Patient safety in women's health-care: professional colleges can make a difference. The Society of Obstetricians and Gynaecologists of Canada MORE(OB) program.

The Society of Obstetricians and Gynaecologists of Canada has played a leadership role in advancing patient safety at the national level with the launching of their obstetric patient safety program 'Managing Obstetric Risks Efficiently' (MORE(OB)). Developed over a 2-year period and launched as a pilot in 2002, the program has extended to 126 hospitals in five provinces that provide care for 48% of the births in Canada. The end-point for the program is to change the culture of blame to a focused and sustained patient safety culture, where patient safety is everyone's responsibility, with observed reductions in events and improved quality of care. The program has integrated the principles of high reliability organizations (HROs), systems error theory, team function, and communities of practice (CoPs) as values for the work environment. In this chapter we describe how the program was developed, the role of the national specialty society in the development, and the funding, structure and implementation of the program, and we report on the impact of the program over the first 3 years. In these first 3 years, knowledge enhancement in all disciplines and in all practice environments, with a significant reduction in variance among the disciplines, has been demonstrated. Culture change has occurred in all practice settings and has continued to improve over time. Using liability claims information from the hospitals, a reduction trend has been observed in liability carrier (hospital) incurred costs.

Prolonged amenorrhea and oral contraceptives.

Of 106 consecutive women referred for secondary amenorrhea of more than 1 year's duration, 65 were diagnosed as having functional amenorrhea. Of these 65, 29 had amenorrhea directly following discontinuation of oral contraceptives (OC group) and 36 had never used oral contraceptives (NOC group). There was no difference in the incidence of prior menstrual irregularity in either group. Similarly, there was no difference in the resting serum estrone, estradiol, luteinizing hormone, follicle-stimulating hormone, and prolactin levels between the OC and NOC groups. Nor was there a difference between the OC and NOC groups in response to medroxyprogesterone acetate, clomiphene citrate, or luteinizing hormone-releasing factor. Of 106 patients, 17 were proven to have prolactinomas. Eight patients had a prior history of OC use, whereas nine did not. With the exception of elevated serum prolactin levels, there were no significant differences in biochemical tests or history of oral contraceptive use between the prolactinoma group and patients with prolonged "functional" amenorrhea (OC plus NOC groups). The lack of historical or biochemical difference between the OC and NOC subjects indicates homogeneity between groups, and does not support the existence of a "postpill" syndrome.

PIP: 65 of 106 consecutive women referred for secondary amenorrhea of more than 1 year's duration were diagnosed as having functional amenorrhea. 29 of the 65 women had amenorrhea directly following discontinuation of oral contraceptives (OC group) and 36 had never used OCs (NOC group). There was no difference in the incidence of prior menstrual irregularity in either group, and there was no difference in the resting serum estrone, estradiol, luteinizing hormone, follicle-stimulating hormone, and prolactin levels between the 2 groups. There was no difference between the groups in response to medroxyprogesterone acetate, clomiphene citrate, or luteinizing hormone-releasing factor. 17 of the 106 patients were proven to have prolactinomas; 8 of these had a prior history of OC use and 9 did not. Except for elevated serum prolactin levels, there was no significant differences in biochemical tests or history of OC use between the prolactinoma group and patients with prolonged "functional" amenorrhea (OC plus NOC groups). The lack of historical or biochemical difference between the OC and NOC subjects suggests homogeneity between groups and fails to support the existence of a "postpill" syndrome.

The FIGO Save the Mothers Initiative: the Uganda-Canada collaboration.

In 1998, the ob/gyn associations of Uganda and Canada launched, under the umbrella of the FIGO Save the Mothers Initiative, a district-wide intervention which aimed to increase the availability and utilization of emergency obstetric care (EmOC) services in a rural district of Uganda. The article describes the experience of two professional ob/gyn associations in the development, implementation, monitoring and evaluation of the project. Preliminary results after 24 months of intervention indicate important gains in the capacity of health professionals to deliver EmOC, the availability of emergency transportation services and met need for EmOC.

Falope Ring tubal ligation.

By minilaparotomy or through the laparpscope, Falope Ring sterilization is accomplished by applying silicone rubber bands to the Fallopian tubes. The applicator and its use are described and 383 cases without any major complication are reported. The major advantage is elimination of thermocoagulation. The occlusion is complete in a short segment and offers theoretical possibilities of tubal reconstruction.

Female sterilization by Falope ring ligation.

Sterilization with the Falope Ring may be performed by means of laparoscopy of the minilaparotomy. This technique avoids the potential hazards of electrocoagulation, such as intestinal burns. Among the 825 cases reported in this paper there was only one serious complication, an ectopic pregnancy. One other patient had an undetected early pregnancy at the time of sterilization. Two patients became pregnant 4 and 42 month after the procedure. In most cases a diagnostic dilatation and curettage was done before hand. Pathological study of the fallopian tubes of one patient 28 days after the ring was applied revealed complete occlusion of the buckled segment of each tube. Falope Ring sterilization is simple, effective and safe, and the rate of subsequent pregnancy is lower than with conventional burning or clipping techniques.

PIP: Sterilization with the Falope Ring may be performed by means of laparoscopy or minilaparotomy. This technique avoids the potential hazards of electrocoagulation, such as intestinal burns. Among the 825 cases reported in this paper, there was only 1 serious complication which occurred, an ectopic pregnancy. 1 other patient had an undetected early pregnancy at the time of the sterilization. 2 patients became pregnant 4 and 42 months after the procedure. In most cases, a diagnostic dilatation and curettage was done prior to the procedure. Pathological study of the fallopian tubes of 1 patient 28 days after the ring was applied revealed complete occlusion of the buckled segment of each tube. Falope Ring sterilization is simple, effective, and safe, and the rate of subsequent pregnancy is lower than with conventional burning or clipping techniques. (author's)

Antenatal unilateral hydrocephalus.

Fetal ventriculomegaly usually involves both lateral ventricles. If dilatation of the dependent lateral ventricle is seen, it might be assumed that the condition is bilateral and symmetric and that reverberation artifact is obscuring the ventricle nearer to the transducer. However, unilateral hydrocephalus can occur, though rarely and usually as a result of unilateral obstruction of the foramen of Monro. Careful attention to visualization of the obscured hemisphere is emphasized. In the patient described here the condition was associated with frontoethmoidal encephalocele.