Obstetric Training for Rural General Practice

In the current debate on the problems faced by rural doctors, lack of training in procedural disciplines such as obstetrics has emerged as a priority issue. With specialist obstetric services concentrated in metropolitan and major provincial cities, general practitioners will continue to provide rural communities with obstetric care. Postgraduate obstetric training programmes for general practitioners must provide procedural skills training for intending rural practitioners or risk being regarded as irrelevant to the needs of rural communities.     

Education for the Management of Obstetric Conditions in Rural General Practice

EDITORIAL COMMENT": The Editorial Subcommittee of this journal agreed to publish this important curriculum statement for advanced obstetric training for rural general practitioners partly because we thought that general practitioner obstetricians who comprise more than half of our 5,000 subscribers will be interested to read this document carefully if for no other reason than to check their own clinical abilities in the various sections provided.     

Extended Role of the Nurse Practitioner In Obstetric and Gynecologic Practice at Hartford Hospital

Documented here, in eight short articles, are the inception, development, practice and progress of a successful nurse practitioner program in obstetrics and gynecology at Hartford Hospital, Hartford, Connecticut. Together, the presentations represent the perspectives of all key hospital personnel involved with the program: administration, physicians, instructors, administrative nurses and the practitioners themselves. They were delivered at a Correlated Seminar for the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists in May, 1912.     

Hysterectomy in Obstetric Practice

A 9-year review (1971-1979) is presented of patients undergoing hysterectomy in the course of pregnancy. The incidence was 1 in 1,044 pregnancies (34 in 35,506). The principal indications were ruptured uterus (9), postpartum haemorrhage (8), placenta accreta (5) and neoplastic trophoblastic disease (4). In spite of the high incidence of hysterectomy in our community, the procedure was undertaken during pregnancy with great reluctance and usually only as a life-saving procedure.     

Neuroleptanalgesia in Obstetric Practice

When general anaesthesia has been required it has been our experience that the obstetric patient is often nervous and apprehensive. In addition, the use of atropine alone, while necessary, has tended to aggravate the patient's discomfort by producing an uncomfortably dry mouth and, occasionally, disturbing palpitations. Similarly, with regional anaesthesia there are many patients in whom anxiety is present, particularly if there has been any technical difficulty with the procedure.     

Racial Variations in Obstetric Practice

This study involves a retrospective analysis of 453 pregnant persons, with the aim of comparing certain disorders of pregnancy as well as infant and placental parameters in various racial groups within the same community. Significant variations were seen in the mean age of the patients, age at first pregnancy, frequency distribution of first pregnancy, infant weight as well as gravida: parity ratio. There was a 3-fold increase in incidence of preeclampsia in the Australian-born population compared to other racial groups. Mild anaemias (haemoglobin less than 11.5 g/dl) were found in up to 61% of the Australian-born population compared to 32% of the other racial groups; however, more significant degrees of anaemia were more commonly found in certain ethnic groups (e.g. Greek 16%, Italian 15%, Australian-born 6%). These studies emphasize that overall incidence studies in a polyglot population can have very limited meaning, and that greater attention must be paid to the actual racial variations within a population.     

Anesthesia Drugs in the Obstetric and Gynecologic Practice

The obstetrician-gynecologist is often solely responsible for analgesia/sedation and regional blocks during office-based and outpatient procedures. The American Society of Anesthesiologists guidelines for the provision of analgesia/sedation for nonanesthesiologists provide helpful recommendations to maximize patient safety during office-based and outpatient procedures. This article provides a review of the fundamentals of sedation/analgesia, monitored anesthesia care, and local anesthetics.Key words: Sedation/analgesia, Monitored anesthesia care, Lipid rescue, Local anesthetic toxicity, Maximum dose recommendationsAnalgesic techniques for obstetric and gynecologic patients include local infiltration and regional blocks with or without sedation, parenteral agents and neuraxial blockade during labor, and general anesthesia for more extensive surgeries and, occasionally, for cesarean deliveries. Although the American College of Obstetricians and Gynecologists (ACOG) and the American Society of Anesthesiologists (ASA) have established goals to ensure prompt provision of anesthetic services in all hospitals providing obstetric care, ensuring such services remains a challenge, particularly in smaller hospitals or in rural locations.¹ As a result, anesthesia expertise may not be available for routine labor management and, rarely, during emergency cesarean deliveries. In addition, the obstetrician-gynecologist (ob-gyn) is often solely or primarily responsible (in conjunction with nursing staff) for analgesia and sedation during office-based or outpatient procedures. This article provides a review of the fundamentals of sedation/analgesia, monitored anesthesia care (MAC), and local anesthetics.     

Changes in Obstetric Practice in Our Time

In the years since 1939 there has been a marked change in the nature and results of obstetric practice at the Royal Women's Hospital, Melbourne. The noteworthy changes have been a reduction in the number of maternal deaths (from 12.2 per 1,000 in the 1940's to 0.2 per 1,000 in the 1980's), especially those due to septic abortion, and an increase in the Caesarean section rate (from 2% to 14%). The increase in the operative delivery rate has been matched by a decrease in mortality in patients thus delivered, the maternal and perinatal mortality rates changing from 5.5 and 88.9 per 1,000 to 0 and 7.6 per 1,000 respectively in the case of forceps delivery and from 24.7 and 162.5 per 1,000 to 0.15 and 10.6 per 1,000 respectively in the case of Caesarean delivery.     

Nurse Practitioner Acceptance in Private Ob/Gyn Practice

One of the ways to help meet consumer demands is by utilizing nurse practitioners in private Ob/Gyn practices. To determine consumer satisfaction with a nurse practitioner in one such practice, patients were asked to fill out a response sheet after their examination by the nurse practitioner. The 86 patients felt they received a good medical examination and would be willing to see the nurse practitioner on future visits. The physician and nurse practitioner found this change in delivery of health care to be a positive experience for both patient and professional.     

The Place of the Vacuum Extractor in Obstetric Practice

Although the vacuum extractor is now employed in most obstetric units, the indications for its use and its complications still give cause for some controversy.
In the present paper, the results for the 5-year period 1962–66 are presented.     

The Cooperative Roles of the Physician and Nurse in Obstetric Practice

The personal experiences of cooperation between physician and nurses are discussed. The author looks forward to a more general realization of the ideal of collegiality between physicians and nurses, with the resultant improvement in maternal-child care.     

A Review of Obstetric Practice in Hobart Over 25 Years

Summary: A study is presented of broad trends in obstetric practice in Hobart during the past 25 years. It is anticipated that the information presented may be useful for reference purposes in other epidemiological studies involving any or all of the parameters assessed.