RESUMEN
This study was designed to assess the impact of selected medical interventions during labor upon cesarean section rates by comparing the maternal and neonatal outcomes of obstetrician- and nurse-midwife-managed low-risk private patients. All patients who delivered at Prentice Women's Hospital in Chicago, Illinois, from January 1, 1987 through December 31, 1990 were evaluated for low-risk criteria to be included in the study. During that time, the nurse-midwives delivered 573 patients and the obstetricians delivered 12,077 patients. Patients with fetal and maternal complications known to increase the cesarean section rate were eliminated from both groups. Eight percent of the nurse-midwife patients and 32% of the physician patients were eliminated, leaving 529 nurse-midwife patients and 8,266 physician patients. These patients were compared for race, parity, age, and birth weight. Information was collected from a perinatal data base and hospital computerized statistics. The rates of cesarean section, administration of oxytocin, analgesia, anesthesia, and infant outcome data were compared by chi-square analysis. Multiple logistic regression analysis was used to assess factors that predicted cesarean section. Nurse-midwife-managed patients had a significantly lower rate of cesarean section (8.5% versus 12.9%; P < .005) and operative vaginal delivery (5.3% versus 17%, P = .0001) than the physician-managed patients. Epidural anesthesia and oxytocin for induction and augmentation were used significantly more frequently in the physician-managed patients. Both interventions were associated with an increased rate of cesarean section. Fetal outcomes in the two groups were not statistically different. Women cared for by nurse-midwives had a lower cesarean section rate, fewer interventions, and equally good maternal and infant outcomes when compared with those cared for by physicians.
Asunto(s)
Cesárea/estadística & datos numéricos , Enfermeras Obstetrices , Obstetricia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Resultado del Embarazo , Adulto , Analgesia Obstétrica , Anestesia Obstétrica , Certificación , Distribución de Chi-Cuadrado , Femenino , Humanos , Modelos Logísticos , Oxitocina/uso terapéutico , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Three patients with Down's syndrome and coincident Tourette syndrome are presented. Two patients had trisomy for G-group chromosome and one patient had mosaic trisomy. All had characteristic features of Gilles de la Tourette syndrome with multiple motor and vocal tics. While Tourette syndrome has been reported in other chromosomopathies, this report appears to be the first to note an association with Down's syndrome. The authors hypothesize that neurotransmitter abnormalities existing in Down's syndrome may predispose such individuals to basal ganglia dysfunction and the subsequent development of tics. In particular, abnormalities in serotonin metabolism may be involved.