The Experts below are selected from a list of 4818 Experts worldwide ranked by ideXlab platform
Deborah Maine - One of the best experts on this subject based on the ideXlab platform.
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Too far to walk: Maternal mortality in context
Social Science and Medicine, 1994Co-Authors: S. Thaddeus, Deborah MaineAbstract:The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of Obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors-distance, cost and quality-alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an Obstetric Emergency may find the closet facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources. © 1994.
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Too To Walk : Maternal Mortality in
Social Science and Medicine, 1994Co-Authors: S. Thaddeus, Deborah MaineAbstract:The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University’s Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of Obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality-alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an Obstetric Emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.
Robert B. Gherman - One of the best experts on this subject based on the ideXlab platform.
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shoulder dystocia management and documentation
Seminars in Perinatology, 2014Co-Authors: Michael L Stitely, Robert B. GhermanAbstract:Shoulder dystocia is an Obstetric Emergency that occurs when the fetal shoulders become impacted at the pelvic inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs. This article reviews the evidence regarding the performance, timing, and sequence of these maneuvers; reviews the mechanism of fetal injury in relation to shoulder dystocia; and discusses issues concerning documentation of the care provided during this Obstetric Emergency.
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shoulder dystocia the unpreventable Obstetric Emergency with empiric management guidelines
American Journal of Obstetrics and Gynecology, 2006Co-Authors: Robert B. Gherman, Joseph G. Ouzounian, Henry M Lerner, Suneet P. Chauhan, Bernard Gonik, Murphy T GoodwinAbstract:Objective Much of our understanding and knowledge of shoulder dystocia has been blurred by inconsistent and scientific studies that are of limited scientific quality. In an evidence-based format, we sought to answer the following questions: (1) Is shoulder dystocia predictable? (2) Can shoulder dsytocia be prevented? (3) When shoulder dystocia does occur, what maneuvers should be performed? and (4) What are the sequelae of shoulder dystocia? Study design Electronic databases, including PUBMED and the Cochrane Database, were searched using the key word "shoulder dystocia." We also performed a manual review of articles included in the bibliographies of these selected articles to further define articles for review. Only those articles published in the English language were eligible for inclusion. Results There is a significantly increased risk of shoulder dystocia as birth weight linearly increases. From a prospective point of view, however, prepregnancy and antepartum risk factors have exceedingly poor predictive value for the prediction of shoulder dystocia. Late pregnancy ultrasound likewise displays low sensitivity, decreasing accuracy with increasing birth weight, and an overall tendency to overestimate the birth weight. Induction of labor for suspected fetal macrosomia has not been shown to alter the incidence of shoulder dystocia among nondiabetic patients. The concept of prophylactic cesarean delivery as a means to prevent shoulder dystocia and therefore avoid brachial plexus injury has not been supported by either clinical or theoretic data. Although many maneuvers have been described for the successful alleviation of shoulder dystocia, there have been no randomized controlled trials or laboratory experiments that have directly compared these techniques. Despite the introduction of ancillary Obstetric maneuvers, such as McRoberts maneuver and a generalized trend towards the avoidance of fundal pressure, it has been shown that the rate of shoulder-dystocia associated brachial plexus palsy has not decreased. The simple occurrence of a shoulder dystocia event before any iatrogenic intervention may be associated with brachial plexus injury. Conclusion For many years, long-standing opinions based solely on empiric reasoning have dictated our understanding of the detailed aspects of shoulder dystocia prevention and management. Despite its infrequent occurrence, all healthcare providers attending pregnancies must be prepared to handle vaginal deliveries complicated by shoulder dystocia.
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Shoulder Dystocia: Prevention and Management
Obstetrics and Gynecology Clinics of North America, 2005Co-Authors: Robert B. GhermanAbstract:: Knowledge of the maneuvers used for the alleviation of shoulder dystocia is relevant not only for Obstetric residents and attending house staff but also for family practitioners, nurses, and nurse midwives. The performance of shoulder dystocia "drills" can be helpful not only to coordinate a teamwork approach to this Obstetric Emergency but also to provide an opportunity to practice the maneuvers. Shoulder dystocia continues to represent an immense area of clinical interest because it typically occurs without prediction. All patients in labor should be considered at risk for the development of shoulder dystocia.
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Shoulder dystocia.
Current opinion in obstetrics & gynecology, 1998Co-Authors: Robert B. Gherman, T M GoodwinAbstract:Shoulder dystocia continues to represent a largely unpredictable and potentially disastrous Obstetric Emergency. Recent attention has been focused on the effectiveness of Obstetric maneuvers employed to alleviate shoulder dystocia. Reports have also questioned the traditional thinking that brachial plexus injury is caused by application of excessive lateral traction to the fetal head. Rather, in-utero forces may underlie a significant portion of these injuries.
S. Thaddeus - One of the best experts on this subject based on the ideXlab platform.
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Too far to walk: Maternal mortality in context
Social Science and Medicine, 1994Co-Authors: S. Thaddeus, Deborah MaineAbstract:The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of Obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors-distance, cost and quality-alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an Obstetric Emergency may find the closet facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources. © 1994.
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Too To Walk : Maternal Mortality in
Social Science and Medicine, 1994Co-Authors: S. Thaddeus, Deborah MaineAbstract:The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University’s Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity. While there are numerous factors that contribute to maternal mortality, we focus on those that affect the interval between the onset of Obstetric complication and its outcome. If prompt, adequate treatment is provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. We examine research on the factors that: (1) delay the decision to seek care; (2) delay arrival at a health facility; and (3) delay the provision of adequate care. The literature clearly indicates that while distance and cost are major obstacles in the decision to seek care, the relationships are not simple. There is evidence that people often consider the quality of care more important than cost. These three factors--distance, cost and quality-alone do not give a full understanding of decision-making process. Their salience as obstacles is ultimately defined by illness-related factors, such as severity. Differential use of health services is also shaped by such variables as gender and socioeconomic status. Patients who make a timely decision to seek care can still experience delay, because the accessibility of health services is an acute problem in the developing world. In rural areas, a woman with an Obstetric Emergency may find the closest facility equipped only for basic treatments and education, and she may have no way to reach a regional center where resources exist. Finally, arriving at the facility may not lead to the immediate commencement of treatment. Shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, become documentable contributors to maternal deaths. Findings from the literature review are discussed in light of their implications for programs. Options for health programs are offered and examples of efforts to reduce maternal deaths are presented, with an emphasis on strategies to mobilize and adapt existing resources.
Stergios K Doumouchtsis - One of the best experts on this subject based on the ideXlab platform.
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shoulder dystocia and associated manoeuvres as risk factors for perineal trauma
International Urogynecology Journal, 2016Co-Authors: Nivedita Gauthaman, Samuel Walters, Inae Tribe, Louise Goldsmith, Stergios K DoumouchtsisAbstract:Shoulder dystocia (SD) is an Obstetric Emergency that can be associated with serious neonatal morbidity and mortality. The aim of this study was to identify the incidence and risk factors for Obstetric anal sphincter injuries (OASIS) in women who sustained SD at birth. This was a retrospective observational study over a 5-year period whereby 403 cases of SD were identified. The primary outcome measure was to identify the incidence of OASIS in women with SD. We also evaluated the role of the manoeuvres used for the management of SD and aimed to identify possible correlations between specific manoeuvres and OASIS by univariate and multivariate regression analysis. Shoulder dystocia was associated with a three-fold increase in the risk of OASIS in our population. The use of internal manoeuvres (OR 2.182: 95 % CI 1.173–4.059), an increased number of manoeuvres ≥4 (OR 4.667: 95 % CI 1.846–11.795), Woods’ screw manoeuvre (OR 3.096: 95 % CI 1.554–6.169), reverse Woods’ screw manoeuvre (OR 4.848: 95 % CI 1.647–14.277) and removal of the posterior arm (OR 2.222: 95 % CI 1.117–4.421) were all associated with a significant increase in the likelihood of OASIS. In our study, instrumental deliveries, the use of internal manoeuvres (Woods’ screw and reverse Woods’ screw) and four or more manoeuvres for the management of SD were independently associated with a higher incidence of OASIS. To effectively manage shoulder dystocia with lower risks of perineal trauma, these factors could be considered when designing further prospective studies and developing management protocols.
Barbara G Kanki - One of the best experts on this subject based on the ideXlab platform.
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mobile in situ Obstetric Emergency simulation and teamwork training to improve maternal fetal safety in hospitals
The Joint Commission Journal on Quality and Patient Safety, 2010Co-Authors: Jeannemarie Guise, Shad Deering, Nancy K Lowe, Patricia O Lewis, Christen Ohaire, Lori K Irwin, Molly Blaser, Laurie S Wood, Barbara G KankiAbstract:Article-at-a-Glance Background Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. Mobile Obstetric Simulation and Team Training Program A mobile Obstetric Emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of Obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. How Do Organizations Determine Which Type of Simulation Is Best for Them? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. Conclusions In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.
