RESUMO
INTRODUCTION: Inappropriate request for laboratory tests is a challenging problem and an important cause for additional healthcare costs. Indeed, it may have further ambiguity for the clinicians. This study aimed to design an education-based program to reduce unnecessary laboratory testing orders and the associated costs. MATERIALS AND METHODS: In this interventional prospective study that took place in an educational hospital, the type and frequency of selected laboratory testing requested by gynecology, and obstetrics residents in the patients with gestational diabetes mellitus, preeclampsia, preterm labor, and premature preterm rupture of the membrane as well as cesarean section and normal vaginal delivery were analyzed periodically in a 1-year interval. At the same time, continuous educational supports and monitoring were performed. The results were compared before and after interventions. RESULTS: The educational intervention regardless of the etiologies of the admission, decreased the requested laboratory testing significantly (p < 0.001), except for CBC. Indeed, no near misses or delays in treatment were observed. Cost analysis showed a 31.3% reduction of expenses per inpatient day due to the decrease in the number of daily laboratory testing ordered. CONCLUSIONS: Appropriate education and continuous monitoring of the residents could reduce the unrequired laboratory testing as well as healthcare costs.
Assuntos
Técnicas de Laboratório Clínico/economia , Parto Obstétrico , Custos de Cuidados de Saúde , Gravidez de Alto Risco/fisiologia , Adulto , Feminino , Humanos , GravidezRESUMO
OBJECTIVE: Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal-directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non-invasive (NICOM®) devices, and to assess agreement between the two devices in measuring CO. METHODS: Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland-Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles. RESULTS: From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from -1.58 (95% CI, -4.47 to -0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. CONCLUSIONS: There are large mean differences between CO measurements obtained during Cesarean section using the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Débito Cardíaco/fisiologia , Cesárea/estatística & dados numéricos , Gravidez de Alto Risco/fisiologia , Adulto , Feminino , Idade Gestacional , Hemodinâmica/fisiologia , Hemorragia/complicações , Humanos , Monitorização Intraoperatória/instrumentação , Monitorização Fisiológica , Gravidez , Estudos ProspectivosAssuntos
Doença , Cuidado Pré-Concepcional , Gravidez de Alto Risco , Gravidez/psicologia , Efeitos Psicossociais da Doença , Aconselhamento , Doença/psicologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Exposição Materna/efeitos adversos , Papel do Médico/psicologia , Gravidez/fisiologia , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/etiologia , Gravidez de Alto Risco/fisiologia , Gravidez de Alto Risco/psicologia , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/etiologia , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Fatores de Risco , Consentimento do Representante Legal/éticaRESUMO
OBJECTIVE: To compare antenatal and obstetric costs for multiple pregnancy versus singleton pregnancy risk groups and to identify factors driving cost differentials. DESIGN: Observational study over 15 months (2001-02). SETTING: Four district hospitals in southeast England. POPULATION: Consecutive women with multiple pregnancy and singleton women with risk factors for fetal congenital heart disease (CHD) (pregestational diabetes, epilepsy, or family history of CHD) or Down syndrome, and a sample of low-risk singleton women. METHODS: Clinical care was audited from the second trimester anomaly scan until postnatal discharge, and the resource items were costed. Multiple regression analysis determined predictors of costs. MAIN OUTCOME MEASURES: NHS mean costs of antenatal and obstetric care for different types of pregnancy. RESULTS: A total of 959 pregnancies were studied. Three percent of 243 women with multiple pregnancy reached 40 weeks of gestation compared with 54-55% of 163 low-risk and 322 Down syndrome risk women and 36% of 231 cardiac risk women. Antenatal costs for cardiac risk (1,153 pounds sterling) and multiple pregnancy (1,048 pounds sterling) were nearly double the costs for other two groups (P < 0.001). As 63% of multiple births were delivered by caesarean section, the obstetric cost for multiple pregnancy (3,393 pounds sterling) was 1,000 pounds sterling greater overall. Pregestational diabetes was the most influential factor driving singleton costs, resulting in similar total costs for multiple pregnancy women (4,442 pounds sterling) and for women with diabetes (4,877 pounds sterling). CONCLUSIONS: Our analyses confirm that multiple pregnancies are substantially more costly than most singleton pregnancies. Identifying women with diabetes as equally costly is pertinent because of the findings of the Confidential Enquiry into Maternal and Child Health that standards of maternal care for diabetics often are inadequate.
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Serviços de Saúde Materna/economia , Gravidez Múltipla , Cuidado Pré-Natal/economia , Cesárea/economia , Custos e Análise de Custo , Síndrome de Down/economia , Inglaterra , Epilepsia/economia , Feminino , Recursos em Saúde/economia , Cardiopatias Congênitas/economia , Humanos , Paridade , Gravidez , Resultado da Gravidez , Gravidez em Diabéticas/economia , Gravidez de Alto Risco/fisiologia , Medicina Estatal/economiaAssuntos
Idade Materna , Obstetrícia/métodos , Gravidez de Alto Risco/fisiologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Doenças Genéticas Inatas/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Infertilidade/terapia , Masculino , Enfermagem Obstétrica/métodos , Cuidado Pré-Concepcional/métodos , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess (1) pulmonary artery and peripheral pulmonary blood flow by using a multigate spectral Doppler system and standard pulsed color Doppler ultrasonography and (2) the reproducibility of peripheral pulmonary artery blood flow velocity waveforms. METHODS: Thirty-three women were enrolled in the study Fetal pulmonary artery flow velocity waveforms were investigated by multigate spectral Doppler scanning and traditional pulsed Doppler ultrasonography plus color flow mapping. To establish the relationship between these 2 methods, we calculated the correlation coefficient, coefficient of variation, and limits of agreement. RESULTS: The 2 methods were not significantly correlated. The range of measurement agreement for these 2 methods suggests that there is a significant difference between the main and peripheral pulmonary artery blood flow, and the difference should be taken into account in the interpretation of Doppler flow velocity studies of the pulmonary artery. CONCLUSIONS: Multigate spectral Doppler scanning with power Doppler imaging may be a better way to assess the average flow impedance in a highly vascularized organ. This technique supplies a large number of Doppler signals in the region of interest and offers a quantified range of Doppler measurements, improving our understanding of fetal hemodynamics.
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Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar/fisiologia , Ultrassonografia Doppler de Pulso , Ultrassonografia Doppler , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Gravidez de Alto Risco/fisiologia , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Apresenta o que é a gestação de alto risco e como as mulheres podem e devem se cuidar nesses casos. Cita os fatores que podem complicar uma gravidez, os sinais de alerta e as situações que merecem cuidados especiais durante toda o período gestacional. Mostra a importância do pré-natal, a necessidade de uma alimentação balanceada e os perigos do tabagismo, do alcoolismo e do uso de outras drogas na gravidez. Alerta sobre a pressão alta, que é uma das principais causas de morte e complicações durante a gestação
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Humanos , Feminino , Gravidez , Saúde da Mulher , Gravidez de Alto Risco/fisiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/métodos , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/diagnóstico , Hipertensão Induzida pela Gravidez/prevenção & controleAssuntos
Anestesia Obstétrica , Obesidade Mórbida/fisiopatologia , Complicações na Gravidez/fisiopatologia , Gravidez de Alto Risco , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Anestesia Obstétrica/efeitos adversos , Anestesia Obstétrica/métodos , Cesárea , Feminino , Humanos , Mortalidade Materna , Auditoria Médica , Guias de Prática Clínica como Assunto , Gravidez , Gravidez de Alto Risco/fisiologia , Medição de Risco , Fatores de Risco , Gestão de RiscosRESUMO
Documento que propicia la comunicación entre la familia en asuntos de salud. Es una recopilación de los artículos que aparecían en el Semanario Gente que servirán a la población de guía y vademecum para resolver y prevenir los priblemas de salud, con consejos sirigidos a toda la familia.
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Feminino , Masculino , Humanos , Anticoncepção/métodos , Preservativos/estatística & dados numéricos , Neoplasias dos Genitais Femininos/fisiopatologia , Ginecologia/educação , Mortalidade Materna/tendências , Política de Saúde/tendências , Gravidez de Alto Risco/fisiologia , Gravidez/fisiologia , Medicina Reprodutiva/educação , Violência/psicologia , Violência Doméstica/tendências , Direitos da Mulher/provisão & distribuiçãoRESUMO
The French system of antenatal care, based on financial incentive, recommends 7 antenatal visits for all pregnancies. Would fewer visits increase perinatal risk? The higher risk of low birthweight and perinatal mortality in women with little or no antenatal care is a well-known observation but data are certainly biased by socioeconomic and environmental conditions. In Western populations, for example, very high risk pregnancies are certainly under-represented in the little or no care comparison groups. Even if the effects of antenatal care may be underestimated, it is highly unlikely that extremely massive risks would be associated with few or no antenatal visits since even in the most favourable conditions, antenatal examinations cannot detect all the possible anomalies which can occur during pregnancy and available means of avoiding perinatal mortality are not perfect. The debate now focuses on optimal antenatal care. Are the 7 visits in France adequate? At present, are there risks of over-medicalization and excessive medical cost? Some answers to these questions may be forth coming from research projects. The perinatal plan, begun in France in 1994, will also provide recommendations for improving the quality of antenatal care.