Management of labor during registrarship: A prospective study during a two-year registrarship program.

AIM: Labor management is often considered to be stressful. Increases in cesarean section (CSD) and assisted vaginal (AVD) deliveries rates have been ascribed to inexperience. To address this issue, we observed the obstetric management activity of four obstetrics and gynecology registrars throughout their 2-year registrarship program. METHODS: We performed a prospective, observational study of urgent and semi-/nonurgent CSD and AVD in a tertiary maternity unit. The registrars' obstetric management was compared with that of a referral group. Changes over time in the registrars' practice were also monitored. RESULTS: A total of 4328 deliveries (including 670 CSD and 736 AVD) were analyzed. The registrars and the experienced obstetricians managed 2930 and 1398 deliveries, respectively, with similar neonatal outcomes. There were no intergroup differences in either total CSD percentage (455 [15.5%] and 215 [15.4%] for registrars and experienced practitioners, respectively, P = 0.90) or AVD percentage (478 [16.3%] and 258 [18.5%], respectively, P = 0.08), or according to degree of urgency. Rates did not change over the course of the registrarship program, regardless of degree of urgency. CONCLUSION: Lower degree of experience was not associated with elevated CSD or AVD rates. Skills required to appropriately manage an obstetric ward seemed to have been acquired at the end of residency.

Efficacy and aesthetic outcomes for quilting sutures in the prevention of seroma after mastectomy.

Worldwide, mastectomy for breast cancer is one of the most frequently performed surgical procedures. As one of the main complications of mastectomy, seroma is associated with pain, infections and a prolonged hospital stay. We performed a prospective multicenter randomized trial to assess the efficacy and esthetic outcomes associated with quilting the skin flap. Eighty-seven patients were included. The proportion of patients with seroma on postoperative day 15 was significantly lower in the quilting group (12 out of 39 (30.8%)) than in a control group with conventional wound closure (21 out of 40 (52.5%); P = 0.05). The mean breast seroma volume was significantly lower in the quilting group (130.2 mL) than in the control group (236.8 mL; P = 0.02). There were no differences in the esthetic outcomes. The pain level on day 1 was similar in the quilting and control groups (mean visual analog scale score: 2.5 vs. 2.1, respectively; P = 0.3). Quilting the skin flap was associated with a lower prevalence of seroma and a lower seroma volume, and did not worsen the esthetic outcomes or pain levels. This technique is technically straightforward and should be offered to all patients scheduled for mastectomy.