epidurals and pain relief in 30 languages ... The organisation will address interventions to improve outcomes, based primarily ... obstetric haemorrhage, and epidural and postoperative analgesia.

  7. Social implications of obstetric fistula: an integrative review.

    Science.gov (United States)

    Roush, Karen M

    2009-01-01

    Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub-Saharan Africa.

  8. Clinical and physical aspects of obstetric vacuum extraction

    NARCIS (Netherlands)

    J.A. Kuit (Jette)

    1997-01-01

    textabstractUntil one century ago the natural wonder of spontaneous childbirth was the turning point in a woman's chances of surviving her pregnancy. When obstructed labor occurred the midwife or surgeon had nothing to offer but patience, blessing and fundal expression, and their frustation was

  9. Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2006-03-01

    Full Text Available Abstract Background A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change. Methods Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice. Results In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey. Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice. Conclusion Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.

  10. The critical role of supervision in retaining staff in obstetric services: a three country study.

    Science.gov (United States)

    McAuliffe, Eilish; Daly, Michael; Kamwendo, Francis; Masanja, Honorati; Sidat, Mohsin; de Pinho, Helen

    2013-01-01

    Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve

  11. The critical role of supervision in retaining staff in obstetric services: a three country study.

    Directory of Open Access Journals (Sweden)

    Eilish McAuliffe

    Full Text Available Millennium Development Goal (MDG 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential

  12. 14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome.

    Science.gov (United States)

    de Jesus, Guilherme R; Agmon-Levin, Nancy; Andrade, Carlos A; Andreoli, Laura; Chighizola, Cecilia B; Porter, T Flint; Salmon, Jane; Silver, Robert M; Tincani, Angela; Branch, D Ware

    2014-08-01

    Pregnancy morbidity is one of the clinical manifestations used for classification criteria of antiphospholipid syndrome (APS). During the 14th International Congress on Antiphospholipid Antibodies (aPL), a Task Force with internationally-known experts was created to carry out a critical appraisal of the literature available regarding the association of aPL with obstetric manifestations present in actual classification criteria (recurrent early miscarriage, fetal death, preeclampsia and placental insufficiency) and the quality of the evidence that treatment(s) provide benefit in terms of avoiding recurrent adverse obstetric outcomes. The association of infertility with aPL and the effectiveness of the treatment of patients with infertility and positive aPL was also investigated. This report presents current knowledge and limitations of published studies regarding pregnancy morbidity, infertility and aPL, identifying areas that need better investigative efforts and proposing how critical flaws could be avoided in future studies, as suggested by participants of the Task Force. Except for fetal death, there are limitations in the quality of the data supporting the association of aPL with obstetric complications included in the current APS classification criteria. Recommended treatments for all pregnancy morbidity associated to APS also lack well-designed studies to confirm its efficacy. APL does not seem to be associated with infertility and treatment does not improve the outcomes in infertile patients with aPL. In another section of the Task Force, Dr. Jane Salmon reviewed complement-mediated inflammation in reproductive failure in APS, considering new therapeutic targets to obstetric APS (Ob APS).

  13. Non Obstetric Causes and Presentation of Acute Abdomen among the Pregnant Women.

    Directory of Open Access Journals (Sweden)

    Monoarul Haque

    2014-09-01

    Full Text Available To identify the non-obstetric causes and presentation of acute abdomen among pregnant women.This was a cross sectional hospital-based study among 128 pregnant women by face to face interview using a semi-structured questionnaire. This study was conducted at the Gynecology & Obstetric Ward of 250 Bed General Hospital, Noakhali, Bangladesh, from January to August 2013. Data were analyzed by a software package used for statistical analysis (SPSS version 11.5 (SPSS, Inc., Chicago, IL, USA.Mean age of participants was 25±4 years. Our findings showed that 81% were Muslim, 67% were lower middle income group, as well as 47% completed primary level of education. The results revealed that 28% had biliary ascariasis, 24% had peptic ulcer disease and 10% had lower urinary tract infection. We also found that 6% had acute pyelonephritis, 6% had acute gastroenteritis, 6% had acute cholecystitis, 6% had acute appendicitis, 2% had acute pancreatitis, 3% had choledocolithiasis, 2% had ovarian solid mass, 2% had twisted ovarian cyst, 4% had renal colic, and 1% had renal calculus. In non-obstetrical presentation of acute abdomen, the study found that 84% of respondents complained their pain lasting more than 24 hours. Besides, half of respondents felt pain in epigastrium and right hypochondrium. Cramping, prickling and aching type of pain were more, while 66% suffered from continuous pain. Our results also showed that 73% did not explain any aggravating factor and relieving factor, and the rest said food, fasting state and position change aggravated pain as well as relieved pain.The study concludes that precise diagnosis of the acute abdomen in pregnant women by continual updating of abdominal assessment knowledge, and clinical skills is necessary in the management of abdominal pain in obstetric settings.

  14. 11 CFR 100.73 - News story, commentary, or editorial by the media.

    Science.gov (United States)

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false News story, commentary, or editorial by the... (2 U.S.C. 431) Exceptions to Contributions § 100.73 News story, commentary, or editorial by the media. Any cost incurred in covering or carrying a news story, commentary, or editorial by any broadcasting...

  15. 11 CFR 100.132 - News story, commentary, or editorial by the media.

    Science.gov (United States)

    2010-01-01

    ... 11 Federal Elections 1 2010-01-01 2010-01-01 false News story, commentary, or editorial by the... DEFINITIONS (2 U.S.C. 431) Exceptions to Expenditures § 100.132 News story, commentary, or editorial by the media. Any cost incurred in covering or carrying a news story, commentary, or editorial by any...

  16. [Husband's presence at childbirth in light of obstetric psychoprophylaxis].

    Science.gov (United States)

    Sioma-Markowska, Urszula; Sipiński, Adam; Majerczyk, Iwona; Selwet, Monika; Kuna, Anna; Machura, Mariola

    2004-01-01

    Contemporary obstetric psychoprophylaxis gives prospective parents wide opportunities to prepare to the pregnancy period and delivery. It is educationally-minded and points the importance to modify the life style, introduces exercises accompanied by the relative during the pregnancy and delivery. The survey portrays husband's--child father's role in obstetric psychoprophylaxis. The importance to continue the psychoprophylaxis in the delivery room was spotted in the survey, too. The continuation might be reached by close relative's presence.

  17. Public private partnerships for emergency obstetric care: Lessons from Maharashtra

    OpenAIRE

    Sarika Chaturvedi; Bharat Randive

    2011-01-01

    Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Me...

  18. Validating Obstetric Emergency Checklists using Simulation: A Randomized Controlled Trial.

    Science.gov (United States)

    Bajaj, Komal; Rivera-Chiauzzi, Enid Y; Lee, Colleen; Shepard, Cynthia; Bernstein, Peter S; Moore-Murray, Tanya; Smith, Heather; Nathan, Lisa; Walker, Katie; Chazotte, Cynthia; Goffman, Dena

    2016-10-01

    Background The World Health Organization's Surgical Safety Checklist has demonstrated significant reduction in surgical morbidity. The American Congress of Obstetricians and Gynecologists District II Safe Motherhood Initiative (SMI) safety bundles include eclampsia and postpartum hemorrhage (PPH) checklists. Objective To determine whether use of the SMI checklists during simulated obstetric emergencies improved completion of critical actions and to elicit feedback to facilitate checklist revision. Study Design During this randomized controlled trial, teams were assigned to use a checklist during one of two emergencies: eclampsia and PPH. Raters scored teams on critical step completion. Feedback was elicited through structured debriefing. Results In total, 30 teams completed 60 scenarios. For eclampsia, trends toward higher completion were noted for blood pressure and airway management. For PPH, trends toward higher completion rates were noted for PPH stage assessment and fundal massage. Feedback resulted in substantial checklist revision. Participants were enthusiastic about using checklists in a clinical emergency. Conclusion Despite trends toward higher rates of completion of critical tasks, teams using checklists did not approach 100% task completion. Teams were interested in the application of checklists and provided feedback necessary to substantially revise the checklists. Intensive implementation planning and training in use of the revised checklists will result in improved patient outcomes.

  19. The role of consulting psychiatrists for obstetric and gynecologic inpatients.

    Science.gov (United States)

    Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh

    2011-01-01

    The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

  20. Emergency obstetric surgery by non-physician clinicians in Tanzania.

    Science.gov (United States)

    Pereira, Caetano; Mbaruku, Godfrey; Nzabuhakwa, Calist; Bergström, Staffan; McCord, Colin

    2011-08-01

    To calculate the met need for comprehensive emergency obstetric care (CEmOC) in 2 Tanzanian regions (Mwanza and Kigoma) and to document the contribution of non-physician clinicians (assistant medical officers [AMOs]) and medical officers (MOs) with regard to meeting the need for CEmOC. All hospitals in the 2 regions were visited to determine the proportion of major obstetric interventions performed by AMOs and MOs. All deliveries (n = 38 758) in these hospitals in 2003 were reviewed. The estimated met need for emergency obstetric care (EmOC) was calculated using UN process indicators, as was the contribution to that attainment by AMOs. Hospital case fatality rates were also determined. Estimated met need was 35% in Mwanza and 23% in Kigoma. AMOs operating independently performed most major obstetric surgery. Outside of the single university hospital, AMOs performed 85% of cesareans and high proportions of other obstetric surgeries. The case fatality rate was 2.0% in Mwanza and 1.2% in Kigoma. AMOs carried most of the burden of life-saving EmOC-particularly cesarean deliveries-in the regions investigated. Case fatality was close to the 1% target set by the UN process indicators, but met need was far below the goal of 100%. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Obstetric hysterectomy: trend and outcome in Ile-Ife, Nigeria.

    Science.gov (United States)

    Badejoko, O O; Awowole, I O; Ijarotimi, A O; Badejoko, B O; Loto, O M; Ogunniyi, S O

    2013-08-01

    Worldwide, the incidence of obstetric hysterectomy is expected to be on the decline due to improvements in obstetric care. This hospital-based 10-year review (2001-10) was performed to determine its incidence and outcome in Ile-Ife, Nigeria. The trend was determined by comparing the current incidence with that from two previous studies from the same centre. There were 58 obstetric hysterectomies and 15,194 deliveries during the review period, giving a rate of 3.8/1,000 deliveries. A rising trend was observed in the obstetric hysterectomy rate in Ile-Ife over two decades (1990-2010). Uterine rupture was the commonest indication (60%). Postoperative complications such as sepsis, vesico-vaginal fistula and renal failure affected 34.5% of the patients. Maternal and fetal case fatality rates were 18.2% and 43.6%, respectively. The obstetric hysterectomy rate in Ile-Ife is high and the trend is rising. Universal access to skilled birth attendance is advocated to reduce uterine rupture and consequently obstetric hysterectomy.

  2. PROGNOSTIC RISK OF OBSTETRIC AND PERINATAL COMPLICATIONS IN PREGNANT WOMEN WITH THYROID DYSFUNCTION.

    Science.gov (United States)

    Morchiladze, N; Tkeshelashvili, B; Gagua, T; Gagua, D

    2017-03-01

    Maternal thyroid pathology takes important role in obstetric and peri-neonatal morbidity structure. Despite of the number of studies conducted in the field of thyroid disorders of pregnant females, the definition of influence of thyroid gland dysfunction on maternal and neonatal health still remains actual. The mentioned topics draw specific interest in the aspect of prognosticaiton of complications and unfavorable outcome. Aim of the study - to define the specificities of gestation period and determine the prognostic risk of obstetric and perinatal complications in pregnant females with thyroid pathology. The study was performed at the base of "David Gagua Clinic" Ltd. Prospective, open controlled study design was applied. Based upon the referral to the clinic, 292 pregnant females with thyroid pathology were involved in the main group. The control group involved 58 conditionally healthy pregnant females of reproductive age. Thyroid status had been monitored accoding to trimesters during the whole period of prgnancy and 1 month following the delivery. The health state of neonates was assessed by international protocols. To define the confidence interval for relative ratio between quantitative data of compared groups, c2 , P and RR indices were calculated, and its critical level was considered to be 0.05. The risks ratio with defining of the data was determined for obstetric and perinatal complications. 120 (41.4%) of pregnant subjects demonstrated hypothyroidism, 104 (35.6%) - isolated hypothyroxinmia, and 13 (4.5%) - hyperthyroidism. High levels of anti-thyroid peroxidase antibodies were observed in 54 (18.5%) of cases, nodular gout was found in 38 (13%) patients, 5 (12.3%) of which was associated with hypothyroidism and 9 (23%) - with isolated hypothyroxinemia. Correcting treatment was administered to all pregnant subjects during the pregnancy period. Based on the analysis of acquired data, the high probability of prengancy-related nausea/vomiting and iron

  3. Rural-urban inequity in unmet obstetric needs and functionality of emergency obstetric care services in a Zambian district

    DEFF Research Database (Denmark)

    Phiri, Selia Ng'Anjo; Fylkesnes, Knut; Moland, Karen Marie

    2016-01-01

    Background: 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....... Method: 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...... was used to assess deficit of life-saving interventions in urban and rural areas. Results: 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...

  4. Sustainable business models and the automotive industry: A commentary

    Directory of Open Access Journals (Sweden)

    Peter Wells

    2013-12-01

    Full Text Available This commentary reviews the position articulated in an article published in 2004 that the business model prevalent in the automotive industry was inadequate to meeting the challenge of sustainability, and reviews the key developments since then. The most noticeable developments the commentary traces are the growth in academic interest in business models, a more responsive government policy particularly in respect of new technologies, and the practical application of the concepts and ideas mooted in the original paper, notably with respect to electric vehicles.

  5. Obstetric and perinatal outcome of teenage pregnancy.

    Science.gov (United States)

    Suwal, A

    2012-01-01

    Adolescents are at higher risk during childbirth than women between 20 to 25 years. Adolescent childbearing initiates a syndrome of failure: failure to complete one's education; failure in limiting family size; failure to establish a vocation and become independent. This study was done to find out the obstetric and perinatal outcome of teenage pregnancy along with factors contributing to teenage pregnancy. A prospective, cross sectional study was carried out in College of Medical Sciences Teaching Hospital (CMSTH), Bharatpur during the period for two years from September 2008 to August 2010. Pregnant girls ≤19 years admitted to labour ward were taken for the study. Cases planned for abortion and MTP were also taken. One hundred cases of pregnant teenagers were admitted in CMSTH during a period of two years. Incidence was 6.85%. In our study, most of the teenagers were unbooked, from low socioeconomic status and with no or inadequate education. They had little knowledge about contraception and less number of teenagers used temporary means of contraception. Because of our social custom of early marriage, most of the teenage mothers were married. All these factors were correlated with teenage pregnancy in present study. This study failed to show any statistically significant difference in the incidence of anaemia, LBW babies, preterm delivery, hypertensive disorder of pregnancy, mode of delivery in different ages of teenage mothers. However, there was significant difference in the incidence of perinatal death in different ages of teenage mothers indicating that perinatal deaths were more in younger teenagers.

  6. Strengthening emergency obstetric care in Ayacucho, Peru.

    Science.gov (United States)

    Kayongo, M; Esquiche, E; Luna, M R; Frias, G; Vega-Centeno, L; Bailey, P

    2006-03-01

    With support from the Averting Maternal Death and Disability (AMDD) Program, CARE began the FEMME Project in 2000 to increase access and utilization of emergency obstetric care (EmOC) services for the approximately 48,000 pregnant women in the northern provinces of Ayacucho. The project targeted 5 facilities with a comprehensive package of interventions designed to improve capacity to provide quality EmOC services and to promote a human rights approach in health care. Key program activities included improvements in infrastructure, human resources capacity development, development of service standards and protocols, quality improvement activities, and promoting a rights-based approach to health. By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the UN process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined and the number of maternal deaths in the entire region declined. CARE's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region. Within CARE, project experiences have supported maternal health programs particularly in the Latin American/Caribbean region.

  7. [Gynecology and obstetrics in Ancient Rome].

    Science.gov (United States)

    Dumont, M

    1992-10-01

    Gods and Goddesses were invoked by the Romans for the termination of a good delivery. Diana, Juno, Lucina and Cybele were the preferred ones. Sterility was sometimes treated by the whip of the Lupercali of ministers of Pan. The first doctors in Rome were coming from Greece. Celsus, Pliny the Elder were encyclopedists, Rufus an anatomist, Dioscorides a pharmacologist. Archigenes, Aretaeus and Antyllus surgeons. Soranus from Ephesus, was the first to recommend podalic version. His works was a long time buried in a profound oblivion and discovered by scholars during the nineteenth century. Galen was looked as the most famous medical man after Hippocrates. During the Roman Empire of Occident (Byzantine Empire), Oribasius, Aurelianus Caelius, Moschion and above all Aetius and Paul of Aegina wrote many works which were many times plagiarized. Roman laws concerning public health were severe. Midwives took an important action in the care of pregnant women. Roman poets as Plautus, Terence, Lucilius, Catullus, Virgil, Tibullus, Ovid and Martial were many times concerned in their writings with gynecologic or obstetric subjects. Children were easily forsaken. Three Emperors, Trajan, Marcus-Aurelius and Alexander Severius, a writer, Aulu-Gelles, and a rhetor, Quintilian, took protection of them.

  8. Outcomes of high-risk obstetric transfers in New South Wales and the Australian Capital Territory: The High-Risk Obstetric Transfer Study.

    Science.gov (United States)

    Goh, Amy; Browning Carmo, Kathryn; Morris, Jonathan; Berry, Andrew; Wall, Margaret; Abdel-Latif, Mohamed

    2015-10-01

    In New South Wales and the Australian Capital Territory, in utero transfers to manage maternal or neonatal risks are highly challenging owing to geography and centralisation of tertiary perinatal care. The study aims to document the outcomes of high-risk obstetric transfers. A prospective observational study was conducted from 2010 to 2011 documenting urgent requests for obstetric transfers to tertiary centres across NSW/ACT for pregnancies 20 weeks' gestation or greater. Outcomes of transfers were allocated apriori to 'delivered at the receiving hospital', 'failed/delayed transfer' or 'discharged/transferred undelivered'. Our hypothesis is that each outcome has a specific group of associated clinical factors. Of the 249 transfer requests included in the study, 40% delivered at the receiving hospital, 7% were failed/delayed transfers, and 45% were discharged/transferred undelivered. Cases delivering at the receiving hospital were significantly associated with older mothers, twin pregnancies, pregnancy induced hypertension (PIH) or premature rupture of membranes (PROM) with/without threatened preterm labour (TPL) as the indications for transfer and having three indications for transfer. Cases that were discharged/transferred undelivered were significantly associated with singleton pregnancies, TPL and/or antepartum haemorrhage (APH) as the indication for transfer and having one indication for transfer. There were no significantly associated factors for failed/delayed transfers. The study confirms the hypothesis that particular transfer outcomes are associated with different factors. The findings also show that less than half of urgent obstetric transfers result in delivery at the receiving hospital, suggesting that there exists significant opportunities for further research into predicting preterm delivery, thereby improving the care of women with high-risk pregnancies. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  9. German Functionalist Approaches to the Chinese-English Translation of Commentaries in Ningxia Museum

    Institute of Scientific and Technical Information of China (English)

    任宁

    2013-01-01

      Museum commentary emerges as the times demand. It falls into the category of publicity text. Not only does museum commentary play an important role in transferring information, but also in disseminating culture. Meanwhile, museum commentary translation is a prominent part of culture, carrying the task of cultural communication between China and foreign countries. Howev⁃er, scholars do not pay enough attention to museum commentary translation. Under the guidance of German functionalism, translators could pay much attention to the function of the museum commentary and adopt flexible translation strategies to fulfill it.

  10. Scissors as symbols: disputed ownership of the tools of biomedical obstetrics in rural Indonesia.

    Science.gov (United States)

    Hildebrand, Vanessa M

    2012-09-01

    In the hands of both traditional and clinic midwives in rural Indonesia a simple biomedical tool, umbilical cord scissors, has come to develop a social life that symbolizes potential futures. In rural Indonesian villages resources are limited, maternal and infant mortality rates are high, and there is robust competition for both patients and status between traditional and clinic midwives, all set against nationalist pressure to "modernize." The perceived right to use the umbilical cord scissors in a professional setting is contested. The folk midwives use the umbilical cord scissors to publically reference access to biomedical obstetric knowledge, a domain claimed by clinic midwives. This paper explores the way that the traditional midwives construct a hybrid modern identity by marking a place for traditional and biomedical obstetric systems in the treatment of childbirth. Further, this paper argues that traditional midwives use the symbolically laden umbilical cord scissors in their attempt to remain locally relevant and to circumvent the mission of the clinic programs to eradicate their practice.

  11. It's All How You "Spin" It: Interpretive Bias in Research Findings in the Obstetrics and Gynecology Literature.

    Science.gov (United States)

    Turrentine, Mark

    2017-02-01

    Scientific publications can be subject to varying degrees of interpretive bias, also known as spin. The rate of spin in randomized controlled trials (RCTs) with nonsignificant primary outcomes in the general obstetrics and gynecology literature is unknown. A decade (January 2006 through December 2015) of the tables of contents of Obstetrics & Gynecology and the American Journal of Obstetrics & Gynecology were screened, with 503 RCTs identified. Limiting assessment to only parallel-group RCTs with a nonsignificant primary outcome (P≥.05) resulted in the identification of 194 studies. The abstracts of the articles reported the primary outcome in 93% of studies with 79% containing a precision estimate but only 25% noting an effect size. The extent of any type of spin occurred in 43% of abstracts and 50% of the main text. In articles that contained spin in the abstract, the more common types were: emphasizing statistically significant secondary results despite a nonsignificant primary outcome (40%); interpreting statistically nonsignificant primary results as showing treatment equivalence or comparable effectiveness (37%); and emphasizing the beneficial effect of the treatment despite statistically nonsignificant results (15%). Half of parallel-group RCTs with nonsignificant primary outcomes published in the two leading journals in general obstetrics and gynecology contains some level of spin. As readers of the medical literature, we should be aware of the concept of spin, the diversity and heterogeneity of spin in the reporting of conclusions, and its effects, particularly when discussing articles that may change clinical practice.

  12. On One Masorah in Rashi's Biblical Commentary

    Directory of Open Access Journals (Sweden)

    Himmelfarb, Lea

    2004-06-01

    Full Text Available The aim of our research was to clarify the Masoretic sources which Rashi used in his commentary on the word נחלה in Ezek. 47:19. Rashi claims that he has see that the stress is penultimate for גחלה מצרים (Num. 34:5 and that the Masorah ad loc is לית בטעמא (= unique with this accentuation. I examined scores of medieval Biblical manuscripts that originated from all known regions but did not find a single Masoretic note formulated in this way. Moreover, they all apply the ב (= two occurrences in different wording, without the use of לית as Rashi does. In only one manuscript, Parma di Rossi 2, did I find the note ל פס דס וחד נתלה עבר על נפשנו (the word-pair מצרים נחלה is unique in the Bible as is נחלה עבר על נפשנו. I suggest viewing this note and the other one quoted by Rashi לית בטעמא as a rewording by the Masoretes of the equivalent note found in the Aleppo and Leningrad Manuscripts: בתרי לישני ב (= a unique pair of words identical in pronunciation but different in meaning.

    El propósito de nuestra investigación ha sido dilucidar cuáles fueron las fuentes masoréticas que Rashi empleó en su comentario a la palabra נחלה en Ezek. 47:19. Rashi sostiene haber visto que el acento va en la penúltima sílaba en גחלה מצרים (Num. 34:5, y que la Masora ad loc es לית בטעמא (única por tener dicha acentuación. Por nuestra parte, hemos examinado numerosos manuscritos originarios de todas las regiones conocidas, pero no hemos encontrado ni una sola anotación masorética formulada de este modo. Además, todos ellos utilizan en sus masoras el ב (dos casos en diferentes ocasiones, pero sin usar לית del modo que lo hace Rashi. Sólo en un manuscrito, Parma di Rossi 2, pudimos encontrar la anotación ל פס דס וחד נתלה עבר על נפשנו (la pareja נחלה מצרים es única en la Biblia, al igual que

  13. Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.

    Science.gov (United States)

    Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen

    2005-03-01

    Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results  Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions  There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.

  14. Commentary on A General Curriculum in Mathematics for Colleges.

    Science.gov (United States)

    Committee on the Undergraduate Program in Mathematics, Berkeley, CA.

    This document constitutes a complete revision of the report of the same name first published in 1965. A new list of basic courses is described, consisting of Calculus I, Calculus II, Elementary Linear Algebra, Multivariable Calculus I, Linear Algebra, and Introductory Modern Algebra. Commentaries outline the content and spirit of these courses in…

  15. Commentary--Culture and Attachment during Middle Childhood

    Science.gov (United States)

    Chen, Bin-Bin

    2015-01-01

    Culture has an important impact on attachment. This commentary highlights three aspects about culture and attachment in middle childhood: (1) the need to have a more sophisticated consideration of the implication of cultural values, (2) the need to incorporate the role of societal or political ecological contexts, and (3) the need to solve the…

  16. A Declaration on Learning--A Commentary Discourse

    Science.gov (United States)

    Walton, John S.

    2005-01-01

    This paper subjects "A Declaration on Learning" published in the UK in 2000 to a critical review. A brief synopsis of the text is followed by a commentary discourse drawing upon critical discourse analysis (Fairclough 2001) and incorporating meta content analysis, rhetorical analysis and genre analysis. Conclusions are drawn related to the…

  17. RTI Confusion in the Case Law and the Legal Commentary

    Science.gov (United States)

    Zirkel, Perry A.

    2011-01-01

    This article expresses the position that the current legal commentary and cases do not sufficiently differentiate response to intervention (RTI) from the various forms of general education interventions that preceded it, thus compounding confusion in professional practice as to legally defensible procedures for identifying children as having a…

  18. Statistics by Example, Exploring Data, Teachers' Commentary and Solutions Manual.

    Science.gov (United States)

    Zelinka, Martha; Sutherland, Michael

    Part I of the teachers' commentary for "Exploring Data" includes a brief description of demands on the reader in terms of reading vocabulary and mathematical skills and comprehension, lists the substantive areas covered by the examples, suggests ways in which the pamphlet might be used in the classroom, and discusses background information for the…

  19. Behavioral Theory and Culture Special Issue: Authors' Response to Commentaries

    Science.gov (United States)

    Pasick, Rena J.; Burke, Nancy J.; Joseph, Galen

    2009-01-01

    This article presents the authors' response to commentaries that focus on the "Behavioral Constructs and Culture in Cancer Screening" (3Cs) study. The 3Cs study had an unremarkable beginning, with two colleagues discussing their frustration over the narrow range of behavioral theories and the limited guidance the theories offered for a study…

  20. Commentary--Culture and Attachment during Middle Childhood

    Science.gov (United States)

    Chen, Bin-Bin

    2015-01-01

    Culture has an important impact on attachment. This commentary highlights three aspects about culture and attachment in middle childhood: (1) the need to have a more sophisticated consideration of the implication of cultural values, (2) the need to incorporate the role of societal or political ecological contexts, and (3) the need to solve the…