BJOG: An International Journal of Obstetrics and Gynaecology
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Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 110 - Trang 301-305 - 2003
The effect of oestradiol on vaginal collagen metabolism in postmenopausal women with genuine stress incontinence
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 109 - Trang 339-344 - 2002
Quantifying severe maternal morbidity: a Scottish population study Objective To quantify the incidence of severe maternal morbidity in Scotland and determine the feasibility of doing so.Design Prospective observational study.Setting All 22 consultant led maternity units in Scotland, between 1 October 2001 and 30 September 2002.Population Women during pregnancy and the puerperium.Methods Definitions for 13 categories of severe maternal morbidity were developed from published work. Recruitment of maternity units, and training of staff, took place at a national meeting. Each month, every unit reported cases meeting the agreed definitions, the category of incident and date. Data were collated centrally and analysed to determine the frequency of incidents. The number of maternal deaths occurring in Scotland over the same period was obtained from the Confidential Enquiry into Maternal Deaths.Main outcome measures Number and rate of defined events being reported. A subjective view of the feasibility of collecting national data routinely.Results Severe morbidity was reported in 196 women, out of 51,165 deliveries in Scotland (rate 3.8 per 1000 deliveries). Thirty percent of cases fell into more than one defined category. Major obstetric haemorrhage accounted for 50% of events. Only a third of identified patients were admitted to intensive care units. Four relevant maternal deaths occurred.Conclusions Categories of severe maternal morbidity can be defined and may provide a useful measure of the quality of maternity services, particularly in developed countries where maternal mortality is very rare. It appears feasible to set up a national reporting system for maternal morbidity, as well as mortality.
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 111 Số 5 - Trang 481-484 - 2004
Learning from adverse clinical outcomes: major obstetric haemorrhage in Scotland, 2003–05 Objective To describe a system for learning from cases of major obstetric haemorrhage.Design Prospective critical incident audit.Setting All consultant‐led maternity units in Scotland, between 1 January 2003 and 31 December 2005.Population Women suffering from major obstetric haemorrhage (estimated blood loss ≥2500 ml or transfused ≥5 units of blood or received treatment for coagulopathy during the acute event).Methods Hospital clinical risk management teams reviewed local cases using a standard, national assessment pro forma.Main outcome measures Standard of care provided and learning points identified.Results Rate of major haemorrhage was 3.7 (3.4–4.0) per 1000 births. Pro formas returned for 517 of 581 reported cases (89%); 41% were delivered by emergency caesarean section (compared with 15% of all Scottish births). Uterine atony was the most common cause (250 women, 48%); 32% had multiple causes. A consultant obstetrician gave hands‐on care to 368 (71%) and a consultant anaesthetist to 262 (50%). Placenta praevia as a cause was independently associated with consultant presence. Central venous pressure monitoring was used in 164 (31%) women, and 108 (21%) women were admitted to intensive care. Parity, blood loss, and placenta praevia as a cause were independently associated with peripartum hysterectomy (performed in 62 women, 12%). Balloon tamponade and haemostatic uterine suturing were successful in 92 of 116 women (79%). Most cases were assessed as well managed, with ‘major suboptimal’ care identified in only 14 cases (3%).Conclusions It is feasible to identify and assess cases of major obstetric haemorrhage prospectively on a national basis. Most women received appropriate care, but many learning points and action plans were identified.
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 114 Số 11 - Trang 1388-1396 - 2007
The UK Obstetric Surveillance System for raredisorders of pregnancy
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 112 Số 3 - Trang 263-265 - 2005
Iron plus folate is more effective than iron alone in the treatment of iron deficiency anaemia in pregnancy: a randomised, double blind clinical trial
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 109 - Trang 1009-1014 - 2002
WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion. I: Efficacy
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 110 - Trang 808-818 - 2003
The future of hysterectomy
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 112 Số 2 - Trang 133-139 - 2005
A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures Objective The aim of this study was to evaluate the complication rate after laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LASH) in case of benign disease.Design All complications were prospectively recorded at the time of surgery and analysed retrospectively.Setting University hospital.Population Among 4505 hysterectomies performed by the same team using the same techniques between 1990 and 2006, 3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy.Methods Laparoscopic hysterectomies, defined as laparoscopic subtotal hysterectomy (LASH) and total laparoscopic hysterectomy [laparoscopy‐assisted vaginal hysterectomy (LAVH) switched to total laparoscopic hysterectomy (TLH) in 2000], were compared with vaginal and abdominal hysterectomies.Main outcome measures and results Since the early 1990s, the number of laparoscopic procedures has continued to grow, while the number of abdominal and vaginal procedures has decreased. Both minor complications (fever >38.5°C after 2 days, bladder incision of <2 cm and iatrogenic adenomyosis) and major complications (haemorrhage, vesicoperitoneal fistula, ureteral injury, rectal perforation or fistula) have been observed during the surgical procedure itself and postoperatively. In the LASH group (n = 1613), the minor complication rate was 0.99% (n = 16) and the major complication rate 0.37% (n = 6). In the total laparoscopic hysterectomy (LAVH/TLH) group (n = 1577), the minor complication rate was 1.14% (n = 18) and the major complication rate 0.51% (n = 8). In the vaginal hysterectomy group (n = 906), minor and major complication rates were 0.77% (n = 7) and 0.33% (n = 3), respectively. In the abdominal hysterectomy group (n = 409), minor and major complication rates were 0.73% (n = 3) and 0.49% (n = 2), respectively.Conclusion The results from our series of 4505 women clearly show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates.
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 116 Số 4 - Trang 492-500 - 2009
THE EFFECTS OF PROGESTERONE ON THE RESPONSES OF THE CARDIOVASCULAR SYSTEM TO INTRAVENOUS INFUSIONS OF ALDOSTERONE Summary The effects on arterial pressure of giving intravenous infusions of aldosterone to untreated rabbits were compared with the effects in rabbits pre‐treated with progesterone for two weeks. The rise in pressure began approximately one hour earlier in the pre‐treated animals. After five hours of infusion the mean pressure rise in the pre‐treated animals was approximately 45 per cent while in the untreated animals it was approximately 20 per cent.
BJOG: An International Journal of Obstetrics and Gynaecology - Tập 77 Số 10 - Trang 928-931 - 1970
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