Obstetric Women Research Articles

Assessment of Genetic Contributions to Risk of Preeclampsia in Ecuadorian Women

Aim: To identify the immunogenetic factors that trigger the beginning of preeclampsia and eclampsia. Methods: A retrospective, case-control study of 142 pregnant women in Obstetrics and Gynecological Hospital Isidro Ayora in Quito, who are grouped into two different groups, diseased and healthy. The study analyzed ethnicity, age, gynecological history, contraception, immunizations, blood type and Rh factor, and family history of preeclampsia-eclampsia of each of the pregnant women; and gestational age, sex, weight, and blood type and Rh factor of the progeny. Results: Age, ethnicity, history of pregnancy, abortions, contraception, and blood type and Rh factor were similar for both groups (p > 0.05). Gestational age and weight of the progeny was lower in cases compared with controls (p < 0.05). There was no statistical difference when comparing the blood type and Rh factor of the two groups (p > 0.05). Male gender was predominant in both groups for cases 69.01 and 87.32% for controls (p < 0.05). Conclusions: There was a higher predisposition for inherited cases (26%) versus controls (9.85%), p < 0.05, for the occurrence of preeclampsia. The frequency of the recessive gene for Mendelian inheritance model mother-fetus homozygous (aa/aa), in agreement with the Hardy-Weinberg Law, was 0.41 for the sample.

Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population

The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery. A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (>500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections. A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss > 500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p > 0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p > 0.05). The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications.

Emergency obstetric care in the southernmost provinces of Thailand *

To assess the accessibility, utilization and quality of emergency obstetric care in the five southernmost provinces of Thailand. A descriptive study was conducted in the five southernmost provinces of Thailand including fifty-six government hospitals and the admitted obstetric women. The accessibility of hospitals that provided emergency obstetric care was assessed over a 3-month period. The utilization and quality of emergency obstetric care were reviewed using the data of obstetric women admitted in a 6-month period. The admitted women with major obstetric complications were identified by the hospital reports. The accuracy of the hospital reports was checked using Lot Quality Assurance Sampling. The accessibility, utilization and quality of emergency obstetric care services, as defined by the United Nations (UN) indicators. There were 8.4 basic and 1.8 comprehensive emergency obstetric care hospitals per 500,000 population. The proportion of births in hospitals was 89.5%, and the adjusted percentage of women with major obstetric conditions treated in the hospitals was 95.5%. The caesarean section rate was 17.8%, and the case fatality rate caused by postpartum haemorrhage was 0.7%. Delays in seeking, reaching and receiving good care were detected in the causes of maternal deaths. Over-reporting due to double-counting and under-reporting of complications were found in the hospital reports. Emergency obstetric care in Southern Thailand met UN guidelines; however, there was a problem of delays in seeking treatment in some maternal deaths. Improvement of over- and under-reporting of obstetric conditions in the hospitals is needed.

Recognition and management of critical illness by midwives: implications for service provision

The aim of this study was to explore midwives' recognition and management of critical illness in obstetric women in order to inform service provision. Critical illness is not confined to Intensive Care. Limited published work was located examining factors affecting critical care provision by midwives. A multi-method design incorporating a paper and pencil simulation (n = 11) and in-depth interviewing (n = 5) was conducted with midwives from a large London National Health Service Trust. This study details and discusses the findings. Findings indicated that frequency and type of critical illness experience impact upon midwives' critical care knowledge and skills. Midwives, especially those who were more junior, expressed anxiety regarding this aspect of practice, and considered the support of senior midwives, medical and nursing staff as crucial to effective client management. This study has yielded important insights into midwives' management of critical illness. Possible mechanisms to enhance the quality of service provision, and midwife support in this area are highlighted.

Roles for knowledge-based computer systems: Case studies in maternity care

The design of medical knowledge-based computer systems requires effective interdisciplinary communication for the development of a community sharing common goals and a common language for design. Over the past 9 years the Perinatal Research Group, an interdisciplinary team of computer scientists, engineers and clinicians, have developed a prototype knowledge-based computer system to aid clinicians in the care of women in labour. The group were uncertain which approach to adopt to progress this system from a prototype to a useful clinical tool to support decision making. A case study and activity theory analysis, of an existing clinical knowledge-based computer system in routine use, helped to resolve a number of communication and methodological issues that the design team encountered. Sharing of backgrounds and perspectives caused the design team to question previous assumptions and to explore alternative functions and roles for knowledge-based computer systems in maternity care. We are now undertaking a longitudinal case study and activity theory analysis of obstetric teams and women in labour to analyse the relationships between clinicians, patients and technology. This work will inform the development of our knowledge-based computer system to place the patient at the centre of the decision-making process.

Changes and challenges for women in academic obstetrics and gynecology

In obstetrics and gynecology, more than 60% of current residents and 36% of medical school faculty are women. However, fewer than 10% of professors and only a small number of department chairs and organizational leaders are women. This paper reviews the data on the growing number of women in obstetrics and gynecology, and in medicine in general, during the past 25 years. It reviews some of the challenges that women have faced and some strategies to enhance equitable opportunities. (Am J Obstet Gynecol 1999;180:837-48.)

Survival of departments of obstetrics and gynecology: Ten points for Association of Professors of Gynecology and Obstetrics action in the 1980s

Major changes have occurred in medicine during the past few years: the number of medical students who graduate per year has recently doubled, the federal government pays a significant portion of health care costs, and the body of scientific information is expanding logarithmically. The changes which will occur during the next 10 to 15 years will be equally dramatic, and in order for our specialty to increase its presence and position in medicine, it needs to begin to consider these changes and take actions to capitalize on them. Four areas of change were singled out and discussed in terms of their significance and possible plans of action to address them. The four include the increased numbers of women in obstetrics and gynecology, the demand for departments to generate more practice income, the reduced support for research, and the large numbers of physicans being trained in obstetrics and gynecology. Ten places for action by academic departments of obstetrics and gynecology were outlined, and these are listed in Table III. Continued review of the past and the present will allow us to be prepared for the future.