RESUMO
The current maternal/newborn care model is outdated and needs to be revised. The health care reform movement has created a window of opportunity to redefine the episode of pregnancy care and develop a more meaningful and more cost-effective model of care. The ultimate satisfaction for physicians will occur when they exert their natural control regarding the manner in which health care dollars are spent by managing the financial risk and the patient care. The optimal management of the health care dollar can only be achieved through initiation of an integrated model in which a coordinated care team supported by the appropriate risk assessment, education, prevention and wellness program, and medically necessary intensive care of the high-risk pregnancy are brought together effectively. An integrated model will give patients what they want: compassionate, convenient, comprehensive care. It will give the payers what they are looking for--appropriate care at an appropriate predicable cost and improved outcomes. Finally, it will give the providers what they want: control over the delivery medical care.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Cuidado Periódico , Programas de Assistência Gerenciada/organização & administração , Modelos Organizacionais , Obstetrícia/organização & administração , Perinatologia/organização & administração , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Reembolso de Seguro de Saúde , Satisfação do Paciente , Gravidez , Gravidez de Alto RiscoRESUMO
A case of true sinusoidal fetal heart rate associated with fetal gastroschisis is presented. No other known etiologic factors associated with a sinusoidal pattern were present. The pathophysiologic mechanism in this case is unclear, but fetal anomalies may be associated with elevated arginine vasopressin levels leading to the distinctive sinusoidal fetal heart rate response.
Assuntos
Músculos Abdominais/anormalidades , Frequência Cardíaca Fetal , Adolescente , Feminino , Monitorização Fetal , Humanos , Recém-Nascido , GravidezRESUMO
Uncontrollable hemorrhage can occur during any surgical procedure, and only an organized approach to its control will minimize morbidity and mortality. When routine hemostatic measures fail, extraordinary methods must be used. The use of intraabdominal packs with a MAST (medical antishock trousers) suit successfully controlled a life-threatening hemorrhage in one such patient.
Assuntos
Hemorragia Gastrointestinal/terapia , Trajes Gravitacionais , Complicações Pós-Operatórias/terapia , Complicações Cardiovasculares na Gravidez/terapia , Tampões Cirúrgicos , Adulto , Cesárea , Feminino , Humanos , Histerectomia , GravidezAssuntos
Movimento Fetal , Complicações na Gravidez , Feminino , Monitorização Fetal/métodos , Humanos , Gravidez , RiscoRESUMO
The management of patients with preterm premature rupture of the membranes is often influenced by the ultrasound measurement of biparietal diameter. The cephalic index has been used in pregnancies with intact membranes to predict the presence of an abnormal biparietal diameter that may be unreliable in estimating gestational age. This study analyzed 100 patients with rupture of the membranes between the beginning of gestation week 28 and the end of week 34. The cephalic index was found to be abnormal 45% of the time; all were in the brachiocephalic range. The biparietal diameter was affected by presentation and presence or absence of amniotic fluid (p less than 0.05). Use of the biparietal diameter was found to be unreliable in estimating gestational age with preterm premature rupture of the membranes. Use of the cephalic index did not enable prediction of which biparietal diameters would be abnormal; therefore use of the biparietal diameter or the cephalic index in preterm premature rupture of the membranes is not recommended. The use of the head circumference, abdominal circumference, and femur measurements may be a better way of predicting gestational age in this select population.
Assuntos
Ruptura Prematura de Membranas Fetais , Feto/anatomia & histologia , Idade Gestacional , Ultrassonografia , Líquido Amniótico , Cefalometria/métodos , Feminino , Humanos , Apresentação no Trabalho de Parto , GravidezRESUMO
Regionalization of perinatal care has contributed to a decline in perinatal morbidity and mortality in neonates delivered at tertiary centers when compared to neonates delivered and transported to the intensive care nurseries. Transportation of the mother to the perinatal center in an emergency situation must be evaluated critically for neonatal outcome, response time, and cost. In a large metropolitan area in Southern California, a helicopter transport service has been used successfully to move emergency patients from referring hospitals to a perinatal center. This experience was examined with respect to response time, cost, obstetric problems, and newborn outcome in our first 100 patients. The results are indicative that when patient and neonates would benefit from delivery at a perinatal center, helicopter transport, even in an urban area, is highly successful and cost effective.
