Physician Response to Prenatal Substance Exposure

Objectives: To examine physician responses to suspected prenatal substance exposure and the reasons underlying these responses. Methods: National mail survey of practicing obstetricians and pediatricians who see neonates. Response rate: 63%. Results: More than 70% of physicians reported having ever suspected prenatal substance exposure. Response rates did not vary by specialty. Twenty-seven percent reported that they had never suspected prenatal substance exposure. The most common lifetime pattern (60%) was some response whenever prenatal substance exposure was suspected; next most common was no suspicion (27%). Just over 10% had a discretionary response: acting in some cases of suspected prenatal substance exposure but ignoring others. Two percent consistently ignored their suspicions. Getting help for the patient and protecting the fetus were the most common reasons to act. Among those who had ignored their suspicions, lack of sufficient evidence of substance use was the most often cited reason. There were some important specialty differences in reasons for response and non-response and in specific responses likely to be taken. Obstetricians are far more likely to provide the patient with information and get a substance use history; pediatricians are more inclined to involve outsiders. Conclusions: Obstetricians and pediatricians seem quite willing to act on their suspicions of prenatal substance exposure, and generally respond by taking positive actions. Specialty differences are few and reflect practice differences.     

产科医师应重视主要诊断的选择和书写

产科主要诊断的选择和书写是有一定的原则的。正确选择和书写产科主要诊断不仅能反映出医师的业务素养,而且也是国际疾病分类的基础,同时也是医保病人医疗费用合理支付的依据,关系到医院和患者的双重利益。所以,产科医师对主要诊断的正确选择和书写应引起足够的重视,并要有充分的认识。文章论述了产科主要诊断的概念,产科主要诊断的选择和书写原则,正确书写主要诊断的意义,正确书写主要诊断的措施。     

精神科医师与产科医师对产后忧郁症识别情况及治疗效果调查

目的了解精神科和产科医师对产后抑郁症的识别情况及对产后抑郁症的治疗效果，为制定精神卫生服务政策提供相关依据。方法收集来自精神科、产科门诊中的产后抑郁症患者47例，分为专科医师组20例和产科医师组27例，在入组时、治疗第2周、第4周、第8周、第12周时，进行汉密顿抑郁量表24项（HAMD24）、汉密顿焦虑量表（HAMA）、健康状况调查问卷（SF-36）、修订社会功能缺陷筛选量表（SDSS）、自编的药物依从性评估等量表评定。结果（1）精神科门诊中专科医师对抑郁症的识别显著高于产科医师组（P〈0．01）。（2）专科医师组对产后抑郁症的治疗效果优于产科医师组（P〈0．01），两者在治疗后第8周及第12周HAMD、HAMA总分减分率有显著性差异。（3）两组在治疗第12周时SF-36各因子分均较入组时有显著提高（P〈0．01）。结论精神科门诊中专科医师在对抑郁症的识别、治疗效果上优于产科医师；产科医师对产后抑郁症的识别及诊治能力有待进一步提高，相关的卫生管理体系作用需要进一步加强。     

Psychological impact of stillbirths on obstetricians

Abstract

Objective: To assess the psychological impact on US obstetricians when they care for women who have suffered a stillbirth and explore whether demographic (e.g. age, gender) and practice (e.g. number of patients, practice type) variables were related to the extent of psychological impact for obstetricians following stillbirth.

Methods: Using a questionnaire that could be completed in about 20?min, we surveyed 1000 American College of Obstetricians and Gynecologists (ACOG) members. Physicians were asked about how stillbirths have affected them personally.

Results: Half of those surveyed responded (499) and of those 365 currently practiced obstetrics. Virtually all obstetricians have looked after women who have had a stillbirth. Grief was the most common reaction experienced with 53.7% reporting that they personally “very much” experienced grief. Other common and significant reactions were self-doubt (17.2%), depression (16.9%) and self-blame (16.4%). Significant psychological impact on the obstetrician was associated with older age, solo practice, higher volume practices and higher proportion of Medicaid patients; gender was not found to be associated with psychological impact when controlling for age. Further, greater self-reported performance and training regarding maternal and family counseling, management of stillbirth, and knowledge of stillbirth evaluation was associated with greater levels of grief.

Conclusion: Physician grief is a common reaction among obstetricians after caring for a patient who has had a stillbirth.     

Sexual violence and the obstetrician/gynecologist.

Sexual violence is a pathological entity that requires urgent attention. The gynecologist/obstetrician (G/O), as a medical professional in charge of women's health, especially as it pertains to women's reproductive organs, should become an active agent in the management of the sociomedical processes that constitute sexual violence. The results of a survey conducted in Mexico on the opinions and practices of G/Os regarding violence against women--especially sexual violence--are reported. It is necessary to sensitize and train G/Os and other physicians in bio-ethics, and to look for formal support of such activities in the legislative branch of government.     

Effects of obstetrician characteristics on cesarean delivery rates: A community hospital experience

Objective: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians’ rates. This study evaluated obstetricians’ characteristics to determine whether they affected cesarean delivery rates. Study Design: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians’ cesarean delivery rates: group 1 had a low rate (≤15%) and group 2 had a high rate (>15%). Pearson χ² analysis was used to evaluate the differences between the proportions. P < .05 was considered significant. Results: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P < .0001), whereas individual obstetricians’ rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P < .0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. Conclusions: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians’ commitment facilitates lowering of cesarean delivery rates. (Am J Obstet Gynecol 1999;180:1364-72.)