- Email: [email protected]
583 Prenatal Care of the Adolescent
430
578
SPO Abstracts
January 1992 Am J Obstet Gynecol
SURVEY OF OPERATIVE VAGINAl DELIVERY IN NORTH AMERICA IN 1990. S. Ramin, B. LittleX, L. Gilstrap, Dept. Ob/Gyn, Univ. Texas Southwestern Med. Ctr., Da llas, TX Nearly a decade ago, a survey of obstetric forceps training in North America was published. Since then, the American College of Obstetricians and Gynecologists has published new definitions for forcep deliveries. Our purpose was to survey residency training and current use of obstetric forceps in 1990. Of 294 programs surveyed, 201 (68%) responded, encompassing a minimum of 458,000 deliveries. All but 2 (99%) were familiar with the new definitions which were utilized by 161 (80%) of the programs. The frequency of operative vaginal delivery ;s surrmarized below:
~
5-9%
Out let
48%
33%
10%
5%
4%
Low
60%
30%
4%
1%
4%
~
<1%
1-4%
5-8%
>9%
No ResQonse
Mid
14%
59%
25%
0.5%
0%
2%
Vacuum
10%
21%
46%
16%
4%
3%
~
10-15% 16-20% No Response
Attending faculty were the primary instructors in 66% of U.S. and 100% of Canadian programs. Simpson forceps were the most callinan instrument for outlet (46%) and low (43%) deliveries. Kielland's (27%) and Simpson (24%) were most commonly used for midforcep deliveries. As with the earlier survey, hospitals with high cesarean section rates did not perform significantly fewer midforcep operations. In conclusion, operative vaginal de1ivery ;s still corrmonly taught in residency training programs in North America in 1990. However, the rate of midforcep use apparently has decreased over the past decade (86% vs. 99%). This may reflect the newer, stricter definitions for midforceps utilized by 80% of the respondents.
580 ACUTE AWENDECTOMY DURING PREGNANCY:
~x, A RISK FOR PRETERM LABOR? L.Leduc, Dept OblGyn, Sainte-Justine Hospital, Montreal, Quebec, Canada. Acute appendicitis is the most common DOnobstetrical surgical complication of pregnancy. Generally, the emphasis has been on the diagnostic challenge rather than on the effects of appendectomy on the pregnancy outcome, Therefore, we determined if there is an increased risk of preterm labor after appendectomy. We reviewed the charts of 27 pregnant women admitted to Ste-Justine hospital over a 10-year period. The patient's and gestational ages at admission ranged from 17-37 years (mean: 27 ~ 1) and 14-37 weeks ( mean: 2S ~ 2) respectively. The incidence of preterm labor was higher when appendectomy was performed after 30 weeks of gestation ( Sill vs 0116, p < 0,01 ). All delivered within I week of surgery and none received prophylactic tocolysis. The mean interval between the admission and the surgery was lS,7 ~ 2.0 hrs before 30 weeks and 27.6 ~ 7.8 hrs after, The overall rate of misdiagnosed appendicitis was 14.8% ( 4127 ) with a lower nte in the group less than 30 weeks (12% vs 18%). CONCLUSION: I)Appendectomy appears to increase the risk of preterm labor after 30 weeks of gestation. 2) Prophylactic tocolysis should be considered in these cues.
581' THE RELATIONSHIP BElWEEN THE BISHOP SCORE AT 41 WEEKS AND THE DURATION OF POSTDATES PREGNANCIES. KB Porter, WF O'Brien, T Nguyen," L Johnson,z E Brooks: J Holbrook! University of South florida College of Medicine, Tampa, florida. A retrospective chart review of 1,268 women delivering at 41 weeks or later over a 3 year period were evaluated. Of this population, 389 women entered a postdates screening program at 41 weeks. One hundred and eight had assured dates having had either a first or second trimester sonogram. When comparing those women with confirmed versus unconfirmed dating, no differences were found in the mean Bishop score, incidence of nulliparity, or in the rate of induction (30%). In both groups those women with unfavorable Bishop scores delivered at a later gestational age. % Delivered Bishop Score 41-42 wk. 42-43 wk. ~43 wk. 0-5 47.40 35.84 16.76 6-8 60.38 33.96 5.66 >8 93.75 6.25 0 In conclusion, cervical condition at 41 weeks regardless of dating accuracy strongly predicts the likelihood of pregnancy lasting beyond 42 weeks.
583
PrenaIaJ Care of the Adolescent C.J. Sims, H.R. Giles, Dept. of Ob/Gyn, Medical College of Pennsylvania/Allegheny Campus, Pittsburgh, PA. In an effort to provide optimum care of the pregnant adolescent a review of the needs of the adolescent in our community was undertaken. Educators, county officials, health care providers, adolescents and community leaders were interviewed. The consortium agreed upon the importance of early, consistent, quality prenatal care that enhanced the long term quality of life of the adolescent family. The importance of continuation of her education ranked high on the list of needs, Therefore, an agreement was made between the city school board and a local health care provider for school based prenatal care. A consistent team of providers was established. Members included: 1) Educational director of the school· based clinic, 2) Maternal-Fetal medicine specialist with an interest in adolescent pregnancy, 3) perinatal nurse specialisVcase manager, 4) school nurse, 5) nurse's assistant, 6) Adolescent medicine specialist (providing long teon care for the adolescent and her infant), and 7) psychiatric social worker. The implementation of this model program was an example of a community's combined efforts enacted to address the alarming concerns of inner city adolescents. After two years of operation, the consortium agrees that this program has a salutary impact. This program is depicted as a successful model of a synergistic health care/educational environment.
578
SPO Abstracts
January 1992 Am J Obstet Gynecol
SURVEY OF OPERATIVE VAGINAl DELIVERY IN NORTH AMERICA IN 1990. S. Ramin, B. LittleX, L. Gilstrap, Dept. Ob/Gyn, Univ. Texas Southwestern Med. Ctr., Da llas, TX Nearly a decade ago, a survey of obstetric forceps training in North America was published. Since then, the American College of Obstetricians and Gynecologists has published new definitions for forcep deliveries. Our purpose was to survey residency training and current use of obstetric forceps in 1990. Of 294 programs surveyed, 201 (68%) responded, encompassing a minimum of 458,000 deliveries. All but 2 (99%) were familiar with the new definitions which were utilized by 161 (80%) of the programs. The frequency of operative vaginal delivery ;s surrmarized below:
~
5-9%
Out let
48%
33%
10%
5%
4%
Low
60%
30%
4%
1%
4%
~
<1%
1-4%
5-8%
>9%
No ResQonse
Mid
14%
59%
25%
0.5%
0%
2%
Vacuum
10%
21%
46%
16%
4%
3%
~
10-15% 16-20% No Response
Attending faculty were the primary instructors in 66% of U.S. and 100% of Canadian programs. Simpson forceps were the most callinan instrument for outlet (46%) and low (43%) deliveries. Kielland's (27%) and Simpson (24%) were most commonly used for midforcep deliveries. As with the earlier survey, hospitals with high cesarean section rates did not perform significantly fewer midforcep operations. In conclusion, operative vaginal de1ivery ;s still corrmonly taught in residency training programs in North America in 1990. However, the rate of midforcep use apparently has decreased over the past decade (86% vs. 99%). This may reflect the newer, stricter definitions for midforceps utilized by 80% of the respondents.
580 ACUTE AWENDECTOMY DURING PREGNANCY:
~x, A RISK FOR PRETERM LABOR? L.Leduc, Dept OblGyn, Sainte-Justine Hospital, Montreal, Quebec, Canada. Acute appendicitis is the most common DOnobstetrical surgical complication of pregnancy. Generally, the emphasis has been on the diagnostic challenge rather than on the effects of appendectomy on the pregnancy outcome, Therefore, we determined if there is an increased risk of preterm labor after appendectomy. We reviewed the charts of 27 pregnant women admitted to Ste-Justine hospital over a 10-year period. The patient's and gestational ages at admission ranged from 17-37 years (mean: 27 ~ 1) and 14-37 weeks ( mean: 2S ~ 2) respectively. The incidence of preterm labor was higher when appendectomy was performed after 30 weeks of gestation ( Sill vs 0116, p < 0,01 ). All delivered within I week of surgery and none received prophylactic tocolysis. The mean interval between the admission and the surgery was lS,7 ~ 2.0 hrs before 30 weeks and 27.6 ~ 7.8 hrs after, The overall rate of misdiagnosed appendicitis was 14.8% ( 4127 ) with a lower nte in the group less than 30 weeks (12% vs 18%). CONCLUSION: I)Appendectomy appears to increase the risk of preterm labor after 30 weeks of gestation. 2) Prophylactic tocolysis should be considered in these cues.
581' THE RELATIONSHIP BElWEEN THE BISHOP SCORE AT 41 WEEKS AND THE DURATION OF POSTDATES PREGNANCIES. KB Porter, WF O'Brien, T Nguyen," L Johnson,z E Brooks: J Holbrook! University of South florida College of Medicine, Tampa, florida. A retrospective chart review of 1,268 women delivering at 41 weeks or later over a 3 year period were evaluated. Of this population, 389 women entered a postdates screening program at 41 weeks. One hundred and eight had assured dates having had either a first or second trimester sonogram. When comparing those women with confirmed versus unconfirmed dating, no differences were found in the mean Bishop score, incidence of nulliparity, or in the rate of induction (30%). In both groups those women with unfavorable Bishop scores delivered at a later gestational age. % Delivered Bishop Score 41-42 wk. 42-43 wk. ~43 wk. 0-5 47.40 35.84 16.76 6-8 60.38 33.96 5.66 >8 93.75 6.25 0 In conclusion, cervical condition at 41 weeks regardless of dating accuracy strongly predicts the likelihood of pregnancy lasting beyond 42 weeks.
583
PrenaIaJ Care of the Adolescent C.J. Sims, H.R. Giles, Dept. of Ob/Gyn, Medical College of Pennsylvania/Allegheny Campus, Pittsburgh, PA. In an effort to provide optimum care of the pregnant adolescent a review of the needs of the adolescent in our community was undertaken. Educators, county officials, health care providers, adolescents and community leaders were interviewed. The consortium agreed upon the importance of early, consistent, quality prenatal care that enhanced the long term quality of life of the adolescent family. The importance of continuation of her education ranked high on the list of needs, Therefore, an agreement was made between the city school board and a local health care provider for school based prenatal care. A consistent team of providers was established. Members included: 1) Educational director of the school· based clinic, 2) Maternal-Fetal medicine specialist with an interest in adolescent pregnancy, 3) perinatal nurse specialisVcase manager, 4) school nurse, 5) nurse's assistant, 6) Adolescent medicine specialist (providing long teon care for the adolescent and her infant), and 7) psychiatric social worker. The implementation of this model program was an example of a community's combined efforts enacted to address the alarming concerns of inner city adolescents. After two years of operation, the consortium agrees that this program has a salutary impact. This program is depicted as a successful model of a synergistic health care/educational environment.