摘要:

SummarySeventy-five per cent of senior obstetricians and gynaecologists (47/63) in the North Thames (West) Region had been involved in litigation. They reported that difficulties with professional relationships and team working is at the heart of much injury to patients, particularly supervision of junior staff and communication between staff and patients. Other common concerns were inadequate record keeping, the use of locums and transient staff and out-of-date equipment. There was little indication of defensive medicine but the effects of litigation on individual doctors was disturbing in a proportion of cases. Many felt distressed and personally attacked, some considered giving up medicine. The human costs, often overshadowed by the concern with financial costs, are great. Clinical risk management strategies must be developed to counter the risk factors identified. Training in communication skills, particularly in helping dissatisfied, distressed or injured patients, is urgently needed. Consideration should be given to formal support or counselling for staff involved in serious obstetric incidents.

ISSN:1340-9654    

DOI:10.3109/01443619409027617

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryProblems associated with current methods of handling and storage of cardiotocograms were studied. In 72 per cent of cases there was no security of traces, in 19 per cent the traces were free in the notes, and in 11 per cent the traces were incomplete. In 33 per cent of cases, the traces were not stored in the relevant case notes. In 14 per cent there was complete loss of a cardiotocographic trace relevant to an important event during labour. A new method of storage, cardiotocogram storage system (CASS), was tested in a clinical trial. After its use in 300 case notes the thickness of cardiotocograms fell from a mean of 8 mm to 4 mm. Timed searches for important traces fell from a mean of 91 seconds to a mean of 21 seconds. These findings have important economic and medicolegal implications. The trial of the new storage method, CASS, appears to work well. We recommend it for use in obstetric units.

ISSN:1340-9654    

DOI:10.3109/01443619409027618

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryIn this review of 46 patients with repeated cervical circlage operations, 29 (63 per cent) had cervical defects. The defects ranged from simple unilateral cervical lip laceration to annular (complete) amputation of the cervix. Post-circlage cervical defects were more prevalent with an increasing number of circlage operations. Cervical defects were associated with previous suture removal in labour as well as with previous preterm labour and infection. Only eight patients (28 per cent) had plastic reconstruction of the cervical defect before the next pregnancy. The aetiology, prevention and management of post-circlage cervical defects are discussed.

ISSN:1340-9654    

DOI:10.3109/01443619409027619

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryA study has been made of pregnancy in 711 patients with proved gynaecological tuberculosis investigated between 1 January 1951 and 1 October 1993. There were in all 95 pregnancies in 57 patients, 43 viable including two neonatal deaths, 31 ectopics and 21 spontaneous abortions. The best results were obtained in patients treated with rifampicin, ethambutol and isoniazid for 12 months and in those receiving streptomycin, PAS (aminosalicylic acid) and isoniazid for 18 months or 2 years.

ISSN:1340-9654    

DOI:10.3109/01443619409027620

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryMarfan's syndrome is a connective tissue disorder with autosomal dominant inheritance. Death from the disorder is most commonly due to a cardiovascular complication—aortic dissection or heart failure secondary to valvular insufficiency. Sufferers are at an increased risk of complications during pregnancy necessitating close fetal and maternal surveillance by a multidisciplinary team including obstetrician, cardiologist and geneticist. We report the reproductive performance of two generations of women with Marfan's syndrome, highlighting the importance of careful genetic and clinical screening in optimising their care, and our views on the management challenges which this syndrome poses.

ISSN:1340-9654    

DOI:10.3109/01443619409027621

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryEclampsia remains a problem worldwide in obstetric practice. Among 29 450 deliveries at the King Faisal University Teaching Hospital, Al-Khobar, Saudi Arabia, between June 1982 and May 1993, there were 50 singleton pregnancies with eclampsia, giving an incidence of 1 in 589 deliveries (0.17 per cent). Twenty-four patients had antepartum eclampsia; 19 had intrapartum and seven had postpartum fits. The efficacy of two treatment regimens used to control eclamptic fits, diazepam and magnesium sulphate, was studied. None of the mothers with eclampsia died but 10 of the 50 babies were lost, giving a perinatal mortality rate of 200/1000. The perinatal deaths were mainly associated with prematurity and intra-uterine growth retardation. There was no difference in maternal morbidity and perinatal mortality between the two treatment groups. Active obstetric intervention as opposed to conservative management improves both the maternal and perinatal outcome in eclampsia.

ISSN:1340-9654    

DOI:10.3109/01443619409027622

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryThe effect of forceps delivery on residual bladder volume after delivery was investigated by real-time ultrasonography. Twenty-six women with Haig-Ferguson forceps deliveries were compared with 52 controls with normal deliveries, all with epidural analgesia. Twenty-five women with Kielland's forceps deliveries were compared with 50 controls. Twenty-one women with Haig-Ferguson forceps deliveries using pudendal block were compared with 22 women with epidural analgesia and the same mode of delivery. Haig-Ferguson forceps delivery and epidural analgesia were not found to be associated with associated with larger residual bladder volumes when compared with controls. Kielland's forceps delivery was associated with a higher residual bladder volume than in controls, even after adjustment for the effect of the duration of maternal pushing in the second stage of labour. Of 43 women with residual bladder volumes<50 ml, no long-term bladder dysfunction was noted and only three women had urinary tract infections. Indwelling urinary catheters are unnecessary in women delivered with Haig-Ferguson forceps but are indicated in those delivered with Kielland's forceps.

ISSN:1340-9654    

DOI:10.3109/01443619409027623

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryPatients with one previous caesarean section (n = 876) were studied. Labour occurred in 80.3 per cent, and 554 (78.7 per cent) had a vaginal delivery. The vaginal delivery rate was highest when labour started spontaneously. Of patients who had previously delivered vaginally, 89 per cent had a vaginal delivery. When the previous caesarean section was for disproportion or failure to progress successful vaginal deliveries were less (65 per cent). There were 5 scar dehiscences or ruptures, 0.7 per cent of those allowed to labour.

ISSN:1340-9654    

DOI:10.3109/01443619409027624

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryA retrospective study was designed to assess the obstetric outcome in relation to oxytocin induction of labour in women with pre-labour spontaneous rupture of membranes at term, with particular reference to those women with a previous caesarean section. All five women who had had one previous caesarean section required an emergency caesarean section for failure to progress when labour was induced using oxytocin while only one out of 12 had emergency caesarean sections for failure to progress when labour started spontaneously and oxytocin was not required (P<0.001). In women who had had no previous caesarean section, the prevalence of emergency caesarean section for failure to progress was 14 per cent when labour was induced using oxytocin and 4 per cent in cases of spontaneous onset of labour where oxytocin was not used (P<0.05). It appears that oxytocin labour induction in cases of pre-labour spontaneous rupture of membranes and in particular in women with one previous caesarean section is associated with an increased likelihood of emergency caesarean section for failure to progress. When spontaneous onset of labour is awaited there is a higher rate of vaginal delivery. A random allocation prospective trial is needed.

ISSN:1340-9654    

DOI:10.3109/01443619409027625

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY

摘要:

SummaryCongenital abnormalities are the leading cause of perinatal and late neonatal mortality at the National Guard King Khalid Hospital in Saudi Arabia. This paper analyses the lethal congenital abnormalities that caused perinatal and late neonatal deaths during the seven years from 1987 to 1993. A total of 119 (103 perinatal and 16 late neonatal) deaths had lethal congenital abnormalities during the 7 years, including two sets of twins. The commonest congenital abnormalities affected the central nervous system (32 per cent) followed by abnormalities in the cardiovascular system (13 per cent) and the renal system (11 per cent).

ISSN:1340-9654    

DOI:10.3109/01443619409027626

出版商:Taylor&Francis    

年代:1994

数据来源: WILEY