Obstetrics and gynecology
-
Obstetrics and gynecology · Nov 2006
Patient safety in obstetrics and gynecology: an agenda for the future.
The effect of medical errors and unsafe systems of care has had a profound effect on the practice of obstetrics and gynecology. From 1975 to 2000, medical malpractice costs for obstetrician-gynecologists have risen nearly four-fold higher than that of other medical costs. In addition, it has been estimated that defensive medicine may cost society $80 billion per year. ⋯ This article discusses other medical specialty society efforts that have been successful in addressing the area of patient safety. Efforts to better track quality outcomes has been initiated by the American College of Surgeons through the National Surgical Quality Improvement Project, and the American Society of Anesthesiologists has demonstrated both dramatically improved outcomes and reduced liability costs through a concerted patient safety effort. The author proposes changes in four areas to specifically address patient safety in obstetrics and gynecology, including: the development of reliable and reproducible quality control measures (and a system to track them); national closed claim reviews to better understand and address the most important safety and liability areas for obstetrician-gynecologists; work prospectively with pharmaceutical and surgical device manufacturers to develop innovative new products that would increase the likelihood of safe outcomes; and create a culture of safety in obstetrics and gynecology by incorporating safety education into all levels of training.
-
Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. ⋯ Similarly, abruption at extremely preterm gestations may be managed conservatively in selected stable cases, with close monitoring and rapid delivery should deterioration occur. Most cases of placental abruption cannot be predicted or prevented. However, in some cases, maternal and infant outcomes can be optimized through attention to the risks and benefits of conservative management, ongoing evaluation of fetal and maternal well-being, and through expeditious delivery where appropriate.
-
Obstetrics and gynecology · Oct 2006
Randomized Controlled TrialBotulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial.
To estimate whether botulinum toxin type A is more effective than placebo at reducing pain and pelvic floor pressure in women with chronic pelvic pain and pelvic floor muscle spasm. ⋯ Australian Clinical Trials Registry, http://www.actr.org.au/, ACTRN012605000515695 LEVEL OF EVIDENCE: I.
-
To evaluate risks for intraoperative or postoperative packed red blood cell transfusion in women who underwent cesarean delivery. ⋯ II-2.
-
Obstetrics and gynecology · Oct 2006
Multicenter StudyFetal injury associated with cesarean delivery.
To describe the incidence and type of fetal injury identified in women undergoing cesarean delivery. ⋯ II-3.