妇产科住院医师培训的量化考核

目的 为强化妇产科住院医师的培训和管理，提高其综合医学素质。方法 针对住院医师存在的主要弱点，制订培训考核细则，进行量化考核。结果 经过1年的努力，甲级病案率和发表论文的数量明显增加；安全医疗状况有所改善；考核性查房的成绩和优质手术率无明显改善。结论 量化考核比较客观、公正、促进了住院医师综合综合素质的提高。     

新生儿窒息产科相关因素分析

目的:探讨新生儿窒息的产科相关因素及防治措施。方法:回顾性分析2009年1月至2010年11月期间115例新生儿窒息的产科资料,采用社会统计学软件SPSS13进行方差分析。结果:①脐带因素和母亲有妊娠合并症式并发症为窒息的主要原因,分别占21.7%和20.87%;母亲妊娠合并症或早产为重度窒息主要原因。②自然分娩与剖宫产的新生儿窒息发病率无显著性差异,臀助产和产钳助产的窒息发病率明显高于前两者(P<0.05)。结论:积极治疗妊娠合并症和并发症,加强孕期保健及产时监护,正确选择分娩方式,提高接产技术,可降低新生儿窒息的发生率。     

Influence of Resident Involvement in Obstetrics and Gynaecology Surgery on Surgical Outcomes: Systematic Review and Meta-Analysis

Objective

The effect of resident involvement during obstetrics and gynaecology (OB/GYN) surgery on surgical outcomes is unclear. This study sought to review the evidence systematically for the influence of resident participation in OB/GYN surgery on (1) operative time, (2) estimated blood loss, and (3) perioperative complications.

Management of HIV in pregnancy

A cohesive multidisciplinary team approach is key in the management of HIV in pregnancy. The primary aim is to prevent transmission to the neonate but also to support the mother in any issues arising from her pre-existing, or new, diagnosis of HIV. Specialist advice should be sought, wherever possible.Key areas discussed in this review include antenatal management of the mother (particularly pharmacological management), obstetric management, pharmacological treatment for the neonate and infant feeding. Due to progress made in both in HIV testing, and in the way all patients with HIV in the UK are managed over the last few decades, most women who present with HIV in pregnancy are aware of their diagnosis and on treatment. However, it is not entirely uncommon for women to be diagnosed in pregnancy and it is these cases that present the greater challenge. The cases in this review cover the most common scenarios encountered.     

Linear association between maternal age and spontaneous breech presentation in singleton pregnancies after 32 weeks gestation

Purpose: To investigate the association between maternal age and spontaneous breech presentation.

Material and methods: Fifteen-year observational study over (2001–2015). All consecutive singleton births delivered at the Centre Hospitalier Universitaire Sud Reunion’s maternity. The only single exclusion criterion was uterine malformations (N?=?123) women.

Results: Of the 60,963 singleton births, there was a linear association (χ² for linear trend, p2 for linear trend?=?64, p?p?Conclusion: Maternal age (x) is an independent factor for breech presentation in singleton pregnancies after 32 weeks gestation with a linear association that may be approximated at y?=?0.1x. (y: incidence, percent).     

Foley catheter versus intravaginal prostaglandins E2 for cervical ripening in women at term with an unfavorable cervix: a randomized controlled trial

Objective: The objective of this study is to compare the efficacy of labor induction by Foley catheter balloon (FCB) insertion to intravaginal dinoprostone tablet placement in women with an unfavorable cervix.

Materials and methods: A prospective randomized controlled trial was conducted. Women were assigned to insertion of a FCB or placement of a vaginal dinoprostone tablets and their outcome were compared.

Results: The study comprised 300 women. The time to active labor was significantly shorter in the FCB compared with the dinoprostone group, but required more oxytocin administration. A lower rate of cesarean section was found only in nulliparous women in the FCB group. The neonatal outcome was favorable and similar in both groups.

Conclusion: Both methods had similar results regarding achieving vaginal delivery within 24?h and cesarean section rate. For nulliparous women, the FCB induction method had the advantage of a shorter time to active labor and a lower rate of cesarean section.     

Birth plans—Impact on mode of delivery,obstetrical interventions,and birth experience satisfaction: A prospective cohort study

Objective

To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.

Methods

This was a prospective cohort study of singleton pregnancies greater than 34 weeks’ gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi‐squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.

Results

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61‐2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

Conclusion

Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth‐related patient satisfaction.