Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Oct 2005
[The Millennium project of the United Nations, particularly the worldwide reduction of childhood and maternal mortality].
This year (2005) marks a pivotal moment in the achievement of the so-called Millennium Development Goals (MDGs) of the United Nations. This article pays attention to 2 of the 8 MDGs, namely those pertaining to childhood and maternal mortality. A number of aspects are of crucial importance to the reduction of childhood and maternal mortality: reduction of the number of (unwanted) pregnancies, worldwide access for women to high-quality healthcare services including prenatal care, care during delivery and postnatal care, and improvement of the referral systems. The impact of the HIV/AIDS epidemic on the outcome of pregnancy is discussed separately.
-
Elderly patients have an increased probability of dying after treatment in an intensive care unit (ICU), compared with younger patients. The risk of dying is largely determined by the admission type (patients with planned admissions have a better prognosis than those with unplanned admissions), severity of illness and functional status prior to admission. Elderly patients surviving ICU often experience a decline in functional status. ⋯ Elderly patients do not necessarily prefer life-sustaining treatment to palliative care. The willingness to undergo ICU treatment depends on the likelihood of survival and beneficial functional outcome. New prognostic models should be developed specifically to predict both survival and functional outcome in individual elderly patients after admission to ICU.
-
The increase in incidence of Caesarean sections in the Netherlands has resulted in improved infant outcomes in breech infants. About two hundred extra caesarean sections are needed to 'save' one baby. ⋯ These factors have to be taken into account when counselling women. Future reproductive considerations and the motivation of the woman and the gynaecologist for a vaginal breech delivery should be discussed during counselling.