College Of Obstetricians Research Articles

The world of womenWellbeing of Women: The Complete Guide to Women's Health Produced in conjunction with the Royal College of Obstetricians and Gynaecologists WellBeing £7.95 plus £2.50 195pp 0-9526596-0-3 0952659603

The world of womenWellbeing of Women: The Complete Guide to Women's Health Produced in conjunction with the Royal College of Obstetricians and Gynaecologists WellBeing £7.95 plus £2.50 195pp 0-9526596-0-3 0952659603

Progress toward a united body — the European Board and College of Obstetrics and Gynaecology (EBCOG): A letter from the president of ECOG to national societies

Progress toward a united body — the European Board and College of Obstetrics and Gynaecology (EBCOG): A letter from the president of ECOG to national societies

Immunological investigation of late intra—uterine death: a survey of current practice in the United Kingdom

SummaryThe aim of this study was to determine the pattern of investigation for maternal immune disorder after late fetal death. We undertook a survey, by questionnaire, of all the Royal College of Obstetricians and Gynaecologists (R.C.0.G.) district tutors in the United Kingdom. There was a 91.6 per cent response rate. Sixty—nine per cent of units wed written guidelines as suggested by the R.C.O.G. Only 33 per cent of units routinely assay for anticardiolipin antibodies. Antibodies to extractable nuclear antigens (anti—Ro and anti—La) were requested by 8 per cent of units and allo—immune anti—platelet antibodies by I per cent. The most commonly performed investigation was assay of antinuclear antibodies (43 per cent). Routine assays for anti—neutrophil cytopiasin antibodies were performed by 4 per cent of units. rheumatoid factor by 12 per cent and C1 esterase inhibitor by 3 per cent. One—third of units undertook no routine investigations at all. Research—based evidence suggests that. after late fetal dea...

Primary Care in Transition-Reply

In Reply. —Dr Harer's letter, sent on behalf of the American College of Obstetricians and Gynecologists, is a disappointment to those who are seriously interested in the future of nonprocedural primary care. Little has changed since Pearson 1 first put forth the OBG agenda two decades ago. The contemporaneous response seems just as tangential now. 2 The reason for proposing separate budgets and a separate fee schedule for primary care and for limiting the definition of the primary care specialties to internal medicine, pediatrics, and family practice lies precisely in the posture of transitional specialists who seem to favor considering themselves as primary care physicians in the sense of being first-contact professionals, but who eschew any significant involvement in the details of managing the care of many of the diseases that characterize the everyday practice of most primary care physicians. For example, when have gynecologists evaluated chest pain? How many

New President of the Royal College of Obstetricians and Gynaecologists

New President of the Royal College of Obstetricians and Gynaecologists

Barriers to prevention of perinatal group B streptococcal disease

During 1992 the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) issued statements on prevention of group B streptococcal (GBS) disease. To assess prevention practices and identify barriers to preventing GBS disease, we surveyed obstetricians, family practitioners and general practitioners in Georgia during 1993. A standard questionnaire was mailed to 1190 clinicians in August and to nonresponders again in September. Of 436 (38%) physicians who responded, 192 (44%) provided obstetric care. Among these 192 obstetric care providers, 121 (63%) screened patients for GBS carriage antenatally. The most frequently cited reasons for not screening were "no clear guidelines" and "not cost-effective" (52 and 39%, respectively). Clinicians who screened patients were significantly more likely to believe that screening was cost-effective (P = 0.05). Of obstetric care providers who screened, only 9% obtained specimens using culture sites recommended by ACOG or AAP. Although most clinicians were aware that antenatal antibiotic treatment of carriers does not prevent perinatal GBS disease, 64% of those who screened reported that they gave oral antibiotics when carriage was detected during pregnancy. Of clinicians who reported using obstetric risk factors to guide prophylaxis choices, < 15% reported using intrapartum antibiotics for the conditions identified in the ACOG and AAP statements as those that suggest the need for prophylaxis when screening is not performed. Many Georgia obstetric care providers do not use effective practices to prevent perinatal GBS disease. Education on appropriate culture methods, obstetric risk factors and the cost effectiveness of prevention strategies might lead to more effective preventive practices.

Ethics in Obstetrics and Gynaecology

Ed Susan Bewley, R Humphry Ward RCOG Press, pounds sterling35, pp 364 ISBN 0 902331 69 8 The front line role of obstetricians and gynaecologists in dealing with the major ethical flashpoints in medicine makes it vital that the ethical basis for good practice be given a high priority by the Royal College of Obstetricians and Gynaecologists, publishers of Ethics in Obstetrics and Gynaecology. Gordon Dunstan outlines what is needed for consistent translation of moral theory into practical judgments. At the clinical level (which must include the conduct of research) he asserts that “it concerns judgement, choices and decisions taken within certain governing relationships.” …

The yearbook of the Royal College of Obstetricians and Gynaecologists, 1994

The yearbook of the Royal College of Obstetricians and Gynaecologists, 1994

Ethics in obstetrics and gynaecology edited by S. Bewley and R. H. Ward Published by The Royal College of Obstetricians and Gynaecologists, London, 1994 380pp

Ethics in obstetrics and gynaecology edited by S. Bewley and R. H. Ward Published by The Royal College of Obstetricians and Gynaecologists, London, 1994 380pp

Cervical Ripening in Women With Previous Cesarean Deliveries

Objective: To evaluate the safety and efficacy of preinduction cervical ripening in women with previous cesarean deliveries undergoing induction of labor. Methods: Retrospective study of women with previous low transverse cesarean deliveries who underwent ripening of an unfavorable cervix prior to induction of labor (n = 89). Multiparas without previous cesarean deliveries undergoing ripening and induction of labor during the same time period were used for comparison (n = 61). Ripening was performed with prostaglandin E2 (PGE2) gel, or an osmotic dilator, or both. Induction of labor with oxytocin followed the American College of Obstetricians and Gynecologists' guidelines. Outcome data were analyzed using the unpaired Student's t-test or χ2-test as appropriate. Significance was established at P < 0.05. Results: The mean gestational age was 39.6 ± 2.6 and 38.2 ± 2.9 weeks for the study and comparison groups, respectively. There were no differences between the groups in Bishop score, duration of the first stage of labor, maximum dose of oxytocin, indications for cesarean delivery, puerperal morbidity, birthweight, Apgar scores or NICU admissions. Sixty-four percent (57 of 89) of study women delivered vaginally compared with 82% (50 of 61) of women in the comparison group (P < 0.03). The data were analyzed separately for those women undergoing cervical ripening with PGE2 gel only. No differences were observed between the groups in any of the categories mentioned above. Conclusion: Cervical ripening appears to be safe and effective in women with previous low transverse cesarean deliveries undergoing induction of labor with an unfavorable cervix.

Papers presented at the Royal College of Obstetricians and Gynaecologists, London, 29 October 1994

Papers presented at the Royal College of Obstetricians and Gynaecologists, London, 29 October 1994

Professional and Managerial Aspects of Clinical Audit

Ed Anthony Hopkins Royal College of Physicians, £14, pp 148 ISBN 1 873 240 77 5 When a subject is rapidly changing, a book based on a conference can be a good way of defining the “state of the art.” This is very much what Professional and Managerial Aspects of Clinical Audit does, and successive sections provide the current views on audit of purchasers and providers, the nine royal colleges, information technologists, and managers. The picture is comprehensive and clear—and depressing. If this is the offering of the best, what hope for the rest of us? Lack of direction and vision permeates the pages. The Royal College of Obstetricians and Gynaecologists has as one main function “to suggest …

Spread of maternal HIV infection in Scotland from 1990 to 1992.

In Scotland since January 1990, unlinked anonymous testing of Guthrie cards has documented maternal HIV-1 antibody in neonatal blood. District postcode and quarter year of birth determined prevalence and spread of infection. The Fujirebio particle agglutination assay screened for HIV-1 antibody, with confirmation by ELISA and full western blotting. Births to known HIV infected women were reported to the Royal College of Obstetricians and Gynaecologists. 0.3/1000 childbearing women were infected with HIV-1 with no significant increase from 1990 to 1992. Spread of infection from 11 to 26 districts has occurred. In 1990, 74%(14/19) of HIV positive deliveries were known to obstetricians falling to 33%(7/21) in 1992. Spread of HIV-1 infection has occurred to mothers who live outside closely defined areas and who do not belong to recognised high risk groups. In Scotland, two thirds of mothers and their infants will not receive early prophylactic care for their HIV disease.

Routine ultrasound screening

In the USA, the cost-effective use of health-care dollars is currently of great importance. The routine use of technology such as ultrasound will undergo great scrutiny. Both the American College of Obstetricians and Gynecologists and the US National Institutes of Health have recommended that ultrasound be used only for indicated reasons because of concerns about safety and efficacy.

Papers presented at the Royal College of Obstetricians and Gynaecologists, London, 4 March 1994

Papers presented at the Royal College of Obstetricians and Gynaecologists, London, 4 March 1994

Training in obstetrics and gynaecology in Europe: A Joint Meeting of the Royal College of Obstetricians and Gynaecologists and the European College of Obstetrics and Gynaecology

Training in obstetrics and gynaecology in Europe: A Joint Meeting of the Royal College of Obstetricians and Gynaecologists and the European College of Obstetrics and Gynaecology

Royal colleges produce evidence of reduced activity

Medical royal colleges have reported to the secretary of state for health and the chief medical officer examples of pressure to reduce activities. Last year Mrs Bottomley asked for hard data rather than anecdotal evidence on the effects of the NHS contractual arrangements on clinical activity. Several colleges have conducted surveys of the work patterns of their consultants during the past year and the results were presented to the Joint Consultants Committee last week. The Royal College of Surgeons had a 75% response from a survey of over 230 surgical tutors. In the eight months from April to November 1993, 44% of surgical divisions were told to reduce or stop some activity. This compares with a reduction to 62% that emerged from the previous year's survey after 10 months. Most of the reduction in activity was related to cold admissions and cold surgery but some units had been told to reduce the number of outpatients and investigations. Fifty seven general surgical units and 45 orthopaedic and trauma units had been told to deal only or selectively with general practice fundholders. Twenty seven general surgical units had been told to deal with non-urgent waiting list cases regardless of clinical priorities. The college found that waiting lists had increased in 98 general surgical and in 68 orthopaedic and trauma units. The Royal College of Obstetricians and Gynaecologists had a 79% response rate from questionnaires sent to over 260 district tutors. Seventy five hospitals reported that waiting lists for gynaecological admissions had increased, 68 that the number of beds had been reduced or wards closed, and 50 that the patients of fundholders were given priority. The Royal College of Ophthalmologists surveyed 160 units and there was a 71% response. More units reported a reduction in clinical activity in the six months from April …

Do the Poor Sue More?

To the Editor. —Recently, Burstin et al 1 studied liability claims rates for medical malpractice among the poor and reported that indigent and elderly patients sue at rates one-fifth to one-tenth that of higher socioeconomic groups. While preparing a recent study on risk prevention related to medical malpractice in breast cancer, 2 I noted a similar effect specifically related to this disease. I write to corroborate the general findings of Burstin et al in the specific area of breast cancer malpractice litigation. Data are derived from three surveys of the professional liability claims experience of the American College of Obstetricians and Gynecologists (ACOG) during the years 1987, 1990, and 1992. 3 About 2000 members, or 10% of ACOG's membership, voluntarily responded to each year's survey. Tabulating the results from all three surveys, members reported 104 claims for breast cancer malpractice (largely failure to diagnose breast cancer) out of 1542 overall

Female genital mutilation (female circumcision)

Female genital mutilation is a more appropriate name for female circumcision. About 18 million females in more than 30 countries have undergone genital mutilation. Most of these women are from Africa the Middle East and Southeast Asia. Pharaonic circumcision is the most extensive form. It occurs between 12 months and puberty. It involves removal of the clitoris and the labia minora and majora and closing the opposing sides by either suturing them together or binding the legs together. A small opening for urination and menstruation is left. Sunna circumcision leaves the clitoris but the vaginal opening and the clitoris are covered by sewing the labia together. A third form involves the removal of the clitoris. Nonmedical people who tend to use unsterilized objects usually perform female genital mutilation. Mutilation generally results in complications such as infection recurrent cystitis recurrent vaginitis chronic pelvic inflammatory disease and mental trauma. The girls suffer pain. Subsequent hemorrhage and infection may kill them. Nonmedical problems include sexual dysfunction and marital strife. Neither the Bible nor the Koran support female genital mutilation yet many people claim that it is a religious practice. It has been incorporated into the culture because a girls mother grandmother and other female relatives have had to undergo it and many think it makes girls pure. In 1985 the UK Parliament passed the Prohibition of Female Circumcision Act which calls for female genital mutilators to be either fined or imprisoned. A woman who has given birth or her family may put pressure on an obstetrician to reinfibulate that woman. The surgeon should do only the least amount of reparative surgery to allow the labia to heal and to leave the vagina opening intact. Laws are not enough to prevent female genital mutilation. Education for women men mothers husbands community leaders and communities is also needed. A Royal College of Obstetricians and gynaecologists statement support groups condemning female mutilation.

Consultants face compulsory education

Consultant obstetricians and gynaecologists in Britain will have to continue their medical education, said the Royal College of Obstetricians and Gynaecologists last week. This will be the first time that continuing medical education has been made compulsory in Britain. From this month each consultant member of the college will have to enter a programme of continuing medical education and register a minimum of 200 credits over five years. These will be earned from a range of educational …