Obstetric-gynecologic Services Research Articles

MORBIDITY RATE AND PATTERNS AMONG WOMEN WHOSE PREGNANCY ENDED IN DELIVERY AS COMPARED TO THOSE WOMEN WHO ABANDONED THEIR CHILDREN DURING ‘HEALTH’ PROGRAMME IMPLEMENTATION

The study analyses the morbidity rate and patterns among women who abandoned their new-born children at maternity clinics. The data was raised from maternity welfare centre and maternity clinic. The study is retrospective and is based on the data collected during 6 recent years; the timeframe includes the term of ‘Health’ national project implementation and some time preceding it. The data analysis suggests considerably higher morbidity rate among women who abandoned their new-born children as compared to the overall number of pregnant women and testifies little impact of the efforts undertaken by the obstetric-gynecologic service within the project framework on the health of women in this category.

THE MEDICO-ORGANIZATIONAL MODEL OF PROTECTION OF REPRODUCTIVE HEALTH OF WOMEN WITH INFLAMMATORY DISEASES OF GENERATIVE ORGANS

The work purpose: To develop, scientifically to prove and introduce medical-organizational model of protection of reproductive health of patients with inflammatory diseases of genitals. Materials and methods. The female population of fertile age with inflammatory diseases of the genitals, living in the Grodno area per 1954–2008 is studied. The system approach is used, following methods were applied: sanitary-statistical, economic-mathematical, expert estimations, sociological, historical, organizational experiment, modelling and forecasting. Results. On the basis of the carried out complex socially-hygienic research including studying of volumes and quality of medical aid, security of obstetric-gynecologic service material, financial and personnel resources, introductions of new organizational, medical and information technologies, studying of the reproductive equipments of women of fertile age and prospects of realisation by them of reproductive function, and also an expert estimation of the importance of the problems bound to disturbances in reproductive system, develop medical-organizational model of protection of reproductive health of women with inflammatory diseases of the genitals, based on state policy realisation in public health services. Model actions are realised in three stages: pregravidal improvement; medical maintenance in pregnancy; The organisation of medical aid to women in childbirth and newborns, and also aftertreatment after a failure of pregnancy and sorts.

A Cohort Study Investigating Compliance with Guidelines for Platelet Count Monitoring During Heparin Thromboprophylaxis

Background: Heparin is the most common agent used for prevention of venous thromboembolism. To promote early detection of heparin-induced thrombocytopenia, guidelines recommend episodic platelet count monitoring for specified patient populations. However, physician compliance with these guidelines has never been reported for patients receiving heparin for pharmacologic prophylaxis. Aim: The aim of this study was to evaluate the frequency of and factors associated with physician failure to monitor patient platelet counts. Results: We conducted a retrospective cohort study of 2350 admissions of patients aged ≥ 18 years who received ≥ 4 consecutive days of prophylactic heparin. There was nonadherence to monitoring recommendations in 659 (28%) patients. Monitoring was not more likely among patients for whom monitoring was recommended compared with patients for whom no monitoring was recommended (31% vs 27%; adjusted hazard ratio, 0.9; 95% CI, 0.7–1.1). Compared with patients admitted to the general medicine service, monitoring was significantly less common among patients admitted to orthopedic surgery or obstetric-gynecologic services (adjusted hazard ratio, 1.6; 95% CI, 1.1–2.2 and adjusted hazard ratio, 2.4; 95% CI, 1.8–3.2, respectively). A decrease in platelet count (≥ 50%) was detected in 90 (4%) patients, but in only 12 (11%) patients was heparin stopped, and in only 11 (12%) patients were heparin-induced thrombocytopenia antibody levels obtained. Of the 11 patients for whom heparin-induced thrombocytopenia antibody levels were obtained, 6 (0.26% of the patient population) were positive. Conclusion: We found that compliance by physicians with platelet count monitoring recommendations was poor for patients who had received heparin for venous thromboembolism prophylaxis, and platelet count monitoring appeared to be unrelated to American College of Chest Physicians recommendations for routine monitoring. Compliance was particularly poor in orthopedic surgery and obstetric-gynecologic services.

Pregnancies in Perinatally HIV-Infected Young Women and Implications for Care and Service Programs

A cohort of individuals with perinatally acquired HIV is maturing into reproductive age. This study describes pregnancy incidence and outcomes among females ages 15-25 with perinatally acquired HIV infection receiving comprehensive family-centered services in New York City. Chart reviews from 1998-2006 indicated 33 pregnancies among 96 young women. Twenty-six percent of the cohort experienced a pregnancy during the study period, with a rate of 125 per 1,000 person years in 2006. The age of first pregnancy ranged from 15-25; 24% were younger than 18. Fourteen pregnancies (42%) were terminated. Nineteen pregnancies resulted in live births, and all infants tested negative for HIV. The success of preventing vertical HIV transmission is attributed to interdisciplinary family-centered services, including reproductive health education, family planning, obstetric-gynecologic services and psychosocial support. Such approach is most likely to be effective at promoting healthy reproductive decisions and reducing morbidity in perinatally infected mothers and their children.

Characteristics and some indicesof work ofobstetric-gynecologic service in ametropolitan region

In the article there is a characteristic of obstetric-gynecologic service in a metropolitan region by the example of Korablinskiy region of Ryazan area and an analysis of some aspects of its work. There is the dynamics of structure of obstetric-gynecologic bed stock, main causes of hospitalization in woman suffering from gynecologic diseases, coverage of preventive gynecologic examinations and gynecologic morbidity according to their results.

Obstetric Anesthesia: The 1982 American College of Obstetricians and Gynecologists Standards and the Role of Robert E. Johnstone, M.D.

Obstetric Anesthesia: The 1982 American College of Obstetricians and Gynecologists Standards and the Role of Robert E. Johnstone, M.D.

A decade of prevalence surveys in a tertiary-care center: trends in nosocomial infection rates, device utilization, and patient acuity.

To evaluate the usefulness of repeated prevalence surveys to determine trends in the rates of nosocomial infections and to detect changes in risk factors (e.g., use of invasive devices) associated with nosocomial infections. Ten annual prevalence surveys were conducted by trained infection control practitioners between 1985 and 1995 for acute-care patients on the medical, surgical, pediatric, and obstetric-gynecologic services at a 900-bed, tertiary-care, teaching hospital with 750 acute-care beds. The same methods of chart review and concurrent reporting from nursing, the microbiology and clinical laboratory, and the pharmacy were used each year to collect data on the prevalence of nosocomial infections, invasive-device utilization, and abnormal laboratory indicators. Although data were collected on a single day, a period-prevalence study approach was used, because charts were reviewed for any infection data occurring within the 7 days prior to the survey. The hospital census for acute care patients, as measured by the prevalence surveys, declined sharply over the 10 years, from 673 to 575 patients (P = .02). However, the medical service census increased from 150 to 188 patients (P = .01). During the same period, there was a significant decrease in the mean length of stay, from 7.3 to 6.0 days (P = .01), and a concomitant increase in the mean diagnosis related-group case-mix index, from 1.03 to 1.24 (P = .001). Overall, nosocomial infection rates remained unchanged over the study period (mean of 9.85 infections per 100 patients), but rates of nosocomial bloodstream infection increased from 0.0% in 1985 to 2.3% in 1995 (P = .05). Nosocomial infection rates were significantly higher on the medical and surgical services than on other services (P<.001). Utilization rates increased significantly for Foley catheters (9.0% to 16.0%, P = .002) and ventilators (5.0% to 8.0%, P = .05). Despite apparent increases in the severity of illness of our patients, overall rates of nosocomial infection remained stable during a decade of study. Rates of nosocomial bloodstream infection increased, in parallel with National Nosocomial Infection Surveillance System data. We found repeated prevalence surveys to be useful in following trends and rates of infection, device utilization, and abnormal laboratory values among patients at our institution. Such methodologies can be valuable and low-cost components of a comprehensive infection surveillance, prevention, and control program and other potential quality-improvement initiatives, because they enable better annual planning of departmental strategies to meet hospital needs.

Underreimbursement of obstetric and gynecologic invasive services by the resource-based relative value scale

To compare the relative value of work and reimbursement by the resource-based relative value scale (RBRVS) and the charge-based McGraw-Hill relative value scale for invasive services performed for women only (obstetric-gynecologic), for men only (urology), and in a gender-neutral specialty (general surgery). Two hundred nineteen obstetric-gynecologic, 125 urology, and 105 general surgery invasive procedures were compared by the mean for each specialty of 1) the ratio of the procedure-specific work component of the RBRVS unit to the total relative value unit, and 2) the ratio of the procedure-specific total RBRVS unit to the McGraw-Hill relative value unit. All procedures were weighted equally. Ratios are reported as percentages. Statistics were compared by analysis of variance with Newman-Keuls test for multiple pairwise comparisons when significant differences were identified. Statistically significant differences were defined as P < .05. The mean percentage of the procedure-specific work component of the RBRVS unit to the total relative value unit and the total RBRVS unit to the McGraw-Hill unit were significantly lower (P < .01 for all comparisons) for obstetric-gynecologic (49.7 and 139.5) than for urology (55.1 and 207.1) or general surgery services (53.2 and 181.0). There were no significant differences between urology and general surgery services among the procedures studied. The data support a lower relative value of work and reimbursement for services performed for women only. This may be the result of 1) high initial estimates of work for urology and general surgery services, 2) low initial estimates of work for obstetric-gynecologic services, or 3) a carry-over of reimbursement bias from the charge-based environment to the RBRVS by the methods used in its development.

Coding and reimbursement for obstetric-gynecologic services

Obstetrician-gynecologists, like physicians in other fields, are faced with increasing restrictions on payment levels and coverage, and increasing oversight by third parties regarding the appropriateness of procedures. Adoption of new payment rules and methods by many insurers compounds the situation by decreasing reimbursement even further. In addition, the development of technologic advances in the specialty often outpaces the ability of payers to recognize the contribution or value of a new procedure or treatment modality, and to compensate for it properly. The new era of medical practice is clearly one of accountability to many parties. Patients properly demand accountability for quality care. Payers demand accountability for not only cost-effective but appropriate care. The employer purchasers of a health care plan demand accountability for demonstrating the value of a particular procedure or service that, if used inappropriately, may drive the costs of the company's health plan higher. The result of all these demands is increased scrutiny of services provided by physicians to patients. The key to proper identification of these services is the correct use of diagnostic and procedural codes. Two Coding Systems

Standards for Obstetric-Gynecologic Services, 7th Edition Quality Assurance in Obstetrics and Gynecology

Standards for Obstetric-Gynecologic Services, 7th Edition Quality Assurance in Obstetrics and Gynecology

Abdominal wound dehiscence

Abdominal wound dehiscence is a surgical complication with a high morbidity rate but which is associated with predictable and preventable factors. During a 10 year period (1966 to 1975) at the New York Lying-In Hospital, 70 cases were found on the obstetric-gynecologic service, and these cases were analyzed to see why dehiscence remains a problem. Those factors contributing to dehiscence include obesity, pre-existing pulmonary and cardiovascular problems, vertical incisions, the triad of ileus, vomiting, and coughing, and, to a lesser extent, hypoproteinemia, fluid and electrolyte imbalance, and wound infection. The incidence of abdominal wound dehiscence would be much lower if high-risk patients were identified, adequate pulmonary toilet was used, ileus was promptly treated with abdominal decompression, and strict attention was paid to electrolyte and protein balance in the pre- and post-operative period. The management of abdomital wound dehiscence is also discussed.

Bacteremia on an obstetric-gynecologic service

In a one-year evaluation of the Obstetric-Gynecologic Services of the Los Angeles County-University of Southern California Medical Center, bacteremia was confirmed on 144 occasions in 139 patients. This represented an over-all incidence of 7/1,000 admissions with gram-negative bacteremia observed in 3.1/1,000 admissions. There were four deaths in this series. The most frequently recovered aerobes were Escherichia coli, enterococci, and beta hemolytic streptococci, not Group A or D, while the most commonly isolated anaerobes were peptostreptococci, peptococci, and Bacteroides. These patterns of bacterial isolation should be acknowledged in antibiotic strategies for septic patients. There is a positive correlation between the incidence of intrapartum maternal and fetal monitoring and postpartum maternal bacteremia. The oncology patients were the most seriously ill women with bacteremia.

The development of a family planning program for private patients in a community hospital.

Description is given of the development of a state-funded family planning education program in a voluntary hospital located in a suburban-rural New York county of 206500 where only 8% of 4497 medically indigent women received contraceptive services. The family planning program proposed would be staffed by a full-time professional nurse who would counsel all women on the Obstetric-Gynecologic service with follow-up care especially for low-income women provided by a non-professional aide. Transportation and child care to facilitate postpartum care would also be offered. In the first 6 months of the program 289 (53.2%) of 544 obstetrical patients attended a group class while an additional 121 (22.2%) had individual counseling. Of 134 women (24.6%) not attending class 19 (14.2%) were discharges 28 (20.9%) were too ill to attend and 50.7% showed lack of interest. IUD use increased with 9.8% of the 544 delivered patients becoming acceptors. Physician enthusiasm for the program increased significantly. It is indicated that initiation of a family planning program requires persistent leadership and that women were responsive to effective efficient contraceptive education from a professional nurse. Further efforts are needed to ensure that all women who desire contraception receive continuous medical supervision.