ABSTRACT
Over the past nine years in Watford the proportion of hospital confinements has increased and domiciliary confinements have almost ceased. The proportion of patients originally booked into the general practitioner obstetric unit and subsequently transferred to the consultant unit has increased. Most patients are transferred during pregnancy, and the numbers transferred in labour are decreasing. The proportion of GPs attending their patients for delivery is low: local practitioners appear to be prepared for the consultant unit to supervise delivery with the practitioner co-operating in antenatal and postnatal care and family planning. There seems little doubt that the success of GP units depends on the enthusiasm and interest of individual practitioners.
Subject(s)
Family Practice/trends , Maternal Health Services/trends , Female , Home Care Services/trends , Hospitalization/trends , Hospitals, Maternity , Humans , Labor, Obstetric , Physician's Role , Pregnancy , Referral and Consultation , United KingdomABSTRACT
Tubal ligation under epidural analgesia in the early puerperium (within 10 hours of delivery) was attempted in 51 patients who had an epidural block established during labour. The results are described. No major difficulties were encountered.
Subject(s)
Anesthesia, Epidural , Postpartum Period , Sterilization, Tubal/methods , Anesthesia, Obstetrical , Bupivacaine , Female , Humans , PregnancyABSTRACT
PIP: Because it has been suggested that induction of labor results in increased perinatal mortality, 1972-1974 statistics from the Maternity Unit, Watford, England, General Hospital, are presented. Perinatal mortality was reduced from 22/1000 in 1972 to 11/1000 in 1974 while the induction of labor rate increased from 28% to 55%. 4 major contributory factors for the fall in perinatal mortality are noted: 1) 70% of all the patients in the unit have continuous fetal heart rate monitoring; 2) the cervix of all patients whose previous pregnancy was terminated is examined at each visit, and when there is early dilatation or effacement of the cervix, cervical circumsuture is inserted; 3) amniocentesis is performed on at risk patients, and abortion may be performed in some cases where there would have otherwise been a stillbirth; and 4) there has not been an increased number of premature babies or of operative deliveries because of precautions taken, and the use of oxytocin has resulted in short labors and healthy babies. It is suggested that obstetric units in Britain publish their perinatal mortality figures and their induction of labor rates along with the units' policies concerning fetal monitoring and the use of ultrasound confirmation of dates.^ieng
