scholarly journals Obstetric medical care and training in the United Kingdom

2016 ◽  
Vol 10 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Adam D Jakes ◽  
Ingrid Watt-Coote ◽  
Matthew Coleman ◽  
Catherine Nelson-Piercy
Keyword(s):  
Core Curriculum ◽  
Contributory Factor ◽  
Medical Conditions ◽  
Medical Problems ◽  
Maternal Deaths ◽  
Obstetric Medicine ◽  
Physician Role ◽  
The Uk ◽  
Maternal Medicine ◽  
In Pregnancy

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal–fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician–obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

scholarly journals Provision of acute medicine services for pregnant women in UK hospitals: Data from the Society for Acute Medicine Benchmarking Audit 2019

2020 ◽  
pp. 1753495X2092950
Author(s):  
Catherine Atkin ◽  
Paarul Prinja ◽  
Anita Banerjee ◽  
Mark Holland ◽  
Dan Lasserson
Keyword(s):  
Pregnant Women ◽  
Medical Problems ◽  
Acute Medicine ◽  
Hospital Size ◽  
Obstetric Medicine ◽  
Provision Of Services ◽  
Timely Access ◽  
The Uk ◽  
Local Guideline ◽  
In Pregnancy

Background Medical problems during pregnancy are the leading cause of maternal mortality in the UK. Pregnant women often present through acute services to the medical team, requiring timely access to appropriate services, physicians trained to manage medical problems in pregnancy, with locally agreed guidance available. Methods Data were collected through the Society for Acute Medicine Benchmarking Audit, a national audit of service delivery and patient care in acute medicine over a 24 hour period. Results One hundred and thirty hospitals participated: 5.5% had an acute medicine consultant trained in obstetric medicine, and 38% of hospitals had a named lead for maternal medicine. This was not related to hospital size (p = 0.313). Sixty-four units had local guidelines for medical problems in pregnancy; 43% had a local guideline for venous thromboembolism in pregnancy. Centres with a named lead had more guidelines (p = 0.019). Conclusion Current provision of services within acute medicine for pregnant women does not meet national recommendations.

Psychiatric causes of maternal deaths: Lessons from the Confidential Enquiries into Maternal Deaths

2014 ◽  
Author(s):  
Margaret R. Oates
Keyword(s):  
Maternal Death ◽  
Cardiac Disease ◽  
Maternity Care ◽  
Marked Reduction ◽  
Blood Transfusions ◽  
Maternal Deaths ◽  
Illegal Abortion ◽  
The Uk ◽  
The 19Th Century ◽  
In Pregnancy

The UK Confidential Enquiries into Maternal Deaths, published triennially, are over 50 years old. Its forebears are even older; enquiries into maternal deaths began early in the 19th century in Scotland. In the 20th century the numbers of women dying from childbirth has steadily declined, influenced by many factors, including improved public health and maternity care, smaller family size, blood transfusions, and antibiotics, to name but a few. The introduction of the Abortion Act in 1967 was followed by a marked reduction of deaths in pregnancy from the consequences of illegal abortion. The rate and causes of maternal death have always been influenced by changes in reproductive epidemiology and technology, and continue to be so. Maternal deaths in pregnancy and in the 6 weeks following delivery are required to be reported to the Coroner, if directly related to childbirth. However, there are other causes of maternal death due to conditions exacerbated by pregnancy: for example, diabetes, cardiac disease, epilepsy. These are referred to as indirect deaths. Women who die from conditions unrelated to pregnancy or childbirth are counted and described as coincidental deaths. Over the years as the direct causes of maternal death have fallen, the indirect causes of maternal death have achieved more prominence and case ascertainment has improved. Improvements in medical care and in particular intensive care have resulted in some women developing their fatal condition within 6 weeks of childbirth, only to die beyond it. For this reason, the UK Enquiry extended their period of surveillance beyond 6 weeks to include late maternal deaths, both a small number of late direct deaths and a larger number of late indirect deaths. Suicide in pregnancy and following delivery has always been included in the Enquiries. However, prior to 1994 the cases were not separately analysed and were included in the group of late Coincidental Deaths (i.e. not thought to be related to pregnancy or childbirth). The 1994–1996 Enquiry, under the Directorship and Editorship of Dr Gwyneth Lewis and Professor James O’Drife, heralded a change in presentation of the Enquiry.

Obstetric Medicine

2020 ◽  
Author(s):  
Charlotte J. Frise ◽  
Sally Collins
Keyword(s):  
Pregnant Women ◽  
Management Strategies ◽  
Chronic Illnesses ◽  
Evidence Based ◽  
Advanced Training ◽  
Medical Problems ◽  
Comprehensive Overview ◽  
Medical Specialties ◽  
Obstetric Medicine ◽  
Maternal Medicine

Pregnant women regularly present with medical problems to many different medical specialties, and as their physiology is changed by the pregnancy, so too is the way in which many chronic illnesses behave. This new specialist handbook, Obstetric Medicine, provides a comprehensive overview of medical conditions in the pregnant woman, and covers the syllabus for both the RCOG Advanced Training Skills Module (ATSM) and sub-specialty training in maternal medicine. This is an essential new addition to the literature for all physicians who work with pregnant women in their practice. It contains links to national and international guidelines, and provides evidence-based management strategies for both chronic and acute illnesses.

scholarly journals Maternal mortality in the developed world: lessons from the UK confidential enquiry

2008 ◽  
Vol 1 (1) ◽  
pp. 7-10
Author(s):  
Michael de Swiet
Keyword(s):  
Maternal Mortality ◽  
De Novo ◽  
Post Partum ◽  
Further Education ◽  
Medical Problems ◽  
The Uk ◽  
Developed World ◽  
Current Report ◽  
Ruptured Uterus ◽  
In Pregnancy

The UK confidential maternal mortality enquiry shows that not only has maternal mortality decreased since 1952, the year of the first enquiry, but also the pattern of maternal mortality has changed markedly. Major surgical causes of death, such as post-partum haemorrhage and ruptured uterus, are no longer as important as medical causes such as heart disease. The ‘Top Ten’ recommendations in the current report for the years 2003–2005 emphasise the need for health care practitioners to be aware of the risks that medical conditions, both pre-existing and those arising de novo in pregnancy, impose on the expectant and newly delivered mother. Training and further education programmes should emphasise the importance of medical problems in pregnancy without omitting the knowledge and skills in basic obstetrics that have made such an impact on maternal mortality in the past.

scholarly journals Obstetric medicine

2013 ◽  
pp. 15-22
Author(s):  
L. Balbi ◽  
V. Donvito ◽  
A. Maina
Keyword(s):  
High Risk ◽  
Severe Disease ◽  
Maternal Deaths ◽  
Perioperative Morbidity ◽  
Excellent Outcome ◽  
Risk Pregnancy ◽  
Obstetric Medicine ◽  
Elective Termination ◽  
In Pregnancy

BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004). DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

scholarly journals Medical complications in pregnancy at Mulago Hospital, Uganda’s national referral hospital

2018 ◽  
Vol 12 (4) ◽  
pp. 168-174 ◽  
Author(s):  
JM Milln ◽  
A Nakimuli
Keyword(s):  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Medical Complications ◽  
High Dependency Unit ◽  
Medical Conditions ◽  
High Dependency ◽  
Obstetric Medicine ◽  
Sub Saharan ◽  
National Referral Hospital ◽  
In Pregnancy

Introduction Medical complications in pregnancy contribute significantly to maternal morbidity in sub-Saharan Africa. Anecdotally, obstetricians in Uganda do not feel equipped to treat complex medical cases, and receive little support from physicians. Methods The aim of the study was to quantify the burden of complex medical conditions on the obstetric high dependency unit at Mulago National Referral Hospital, and potential deficiencies in the referral of cases and training in obstetric medicine. A prospective audit was taken on the obstetric high dependency unit from April to May 2014. In addition, 50 trainees in obstetrics and gynaecology filled a nine-point questionnaire regarding their experiences. Results Complex medical disorders of pregnancy accounted for 22/106 (21%) admissions to the high dependency unit, and these cases were responsible for 51% of total bed occupancy, and had a case fatality rate of 6/22 (27.2%). Only 6/14 (43%) of referrals to medical specialties were fulfilled within 48 h. Of the six women who died due to medical conditions, three specialty referrals were made, none of which were fulfilled. Trainees reported deficiencies in obstetric medicine training and in referral of complex conditions. They were least confident addressing non-communicable conditions in pregnancy. Discussion Deficiencies exist in the care of women with complex medical conditions in pregnancy in Uganda. Frameworks of obstetric medicine training and referral of complex cases should be explored and adapted to the sub-Saharan African setting.

Serum Zinc Level in Pre-eclamptic Pregnancies: Association with Clinical Complication

1970 ◽  
Vol 39 (1) ◽  
pp. 7-10
Author(s):  
Touhida Ahsan ◽  
Razia Sultana Begum ◽  
Sheikh Naznul Islam
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Zinc Concentration ◽  
Serum Zinc ◽  
Zinc Level ◽  
Contributory Factor ◽  
Serum Zinc Concentration ◽  
Correlative Analysis ◽  
Blood Pressures ◽  
In Pregnancy

Pre-eclampsia is one of the fatal complications in pregnancy. Zinc plays an important role in the course and eventual outcome of human pregnancy, and is essential for normal embryogenesis and fetal growth. Zinc deficiency in pregnancy is thought to be associated with pre-eclampsia. The aim of this study was, therefore, to investigate the scum zinc level in pre-eclampsia and to examine its association (if any) with pre-eclampsia. A case control study was done among 45 pre-eclamptic and 35 normotensive pregnants at their third trimester. Serum zinc concentration was determined by Atomic Absorption Flame Spectrophotometric method. Correlative analysis was made to find any correlation, of serum zinc with blood Pressure. Results showed identical Maternal and gestational age, and different gravida distribution for the patients and controls, and significantly (P<0.005) higher blood pressures (systolic and diastolic) for pre-eclampsia. Serum zinc concentration were estimated 0.65±0.09mg/L in pre-eclamsia and 0.60±0.08mg/L in pregnant controls, difference of which was insignificant (p=0.284). Correlative analysis wowed that there was a linear correlation between serum level and diastolic blood pressure, but it was found to be insignificant (r=0.158, p=0.330). It was suggested that changes in zinc status may not be an etiological or contributory factor in pre-eclamsia. Key words: Serum zinc; pre-eclampsia; diastolic blood pressure DOI: 10.3329/bmj.v39i1.6226 Bangladesh Medical Journal 2010; 39(1): 7-10

scholarly journals Iodine and pregnancy – a UK cross-sectional survey of dietary intake, knowledge and awareness

2015 ◽  
Vol 114 (1) ◽  
pp. 108-117 ◽  
Author(s):  
E. Combet ◽  
M. Bouga ◽  
B. Pan ◽  
M. E. J. Lean ◽  
C. O. Christopher
Keyword(s):  
Iodine Intake ◽  
Dietary Recommendations ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Nutritional Recommendations ◽  
Level Of Confidence ◽  
Healthy Growth ◽  
The Uk ◽  
The Right ◽  
In Pregnancy

Iodine is a key component of the thyroid hormones, which are critical for healthy growth, development and metabolism. The UK population is now classified as mildly iodine-insufficient. Adequate levels of iodine during pregnancy are essential for fetal neurodevelopment, and mild iodine deficiency is linked to developmental impairments. In the absence of prophylaxis in the UK, awareness of nutritional recommendations during pregnancy would empower mothers to make the right dietary choices leading to adequate iodine intake. The present study aimed to: estimate mothers' dietary iodine intake in pregnancy (using a FFQ); assess awareness of the importance of iodine in pregnancy with an understanding of existing pregnancy dietary and lifestyle recommendations with relevance for iodine; examine the level of confidence in meeting adequate iodine intake. A cross-sectional survey was conducted and questionnaires were distributed between August 2011 and February 2012 on local (Glasgow) and national levels (online electronic questionnaire); 1026 women, UK-resident and pregnant or mother to a child aged up to 36 months participated in the study. While self-reported awareness about general nutritional recommendations during pregnancy was high (96 %), awareness of iodine-specific recommendations was very low (12 %), as well as the level of confidence of how to achieve adequate iodine intake (28 %). Median pregnancy iodine intake, without supplements, calculated from the FFQ, was 190 μg/d (interquartile range 144–256μg/d), which was lower than that of the WHO's recommended intake for pregnant women (250 μg/d). Current dietary recommendations in pregnancy, and their dissemination, are found not to equip women to meet the requirements for iodine intake.

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