摘要:

There was a steady increase in the yearly cesarean delivery rate, from 14.0 to 24.8%, between July 1, 1978 and June 30, 1986 at Duke University Medical Center; this was associated predominantly with an increase in the rate of primary cesarean deliveries. The three most frequent major diagnoses associated with primary cesarean delivery changed significantly over the study period. Fetal compromise became the most commonly associated diagnosis (from third), dystocia second (from first), and maternal disease third (from second). The categories of fetal positional abnormalities (fourth), abnormalities of placentation (fifth), and multiple pregnancy (sixth) did not change in rank. Primary cesarean delivery patients were compared with patients who delivered vaginally using odds ratios, prevalence, and population- attributable fractions. The risk factors of nulliparity, gestational age less than 37 weeks, late decelerations, and referral had the largest impact on the primary cesarean rate. Decreases in rates related to an increased tolerance of abnormalities of labor were overshadowed by the effects of increased concerns related to fetal health.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Hyperemesis gravidarum is a complication of pregnancy that can lead to severe maternal nutritional deprivation. Total parenteral nutrition has been used in pregnancy complicated by hyperemesis gravidarum. However, little has been done to study the nutritional aspects of hyperemesis or the maternal effects of total parenteral nutrition when given during the first trimester of pregnancy. The purpose of this study was to examine the nutritional state of pregnancy complicated by hyperemesis gravidarum and the effects of total parenteral nutrition on maternal nutrition and fetal outcome when given during the first trimester of pregnancy. Using a standard method of indirect calorimetry, the basal metabolic expenditure and adjusted metabolic expenditure were determined, and appropriate calories were calculated for each patient. The patients were then started on total parenteral nutrition. Follow-up indirect calorimetry studies showed improved nutritional status, with return of anabolic parameters. The results of this study support the conclusion that total parenteral nutrition given during the first trimester is a safe and effective method of nutritional support.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Hypothyroidism rarely complicates pregnancy because most affected women are anovulatory. In this report, we describe 28 complicated pregnancies cared for over a ten-year period at Parkland Memorial Hospital. In the group of 16 pregnancies in 14 overtly hypothyroid women, maternal complications were common and included anemia (31%), preeclampsia (44%), placental abruption (19%), postpartum hemorrhage (19%), and cardiac dysfunction. Perinatal morbidity and mortality were also high mainly because of placental abruption, and reflected frequent low birth weight (31%) and fetal death (12%). In a group of 12 women with subclinical hypothyroidism, these complications were less impressive. We speculate that overt thyroid deficiency is associated with adverse pregnancy outcome related to preeclampsia and placental abruption. Thyroxine replacement probably improves these outcomes even if subclinical hypothyroidism persists.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Aortic stenosis is uncommon during pregnancy. Five cases are described in which clinical management was facilitated by the use of Doppler echocardiography to assess the severity of disease and pulmonary artery catheterization to manage maternal hemodynamics. Regional anesthesia was used without complication. In patients with severe stenosis, significant morbidity and mortality were experienced when aortic valve replacement was delayed beyond the postpartum period.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The current literature was reviewed to evaluate the Apgar score as a diagnostic test for the presence of asphyxia. Several studies were examined and the sensitivity, specificity, and predictive values of the Apgar scores calculated. Using an umbilical cord arterial pH below 7.2 as evidence of asphyxia, the one-minute Apgar score showed poor sensitivity as a marker of asphyxia. Therefore, we discourage reference to the term “asphyxia” when Apgar scores alone are used as supportive evidence.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Levels of five antibiotics used in treating chorioamnionitis were measured in maternal and cord blood and placenta. Ampicillin provided the highest ratio of cord to maternal blood (0.71). Gentamicin was also relatively high in this respect and also had the highest placenta to maternal blood ratio (3.97). Based on these findings, the commonly used combination of ampicillin and gentamicin seems appropriate, although additional anaerobic coverage may be needed.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A critical aspect of any residency is the process of selection and evaluation. However, the research literature has failed to provide an adequate behavioral specification of performance components to assist in selection and evaluation decisions. In this investigation, we applied a widely accepted method of job analysis from personnel psychology, the critical incident technique, to define those behaviors and attitudes necessary for successful resident performance in obstetrics and gynecology. Nine mutually exclusive categories of behavior were identified, including conscientiousness, recognition of limits, confidence in skills and training, ability to handle crisis/emergency situations, integration of knowledge with practice, technical skills, relationships with staff, relationships with patients, and ethical actions. These categories appear to be reliable, as physician raters were able to sort incidents into appropriate categories with 94% reliability. Identification of these categories represents a beginning step toward determining necessary aspects of performance in a structured and replicable manner and toward defining these performance aspects in a manner that allows precise and reliable measurement.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The current malpractice situation exists for the following reasons: 1) society's belief that all wrongs must have a reason and that the wrong must be put right, 2) the pervasive lottery mentality, 3) the inability of many individuals to accept responsibility for themselves or their actions, and 4) an increasing incidence of true medical negligence. The physician who gives careful detail to practice style, who constantly attempts to upgrade his skills and knowledge, and who prepares himself when involved in the inevitable legal quagmire will survive during this difficult time to practice the healing arts.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Recent reports have suggested that patient-controlled analgesia is an effective means of narcotic administration in postoperative patients. This prospective investigation was undertaken to determine the efficacy and safety of patientcontrolled anesthesia infusion after cesarean section. During a recent ten-month period, 130 patients were assigned randomly to receive meperidine by pump or intramuscular injection. Meperidine consumption using the device varied widely to meet individual needs. Overdosage and drug dependence were not encountered with the prescribed drug concentrations. The patient-controlled analgesia method provided less sedation and more immediate pain relief without the need for painful injections. The additional cost of renting the infuser device was offset by combined patient and nursing satisfaction. We conclude that patientcontrolled infusion of meperidine is safe and effective in satisfying individual patient needs after cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:1988

数据来源: OVID