Prenatal records: a national survey of content

Article Abstract:

Prenatal records serve several functions in addition to facilitating prenatal care for individual patients: they also enable communication among health care providers, allow monitoring of quality assurance, provide legal documentation, and establish a basis for financial compensation. The records should be problem-oriented, systematic, and detailed. To evaluate the extent to which maternity records actually meet these standards, 940 randomly selected physicians (90 percent were obstetricians, gynecologists, or specialists in maternal-fetal medicine) and 29 doctors of osteopathy were studied. They were asked to send blank copies of the prenatal records used and to complete questionnaires concerning practice and demographic data. Respondents represented 38 percent of an original group of 2,746 who were asked to participate. The records were evaluated to determine the inclusion of 53 specific items relevant to the pregnant patient; background data, especially socioeconomic; medical and obstetrical history; initial pregnancy surveillance; patient education; complications; risk factors; laboratory tests; other diagnostic procedures; and therapeutic procedures. Ten factors, present in between 11 percent and 89 percent of the records, were selected for more extensive analysis. Results showed that almost half the respondents used prenatal records that were not commercial forms. In more than 90 percent of the cases, traditional medical-obstetric items were included in the records, such as the date of the last menstrual period or a history of previous pregnancies. However, a much smaller proportion (fewer than 10 percent, for some items) contained information about factors recognized as significant in recent years. These included psychological stress, smoking habits, or risk factors. These items were usually included on commercial forms. Physicians who included them tended to practice in hospital- or government-based settings, and to have been in practice for 15 or fewer years. The results show that the detailed prenatal records needed for a variety of purposes other than are not commonly used by physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Methods, Surveys, Pregnant women, Medical records, Records and correspondence, Prenatal care

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Should physicians infected with human immunodeficiency virus be allowed to perform surgery?

Article Abstract:

Restricting the practice of HIV-infected physicians is controversial especially for those in different surgical specialities. The main conflict is between preserving the rights of the infected individual and preventing the transmission of HIV to patients. It has been estimated that more than 300 physicians in different surgical specialities may be infected with HIV. The Centers for Disease Control and Prevention (CDC) has recommended that the practice of HIV-positive physicians be restricted. It proposed that different invasive procedures with a high risk of HIV transmission be identified. HIV-infected physicians would not be allowed to perform these types of 'exposure prone' procedures. Many medical organizations protested the CDC's recommendations, which the agency subsequently dropped. A more reasonable guideline might be to prohibit surgeons from performing procedures involving an open wound.

Surgery, HIV infection, HIV infections, Disease transmission

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Differences in practice patterns between obstetricians and family physicians: use of serum screening

Article Abstract:

Family physicians may be less likely to offer maternal blood screening for birth defects than obstetricians. Researchers surveyed 132 obstetricians and 321 family physicians practicing obstetrics in Iowa to analyze practice differences and attitudes toward maternal blood screening. Family physicians had a lower rate of offering the state blood screening program to all pregnant patients than did obstetricians. Family physicians were less likely to offer blood screening to women who said they would not terminate a pregnancy if birth defects were found prenatally, and were more likely to offer testing to women they thought might benefit from it. Specialists may be more likely to adopt practice guidelines from their specialty organizations and to do so more quickly than generalists.

Prenatal diagnosis, Obstetricians

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