Prognostic factors and complication rates for cervical cerclage: a review of 482 cases

Article Abstract:

Cervical cerclage involves the use of ligatures (stitches that hold tissues together) around an incompetent cervix to prevent spontaneous abortion. This is an established treatment, but it is unclear whether the benefits outweigh the potential complications in individual cases. The best time for performing cerclage is between 14 and 18 weeks of gestation, as potentially severe complications are more frequent after that time. The type of patient for which the technique is suited and the best surgical technique are disputed. The outcome of 482 cases in which cervical cerclage was performed was reviewed to help clarify these issues. Advanced cervical dilatation at the time of cerclage and a history of previous spontaneous abortion were associated with increased premature deliveries. Premature rupture of membranes (PROM) occurred in 38 percent of the women; this was also related to dilatation at cerclage. The infection rate was significantly higher in cases with greater cervical dilatation and for emergency procedures. In comparing the outcomes of two surgical techniques, the cesarean rate was about twice as high in first-time cases treated with the Shirodkar method compared with the McDonald technique. However, in patients undergoing repeat cerclage, a better outcome, indicated by older gestational age at delivery and higher birth weight, was associated with Shirodkar technique. The study indicates that cerclage outcome is poorer when cervical dilatation has already begun and in emergency situations; the benefits do not outweigh the risks in these cases. Patients with repeat cerclage may do better with the Shirodkar technique. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Surgery, Cervix uteri, Pregnancy, Complications of, Pregnancy complications, Miscarriage, Cervical conization

---

The doctor-nurse game revisited

Article Abstract:

In 1967, an article reviewed the relationship between physicians and nurses and discussed how their complex interactions resulted in improved patient care. It is perhaps time now, in 1990, to review again the relationships between these two integral providers of patient care. In 1967, nurses communicated recommendations to physicians without appearing to be giving advice, and physicians requesting a recommendation did so in such a way that they did not seem to be asking for advice. Skillful tacticians in this game fared well on both sides. Clumsy physicians who could not appreciate subtle advice when it was presented were regarded as clods; nurses who could not couch advice appropriately were regarded as insolent. Today, the nursing profession is continuing its long-standing drive towards autonomy as a health profession, and advice is much more likely to be direct. Nurses believe that their advice has merit, and should be considered. Furthermore, many nurses perceive physicians as narrow technicians who treat illnesses without having an overview of patients or healthcare. Some physicians are resentful of the attitudes they find in some nurses and feel that nurses should merely do what they are told to do. It is clear, however, that the two professions are moving towards a relationship based upon autonomy and mutual interdependence, rather than upon domination and subservience as was the case in the past. (Consumer Summary produced by Reliance Medical Information, Inc.)

Telecommunications systems, Nurses, Nurse and physician, Nurse-physician relationship

---

The physician factor in cesarean birth rates

Article Abstract:

The cesarean section rate in the United States has increased from 5 percent in the 1960s to over 25 percent in 1988. Cesarean section involves delivery of an infant by means of an incision into the uterus through the abdomen. Factors influencing the increase in use of cesarean section include previous cesarean sections and an increase in the use of the procedure to handle such delivery complications as fetal distress and unusual fetal presentation (position). The relationship between practice styles and high cesarean section rates was examined by studying 1533 women treated by 11 physicians in a single community hospital in an affluent suburb of Detroit over a 12-month period in 1986-1987. Although the mean cesarean section rate was 26.9 percent, individual physician rates ranged between 19.1 and 42.3 percent. Practice styles were not influenced by the hospital setting, patient population, degree of risk or recent legal experience. There were no differences in infant outcome for different section rates. It is suggested that physician style was a determining factor in influencing the choice of cesarean section in this small study.

Analysis, Management, Surveys, Cesarean section, Medical protocols, Obstetricians

Similar abstracts:

• Abstracts: Grim wards an acute problem. Critical coverage of ICU discharge deaths
• Abstracts: Dental considerations for the patient with renal disease receiving hemodialysis. The dental patient with asthma: an update and oral health considerations
• Abstracts: Acute bacterial meningitis in adults: a review of 493 episodes. Recognition and management of anthrax -- an update
• Abstracts: Action research in rehabilitation care for older people. Using clinical governance to improve care of older people
• Abstracts: Head and neck cancer. Clonal origin of bladder cancer

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.