Subject(s)
Granulosa Cell Tumor/secondary , Neoplasm Recurrence, Local/pathology , Ovarian Neoplasms/pathology , Pelvic Neoplasms/secondary , Aged , Diagnosis, Differential , Female , Granulosa Cell Tumor/diagnostic imaging , Granulosa Cell Tumor/surgery , Hemorrhage/etiology , Humans , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/surgery , Ovarian Neoplasms/surgery , Pelvic Neoplasms/diagnostic imaging , Pelvic Neoplasms/surgery , Rectal Diseases/etiology , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To evaluate whether a 30-minute decision-to-delivery interval is a realistic target for emergency caesarean section. DESIGN: An audit of all emergency caesarean sections over five separate periods. SETTING: A district general hospital. PARTICIPANTS: Five groups of women (343 women) with an indication for emergency caesarean section. METHODS: Following an initial survey, a structured time sheet was introduced, followed by four other surveys to complete the audit cycle. MAIN OUTCOME MEASURE: The proportion of caesarean sections where the decision-to-delivery interval was achieved within 30 minutes. The reasons for delay. RESULTS: In the first survey of 73 emergency caesarean sections, the time to deliver the infant exceeded 30 minutes in 47 women (64%). The main sources of delay were transferring the women to the operating theatre and starting the anaesthetic. After the introduction of a structured time sheet, there was an improvement with each survey, but the target of 30 minutes was reached in only 71% of caesarean sections in the final survey. CONCLUSIONS: The introduction of a time sheet can improve the decision-to-delivery interval for emergency caesarean section; however, a universal standard of 100% in 30 minutes is unrealistic.
Subject(s)
Cesarean Section/methods , Decision Making , Emergencies , Pregnancy, Prolonged , Female , Gestational Age , Humans , Medical Audit , Pregnancy , Time FactorsABSTRACT
We describe a study which takes an alternative approach to the management dilemma of the mildly dyskaryotic cervical smear. Two hundred and fifty women with a smear showing mild dyskaryosis were studied by auditing the clinical outcome as well as the cost. The cost of providing the colposcopy services during the index year was approximately pounds sterling 70000 for an average size district general Hospital. The proportion of women managed by the current guidelines and avoiding colposcopy after a first mildly dyskaryotic smear was only 30%. The majority of patients will eventually have colposcopy despite a policy of cytological surveillance. The alternative approach, to offer colposcopy immediately after the first mildly dyskaryotic smear, would result in a small increase in cost for our unit, equivalent to one extra colposcopy patient per week.
Subject(s)
Colposcopy/economics , Uterine Cervical Neoplasms/pathology , Vaginal Smears/economics , Female , Humans , Medical Audit , United KingdomABSTRACT
This paper presents the results of a study using the product of symphysio-fundal height and abdominal girth at the umbilical level measured in centimeters and the results expressed in grams to estimate fetal weight at term in utero. The estimated weight before delivery correlated well with the birth weight. This simple method can be used in areas where sophisticated methods are unavailable.
