Patient costs for prophylaxis and treatment of obstetric and gynecologic surgical infections

Article Abstract:

Obstetric and gynecologic surgery may be complicated by the development of infections despite surgical improvements and antibiotic therapy. Pelvic infections may develop after commonly performed procedures, such as vaginal hysterectomy (removal of the uterus through the vagina) and cesarean section, and are caused by both aerobic and anaerobic bacteria. Infections with beta hemolytic streptococci, Escherichia coli, Neisseria gonorrhoeae, Chlamydia trachomatis, coagulase-negative staphylococci, and anaerobic bacteria can cause inflammation of the uterus and parametrium, the loose connective tissue around the uterus. Because these infections are caused by several different types of bacteria, antibiotics used to treat them should have a wide spectrum of activity, and be active against both aerobic and anaerobic bacteria. To prevent infection, a single dose of a cephalosporin that remains in the body for a long duration can be as effective as a cephalosporin given over a prolonged period. Single doses of antibiotics with long half-lives (a measure of the duration that the drugs remains in the body) cause less toxicity and are less costly to the patient. In addition, the use of single doses reduces the development of drug-resistant forms of bacteria. Broad-spectrum antibiotics may be more effective in treating pelvic infections that develop after surgery and may also prevent the development of abscesses. Newer cephalosporins and penicillin combinations that include beta-lactamase inhibitor are being used. Beta-lactamase interferes with the actions of penicillins and thereby renders bacteria resistant to the antibiotic; beta-lactamase inhibitor blocks the bacterial enzyme beta-lactamase. With the development of new cephalosporins and beta lactamase-penicillin combinations, infections caused by several types of bacteria can now be controlled by monotherapy, or the use of one type of antibiotic. Monotherapy is associated with reduced drug costs, fewer side effects, and less need for continuous monitoring. Treatment with oral antibiotics helps to reduce the costs of intravenous therapy and the need for hospitalization. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Dosage and administration, Cephalosporins, Gynecology, Operative, Gynecological surgery

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Analysis of 500 obstetric and gynecologic malpractice claims: causes and prevention

Article Abstract:

Studies have shown that 78 percent of obstetricians and gynecologists have been sued at least once, and 37 percent have been sued three or more times. One survey found that 36 percent of obstetricians have been sued while still in training. In a 1990 study of 500 obstetric and gynecologic malpractice claims, 59 percent were obstetric and 41 percent were gynecologic. The causes of these claims and percentage of indefensible claims were assessed. Indefensible claims were cases that could not be defended because of inadequate standards of medical care and/or inadequate documentation. Seventy-nine obstetric claims were indefensible due to inappropriate standards of care, and 71 percent of cases could not be defended because of inadequate documentation. Twenty-four percent of the indefensible cases had indications of both inadequate care and documentation. Sixty-two percent of the gynecologic claims were indefensible due to insufficient standards of care, and 24 percent of cases had documentation problems. A combination of both problems was found in 13 percent. The overall incidence of indefensible claims was 25 percent. Some common causes of malpractice claims against obstetrics included cord-placental problems, failure to recognize difficulties of labor, and failure to properly monitor fetal heart rate. Gynecologic problems included failure to detect breast cancer, surgical failures of sterilization procedures, and failure to recognize injury to the genitourinary tract. Some recommendations are presented to help to reduce the number of indefensible malpractice claims. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Causes of, Medical care, Practice, Malpractice, Medical malpractice, Obstetrics, Obstetricians

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Clinical utility of saline solution infusion sonohysterography in a primary care obstetric-gynecologic practice

Article Abstract:

Infusing salt water into the uterus may assist gynecologists in using ultrasound imaging to try to determine the cause of abnormal uterine bleeding. Overall, 114 women with abnormal uterine bleeding had ultrasonography with salt water infusion. Expanding the uterine cavity enabled gynecologists to better determine the presence of polyps, fibroid tumors, and to measure the thickness of the uterine lining. No patients experienced complications. This technique may enable gynecologists to avoid invasive procedures such as biopsy or curettage in some patients.

Methods, Ultrasound imaging, Diagnosis, Uterine bleeding, Uterine hemorrhage, Injections, Saline, Saline injections

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