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Delius M, Kolben T, Nußbaum C, Bogner-Flatz V, Delius A, Hahn L, Buechel J, Hasbargen U, Flemmer AW, Mahner S, Hertlein L. Changes in the rate of preterm infants during the COVID-19 pandemic Lockdown Period-data from a large tertiary German University Center. Arch Gynecol Obstet 2024; 309:1925-1933. [PMID: 37231277 PMCID: PMC10212226 DOI: 10.1007/s00404-023-07048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/25/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE After living with the COVID-19 pandemic for more than 2 years, the impact of lockdown measures on preterm birth rates is inconsistent according to data from different countries. In this study, rates of preterm-born infants during the time of COVID-19-related lockdowns were analyzed in a tertiary perinatal center at Munich University, Germany. METHODS We analyzed the number of preterm births, infants, and stillbirths before 37 weeks of gestation during the German COVID-19 lockdown period compared to the same time periods in the years 2018 and 2019 combined. Additionally, we expanded the analysis to Pre- and Post-Lockdown Periods in 2020 compared to the respective control periods in the years 2018 and 2019. RESULTS Our database shows a reduction in the rate of preterm infants during the COVID-19 lockdown period (18.6%) compared to the combined control periods in 2018 and 2019 (23.2%, p = 0.027). This was mainly based on a reduced rate of preterm multiples during the lockdown period (12.8% vs. 28.9%, p = 0.003) followed by a reversed effect showing a threefold rise in multiple births after the lockdown. In singletons, the rate of preterm births was not reduced during the lockdown. The rate of stillbirths was not affected by the lockdown measures as compared to the control period (0.9% vs. 0.7%, p = 0.750). CONCLUSION During the COVID-19 pandemic lockdown period, we found a reduced rate of preterm-born infants compared to a combined control period in the years 2018 and 2019 in our large tertiary University Center in Germany. Due to the predominant reduction in preterm multiples, we postulate that less physical activity might have led to the protective effect by lockdown measures.
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Affiliation(s)
- Maria Delius
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Claudia Nußbaum
- Division of Neonatology, Department of Pediatrics, Dr. Von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Laura Hahn
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Johanna Buechel
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Uwe Hasbargen
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Andreas W Flemmer
- Division of Neonatology, Department of Pediatrics, Dr. Von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany
| | - Linda Hertlein
- Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Ziemssenstraße 5, 80337, Munich, Germany.
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Lange S, Krüger N, Warm M, Buechel J, Genzel-Boroviczény O, Fischer MR, Dimitriadis K. Lost in translation: Unveiling medical students' untold errors of medical history documentation. The Clinical Teacher 2024. [PMID: 38433499 DOI: 10.1111/tct.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The accurate documentation of a medical history interview is an important goal in medical education. As students' documentation of medical history interviews is mostly decentralised on the wards, a systematic assessment of documentation quality is missing. We therefore evaluated the extent of details missed in students' medical history reports in a standardised setting. METHODS In this prospective, observational study, 123 of 380 students (32.4%) participated in an Objective Structured Clinical Examination (OSCE) regarding history taking and documentation. Based on the interviews and nine deductively selected main categories, a categorical system was established using a summarising qualitative content analysis. The items in the transcripts (defined as ground truth) and in students' reports were labelled and assigned to the correct subcategory. The ground truth and students' reports were compared to quantify students' documentation completeness. RESULTS Next to the nine deductively selected main categories, 61 subcategories were defined. A total of 8943 items were labelled in the 123 interview transcripts (ground truth), compared with 5870 items labelled in students' reports (65.6% completeness of students' reports compared with ground truth). The main category personal details overlapped with 94.2% between students' report and ground truth in contrast to the main category with the highest discrepancy, allergy, with 41.1% overlap. Pertinent negative items and non-numerical quantifications were often missed. CONCLUSIONS Medical students show incomplete documentation of medical history interviews. Therefore, accurate documentation should be taught as an important goal in medical education.
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Affiliation(s)
- Silvan Lange
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nils Krüger
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Warm
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
| | - Johanna Buechel
- Department for Obstetrics and Gynecology, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - Orsolya Genzel-Boroviczény
- Division of Neonatology Campus Innenstadt, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin R Fischer
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
| | - Konstantinos Dimitriadis
- Institute of Medical Education, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
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Buechel J, Monod C, Alba Alejandre I, Ninke T, Hoesli I, Starrach T, Delius M, Mahner S, Kaltofen T. Amniotic Fluid Embolism: a comparison of two classification systems in a retrospective 8-year analysis from two tertiary hospitals. J Gynecol Obstet Hum Reprod 2023; 52:102597. [PMID: 37087046 DOI: 10.1016/j.jogoh.2023.102597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Amniotic fluid embolism (AFE) is a rare life-threatening complication in obstetrics, but the diagnosis lacks a consensual definition. The objective of this study was to compare two different AFE classification systems by analysing the AFE cases from two university hospitals. MATERIAL AND METHODS In this retrospective study, all patients with a strong suspicion of AFE between 2014 and 2021 at two university hospitals, LMU Women's University Hospital Munich, and Women's University Hospital Basel, were included. Patient records were checked for the ICD-10 code O88.1 (AFE). Diagnoses were confirmed through clinical findings and/or autopsy. The presence of the diagnostic criteria of the Society of Maternal Fetal Medicine (SMFM) and the AFE Foundation (AFEF) and of a new framework by Ponzio-Klijanienko et al. from Paris, France, were checked and compared using Chi-square-test. RESULTS Within our study period, 38,934 women delivered in the two hospitals. Six patients had a strong suspicion of AFE (0.015%). Only three of six patients (50%) presented with all the four diagnostic criteria of the SMFM/AFEF framework. All six patients met the criteria of the modified "Paris AFE framework". CONCLUSION Using the "Paris AFE framework" based exclusively on clinical criteria can help clinicians to diagnose AFE, anticipate the life-threatening condition of the patient and prepare immediately for best clinical care.
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Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - C Monod
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - I Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Ninke
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - I Hoesli
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Kaltofen
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany; Department for Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Labrosse KB, Buechel J, Guelmez H, Butenschoen A, Schoenberger H, Visca E, Schoetzau A, Manegold-Brauer G. Presentation of ventriculomegaly at 11-14 weeks of gestation: An analysis of longitudinal data. Prenat Diagn 2023. [PMID: 36588196 DOI: 10.1002/pd.6293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/21/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to examine the value of the sonographic measurements of the choroid plexus and the lateral ventricles at 11-14 gestational weeks in fetuses that had the diagnosis of second-trimester ventriculomegaly (VM) as a clinical reference. METHODS The standard axial plane used for biparietal diameter measurement from 2D stored images in the first trimester was used to calculate the ratio between the choroid plexus and lateral ventricle diameter (PDVDR), the choroid plexus and lateral ventricle length (PLVLR) and the choroid plexus and lateral ventricle area (PAVAR) in 100 normal and 15 fetuses diagnosed with second-trimester VM. RESULTS In fetuses with VM, the measurements of PDVDR, PLVLR and PAVAR were all significantly smaller compared to normal fetuses (p = < 0.001, <0.001, <0.01). Four out of seven cases with mild VM had measurements below the 5th percentile (57%). 75% of cases with moderate or severe VM had at least one measurement below the 5th percentile. CONCLUSIONS Since the axial plane of the fetal head is obtained in all first-trimester routine screenings, the measurements of PDVDR, PLVLR and PAVAR could easily be integrated into routine examinations for an early detection of VM.
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Affiliation(s)
- Kathrin B Labrosse
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland.,Department of Biomedicine, University Basel, Basel, Switzerland
| | - Johanna Buechel
- Department of Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Huelya Guelmez
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Annkathrin Butenschoen
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Heidrun Schoenberger
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | - Eva Visca
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland
| | | | - Gwendolin Manegold-Brauer
- Department for Gynecological Ultrasound and Prenatal Diagnostics, Women's Hospital, University of Basel, Basel, Switzerland.,Department of Biomedicine, University Basel, Basel, Switzerland.,Medical Faculty, University Basel, Basel, Switzerland
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Starrach T, Schmidhuber L, Elger L, Franz M, Buechel J, Hübener C, Kolben T, Koliogiannis V, Mahner S, Hasbargen U, Fischer B. Pelvic inlet area is associated with birth mode. Acta Obstet Gynecol Scand 2022; 102:59-66. [PMID: 36320156 PMCID: PMC9780724 DOI: 10.1111/aogs.14478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To determine whether a pelvis is wide enough for spontaneous delivery has long been the subject of obstetric research. A number of variables have been proposed as predictors, all with limited accuracy. In this study, we use a novel three-dimensional (3D) method to measure the female pelvis and assess which pelvic features influence birth mode. We compare the 3D pelvic morphology of women who delivered vaginally, women who had cesarean sections, and nulliparous women. The aim of this study is to identify differences in pelvic morphology between these groups. MATERIAL AND METHODS This observational study included women aged 50 years and older who underwent a CT scan of the pelvis for any medical indication. We recorded biometric data including height, weight, and age, and obtained the obstetric history. The bony pelvis was extracted from the CT scans and reconstructed in three dimensions. By placing 274 landmarks on each surface model, the pelvises were measured in detail. The pelvic inlet was measured using 32 landmarks. The trial was registered at the German Clinical Trials Register DRKS (DRKS00017690). RESULTS For this study, 206 women were screened. Exclusion criteria were foreign material in the bony pelvis, unknown birth mode, and exclusively preterm births. Women who had both a vaginal birth and a cesarean section were excluded from the group comparison. We compared the pelvises of 177 women between three groups divided by obstetric history: vaginal births only (n = 118), cesarean sections only (n = 21), and nulliparous women (n = 38). The inlet area was significantly smaller in the cesarean section group (mean = 126.3 cm2 ) compared with the vaginal birth group (mean = 134.9 cm2 , p = 0.002). The nulliparous women were used as a control group: there was no statistically significant difference in pelvic inlet area between the nulliparous and vaginal birth groups. CONCLUSIONS By placing 274 landmarks on a pelvis reconstructed in 3D, a very precise measurement of the morphology of the pelvis is possible. We identified a significant difference in pelvic inlet area between women with vaginal delivery and those with cesarean section. A unique feature of this study is the method of measurement of the bony pelvis that goes beyond linear distance measurements as used in previous pelvimetric studies.
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Affiliation(s)
- Teresa Starrach
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Lisa Schmidhuber
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Luisa Elger
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Marie Franz
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Johanna Buechel
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Christoph Hübener
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Thomas Kolben
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Vanessa Koliogiannis
- Department of RadiologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Sven Mahner
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Uwe Hasbargen
- Department of Obstetrics and GynecologyUniversity Hospital, Ludwig Maximilian UniversityMunichGermany
| | - Barbara Fischer
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
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Lange S, Krüger N, Warm M, op den Winkel M, Buechel J, Huber J, Genzel-Boroviczény O, Fischer MR, Dimitriadis K. Online medical history taking course: Opportunities and limitations in comparison to traditional bedside teaching. GMS J Med Educ 2022; 39:Doc34. [PMID: 36119150 PMCID: PMC9469571 DOI: 10.3205/zma001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/27/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Obtaining a systematic medical history (MH) from a patient is a core competency in medical education and plays a vital role in the diagnosis of diseases. At the Faculty of Medicine at LMU Munich, students have their first course in MH taking during their second year. Due to the COVID-19 pandemic, the traditional bedside MH taking course had to be transformed into an online course (OC). Our objectives were to implement an online MH taking course, to evaluate its feasibility and to compare the evaluation results to a historic cohort that had undertaken the traditional bedside teaching course (BTC). METHODS 874 second-year students participated in the OC (BTC=827). After teaching the theoretical background via asynchronous online lectures, students participated in a practical exercise with fellow students using the video communication platform Zoom where they were able to practice taking a MH on the basis of fictitious, text-based patient cases. Students were then asked to evaluate the course through a standardized online survey with 31 questions on teaching quality and self-perceived learning success, which had also been used in previous years. The survey results were compared to the results of the historic cohort using the Mann-Whitney U test. RESULTS A total of n=162 students (18.5%) evaluated the OC. In the historic cohort, n=252 (30.5%) completed the survey. 85.3% of the OC respondents thought that the atmosphere during the practical exercise was productive and 83.0% greatly appreciated the flexibility in terms of time management. Moreover, they appreciated the online resources as well as having the opportunity to undertake a MH taking course during the COVID-19 pandemic. 27.7% of the respondents thought that traditional BTCs should be supplemented through more online activities in the future. With respect to the ability of independently taking a MH upon completion of the course, the OC was rated significantly lower relative to the BTC (mean OC=2.4, SD=±1.1 vs. mean BTC=1.9, SD=±1.1 (1=strongly agree; 5=strongly disagree); p<0.0001). CONCLUSION OCs are a feasible format and seem to convey the theory and practical implementation in a peer-exercise format of MH taking to medical students. The theoretical background can be acquired with great flexibility. Nevertheless, the students' self-appraisal suggested that the traditional teaching format was more effective at teaching MH taking skills. Thus, we propose a blended learning concept, combining elements of both formats. In this context, we suggest prospective, randomized trials to evaluate blended learning approaches.
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Affiliation(s)
- Silvan Lange
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
| | - Nils Krüger
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
| | - Maximilian Warm
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Department of Internal Medicine III, Munich, Germany
| | - Mark op den Winkel
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Department of Internal Medicine II, Munich, Germany
| | - Johanna Buechel
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Department of Gynecology and Obstetrics, Munich, Germany
| | - Johanna Huber
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
| | - Orsolya Genzel-Boroviczény
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Dr. von Hauner Children's Hospital, Division of Neonatology Campus Innenstadt, Munich, Germany
| | - Martin R. Fischer
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
| | - Konstantinos Dimitriadis
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute of Medical Education, Munich, Germany
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Department of Neurology, Munich, Germany
- University Hospital, Ludwig-Maximilians-University (LMU) Munich, Institute for Stroke and Dementia Research (ISD), Munich, Germany
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Buechel J, Bruder E, Manegold-Brauer G. Three-dimensional imaging of rare mesenchymal tumor of umbilical cord. Ultrasound Obstet Gynecol 2020; 55:279-280. [PMID: 31115104 DOI: 10.1002/uog.20349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/01/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
| | - E Bruder
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - G Manegold-Brauer
- Department of Obstetrics and Gynecology,Division of Gynecologic and Prenatal Ultrasound, University Hospital Basel, Basel, Switzerland
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Monod C, Buechel J, Gisin S, Abo El Ela A, Vogt DR, Hoesli I. Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program. J Perinat Med 2019; 47:857-866. [PMID: 31494636 DOI: 10.1515/jpm-2019-0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
Abstract
Background Although cesarean sections at full dilatation are increasing, training in delivering a deeply impacted fetal head is lacking among obstetricians. The purpose of the study was to implement and evaluate a theoretical and simulation-based training program for this obstetrical emergency. Methods We developed a training program consisting of a theoretical introduction presenting a clinical algorithm, developed on the basis of the available literature, followed by a simulation session. We used the Kirkpatrick's framework to evaluate the program. A questionnaire was distributed, directly before, immediately and 6 weeks after the training. Self-perceived competencies were evaluated on a 6-point Likert scale. Pre- and post-test differences in the Likert scale were measured with the Wilcoxon signed rank test. Additionally, the training sessions were video recorded and rated with a checklist in relation to how well the algorithm was followed. Results Eleven residents and eight senior physicians took part to the training. More than 40% of participants experienced a comparable situation after the course during clinical work. Their knowledge and self-perceived competencies improved immediately after the training program and 6 weeks later. Major improvements were seen in the awareness of the algorithm and in the confidence in performing the reverse breech extraction (14.3% of the participants felt confident with the maneuver in the pre-training assessment compared with 66.7% 6 week post-training). Conclusion Our theoretical and simulation-based training program was successful in improving knowledge and confidence of the participants in delivering a deeply impacted fetal head during a cesarean section performed at full dilation.
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Affiliation(s)
- Cécile Monod
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Johanna Buechel
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Stefan Gisin
- Department of Anesthesia, University Hospital Basel and Simulation Center SimBa, Basel, Switzerland
| | - Aisha Abo El Ela
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trial Unit, Department Clinical Research, University Hospital Basel and University Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Gynecology and Obstetrics, University Hospital Basel, Basel, Switzerland
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Buechel J, Berset A, Lehmann MA, Lapaire O. Unresponsive primipara after rupture of membranes. BMJ Case Rep 2015; 2015:bcr-2015-209765. [PMID: 25883261 DOI: 10.1136/bcr-2015-209765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Amniotic fluid embolism, also called anaphylactoid syndrome of pregnancy, is a rare but severe problem in obstetrics. It occurs in 8/100,000 births and the maternal mortality is up to 90%. We report the case of a patient with amniotic fluid embolism who was transferred to our hospital. The initial presentation was an unresponsive patient after spontaneous rupture of the membranes. The massive hypotension and coagulopathy as well as fetal bradycardia of 60 bpm led, after stabilisation of the mother, to an emergency caesarean section. The neonate expired hours later, despite neonatological intensive care. During the operation, we had to deal with massive bleeding due to the coagulopathy. Through interdisciplinary teamwork including Bakri postpartum balloon insertion through the obstetrics team, uterine artery embolism by the interventional radiologists and transfusion of blood products, the maternal life was saved and the patient was discharged 9 days after admission.
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Affiliation(s)
- Johanna Buechel
- Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
| | - Andreas Berset
- Department of Anesthesiology, Universitätsspital Basel, Basel, Switzerland
| | - Michael A Lehmann
- Department of Anesthesiology, Universitätsspital Basel, Basel, Switzerland
| | - Olav Lapaire
- Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
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Manegold-Brauer G, Kang Bellin A, Hahn S, De Geyter C, Buechel J, Hoesli I, Lapaire O. A new era in prenatal care: non-invasive prenatal testing in Switzerland. Swiss Med Wkly 2014; 144:w13915. [PMID: 24549748 DOI: 10.4414/smw.2014.13915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
QUESTIONS UNDER STUDY Prenatal care has been significantly influenced by the introduction of non-invasive prenatal testing (NIPT) for aneuploidies in 2012. The aim of this study was to describe the current impact of NIPT on prenatal care. METHODS We performed a retrospective data analysis including all women with singleton pregnancies who presented for first trimester screening (FTS) between 1 October 2011 and 30 March 2013 and those seeking NIPT. According to the results of FTS the women were categorised into three risk groups: low risk for aneuploidy (<1:300), intermediate risk (1:300-1:50) and high risk (>1:50). They were counselled about the available options for invasive prenatal testing (IPT) and NIPT available at the time of FTS. The nine months before and after the introduction of NIPT were evaluated regarding further testing after FTS. RESULTS In total, 951 women were included: 505 examinations (group 1) were carried out before NIPT became available, 446 (group 2) thereafter. In group 2, 9.0% (40/446) had NIPT. Here, 60.0% (24/40) had a low risk according to FTS. In group 2 there was an increase of 3.6% of additional prenatal tests after FTS. The greatest increase was noted in the intermediate-risk category (10.7%). The number of invasive prenatal tests decreased by 67.4%. CONCLUSIONS We observed a notable increase in prenatal testing after the implementation of NIPT. NIPT is an additional test for women who need more reassurance. Since the options for pregnant women become more complex and the costs of NIPT are high, prenatal counselling has become more challenging.
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Cornbleet PJ, Buechel J. Red cell distribution width on the Coulter Model S-Plus. Am J Med Technol 1983; 49:865-7. [PMID: 6670664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Red cell distribution width (RDW) on the Coulter S-Plus has many limitations. Normal values (mean +/- 2 SD) were found to be sex dependent: 10.7 +/- 2.4 for males, and 9.8 +/- 1.8 for females. These ranges are broader than the normal range of 10.0 +/- 1.5 given by Coulter. When these broader ranges were applied, none of 29 patients with iron deficiency anemia showed an elevated RDW. Furthermore, a decrease in RDW with room temperature storage was observed and may contribute to erroneous results. The Coulter S-Plus RDW may not be as useful in quantitating anisocytosis as other methods of measuring the dispersion of the red cell volume histogram.
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