Best practice & research. Clinical obstetrics & gynaecology
-
Best Pract Res Clin Obstet Gynaecol · Feb 2011
ReviewInsulin during pregnancy, labour and delivery.
Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. ⋯ Continuous glucose monitoring can offer better insights into the glycaemic profile than self-monitoring of blood glucose levels by the patients but the place of these new monitoring techniques has yet to be established more clearly. Insulin therapy during labour means short-acting insulin adjusted to achieve glucose levels between 4 and 8 mmol l(-1) to prevent neonatal hypoglycaemia as much as possible. After delivery, glycaemic control must be relaxed to prevent hypoglycaemia, especially in women who breastfeed.
-
An epidemic of obesity is affecting growing numbers of women in their childbearing years increasing their risk of obstetric complications including diabetes, hypertension, pre-eclampsia, some malformations, macrosomia and the need for obstetric intervention. There is growing evidence that maternal obesity may increase the risk of obesity and diabetes in the offspring. ⋯ Limiting gestational weight gain to 5-9 kg among pregnant obese women is likely to improve obstetric outcomes, but how to achieve this remains an active area of research. If gestational diabetes develops, there is good evidence that clinical management reduces the risk of adverse pregnancy outcomes.
-
Best Pract Res Clin Obstet Gynaecol · Dec 2010
Training and assessment in obstetrics: the role of simulation.
Simulation is becoming an integral part of the training and assessment of obstetricians. Given the variety of manual skills that must be learned, awake patients and high-risk environment, obstetrics is uniquely suited for simulation. Simulation provides opportunities to rehearse and learn from mistakes without risks to patients. ⋯ Basic and advanced skills as well as the management of obstetric emergencies are amenable to simulation. For a simulation programme to be successful, one must identify the learner and the skills that are to be learned. In the future, simulation will be more available and realistic and will be used not only for education, but also for ongoing assessment of providers.
-
Best Pract Res Clin Obstet Gynaecol · Dec 2010
Evaluating the utility of workplace-based assessment tools for speciality training.
Workplace assessment has been incorporated into speciality training in the UK following changes in the training and work patterns within the National Health Service (NHS). There are various types of assessment tools that have been adopted to assess the clinical competence of trainees. ⋯ This review provides a theoretical background of workplace assessment and the educational framework that may be adopted to evaluate their effectiveness. It summarises current evidence for the utility of these tools with regard to reliability, validity, acceptability, educational impact and cost.
-
Best Pract Res Clin Obstet Gynaecol · Dec 2010
Training and assessment in gynaecologic surgery: the role of simulation.
The paradigm of surgical education is changing. Surgical residencies are now required to have skills laboratories so that varying degrees of surgical training and skills acquisition can occur outside of the operating room. There is mounting evidence that surgeons can learn many fundamental skills and specific procedures with simulators. ⋯ Less-expensive models are often as effective for training as low-fidelity models. Developing an effective surgical simulation programme requires a commitment to the concept and finding the time and space. Most importantly, it requires desire on the part of the trainees to devote the hours of practise needed to make themselves accomplished surgeons.