Community-based learning in obstetrics for undergraduate medical students.

Medical students on their obstetrics and gynaecology attachment were randomly assigned to attend hospital (n = 24) or general practice (n = 18) obstetric clinics once weekly for 4 weeks. The students completed self-assessment questionnaires at the beginning and end of the attachment. There was a significant improvement in the level of knowledge and skills required for antenatal care, care in labour and postnatal care by the end of the attachment, with no difference between hospital or general practice groups. There was a significant increase in the level of interest in the future practice of obstetrics only in the general practice group. However, this difference could be explained by the greater number of students in the general practice group who were by chance in the 'no or don't know' category at the start of their attachment. We conclude that general practice based clinical teaching of obstetrics can be a suitable alternative to hospital-based clinical teaching for undergraduate medical students.

An obstetric scoring system: its development and application in obstetric management.

OBJECTIVE: To develop a statistically derived but clinically usable antenatal risk scoring system. METHODS: Data from 20,985 pregnancies were statistically analyzed to identify significant risk factors. Logistic regression analysis was then used to produce a final scoring system, which was subsequently tested for validity on a separate population of 3120 pregnancies. RESULTS: Twenty-seven significant antenatal variables were included in the final scoring system. Application of the system in early pregnancy resulted in a predictive accuracy of 0.73; at the onset of labor, predictive accuracy was 0.91. At the time of labor, 87% of poor outcomes were accurately identified by allocation of only 16% of the women to the high-risk group. CONCLUSIONS: It was possible to develop a risk scoring system with a predictive accuracy higher than any previously reported statistically derived score. Summation of the logistic coefficients provides a score that by comparison with a chosen threshold identifies a high-risk pregnancy. In this way, despite the complexity of statistical analysis, all clinicians can quickly apply this scoring system.

Risk factors for neonatal infection.

A retrospective case-control study was designed to assess risk factors for neonatal infection. Nonprivate patients (8,215) who delivered in a period from January 1, 1983 to June 30, 1988 were studied. Ninety three cases of conjunctivitis (incidence 2.4/1,000), 104 cases of pneumonia (incidence 2.8/1,000), and 50 cases of sepsis (incidence 1.3/1,000) were identified. Group B streptococcus was cultured from septic neonates in 46%. Calculated Odds ratio's indicated prematurity/low birth-weight (OR 6.9) and antepartum fetal tachycardia (OR 6.3) as important risk factors for pneumonia/sepsis. Prematurity/low birth-weight (OR 3.0) and an abnormal presentation in the birth canal (OR 2.8) were identified as risk factors for conjunctivitis. After testing all the risk factors found by univariate analysis in a logistic regression model tachycardia (chi 2 35.21, p less than 0.001) remained an independent predictor for neonatal pneumonia/sepsis and abnormal vaginal presentation (chi 2 7.58, p 0.006) for conjunctivitis.

Stillbirths in Auckland 1983-1986.

One hundred and ninety eight stillbirth deliveries occurred in three major obstetric departments of Auckland hospitals between July, 1983 and June, 1986. Post mortem examinations were performed in 74.7% of cases. The overall stillbirth rate was 5.92 per 1000 total births and the major causes of death were fetal abnormality, fetal anoxia and unexplained fetal death. Of normally formed stillbirths, about 60% occurred in uncomplicated pregnancies. Intracranial haemorrhage was common amongst Pacific Island patients while abruptio placentae occurred more commonly in caucasians. The study suggests that stillbirths occur more commonly in small for dates infants at earlier gestations, but this trend has disappeared by term. Cord problems were rare and occurred mainly in babies over 2500 g, and the absence of post mortem evidence of anoxia in the majority of these babies may suggest that the cord complications occurred as a post mortem phenomenon. Cardiotocographs were recorded 24 hours prior to death in 16 patients. The risk of stillbirth during each subsequent week of pregnancy is calculated and it is found that this risk increases sharply after 42 weeks gestation.

Comprehensive antenatal care and education of young adolescents: beneficial effects on pregnancy and outcome.

Fifty-five consecutive adolescents, aged sixteen years or under at delivery, were cared for at a special antenatal clinic by one nurse and doctor and educated about pregnancy, health and reproduction. A philosophy of self-care and respect was engendered in these adolescents by the nurse and doctor. The effects of such care on the pregnancy and outcome were compared with a group of 55 consecutive patients (of similar age and background) cared for by the general clinic immediately prior to the introduction of the special care clinic. Urinary tract infection, anaemia, premature labour, fetal distress, operative delivery, primary postpartum haemorrhage, low birth weight infants, infant admission rate to neonatal unit and artificial feeding, were all significantly less common in the special clinic patients who also rarely missed outpatient appointments.

A second means of identifying fetal breathing movements using Doppler ultrasound.

A new low-frequency Doppler shift signal associated with fetal breathing has been observed. This signal is out of phase with the previously described signal from the inferior vena cava and originates from the umbilical vein.

Breathing movements in the human fetus.

Simultaneous observations of the movements of opposite sides of the human fetal trunk were made by an ultrasonic device. Rhythmical excursions that were in time but out of phase were recorded from the lateral chest walls. These movements are considered to be the result of changes in the shape of the chest and are consistent with breathing movements. Large excursions of the antior abdominal wall compared to the chest movements suggest that the diaphragm shares in the breathing movement.