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4.
Ultraschall Med ; 41(2): 120-137, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32259863

RESUMEN

In the last decades, abnormal placentation and umbilical cord insertion have become an increasingly relevant and feared pathology in obstetrics with increased morbidity and mortality for mother and child. In addition to several increasingly common risk factors, such as assisted reproduction, the main reason for the increased occurrence is the greater frequency of Cesarean sections. Correct diagnosis, which is primarily determined sonographically, is essential for targeted perinatal management. In particular, the diagnostic criteria and current management recommendations are described in the following article.


Asunto(s)
Obstetricia , Placentación , Cesárea , Niño , Femenino , Humanos , Embarazo , Factores de Riesgo , Cordón Umbilical
5.
Int J Gynaecol Obstet ; 149(3): 377-378, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32267531

RESUMEN

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Infecciones por Coronavirus , Asignación de Recursos para la Atención de Salud , Maternidades/normas , Obstetricia/normas , Pandemias , Atención al Paciente/normas , Neumonía Viral , Instituciones de Atención Ambulatoria/organización & administración , Femenino , Asignación de Recursos para la Atención de Salud/organización & administración , Asignación de Recursos para la Atención de Salud/normas , Maternidades/organización & administración , Hospitales Especializados/organización & administración , Hospitales Especializados/normas , Humanos , Italia , Equipo de Protección Personal/provisión & distribución , Embarazo
6.
Med Hist ; 64(2): 173-194, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32284633

RESUMEN

This article examines female sterilisation practices in early twentieth-century Rio de Janeiro, Brazil. It argues that the medical profession, particularly obstetricians and psychiatrists, used debates over the issue to solidify its moral and political standing during two political moments of Brazilian history: when the Brazilian government separated church and state in the 1890s and when Getúlio Vargas's authoritarian regime of the late 1930s renewed alliances with the Catholic church. Shifting notions of gender, race, and heredity further shaped these debates. In the late nineteenth century, a unified medical profession believed that female sterilisation caused psychiatric degeneration in women. By the 1930s, however, the arrival of eugenics caused a divergence amongst physicians. Psychiatrists began supporting eugenic sterilisation to prevent degeneration - both psychiatric and racial. Obstetricians, while arguing that sterilisation no longer caused mental disturbances in women, rejected it as a eugenic practice in regard to race. For obstetricians, the separation of sex from motherhood was more dangerous than any racial 'impurities', both phenotypical and psychiatric. At the same time, a revitalised Brazilian Catholic church rejected eugenics and sterilisation point blank, and its renewed ties with the Vargas regime blocked the medical implementation of any eugenic sterilisation laws. Brazilian women, nonetheless, continued to access the procedure, regardless of the surrounding legal and medical proscriptions.


Asunto(s)
Catolicismo/historia , Eugenesia/historia , Obstetricia/historia , Médicos/historia , Religión y Medicina , Esterilización Reproductiva/historia , Brasil , Eugenesia/legislación & jurisprudencia , Femenino , Identidad de Género , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Trastornos Mentales/etiología , Trastornos Mentales/historia , Rol del Médico/historia , Médicos/ética , Sistemas Políticos/historia , Psiquiatría/historia , Caracteres Sexuales , Esterilización Reproductiva/ética , Esterilización Reproductiva/legislación & jurisprudencia , Esterilización Reproductiva/psicología
7.
J Assoc Physicians India ; 68(3): 14-18, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138476

RESUMEN

Aim: : Appropriate calculation of sample size and choosing the correct sampling technique are of paramount importance to produce studies that are capable of drawing clinically relevant conclusions with generalizability of results. The current study was planned with an objective to determine reporting of sample size and sampling considerations in clinical research articles published in the year 2017. Methods: One high impact factor journal and one low impact factor journal belonging to the specialities of Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics and Pharmacology were selected and checked for adherence to reporting of sample size and sampling considerations. Results: A total of 264 articles were examined. These consisted of 55 interventional studies and 209 observational studies. Interventional studies showed higher reporting of sample size calculation/justification for sample size selection (29.1%) compared to observational studies (14.8%). Only 33 out of 155 articles from high impact factor journals and 14 out of 109 articles from low impact factor journals mentioned about sample size calculation or justified the sample size. In addition to this, merely 68 out of 209 observational studies mentioned about sampling considerations such as sampling technique/participant follow up/matching details. Conclusion: The reporting of sample size and sampling considerations was found to be low in both high impact factor and low impact factor journals. Though interventional studies had better reporting compared to other study designs, the reporting was still not adequate and there is an immense scope for improvement.


Asunto(s)
Periodismo Médico , Publicaciones Periódicas como Asunto , Publicaciones , Niño , Humanos , Factor de Impacto de la Revista , Obstetricia , Proyectos de Investigación , Tamaño de la Muestra
10.
Gynecol Obstet Fertil Senol ; 48(5): 436-443, 2020 05.
Artículo en Francés | MEDLINE | ID: mdl-32199996

RESUMEN

A new coronavirus (SARS-CoV-2) highlighted at the end of 2019 in China is spreading across all continents. Most often at the origin of a mild infectious syndrome, associating mild symptoms (fever, cough, myalgia, headache and possible digestive disorders) to different degrees, SARS-Covid-2 can cause serious pulmonary pathologies and sometimes death. Data on the consequences during pregnancy are limited. The first Chinese data published seem to show that the symptoms in pregnant women are the same as those of the general population. There are no cases of intrauterine maternal-fetal transmission, but cases of newborns infected early suggest that there could be vertical perpartum or neonatal transmission. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. Pregnancy is known as a period at higher risk for the consequences of respiratory infections, as for influenza, so it seems important to screen for Covid-19 in the presence of symptoms and to monitor closely pregnant women. In this context of the SARS-Covid-2 epidemic, the societies of gynecology-obstetrics, infectious diseases and neonatalogy have proposed a French protocol for the management of possible and proven cases of SARS-Covid-2 in pregnant women. These proposals may evolve on a daily basis with the advancement of the epidemic and knowledge in pregnant women. Subsequently, an in-depth analysis of cases in pregnant women will be necessary in order to improve knowledge on the subject.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Transmisión Vertical de Enfermedad Infecciosa , Obstetricia/normas , Neumonía Viral/terapia , Complicaciones Infecciosas del Embarazo/diagnóstico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Femenino , Guías como Asunto , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Sociedades Médicas
12.
Rev Saude Publica ; 54: 23, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32049212

RESUMEN

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON-Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC-Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.


Asunto(s)
Maternidades/organización & administración , Hospitales de Enseñanza/organización & administración , Programas Nacionales de Salud/organización & administración , Neonatología/educación , Obstetricia/educación , Brasil , Cesárea/normas , Parto Obstétrico/normas , Femenino , Maternidades/normas , Hospitales de Enseñanza/normas , Humanos , Recién Nacido , Trabajo de Parto , Nacimiento Vivo , Programas Nacionales de Salud/normas , Neonatología/normas , Obstetricia/normas , Periodo Posparto , Embarazo
13.
Rev Med Suisse ; 16(682): 345-349, 2020 Feb 19.
Artículo en Francés | MEDLINE | ID: mdl-32073767

RESUMEN

Prenatal care allows early detection of risks and complications in the pregnant women in an attempt to minimize problems at birth and delivery. In Geneva, prenatal care is organized as a collaboration between private and liberal in-hospital network with a ranking in the pregnancy risk levels to adapt follow-up. The perinatal care structure should be built in a way to identify risks prompting professionals to adapt from the normal physiological care to a therapeutic escalation one appropriated to the detected risk level. Effective inter-professional collaboration around the mother-child dyad (and even the family) depends on a privileged multidisciplinary interaction platform in which, wide inter-professional communication, particularly between midwife-obstetrician-neonatalogist, is essential.


Asunto(s)
Madres , Atención Perinatal , Atención Prenatal , Niño , Femenino , Humanos , Recién Nacido , Partería , Obstetricia , Embarazo
14.
Radiol Clin North Am ; 58(2): 445-462, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32044017

RESUMEN

Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.


Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/terapia , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/terapia , Ultrasonografía Intervencional/métodos , Femenino , Enfermedades Urogenitales Femeninas/patología , Ginecología , Humanos , Biopsia Guiada por Imagen/métodos , Obstetricia , Embarazo , Complicaciones del Embarazo/patología
15.
Int J Gynaecol Obstet ; 149(2): 197-202, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32077092

RESUMEN

OBJECTIVE: To evaluate residents' knowledge about the evolution of abortion rates in countries where abortion has been legalized, and to assess whether such knowledge correlates with residents' sociodemographic characteristics and experience in abortion care. METHODS: A multicenter, cross-sectional study was conducted in 21 Brazilian hospitals with 404 medical residents in obstetrics and gynecology. Data collection occurred during February 2015 through January 2016. Data were collected through a self-administered, anonymous questionnaire. The χ2 test, Fisher exact test, and multiple logistic regression analysis were performed. RESULTS: Of residents, 60% believed that the abortion rate would increase after legalization; 82% had been involved in the care of women with incomplete abortion and 71% in the care of women admitted for legal abortion. Associations were found between knowledge of the evolution of the abortion rate after legalization and region of birth, region of medical school, and importance attached to religion. Multiple regression confirmed that studying medicine in the south/southeast of Brazil and attaching little importance to religion were associated with knowing that legalization does not lead to an increase in abortion rate. CONCLUSION: Information relating to abortion in medical schools and during residency is very limited and should be improved.


Asunto(s)
Aborto Inducido/psicología , Aborto Legal/legislación & jurisprudencia , Actitud del Personal de Salud , Aborto Inducido/estadística & datos numéricos , Adulto , Brasil , Estudios Transversales , Femenino , Ginecología/educación , Humanos , Internado y Residencia/estadística & datos numéricos , Obstetricia/educación , Embarazo , Encuestas y Cuestionarios , Adulto Joven
16.
Int J Gynaecol Obstet ; 148 Suppl 1: 9-15, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31943185

RESUMEN

Obstetric fistula is a neglected public health and human rights issue. It occurs almost exclusively in low-resource regions, resulting in permanent urinary and/or fecal incontinence. Although the exact prevalence remains unknown, it starkly outweighs the limited pool of skilled fistula surgeons needed to repair this childbirth injury. Several global movements have, however, enabled the international community to make major strides in recent decades. FIGO's Fistula Surgery Training Initiative, launched in 2012, has made significant gains in building the capacity of local fistula surgeons to steadily close the fistula treatment gap. Training and education are delivered via FIGO and partners' Global Competency-based Fistula Surgery Training Manual and tailored toward the needs and skill level of each trainee surgeon (FIGO Fellow). There are currently 62 Fellows from 22 fistula-affected countries on the training program, who have collectively performed over 10 000 surgical repairs. The initiative also contributes to the UN's Sustainable Development Goals (1, 3, 5, 8, 10, and 17). The UN's ambitious target to end fistula by 2030 will be unobtainable unless sufficient resources are mobilized and affected countries are empowered to develop their own sustainable eradication plans, including access to safe delivery and emergency obstetric services.


Asunto(s)
Obstetricia/educación , Fístula Rectovaginal/cirugía , Fístula Vesicovaginal/cirugía , Creación de Capacidad , Parto Obstétrico/efectos adversos , Incontinencia Fecal , Femenino , Humanos , Cooperación Internacional , Embarazo
17.
Int J Gynaecol Obstet ; 148 Suppl 1: 6-8, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31943187

RESUMEN

Thirteen years after the last supplement on obstetric fistula, the authors challenge the progress achieved. Citing the ongoing need for a standardized classification system, uniform surgical training and certification, evaluation, follow-up, and research, we emphasize the need for improved communication and coordination between government and nongovernment entities invested in ending obstetric fistula. Struck by the call by the United Nations to end obstetric fistula by 2030, we stress the need for increased and targeted funding of programs that are of the highest quality and impact.


Asunto(s)
Obstetricia/normas , Fístula Vesicovaginal/cirugía , Competencia Clínica , Parto Obstétrico/efectos adversos , Femenino , Humanos , Cooperación Internacional , Complicaciones del Trabajo de Parto , Obstetricia/educación , Embarazo , Fístula Vesicovaginal/prevención & control
18.
Am J Obstet Gynecol ; 222(4): 330-337, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31982386

RESUMEN

As gestational surrogacy (a process by which intended parents contract with a woman to carry a fetus that the intended parents will raise) increases across the United States, it is imperative that obstetrician/gynecologists understand the unique nuances of caring for patients who are gestational surrogates. Gestational surrogacy offers a route to parenthood for individuals and families who may otherwise have limited options. Understanding surrogacy requires multiple ethical considerations about the potential medical and psychosocial effects on gestational surrogates as well as the families built through surrogacy. There is a dearth of research on the subject, particularly in the United States and other countries that practice compensated surrogacy. Here we seek to review the process of gestational surrogacy in the United States, including the legal landscape, current trends in gestational surrogacy use, and what is known about the medical and social effects of this process on all participants. We also aim to highlight the limitations of available data and to identify topics for future research to provide optimal evidence-based and just care for these patients.


Asunto(s)
Ginecología/métodos , Obstetricia/métodos , Madres Sustitutas , Ética , Femenino , Humanos , Embarazo , Resultado del Embarazo/psicología , Madres Sustitutas/legislación & jurisprudencia , Madres Sustitutas/psicología , Madres Sustitutas/estadística & datos numéricos , Estados Unidos
19.
BJOG ; 127(5): 600-608, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31986555

RESUMEN

OBJECTIVES: To explore obstetricians' and gynaecologists' experiences of work-related traumatic events, to measure the prevalence and predictors of post-traumatic stress disorder (PTSD), any impacts on personal and professional lives, and any support needs. DESIGN: Mixed methods: cross-sectional survey and in-depth interviews. SAMPLE AND SETTING: Fellows, members and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG). METHODS: A survey was sent to 6300 fellows, members and trainees of RCOG. 1095 people responded. Then 43 in-depth interviews with trauma-exposed participants were completed and analysed by template analysis. MAIN OUTCOME MEASURES: Exposure to traumatic work-related events and PTSD, personal and professional impacts, and whether there was any need for support. Interviews explored the impact of trauma, what helped or hindered psychological recovery, and any assistance wanted. RESULTS: Two-thirds reported exposure to traumatic work-related events. Of these, 18% of both consultants and trainees reported clinically significant PTSD symptoms. Staff of black or minority ethnicity were at increased risk of PTSD. Clinically significant PTSD symptoms were associated with lower job satisfaction, emotional exhaustion and depersonalisation. Organisational impacts included sick leave, and 'seriously considering leaving the profession'. 91% wanted a system of care. The culture in obstetrics and gynaecology was identified as a barrier to trauma support. A strategy to manage the impact of work-place trauma is proposed. CONCLUSIONS: Exposure to work-related trauma is a feature of the experience of obstetricians and gynaecologists. Some will suffer PTSD with high personal, professional and organisational impacts. A system of care is needed. TWEETABLE ABSTRACT: 18% of obstetrics and gynaecology doctors experience post-traumatic stress disorder after traumatic events at work.


Asunto(s)
Ginecología , Obstetricia , Estrés Laboral/epidemiología , Médicos/psicología , Trastornos por Estrés Postraumático/epidemiología , Adulto , Agotamiento Profesional/epidemiología , Desgaste por Empatía/epidemiología , Estudios Transversales , Despersonalización , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Grupos Minoritarios/psicología , Ausencia por Enfermedad , Encuestas y Cuestionarios , Reino Unido/epidemiología
20.
JAMA ; 323(4): 352-366, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31990319

RESUMEN

Importance: The tort liability system is intended to serve 3 functions: compensate patients who sustain injury from negligence, provide corrective justice, and deter negligence. Deterrence, in theory, occurs because clinicians know that they may experience adverse consequences if they negligently injure patients. Objective: To review empirical findings regarding the association between malpractice liability risk (ie, the extent to which clinicians face the threat of being sued and having to pay damages) and health care quality and safety. Data Sources and Study Selection: Systematic search of multiple databases for studies published between January 1, 1990, and November 25, 2019, examining the relationship between malpractice liability risk measures and health outcomes or structural and process indicators of health care quality. Data Extraction and Synthesis: Information on the exposure and outcome measures, results, and acknowledged limitations was extracted by 2 reviewers. Meta-analytic pooling was not possible due to variations in study designs; therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures: Associations between malpractice risk measures and health care quality and safety outcomes. Exposure measures included physicians' malpractice insurance premiums, state tort reforms, frequency of paid claims, average claim payment, physicians' claims history, total malpractice payments, jury awards, the presence of an immunity from malpractice liability, the Centers for Medicare & Medicaid Services' Medicare malpractice geographic practice cost index, and composite measures combining these measures. Outcome measures included patient mortality; hospital readmissions, avoidable admissions, and prolonged length of stay; receipt of cancer screening; Agency for Healthcare Research and Quality patient safety indicators and other measures of adverse events; measures of hospital and nursing home quality; and patient satisfaction. Results: Thirty-seven studies were included; 28 examined hospital care only and 16 focused on obstetrical care. Among obstetrical care studies, 9 found no significant association between liability risk and outcomes (such as Apgar score and birth injuries) and 7 found limited evidence for an association. Among 20 studies of patient mortality in nonobstetrical care settings, 15 found no evidence of an association with liability risk and 5 found limited evidence. Among 7 studies that examined hospital readmissions and avoidable initial hospitalizations, none found evidence of an association between liability risk and outcomes. Among 12 studies of other measures (eg, patient safety indicators, process-of-care quality measures, patient satisfaction), 7 found no association between liability risk and these outcomes and 5 identified significant associations in some analyses. Conclusions and Relevance: In this systematic review, most studies found no association between measures of malpractice liability risk and health care quality and outcomes. Although gaps in the evidence remain, the available findings suggested that greater tort liability, at least in its current form, was not associated with improved quality of care.


Asunto(s)
Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Calidad de la Atención de Salud , Humanos , Seguro de Responsabilidad Civil/economía , Mala Praxis/economía , Mala Praxis/estadística & datos numéricos , Obstetricia/normas , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias
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