1
|
Barnett NR, George RM, Hatter KH, Janosy NR, Vizzini SJ, Singh S, Lee RE, Wolf BJ, Cabrera C, Duhachek-Stapelman AL, Katz D. Pregnancy complications and loss: an observational survey comparing anesthesiologists and obstetrician-gynecologists. J Matern Fetal Neonatal Med 2024; 37:2311072. [PMID: 38326280 DOI: 10.1080/14767058.2024.2311072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE While there is increasing information regarding the occupational risks to pregnant physicians, there is inconsistent and limited subspecialty data. Physicians may be at increased risk for pregnancy complications due to occupational exposure, long work hours, nightshifts, and physical/mental demands. Additionally, little is known regarding the education physicians receive pertaining to pregnancy risks respective to their specialties as well as departmental/institutional support for pregnancy loss or complication. Therefore, a survey was developed and distributed across multiple academic sites to ascertain if there is an inherent occupation-associated risk of pregnancy complication(s) and/or pregnancy loss for anesthesiologists (ANES) when compared to obstetrician/gynecologists (OB/GYN). METHODS A specialty-specific survey was distributed electronically to attending ANES and OB/GYN, via departmental listservs at six participating academic medical centers. Responses were collected from March to October 2022 and included demographic information, practice characteristics, education about pregnancy risks and details of pregnancy complications and loss. The primary comparison between specialty groups was the occurrence of at least one pregnancy complication and/or loss. Logistic regression was used to evaluate specialty outcome associations. Additionally, complication rates and types between specialties were compared using univariate and multivariable models. RESULTS The survey was distributed to 556 anesthesiology and 662 obstetrics-gynecology faculty members with 224 ANES and 168 OB/GYN respondents, yielding an overall 32.2% response rate. Of the survey respondents, 103 ANES and 116 OB/GYN reported at least one pregnancy. Demographics were similar between the two cohorts. ANES had higher gravidity and parity relative to OB/GYN and tended to be earlier in their career at first pregnancy (p = .008, <.001, and .043, respectively). The rate of any pregnancy complication, including loss, was similar between specialties (65.1% (67/103) vs. 65.5% (76/116), p = .942). Of the respondents reporting at least one pregnancy, 56.7% of ANES and 53.9% of OB/GYN experienced a complication while at work. Obstetrician-gynecologists had higher use of reproductive assistance (28% (47/116) vs. 11% (20/103), p < .001). There were no notable differences between cohorts for complications, prematurity, and neonatal intensive care admission. Forty-one percent (161/392) of total respondents recalled learning about occupational risks to pregnancy, and ANES were more likely than OB/GYN to have recalled learning about these risks (121/224 (54%) and 40/168 (23.8%), respectively, p < .001). CONCLUSIONS ANES and OB/GYN had similar risks for pregnancy complications and loss. Anesthesiologists were more likely to recall receiving education regarding occupational risk to pregnancy, though fewer than half of all survey respondents recalled learning about these risks. Our survey results are similar to the previously identified higher rate of pregnancy complications and loss in female physicians while uncovering areas of potential knowledge gaps for which institutions and practices could strive to improve upon. More research is needed to examine the relationship between occupation and pregnancy risk pertaining to female physicians with the goal being to identify modifiable risk factors.
Collapse
Affiliation(s)
- Natalie R Barnett
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Renuka M George
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine H Hatter
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Norah R Janosy
- Department of Anesthesiology, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Samantha J Vizzini
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Shubhangi Singh
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca E Lee
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Camila Cabrera
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
2
|
Ayres-de-Campos D, Louwen F, Vivilaki V, Benedetto C, Modi N, Wielgos M, Tudose MEP, Timonen S, Reyns M, Yli B, Stenback P, Nunes I, Yurtsal B, Vayssière C, Roth GE, Jonsson M, Bakker P, Lopriore E, Verlohren S, Jacobsson B. European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour - because words matter. Eur J Obstet Gynecol Reprod Biol 2024; 296:205-207. [PMID: 38460251 DOI: 10.1016/j.ejogrb.2024.02.048] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect.
Collapse
Affiliation(s)
| | - Frank Louwen
- Department of Obstetrics and Gynecology and Obstetrics, Goethe University Frankfurt/Main and University Hospital, Germany
| | | | - Chiara Benedetto
- Department of Gynecology and Obstetrics, University Division at St. Anna Hospital, Torino, Italy
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Imperial College London, London, UK
| | - Miroslaw Wielgos
- Department of Obstetrics and Perinatology, National Medical Institute of the Ministry of Interior and Administration, Medical Faculty, Lazarski University, Warsaw, Poland
| | - Melania-Elena Pop Tudose
- Obstetrics Department, Emergency Hospital, Buzau, Carol Davila University of Medicine and Pharmacy, Faculty of Midwifery and Nursing, Bucharest, Romania
| | | | | | - Branka Yli
- Delivery Department, Oslo University Hospital, Oslo, Norway
| | | | - Inês Nunes
- Department of Obstetrics and Gynecology, Unidade Local de Saúde de Gaia/Espinho, Faculty of Medicine, University of Porto, Portugal
| | - Burcu Yurtsal
- Department of Midwifery, Sivas Cumhuriyet University, Turkey
| | - Christophe Vayssière
- Department of Obstetrics-Gynecology-Reproduction, Paule de Viguier Hospital, CHU Toulouse, Toulouse III University, France
| | - Georges-Emmanuel Roth
- Department of Obstetrics and Gynecology, CHU Strasbourg, France, University of Strasbourg, France
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Sweden
| | - Petra Bakker
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU Medical Center, Amsterdam, the Netherlands
| | - Enrico Lopriore
- Department of Neonatology, Leiden University Medical Center, Netherlands
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Germany
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
3
|
Baas MAM, Stramrood CAI, Molenaar JE, van Baar PM, Vanhommerig JW, van Pampus MG. Continuing the conversation: a cross-sectional study about the effects of work-related adverse events on the mental health of Dutch (resident) obstetrician-gynaecologists (ObGyns). BMC Psychiatry 2024; 24:286. [PMID: 38627649 PMCID: PMC11022402 DOI: 10.1186/s12888-024-05678-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Obstetrician-Gynaecologists (ObGyns) frequently face work-related adverse events such as severe obstetric complications and maternal or neonatal deaths. In 2014, the WATER-1 study showed that ObGyns are at risk of developing work-related posttraumatic stress disorder (PTSD), while many hospitals lacked a professional support system. The aim of the present study is to evaluate the current prevalence of work-related traumatic events and mental health problems among Dutch ObGyns, as well as to examine the current and desired support. METHODS In 2022, an online questionnaire was sent to all members of the Dutch Society of Obstetrics and Gynaecology (NVOG), including resident and attending ObGyns. The survey included questions about experienced work-related events, current and desired coping strategies, and three validated screening questionnaires for anxiety, depression, and PTSD (HADS, TSQ, and PCL-5). RESULTS The response rate was 18.8% and 343 questionnaires were included in the analysis. Of the respondents, 93.9% had experienced at least one work-related adverse event, 20.1% had faced a complaint from the national disciplinary board, and 49.4% had considered leaving the profession at any moment in their career. The prevalence rates of clinically relevant anxiety, depression, and psychological distress were 14.3, 4.4, and 15.7%, respectively. The prevalence of work-related PTSD was 0.9% according to DSM-IV and 1.2% according to DSM-5. More than half of the respondents (61.3%) reported the presence of a structured support protocol or approach in their department or hospital, and almost all respondents (92.6%) rated it as sufficient. CONCLUSIONS The percentages of anxiety, depression, psychological distress and PTSD are comparable to the similar study performed in 2014. Most Dutch ObGyns experience adverse events at work, which can be perceived as traumatic and, in certain cases, may lead to the development of PTSD. Structured support after adverse work-related events is now available in almost two-thirds of workplaces, and was mostly experienced as good. Despite substantial improvements in the availability and satisfaction of professional support after work-related adverse events, the prevalence rates of mental problems remain considerable, and it is imperative to sustain conversation about the mental well-being of ObGyns.
Collapse
Affiliation(s)
- Melanie A M Baas
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, 9700 RB, Groningen, PO box 30.001, The Netherlands
| | - Claire A I Stramrood
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Beval Beter, 1000 AH, Amsterdam, PO box 345, The Netherlands
| | - Jolijn E Molenaar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Petra M van Baar
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, 1105 AZ, Amsterdam, the Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, 1090 HM, Amsterdam, PO box 95500, The Netherlands.
| |
Collapse
|
4
|
Sorel M, Gachon B, Coste-Mazeau P, Aubard Y, Pierre F, Fradet L. Analysis of the obstetrician's posture and movements during a simulated forceps delivery. BMC Pregnancy Childbirth 2024; 24:253. [PMID: 38589802 PMCID: PMC11000395 DOI: 10.1186/s12884-024-06457-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The objective of this study was to identify and qualify, by means of a three-dimensional kinematic analysis, the postures and movements of obstetricians during a simulated forceps birth, and then to study the association of the obstetricians' experience with the technique adopted. METHOD Fifty-seven volunteer obstetricians, 20 from the Limoges and 37 from the Poitiers University hospitals, were included in this multi-centric study. They were classified into 3 groups: beginners, intermediates, and experts, beginners having performed fewer than 10 forceps deliveries in real conditions, intermediates between 10 and 100, and experts more than 100. The posture and movements of the obstetricians were recorded between December 2020 and March 2021 using an optoelectronic motion capture system during simulated forceps births. Joint angles qualifying these postures and movements were analysed between the three phases of the foetal traction. These phases were defined by the passage of a virtual point associated with the forceps blade through two anatomical planes: the mid-pelvis and the pelvic outlet. Then, a consolidated ascending hierarchical classification (AHC) was applied to these data in order to objectify the existence of groups of similar behaviours. RESULTS The AHC distinguished four different postures adopted when crossing the first plane and three different traction techniques. 48% of the beginners adopted one of the two raised posture, 22% being raised without trunk flexion and 26% raised with trunk flexion. Conversely, 58% of the experts positioned themselves in a "chevalier servant" posture (going down on one knee) and 25% in a "squatting" posture before initiating traction. The results also show that the joint movement amplitude tends to reduce with the level of expertise. CONCLUSION Forceps delivery was performed in different ways, with the experienced obstetricians favouring postures that enabled observation at the level of the maternal perineum and techniques reducing movement amplitude. The first perspective of this work is to relate these different techniques to the traction force generated. The results of these studies have the potential to contribute to the training of obstetricians in forceps delivery, and to improve the safety of women and newborns.
Collapse
Affiliation(s)
- Manon Sorel
- Department of Obstetrics and Gynecology, University of Poitiers, University Hospital Center of Poitiers, Poitiers, 86000, France.
- Pprime Institute UPR 3346-CNRS, University of Poitiers, Axe RoBioSS, Poitiers, 86073, France.
| | - Bertrand Gachon
- Department of Obstetrics and Gynecology, University of Poitiers, University Hospital Center of Poitiers, Poitiers, 86000, France
- Clinical Investigation Center, INSERM CIC 1402, Poitiers, 86000, France
| | - Perrine Coste-Mazeau
- Department of Obstetrics and Gynecology, University of Limoges, University Hospital Center of Limoges, Limoges, 87000, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, University of Limoges, University Hospital Center of Limoges, Limoges, 87000, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, University of Poitiers, University Hospital Center of Poitiers, Poitiers, 86000, France
| | - Laetitia Fradet
- Pprime Institute UPR 3346-CNRS, University of Poitiers, Axe RoBioSS, Poitiers, 86073, France
| |
Collapse
|
5
|
Shaath MK, Garrett C, Pattisapu N, Routt MLC. Obstetricians are likely to elect for cesarean section in women with retained pelvic implants: a radiographic survey study. Eur J Orthop Surg Traumatol 2024; 34:1345-1348. [PMID: 38133652 DOI: 10.1007/s00590-023-03803-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Women with a history of pelvic fracture undergo cesarean section (CS) at a higher rate than the general population. The purpose of our study is to query obstetricians on their preferences. METHODS An electronic survey consisting of 22 radiographs of patients who underwent pelvic fixation was sent to obstetricians at 3 academic medical centers. For each radiograph, a hypothetical scenario was given, and the respondents were asked if they would elect for a vaginal delivery or CS. RESULTS We collected 58 responses. The overall CS rate was 59%. Respondents were significantly more likely to elect for CS with trans-symphyseal fixation or sacroiliac fixation, independently (p < 0.001). DISCUSSION Obstetricians are likely to elect for elective CS in the presence of pelvic implants especially in patients with trans-symphyseal and sacroiliac fixation. Based on there is an opportunity for collaboration between orthopedic trauma surgeons and obstetricians.
Collapse
Affiliation(s)
- M Kareem Shaath
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA.
| | - Christopher Garrett
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA
| | | | - Milton L Chip Routt
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, McGovern Medical School at UTHealth, Houston, USA
| |
Collapse
|
6
|
Shahawy S, Raya L, Al Kassab L. Caring for Muslim Patients: A Primer for the Obstetrician Gynecologist. Obstet Gynecol Clin North Am 2024; 51:57-67. [PMID: 38267131 DOI: 10.1016/j.ogc.2023.10.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Studies show that Muslim American patients experience discrimination and feel uncomfortable seeking appropriate health care for various reasons. Obstetrician-gynecologists should be educated regarding Islamic perspectives on topics such as modesty, sexual health, contraception, abortion, infertility, and fasting during pregnancy. Understanding the barriers Muslim patients face and improving cultural humility will improve the quality of sexual and reproductive care delivered to Muslim patients.
Collapse
Affiliation(s)
- Sarrah Shahawy
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA.
| | - Lobna Raya
- Tufts University, 419 Boston Avenue, Medford, MA 02155, USA
| | - Leen Al Kassab
- Department of Obstetrics & Gynecology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
7
|
Matsubara S, Matsubara D. Triple responsibilities of academic institute obstetrician-gynecologists: Still valid? J Obstet Gynaecol Res 2024; 50:530-531. [PMID: 38072916 DOI: 10.1111/jog.15853] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 03/04/2024]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
- Department of Obstetrics and Gynecology, Koga Red Cross Hospital, Koga, Japan
- Medical Examination Center, Ibaraki Western Medical Center, Chikusei, Japan
| | - Daisuke Matsubara
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
- Department of Pediatrics, International University of Health and Welfare Hospital, Nasushiobara, Japan
| |
Collapse
|
8
|
Robertson DK. Trudging Through Infertility: A Male Obstetrician-Gynecologist's Personal Infertility Struggle. Obstet Gynecol 2024; 143:e86-e87. [PMID: 38176011 DOI: 10.1097/aog.0000000000005495] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Dale Kesley Robertson
- Family Health Centers of Georgia, Inc., and the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
9
|
Brohan MP, Barrett PM. Hypertensive disorders of pregnancy: no longer just an "obstetrician's disease". Am J Obstet Gynecol 2024; 230:e32. [PMID: 37944840 DOI: 10.1016/j.ajog.2023.11.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Matthew P Brohan
- School of Medicine, University College Cork, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland.
| | - Peter M Barrett
- School of Public Health, University College Cork, Cork, Ireland
| |
Collapse
|
10
|
Debessai H, Jones JM, Meaney-Delman D, Rasmussen SA. What U.S. Obstetricians Need to Know About Respiratory Syncytial Virus. Obstet Gynecol 2024; 143:e54-e62. [PMID: 38061043 DOI: 10.1097/aog.0000000000005492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/17/2024]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections in neonates, infants, and children worldwide. The virus is estimated to infect 97% of this population in the United States by the age of 2 years, leading to hospitalization for severe lower respiratory tract disease in 2-3% of infants younger than age 6 months. Two preventive options, prenatal administration of a maternal vaccine and administration of a long-acting monoclonal antibody to the infant, are now available for the prevention of RSV-associated lower respiratory tract infection in infants in the United States. The U.S. Food and Drug Administration (FDA) has approved and the Centers for Disease Control and Prevention (CDC) has recommended a new maternal vaccination, RSVPreF, to be administered between 32 0/7 and 36 6/7 weeks of gestation to reduce the risk of RSV-associated lower respiratory tract infection in infants in the first 6 months of life. The monoclonal antibody nirsevimab was approved by the FDA and recommended by the CDC for prevention of RSV-associated lower respiratory tract infection in infants younger than age 8 months who are born during or entering their first RSV season and for infants and children aged 8-19 months who are at high risk for RSV-associated lower respiratory tract infection and entering their second RSV season. Either maternal vaccination during pregnancy or monoclonal antibody administration to the infant is recommended to prevent RSV-associated lower respiratory tract infection among infants, but both are not needed for most infants. Given that the availability of these products may vary as these recommendations are implemented, it is important that obstetricians and other prenatal practitioners have the information they need to counsel their pregnant patients about both options. We review the safety and efficacy of these products, current recommendations for their use, and relative advantages and disadvantages of both newly approved options for the prevention of RSV-associated lower respiratory tract infection in infants to assist obstetricians and other prenatal practitioners in their counseling of pregnant patients.
Collapse
Affiliation(s)
- Haben Debessai
- CDC Foundation, the National Center on Immunization and Respiratory Diseases, and the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and the Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | | |
Collapse
|
11
|
Dyer C. Torbay hospital needs four more obstetricians to make maternity service safe, says regulator. BMJ 2024; 384:q457. [PMID: 38383027 DOI: 10.1136/bmj.q457] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
|
12
|
Borges VEL, Barbosa F, Neves FF, Mesquita MRDS, Moisés ECD. National survey regarding obstetricians' perspective of obstetric emergencies in Brazil. Clinics (Sao Paulo) 2024; 79:100333. [PMID: 38330790 PMCID: PMC10864865 DOI: 10.1016/j.clinsp.2024.100333] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/30/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. METHODS An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. RESULTS More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. CONCLUSION A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.
Collapse
Affiliation(s)
| | - Francisco Barbosa
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | |
Collapse
|
13
|
Dahl CM, Turok D, Heuser CC, Sanders J, Elliott S, Pangasa M. Strategies for obstetricians and gynecologists to advance reproductive autonomy in a post-Roe landscape. Am J Obstet Gynecol 2024; 230:226-234. [PMID: 37536485 DOI: 10.1016/j.ajog.2023.07.055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
The monumental reversal of Roe vs Wade dramatically impacted the landscape of reproductive healthcare access in the United States. The decision most significantly affects communities that historically have been and continue to be marginalized by systemic racism, classism, and ableism within the medical system. To minimize the harm of restrictive policies that have proliferated since the Supreme Court overturned Roe, it is incumbent on obstetrician-gynecologists to modify practice patterns to meet the pressing reproductive health needs of their patients and communities. Change will require cross-discipline advocacy focused on advancing equity and supporting the framework of reproductive justice. Now, more than ever, obstetrician-gynecologists have a critical responsibility to implement new approaches to service delivery and education that will expand access to evidence-based, respectful, and person-centered family planning and early pregnancy care regardless of their practice location or subspecialty.
Collapse
Affiliation(s)
- Carly M Dahl
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT.
| | - David Turok
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Cara C Heuser
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Sarah Elliott
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Misha Pangasa
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| |
Collapse
|
14
|
Clark JA, Smith LK, Armstrong N. Midwives' and obstetricians' practice, perspectives and experiences in relation to altered fetal movement: A focused ethnographic study. Int J Nurs Stud 2024; 150:104643. [PMID: 38043485 DOI: 10.1016/j.ijnurstu.2023.104643] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Reducing avoidable stillbirth is a global priority. The stillbirth rate in England compares unfavourably to that of some other high-income countries. Poorly-managed episodes of altered fetal movement have been highlighted as a key contributor to avoidable stillbirth, and strategies introduced in England in 2016 to reduce perinatal mortality included recommendations for the management of reduced fetal movement. Despite a downward trend in stillbirth rates across the UK, the effects of policies promoting awareness of fetal movement remain uncertain. OBJECTIVE To provide in-depth knowledge of how practice and clinical guidance relating to altered fetal movement are perceived, enacted and experienced by midwives and obstetricians, and explore the relationship between recommended fetal movement care and actual fetal movement care. DESIGN A focused ethnographic approach comprising over 180 h of observation, 15 interviews, and document analysis was used to explore practice at two contrasting UK maternity units. SETTINGS Antenatal services at two UK maternity units, one in the Midlands and one in the North of England. PARTICIPANTS Thirty-six midwives, obstetricians and sonographers and 40 pregnant women participated in the study across 52 observed care episodes and relevant unit activity. Twelve midwives and three obstetricians additionally participated in formal semi-structured interviews. METHODS Fieldnotes, interview transcripts, policy documents, maternity notes and clinical guidelines were analysed using a modified constant comparison method to identify important themes. RESULTS fetal movement practice was mostly consistent and in line with guideline recommendations. Notwithstanding, most midwives and obstetricians had concerns about this area of care, including challenges in diagnosis, conflicting evidence about activity, heightened maternal anxiety, and high rates of monitoring and intervention in otherwise low-risk pregnancies. To address these issues, midwives spent considerable time reassuring women through information and regular monitoring, and coaching them to perceive fetal movement more accurately. CONCLUSIONS Practice relating to altered fetal movement might be more uniform than in the past. However, a heightened focus on fetal movement is associated by some midwives and obstetricians with potential harms, including increased anxiety in pregnancy, and high rates of monitoring and intervention in pregnancies where there are no 'objective concerns'. Challenges in diagnosing a significant change in fetal movement with accuracy might mean that interventions and resources are not being directed towards those pregnancies most at risk. More research is needed to determine how healthcare professionals can engage in conversations about fetal movement and stillbirth to support safe outcomes and positive experiences in pregnancy and birth. REGISTRATION Not registered. TWEETABLE ABSTRACT Midwives and obstetricians take #reducedfetalmovement seriously but worry this 'unreliable' symptom increases anxiety, monitoring and intervention in many 'low risk' pregnancies.
Collapse
Affiliation(s)
- Julia A Clark
- Department of Population Health Sciences, University of Leicester, Leicester, UK; School of Health Science, The University of Nottingham, Nottingham, UK.
| | - Lucy K Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Natalie Armstrong
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
15
|
Lu C, Georgousopoulou E, Baloch S, Walton-Sonda D, Hegarty K, Sethna F, Brown NAT. Identifying the barriers faced by obstetricians and registrars in screening or enquiry of intimate partner violence in pregnancy: A systematic review of the primary evidence. Aust N Z J Obstet Gynaecol 2024; 64:19-27. [PMID: 37786258 DOI: 10.1111/ajo.13747] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/10/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Intimate partner violence (IPV) disproportionally affects women compared to men. The impact of IPV is amplified during pregnancy. Screening or enquiry in the antenatal outpatient setting regarding IPV has been fraught with barriers that prevent recognition and the ability to intervene. AIMS The aim of this systematic review was to determine the barriers that face obstetricians/gynaecologists regarding enquiry of IPV in antenatal outpatient settings. The secondary objective was to determine facilitators. METHODS Primary evidence was searched using Ovid MEDLINE, Ovid Maternity and Infant Care, PubMed and Proquest from 1993 to May 2023. The included studies comprised empirical studies published in English language targeting a population of doctors providing antenatal outpatient care. The review was PROSPERO-registered (CRD42020188994). Independent screening and review was performed by two authors. The findings were analysed thematically. RESULTS Nine studies addressing barriers and two studies addressing facilitators were included: three focus-group or semi-structured interviews, six surveys and two randomised controlled trials. Barriers for providers centred at the system level (time, training), provider level (personal beliefs, cultural bias, experience) and provider-perceived patient level (fear of offending, patient readiness to disclose). Increased experience and the use of validated tools were strong facilitators. CONCLUSION Barriers to screening reflect multi-level obstruction to the identification of women exposed to IPV. Although the antenatal outpatient clinic setting addresses a particular population vulnerable to IPV, the barriers for obstetricians are not unique. The use of validated cueing tools provides an evidence-based method to facilitate enquiry of IPV among antenatal women, assisting in identification by clinicians. Together with education and human resources, such aids build capacity in women and obstetric providers.
Collapse
Affiliation(s)
- Corrine Lu
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | | | - Surriya Baloch
- University of Melbourne Royal Women's Hospital, Parkville, Victoria, Australia
| | | | - Kelsey Hegarty
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Farah Sethna
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Nick A T Brown
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
- University of Canberra, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
16
|
Dlugatch R, Georgieva A, Kerasidou A. AI-driven decision support systems and epistemic reliance: a qualitative study on obstetricians' and midwives' perspectives on integrating AI-driven CTG into clinical decision making. BMC Med Ethics 2024; 25:6. [PMID: 38184595 PMCID: PMC10771643 DOI: 10.1186/s12910-023-00990-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Given that AI-driven decision support systems (AI-DSS) are intended to assist in medical decision making, it is essential that clinicians are willing to incorporate AI-DSS into their practice. This study takes as a case study the use of AI-driven cardiotography (CTG), a type of AI-DSS, in the context of intrapartum care. Focusing on the perspectives of obstetricians and midwives regarding the ethical and trust-related issues of incorporating AI-driven tools in their practice, this paper explores the conditions that AI-driven CTG must fulfill for clinicians to feel justified in incorporating this assistive technology into their decision-making processes regarding interventions in labor. METHODS This study is based on semi-structured interviews conducted online with eight obstetricians and five midwives based in England. Participants were asked about their current decision-making processes about when to intervene in labor, how AI-driven CTG might enhance or disrupt this process, and what it would take for them to trust this kind of technology. Interviews were transcribed verbatim and analyzed with thematic analysis. NVivo software was used to organize thematic codes that recurred in interviews to identify the issues that mattered most to participants. Topics and themes that were repeated across interviews were identified to form the basis of the analysis and conclusions of this paper. RESULTS There were four major themes that emerged from our interviews with obstetricians and midwives regarding the conditions that AI-driven CTG must fulfill: (1) the importance of accurate and efficient risk assessments; (2) the capacity for personalization and individualized medicine; (3) the lack of significance regarding the type of institution that develops technology; and (4) the need for transparency in the development process. CONCLUSIONS Accuracy, efficiency, personalization abilities, transparency, and clear evidence that it can improve outcomes are conditions that clinicians deem necessary for AI-DSS to meet in order to be considered reliable and therefore worthy of being incorporated into the decision-making process. Importantly, healthcare professionals considered themselves as the epistemic authorities in the clinical context and the bearers of responsibility for delivering appropriate care. Therefore, what mattered to them was being able to evaluate the reliability of AI-DSS on their own terms, and have confidence in implementing them in their practice.
Collapse
Affiliation(s)
- Rachel Dlugatch
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Antoniya Georgieva
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3 Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Angeliki Kerasidou
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| |
Collapse
|
17
|
Sabbath EL, McKetchnie SM, Arora KS, Buchbinder M. US Obstetrician-Gynecologists' Perceived Impacts of Post-Dobbs v Jackson State Abortion Bans. JAMA Netw Open 2024; 7:e2352109. [PMID: 38231510 PMCID: PMC10794934 DOI: 10.1001/jamanetworkopen.2023.52109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Following the Dobbs v Jackson Women's Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences. Objective To characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion. Design, Setting, and Participants This qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023. Exposure State abortion bans enacted between June 2022 and March 2023. Main Outcomes and Measures OB-GYNs' perceptions of clinical and personal impacts of abortion bans. Results This study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety). Conclusions and relevance In this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians' clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.
Collapse
Affiliation(s)
- Erika L. Sabbath
- School of Social Work, Boston College, Chestnut Hill, Massachusetts
- Center for Work, Health, and Wellbeing, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Kavita S. Arora
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Mara Buchbinder
- Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| |
Collapse
|
18
|
Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. Gynecol Obstet Fertil Senol 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
Collapse
Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
| |
Collapse
|
19
|
Fidalgo AM, Miguel R, Fernández-Buhigas I, Aguado A, Cuerva MJ, Corrales E, Rolle V, Santacruz B, Gil MM, Poon LC. Level of agreement between midwives and obstetricians performing ultrasound examination during labor. Int J Gynaecol Obstet 2024; 164:131-139. [PMID: 37401541 DOI: 10.1002/ijgo.14956] [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: 01/13/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training. METHODS In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position. RESULTS We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80-0.98). CONCLUSIONS Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.
Collapse
Affiliation(s)
- Ana M Fidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Raquel Miguel
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | | | - Asunción Aguado
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Marcos J Cuerva
- Department of Obstetrics and Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Elisa Corrales
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Valeria Rolle
- Bioestatistics and Epidemiology Platform at Fundación para la Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Belén Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
- School of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - María M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
- School of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
20
|
Bragazzi NL, Buchinger M, Szarpak L, Chmielewski J, Goździewska M, Gotlib J, Farah RE. Knowledge, attitudes, and practices towards COVID-19 and COVID-19 vaccines among Obstetrician-Gynaecologists. Ann Agric Environ Med 2023; 30:669-676. [PMID: 38153070 DOI: 10.26444/aaem/176959] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION AND OBJECTIVE The article assesses the knowledge, attitudes, and practices of Obstetrician-Gynaecologists (OB/GYNs) in Israel regarding COVID-19, its impact on fertility, pregnancy and childbirth, and their positions on COVID-19 vaccines. MATERIAL AND METHODS A cross-sectional anonymous survey was employed, and the data analyzed using logistic regression models. RESULTS A total of 172 OB/GYN participants aged 44.9 years, primarily female (59.7%), mostly attending physicians (60.4%), had a mean knowledge score of 75.62%, with 81.1% having sufficient knowledge about general COVID-19 information, 11.9% having specific knowledge about pregnancy, birth, and breastfeeding, and 40.3% having knowledge about COVID-19 vaccination. Notably, only 27% of participants correctly identified the increased risk of preeclampsia in pregnant women with COVID-19. Nevertheless, all OB/GYN participants recommended the COVID-19 vaccination during pregnancy. The majority (65.1%) recommended vaccination across all trimesters, while a smaller percentage recommended it only in the second (25%) or third (6%) trimesters, and very few in the first trimester (4%). The study found that attitudes towards vaccination were influenced by workplace, role, religion, religious observance, and marital status. CONCLUSIONS The study showed a good level of knowledge regarding COVID-19 vaccines which contributed to OB/GYNs' recommendations to their patients. These findings can be valuable for designing future COVID-19 vaccination campaigns.
Collapse
Affiliation(s)
| | | | - Lukasz Szarpak
- Baylor College of Medicine, Houston, United States
- LUXMED Group, Poland
| | | | | | | | - Rola Elias Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Tel Aviv, Israel
| |
Collapse
|
21
|
Bomba-Opon D, Gutaj P, Kedzia M, Leszczynska-Gorzelak B, Majewska A, Radzicka-Mularczyk S, Stanirowski P, Wender-Ozegowska E. Guidelines of the Polish Society of Gynecologists and Obstetricians on the obstetric care of women with obesity. Ginekol Pol 2023; 94:1011-1029. [PMID: 38099668 DOI: 10.5603/gpl.97361] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Dorota Bomba-Opon
- Collegium Medicum Jan Kochanowski University of Kielce, Poland
- Department of Reproduction, Chair of Perinatal Medicine, Poznan University of Medical Sciences, Poland
| | - Pawel Gutaj
- Department of Reproduction, Chair of Perinatal Medicine, Poznan University of Medical Sciences, Poland
| | - Malgorzata Kedzia
- Department of Reproduction, Chair of Perinatal Medicine, Poznan University of Medical Sciences, Poland
| | | | - Agata Majewska
- Department of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland
| | - Sandra Radzicka-Mularczyk
- Department of Reproduction, Chair of Perinatal Medicine, Poznan University of Medical Sciences, Poland
| | - Pawel Stanirowski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Ewa Wender-Ozegowska
- Department of Reproduction, Chair of Perinatal Medicine, Poznan University of Medical Sciences, Poland
| |
Collapse
|
22
|
Dyer C. Obstetrician who sterilised woman without consent is suspended for 12 months. BMJ 2023; 383:2932. [PMID: 38086553 DOI: 10.1136/bmj.p2932] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
|
23
|
Koranteng YB, Adu-Bonsaffoh K, Oppong-Yeboah B. Physiotherapy practice in women's health: awareness and attitudes of obstetricians and gynecologists in Ghana. BMC Womens Health 2023; 23:666. [PMID: 38082319 PMCID: PMC10714590 DOI: 10.1186/s12905-023-02705-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physiotherapy is relatively well integrated into women's health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women's health among obstetricians/gynecologists and factors associated with its utilization in Ghana. METHODS A cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an "Awareness and Attitude Questionnaire" adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors' awareness level of physiotherapy's role in women's health and years of clinical practice. RESULTS Sixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29-65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists' role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors' awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors' attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice. CONCLUSION Although obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women's health in the hospital.
Collapse
Affiliation(s)
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.
| | - Bertha Oppong-Yeboah
- Department of Physiotherapy, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
24
|
Liu X, Liu S, Wang H, Sun L, Li T, Hu T. [Discussion on the status quo and solutions to the prevention and control of birth defects among primary obstetricians and gynecologists in the era of molecular genetic testing]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2023; 40:1447-1450. [PMID: 37994121 DOI: 10.3760/cma.j.cn511374-20220919-00631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Birth defects are an important factor for the quality of newborn population. With the development of molecular genetic technology, an increasing number of genetic disorders leading to birth defects can now be detected. The lack of the knowledge for the basics and clinical applications of molecular genetic techniques have emerged as a shortcoming for primary care physicians who have formed the first tier prevention for birth defects. Currently, government has paid more attention to the above problems and formulated more training programs for primary obstetricians and gynecologists, e.g., "Prenatal Screening and Prenatal Diagnosis Post Training Program", "National Birth Defects Training Program", "National Primary Obstetrician Training Program". To some extent, such programs have met the urgent need for birth defect prevention in primary hospitals. But at the same time, some problems have also emerged. For instance, the knowledge for birth defects among primary obstetricians and gynecologists is poor, and there is lack of young personnel. This article has aimed to discuss the strategies to systematically improve the ability for preventing birth defects among primary care physicians by analyzing the obstacles and challenges for primary obstetricians and gynecologists in the era of molecular genetic testing.
Collapse
Affiliation(s)
- Xijing Liu
- Department of Medical Genetics, Key Laboratory for Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
| | | | | | | | | | | |
Collapse
|
25
|
Chandraharan E, Ghi T, Pereira S. It is time for midwives and obstetricians to forget about the baroreflex in labor: a response. Am J Obstet Gynecol 2023; 229:708. [PMID: 37506749 DOI: 10.1016/j.ajog.2023.07.039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Edwin Chandraharan
- Global Academy of Medical Education & Training Ltd, London, United Kingdom.
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | |
Collapse
|
26
|
Roper JC, Thakar R, Hurt KJ, Sultan AH. Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians. Int Urogynecol J 2023; 34:2873-2883. [PMID: 37498432 PMCID: PMC10756863 DOI: 10.1007/s00192-023-05590-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Perineal trauma during vaginal delivery is very common. Training in diagnosis and repair of trauma, including obstetric anal sphincter injuries, varies in the UK. We aimed to investigate the current knowledge and training received by obstetric physicians. METHODS A national, validated survey was conducted online, using Qualtrics. The National Trainees Committee distributed the survey. It was also sent directly to consultants via email. RESULTS A total of 302 physicians completed the survey and were included in the analysis. 3.9% of participants described their training in obstetric perineal trauma as "very poor" or "poor". 20.5% said they have not received training. 8.6% of physicians practising for more than 10 years had not had training for over 10 years. 70.5% responded "somewhat agree" or "strongly agree" when asked if they would like more training. Identification of first, second, third-, and fourth-degree tears from images and descriptions was very good (more than 80% correct for all categories). Classification of other perineal trauma was less consistent, with many incorrectly using the Sultan Classification. "Manual perineal support" and "Controlled or guided delivery" were the most frequently selected methods for the prevention of obstetric anal sphincter injury (OASI). CONCLUSIONS Training experience for physicians in obstetric perineal trauma varies. Further improvement in training and education in perineal trauma, particularly in OASI, is needed for physicians. Perineal trauma that is not included in the Sultan Classification is often misclassified.
Collapse
Affiliation(s)
- Joanna C Roper
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK
| | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK
- St George's University of London, London, UK
| | - K Joseph Hurt
- Divisions of Maternal Fetal Medicine and Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Abdul H Sultan
- Department of Obstetrics and Gynaecology, Croydon University Hospital, London Road, Croydon, CR7 7YE, UK.
- St George's University of London, London, UK.
| |
Collapse
|
27
|
Lear CA, Westgate JA, Gunn AJ. It is time for midwives and obstetricians to forget about the baroreflex in labor. Am J Obstet Gynecol 2023; 229:707. [PMID: 37506753 DOI: 10.1016/j.ajog.2023.07.038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Christopher A Lear
- Fetal Physiology and Neuroscience Group, Faculty of Medical and Health Sciences, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Jennifer A Westgate
- Fetal Physiology and Neuroscience Group, Faculty of Medical and Health Sciences, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Fetal Physiology and Neuroscience Group, Faculty of Medical and Health Sciences, Department of Physiology, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
28
|
Annual Scientific Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), 28 October - 1 November 2023. Aust N Z J Obstet Gynaecol 2023; 63 Suppl 1:3-75. [PMID: 38098288 DOI: 10.1111/ajo.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
|
29
|
Шляхто ЕВ, Сухих ГТ, Серов ВН, Дедов ИИ, Арутюнов ГП, Сучков ИА, Орлова ЯА, Андреева ЕН, Юренева СВ, Явелов ИС, Ярмолинская МИ, Виллевальде СВ, Григорян ОР, Дудинская ЕН, Илюхин ЕА, Козиолова НА, Сергиенко ИВ, Сметник АА, Тапильская НИ. [Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia]. Probl Endokrinol (Mosk) 2023; 69:115-136. [PMID: 37968959 PMCID: PMC10680541 DOI: 10.14341/probl13394] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.
Collapse
Affiliation(s)
- Е. В. Шляхто
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - Г. Т. Сухих
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - В. Н. Серов
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - И. И. Дедов
- Национальный медицинский исследовательский центр эндокринологии
| | - Г. П. Арутюнов
- Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
| | - И. А. Сучков
- Рязанский государственный медицинский университет им. акад. И.П. Павлова
| | - Я. А. Орлова
- Медицинский научно-образовательный центр МГУ им. М.В. Ломоносова
| | - Е. Н. Андреева
- Национальный медицинский исследовательский центр эндокринологии
| | - С. В. Юренева
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - И. С. Явелов
- Национальный медицинский исследовательский центр терапии и профилактической медицины
| | - М. И. Ярмолинская
- Научно-исследовательский институт акушерства и гинекологии и репродуктологии им. Д.О. Отта
| | | | - О. Р. Григорян
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. Н. Дудинская
- Российский геронтологический научно-клинический центр Российского национального исследовательского медицинского университета им. Н.И. Пирогова
| | | | - Н. А. Козиолова
- Пермский государственный медицинский университет им. акад. Е.А. Вагнера
| | - И. В. Сергиенко
- Национальный медицинский исследовательский центр кардиологии им. акад. Е.И. Чазова
| | - А. А. Сметник
- Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова
| | - Н. И. Тапильская
- Научно-исследовательский институт акушерства и гинекологии и репродуктологии им. Д.О. Отта
| |
Collapse
|
30
|
Bechina C, Bonvillain G, Rethore G, Soueidan A, Winer N, Maitre Y, Struillou X. Knowledge and Practice Behaviours of Obstetricians/Gynecologists and Midwives Concerning Periodontal Health and Pregnancy. Oral Health Prev Dent 2023; 21:383-390. [PMID: 37916549 DOI: 10.3290/j.ohpd.b4586823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the level of knowledge of prenatal health professionals concerning the relationship between periodontal diseases and pregnancy complications, as well as their professional implications in the oral health field. MATERIALS AND METHODS A questionnaire was distributed to obstetricians/gynecologists, interns specialised in obstetrics/gynecology, midwives, and student midwives at Loire Atlantique and Vendée hospitals (France). The questionnaire included 5 sociodemographic questions and 14 questions regarding the level of knowledge about the relationship between periodontal diseases and pregnancy complications as well as the professionals' level of involvement in oral health care. RESULTS Twenty-three obstetricians/gynecologists and 55 midwives responded to the questionnaire. Preterm delivery and chorioamnionitis were the most frequently mentioned complications of pregnancy, whereas the risk of pre-eclampsia was rarely mentioned. Half of the professionals said they were aware of the oral manifestations of pregnancy. Gingivitis and an increased risk of caries were the most frequently mentioned items, whereas epulis was the least frequently mentioned item. The level of involvement of prenatal care practitioners in oral health care was limited due to a lack of competence and time. Nevertheless, 64% of the participants discussed the risks of poor oral hygiene with their patients. CONCLUSION There is good knowledge among French gynecologists/obstetricians and midwives regarding the oral manifestations of pregnancy. However, there is still a lack of knowledge concerning the links between periodontal diseases and pregnancy complications. The involvement and behaviour of pregnancy professionals in the oral health field is inadequate. The present survey highlights the need to improve the initial and continuing education of obstetricians and midwives on this topic.
Collapse
|
31
|
Topcu EG, Ramirez A, Ubom AE. A global study on the abortion views and knowledge of trainee obstetrician-gynecologists. Int J Gynaecol Obstet 2023; 163:453-460. [PMID: 37694673 DOI: 10.1002/ijgo.15119] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess the knowledge and views of trainee obstetrician-gynecologists (ObGyn) on abortion. METHODS A cross-sectional study of trainee ObGyn was conducted by the World Association of Trainees in Obstetrics and Gynecology. A study-specific questionnaire designed using Google Forms® was utilized for the study. The questionnaire was distributed electronically to study participants, to gather information on their sociodemographic characteristics, opinions, knowledge, and training on abortion. Collected data were analyzed using the IBM SPSS, version 25. RESULTS Most (140, 74.8%) trainee ObGyn reported that abortion was legal in their countries and most (171, 91.4%) supported the legalization of abortion. Eleven (5.9%) trainees who did not support the legalization of abortion cited religious concerns as their most common reason (5/11, 45.5%). Nearly three-quarters (133, 71.1%) of the trainees would perform an abortion on request. Most of the trainees reported that abortion education was included in the medical school curricula (131, 70.1%) and the ObGyn residency training programs (155, 82.9%) in their countries. Notwithstanding, 36.4% (68) either did not know or did not correctly know the legal status of abortion in their countries. CONCLUSION There is some disparity between ObGyn trainees' knowledge of safe abortion and their awareness of the legality of the same in their countries. There is a need for all countries to include abortion education in the curricula of medical schools and all ObGyn residency programs should offer abortion training to all residents. There is a need for increased advocacy for the legalization of abortion in countries where abortion remains criminalized.
Collapse
Affiliation(s)
- Elif G Topcu
- Istanbul Health and Technology University, Istanbul, Turkey
| | | | - Akaninyene E Ubom
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
32
|
Sorel M, Fradet L, Coste-Mazeau P, Aubard Y, Pizzoferrato AC, Pierre F, Gachon B. A new approach to assessing the obstetrician's posture and movement during an instrumental forceps delivery. J Gynecol Obstet Hum Reprod 2023; 52:102654. [PMID: 37643694 DOI: 10.1016/j.jogoh.2023.102654] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number of deliveries by forceps decreases significantly in favour of the vacuum. Now, when the use of forceps is necessary, physicians less experimented with this procedure are likely to induce serious and preventable perineal or foetal injuries. Training therefore becomes essential. However, there are no clear recommendations on the technique to perform a delivery by forceps, namely the body posture and gesture to adopt. Our goal is then to provide a protocol that can help to determine if there is an optimal technique to perform a delivery by forceps. METHOD We will include voluntary participants whose level of experience and type of practice differ. We will propose to record their postures and gestures using an optoelectronic motion analysis system during a forceps delivery simulated on a mannequin. We will also measure the traction force produced by the subject on the forceps using force platforms and technical markers placed on the forceps. We will then perform a principal component analysis to look for similar motion patterns. EXPECTED RESULTS We plan to analyse about fifty participants (25 seniors and 25 juniors). Our hypothesis is that the realism of the simulation will be deemed satisfactory by the participants, that the experimental conditions will not modify their gestures, and that the degree of experience will result in different techniques. CONCLUSION A better knowledge on the posture and gesture to adopt to realise a forceps delivery should improve the safety of women and new-borns. The results of this study could also be a valuable contribution for the training of obstetricians.
Collapse
Affiliation(s)
- Manon Sorel
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France.
| | - Laetitia Fradet
- Pprime Institute UPR 3346-CNRS, Axe RoBioSS, University of Poitiers, 2 Boulevard des Frères Lumière 86360 Chasseneuil-du-Poitou, France
| | - Perrine Coste-Mazeau
- Department of Obstetrics and Gynecology, University Hospital Center of Limoges, 2 Avenue Martin Luther King 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, University Hospital Center of Limoges, 2 Avenue Martin Luther King 87000 Limoges, France
| | - Anne-Cécile Pizzoferrato
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France; Clinical investigation center, INSERM CIC 1402, Entrée 5 - Cours Est Jean Bernard CHU de Poitiers 2 rue de la Milétrie 86000 Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynecology, University Hospital Center of Poitiers, 2 rue de la Milétrie, CS 90577, 86021 Poitiers Cedex, France; Clinical investigation center, INSERM CIC 1402, Entrée 5 - Cours Est Jean Bernard CHU de Poitiers 2 rue de la Milétrie 86000 Poitiers, France; Motricité Interaction Performance, EA 4334, University of Nantes, 23 rue du Recteur Schmitt Bâtiment F0 - BP 92235 44322 Nantes France
| |
Collapse
|
33
|
Ramirez Negrin A, Iturralde Rosas-Priego P, Gomez-Pedroso Rea J, Meade Treviño PF, Salazar Lopez Ortiz CG, Ceballos Mendoza JI, Aurioles Lopez GEA, Pedraza LA, Santana Garcia HR. Improving Migrant's Care in Mexico: A statement by the Mexican Federation of Colleges of Obstetricians and Gynecologists. Int J Gynaecol Obstet 2023; 163:461-462. [PMID: 37144758 DOI: 10.1002/ijgo.14842] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
SynopsisThe following is an official statement by the leadership of the Mexican Federation of Colleges of Obstetricians and Gynecologists regarding migrant care in Mexico, given the current context of Central and South America.
Collapse
Affiliation(s)
- Atziri Ramirez Negrin
- Federación Mexicana de Colegios de Obstetricia y Ginecología, A.C., Mexico City, Mexico
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:493-510. [PMID: 37806861 DOI: 10.1016/j.gofs.2023.09.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.
Collapse
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - P Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - D Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - F Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| |
Collapse
|
35
|
Schneider K, Müller J, Schleußner E. German obstetrician's self-reported attitudes and handling in threatening preterm birth at the limits of viability. J Perinat Med 2023; 51:1097-1103. [PMID: 37256371 DOI: 10.1515/jpm-2022-0547] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Antenatal treatment and information influences the course of pregnancy and parental decision-making in cases of threatened prematurity on the borderline of viability. Numerous studies have shown significant interprofessional differences in assessing ethical boundary decisions; hence, this study aimed to evaluate obstetricians attitudes, practices and antenatal parental counseling regarding threatened preterm birth in Germany. METHODS An anonymous online questionnaire was administered to 543 obstetricians at tertiary perinatal centers and prenatal diagnostic centers in Germany. The survey contained questions on basic ethical issues assessed using the Likert scale and a case vignette regarding the practical procedures of an imminent extreme premature birth at 23 1/7 gestational weeks. RESULTS In the case of unstoppable preterm birth, 15 % of clinicians said they would carry out a cesarean section; however, specialists from centers with a high number of very low birth weight infants would do so significantly more often. Among respondents, 29.8 % did not take any therapeutic measures without discussing the child's treatment options with their parents, 19.9 % refused to offer actionable advice to the parents, and 57 % said they would advise parents to seek intensive care treatment for the child with the option of changing treatment destination in the event of serious complications. Moreover, 84 % said they would provide information together with neonatologists. CONCLUSIONS Joint counseling with neonatologists is widely accepted. The size of the perinatal center significantly influences the practical approach to threatened preterm births. Respect for parents' decision-making autonomy regarding the child's treatment options is central and influences therapy initiation.
Collapse
Affiliation(s)
- Katja Schneider
- Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany
| | - Johanna Müller
- Department of Obstetrics, University Hospital Jena, Jena, Germany
| | | |
Collapse
|
36
|
Curtin M, Murphy M, Savage E, O’Driscoll M, Leahy-Warren P. Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review. PLoS One 2023; 18:e0293007. [PMID: 37878625 PMCID: PMC10599554 DOI: 10.1371/journal.pone.0293007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/04/2023] [Indexed: 10/27/2023] Open
Abstract
Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.
Collapse
Affiliation(s)
- Mary Curtin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | | |
Collapse
|
37
|
Fischer A, Rietveld A, Teunissen P, Hoogendoorn M, Bakker P. What is the future of artificial intelligence in obstetrics? A qualitative study among healthcare professionals. BMJ Open 2023; 13:e076017. [PMID: 37879682 PMCID: PMC10603416 DOI: 10.1136/bmjopen-2023-076017] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This work explores the perceptions of obstetrical clinicians about artificial intelligence (AI) in order to bridge the gap in uptake of AI between research and medical practice. Identifying potential areas where AI can contribute to clinical practice, enables AI research to align with the needs of clinicians and ultimately patients. DESIGN Qualitative interview study. SETTING A national study conducted in the Netherlands between November 2022 and February 2023. PARTICIPANTS Dutch clinicians working in obstetrics with varying relevant work experience, gender and age. ANALYSIS Thematic analysis of qualitative interview transcripts. RESULTS Thirteen gynaecologists were interviewed about hypothetical scenarios of an implemented AI model. Thematic analysis identified two major themes: perceived usefulness and trust. Usefulness involved AI extending human brain capacity in complex pattern recognition and information processing, reducing contextual influence and saving time. Trust required validation, explainability and successful personal experience. This result shows two paradoxes: first, AI is expected to provide added value by surpassing human capabilities, yet also a need to understand the parameters and their influence on predictions for trust and adoption was expressed. Second, participants recognised the value of incorporating numerous parameters into a model, but they also believed that certain contextual factors should only be considered by humans, as it would be undesirable for AI models to use that information. CONCLUSIONS Obstetricians' opinions on the potential value of AI highlight the need for clinician-AI researcher collaboration. Trust can be built through conventional means like randomised controlled trials and guidelines. Holistic impact metrics, such as changes in workflow, not just clinical outcomes, should guide AI model development. Further research is needed for evaluating evolving AI systems beyond traditional validation methods.
Collapse
Affiliation(s)
- Anne Fischer
- Department of Obstetrics and Gynecology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Anna Rietveld
- Department of Obstetrics and Gynecology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Pim Teunissen
- School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology & Obstetrics, Maastricht UMC, Maastricht, The Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra Bakker
- Department of Obstetrics and Gynecology, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Takeda T, Yoshimi K, Inoue F, Odai T, Shirato N, Watanabe Z, Otsubo T, Terauchi M. Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study. TOHOKU J EXP MED 2023; 261:95-101. [PMID: 37612076 DOI: 10.1620/tjem.2023.j059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.
Collapse
Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Fumi Inoue
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University
| | - Tamami Odai
- Department of Women's Health, Tokyo Medical and Dental University
| | - Nahoko Shirato
- Department of Obstetrics and Gynecology, Showa University School of Medicine
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine
| | - Tempei Otsubo
- Department of Psychosomatic and Psychiatric Medicine, Tokyo Women's Medical University Adachi Medical Center
| | | |
Collapse
|
39
|
Neill S, Hoe E, Fortin J, Goldberg AB, Janiak E. Management of early pregnancy loss among obstetrician-gynecologists in Massachusetts and barriers to mifepristone use. Contraception 2023; 126:110108. [PMID: 37394110 DOI: 10.1016/j.contraception.2023.110108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To measure the prevalence of early pregnancy loss management types among obstetrician-gynecologists in Massachusetts, and delineate barriers, facilitators, demographic and practice-related factors associated with mifepristone use for early pregnancy loss. STUDY DESIGN We surveyed a census of obstetrician-gynecologists in Massachusetts. Descriptive statistics measured the prevalence of offering expectant, misoprostol-alone, mifepristone and misoprostol, dilation and curettage in the office and operating room, and multivariate logistic regression analysis evaluated barriers and facilitators to mifepristone use. Data were weighted to account for nonresponders. RESULTS 198 obstetrician-gynecologists responded to the survey (response rate=29%). Participants most commonly offered expectant management (98%), dilation and curettage in the operating room (94%), and misoprostol-only medication management (80%). Fewer offered mifepristone-misoprostol (51%) or dilation and curettage in an office setting (45%). Those in private practice or other practice types had lower odds of offering mifepristone-misoprostol than those in academic practice (private practice: aOR 0.34, 95% confidence interval [CI] [0.19, 0.61]). Female physicians had higher odds of offering mifepristone-misoprostol (aOR 1.97, 95% CI [1.11, 3.49]). Obstetrician-gynecologists who included medication abortion in their practice had much higher odds of using mifepristone for early pregnancy loss (aOR 25.06, 95% CI [14.52, 43.24]). The Food and Drug Administration Risk and Evaluation Management Strategies Program was a primary barrier among those not using mifepristone (54%). CONCLUSIONS Many obstetrician-gynecologists do not offer mifepristone-based regimens for early pregnancy loss, which are more efficacious than misoprostol-only regimens. The Food and Drug Administration Risk Evaluation and Mitigation Strategies Program is a major barrier to mifepristone use. IMPLICATIONS Half of obstetrician-gynecologists in Massachusetts do not use mifepristone for early pregnancy loss management. Major barriers include lack of experience with mifepristone and the Food and Drug Administration Risk Evaluation and Mitigation Strategies Program regulations. Removing medically unnecessary regulations and increasing education on mifepristone via access to abortion care experts may increase uptake of this practice.
Collapse
Affiliation(s)
- Sara Neill
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Hoe
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer Fortin
- ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| | - Elizabeth Janiak
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; ASPIRE Center for Sexual and Reproductive Health, Planned Parenthood League of Massachusetts, Boston, MA, USA
| |
Collapse
|
40
|
Erhardt-Ohren B, Pier E, Arroyo D, Cole W, Hilliard M, Otero-Gonzalez A, Hidalgo-Mora O, Ospina-Henao S, Rochat R, Newton-Levinson A. Extra-legal abortion and post-abortion care knowledge, attitudes, and practices among obstetrician-gynecologist clinicians and medical residents in San José, Costa Rica: a qualitative study. BMC Womens Health 2023; 23:503. [PMID: 37735400 PMCID: PMC10512472 DOI: 10.1186/s12905-023-02639-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: 06/01/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Induced abortion in Costa Rica is illegal in all cases except to save the life of the pregnant person. Despite severe restrictions to legal abortion, individuals in Costa Rica still induce abortions outside of the formal healthcare system. These individuals and those with spontaneous abortions, also known as miscarriages, occasionally need medical care for complications. In Costa Rica, an estimated 41% of unintended pregnancies end in abortion, yet there is very little published literature exploring the perspectives of healthcare providers on abortion in Costa Rica. METHODS We interviewed ten obstetrician-gynecologist clinicians and five obstetrician-gynecologist medical residents in San José, Costa Rica about their beliefs and practices related to extra-legal abortion and post-abortion care (PAC) using a Spanish language in-depth semi-structured interview guide. After transcription and translation into English, analysis team pairs used a combination of deductive and inductive coding to identify themes and sub-themes within the data. RESULTS Obstetrician-gynecologist clinicians and medical residents were aware of the presence of extra-legal abortion, and particularly, medication abortion, in their communities, but less familiar with dosing for induction. They expressed the desire to provide non-judgmental care and support their patients through extra-legal abortion and PAC journeys. Study participants were most familiar with providing care to individuals with spontaneous abortions. When discussing PAC, they often spoke about a policy of reporting individuals who seek PAC following an extra-legal abortion, without commenting on whether or not they followed the guidance. CONCLUSIONS This study contributes to a gap in research about the knowledge, attitudes, and practices of Costa Rican obstetrician-gynecologist clinicians and medical residents around extra-legal abortion and PAC. The results reveal an opportunity to train these healthcare providers as harm reduction experts, who are able to accurately counsel individuals who are seeking abortion services outside of the healthcare system, and to provide training to improve care for individuals needing PAC.
Collapse
Affiliation(s)
| | - Ellyn Pier
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Daniel Arroyo
- Faculty of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | - Whitney Cole
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | | | | - Oscar Hidalgo-Mora
- Faculty of Medicine, Universidad de Ciencias Médicas, San José, Costa Rica
| | | | - Roger Rochat
- Rollins School of Public Health, Emory University, Atlanta, USA
| | | |
Collapse
|
41
|
Al Aloola N, Almuneef S, Alasmari R, Al Ewairdhi H. Qualitative insights into the need for a contraception protocol from obstetricians' and gynecologists' perspectives. BMC Womens Health 2023; 23:496. [PMID: 37726775 PMCID: PMC10510242 DOI: 10.1186/s12905-023-02657-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Studies on the use of contraception in the Saudi community highlight the need for improving community knowledge about contraception, implementing guidelines, and restricting contraception dispensing. However, there is a lack of studies assessing the need for contraception protocols from obstetricians' and gynecologists' (Ob/Gyn) perspectives. This study aimed to assess the need for a contraception protocol from the perspectives of Ob/Gyn physicians. METHODS Qualitative in depth, semi-structured interviews were conducted with a convenience sample that comprised physicians from the Department of Obstetrics and Gynecology in a tertiary teaching hospital. Interviews were audio recorded and transcribed verbatim and then analyzed using NVivo (QSR International) software. RESULTS A total of 12 interviews were conducted and analyzed. Participants indicated a lack of prescribing restrictions and highlighted issues of low contraception literacy in Saudi communities, self-prescribing behaviors, health system organization, and physicians' knowledge. Participants perceived the need for a contraception protocol guiding the prescribing process and patient counseling without restricting prescribing. Moreover, participants highlighted a number of factors affecting the development and implementation of such a protocol, including the availability of contraception, the need for research by physicians, patient factors, and the expected increased load on the hospital. CONCLUSIONS This research described current practices, showed the need for a contraception protocol, and highlighted the factors affecting the development and implementation of such a protocol.
Collapse
Affiliation(s)
- Noha Al Aloola
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Shaden Almuneef
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Alasmari
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Huda Al Ewairdhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
42
|
Society for Maternal-Fetal Medicine. Electronic address: pubs@smfm.org. Executive summary: Workshop on developing an optimal maternal-fetal medicine ultrasound practice, February 7-8, 2023, cosponsored by the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Registry for Diagnostic Medical Sonography, International Society of Ultrasound in Obstetrics and Gynecology, Gottesfeld-Hohler Memorial Foundation, and Perinatal Quality Foundation. Am J Obstet Gynecol 2023; 229:B20-4. [PMID: 37285952 DOI: 10.1016/j.ajog.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
43
|
Knochenhauer HE, Lim SL, Brown DA, Darner G, Levinson H, Havrilesky LJ, Previs RA. An obstetrician-gynecologist's review of hernias: risk factors, diagnosis, prevention, and repair. Am J Obstet Gynecol 2023; 229:214-221. [PMID: 37120051 DOI: 10.1016/j.ajog.2023.04.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Management of obstetrical and gynecologic patients with hernias poses challenges to providers. Risks for hernia development include well-described factors that impair surgical wound healing and increase abdominal pressure. Among the diverse populations cared for by obstetricians and gynecologists, pregnant patients and those with gynecologic malignancies are at the highest risk for hernia formation. This article provides an overview of the existing literature, with a focus on patients cared for by obstetrician-gynecologists and commonly encountered preoperative and intraoperative scenarios. We highlight scenarios when a hernia repair is not commonly performed, including those of patients undergoing nonelective surgeries with known or suspected gynecologic cancers. Finally, we offer multidisciplinary recommendations on the timing of elective hernia repair with obstetrical and gynecologic procedures, with attention to the primary surgical procedure, the type of preexisting hernia, and patient characteristics.
Collapse
Affiliation(s)
| | - Stephanie L Lim
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - David A Brown
- Division of Plastic, Oral, and Maxillofacial Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | | | | | - Laura J Havrilesky
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, NC
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC; LabCorp, Enterprise Oncology, Durham, NC.
| |
Collapse
|
44
|
Xie F, Davis DMR, Baban F, Johnson EF, Theiler RN, Todd A, Pruneddu S, Murase JE, Maul JT, Ambros-Rudolph CM, Lehman JS. Use of a pregnancy dermatology clinical scoring system to differentiate between pemphigoid gestationis and polymorphic eruption of pregnancy: practical considerations for the obstetrician. Am J Obstet Gynecol MFM 2023; 5:101078. [PMID: 37399893 DOI: 10.1016/j.ajogmf.2023.101078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Dawn Marie R Davis
- Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, MN
| | - Sara Pruneddu
- Department of Dermatology, King's College Hospital, London, United Kingdom
| | - Jenny E Murase
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Julia S Lehman
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905.
| |
Collapse
|
45
|
Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2023; 288:90-107. [PMID: 37499278 DOI: 10.1016/j.ejogrb.2023.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/25/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding (i.e. pharmaceutical or medical device companies). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège National des Gynécologues et Obstétriciens Français on the management of women with AUB were published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescents; idiopathic AUB; endometrial hyperplasia and polyps; type 0-2 fibroids; type 3 or higher fibroids; and adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and evidence profiles were compiled. The GRADE® methodology was applied to the literature review and the formulation of recommendations. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 are strong and 17 weak. No response was found in the literature for 14 questions. We chose to abstain from recommendations rather than providing advice based solely on expert clinical experience. CONCLUSIONS The 36 recommendations make it possible to specify the diagnostic and therapeutic strategies for various clinical situations practitioners encounter, from the simplest to the most complex.
Collapse
Affiliation(s)
- J L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165 chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital europeen Georges-Pompidou, APHP, 20 rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hotel Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40 avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
| |
Collapse
|
46
|
Pearce A, Scarfe J, Jones M, Cashmore A, Milat A, Barnes L, Passey ME. Study protocol of an economic evaluation embedded in the Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) trial. BMC Health Serv Res 2023; 23:939. [PMID: 37658343 PMCID: PMC10472694 DOI: 10.1186/s12913-023-09898-3] [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: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Tobacco smoking during pregnancy is the most important preventable risk factor for pregnancy complications and adverse birth outcomes and can have lifelong consequences for infants. Smoking during pregnancy is associated with higher healthcare costs related to birth complications and during childhood. Psychosocial interventions to support pregnant women to quit are effective, yet provision of smoking cessation support has been inconsistent. The Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) intervention provides systems change, and leadership and clinician elements, to support clinicians to help women stop smoking in pregnancy. There have been few long-term analyses conducted of the cost-effectiveness of smoking cessation interventions for pregnant women that target healthcare providers. This protocol describes the economic evaluation of the MOHMQuit trial, a pragmatic stepped-wedge cluster-randomised controlled implementation trial in nine public maternity services in New South Wales (NSW), Australia, to ascertain whether MOHMQuit is cost-effective in supporting clinicians to help women quit smoking in pregnancy compared to usual care. METHODS Two primary analyses will be carried out comparing MOHMQuit with usual care from an Australian health care system perspective: i) a within-trial cost-effectiveness analysis with results presented as the incremental cost per additional quitter; and ii) a lifetime cost-utility analysis using a published probabilistic decision analytic Markov model with results presented as incremental cost per quality-adjusted life-year (QALY) gained for mother and child. Patient-level data on resource use and outcomes will be used in the within-trial analysis and extrapolated and supplemented with national population statistics and published data from the literature for the lifetime analysis. DISCUSSION There is increasing demand for information on the cost-effectiveness of implementing healthcare interventions to provide policy makers with critical information for the best value for money within finite budgets. Economic evaluation of the MOHMQuit trial will provide essential, policy-relevant information for decision makers on the value of evidence-based implementation of support for healthcare providers delivering services for pregnant women. TRIAL REGISTRATIONS ACTRN12622000167763, registered 2 February 2022.
Collapse
Affiliation(s)
- Alison Pearce
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Joanne Scarfe
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Sydney, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Matthew Jones
- Centre for Academic Primary Care, Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Aaron Cashmore
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Andrew Milat
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Larisa Barnes
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Sydney, Australia
- University Centre for Rural Health, The University of Sydney, Sydney, Australia
| | - Megan E Passey
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Sydney, Australia
- University Centre for Rural Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
47
|
McGurgan P. Hiding in plain sight: Inconvenient facts for patient safety in non-24/7 theatre on-site staffed obstetric units. Aust N Z J Obstet Gynaecol 2023; 63:606-611. [PMID: 37555707 DOI: 10.1111/ajo.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 08/10/2023]
Abstract
The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on-site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on-call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro-located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles.
Collapse
Affiliation(s)
- Paul McGurgan
- Divison of Obstetrics and Gynaecology, UWA Medical School, Perth, Western Australia, Australia
| |
Collapse
|
48
|
Nicklin J, Robertson G. Is it time to drop royal patronage of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists? Aust N Z J Obstet Gynaecol 2023; 63:603-605. [PMID: 37555704 DOI: 10.1111/ajo.13707] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 08/10/2023]
Abstract
Historically there is a strong, amiable and mutually respectful relationship between Australian and New Zealand obstetricians and gynaecologists (O&Gs) and the British O&G establishment represented by the Royal College of Obstetricians and Gynaecologists (RCOG). The 'Royal' prefix pays homage to this relationship. With the evolution of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), there have been suggestions that the Royal prefix no longer accurately reflects the raison d'être and aspirations of RANZCOG. This paper will explore the arguments in favour and against dropping the Royal prefix from RANZCOG.
Collapse
Affiliation(s)
- James Nicklin
- VMO Wesley Hospital, University of Queensland, Auchenflower, Queensland, Australia
| | - Greg Robertson
- University of NSW, St George Private Hospital, Kogarah, New South Wales, Australia
| |
Collapse
|
49
|
Elammary MN, Zohiry M, Sayed A, Atef F, Ali N, Hussein I, Mahran MA, Said AE, Elassall GM, Radwan AA, Shazly SA. Middle eastern college of obstetricians and gynecologists (MCOG) practice guidelines: Role of prediction models in management of trial of labor after cesarean section. Practice guideline no. 05-O-22 ✰,✰✰,★,★★. J Gynecol Obstet Hum Reprod 2023; 52:102598. [PMID: 37087045 DOI: 10.1016/j.jogoh.2023.102598] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
Cesarean delivery rates have been steadily rising since the beginning of the 21st century. The growing incidence is even more prominent in developing countries owing to lack of evidence-based guidance and audit, and the expansion of private practice. The uprise in Cesarean delivery rate has been associated with considerable financial burden and has increased the risk otherwise uncommon serious complications such as placenta accreta disorders and uterine rupture. In addition to primary prevention of Cesarean delivery, trial of labor after cesarean section is one of the most successful strategies to reduce Cesarean deliveries and minimize risks associated with higher order Cesarean deliveries. This guideline appraises patient selection strategies and use of prediction model to promote counseling and enhance safety in women considering vaginal birth after Cesarean.
Collapse
Affiliation(s)
| | - Mariam Zohiry
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Asmaa Sayed
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Fatma Atef
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Nada Ali
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Islam Hussein
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Manar A Mahran
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Aliaa E Said
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Gena M Elassall
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Ahmad A Radwan
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom
| | - Sherif A Shazly
- Middle Eastern College of Obstetricians and Gynecologists (MCOG) Practice Office. Leeds, United Kingdom; Department of Obstetrics and Gynecology, Leeds Teaching Hospitals, Leeds, United Kingdom.
| |
Collapse
|
50
|
Mckechnie J, McIntyre JL. The Professional and Legal Relationship Between a Certified Nurse-midwife and Their Obstetrician/Gynecologist Physician Colleagues. Clin Obstet Gynecol 2023; 66:323-330. [PMID: 37036380 DOI: 10.1097/grf.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The article describes the relationship between a certified nurse-midwife and their supervising obstetrician. The article deals with the relationship of both parties and the requirement of a collaborative agreement in a majority of states. The legal responsibilities of both the certified nurse-midwife and obstetrician are discussed and how it impacts both providers. The key factor is the trust relationship between the parties involved and how this can lead to more diverse obstetrical care and access for patients in the United States.
Collapse
Affiliation(s)
| | - John L McIntyre
- Dickie, McCamey and Chilcote Law Offices, Pittsburgh, Pennsylvania
| |
Collapse
|