Asunto(s)
Histeroscopía , Laparoscopía , Oligomenorrea/etiología , Embarazo , Anomalías Urogenitales , Adulto , Femenino , Hematocolpos , Humanos , Riñón/anomalías , Útero/anomalías , Vagina/anomalíasAsunto(s)
Absceso/diagnóstico , Mallas Quirúrgicas/efectos adversos , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/efectos adversos , Enfermedades Vaginales/diagnóstico , Absceso/etiología , Absceso/cirugía , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Recurrencia , Vagina/cirugía , Enfermedades Vaginales/etiología , Enfermedades Vaginales/cirugíaAsunto(s)
Complicaciones Neoplásicas del Embarazo/diagnóstico , Neoplasias de la Vulva/diagnóstico , Adulto , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Colostomía , Resultado Fatal , Femenino , Humanos , Trabajo de Parto Inducido , Metástasis de la Neoplasia , Embarazo , Neoplasias de la Vulva/radioterapiaRESUMEN
OBJECTIVE: To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. DESIGN: Population based comparison of outcomes. Data derived from the St Mary's maternity information system. SETTING: North West Thames Regional Health Authority, 1988-90. SUBJECTS: 3447 singleton fetuses presenting by the breech at term. MAIN OUTCOME MEASURES: Intrapartum and neonatal mortality, low Apgar scores, intubation at birth, and admission to special care baby units. RESULTS: After the exclusion of babies with congenital anomalies the incidence of intrapartum and neonatal death associated with vaginal birth was 8/961 (0.83%) compared with 1/2486 (0.03%) in babies born by caesarean section (relative risk 20, 95% confidence interval 2.5 to 163). The numbers of low Apgar scores and neonatal intubation were doubled in babies born vaginally or by emergency caesarean section compared with those delivered by elective operation. CONCLUSIONS: The good neonatal outcome associated with elective caesarean delivery of the term breech fetus may influence the decision of women and their obstetricians about mode of delivery.
Asunto(s)
Presentación de Nalgas , Parto Obstétrico/métodos , Resultado del Embarazo , Puntaje de Apgar , Cesárea/estadística & datos numéricos , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Intubación , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To establish what is known about the role of feedback of statistical information in changing clinical practice. DESIGN: Review of 36 studies of interventions entailing the use of statistical information for audit or practice review, which used a formal research design. SUBJECTS: Papers identified from computer searches of medical and health service management publications, of which 36 describing studies of interventions designed to influence clinical care and including information feedback from clinical or administrative data systems were reviewed. MAIN OUTCOME MEASURES: Evidence for effect of information feedback on change in clinical practice. RESULTS: Information feedback was most likely to influence clinical practice if it was part of strategy to target decision makers who had already agreed to review their practice. A more direct effect was discernable if the information was presented close to the time of decision making. The questions of the optimum layout and quantity of information were not addressed; the 36 papers were insufficient for defining good formats for information to be used for audit or quality assurance. CONCLUSIONS: Given the cost of information processing and the current emphasis on closing the audit loop in the health services, it is important that the use of information in the audit process should be critically evaluated.
Asunto(s)
Medicina Clínica/normas , Retroalimentación , Auditoría Médica/estadística & datos numéricos , Humanos , Servicios de Información , Pautas de la Práctica en Medicina/tendencias , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Reino UnidoAsunto(s)
Analgesia Epidural , Analgesia Obstétrica , Parto Obstétrico/métodos , Femenino , Humanos , EmbarazoRESUMEN
Recurrent embolisation from venous thrombosis despite anticoagulation, in pregnancy, constitutes a major diagnostic and management problem. We present just such a patient who was managed with a Greenfield vena caval filter, which enabled her pregnancy to continue, resulting in a vaginal delivery of a healthy female infant at 38 weeks gestation.