RESUMEN
The use of oxytocin for labor induction or augmentation in patients with previous cesarean delivery is controversial. This paper presents a series of 1776 patients allowed to labor after a previous cesarean section, of whom 485 (27%) were treated with oxytocin. When the patients who received oxytocin were compared with those who did not, no significant differences were found with respect to uterine rupture, maternal morbidity, fetal morbidity, or fetal mortality. We conclude that the judicious use of oxytocin is safe in the patient with a previous low transverse cesarean section.
Asunto(s)
Cesárea , Oxitocina , Esfuerzo de Parto , Ensayos Clínicos como Asunto , Femenino , Humanos , Mortalidad Infantil , Primer Periodo del Trabajo de Parto/efectos de los fármacos , Embarazo , Factores de Tiempo , Rotura Uterina/epidemiologíaRESUMEN
Development and use of a drug-use evaluation (DUE) program for hospital and outpatient facilities of a health-maintenance organization (HMO) are described. A full-time pharmacist coordinates the DUE program. Primary components of the DUE program are (1) establishment and use of drug therapy management protocols, (2) periodic review and evaluation of drug-use statistics by the pharmacy and therapeutics (P&T) committee, (3) monitoring of pharmacist interventions, and (4) evaluation of specific drug use within individual medical staff departments. Information from all DUE activities is channeled through the P&T committee and linked to the HMO's overall quality assurance program. The DUE program has the support of the HMO physicians. It has enhanced the quality of drug use and identified opportunities to further improve the quality of patient care. In surveys by the Joint Commission on Accreditation of Healthcare Organizations, the HMO facilities have received no recommendations. Pharmacists and physicians have cooperated to develop a comprehensive DUE program for an HMO.
Asunto(s)
Quimioterapia/normas , Sistemas Prepagos de Salud/normas , Servicio de Farmacia en Hospital/normas , Garantía de la Calidad de Atención de Salud/organización & administración , California , Protocolos Clínicos , Utilización de Medicamentos/estadística & datos numéricos , Hospitales con 100 a 299 Camas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Grupo de Atención al Paciente , Comité Farmacéutico y Terapéutico , Evaluación de Programas y Proyectos de Salud , Proyectos de InvestigaciónRESUMEN
The antenatal sonographic appearance of gastroschisis is described. The findings consist of numerous extra-abdominal "cystic masses" respresenting loops of fluid-filled bowel eviscerated through the abdominal defect. This patient also had associated polyhydramnios, possibly on the basis of a functional bowel abnormality.
Asunto(s)
Músculos Abdominales/anomalías , Hernia Ventral/diagnóstico , Diagnóstico Prenatal , Ultrasonografía , Femenino , Humanos , Recién Nacido , Masculino , EmbarazoRESUMEN
The cesarean section rate continues to rise, and, as new indications for the operation continue to be proposed, a method for safely decreasing the rate is truly needed. Less than 1% of patients in the United States are allowed a trial of labor after a cesarean section, in spite of the thousands of (safe) vaginal deliveries after cesarean section now reported in the literature. Few reports in the literature mention the use of oxytocin or regional anesthesia in these patients. We present our experience with 230 trials of labor after primary low transverse cesarean section. One hundred eighty-one patients (79%) were delivered vaginally, 73 patients (32%) received epidural anesthesia, and 94 patients (41%) received oxytocin augmentation of labor. Internal tocodynamic and fetal heart monitoring was used in all patients. Our rationale for this controversial management is discussed.