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KONGNYUY, EUGENE JUSTINE; UTHMAN, OLALEKAN ABULRAHMAN
doi: 10.1080/00016340903093542pmid: 19557553
Although there is evidence that audit and feedback can improve health outcomes, little is known about the effect of audit on the quality of care from client's perspective. The aim of the current review was to explore the use of criterion‐based audit to improve quality of obstetric care from both the midwives/doctors’ and women/mothers’ perspectives. Electronic searches of Cochrane Library, MEDLINE, and EMBASE were conducted. Randomized controlled trials (RCTs) and before‐and‐after studies that assessed the effect of criterion‐based audit on health outcomes or women/mothers’ perception of obstetric care were set as selection criteria. Data were extracted, analyzed using Revman 4.2 software, and results expressed as weighted mean differences for continuous data, and odds ratios for dichotomous data. Nineteen studies (one RCT and 18 before‐and‐after studies) involving 32,972 participants met our inclusion criteria. None of these studies assessed the effect of audit on quality from the women/mothers’ perspective and none of the studies compared the effectiveness of different types of feedback. Ninety‐five percentage (18/19) of studies showed significant improvement in at least one standard measured. Criterion‐based audit has been used in obstetrics to improve quality from one dimension, namely the midwives/doctors’ perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers’ view. There is need for well‐designed RCTs to assess the effectiveness of different types of feedback in criterion‐based audit.
GARCIA‐TEJEDOR, AMPARO; MAIQUES, VICENTE; PERALES, ALFREDO; LÓPEZ‐ALDEGUER, JOSE
doi: 10.1080/00016340903062836pmid: 19557554
Objective. To analyze the influence of highly active antiretroviral treatment (HAART) on risk factors for perinatal transmission of human immunodeficiency virus (HIV). Design. A prospective cohort study was performed between HIV pregnant women under HAART therapy and without treatment. Setting. The maternity hospital ‘La Fe’ in Valencia, Spain. Population or sample. Five hundred HIV‐positive pregnant women. Method. Known maternal and obstetrical perinatal risk factors were analyzed by univariate and multivariate methods (logistic regression). The influence of HAART on the risk factors was evaluated independently to determine whether there was a modulation in perinatal HIV transmission. Main outcome measures. Known perinatal risk factors were found not to have any significant influence on perinatal HIV transmission in women under HAART therapy. Results. Vertical transmission risk decreased significantly from 18.2% without treatment to 8.6% with mono/dual therapy and 0.6% with HAART. A CD4+ cell count below 500 cell/μl, intrapartum use of invasive procedures, rupture of membranes >six hours, labor length >five hours, and birthweight were the significant risk factors associated to vertical HIV transmission and elective cesarean section. Antiretroviral treatment administered during delivery was a protective factor in HIV pregnant women before HAART therapy. Conclusions. HAART therapy reduces the influence of the perinatal risk factors on vertical HIV transmission.
MARTINELLI, SILVIO; FRANCISCO, ROSSANA PULCINELLI VIEIRA; BITTAR, ROBERTO EDUARDO; ZUGAIB, MARCELO
doi: 10.1080/00016340903090985pmid: 19551526
Objective. To correlate Doppler results with hematological indices at birth in small‐for‐gestational‐age (SGA) fetuses. Design. Prospective study. Setting. Tertiary teaching hospital, Sao Paulo, Brazil. Population. One hundred singleton pregnancies with SGA fetuses of >27 weeks gestational age. Methods. All women had Doppler velocimetry of the umbilical arteries, middle cerebral artery, and ductus venosus within <72 hours prior to delivery. After birth, umbilical artery blood was collected for hematological analysis. Main outcome measures. The association between fetal Doppler velocimetry pulsatility index (PI) and some hematological indices. Results. Umbilical artery PI showed a positive correlation with nucleated red blood cell count in the umbilical cord (r = 0.46; p<0.01), and a negative correlation with platelet count (r= − 0.53; p<0.01) and white blood cell count (r= − 0.42; p<0.01). Middle cerebral artery PI was positively correlated with platelet count (r = 0.43; p<0.01) and white blood cell count (r = 0.38; p<0.01), and was negatively correlated with nucleated red blood cell count (r= − 0.39; p<0.01). The ductus venosus pulsatility index showed a positive correlation with nucleated red blood cell count (r = 0.36; p<0.01), and a negative correlation with platelet count (r= − 0.37; p<0.01) and white blood cell count (r= − 0.26; p<0.01). Conclusion. A significant positive or negative correlation between nucleated red blood cell, platelet and white blood cell counts, and Doppler indices suggests an association between placental insufficiency and the fetal hematological response.
KARCAALTINCABA, DENIZ; AKDAG, DERYA; KANDEMIR, OMER; YALVAC, SERDAR; GUVEN, EMINE SEDA GUVENDAG; HABERAL, ALI
doi: 10.1080/00016340903100347pmid: 19562559
Objective. To investigate the relation between changes in Doppler parameters of fetal and uterine arteries and development of persistent non‐reassuring fetal heart rate (FHR) pattern during induction of labor with dinoprostone (Propess®) in pregnancies at ≥41 weeks gestation. Design. Prospective cohort study. Setting. Etlik Zubeyde Hanim Women's Hospital, Turkey. Sample. One hundred forty‐one prolonged pregnancies. Methods. Doppler parameters of umbilical, middle cerebral, and uterine arteries were measured before and 4–6 hours after dinoprostone application between uterine contractions. Non‐reassuring FHR pattern and persistent non‐reassuring FHR pattern criteria were defined based on NICE 2007 guidelines. Women with successful spontaneous vaginal delivery were recruited as a control group (n = 108), while women who underwent cesarean delivery due to persistent non‐reassuring FHR pattern were recruited as a study group (n = 15). Main outcome measures. Prediction of non‐reassuring FHR pattern with Doppler analysis of uterine and fetal arteries. Results. After dinoprostone application there was significant enhancement in uterine artery resistance index (RI) in the study group compared to the control group (p = 0.002). Receiver operating characteristics curve analysis identified a uterine artery RI increase value of 0.11 as the optimal threshold for prediction of persistent non‐reassuring FHR pattern with 73.3% sensitivity and 69.4% specificity. Logistic regression analysis demonstrated that an increase in the uterine artery RI was predictive for persistent non‐reassuring FHR pattern (odds ratio (OR) 4.97; 95% CI 1.5–16.8). Conclusion. Acute increase in uterine artery RI due to dinoprostone use may end with persistent non‐reassuring FHR pattern in prolonged pregnancies. This may allow earlier prediction of persistent non‐reassuring FHR pattern development and risk assessment.
RAHKONEN, LEENA; UNKILA‐KALLIO, LEILA; NUUTILA, MIKA; SAINIO, SUSANNA; SAISTO, TERHI; RUTANEN, EEVA‐MARJA; PAAVONEN, JORMA
doi: 10.1080/00016340903104281pmid: 19575312
Objectives. To evaluate the performance of cervical phosphorylated insulin‐like growth factor binding protein‐1 (phIGFBP‐1) testing and cervical length measurement separately and in combination with physician's clinical judgment in prediction of preterm birth among patients with self‐reported uterine contractions and intact membranes. Design. We enrolled a total of 246 women between 22 and 34 weeks of gestation. Methods. The initial evaluation included cervical length measurement using transvaginal ultrasonography. Short cervix was defined as <25 mm. A swab sample was obtained from the cervix for phIGFBP‐1. Admission was used as a clinical marker of an increased risk of preterm delivery ≤34 weeks. The diagnostic performances of the tests and clinician's judgment, as well as likelihood ratios (LRs) were calculated. Main outcome measures. Delivery ≤34 weeks and within 14 days. Results. The overall rate of spontaneous preterm delivery ≤34 weeks was 4.1% (10/246). Short cervix, positive phIGFBP‐1 test, combination of both, and clinician's judgment were all associated with preterm delivery ≤34 weeks or within 14 days (p<0.01). The negative predictive values for delivery ≤34 weeks were 97.4, 97.6, 97.1, and 98.7%, respectively, and within 14 days 98.7, 99.0, 98.3, and 99.6%, respectively. The corresponding positive LRs for delivery ≤34 weeks were 6.8, 3.8, 75.0, 14.9, and within 14 days 9.7, 5.5, 107.3, 17.1. The negative LRs were 0.6, 0.6, 0.7, 0.3 and 0.5, 0.3, 0.6, 0.2. Conclusion. The rapid phIGFBP‐1‐test has a high negative predictive value for preterm delivery, comparable to that of ultrasonographic cervical length measurement.
FEIGENBERG, TOMER; EITAN, YAEL; SELA, HEN Y.; ELCHALAL, URIEL; BEN‐MEIR, ASSAF; ROJANSKY, NATHAN
doi: 10.1080/00016340903093559pmid: 19565365
Background. Secondary post‐partum hemorrhage (PPH) is defined as any abnormal bleeding from the birth canal occurring between 24 hours and 12 weeks postnatally. Treatment usually falls into one of the two categories: surgical evacuation of the uterus or medical treatment. Objective. To compare the two different clinical approaches and the implications on future fertility. Study design. A retrospective study. Setting. From 1990 to 2002, 168 women diagnosed with late PPH were admitted to the Hadassah Medical Centers in Jerusalem. The cases were divided into two groups according to the planned initial treatment: primary surgical treatment vs. primary medical treatment. Results. Primary surgical treatment was associated with significantly more primary negative events (p = 0.01). After the primary event, primary surgical treatment was associated with fewer future deliveries (p = 0.04) and resulted in increased rate of secondary infertility of borderline significance (p = 0.06). Conclusions. Our results show that secondary PPH is related to high rates of immediate and long‐term complications. It is possible that a conservative medical approach for secondary PPH may be superior to surgical treatment.
FAGERVOLD, BENTE; JENSSEN, MARITA; HUMMELSHOJ, LONE; MOEN, METTE HAASE
doi: 10.1080/00016340903108308pmid: 19568961
Objective. Previous studies have elucidated the negative impact of endometriosis on life, but the patient selection may have contributed to a skewed picture. The aim of this study was to investigate longitudinally the consequences of the disease in women diagnosed with endometriosis 15 years ago. Design. Retrospective descriptive. Setting. Trondheim 2007. Sample. One hundred thirty women diagnosed with endometriosis at St. Olav's Hospital in Trondheim between 1991 and 1993. Methods. Questionnaires. Response rate of 60%. Main outcome measures. Consequences of living with endometriosis. Results. Of the women, 19.2% never experienced pelvic pain and 21.8% did not have any further visits to the gynecological department after being diagnosed. Almost 70% had received pharmaceutical treatment and positive effect on pain was reported by 41% for NSAIDs and oral contraceptives, and by 62% for progestins and GnRH‐analogues. Satisfactory effect on pain after surgical interventions at the time of diagnosis was reported by 60.9%, and by 89.9% after later surgeries. Of the infertile patients, 75.6% succeeded in delivering one or more biological children. Half of the women reported that endometriosis had some negative impact on their lives. After menopause, 96.9% were free from pain. Conclusion. This study confirms that endometriosis is a condition that often has considerable impact on a woman's life. However, the study also found that endometriosis does not always cause pain, that treatment in many cases is effective, that infertility may be overcome, and that almost all postmenopausal women were free from endometriosis‐associated pain.
GÜNGÖRDÜK, KEMAL; CELEBI, IBRAHIM; ARK, CEMAL; CELIKKOL, OZGU; YILDIRIM, GOKHAN
doi: 10.1080/00016340903100354pmid: 19565366
Objective. To compare tension‐free vaginal tape (TVT) and transobturator tape (TOT) for surgical treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency. Design. Retrospective study. Setting. Gynecology department, Bakirkoy Women and Childrens’ Hospital, Istanbul. Sample. Three hundred women urodynamically diagnosed with stress incontinence with intrinsic sphincter deficiency underwent synthetic mid‐urethral sling procedures (TVT = 180, TOT = 120). Methods. Before the operation, a complete medical history was taken and a gynecologic examination was performed. Subjects with detrusor overactivity or previous sling surgery were excluded. Clinical checkups were conducted at 3, 6, and 12 months, and then annually. Main outcome measures. Intraoperative complications, postoperative complications, and subjective cure rates. Results. There were no significant differences in demographics between the TVT and TOT groups: mean age, parity, body mass index, menopausal status, and hormone replacement therapy. At a mean follow‐up of 31.2±9.1 (range 12–46) months, the overall cure rates were 78.3% for TVT and 52.5% TOT (p<0.0001). The risk of treatment failure in women who received TOT was 4.9 times higher than in women who underwent TVT. There were no significant differences in perioperative and postoperative complication rates between the two groups. Conclusion. TVT appears to be the preferable surgical option for the treatment of SUI with intrinsic sphincter deficiency.
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