摘要:

ObjectiveTo describe patient-obstetrician communication during the first prenatal visit and its relationship to physician gender and patient satisfaction.MethodsThe first prenatal visit of 87 women with 21 obstetricians (11 male and ten female) was audiotaped and analyzed using the Roter Interaction Analysis System. Patient satisfaction was measured by postvisit questionnaire.ResultsCommunication during first prenatal visits was largely biomedical, with little psychosocial or social discussion. Male physicians conducted longer visits than females (26 minutes versus 21.9 minutes,P< .05) and engaged in more facilitative communication (ie, making sure they were understood and providing direction and orientation) and explicit statements of concern and partnership (z> 1.96,P< .05). Female physicians devoted more communication to agreements, disagreements, and laughter than males (z> 1.96,P< .05). Satisfaction with physicians' emotional responsiveness and informational partnership was related to female physician gender and a variety of task-focused and affective communication variables.ConclusionCommunication and satisfaction between women and obstetricians during initial prenatal visits is related to physician gender and patient satisfaction. Male physicians conducted longer visits but women were more satisfied with female physicians.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo investigate obstetricians' genetic knowledge base and practice trends.MethodsA questionnaire survey was sent to 1003 ACOG Fellows, 554 (55%) of whom responded. Results from the 446 respondents practicing obstetrics are reported.ResultsThe majority of obstetricians surveyed (85.6%) reported completing standardized genetic-history forms for prenatal patients, and about half (48%) performed their own invasive diagnostic procedures. Most (87%) had access to genetic counselors. For aneuploidy risks associated with advanced maternal age, up to 69% of respondents provided at least some patient counseling in their offices. Physician knowledge of risk assessment and diagnostic testing in the areas of aneuploidy and neural tube defects was very good; however, for single-gene disorders such as cystic fibrosis, Tay-Sachs disease, and sickle cell disease, correct risk assessment or appropriate test selection presented difficulties for at least half of the respondents. Respondents cited the rapidity of changes in genetic testing as the greatest obstacle to providing genetic information to patients.ConclusionObstetricians' knowledge of inheritance and test selection pertaining to single-gene disorders was more limited than that for aneuploidy and neural tube defects. Comparable deficits were noted in patient-education efforts for single-gene disorders.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectivesTo assess the ability of obstetricians to recognize parturients at risk for difficult intubation and to examine the effect of education in airway examination on that ability.MethodsThe airways of 160 parturients were examined by four physicians: one attending and one resident obstetrician, and one attending and one resident anesthesiologist. After each airway examination, the physicians completed questionnaires about possible difficult intubation, use of antepartum consultation, and choice of analgesia early in labor.ResultsInstruction in airway examination did not affect obstetricians' ability to assess airways. Compared with the attending anesthesiologist's opinion, the sensitivity and specificity of the attending obstetrician before instruction were 0.59 and 0.82, respectively, and for the obstetric resident, 0.41 and 0.89, respectively. After instruction, the sensitivity and specificity for the obstetric attending physician were 0.60 and 0.83, respectively and for the obstetric resident, 0.50 and 0.87, respectively. In airways judged possible difficult intubations by the obstetricians, instruction did not affect the use of antepartum consultation or early epidural analgesia by the residents. In the obstetric attending physicians there was a significant increase in use of early epidural analgesia.ConclusionAlthough instruction in airway examination did not affect obstetricians' ability to predict difficult airways, it did affect treatment of labor analgesia.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo estimate the community prevalence in Olmsted County, Minnesota of elevated scores on the Edinburgh Postnatal Depression Scale, a self-report screening tool for postpartum depression.MethodsAt the 6-week postpartum visit, the Edinburgh Postnatal Depression Scale was administered to women who gave birth in Olmsted County between July 28, 1997 and March 28, 1998. Study sites included all ambulatory clinics that provide pregnancy care in the county, and women who missed postpartum visits were contacted by mail. A threshold of 12 or more points on the scale was selected for clinical use; data for scores of ten and above were also examined.ResultsOf the 909 Olmsted County women studied (response rate 83.2%), 11.4% (n= 104) had scores of 12 or greater, with a 95% confidence interval (CI) of 9.4%, 13.5%. The percentage of women with a positive screen increased to 19.8% (n= 180; 95% CI 17.2%, 22.4%) when scores of 10 or higher were included, as has been recommended for screening in primary care settings. Forty-eight or 5.3% of the subjects (95% CI 3.8%, 6.7%) indicated experiencing suicidal ideation during the previous week.ConclusionMore than 11% of women had elevated scores on the Edinburgh Postnatal Depression Scale, indicating a high likelihood of postpartum depression and the need for further assessment. The screening process required little extra time and was acceptable to the subjects and clinicians. Screening for postpartum depression is appropriate and feasible for clinical practice and increases the identification of women suffering from this serious, common, and highly treatable disorder.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether the rate of human cytomegalovirus transmission in utero is related to the gestational age at the time of maternal infection.MethodsOne hundred twenty-three pregnant women followed in our units between 1988 and 1998 were studied retrospectively. Each had developed a primary infection with cytomegalovirus evidenced by a seroconversion, confirmed by specific enzyme immunoassays. Infants were diagnosed by urine culture.ResultsRegardless of gestational age at the time of maternal cytomegalovirus seroconversion, the mean rate of intrauterine transmission was 57.5%. There was a statistically significant difference between early seroconversion (during the first trimester) and late seroconversion (during the third trimester) (36.0% versus 77.6%;P< .001). The risk of transmission calculated for seroconversion during the second trimester was intermediate (44.9%).ConclusionA statistically significant difference in the rate of intrauterine cytomegalovirus transmission was observed according to the duration of pregnancy at which primary infection occurred. The rate of transmission increased with gestational age.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes.MethodsWe used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women's physical violence during pregnancy were based on self-reports of “partner-inflicted physical hurt and being involved in a physical fight.” Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes.ResultsThe prevalence of physical violence was 11.1%. Among women who experienced physical violence, 54% reported having been involved in physical fights only and 46% had been hurt by husbands or partners. In the latter group, 70% also reported having been involved in fighting. Compared with those not reporting physical violence, women who did were more likely to deliver by cesarean and be hospitalized before delivery for maternal complications such as kidney infection, premature labor, and trauma due to falls or blows to the abdomen.ConclusionPhysical violence during the 12 months before delivery is common and is associated with adverse maternal conditions. The findings support the need for research on how to screen for physical violence early in pregnancy and to prevent its consequences.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the efficacy of managing pregnancies complicated by anti-Kell isoimmunization using the methods developed for evaluating anti–Rh-D isoimmunization.MethodsWe reviewed 156 anti-Kell-positive pregnancies seen from 1959 to 1995, which were managed with serial maternal titers, amniotic fluid ΔOD450determination, and funipuncture. Data on maternal titers, paternal phenotypes, invasive fetal testing and therapies, and neonatal outcomes were collected and analyzed to determine whether severely affected pregnancies were identified in time for successful fetal and neonatal therapy.ResultsTwenty-one fetuses were affected, eight with severe disease, and two fetuses in this group died. All of the severely affected fetuses were associated with maternal serum titers of at least 1:32. A critical titer of 1:32 was found to be 100% sensitive for identifying the affected pregnancies. The affected group had significantly higher amniotic fluid ΔOD450values over the range of gestational ages than did the unaffected group (P< .001). The upper Liley curve was a specific discriminator for the diagnosis of affected fetuses, and the lower curve was specific for the diagnosis of unaffected or mild cases.ConclusionFetal anemia due to anti-Kell isoimmunization might be due in part to erythropoietic suppression, but it is still largely a hemolytic process. The methods based on a hemolytic process, including use of a critical maternal serum titer of 1:32, serial amniotic fluid analyses when the titer was exceeded, and liberal use of funipuncture, were successful in identifying severely affected fetuses.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo expand on prior investigations and further evaluate the fetal risk associated with vaginal birth after cesarean (VBAC) by examining the incidence not only of a depressed Apgar score at 5 minutes but also of fetal acidemia.MethodsBetween January 1, 1991, and December 31, 1996, the following groups of patients who delivered a singleton fetus with birth weight greater than 750 g were identified: 2082 patients with one or more prior cesarean deliveries who were allowed a trial of labor, 1677 of whom delivered vaginally and 405 of whom delivered by repeat cesarean; 920 patients delivered by elective repeat cesarean; 22,863 patients without a prior cesarean who delivered vaginally; and 2432 patients delivered by primary cesarean after laboring. Umbilical cord arterial blood gases were obtained in 88.3% of these deliveries. Comparisons of Apgar scores at 5 minutes and umbilical cord arterial pH measurements were made between groups with χ2or Fisher exact test, and odds ratios (ORs) were calculated.ResultsThe only significant differences were noted between those patients who delivered vaginally after a prior cesarean and those patients who delivered vaginally without a prior cesarean. Neonates in the successful VBAC group were more likely to have an Apgar score at 5 minutes less than 7 (OR 1.52) or an umbilical arterial pH less than 7.1 (OR 1.69). Those neonates, however, were not at greater risk for an Apgar score less than 4 or a pH less than 7.0.ConclusionOur experience suggests that VBAC poses a low level of fetal risk, although a much larger sample size would be required to exclude a two-fold increase in potentially damaging fetal acidemia.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the influence of active maternal smoking on fetal amino acid and enzyme levels in early pregnancy.MethodsThe concentrations of 23 free amino acids and total protein, and the activity levels of four enzymes were measured in samples of maternal and fetal plasma from nine nonsmokers who were not exposed to tobacco smoke and nine long-term, heavy smokers matched for gestational age. To determine fetal exposure to smoking, cotinine levels were measured in maternal and fetal plasma and fetal liver samples from both groups. The pregnancies were between 12 and 17 weeks' gestation.ResultsIn women who smoke, the median cotinine concentrations were 156 mg/mL in maternal plasma and 89 ng/mL in fetal plasma, but only one fetal liver sample contained detectable cotinine. Significantly lower concentrations of serine, proline, &agr;-aminobutyric acid, leucine, and arginine were found in smokers compared with nonsmokers, with the lowest in arginine. Fetal plasma amylase activity was significantly higher in smokers than controls. There were no differences in concentrations of other amino acids or activity levels of other enzymes in the two groups.ConclusionMaternal smoking affected placental and fetal protein metabolism and enzyme activity from at least 12 weeks' gestation. That finding indicates that high levels of tobacco exposure in the first trimester might cause irreversible changes in the cellular functions of the villous trophoblastic barrier.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the relationship between intra-amniotic bleeding and fetal echogenic bowel.MethodsComprehensive fetal ultrasound examinations were done before and 12 hours after fetal transfusions. Follow-up ultrasound examinations were done weekly in 28 fetuses with intra-amniotic bleeding. Hyperechogenic bowel was diagnosed when the echogenicity of fetal bowel was similar to that of bone. Postpuncture bleeding was identified when a stream of echogenic material from the cord into the amniotic space was seen, lasting at least 60 seconds.ResultsNone of the fetuses had echogenic bowel before initial transfusions. Intra-amniotic bleeding was followed by bowel echogenicity in seven of 28 fetuses within the first 12 hours after bleeding episodes. Echogenic bowel remained in five fetuses 2 weeks after the bleeding episodes. In three fetuses, echogenic bowel was still seen 4 weeks later.ConclusionIntra-amniotic bleeding can lead to echogenic bowel.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID