DOCSLIB.ORG

UWOMJ Volume 74, No. 1 Western University

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Western University Scholarship@Western University of Western Ontario Medical Journal Digitized Special Collections 2005 UWOMJ Volume 74, No. 1 Western University Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons Recommended Citation Western University, "UWOMJ Volume 74, No. 1" (2005). University of Western Ontario Medical Journal. 5. https://ir.lib.uwo.ca/uwomj/5 This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected]. Paediatrics London Health Sciences Centre 800 Cmnmissioners Road East London, ON N6A 405 v Canada's Trusted Choice Adverse Reactions Advene Drug Reection Overview MoA Common Adotetu Eft.cts I lodJ Syrtem I Clmetldlne (--.) ~D ('Mt) I<NS 1hood•"'• r-z.1-' ·' !Endocrtne end Het.bollsm - I I GJnecomerti• r- 0.3-4,0 I N/A [CedTolnt .. cttn•l - Wffi. Current drug information <•• ~~~~ at your fingertips! • Instant access to approximately 3000 Health-Canada-approved product monographs Updated and always current Search products by brand name, generic name and/or therapeutic class CANADLAN PHARMACISTS Search directories for Canada's poison control centres, various health organizations, ASSOCIATION manufacturers and distributors of pharmaceutical products ASSOCIATION DES PHARMACIENS DUCANADA • Printable, easy-to-read "Information for the Patient" leaflets - now the only resource offering these customer-friendly pages Subscribe online at www.e-cps.ca OMJ Volume 74 Number 1 Contents EDITORIAL Health Promotion Changes A Review of Current Literature on NuvaRing , Leanne Tran, Editor-in-Chief 3 a Contraceptive Vaginal Ring DEPARTMENT ARTICLES Michelle Ngo, B.Sc. B.Ed., Meds 2007 23 Ethics Medicine and the Law Prenatal Testing & Disability Rights: The Role of A New Plan for Plan B Healthcare Professionals Daren Lin, Meds 2007 and Andrea Guerin, Meds 2008 25 Tanya Raha, Meds 2006 4 FEATURE ARTICLES Diagnostic Review "Born to be a Burden":A dramatic way to educate medical Ultrasound's Role in Obstetrics and Gynecology: students about the ethics of prenatal screening Fetal Assessment and Pelvic Bleeding Tim Heerema, Kevin Kuo, Patricia Lee, Ray mond Lim, Nooreen Popat, Meds 2008, Janet Malowany, Meds 2008, Jeff Rade1; Harry Wu, Meds 2005 28 and Jeremy Keller, Meds 2007 7 Non-Directive Counselling: Rhetoric Or Reality? Proftles David Silver, M eds 2006 30 A Conversation with Dr. Paul Bernstein, The Experience of Infertility For Women From a Obstetrician/Gynecologist Psychological and Social Perspective Betty Lee, B.Sc., Medicine 2006 10 Shirley Chow, Meds 2006 33 Clinical Procedures Perinatal Care for Adult Survivors of Child Sexual Abuse The Pap Smear Nelvia Van Dorp, B.Sc., Meds 2006 36 Christopher Gillis, Meds 2008 12 The Motherisk Program - Now at UWO Medicine and the Internet Gideon Koren, MD, FRCPC, Telemedicine in Ontario l vey Chair in Molecular Toxicology, UWO 39 Deric Morrison, Meds 2005 13 Ocular Manifestations of Pre-eclampsia Thinking on Your Feet Chetna Tail01; Meds 2004 40 An Approach to Postpartum Hemorrhage Maternal Hypothyroidism in Pregnancy: Jay Banerjee, Meds 2005 and Sujiva Heyn, Meds 2006 15 The Neurodevelopmental Manifestations in the Offspring Joint Replacement: Past, Present, and Future Natalie Kotowycz, Meds 2005 42 Sujiva Heyn, Meds 2006 and Jay Banerjee, Meds 2005 17 Fetal Surgery: A Review Zebra Files Sandeep K. Aggarwal, Meds 2006 45 Amniotic Fluid Embolism - An Unpredictable and Often The Next Wave - Medical Education Without Borders Catastrophic Obstetrical Emergency Sherryn Rambihar, Meds 2005 Stephen Chihrin, Meds 2008 and Leslie Wong, Meds 2007 20 47 ©2005 UWOMJ UWOMJ is published every 6 months. Editorial Staff Upcoming Issue: EDITORIAL BOARD PEDIATRICS COVER ART Cover art: "Bloodroot", by Emily Kelly. Emily is in third year medicine at the Schulich School of Medicine and Dentistry. She paints in acrylic and oil media to fi ll her wall space with pic­ tures more interesting than textbook illustrations. Emily can be contacted at [email protected] Editor-in-Chief (right} Leanne Tran Med 2005 Senior Associate Editor (not pictured) Mohammed Loubani Med 2006 Junior Associate Editor (left) Eisar Al-Sukhni Meds 2007 DEPARTMENTAL EDITORS Ethics Medicine and the Internet Sr: Tarek Loubani, Meds 2007 Sr: Patricia Lee, Med 2007 Jr: Sankalp Bhavsar, Med 2008 Jr: Joanna Zuraw ka, Med 2008 UWOMJ Clinical Procedures Profiles Room MS-175 Sr: John Omura, Meds 2007 Sr: Sheldon Lyn, Med 2007 Medical Sciences Building Jr: Christopher Gi ll is, Meds 2008 Jr: Aaron Mocon, Meds 2008 The University ofWestern Ontario London, ON Diagnostic Review Thinking on Your Feet 6A 5C l Sr: Jeremy Kell er, Meds 2007 Sr: Alan Gob, Meds 2007 Jr: Janet Malowany, Meds 2008 Jr: Melani e Sproule, Meds 2008 Jr: Nooreen Popat, Meds 2008 Phone/Fax: (519) 661-4238 Zebra Files Email : [email protected] Health Promotion Sr: Le lie Wong, Med 2007 URL: www. med.uwo.ca/medjrnl Sr: Michell e Ngo, Med 2007 Jr: Stephen hihrin, Meds 2008 Jr: Luke Harris, Meds 2008 For info rmation about writing fo r the Histo ry of Medicine UWOMJ, please follow the guidelines out­ Sr: Jacqueline Joza, Med 2007 lined on the website. Jr: Urszu la Zuraw ka, Meds 2008 Medicine and the Law The UWOMJ is a peer-reviewed publica­ Sr: Daren Lin, Meds 2007 tion. All editorial matter in the UWOMJ Jr: Andrea Guerin, Med 2008 represents the opinions of the authors and not necessarily those of the edi torial staff and advisory council. The edi torial staff UWOMJ ADVISORY COUNCIL and advisory council asswne no responsi­ Dr. Colby, Microbiology Dr. Silcox, Obstetrics I Gynecology bili ty or li ability for damage arising from Dr. Wexler, Anesthesiology Dr. Nisker, Obstetrics I Gynecology any error or omission or from use of any Dr. Ri eder, Paediatrics information or advice contained in UWOMJ. ADVERTISING PRINTER Kenmara Inc. Willow Printing Group Ltd. Canada Post - Publication Mai l Agreement Number 17201 98 POSTMASTER: Undeliverable copie , please return to the address above. 2 UWOMJ 74( 1) 2005 Editorial Changes Leanne Tran, Editor-in-Chief If we look at the field of obstetrics and gynecology, the fea­ inception at the Hospital for Sick Children in Toronto and is now ture topic of this issue, and compare it to even ten years ago, we also operating at UWO. In addition to the start of the Motherisk would find that in terms of the practice structure, technology and Program here at UWO, I am pleased to inform you that there have lifestyle, there have been significant changes. These changes are been major developments to UWO's Global Health curriculum indicative of the way that medicine in general is progressing. As since the publication of the last issue of the journal. The Joint stated by Dr. Paul Bernstein, an obstetrician and gynecologist at issue editorial entitled Physicians and Peace: Promoting Peace by Mount Sinai Hospital in Toronto, "I personally think that [obstet­ Pursuing Health spoke about a new academic discipline, "Peace rics and gynecology] will evolve into more sub-specialization, Through Health". Research has shown that health initiatives can perhaps into surgical and non-surgical aspects. It would be prac­ not only foster health in a region of conflict but peace as well. tical to have streaming, as that would provide focus and improve Given the increasing awareness of the importance of global resources for new clinicians". Upon reading this Profiles health, it is only appropriate that the journal give an update on Interview, I noted that this trend is not isolated to obstetrics and UWO's contributions to this area. I believe that the piece The gynecology but holds true for all of medicine. There is a notice­ Next Wave: Medical Education Without Borders is particularly able shift of medicine towards greater specialization and focus on timely given the recent tsunami and the changes currently under­ individual interests whether one is a family physician, an internist way in academic and clinical medicine. The article emphasizes or a surgeon. This is inevitable; as we progress through medical the unique opportunity that we as health care workers have in school, postgraduate training, independent practice and yes, life, affecting the economic, political, legal and social network around we are exposed to different ideas and people that shape our inter­ us and in the process, promote peace by pursuing health. Above ests. Similarly, this issue of the UWOMJ is filled with a range of all, it reminds us to take a patient-centered, culturally sensitive, exciting topics that include pregnancy complications, technologi­ and globally conscious approach to medicine. With this in mind, cal developments, ethical debates, and psychosocial perspectives. I hope you enjoy reading this Obstetrics and Gynecology issue as In particular, I would like to draw your attention to an article much as we, at the medical journal, have enjoyed putting it written by Dr. Gideon Koren, the Ivey Chair in Molecular together for you. Toxicology at UWO. I encourage all of you to read this as it serves as an introduction to the Motherisk Program that had its UWOMJ 74(1) 2005 3 Ethics Prenatal Testing & Disability Rights: The Role of Healthcare Professionals Tanya Raha, Meds 2006 Prenatal genetic diagnosis (PND) and pre-implantation genetic diagnosis (PGD) are becoming increasingly avaiJable as options for parents-to-be. Despite the benefits of both procedures, several ethically troublesome issues remain. In particular, disability rights advocates have expressed a number of concerns: the "expres­ sivist" argument that such practices deem disabled individuals on a whole as unfit for living, that it accepts and encourages parental attitudes of selectivity and intolerance, that PND-related decisions are often based on misinformation or misconceptions, that it threatens the fair & equitable integration of disabled individu­ als as a part of our society and that it foretells a tendency towards eugenics.
Recommended publications
  • Journal of Surgery and Trauma

    Journal of Surgery and Trauma

    In the name of GOD Journal of Birjand University of Medical Surgery and trauma Sciences & Health Services 2345-4873ISSN 2015; Vol. 3; Supplement Issue 2 Publisher: Deputy Editor: Birjand University of Medical Sciences & Health Seyyed Amir Vejdan, Assistant Professor of General Services Surgery, Birjand University of Medical Sciences Director-in-Charge: Managing Editor: Ahmad Amouzeshi, Assistant Professor of General Zahra Amouzeshi, Instructor of Nursing, Birjand Surgery, Birjand University of Medical Sciences University of Medical Sciences Editor-in-Chief: Journal Expert: Mehran Hiradfar, Associate professor of pediatric Fahime Arabi Ayask, B.Sc. surgeon, Mashhad University of Medical Sciences Editorial Board Ahmad Amouzeshi: Assistant Professor of General Surgery, Birjand University of Medical Sciences, Birjand, Iran; Masoud Pezeshki Rad: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Taghizadeh kermani: Assistant professor Department of Radiology, Mashhad university of Medical Sciences, Mashhad, Iran; Ali Jangjo: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Sayyed-zia-allah Haghi: Professor of Thoracic-Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Ramin Sadeghi: Assistant professor Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran; Mohsen Aliakbarian: Assistant Professor of General Surgery, Mashhad University of Medical Sciences, Mashhad, Iran; Mohammad Ghaemi: Assistant Professor
  • Postpartum Haemorrhage

    Postpartum Haemorrhage

    Guideline Postpartum Haemorrhage Immediate Actions Call for help and escalate as necessary Initiate fundal massage Focus on maternal resuscitation and identifying cause of bleeding Determine if placenta still in situ Tailor pharmacological management to causation and maternal condition (see orange box). Complete a SAS form when using carboprost. Pharmacological regimen (see flow sheet summary) Administer third stage medicines if not already done so. Administer ergometrine 0.25mg both IM and slow IV (contraindicated in hypertension) IF still bleeding: Administer tranexamic acid- 1g IV in 10mL via syringe driver set at 1mL/minute administered over 10 minutes OR as a slow push over 10 minutes. Administer carboprost 250micrograms (1mL) by deep intramuscular injection Administer loperamide 4mg PO to minimise the side-effect of diarrhoea Administer antiemetic ondansetron 4mg IV, if not already given Prophylaxis Once bleeding is controlled, administer misoprostol 600microg buccal and initiate an infusion of oxytocin 40IU in 1L Hartmann’s at a rate of 250mL/hr for 4 hours. Flow chart for management of PPH Carboprost Bakri Balloon Medicines Guide Ongoing postnatal management after a major PPH 1. Purpose This document outlines the guideline details for managing primary postpartum haemorrhage at the Women’s. Where processes differ between campuses, those that refer to the Sandringham campus are differentiated by pink italic text or have the heading Sandringham campus. For guidance on postnatal observations and care after a major PPH, please refer to the procedure ‘Postpartum Haemorrhage - Immediate and On-going Postnatal Care after Major PPH 2. Definitions Primary postpartum haemorrhage (PPH) is traditionally defined as blood loss greater than or equal to 500 mL, within 24 hours of the birth of a baby (1).
  • Educational Exhibit Posters Chosen by the Annual Scientific Meeting

    Educational Exhibit Posters Chosen by the Annual Scientific Meeting

    Educational Exhibit Posters Chosen by the Annual Scientific Meeting Committee In advance of the upcoming annual meeting of the Society of Interventional Radiology in Washington, DC, the program committee wishes to highlight the educational exhibit e-posters that will be presented. The posters were chosen using blinded review. Authors are congratulated for their contributions. Daniel Sze, MD, FSIR Chair, 2017 Annual Meeting Scientific Program Educational Exhibit e-Posters Abstract No. 581 Etiology Technique Used Hepatic artery pseudoaneurysms: a pictorial review of Trauma Falling injury Gelfoam with intraprocedural different scenarios and managements cone-beam 3D CT imaging R. Galuppo Monticelli1, Q. Han1, G. Gabriel1, S. Krohmer1, D. Raissi1 Gunshot injury Coiling Iatrogenic Post cholecystectomy Onyx embolization 1University of Kentucky, Lexington, KY Post biliary drain Coiling PURPOSE: The focus of this educational exhibit is to present a pictorial placement review of the anatomical considerations and management in varied Post ERCP Gelfoam cases of hepatic artery pseudoaneurysms (HAPs) secondary to differ- Tumor Hemorrhage Embozene ent etiologies. Special attention is given to troubleshooting HAPs with Tumor related Post TACE N-Butyl cyanoacrylate varied anatomical presentations. Transplant related Portal hypertension iCAST covered Stent MATERIALS: Hepatic artery pseudoaneurysm (HAP) is an unusual but Idiopathic Otherwise healthy male Coiling with sandwich technique serious complication of acute or chronic injury to the hepatic artery that can potentially be fatal. HAPs are classified as intrahepatic or extrahe- patic. There are many etiologies of HAP formation, including trauma, iat- Abstract No. 582 rogenic, tumor, pancreatitis, inflammatory and idiopathic. Early detection Stenting as a first-line therapy for symptomatic and treatment is critical to decrease morbidity and mortality.
  • Ⅰ Obstetric Hemorrhage Safety Bundle Implementation in a Rural

    Ⅰ Obstetric Hemorrhage Safety Bundle Implementation in a Rural

    Obstetric Hemorrhage Safety Bundle Implementation in a Rural CAH Dale C Robinson MD,FACOG Chief Ob/Gyn Grande Ronde Hospital La Grande Oregon S Planning for and Responding to Obstetric Hemorrhage California Maternal Quality Care Collaborative Obstetric Hemorrhage Version 2.0 Task Force This project was supported by Title V funds received from the California Department of Public Health; Maternal, Child and Adolescent Health Division 2 CMQCC S California Maternal Quality Care Collaborative S Multidisciplinary Task Force S Recommendations/ Obstetric Safety Bundle S Yellow/Blue Slides Maternal Mortality Rates, Moving Average, California Residents; 1999-2010 16 14 14.0 12.2 13.5 13.2 12 12.7 11.6 12.1 11.5 10 9.4 10.2 8 6 4 Maternal Deaths per 100,000 Live Births 2 0 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 Three-Year Moving Average SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2010. Maternal mortality for California (deaths ≤ 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99) for 1999-2010. On average, the mortality rate increased by 2% each year [(95% CI: 1.0%, 4.2%) p=0.06. Poisson regression] for a statistically significant increasing trend from 1999-2010 (p=0.001 one-sided Cochran-Armitage, based on individual year data). Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, December, 2012. North Carolina: Mortality Mostly Preventable Cause of Death (n=108) % of All Deaths % Preventable Cardiomyopathy 21% 22% Hemorrhage 14 93 PIH 10 60 CVA 9 0 Chronic condition 9 89 AFE 7 0 Infection 7 43 Pulmonary embolism 6 17 Berg CJ, Harper MA, Atkinson SM, et al.
  • (EXIT), a Resuscitation Option for Intra-Thoracic Foetal Pathologies

    (EXIT), a Resuscitation Option for Intra-Thoracic Foetal Pathologies

    Original article SWISS MED WKLY 2007;137:279–285 · www.smw.ch 279 Peer reviewed article Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies Christian Kerna, Michel Ange, Moralesb, Barbara Peiryc, Riccardo E. Pfisterc a Anaesthesia, University Hospital Geneva, Switzerland b Gynaecology and Obstetrics, University Hospital Geneva, Switzerland c Paediatrics, University Hospital Geneva, Switzerland Summary The ex utero intrapartum treatment (EXIT) requires a caesarean section that specifically differs procedure is designed to guarantee sufficient oxy- from the traditional caesarean section during genation for a foetus at risk of airway obstruction. which uterine tone is maintained to minimize ma- This is achieved by improving lung ventilation, ternal bleeding. To guarantee foetal oxygenation usually by establishing an airway during caesarean during the EXIT procedure, profound uterine delivery whilst preserving the foetal-placental cir- relaxation is desired. To gain time with optimal culation temporarily. Indications for the EXIT placental oxygenation in order to safely perform an procedure have extended from its original use in airway intervention in a baby at risk of hypoxia may reversing iatrogenic tracheal obstruction in con- require deep inhalation anaesthesia and/or to- genital diaphragmatic hernia to naturally occur- colytic agents. We review the EXIT procedure and ring upper airway obstructions. We report our present a case series from the University Hospital experience with a new and rarely mentioned indi- of Geneva that contrasts with the common indica- cation for the EXIT procedure, intra-thoracic tion for the EXIT procedure usually based on volume expansions. The elaboration of lowest risk upper airway obstruction by its exclusive indica- scenarios through balancing risks with alternative tion for intra-thoracic malformations/diseases.
  • • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –

    • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –

    • Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion – Oligohydramnios – Umbilical cord compression – Reduction of recurrent variable decelerations – Dilution of meconium-stained amniotic fluid – Replaces the “cushion ” for the umbilical cord and relieves the variable decelerations • Obstetric Procedures (cont.) • Amniotomy – The artificial rupture of membranes – Done to stimulate or enhance contractions – Commits the woman to delivery – Stimulates prostaglandin secretion – Complications • Prolapse of the umbilical cord • Infection • Abruptio placentae • Obstetric Procedures (cont.) • Observe for complications post-amniotomy – Fetal heart rate outside normal range (110-160 beats/min) suggests umbilical cord prolapse – Observe color, odor, amount, and character of amniotic fluid – Woman ’s temperature 38 ° C (100.4 ° F) or higher is suggestive of infection – Green fluid may indicate that the fetus has passed a meconium stool • Nursing Tip • Observe for wet underpads and linens after the membranes rupture. Change them as often as needed to keep the woman relatively dry and to reduce the risk for infection or skin breakdown. • Induction or Augmentation of Labor • Induction is the initiation of labor before it begins naturally • Augmentation is the stimulation of contractions after they have begun naturally • Indications for Labor Induction • Gestational hypertension • Ruptured membranes without spontaneous onset of labor • Infection within the uterus • Medical problems in the
  • Obstetrics Seventh Edition

    Obstetrics Seventh Edition

    PROLOGObstetrics seventh edition The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS Obstetrics seventh edition Assessment Book The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS ISBN 978-1-934984-22-2 Copyright 2013 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. 12345/76543 The American College of Obstetricians and Gynecologists 409 12th Street, SW PO Box 96920 Washington, DC 20090-6920 Contributors PROLOG Editorial and Advisory Committee CHAIR MEMBERS Ronald T. Burkman Jr, MD Bernard Gonik, MD Professor of Obstetrics and Professor and Fann Srere Chair of Gynecology Perinatal Medicine Tufts University School of Medicine Division of Maternal–Fetal Medicine Division of General Obstetrics and Department of Obstetrics and Gynecology Gynecology Department of Obstetrics and Wayne State University School of Gynecology Medicine Baystate Medical Center Detroit, Michigan Springfield, Massachusetts Louis Weinstein, MD Past Paul A. and Eloise B. Bowers Professor and Chair Department of Obstetrics and Gynecology Thomas Jefferson University Philadelphia, Pennsylvania Linda Van Le, MD Leonard Palumbo Distinguished Professor UNC Gynecologic Oncology University of North Carolina School of Medicine Chapel Hill, North Carolina PROLOG Task Force for Obstetrics, Seventh Edition COCHAIRS MEMBERS Vincenzo Berghella, MD Cynthia Chazotte, MD Director, Division of Maternal–Fetal Professor of Clinical Obstetrics and Medicine Gynecology and Women’s Health Professor, Department of Obstetrics Department of Obstetrics and Gynecology and Gynecology Weiler Hospital of the Albert Einstein Thomas Jefferson University College of Medicine Philadelphia, Pennsylvania Bronx, New York George A.
  • Safety Profile of Misoprostol for Obstetrical Indications

    Safety Profile of Misoprostol for Obstetrical Indications

    SAFETY PROFILE OF MISOPROSTOL FOR OBSTETRICAL INDICATIONS Lenita Wannmacher INTRODUCTION Cervical ripening, full‐term labour induction, and postpartum haemorrhage (PPH) are obstetric conditions that require proper and early interventions in order to save maternal and fetal lives. These interventions include pharmacological (uterotonic agents, mainly) and non‐pharmacological methods that have been tested and compared throughout the past decade. Regarding injectable uterotonic medicines (such as oxytocin, ergometrine, syntometrine, prostaglandins, and, more recently, carbetocin), factors limiting their use in low‐resource settings have been their cost, instability at high ambient temperatures, and difficult requirements of administration. In poor and rural settings, birth attendant skills are limited, transport facilities are inadequate, and injectable uterotonics and blood are hardly available. In contrast, misoprostol, a synthetic prostaglandin E1 analogue, presents low cost, storage at room temperature, and widespread availability. Misoprostol could also be easily administered by unskilled attendants or the women themselves, thus making them available for women giving birth at home or in isolated areas. These are benefits that make it particularly appealing for developing poor countries.1 Despite the built evidence of efficacy, induction of full‐term labour in women with a live fetus, as well as prevention and treatment of PPH, remains as a major challenge in modern obstetrics. Safety profile of misoprostol is still a matter of concern, especially relating to doses and routes used for the mentioned purposes.2 Misoprostol can be effectively administered vaginally, rectally, bucally, orally and sublingually. Pharmacokinetic studies have demonstrated the properties of misoprostol after various routes of administration. The rate of absorption varies considerably between routes, and care must be taken to use the correct dose and frequency for the specified route.
  • History Midwives Representing MANA Statistics Project the Profession Data Collection Form Alliance of Midwifery of North America Revision 2.0 – Page 1 of 8

    History Midwives Representing MANA Statistics Project the Profession Data Collection Form Alliance of Midwifery of North America Revision 2.0 – Page 1 of 8

    History Midwives Representing MANA Statistics Project the Profession Data Collection Form Alliance of Midwifery of North America Revision 2.0 – Page 1 of 8 Practice Code1 Y N Previous pregnancy and delivery history Midwife Code1 Number of previous: pregnancies Second Midwife Code1 (OPTIONAL) miscarriages5 Third Midwife Code1 (OPTIONAL) induced abortions Birth Code2 (MIDWIFE’S IDENTIFYING CODE) stillbirths5 live births Number of previous: History home births Client’s municipality: ___________________________ birth center births State or Province: ______________________________ Population: (CHOOSE ONLY ONE) caesarean sections | city | suburb | small town | rural VBACs Postal (ZIP) Code episiotomies Mother’s— postpartum hemorrhages age at booking Other previous pregnancy/delivery occurrences: last grade of high school completed gestation <37 weeks gestation >42 weeks post secondary formal education (YEARS) hypertension or pre/eclampsia6 3 Occupation : ___________________________________ breech Race/Ethnic origin: forceps/vacuum Caucasian IUGR/SGA7 African or Caribbean birth defect Native American shoulder dystocia Asian other: __________________________________ Hispanic none other4: _____________________________________ Mother’s height: (OR ESTIMATE) Special group: (CHECK ANY THAT APPLY) Amish feet inches OR Mennonite centimeters Francophone Mother’s prepregnancy weight: Immigrant of <10 years pounds OR kg Immigrant of >= 10 years Method of conception: (CHOOSE ONLY ONE) other group: ________________________________ | coitus Partner status
  • Florida Obstetric Hemorrhage Initiative (Ohi) Tool Kit

    Florida Obstetric Hemorrhage Initiative (Ohi) Tool Kit

    FLORIDA OBSTETRIC HEMORRHAGE INITIATIVE (OHI) TOOL KIT A QUALITY IMPROVEMENT INITIATIVE FOR OBSTETRIC HEMORRHAGE MANAGEMENT Updated Version 10/2015 P a g e | 1 v. 10/2015 OHI Tool Kit Suggested Citation: Florida Perinatal Quality Collaborative (2015) Florida Obstetric Hemorrhage Initiative Toolkit: A Quality Improvement Initiative for Obstetric Hemorrhage Management. Acknowledgements: The FPQC gratefully acknowledges and thanks our partner organizations, including ACOG District XII, the Florida Chapter of AWHONN, the Florida Council of Nurse Midwives, the Florida Hospital Association, and the Florida Department of Health. The creation of this toolkit would not have been possible without the volunteer members of our Maternal Health Committee, including the members of the Obstetric Hemorrhage Advisory Team listed on page three of this toolkit, Washington Hill, MD and Karla Olson, as well as Kris-Tena Albers and Rhonda Brown from the Florida Department of Health. The FPQC would also like to thank the California Maternal Quality Care Collaborative, ACOG District II, and the Illinois Department of Public Health for sharing their materials, expertise, and time to assist the FPQC in the development of this Quality Improvement (QI) Initiative. This toolkit has been adapted and modeled from the California Improving Healthcare Response to Obstetric Hemorrhage Toolkit: The California Toolkit, IMPROVING HEALTHCARE RESPONSE TO OBSTETRICAL HEMORRHAGE, was developed through the California Maternal Quality Care Collaborative with leadership from the California Department of Public Health, Maternal Child and Adolescent Health (CDPH-MCAH), and is available through the California Maternal Quality Care Collaborative website: www.cmqcc.org/ob_hemorrhage. Funding for the development of the California toolkit was provided by: Federal Maternal & Child Health Title V block grant funding from the California Department of Public Health; Maternal, Child and Adolescent Health Division and Stanford University.
  • Medicalverdicts

    Medicalverdicts

    Medical Verdicts Notable judgmeNts aNd settlemeNts times she refused consent; her fam- Wrongful birth claim: Child has ily could not be contacted without her a chromosomal disorder authorization. Proper actions were A woman’S husband and an interpreter came to taken when consent was obtained. her first prenatal appointment at 10 weeks’ gesta- } VERDICT An Illinois defense verdict tion, as she spoke only Mandarin and the father’s was returned. English was limited. The ObGyn offered maternal serum sequential screening. At subsequent visits, Epidural pump stolen— with the husband and interpreter present, the mother saw a geneticist, genetic counselor, and nurse practitioner. At no time was additional while in use genetic testing offered. At the 23-week visit, the husband was present, but the interpreter had not yet arrived; the ObGyn attempted to communi- A WOMAN WAS GIVEN AN EPIDURAL cate through the husband. during labor. While she slept, a newly The baby was born at term with cri-du-chat syndrome. The child is hired physician assistant (PA) entered severely physically and mentally handicapped, and will require constant her room, disconnected the epidural medical and attendant care for life. pump, and stole it. The woman awoke but the PA assured her that every- } patient’S CLAIM The ObGyn did not offer amniocentesis or chorionic thing was fine. Soon, she experienced villus sampling (CVS), and failed to inform the parents that the chance significant labor pains and called the of a 37-year-old woman having a child with a chromosomal aberration nurses, who paged an anesthesiologist was 1.5%.
  • 00I-Iv Sieog Linee Guida 2010-2.Pmd

    00I-Iv Sieog Linee Guida 2010-2.Pmd

    I LINEE GUIDA SIEOG Società Italiana di Ecografia Ostetrico Ginecologica Edizione 2010 SIEOG II SIEOG Società Italiana di Ecografia Ostetrico Ginecologica e Metodologie Biofisiche Segreteria permanente e tesoreria: Via dei Soldati, 25 - 00186 ROMA - Tel. 06.6875119 - Fax 06.6868142 [email protected] - www.sieog.it - C/C postale N. 20857009 CONSIGLIO DIRETTIVO 2008-2010 PRESIDENTE Paolo Volpe (Bari) PAST-PRESIDENT Tullia Todros (Torino) VICEPRESIDENTI Clara Sacchini (Parma) Antonia Testa (Roma) CONSIGLIERI Carolina Axiana (Cagliari) Elisabetta Coccia (Firenze) Lucia Lo Presti (Catania) Simona Melazzini (Udine) Giuliana Simonazzi (Bologna) TESORIERE Cinzia Taramanni (Roma) SEGRETARIO Valentina De Robertis (Bari) Copyright © 2010 ISBN: 88-6135-124-7 978-88-6135-124-0 Via Gennari 81, 44042 Cento (FE) Tel. 051.904181/903368 Fax 051.903368 www.editeam.it [email protected] Progetto Grafico: EDITEAM Gruppo Editoriale Tutti i diritti sono riservati. Nessuna parte di questa pubblicazione può essere riprodotta, trasmessa o memorizzata in qualsiasi forma e con qualsiasi mezzo senza il permesso scritto dell’Editore. Finito di stampare nel mese di Ottobre 2010. LETTERA AI SOCI III Cari Soci, come da impegno preso per iscritto negli anni precedenti che cadenzava l’aggiornamento delle Linee Guida SIEOG ad un intervallo di 3 anni, allo scadere del mandato di questo Consiglio di Presidenza (CDP) presentiamo la revisione delle LG SIEOG. Sono state realizzate in sintonia con il lavoro dei colleghi dei CDP che ci hanno preceduto e che ha portato alla pubblicazione delle precedenti LG nel 1996, 2002 e 2006. Sono espressione della continua evoluzione scientifica e tecnologica nel nostro settore nonché del ruolo importante, che dal punto di vista clinico, la metodica ecografica ha raggiunto nella nostra disciplina.