ABSTRACT
OBJECTIVE: To evaluate the impact of a standardized surgical technique for primary cesarean deliveries (CDs) on operative time and surgical morbidity. MATERIALS AND METHODS: Two-year retrospective chart review of primary CD performed around the implementation of a standardized CD surgical technique. The primary outcome was total operative time (TOT). Secondary outcomes included incision-to-delivery time (ITDT), surgical site infection, blood loss, and maternal and fetal injuries. RESULTS: When comparing pre- versus postimplementation surgical times, there was no significant difference in TOT (76.5 vs. 75.9 minutes, respectively; p = 0.42) or ITDT (9.8 vs. 8.8 minutes, respectively; p = 0.06) when the entire cohort was analyzed. Subgroup analysis of CD performed early versus late in an academic year among the pre- and postimplementation groups showed no significant difference in TOT (79.3 early vs. 73.8 minutes late; p = 0.10) or ITDT (10.8 early vs. 8.8 minutes late; p = 0.06) within the preimplementation group. In the postimplementation group, however, there was significant decrease in TOT (80.5 early vs. 71.3 minutes late; p = 0.02) and ITDT (10.6 early vs. 6.8 minutes late; p < 0.01). Secondary outcomes were similar for both groups. CONCLUSION: A standardized surgical technique combined with surgical experience can decrease TOT and ITDT in primary CD without increasing maternal morbidity.
Subject(s)
Cesarean Section/standards , Obstetrics/education , Operative Time , Postoperative Cognitive Complications/prevention & control , Quality Improvement , Adult , Attitude of Health Personnel , Cesarean Section/education , Cesarean Section/methods , Education, Medical, Continuing , Female , Humans , Obstetrics/standards , Postoperative Cognitive Complications/epidemiology , Pregnancy , Retrospective Studies , Surveys and Questionnaires , TexasABSTRACT
McGowan and Tuohy carried out a survey in Belfast in 1968 to identify patients with cardiac lesions susceptible to infective endocarditis. They also asked whether adequate precautions had been taken by the patients' medical and dental advisers in respect of antibiotic cover for dental surgical procedures. This survey has now been repeated in the Belfast and Glasgow Dental Schools. When compared with those of 1968, the results of these recent studies show that while more 'at risk' patients are receiving antibiotic cover for dental surgical procedures there is still room for improvement in the advice given to patients by medical and dental practitioners.
