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  1. Home
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  3. Operative Obstetrics
Publisher:
Cambridge University Press
Online publication date:
May 2010
Print publication year:
2008
Online ISBN:
9780511580987
DOI:
https://doi.org/10.1017/CBO9780511580987
Subjects:
Obstetrics and Gynecology, Reproductive Medicine, Medicine
Information

Book description

The ten years since the first edition of Operative Obstetrics have witnessed considerable changes in obstetric practice. There has been a continued increase in the rate of cesarean delivery, and the use of minimally-invasive surgery has rapidly gained popularity. Social changes affecting practice have also been significant, prompting a re-evaluation of the appropriateness of certain types of operations during pregnancy. This fully-updated edition includes chapters on cesarean delivery, birth injury, ectopic pregnancy, and common surgical complications. It features a new discussion of surgical procedures performed by non-physicians and an updated treatment of fetal surgery. The text also considers complicated and controversial subjects such as cervical insufficiency, pregnancy termination, instrumental delivery, and shoulder dystocia. Each of the four sections includes an in-depth analysis of the important ethical and legal issues underlying practice for the area in question. An expanded appendix reviews legal concepts pertinent to practitioners in the field of obstetrics.

Reviews

'… readable, factual and useful …'

Source: The Obstetrician and Gynaecologist

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Contents

Page 2 of 2

Contents
  • Part IV - SPECIAL ISSUES
  • View abstract

    Summary

    This chapter focuses primarily on surveillance during the intrapartum period using electronic fetal heart rate (FHR) monitoring and ancillary techniques of fetal evaluation, including capillary blood sampling, pulse oximetry, and automated electrocardiographic (ECG) analysis of ST waveform changes in refining the evaluation of moderately abnormal FHR pattern. It is critical to the understanding of FHR patterns that in the presence of uterine contractions, any fetal hypoxia is reflected by the appearance of decelerations before a rise in the baseline rate or decrease in variability. In the evaluation of decelerations, recovery from a deceleration sequence means a return to the previously normal baseline rate and variability. There is universal agreement that the frequency of decelerations increases dramatically in the second stage of labor, probably because of the effects of frequent uterine contractions and maternal expulsive forces on the fetal head and the cord.
  • Chapter 23 - Birth Injuries
    pp 725-786
  • View abstract

    Summary

    This chapter presents an overview of both maternal and infant birth injuries, considering their etiology, potential methods of avoidance, and critiques of current obstetric practices. The more significant maternal complications of parturition include birth canal lacerations, episiotomy extensions, other perineal or rectal injuries, and various degrees of intrapartum and postpartum hemorrhage. Certain clinical settings predispose to birth injury, including labor stimulation, dystocia/macrosomia, preterm delivery, the diagnosis of acute fetal jeopardy from any cause, and instrumental or cesarean delivery. Superficial maternal birth canal injuries such as soft-tissue abrasions, ecchymoses, or small lacerations are common enough to be considered normal. Vaginal and cervical lacerations, urinary tract dysfunction, uterine infection, uterine rupture are other specific maternal birth injuries discussed in the chapter. The most common direct fetal injury after maternal blunt trauma is a cranial fracture.
  • Chapter 24 - Midwives and Operative Obstetrics
    pp 787-796
    • By Lisa Summers, Director, Professional Services American College of Nurse Midwifery Silver Spring, Maryland
  • View abstract

    Summary

    This chapter focuses on the practice of midwives with regard to operative obstetrics. The mission of American College of Nurse-Midwives (ACNM), the oldest women's health care organization in the United States, is to promote the health and well-being of women and infants within their families and communities through the development and support of the profession of midwifery as practiced by certified nurse-midwives and certified midwives. The standards direct the midwife to consider relevant statutes and regulations that might constrain the midwife from incorporation of a particular procedure. First assisting is one of the most common expanded practice skills of interest to midwives. Midwives are cautioned to ensure that privileging bodies and insurers understand when a midwife is providing vacuum-assisted birth services. The use of hospitalist physicians is a trend that might influence the profession of midwifery and midwifery practice in the future.
  • Chapter 25 - Education and Certification
    pp 797-809
    • By Andrew J. Satin, Chair, Department of Obstetrics and Gynecology Johns Hopkins Bayview Medical Center, Shad H. Deering, Medical Director, Andersen Simulation Center Staff Physician Maternal-Fetal Medicine Madigan Army Medical Center Tacoma, Washington
  • View abstract

    Summary

    The growing interest in simulations for obstetrics has been prompted by contemporary changes in medical education and concerns for patient safety. Obstetrics and gynecology as a field is uniquely suited to the use of simulation training for medical students, residents, and staff physicians. Many common procedures and examinations taught to medical students, such as a spontaneous vaginal delivery or pelvic examination, can be intensely emotional and private issues for the patient. With the implementation of the 80-hour workweek restrictions, program directors and academic physicians have turned to simulation to supplement their residents' educational experience by focusing on important tasks and targeted simulation training. In contrast to medicine, other vocations that involve life-threatening emergencies on a daily basis, such as commercial and military aviators, must complete hands-on tests to maintain their certification. The ultimate goal of all medical simulation training is to improve patient safety and outcomes.
  • Chapter 26 - Ethical Issues
    pp 810-819
    • By Joanna M. Cain, Professor and Chair, Department of Obstetrics and Gynecology
  • View abstract

    Summary

    The moral conflicts that surround abortion, prenatal diagnosis, invasive fetal therapy, and maternal refusal of recommended care all carry an implied concern for the dependent variable in the choices made, the fetus. The social context is important in understanding the maternal-fetal relationship; however, genetic linkages that have traditionally been called on in this context are being challenged by surrogacy and other reproductive technologies. Continued fetal existence depends on an intact maternal circulation. Access to the fetus is possible only by accepting varying levels of maternal risk. Physicians can also be, secondarily, advocates for fetal well-being, but not at the expense of their obligation to the mother. If physicians can maintain this ethical focus, it is likely to encourage use of the medical care system by those wary of implied police activities of healthcare givers.
  • Chapter 27 - Perinatal Loss
    pp 820-830
  • View abstract

    Summary

    Work in recent decades has emphasized the importance of grieving rituals and, in the response to perinatal loss, recent experience favors proactive involvement with affected families, despite the difficulties that this presents for the birth attendants. Recognizing the importance of death and the historical limitations of medical specialists in facing these issues, this chapter explores the literature concerning perinatal losses, grief, and bereavement. Because perinatal loss is often sudden and contrary to the expectations of motherhood, it can have a particularly devastating and traumatic affect on the mother. When there is a miscarriage or a stillborn child, fathers are often overlooked during mourning, even more so than if the death involved an older child. In talking to a grieving family, health practitioners should always be honest, but they must combine this with empathy. Hospital personnel have a special and important role in perinatal grief and mourning.
  • Chapter 28 - Birth Injury: Legal Commentary IV
    pp 831-842
  • View abstract

    Summary

    The patient condition that results in the most malpractice cases against physicians is pregnancy, with the largest number of claims brought on behalf of the birth-injured infant. The fetal heart monitoring strips are analyzed and reanalyzed by the minute, with the hindsight that the baby's condition at birth was compromised. Histologic examination of the placenta and cord can provide valuable insight in explaining abnormal neonatal outcomes. Placental villous abnormalities, identification of infarcts, and the presence of nucleated red blood cells in fetal vessels, among other findings, can assist in establishing the onset of an injury. Simulations have become progressively more important components in educational systems. The legality and regulation of direct-entry midwifery varies from state to state. The use of midwives in attending the labor and delivery of mothers who are at low risk for obstetric complications has been shown to be a cost-effective, safe alternative to delivery by physicians.

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