Contemporary Obstetrics Research Articles

CONCEPTOS EN TORNO A LA INFORMÁTICA EN OBSTETRICIA

SUMMARY Contemporary obstetrics must rely on the suitable use of information to permanently assess the effectiveness and quality of its interventions. The vertiginous advances in the last quarter of the century, and the consolidation of the feto-maternal specialization, have forced the physicians to work with multiple biological variables based on maintaining a permanent vision of the fetal-maternal relationship through time. The necessity of using a multi-variate linear analysis makes the strategic of incorporating software tools a big advantage for researches and clinicians. Furthermore, there are clear advantages over the arrangement, comparison and analysis of information, in order to achieve an adequate planning and execution of effective actions, thus reducing the costs and optimizing resources. The aim of this study is to describe the evolution and current concepts and state of the art in computer science applying to feto-maternal area. In addition, this review take into account the basic concepts and recommendations on the handling of digital information.

From Concept to Practice: The Recent History of Preterm Delivery Prevention. Part I: Cervical Competence

The prevention of preterm delivery (PTD) is a major desiderate in contemporary obstetrics and a societal necessity. The means to achieve this goal remain elusive, and the research efforts have been punctuated by several ineffective intervention proposals. More recently, new areas of proposed preventive strategy have arisen, focusing on cervical competence, subclinical infection, and hormonal effects. This review, based on a comprehensive and unbiased review of the available literature, will address the rationale and current status of these new concepts of significant clinical interest. We will describe the microcosm of thought and research dedicated to the prevention of PTD during the last 10 years, and the arduous efforts to establish a linkage between predictive observations and therapeutic hypotheses. In its first part, the review will discuss the recently emerging view that regardless of the preterm labor etiology, a common pathway is eventually reached, reflected in cervical changes. The new concept of functional cervical insufficiency is addressed from the perspective of cervical assessment by ultrasound. Although the existing research has not accurately quantified yet the usefulness of ultrasound cervical examination, the technique has become commonplace. Several recent studies have demonstrated a continuum of risk between shorter cervix on ultrasound and higher rate of PTD, leading to the hypothetical argument that women with short cervix on ultrasound might benefit from cervical cerclage. Observational and randomized clinical trials of cerclage as a modality of pregnancy prolongation have provided conflicting results. The relative paucity of data and the conflicting nature of the available evidence dictate caution whenever decisions for cervical monitoring or intervention are made.

Tthe structure of uterine contractions anomalies in contemporary obstetrics: clinical and statistical aspects

The complex clinical end statistical analysis of features of current of labors in the period with 1994 for 2003 has shown, that in structure of anomalies of patrimonial activity there are authentic changes. Along with significant decrease of frequency of revealing of weakness of patrimonial activity and tendency to decrease of frequency of revealing notcoordinated of patrimonial activity frequency of revealing of fast and prompt labors essentially has increased. Diagnostics notcoordinated of patrimonial activity in the greatest degree is connected to preferences, erudition and experience of the doctor, than with real correlation of revealed attributes and symptoms specific of this pathology of labors. The precisely same attributes and symptoms are characteristic for some variants of weakness of patrimonial activity, that gives the basis to attribute both kinds of this pathology of labors to hypertonic dysfunction of uterus, in a basis of which development lays corporalcervical dyssinergia, instead of the pathology the driver of a rhythm, as it was considered earlier.

Contemporary Obstetrics and Gynaecology for Developing Countries

Contemporary Obstetrics and Gynaecology for Developing Countries

Response: public and private intervention rates in obstetric practice

TO THE EDITORS: Dodd and Robinson (2004) present a commentary on our recently published work (Shorten B & Shorten A 2004) which examines the trends in obstetric interventions within New South Wales (NSW) public and private hospitals from 1997-2001. We welcome discussion on this important issue which has both clinical and economic implications. They acknowledge that our emphasis on recent changes in subsidies for private health insurance adds a concerning new dimension to what is a well established debate regarding obstetric intervention rates in Australian private and public hospitals. Rather than being primarily a concern for the 'health funders', it has implications for all Australian taxpayers, who bear the opportunity costs associated with subsidising potentially ineffective, or even harmful, health care interventions or models of care at the expense of other worthy health care programs.In acknowledging that risks and benefits exist for all health care choices we must be cautious in recommending that as long as consumers are fully informed of the risks and benefits then it is acceptable to provide funding, ignoring the broader societal implications of such resource consumption. Therefore the need for transparency and accountability (Dodd & Robinson 2004, p. 11) within the private obstetric sector is both an economic and ethical imperative.One of the interesting contradictions in contemporary obstetrics is the use of the argument that consumer demand is a contributing factor behind the growing rate of birth intervention. However, practitioners simultaneously recommend funding of high quality research with the purpose of gaining better evidence upon which to base clinical practice. It is important for high quality evidence to be produced and disseminated, but the existence of that evidence alone will not address the current trend in obstetric interventions. Those who support the principles of evidence based practice will be aware of the challenges faced by those attempting to 'get evidence into practice'. The presence of evidence does not equate to evidence-based practice, and consumers are not necessarily aware of this. Further, the presumption that consumers are not well informed about the vitally important consequences of their health care choices is a central pillar underpinning extensive public regulation of, in particular, the health care professions. This provides further reason to be cautious in evaluating arguments relating to consumer choice as a factor in observed interventions and outcomes.If it is the case that most private obstetncians are also gynaecologists, and work in several settings; and ... non-clinical factors may have a greater impact on interventions than evidence from systematic reviews (Dodd & Robinson 2004, p. …

Book Review: Contemporary Obstetrics and Gynaecology for Developing Countries

Editors: Friday Okonofua and Kunle Odunsi Year of Publication: 2003 Page Extent: 683 + xix ISBN: 978-35481-1-5 (cased)

Fetal Scalp Blood Sampling—Limited Role in Contemporary Obstetric Practice: Part II

Fetal Scalp Blood Sampling—Limited Role in Contemporary Obstetric Practice: Part II

Fetal Scalp Blood Sampling--Limited Role in Contemporary Obstetric Practice: Part II

Fetal Scalp Blood Sampling--Limited Role in Contemporary Obstetric Practice: Part II

Fetal Scalp Blood Sampling—Limited Role in Contemporary Obstetric Practice: Part I

pH, if available, may be used to clarify acid-base status. ACOG also suggests, however, that technique, while occa- sionally helpful, is used uncommonly in current obstetric practice. 1 In this 2-part review, we will focus on intrapartum evaluation of fetal well being and critically examine the useful- ness of fetal scalp sampling (FSS) in com- parison to other available methods of intrapartum fetal assessment, including fetal scalp stimulation, vibroacoustic stim- ulation, fetal pulse oximetry, and scalp blood lactate concentration. We will also define those settings in which we believe the risk and/or expense of FSS evaluation is warranted.

Fetal Scalp Blood Sampling--Limited Role in Contemporary Obstetric Practice: Part I

Fetal Scalp Blood Sampling--Limited Role in Contemporary Obstetric Practice: Part I

Intensive treatment in observing pregnant women with Rh-isoimmunization

Diagnosis and treatment of hemolytic disease of fetus is one of the urgent problems of contemporary obstetrics. This article reveals the cause and pathophysiologic basis of its development. It shows steps in observing pregnant women with Rh-immunization, determines criteria of severity of hemolytic disease. One can find indications for intra-uterine transfusion of donor's erythrocytes.

Is the academic physician-scientist an oxymoron in contemporary obstetrics and gynecology?

Because of changes in health care reimbursement and decreasing federal funding, academic obstetrics and gynecology is at a pivotal point. Either the discipline can regress to the past, when the field and its practitioners were viewed negatively and failed to attract the academic upper echelons of medical students, or it can build on the immense gains it has made in recent years and develop a critical cadre of well-trained clinician-scientists who maintain the discipline at the leading edge of medicine and biology. Data from two programs in which extensive contemporary training in biomedical research is provided, the Reproductive Scientist Development Program and the American Association of Obstetricians and Gynecologists Foundation fellowship program, indicate that the superb physician-scientists in these programs are obtaining peer-reviewed funding in excess of 70%. Thus the risk of recruiting such individuals to academic faculties is small. More important, these individuals are the linchpins for an even more exciting future. The alternatives are unthinkable. (Am J Obstet Gynecol 1997;177:892-3)

The grand multipara

Grandmultiparity (GMP) has long been considered an obstetric complication for both mother and fetus, although recent studies indicate that, with proper perinatal care, wome with high-parity rates are no longer at high risk. The current study examines the outcome of delivery in 1700 women in their fifth or more delivery, as compared with two control groups: 622 primiparas and 735 multiparas (two to three previous deliveries). Excellent prenatal care was available free of charge to all parturients. Our objectives were to evaluate the management of GMP in contemporary obstetrics and to assess whether grand multiparas are still high-risk patients. The age of the grandmultiparas was significantly higher compared with the control groups, which may explain the higher incidence among them of antenatal medical disorders, such as diabetes mellitus and hypertensive disease. No significant differences were found among the three groups for preterm or post-term births, small-for-gestational-age infants, polyhydramnios, oligohydramnios, perinatal death, fetal distress, multiple births, placenta previa, abruptio placentae or cord prolapse. Macrosomia was markedly higher in the grandmultiparas and multiparas than in nulliparas. Thus, our results indicate that good perinatal care can ensure better results in grandmultiparas, and that grandmultiparity no longer needs to be considered a high-risk obstetric category in our population.

Recurrent Spontaneous Abortion

The laboratory diagnosis and clinical management of unexplained recurrent spontaneous abortion (RSA) patients is a controversial issue in contemporary obstetrics. In this report, the results of laboratory investigations and immunotherapy of RSA patients referred to our Center since 1986 are detailed. Our analyses have resulted in grouping RSA patients into primary (1 degree), secondary (2 degrees), and unexplained classifications. Laboratory evaluation criteria included assays for both complement-dependent and complement-independent antipaternal antibodies as well as histocompatibility antigen tissue typing for HLA, A, B, C, and DR antigens. In addition, mixed lymphocyte cultures (MLC) were performed to assess the degree of HLA-D locus compatibility between couples and to test for the presence of MLC inhibitors in maternal blood. Immunotherapy options and the rationale for their use are given and preliminary outcome data are presented from randomized double-blinded, placebo-controlled clinical trials.

BOOK REVIEWS

Advances in Reproductive and Perinatal Medicine edited by W. C. Cheng & S. L. Tan. P.G. AIDS and Obstetrics and Gynaecology (Proceedings of the 19th Study Group of the Royal College of Obstetricians and Gynaecologists) edited by C. N. Hudson & S. Sharp. Ultrasonography in Obstetrics and Gynecology Second edition edited by Peter Callen. Contemporary Obstetrics and Gynaecology edited by Geoffrey Chamberlain. Effective Prevention of Preterm Birth: the French Experience Measured at Haguenau Birth Defects Original Article Series Vol. 25 No. 1 edited by E. Papiernik, L. G. Keith, J. Bouyer, J. Dreyfus & P. Lazar.

Ultrasound screening for detection of intra-uterine growth retardation.

Intra-uterine growth retardation (IUGR) is a major problem in contemporary obstetrics. Early antenatal diagnosis is important if morbidity and mortality are to be minimized. We present the results of one years ultrasound fetometric screening for IUGR of the pregnant population in the city of Malmö. All pregnancies were dated by early biparietal diameter (BPD) measurement. From findings at 32 weeks of gestation, an IUGR risk-group (n = 436) was selected on the basis of predicted birthweight deviations with reference to standard curves, established at the Department, for BPD, abdominal diameter, femur length, and intra-uterine weight, all plotted against gestational age. The risk-group, which included 60 (77%) of the 78 IUGR infants eventually born, was subjected to additional fetometry examinations at 34, 36 and 38 weeks of gestation, in the total pregnant population of 2,068, each pregnancy was the subject of 2.3 examinations. Other fetometry variables were evaluated for their efficacy as IUGR markers, but were not found to be superior to the current screening procedure in which BPD and abdominal diameter are combined in a simple formula to assess intra-uterine growth. Overall, the screening procedure currently used at Malmö had a sensitivity of 64.1% and a specificity of 96.5%, the prevalence for IUGR being 3.8%.

BOOK REVIEWS

Book reviewed in this article: The Biochemical Effect of Drugs in Pregnancy Vol 2 by A. Onnis and P. Grella. Preterm Birth: Causes, Prevention and Management edited by Fritz Buchs and Phillip G. Stubblefield Dose and Volume Specification for Reporting Intracavitary Therapy in Gynecology. Progress in Clinical and Biological Research. Prevention of Physical and Mental Congenital Defects. Vol 163 A. Part A: The Scope of the Problem, Vol 163B. Part B: Epidemiology, Early Detection and Therapy, and Environmental Factors, Vol 163C. Part C: Basic and Medical Science, Education, and Future Strategies Contemporary Obstetrics, 293 pages with figures and tables, Contemporary Gynaecology The Critically III Obstetric Patient by R. W. M. Baldwin and Gillian C. Hanson. An Outline History of Medicine by Philip Rhodes. Atlas of Obstetric, Gynaecologic and Perinatal Ultrasonography edited by Kenneth J. W. Taylor Clinics in Obstetrics and Gynaecology. Vol 12. No 1 ‘Cancer of the Cervix: Diagnosis and Treatment’ edited by Albert Singer Premenstrual Syndrome and Dysmenorrhea edited by M. Y. Darwood, J. L. McGuire and L. M. Demers.

Book Reviews

Book reviewed in this article: Active Birth. Janet Balaskas. Unwin Paperbacks. Androgenization in Women. Ed. GM. Molinatti, L. Martini and V.H.T. James. Immunological Fertility Regulation. Warren R. Jones. Clinics in Obstetrics and Gynaecology. The Small Baby. P. W. Howie and N. B. Patel — Guest Editors. Obstetrics for the House Officer. Authors: William F. Rayburn, Justin P. Lavin Jnr. Contemporary Obstetrics. — Edited by Geoffrey Chamberlain 1984 Year Book of Obstetrics and Gynecology. Pitkin and Zlatnik Current Therapy of Infertility 1984–1985. Garcia, Mastroianni, Amelar & Dubin, B. C. Decker/C. V. Mosby. Human Milk Banking. (Nestle Nutrition Workshop Series, Volume 5) Edited by A. F. Williams and J. D. Baum. The New Good Birth Guide. How to Research and Plan the kind of Birth to Suit You and Your Partner. Sheila Kitzinger. Female Puberty and its Abnormalities. Sir John Dewhurst Handbook of Obstetrics and Gynecology. Edited by Barry G. Wren, Chapman & Hall Perinatal Epidemiology. Edited by M. B. Bracken. Contemporary Obstetrics and Gynaecology. Twin Volumes. Edited by Geoffrey Chamberlain Butterworths Principles and Practice of Clinical Gynaecology. Kase, 1983, John Wiley Infertility. Gabor Kovacs and Carl Wood Clinics in Obstetrics and Gynaecology, Volume 10/Number 2: Ovarian Cancer. Guest Editor — Philip J. DiSaia

FETAL ADRENAL CORTEX

The fetal adrenal cortex is the central steroid modulator in the fetal placental complex. Its anatomic structure and physiology clearly identify it as a uniquely fetal organ that undergoes atrophy to a fraction of its intrauterine size after birth and assumes markedly different steroidogenic functions on the assumption of extrauterine life. Its importance as a regulator of maturation and parturition in normal gestation is just being understood. The fetal adrenal cortex no doubt plays major roles in the pathogenesis of some of the most important clinical problems currently faced in contemporary obstetrics. Continued research that provides a more complete understanding of this organ will serve as the major base for innovative diagnostic and therapeutic advancements of the future.

Book Review: Contemporary Obstetrics and Gynaecology

Book Review: Contemporary Obstetrics and Gynaecology