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1.
Am Fam Physician ; 104(5): 486-492, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34783495

RESUMO

Fetal growth restriction, previously called intrauterine growth restriction, is a condition in which a fetus does not achieve its full growth potential during pregnancy. Early detection and management of fetal growth restriction are essential because it has significant clinical implications in childhood. It is diagnosed by estimated fetal weight or abdominal circumference below the 10th percentile on formal ultrasonography. Early-onset fetal growth restriction is diagnosed before 32 weeks' gestation and has a higher risk of adverse fetal outcomes. There are no evidence-based measures for preventing fetal growth restriction; however, aspirin used for the prevention of preeclampsia in high-risk pregnancies may reduce the likelihood of developing it. Timing of delivery for pregnancies affected by growth restriction must be adjusted based on the risks of premature birth and ongoing gestation, and it is best determined in consultation with maternal-fetal medicine specialists. Neonates affected by fetal growth restriction are at risk of feeding difficulties, glucose instability, temperature instability, and jaundice. As these children age, they are at risk of abnormal growth patterns, as well as later cardiac, metabolic, neurodevelopmental, reproductive, and psychiatric disorders.


Assuntos
Retardo do Crescimento Fetal , Nascimento Prematuro/prevenção & controle , Cuidado Pré-Natal/métodos , Efeitos Tardios da Exposição Pré-Natal , Ultrassonografia Pré-Natal/métodos , Diagnóstico Precoce , Feminino , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/terapia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/prevenção & controle , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Perinatologia/métodos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/classificação , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Serviços Preventivos de Saúde/métodos , Risco Ajustado/métodos
3.
Dev Psychobiol ; 63(7): e22201, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34674234

RESUMO

Fetuses are able to process olfactory stimuli present in the womb and continue to show a preference for these odors for months after birth. Despite the accumulated knowledge about their early ability to perceive odors, there is a lack of validated scales for odor response in newborns. The evaluation of reactions of the olfactory system to environmental stimuli in infants has been defined by methodological theoretical approaches of experimental and clinical assessment tools. These approaches are mainly based on psychophysical approaches and predominantly use behavioral and physiological measures. Examples can be found in studies describing early abilities of newborn babies for behaviors or heart rate variability showing memory of maternal food preferences or mother's breast milk. This systematic review aimed to determine whether validated odor assessment tools can be feasibly used in studies. Particularly in light of the current COVID-19 pandemic and evidence of associated olfactory impairment resulting from SARS-COV-2 infection, the study is also motivated by the need for tools to assess olfactory function in neonates.


Assuntos
Recém-Nascido/fisiologia , Olfato , Anosmia/diagnóstico , COVID-19/diagnóstico , COVID-19/fisiopatologia , Humanos , Doenças do Recém-Nascido/diagnóstico , Odorantes , Olfato/fisiologia
8.
JNMA J Nepal Med Assoc ; 59(236): 369-373, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508543

RESUMO

INTRODUCTION: Ophthalmia neonatorum although runs a benign course mostly, sometimes may progress to sight threatening complications. The study was conducted to find the prevalence of culture positive cases of opthalmia neonatorum. METHODS: It was a descriptive cross-sectional study conducted at a tertiary care center from January to December 2019. Ethical clearance was obtained from institutional review committee of Kathmandu Medical College. Convenience sampling was done. All data were entered into excel and, then for analysis, exported to Statistal Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of culture positive cases of opthalmia neonaturum is 10 (55.55%) (32.61-78.49 at 95% Confidence Interval). The causative organisms were coagulase negative Staphylococcus 4 (40%), Staphylococcus aureus 3 (30%), Klebsiella 2 (20%) and Pseudomonas 1 (10%). Culture sensitivity of the isolated organisms were different according to the patient even in case of the same organism. Vancomycin 7 ( 70%) was the most sensitive antibiotic followed by Ciprofloxacin 6 (60%), Amikacin 5 (50%) and Cloxacillin 5 (50%) while Azithromycin 1 (10%), Cefixime 1 (10%) and Cotrimoxazole 1 (10%) were the least sensitive. CONCLUSIONS: Staphylococcus species was the most common organism isolated from neonates with ophthalmia neonatorum and vancomycin was the most sensitive antibiotic.


Assuntos
Doenças do Recém-Nascido , Oftalmia Neonatal , Estudos Transversais , Humanos , Recém-Nascido , Nepal/epidemiologia , Oftalmia Neonatal/diagnóstico , Oftalmia Neonatal/epidemiologia , Centros de Atenção Terciária
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(8): 860-866, 2021 Aug 15.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34511178

RESUMO

Neonatal cerebral sinovenous thrombosis (CSVT) is a cerebrovascular disease with a seriously underestimated incidence rate. Due to a lack of specific clinical manifestations and the low sensitivity of conventional imaging examinations, it has long been considered a rare disease in neonates. In recent years, the development of magnetic resonance technology has improved the diagnostic rate of CSVT. This article reviews the research advances in intracranial venous anatomy of neonates and clinical manifestations, imaging features, treatment, and prognosis of CSVT and deep venous thrombosis, in order to improve the understanding and to make correct diagnosis and treatment of neonatal CSVT.


Assuntos
Doenças do Recém-Nascido , Trombose dos Seios Intracranianos , Trombose , Humanos , Recém-Nascido , Prognóstico , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/terapia
11.
Adv Neonatal Care ; 21(5): 365-370, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34469367

RESUMO

BACKGROUND: Abdominal x-ray (KUB) routinely aids in detecting necrotizing enterocolitis (NEC), one of the most serious neonatal intestinal diseases. However, a KUB may miss up to 50% of the early signs of NEC. Recent advances in abdominal ultrasound (AUS) can expedite this diagnosis and improve clinical management. PURPOSES: To illustrate AUS findings that suggest NEC through 3 case examples. To review current literature regarding advantages and limitations of AUS compared with KUB. RESULTS: The added visualization of intra-abdominal structures with AUS compared with KUB improves the diagnosis and management of NEC. Some AUS features are highly suggestive of impending bowel perforation, while others can confirm bowel perforation despite a negative radiograph. IMPLICATIONS FOR PRACTICE: AUS expedites time to diagnosis of NEC and helps to stratify patients who may fail medical management and require surgical intervention. IMPLICATIONS FOR RESEARCH: More quality improvement studies are needed to validate an AUS protocol for the management of NEC. Advances in technology, such as contrast-enhanced ultrasound, may improve NEC detection with AUS in the future.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.


Assuntos
Enterocolite Necrosante , Doenças do Recém-Nascido , Enterocolite Necrosante/diagnóstico por imagem , Enterocolite Necrosante/terapia , Humanos , Recém-Nascido , Radiografia , Ultrassonografia
13.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34429339

RESUMO

OBJECTIVES: To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. METHODS: We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. RESULTS: The unexpected complications rate was 48.0 per 1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3-1.9]; odds ratio: 1.2 [95% confidence interval 1.1-1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from 25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with 10% of white and Asian American women (P < .001). CONCLUSIONS: Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Disparidades em Assistência à Saúde , Hospitais , Mortalidade Infantil , Doenças do Recém-Nascido/epidemiologia , Qualidade da Assistência à Saúde , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Estudos Retrospectivos , Nascimento a Termo , Adulto Jovem
14.
Bol Med Hosp Infant Mex ; 78(4): 331-334, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34351891

RESUMO

El desarrollo de enterocolitis necrosante, con la consecuente perforación intestinal, es frecuente en los recién nacidos pretérmino. El tratamiento estándar de la perforación intestinal es quirúrgico. Sin embargo, se sugiere que la inserción de un drenaje en el abdomen puede ser efectivo para tratar esta afección. Se resumen los resultados de una revisión sistemática Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomía en neonatos con enterocolitis necrosante perforada.Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.


Assuntos
Enterocolite Necrosante , Doenças do Recém-Nascido , Drenagem , Enterocolite Necrosante/cirurgia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Laparotomia
15.
Clin Perinatol ; 48(3): 665-679, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353586

RESUMO

This review provides an update on neonatal hypoglycemia in the term infant, including discussion of glucose metabolism, definitions of hypoglycemia, identification of infants commonly at risk, and the screening, treatment, and potential neurologic outcomes of postnatal hypoglycemia. Neonatal hypoglycemia is a common metabolic condition that continues to plague clinicians because there is no clear relationship between low glucose concentrations or their duration that determines adverse neurologic outcomes. However, severely low, prolonged, recurrent low glucose concentrations in infants who also have marked symptoms such as seizures, flaccid hypotonia with apnea, and coma clearly are associated with permanent brain damage. Early identification of at-risk infants, early and continued breastfeeding augmented with oral dextrose gel, monitoring prefeed glucose concentrations, treating symptomatic infants who have very low and recurrent low glucose concentrations, and identifying and aggressively managing infants with persistent hyperinsulinemia and metabolic defects may help prevent neuronal injury.


Assuntos
Hiperinsulinismo , Hipoglicemia , Doenças do Recém-Nascido , Géis , Glucose , Humanos , Hipoglicemia/diagnóstico , Lactente , Recém-Nascido
16.
Clin Perinatol ; 48(3): 681-695, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353587

RESUMO

Neonatal encephalopathy due to perinatal hypoxia-ischemia (hypoxic-ischemic encephalopathy [HIE]) occurs at a rate of 1 to 3 per 1000 live births. Therapeutic hypothermia is the standard of care and the only currently available therapy to reduce the risk of death or disability in newborns with moderate to severe HIE. Hypothermia therapy needs to be initiated within 6 hours after birth in order to provide the best chance for neuroprotection. All pediatricians and delivery room attendants should be trained to recognize encephalopathy and understand the eligibility criteria for treatment. The modified Sarnat examination is the most frequently used tool to assess the degree of encephalopathy and has six categories, each of which can have mild, moderate, severe abnormalities. Apart from historical and biochemical criteria, a neonate must have 3 of 6 categories scored in the moderate or severe range in order to qualify for hypothermia as was done in the randomized trials. Whether an infant qualifies or there is concern that an infant might have HIE, transfer to a center that can perform treatment should be initiated immediately. Hypothermia significantly reduces the risk of death or moderate to severe impairments at 2 years and at school age. On average, only 7 neonates need to be treated for one neonate to benefit. Although easy in concept, implementation of hypothermia does require expertise and should be carried out under the guidance of a neonatologist. If infants are passively cooled prior to transport, core temperature needs to be closely monitored with a target of 33.5°C ± 0.5°C. Maintenance of homeostasis is important in order to prevent conditions that may result in additional brain injury. Seizures are common in neonates with HIE, but electrographic seizures are rare in the first few hours after birth if the insult occurred during labor and delivery. Prophylactic antiepileptic drugs should not be administered. Brain monitoring in the form of electroencephalogram (EEG) and or amplitude-integrated EEG should be implemented as soon as possible to help with prognosis and to accurately diagnose seizures.


Assuntos
Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Doenças do Recém-Nascido , Eletroencefalografia , Feminino , Humanos , Hipóxia-Isquemia Encefálica/terapia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/terapia , Gravidez , Convulsões
17.
J Pediatr Surg ; 56(11): 1911-1915, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34392969

RESUMO

BACKGROUND: Necrotizing enterocolitis (NEC) is a neonatal disease associated with necrosis and perforation of the bowel. We investigated the association between blood group and NEC outcomes and the potential contribution of fetal-maternal blood group incompatibility. METHODS: Retrospective study including all preterm-born infants with NEC (≥ Bell's stage IIa) admitted to our NICU between January 2008 and October 2019. We analyzed the association between infants' blood groups and fetal-maternal blood group incompatibility with Bell stage severity, need for surgery, and mortality due to NEC. RESULTS: We included 237 NEC patients. In univariable analyses both AB blood group and fetal-maternal blood group incompatibility increased infants' risk of severe outcomes, with odds ratios (OR) ranging from 6.57 to 12.06 and 1.97 to 2.38, respectively. When adjusted for gestational age only AB blood group remained significant with OR 7.47 (95% confidence interval, 1.95-28.53, P = 0.003), 12.37 (2.63-58.20, P = 0.001), and 8.16 (2.28-29.14, P = 0.001) for NEC Bell's stage III, need for surgery, and NEC related mortality, respectively. Blood group incompatibility adjusted for gestational age was not related to worse outcomes with OR 1.84 (0.87-3.89, P = 0.11, 2.08 (0.98-4.41, P = 0.06) 1.52 (0.68-3.42, P = 0.31), for NEC Bell's stage III, need for surgery, and NEC related mortality, respectively. CONCLUSION: Our data confirm an association between blood group AB and worse outcomes in NEC infants, but this is not based on fetal-maternal blood group incompatibility.


Assuntos
Antígenos de Grupos Sanguíneos , Enterocolite Necrosante , Doenças do Recém-Nascido , Humanos , Lactente , Recém-Nascido , Estudos Retrospectivos , Fatores de Risco
18.
Rev. inf. cient ; 100(4): e3438, 2021. tab
Artigo em Espanhol | LILACS | ID: biblio-1289655

RESUMO

RESUMEN Introducción: La depresión cardiorrespiratoria neonatal es un problema clínico que, en dependencia de su etiología, conduce a una alta morbilidad neurológica y elevada mortalidad. Objetivo: Caracterizar al recién nacido con depresión cardiorrespiratoria en el servicio de Neonatología del Hospital Ginecobstétrico "Fé del Valle Ramos", de Manzanillo, Granma. Método: Se realizó un estudio retrospectivo, observacional, descriptivo y transversal. Se seleccionaron 88 neonatos que cumplieron con los criterios de inclusión de recién nacido con depresión cardiorrespiratoria. Los datos se recolectaron durante el período de enero de 2017 a diciembre de 2018. Se tomaron en cuenta las siguientes variables: puntaje de Apgar, años de estudio, sexo, tipo de depresión cardiorrespiratoria, peso al nacer, factores maternos, edad gestacional y afecciones asociadas. Resultados: La depresión severa al nacer predominó en la mayoría de los neonatos (56,8 %). Prevalecieron los recién nacido de buen peso (73,9 %), nacidos a término (77,2 %). Las infecciones maternas (45,5 %) durante la gestación, el tiempo de rotura de membranas prolongado (31,8 %) y la presencia de líquido amniótico meconial (30,7 %), constituyeron los factores maternos que mayor vínculo guardaron con el neonato deprimido. Conclusiones: Las infecciones maternas, la rotura prematura de membranas, la presencia de líquido amniótico meconial, los nacimientos por cesárea, la nuliparidad, prematuridad y el embarazo en la adolescencia, son algunos de los factores de riesgo relacionados en este estudio que guardan vínculo estrecho con el predominio de estas afecciones en los neonatos deprimidos.


ABSTRACT Introduction: The cardiorespiratory depression in neonates is a clinical complication that, depending on its etiology, leads to high neurological morbidity and mortality. Objective: To characterize neonates with cardiorespiratory depression treated in the neonatology service at the Hospital Ginecobstétrico "Fé del Valle Ramos" in Manzanillo, Granma. Method: A retrospective, observational, descriptive and cross-sectional study was carried out. A total of 88 neonates with cardiorespiratory depression criteria were selected in the study. All information gathered includes the period January 2017 throughout December 2018. Variables assessed were as follow: Apgar score, years of study, sex, type of cardiorespiratory depression, birth weight, maternal factors, gestational age and associated conditions. Results: Severe depression at birth was predominant in most of neonates (56.8%). Newborn infants with a normal birth weight (73.9%), and born at term (77.2%) were predominant. Maternal infections during gestation (45.5%), prolonged rupture of membranes (31.8%) and the presence of meconium in the amniotic fluid (30.7%) were the maternal factors most associated with depressed neonate. Conclusions: The maternal infections, premature rupture of membranes, the presence of meconium in the amniotic fluid, cesarean birth, nulliparous status, premature and adolescent pregnancy are some of the risk factors assessed in this study that are closely linked to the prevalence of arising conditions in depressed neonates.


RESUMO Introdução: A depressão cardiorrespiratória neonatal é um problema clínico que, dependendo de sua etiologia, leva a alta morbidade neurológica e alta mortalidade. Objetivo: Caracterizar o recém-nascido com depressão cardiorrespiratória no serviço de Neonatologia do Hospital Gineco-obstétrico "Fé del Valle Ramos", Manzanillo, Granma. Método: Foi realizado um estudo retrospectivo, observacional, descritivo e transversal. Foram selecionados oitenta e oito lactentes que atenderam aos critérios de inclusão de um recém-nascido com depressão cardiorrespiratória. Os dados foram coletados no período de janeiro de 2017 a dezembro de 2018. Foram consideradas as seguintes variáveis: índice de Apgar, anos de estudo, sexo, tipo de depressão cardiorrespiratória, peso ao nascer, fatores maternos, idade gestacional e condições associadas. Resultados: A depressão grave ao nascer prevaleceu na maioria dos neonatos (56,8%). Prevaleceram os recém-nascidos de bom peso (73,9%) e a termo (77,2%). Infecções maternas (45,5%) durante a gestação, tempo prolongado de ruptura da membrana (31,8%) e presença de líquido amniótico mecônio (30,7%) foram os fatores maternos mais associados ao neonato deprimido. Conclusões: Infecções maternas, ruptura prematura de membranas, presença de líquido amniótico mecônio, partos cesáreos, nuliparidade, prematuridade e gravidez na adolescência, são alguns dos fatores de risco relacionados neste estudo que estão intimamente ligados ao predomínio dessas condições na recém-nascidos deprimidos.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Índice de Apgar , Insuficiência Respiratória/epidemiologia , Doenças do Recém-Nascido/mortalidade , Doenças do Recém-Nascido/epidemiologia , Complicações na Gravidez/etiologia , Epidemiologia Descritiva , Estudos Transversais , Estudos Retrospectivos , Estudos Observacionais como Assunto
19.
BMC Pregnancy Childbirth ; 21(1): 546, 2021 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-34364368

RESUMO

BACKGROUND: Respiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This matched cohort study aimed to assess how the antenatal dexamethasone use affect the respiratory distress (RD) proportion in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation. METHODS: This was a prospective cohort study on 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone, who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group without dexamethasone use included 78 pregnant women diagnosed with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 h for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software, version 26.0. RESULTS: The proportion of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), adjusted Odds Ratio [aOR] 0.29; 95% confidence interval [CI] 0.10 - 0.83 and p = 0.021. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; aOR, 2.59; 95% CI, 1.06 - 6.33; p = 0.037). There were no significant between-groups differences in the incidence of respiratory support, NICU admission or length of hospital stay. CONCLUSIONS: Administration of antenatal dexamethasone to women at risk for late preterm birth could help to lower the proportion of respiratory distress in late preterm infants.


Assuntos
Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Nascimento Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Insuficiência Respiratória/prevenção & controle , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/prevenção & controle , Recém-Nascido Prematuro , Gravidez , Cuidado Pré-Natal , Vietnã/epidemiologia
20.
S Afr Med J ; 111(7): 661-667, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34382550

RESUMO

BACKGROUND:  The viability of obstetric practice in the private sector has been threatened as a result of steep increases in professional indemnity fees over the past 10 years. Despite this, empirical research investigating key aetiological factors to target risk management interventions has been lacking. OBJECTIVES: To explore private practice medicolegal data linked to obstetricians and gynaecologists (O&Gs) to identify factors in clinical practice associated with claims, for the purposes of guiding future research and risk management solutions. METHODS:  This was a retrospective, observational study of private sector O&Gs' medicolegal case histories. All incidents declared to a prominent local professional indemnity insurer were categorised in terms of medicolegal case type, as well as clinical parameters. To allow for risk-adjusted calculations of case incidence, year of entry into private practice was estimated for all practitioners. RESULTS:  Steep increases in medicolegal investigations and demands were demonstrated for both obstetrics- and gynaecology-related cases from about 2003 to 2012. Whereas the total numbers of claims, regulatory complaints and requests for records were similar for obstetrics and gynaecology in recent years (accounting for 52% v. 48% of known cases, respectively), a significantly greater percentage of demands and paid settlements related to gynaecology rather than obstetrics (58% and 76% v. 42% and 24% of cases, respectively). In obstetrics, about half of all cases on record with a paid settlement were in the context of severe neonatal birth-related neurological injury (n=9). For gynaecology, procedure-related complications accounted for 92% of settlements, of which at least 41% were for intraoperative injuries to internal organs and vessels. Laparoscopic procedures were most frequently associated with such intraoperative injuries, followed by vaginal and abdominal hysterectomies/oophorectomies and caesarean sections. For O&Gs in private practice for >2 years, 50/458 (11%) accounted for 138/228 (61%) of demands over a 10-year period. CONCLUSIONS:  The higher number of gynaecological demands and settlements in comparison with obstetric cases was unexpected and is contrary to international experiences and public sector findings, calling for more research to identify reasons for this finding. Other than further exploring surgical outcomes in private sector gynaecological patients, aspects of surgical training and accreditation standards in gynaecology may need review. Regarding birth-related injuries, the contribution of system failures needs quantification and further interrogation. The high contribution towards the medicolegal burden by a small group of practitioners suggests a need for doctor-focused interventions, including strengthening of peer review and regulatory oversight.


Assuntos
Ginecologia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Obstetrícia/legislação & jurisprudência , Adulto , Idoso , Parto Obstétrico/efeitos adversos , Parto Obstétrico/legislação & jurisprudência , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/legislação & jurisprudência , Setor Privado/legislação & jurisprudência , Setor Privado/estatística & dados numéricos , Estudos Retrospectivos , África do Sul
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