Teaching Of Obstetrics Research Articles

Morbimortalidad por CIUR. Estudio del año 2002 en el Hospital Docente Ginecobstétrico América Arias

A retrospective, and descriptive study of 154 mothers who had children with Intrauterine Growth Retardation (IUGR) at birth. The study was conducted at the America Arias Gynaecology and Obstetric Teaching Hospital in 2002, It was aimed at identifying the mortality and morbidity in our cases. The continual delivery registries, as well as the medical history of mothers and neonates, were reviewed. Results The IURG most frequently found was moderate, and at the end of pregnancy, a only half o these cases were diagnosed before birth. The highest percent of these births were by caesarean section, and the Apgar was normal. It was concluded that the most important aspect in the management of IUGR is its early diagnosis.

Using logistic regression analysis in preliminary differential diagnosis of adnexal masses

The aim of our study was to generate predictive model, which would allow to estimate the influence of analyzed parameters on predictive accuracy of differential diagnosis of adnexal masses and to evaluate prospectively diagnostic efficacy of the statistic model in the new set of patients. A total of 686 women diagnosed and surgically treated in the Gynecological and Obstetrical Teaching Hospital of University of Medical Sciences in Poznan, Poland, were recruited into the study. Preoperative diagnostics included gynecological examination, ultrasonographic evaluation, tumor Doppler blood flow analysis, and serum levels of CA125 and TPS. In order to find the best combination of features and to calculate the individual probability of the malignancy, stepwise logistic regression analysis with quasi-Newton estimation was applied. The essential part of the best prognostic model, described by foregoing variables, is as follows: [z = -6.005 + 0.058 x age + 1.174 x septa + 1.317 x tumor localization + 1.185 x ascites + 2.28 x solid element + 2.429 x vessels localization -2.386 x PI + 0.084 x MEDV]. The highest sensitivity and specificity for the obtained model were 87.84% and 93.74%, respectively. Prognostic model, constructed with the use of logistic regression analysis, is characterized by higher sensitivity and specificity than individually applied diagnostic tests. Prospective evaluation of this model application in a larger group of patients with adnexal masses will enable precise assessment of its objective clinical usefulness.

Axiom or Myth? Pregnant Patients Never Get PID

Axiom or Myth? Pregnant Patients Never Get PID

VAGINAL DELIVERY OF THE TRIPLETS

The spontaneous conception & delivery of triplets occurs in 1: 6889 births. Most ofthe literature recommends caesarean section for triplets for better perinatal outcomeof especially second and third baby, however, we describe vaginally delivered tripletswith good perinatal outcome.1. Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.Address for correspondence : Dr. Rachana Saha, LecturerDepartment of Obstetrics and GynaecologyKathmandu Medical College Teaching Hospital, SinamangalP. O: 5919, Kathmandu, NepalKey Words: Triplets, Mode of delivery, Neonatal outcome.

Medical and midwifery students: how do they view their respective roles on the labour ward?

It has been suggested that much of the medical and midwifery student curricula on normal pregnancy and birth could be taught as a co-operative effort between obstetric and midwifery staff. One important element of a successful combined teaching strategy would involve a determination of the extent to which the students themselves identify common learning objectives. The aim of the present study was to survey medical and midwifery students about how they perceived their respective learning roles on the delivery suite. A descriptive cross-sectional survey study was undertaken. The study venue was an Australian teaching and tertiary referral hospital in obstetrics and gynaecology Survey participants were medical students who had just completed a 10 week clinical attachment in obstetrics and gynaecology during the 5th year of a six year undergraduate medical curriculum and midwifery students undertaking a one year full-time (or two year part-time) postgraduate diploma in midwifery. Of 130 and 52 questionnaires distributed to medical and midwifery students, response rates of 72% and 52% were achieved respectively The key finding was that students reported a lesser role for their professional colleagues than they identified for themselves. Some medical students lacked an understanding of the role of midwives as 8%, 10%, and 23% did not feel that student midwives should observe or perform a normal birth or neonatal assessment respectively. Of equal concern, 7%, 22%, 26% and 85% of student midwives did not identify a role for medical students to observe or perform a normal birth, neonatal assessment or provide advice on breastfeeding respectively. Medical and midwifery students are placed in a competitive framework and some students may not understand the complementary role of their future colleagues. Interdisciplinary teaching may facilitate co-operation between the professions and improve working relationships.

Prospective Multicenter Study of Pregnancy Outcomes in Women With Heart Disease

Siu, Samuel C.; Sermer, Mathew; Colman, Jack M.; Alvarez, A. Nanette; Mercier, Lise-Andree; Morton, Brian C.; Kells, Catherine M.; Bergin, M. Lynn; Kiess, Marla C.; Marcotte, Francois; Taylor, Dylan A.; Gordon, Elaine P.; Spears, John C.; Tam, James W.; Amankwah, Kofi S.; Smallhorn, Jeffrey F.; Farine, Dan; Sorensen, Sheryll on behalf of the Cardiac Disease in Pregnancy (CARPREG) Investigators

The humanization of birth experience at the University of Santa Catarina maternity hospital

The Federal University of Santa Catarina (FUSC) Maternity Hospital (UH) initiated its activities on October 24, 1995, after several years of interdisciplinary committee work. The Committee based its work on the principles of humanization and interdisciplinarity. In this report we describe the process by which these services were implemented in this hospital, emphasizing the difficulties and possibilities of such an interdisciplinary project, the philosophical principles which guided the process, the work being carried out and the opinion of the clients on the care that they received. The work carried out at the UH generated a number of changes in the care and teaching of obstetrics at different professional levels. The maintenance of the basic principals of this work has, however, proved to be a continuous challenge with a constant struggle to ensure that the philosophy is adhered to by professionals and students, which strongly depends upon a continual educational process.

Incidence and Outcome of Ureteral Injuries in an Obstetrics and Gynecology Teaching Program

Incidence and Outcome of Ureteral Injuries in an Obstetrics and Gynecology Teaching Program

Prospective 12 month study of 30 minute decision to delivery intervals for “emergency” caesarean section

Editorial by James Papers p 1330 Clinical governance requires evidence based standards of clinical relevance to assess performance. The recommended interval between the decision to perform an “emergency” caesarean section...

Designing a community-based fourth-year obstetrics and gynaecology module: an example of innovative curriculum development.

This paper describes the design and evaluation of the community-based obstetrics and gynaecology module at St Bartholomew's and the Royal London School of Medicine and Dentistry. This module sets out to comply with the General Medical Council's recommendations of encouraging students to consider the community perspective, and places less emphasis on a disease-orientated approach. The development of the module, issues of improving student acceptance of the course, staff development and the benefits of community teaching in obstetrics and gynaecology are discussed. The 2-week module precedes the 8-week hospital obstetrics and gynaecology firms that occur in the fourth undergraduate year. The course is organized into three components: general practice, departmental teaching, and self-directed learning. Students are allocated to general practices for their clinical teaching, for eight sessions. Seven departmental sessions are run by the Academic Department of General Practice and Primary Care. These include a review of the students' self-directed learning. Evaluation data are reported for the three components of the course. Overall the majority of students rated the module as useful, GP attachments being most favourably received. The majority of students have grasped the basic obstetric and gynaecological history and examination skills and found this useful before starting their hospital firms. Aspects of a specialist subject, such as, obstetrics and gynaecology, can be taught successfully in the community and GP tutors are, as yet, an untapped source of excellent obstetric and gynaecology teaching.

Incidence and Outcome of Ureteral Injuries in an Obstetrics and Gynecology Teaching Program

The purpose of this study was to determine the exact cause and anatomic location of ureteral injuries sustained at the time of gynecologic and obstetric surgery at this institution. The authors also wished to identify any factors that might have contributed to the injury, the time of injury recognition, the method of repair, and sequelae of the injury. Surgical logbooks maintained by the Division of Gynecologic Oncology dating back to 1985 were reviewed to identify cases of ureteral injury. The operative reports were reviewed to determine the cause of each injury and to determine predisposing factors present at the time of surgery. Fifteen cases were identified. The charts of 12 cases were available for review. Seven injuries were sustained during surgical procedures performed for malignancy, two occurred at the time of cesarean hysterectomy, two occurred during a hysterectomy and bilateral salpingo-oophorectomy for a benign condition, and one occurred during a sigmoid resection for severe radiation proct...

Profile and recruitment in Australasia

There are 12 medical schools in Australia and New Zealand producing a total of 1600 graduates per year. Academic recruitment is poor as a result of lack of career paths, poor financial remuneration, problems with lack of research funding and the small size of departments. Increased demands from the clinical service and lack of ‘start-up’ research funds act as a deterrent to recruitment of junior academics. Clinical academics need to convince governments that, without strong and continuing academic leadership, there will be a deterioration in patient care, teaching and research in obstetrics and gynaecology.

Obstetrics and gynecology

A change in medical technology and the expansion of our informational resources continues to occur at the speed of light. Nowhere is this more evident than in obstetrics and gynecology. These new technologies improve patient outcomes and the quality of care that we can provide for our patients, but they are not without risks. We will not only look at a few of the new specific technologies, but we will also look at how these changes are affecting the practice and teaching of obstetrics and gynecology.

Family history of pre-eclampsia as a predictor for pre-eclampsia in primigravidas

Objective: To assess the clinical utility of knowledge of a family history of pre-eclampsia as a predictor for the development of pre-eclampsia in primigravid women. Methods: 368 primigravid women were prospectively recruited from the outpatients department of an obstetric teaching hospital. Details of any family history of pre-eclampsia were obtained from the women and their subsequent obstetric outcomes were observed. Results: Of 368 primigravid women, 34 (9.2%) developed pre-eclampsia. Eighteen (4.9%) women of the total group stated that they had a mother (12), sister (five) or both (one) who had had pre-eclampsia. Of these 18 women, five (27.8%) developed pre-eclampsia. Of the women who had no family history, 29 (8.3%) developed pre-eclampsia (relative risk, RR = 3.4; 95% CI, 1.5–7.6; P = 0.018). Four (22.2%) of the women with a positive family history developed severe pre-eclampsia compared to 18 (5.1%) with a negative family history (RR = 4.3; 95% CI, 1.6-11.5; P = 0.017). Conclusions: In a primigravida, a family history of pre-eclampsia is associated with a fourfold increased risk of severe pre-eclampsia. This clinical history identifies a group who warrant close clinical surveillance during pregnancy and who may be suitable for trials of prophylactic interventions.

Les débuts de l’obstétrique et de la gynécologie à Québec

The history of medicine in Canada started around 1639 with Robert Giffard, Michel Sarrazin, Jean Madry, and François Gaultier, “surgeons-barbers” who transmitted their art through apprenticeship from the early seventeenth century up to the mid-eighteenth century. The first school of medicine was established in Quebec City on January 18, 1819, and was recognized by Parliament in 1845. In 1837, formal teaching in obstetrics and gynaecology was provided at Hôpital de la Marine by Joseph Painchaud.The Faculty of Medicine of Laval University took over the School of Medicine in 1854 with 120 hours of formal teaching in obstetrics in two hospitals: Hôpital de la Marine and Hôpital de la Miséricorde. Progressively, obstetrics and gynaecology teaching was carried out at several hospitals adding Hôtel-Dieu de Québec and, eventually, Hôpitals Saint-Sacrement, Enfant-Jésus, and Saint-François d’Assise. The Department of Obstetrics and Gynaecology was formally recognized within the Faculty of Medicine in 1955.

Medicolegal matters involving a major obstetric and gynaecological teaching hospital.

Review of medicolegal files held by the Royal Women's Hospital. Melbourne confirms that during the last 25 years there has been a marked increase in the number of claims for compensation brought by patients who believe that the care they received was inadequate; thus 4 claims for compensation were received during the first 5 years of the study period and 29 claims in the last 5 years. Complaints about service provision resulted in a claim for compensation in 29.7% of cases in which the dissatisfied client was represented by a legal firm and in 6.25% of cases where the initial approach was made through the Health Services Commission. One half of all claims for compensation were received in response to perceived complications of birth, surgery or treatment of a premature baby.

A review of eclampsia in Melbourne: 1978-1992.

A retrospective review of all cases of eclampsia diagnosed at 3 obstetric teaching hospitals in Melbourne from January, 1978 to December, 1992 was undertaken. Ninety cases were identified; there were 5 maternal deaths and 17 perinatal deaths. Severe maternal morbidity such as pulmonary oedema, acute renal failure or HELLP syndrome was found in 26%. Significant maternal thrombocytopenia (< 100 x 10(9)/L) was found in 50% and 35% had abnormal maternal liver function tests. Forty six women received magnesium sulphate for treatment of eclampsia and of these 3 had further seizures compared to 4 of 18 who received phenytoin (odds ratio 0.24 (0.04-1.52) X2, p = 0.09). Eclampsia remains a significant complication of pregnancy with high maternal and perinatal mortality and morbidity. Results of this study show a trend that is in agreement with recent randomized controlled trials which demonstrate a reduced incidence of seizures and maternal and fetal complications with the use of magnesium sulphate. The results of these recent trials suggest that magnesium sulphate should be the drug of choice in the prevention and treatment of eclampsia.

Birth representation with reference to the magical coriander prescription of Codex Vindobonensis 93, fol. 102r, of the Austrian National Library

One of the most impressive manuscript illustrations of the medieval history of midwifery is found in the Codex Vindobonensis 93, fol. 102r (a manuscript from the early 13th century), illustrating a magic prescription of herba coriandrum to accelerate childbirth. The composition of the omnibus manuscript is critically delineated in its historical context. The illustration, being isolated without any obstetrical teaching text, is judged as part of the ancient tradition of teaching by images which has no parallel north of the Alps. The different image traditions are reflected in the historical use and illustration of the midwifery chair, which can be traced back only to the beginning of the 16th century in Central Europe and on the British Isles. The importance of the magic prescription is shown by comparison within the same and other collections used in the Middle Ages and classified in the context of further traditions of magic in midwifery.

The role of emergency obstetric care in preventing maternal deaths: an historical perspective on European figures since 1751

A review of the time-relationships is provided between the introduction of obstetric techniques and organization of obstetric care in Europe and the decrease of maternal death rates from 1751 to 1980. Published figures were used to discover the evolution of maternal deaths in Europe for the last 250 years, and to propose a parallel analysis of major modifications of obstetric care. The teaching of obstetrics to midwives and general practitioners, introduction of forceps and of low-segment cesarean section technique, disappearance of home deliveries, antibiotics, anesthesia and blood banks are among the addressed techniques. Even if a causal relationship cannot be proposed, the major inflection in the rate of reduction of maternal deaths is related to the introduction of low segment cesarean section in the first years of the 20th century. This progress was also related to the progressive transfer of birth sites, from home to specialized units.

Community-based learning in obstetrics for undergraduate medical students

Medical students on their obstetrics and gynaecology attachment were randomly assigned to attend hospital (n = 24) or general practice (n = 18) obstetric clinics once weekly for 4 weeks. The students completed self-assessment questionnaires at the beginning and end of the attachment. There was a significant improvement in the level of knowledge and skills required for antenatal care, care in labour and postnatal care by the end of the attachment, with no difference between hospital or general practice groups. There was a significant increase in the level of interest in the future practice of obstetrics only in the general practice group. However, this difference could be explained by the greater number of students in the general practice group who were by chance in the 'no or don't know' category at the start of their attachment. We conclude that general practice based clinical teaching of obstetrics can be a suitable alternative to hospital-based clinical teaching for undergraduate medical students.