Obstetric Technology Research Articles

Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian University students

Objectiveto examine attitudes towards birth that may be common among young adults who have been socialised into a medicalised birth culture. Specifically, we were interested in examining factors that might be associated with fear of birth and preferences for elective obstetric interventions among the next generation of maternity care consumers. Designsecondary analysis of an online survey of university students. SettingBritish Columbia, Canada. Participantsstudents from the University of British Columbia (n=3680). A quarter of the sample comprised Asian students, which allowed for analysis of cultural differences in attitudes towards birth. Both male and female students participated in the study; results are reported for the full sample, and by gender. Measurementsa six item fear of childbirth scale was developed, as well as a 4 item index that measures students' concerns over physical changes following pregnancy and birth and a 2 item scale that assesses students' attitudes towards obstetric technology. Findingsas we hypothesised, students who were more fearful of birth preferred epidural anaesthesia and birth by CS. Worries over physical changes following pregnancy and birth, favourable attitudes towards obstetric technology, and exposure to pregnancy and birth information via the media were also significantly associated with a preference for CS. Fear of birth scores were highest among students who reported that the media had shaped their attitudes towards pregnancy and birth. Asian students had significantly higher fear of birth scores and were more likely to prefer CS, compared to Caucasian students. Implications for practiceyoung adults are contemplating pregnancy and birth in an increasingly technology-dependent society. Educational programmes aimed at reducing fear of childbirth and concerns over physical changes following pregnancy and childbirth might contribute to vaginal birth intentions among young adults. Midwives may use the findings to identify and counsel nulliparas who exhibit fear of birth and other childbirth attitudes that may predispose them to choose elective obstetric interventions.

Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial

Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second-level referral (regional) hospitals outside the capitals (OR 1·02, 95% CI 0·79-1·31, p=0·89). No hospitals were lost to follow-up. Concrete actions were implemented comprehensively to improve quality of care in intervention hospitals. Regular visits by a trained external facilitator and onsite training can provide health-care professionals with the knowledge and confidence to make quality improvement suggestions during audit sessions. Maternal death reviews, combined with best practices implementation, are effective in reducing hospital-based mortality in first-level referral hospitals. Further studies are needed to determine whether the benefits of the intervention are generalisable to second-level referral hospitals. Canadian Institutes of Health Research.

Multigate Quality Doppler Profiles Technology in Vascular, Obstetrics and Cardiology Applications

Article Multigate Quality Doppler Profiles Technology in Vascular, Obstetrics and Cardiology Applications was published on August 24, 2012 in the journal Biomedical Engineering / Biomedizinische Technik (volume 57, issue SI-1-Track-B).

Preterm birth and neurodevelopmental outcome: a review

The incidence of preterm delivery and the survival rate of preterm newborns are rising, due to the increased use of assisted reproductive technology associated with multiple gestations and improved technology in obstetrics and neonatology, which allow saving preterm infants at earlier gestational ages. As a consequence, the risk of developmental disabilities in preterm children is high, and clinical pictures need to be fully defined. Narrative review including articles regarding neurodevelopmental disorders published in the international medical literature and reported in PubMed between the years 2000 and January 2010. Although survival rates of extremely low birth weight infants (ELBW) significantly increased during the last decade, the substantial stability of disability trends in this population was disappointing. Late-preterm infants, who account for about 75% of all preterm births and had not been considered at risk for adverse long-term neurodevelopmental outcomes in the past, are now reconsidered as more likely to develop such events, though their risk remains lower than in ELBW. The findings of the studies discussed in our article support the importance of early diagnosis in order to make decision about appropriate treatment of preterm infants.

O587 High technology in obstetrics & gynecology for lower level medical students

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S260-S260 Free communication (oral) presentations O587 High technology in obstetrics & gynecology for lower level medical students M. Martin, M. MartinSearch for more papers by this author M. Martin, M. MartinSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60960-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S260-S260 RelatedInformation

QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali.

BackgroundMaternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel.Methods/DesignThis is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1) Educational outreach visits; and 2) the implementation of facility-based maternal death reviews.The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of resources and the satisfaction surveys administered to the health personnel, will allow us to measure results before, during, and after the intervention. The overall rate of maternal mortality measured in hospitals during the post-intervention period (Year 4) is the primary outcome. The evaluation will also include cost-effectiveness.Trial RegistrationThe QUARITE trial is registered on the Current Controlled Trials website under the number ISRCTN46950658 .

Laser application in obstetrics and gynecology – A short introduction to therapeutic options

Abstract For the last 20 years, laser technology has evolved as an important tool in surgical treatment and it is widely used in gynecology and obstetrics. Especially in the treatment of vulvar and benign and premalignant cervical dysplasias it can be considered as the gold standard. In prenatal medicine, laser coagulation of placenta vessels has been shown to be superior to any other intrauterine therapy of twin-to-twin transfusion syndrome in monochorionic twin pregnancies. However, not all expectations in laser technology have been fulfilled. In laparoscopy, for instance, the use of the laser has been abandoned in favor of high-frequency electric surgery. This manuscript gives a short introduction to current therapeutic applications and limits of laser technology in gynecology and obstetrics.

Simulation and simulator technology in obstetrics: past, present and future

Healthcare has come to appreciate the value of simulation and its role in education, training, evaluation and research. This article reviews simulator technology and the role of simulation in obstetrics. The scope and nature of the obstetric literature published between January 1950 and July 2007 were reviewed. A total of 84 out of the 305 articles identified met criteria for inclusion in this review, most (59/84) having been published since 2000. The field of obstetrical simulation has grown substantially over the past decade. Thus far, the literature supports simulation as an essential tool for practicing routine and critical events, and improving technical proficiency and teamwork. Simulation can serve as a strategy for improving procedural and behavioral skills, potentially mitigating adverse perinatal events. More research is needed to determine whether obstetrical simulation leads to a significant reduction in the risk of birth-related injury and improved birth outcomes.

Chinese midwifery: the history and modernity

Aim to investigate how and why Chinese midwife numbers are dwindling, and to help understand the role of midwives in society in general. Method to critically examine Chinese midwifery in three stages: (1) historical literature overview; (2) identification and reinterpretation of Chinese midwifery and its development; (3) placing issues that have arisen within a sociological context (i.e. the modernisation of obstetric technologies and the meaning of modernity). Findings no books on the history of Chinese midwifery were found. History was classified into three stages: (1) before 1929, a period of an indigenous model; (2) 1929–1996, the highs and lows of the bio-medical model; (3) after 1996, the demise of Chinese midwives. The issues identified were the legitimacy and professionalisation of Chinese midwives, the meaning of modernity and the reasons for the decline of Chinese midwifery. Conclusion no sufficient evidence-based research was conducted to support the recent changes made to Chinese midwifery. The modernisation of maternity care in China took place amid dramatic social and cultural changes within society. As a consequence, midwifery as a profession in China has been marginalised. The modernisation of maternity care has failed to deliver on personal choice, quality of service and professional diversity. Implications for practice evidence-based research and the state's responsibility are essential to ensure the quality of maternity care and to protect the interests of women. The state's responsibilities include legislation regarding the role of midwives, code of practice, professional standards, responsibility and accountability in order to make midwifery care a true choice for women.

Picture Perfect

The purpose of this literature review was to survey available information and research related to routine three-dimensional (3D) ultrasound technology in obstetrics, with an emphasis on current medical uses, safety, and availability issues. Several data bases, including Cochrane, WHO, NIH, CINALH, Blackwell Synergy, ERIC, PubMed, and Medline, were used along with information from Internet search engines. Although fetal 3D ultrasound is used in both medical and commercial settings, recent studies focus on its possible uses rather than the more difficult issues of safety and commercial applications. Professional organizations associated with ultrasound technology support limiting ultrasounds in pregnancy to medically necessary events, whereas commercial venues use "direct to consumer" marketing to promote this technology as a way to "see" the baby before it is born. How safe is routine or frequent use of 3D ultrasound? Further research is needed to address these important questions.

What‘s new in the other journals?

What‘s new in the other journals?

The birth of perinatal medicine in the United Kingdom

Slow but steady progress in the medical care of mothers and their infants during the 16th-19th centuries received a setback early in the 20th century following a shift of focus from the baby towards gynaecological surgery. The development of paediatrics after 1928 and the formation of a national health service in 1948 led to a renewed interest in the fetus and newborn infant. Special care baby units (SBCUs) were created in the 1960s. At this time, too, obstetric technology arrived in the delivery room and domiciliary birth largely gave way to hospital delivery. Neonatal intensive care arrived in the 1970s. However, a severe lack of resources retarded progress. Many medical reports in the 1970s drew attention to the deplorable situation. In 1980 a House of Commons working party called for the establishment of a sound perinatal service. In 1982 the Government recognized all newborn infants as NHS patients from the moment of birth rather than after their registration. That year too the Royal College of Obstetricians and Gynaecologists (RCOG) acknowledged the need for a subspecialty in maternal and fetal medicine. Meanwhile, a paediatric perinatal pressure group, arising in 1976, became a multidisciplinary association of perinatal medicine in 1981. By 1983 the new discipline of perinatal medicine had become firmly established.

Uterine EMG and Cervical LIF - Promising Technologies in Obstetrics

No current objective measures exist to determine uterine or cervical function during pregnancy, or to accurately predict term or preterm labor and delivery. Uterine electromyography (EMG) and cervical light-induced fluorescence (LIF) studies were performed in term and pre-term animals and humans to evaluate the state and function of the uterus and cervix, and to determine the predictive capability of measurements made using these new technologies. Both uterine EMG and cervical LIF produced high positive and negative predictive values, compared to other currently-used methods. Uterine EMG and cervical LIF show great promise as diagnostic tests during pregnancy and for patient monitoring in obstetrics.

Norwegian midwives’ perception of the labour admission test

To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. In-depth interviews transcribed verbatim and analysed using the grounded theory technique. Four different labour wards in Norway. A theoretical sample of 12 practising midwives. The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

Passive Trust or Active Application: Changes in the Management of Difficult Childbirth and the Edinburgh Royal Maternity Hospital, 1850–1890

The history of the medical and nursing care given to parturient women has been approached in a number of ways. Early studies largely equated it with the development of obstetric technology that occurred from the early eighteenth century onwards, focusing on its potential to save maternal and foetal life, but without examining closely the frequency and significance of its actual use. Thereafter, feminist historians re-interpreted similar evidence to stress what they regarded as the degrading and invasive aspects of such technology, especially as it related to the increasing use of chloroform anaesthesia in the latter half of the nineteenth century. Interest then moved from the technology itself, to its effects on other aspects of care in childbirth, particularly on the eighteenth-century decline of the traditional midwife and the concomitant rise of the man-midwife.

Causes of late fetal death in New Zealand 1980-1999.

In recent years there has been an emerging interest in sudden unexplained intrauterine death. To determine the major causes of late fetal death (LFD) in New Zealand during 1980-1999 and to document the proportion of deaths considered unexplained. In addition, to quantify the number of LFD undergoing post-mortem during this period. Using the Office for National Statistics (UK) hierarchical classification system, all information available on death certificates was used to assign a single cause to LFD for the period 1980-1999. Trends were analysed using logistic regression and risk factor profiles established for each cause of death. Post-mortem rates and the characteristics of those failing to undergo post-mortem were analysed for the period 1989-1999. LFD rates declined from 60.1 per 10 000 in 1980-1981 to 30.5 in 1998-1999. The declines were not uniform across all causes, with intrapartum deaths declining 73%, congenital anomalies 70% and antepartum asphyxia 50%. In contrast, unspecified deaths increased 1%, and with the decline in other causes of death, also increased proportionally, from 10.8% of LFD in 1980-81 to 28.1% in 1998-1999. Post-mortem rates fell by 31% during 1989-1999, with Maori and Pacific babies and those in more deprived New Zealand Deprivation Index areas being significantly less likely to undergo post-mortem. While total LFD rates declined significantly during 1980-1999, rates of unspecified LFD remained static. Low post-mortem rates, however, suggest that many of these deaths may be uninvestigated rather than truly unexplained. Nevertheless, the persistence of a category of death which, to date, has failed to improve with advances in obstetric technology suggests that further measures are necessary if New Zealand's LFD rates are to continue to decline.

Access Denied, Science Denied

It would be useful to be writing about ways to move forward creatively to tackle the daunting reproductive health problems that trouble the world. In the United States, these include rapidly rising rates of sexually transmitted HIV infection among young women and striking disparities between the many women experiencing unwanted pregnancies and those desperately pursuing quasi-experimental assisted reproductive technologies to achieve pregnancy. The developing world also confronts high rates of HIV and unwanted pregnancy, with the latter too often leading to deaths from illegal abortion. Lack of access to modern obstetric technology in parts of the developing world makes pregnancy a high-risk venture and contributes to maternal mortality rates at premodern levels. Yet here in the United States we are forced to keep our attention turned backward, to continue defending earlier advances from the unrelenting assault of the Bush administration on access to and correct information about abortion, contraception, and HIV prevention.

Obstetric technologies: What determines clinical acceptance or rejection of results of randomized controlled trials?

Objective: The acceptance or rejection of obstetric technologies in clinical practice is not always based on the results of randomized controlled trials (RCTs). In this study, possible reasons for this discordance are examined. Study Design: Eleven technologies introduced over the past 30 years were examined. RCT results were determined from the published literature, with emphasis on meta-analyses and the Cochrane reviews. Results were graded for quality of evidence (I-III) and strength of recommendations (A-E) on the basis of criteria adopted by the United States Preventive Services Task Force. Clinical use was based on data from the literature, or when this was lacking, on an estimate, and graded + to +++ or – to – – –, based on degree of acceptance or rejection. Results: There was concordance of results with midtrimester ultrasound (US) imaging, home uterine activity monitoring (HUAM), Doppler velocimetry in high-risk pregnancy, short-term tocolysis, single-course antenatal corticosteroids (BMZ), thyroid-releasing hormone (TRH), and fetal fibronectin (fFN). There was discordance of results with fetal heart rate monitoring (FHRM), fetal blood sampling (FBS), US imaging in late pregnancy, Doppler velocimetry in low-risk pregnancy, and tocolysis beyond 7 days. In several cases there are published RCTs, but clinical acceptance is still evolving (multiple course BMZ, pulse oximetry, and electrocardiogram ST-segment analysis). Conclusion: These observations suggest that technologies which are simple to apply, and have a single endpoint, show concordance between RCT results and clinical use (HUAM, short-term tocolysis, single-course BMZ, TRH, and fFN). Those that are complex to apply (FBS), or interpret (FHRM), and/or do not have a single clear end point (FHRM, Doppler), or have results that are of great personal interest to the patient (FHRM, US imaging, long-term tocolysis), are more likely to show discordance. In several cases despite published RCTs, clinical acceptance or rejection is still evolving (multiple course BMZ, pulse oximetry, and electrocardiogram ST-segment analysis). These inconsistent relationships suggest that the decision-making processes of obstetric providers and patients would be a fruitful area of investigation. (Am J Obstet Gynecol 2003;188:1622-8.)

Data Monitoring and Safety Committees and Their Operations

The scientific burden of proof for new therapies and technologies in obstetrics and gynecology has risen steadily over the past 15 to 20 years, and the randomized clinical trial has become integral to this higher standard. Data monitoring and safety committees are now critical components of clinical trials, yet their history, rationale, methods of operation, and overall role have not been well-characterized in the obstetrics and gynecology literature. In this review, an overview of the important and evolving role of data monitoring and safety committees is provided. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to describe what a data monitoring and safety committee is, plan who should comprise the DMSC, and outline the functions of a DMSC.

The art of developmental care in the NICU: a concept analysis.

The survival rate of infants born prematurely and hospitalized in Neonatal Intensive Care Units (NICUs) has increased due to improvement of the technology in obstetrics and neona tology that allows saving preterm infants at earlier gestational ages. Preterm infants are hospitalized in a care environment which is quite different from the maternal womb. Therefore the application of developmental care in NICUs is critical to promote the development of preterm infants while they are hospitalized. This concept analysis contributes to the body of knowledge in developmental care and clarifies its understanding as well as its involvement in neonatal practice and research. Using the method of concept analysis of Walker and Avant, this article identifies the definitions and uses of the concept of developmental care, exposes its main attributes and introduces a model case representing the acknowledged attributes. The antecedents of the concept and consequences of the application of developmental care are discussed. This concept analysis provides guidelines for nurses and health professionals to establish a 'developmental care' environment which is conducive for preterm infants. Moreover, it suggests conceptual and operational foundations of developmental care for clinicians and researchers in the neonatal field.