The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) announced a new database to assist Women's Service Line Leaders with generating the evidence needed to drive clinical, staffing and financial decisions.

The AWHONN EDGE™, which stands for "Extract Data & Generate Evidence", is currently in the beta testing phase with 20 hospitals nationwide, and is expected to launch in early 2009. The AWHONN EDGE™ technology automatically extracts data directly from a patient's electronic medical record into the database. It will also allow institutions to trend their own data, as well as compare their data to "like" hospitals and to all participating hospitals. The database is online, allowing leaders to access reports at any time.

"AWHONN is committed to providing professional resources and support, empowering nurses to provide superior evidence-based care to newborns and women. The AWHONN EDGE™ database is a unique tool that allows us to further our mission," said AWHONN Interim Executive Director Karen Peddicord, RNC, PhD.

Mary Lou Jones, RN, PhD, CNAA (BC), Women and Children's Service Director, Kaiser Permanente, Sacramento Medical Center, adds, "AWHONN recognized a need for institutions to have clinical data to drive staffing, financial and quality decisions specific to women and infant's health. The AWHONN EDGE™ database fills the need of nurse executives to make better, evidence-based decisions in patient care. In addition, the database will provide a benchmark and national standards to guide nursing practice in perinatal care for the future." Strategic Thinking Industries (STI) is the AWHONN technology partner for AWHONN EDGE™ database. STI was chosen as a partner because of its specialization and expertise in providing women's and children's health care professionals with industry leading information technologies.

About AWHONN

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) is the foremost nursing authority that advances the health care of women and newborns through advocacy, research and the creation of high quality, evidence-based standards of care.

AWHONN's 22,000 members worldwide are clinicians, educators and executives who serve as patient care advocates focusing on the needs of women and infants.

A leader in professional development, AWHONN is the first and only association to be awarded the designation Premier Provider by the American Nurses Credentialing Center for innovation and excellence in Continuing Nursing Education.

AWHONN was founded in 1969 as the Nurses Association of the American College of Obstetrics and Gynecology. The association became a separate nonprofit organization called the Association of Women's Health and Neonatal Nurses in 1993.

Association of Women's Health, Obstetric and Neonatal Nurses

More babies are born by C-section (Cesarean section) today than ever before, says the Society of Obstetricians and Gynaecologists of Canada. The Society adds that the numbers continue to rise (1).

Apart from placing mothers at raised risks during childbirth and subsequent pregnancies, these figures are placing an excessive burden on the nation's healthcare system, the Society claims.

Canadian doctors and pregnant mothers should opt for C-sections only when medically necessary, the Society urges.

Dr. Guylaine Lefebvre, President of the Society of Obstetricians and Gynaecologists of Canada, said "While the individual risk for a woman having a C-section is very small, the rising rate is certainly a concern. We fear that there may be an emerging trend towards more scheduled childbirth and routine intervention. We need to be sure that C-sections are not driven by convenience, that interventions are medically indicated, and that the safety of a woman and her baby are the driving factors in these decisions."

There are several reasons for the rise in the number of C-sections, most notably the recent increase in obesity rates, as well as the trend for women to delay pregnancy until later in life. The society says there are other less clearly understood factors, such as the current shortage of maternity care providers, as well as the role of changing the patient and physician attitudes about intervention during childbirth.

In 1993 17.6% of all Canadian births were by C-section, in 2006 the figure stood at 26.3%, and continues to go up. This is a concerning trend for the future, says the Society, especially in one of the safest places in the world to give birth.

For a low-risk childbirth that is progressing normally, a mother who undergoes C-section needs much longer to recover, compared to a natural birth. She is also at significantly greater risk of infection, bleeding, scarring, chronic pelvic pain, and damage to the intestines and bladder.

A mother who has a C-section is much more likely to require C-sections in subsequent pregnancies - she also faces greater risks during her subsequent pregnancies.

According to a study carried out by the Canadian Perinatal Surveillance System in 2007, elective C-sections carry a higher risk of anesthetic complications, major infections, obstetrical wound, and cardiac arrest. The researchers also found that elective C-section increased a woman's risk of having to have a hysterectomy due to bleeding (2).

Dr. André Lalonde, the Society's Executive Vice-President, said "These additional C-sections place excess burden on a maternity care system that is already facing a shortage of obstetricians and other health professionals."

The Society of Obstetricians and Gynaecologists of Canada is actively working to provide continuing education for Canadian healthcare professionals on best practices relating to Cesarean section. In addition, the group is seeking collaboration and support from its government and health partners to further explore the root causes of these rising rates, to identify potential solutions, and to properly assess the implications for the safety of childbirth in this country. www.sogc.org

The medical malpractice climate in Florida is discouraging medical students from pursuing careers in obstetrics and gynecology - a trend that could further reduce patients' access to obstetric care, a survey by the University of South Florida College of Medicine found.

The survey results were announced earlier this month at the Florida Obstetric and Gynecological Society (FOGS) annual meeting in West Palm Beach. Aaron Deutsch, MD, lead author of the study and chief resident in the USF Department of Obstetrics and Gynecology, presented the findings. The paper received the 2006 first-place resident research award from FOGS.

"Florida is already a state without enough obstetrician/gynecologists to meet the needs of patients. In some parts of the state, women must wait several months to see an obstetrician, and there are no perinatologists or maternal-fetal medicine specialists to take care of high-risk pregnancies," Dr. Deutsch said. "Our findings suggest this shortage may get even worse."

The USF researchers sent surveys to all fourth-year medical students in Florida in fall 2005. The senior year is when medical students find out where they will conduct their residencies - the period of specialized training for licensed medical graduates in their chosen medical field.

Florida mirrors a national trend of fewer medical students applying for ob/gyn residencies. The USF researchers hypothesized that student concerns about the rising cost of malpractice premiums and medical liability in Florida may contribute to the marked decline of students specializing in ob/gyn.

Half of the Florida students surveyed - 42 percent men and 58 percent women - responded. The respondents were divided into three groups - students who selected ob/gyn as a career (had applied to ob/gyn residencies) those who considered ob/gyn as a career but ultimately decided against it and those who never considered ob/gyn. Of the students selecting a career in ob/gyn, 86 percent reported they are considering leaving Florida to practice because of the medical liability concerns.

Overall, interest in another specialty and lifestyle concerns - work hours and unpredictable schedule - were major reasons students cited for not choosing ob/gyn careers, whether they initially considered the specialty or not. However, the survey demonstrated a significant split in concerns about Florida's medical-legal climate between these two groups.

Of the students who considered ob/gyn but decided against it, 32 percent ranked "fear of malpractice" as the first or second deterrent to entering the field, compared to 21 percent who never considered ob/gyn. Nearly 27 percent of students who considered ob/gyn ranked "fear of being sued" as a first or second deterrent compared to 7 percent who never considered the specialty.

"It appears that some students may have chosen ob/gyn except for the fear of high malpractice insurance costs and lawsuits are associated with our field of medicine," Dr. Deutsch said.

In 2005, Florida ranked first in the top10 states with the most expensive average base rate medical malpractice premiums for obstetrician-gynecologists, according to the Medical Liability Monitor.

The USF authors acknowledge that students who felt strongly about Florida's malpractice climate may have been more inclined to respond to the survey, and cite the need for more national research to clarify future practitioners' concerns.

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Article adapted by Medical News Today from original press release.
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Joan McCarthy, MD, USF assistant residency director of ob/gyn, and Kelly Murray, MD, were co-authors of the research paper titled "Why are Fewer Medical Students in Florida Choosing Obstetrics and Gynecology?"

Contact: Anne DeLotto Baier
University of South Florida Health

The National Health and Medical Research Council of Australia released new alcohol guidelines for pregnant women, stating that 'no drinking is the safest option'.

Alcohol consumption during pregnancy has been associated with increased risks of miscarriage, stillbirth, intrauterine growth restriction, pre-term birth and low birth-weight.

However, the best known adverse effect of alcohol exposure on the fetus is the fetal alcohol syndrome (FAS) which is associates with a range of birth defects and ongoing educational, behavioral and psychological problems.

With over half the Australian women still consuming alcohol during pregnancy, obstetricians and other health professionals have the responsibility to provide accurate information about the harmful effects of alcohol.

"Alcohol and Pregnancy: The pivotal role in the obstetrician"
Elizabeth J. Elliott And Carol Bower
The Australian and New Zealand Journal of Obstetrics and Gynaecology 48 (3) 236-239 doi:10.1111/j.1479-828X.2008.00876.x
Click here to view abstract online

The Australian and New Zealand Journal of Obstetrics and Gynaecology(ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work.

The Australian and New Zealand Journal of Obstetrics and Gynaecology


The Australian and New Zealand Journal of Obstetrics and Gynaecology

Maternal obesity is associated with the increase in maternal and fetal complications in pregnancy.

Obesity among women of reproductive age in western societies has been increasing at an alarming rate. Excessive weight gain during pregnancy also seems to be an independent risk factor, regardless of the mother's weight before pregnancy.

The dramatic increase in the incidence of overweight and obese women of a reproductive age results in new challenges for health care professionals.

The study suggests that appropriate lifestyle and diet interventions can enable obese women to achieve strict limits in their weight gain during pregnancy.

"Maternal Obesity and Pregnancy Complications: A Review"
Jonathan Ramachenderan, Jennifer Bradford, Mark Mclean
The Australian and New Zealand Journal of Obstetrics and Gynaecology 48 (3) 228-235 doi:10.1111/j.1479-828X.2008.00860.x
Click here to view abstract online

The Australian and New Zealand Journal of Obstetrics and Gynaecology(ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work.

The Australian and New Zealand Journal of Obstetrics and Gynaecology


The Australian and New Zealand Journal of Obstetrics and Gynaecology

Researchers have successfully identified several genes associated with Premature Ovarian Failure (POF) or premature menopause, enabling carriers to make informed choices with regards to family planning.

The study by Dr Kathryn Woad, Wendy Watkins, Deborah Prendergast and Associate Professor Andrew Shelling - all from the Department of Obstetrics and Gynaecology in the Faculty of Medical and Health Sciences from University of Auckland - is published by Blackwell Publishing in the June issue of the Australian and New Zealand Journal of Obstetrics and Gynaecology, for the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Affecting approximately 1:100 women under the age of 40, POF often coincides with infertility and menopausal symptoms.

Only a few causes have been identified, and researchers have demonstrated a genetic component.

Approximately 20-30% of women with POF will have other affected female family members, suggesting that an inherited predisposition to the condition is common.

Two significant consequences of POF are the loss of fertility, and clinical effects of hypoestrogenism.

Women with POF are found to express anger, depression, anxiety, loss and sadness at their diagnosis - the condition may have a deleterious psychological impact, and its emotional importance is often underestimated.

Andrew Shelling added, "A better understanding of the causes of premature ovarian failure will provide the potential for early diagnosis, and also will allow us to consider new ways to treat the condition once it arises."

"Premature ovarian failure will remain a significant cause of infertility if women continue to leave child-bearing to later in life."

This study is published in the June 2006 issue of The Australia and New Zealand Journal of Obstetrics and Gynaecology (Vol. 46, No. 3).

About The Australian and New Zealand Journal of Obstetrics and Gynaecology

The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work.

The American Journal of Obstetrics & Gynecology (AJOG), known popularly as "The Gray Journal," has undergone a significant transformation specifically designed to improve the flow of information to its readers. Beginning with the January 2007 issue, it has adopted a multidimensional, multimedia approach, revamping its editorial content and format to help physicians deal with the challenge of the limited time to locate and read the relevant medical literature. An innovative Web edition of AJOG now complements a redesigned print version.

AJOG Editors-in-Chief, Thomas J. Garite MD, Professor Emeritus in the Department of Obstetrics and Gynecology at the University of California, Irvine and Moon H. Kim MD, Director of the University of California, Irvine Reproductive Endocrinology and Infertility Division, explain, "Several years ago the editors of AJOG began to think about the future of the biomedical journal and how it can best meet the needs of its readers and contributors and, by extension, of patients. The new format launched with the January issue of the Journal is our first comprehensive response to this challenge. What we offer is a departure from the comfortable position of the print-based biomedical journal. We remain strongly committed to our scholarly mission, yet aspire to reach the largest possible audience while providing information-rich content. To accomplish this goal, we have redesigned the Journal both literally and philosophically."

The official version of the American Journal of Obstetrics & Gynecology appears online at http://www.ajog.org/. This arrangement permits authors to convey information unconstrained by the limitations of print. In addition, the online version is published much sooner than was possible before, thus disseminating important information much more rapidly. Authors are now encouraged to submit supplementary material, including video clips, animations, illustrations, and downloadable slide presentations, taking advantage of the full scope of available Web technology to maximize the understanding and impact of their work.

Each issue of the print version of the Journal features abridged versions of all the research articles that are posted in full at http://www.ajog.org/. Running approximately two pages, each article summary highlights the key points of the study and discusses its rationale, methods and results. Elements found only in the summaries are an Overview (describes the point of the study in a sentence or two) and Clinical Implications (bullet points that quickly apply the significance of the study's findings to daily practice, future research or both). References are included only in the online version.

Similarly, Clinical Opinions are published in abridged form in print and in full online. The print format contains unabridged review articles and editorials. Exciting new features that take full advantage of electronic media include a Journal Club discussion of a research article in the same issue, with the full discussion online and a recap in print Images in Obstetrics alternating with Images in Gynecology and Surgeon's Corner, featuring a video clip online.

Associate Editor, Professor Roberto Romero, MD (Professor of Obstetrics and Gynecology at the Wayne State University and Chief of the Perinatology Research Branch of the National Institute of Child Health and Human Development, NIH) comments, "As a way to provide our contributors with a platform for reaching as broad a readership as possible, we are pleased that the publisher, Elsevier, has instituted free distribution of the print version of the Journal to all obstetricians and gynecologists in the United States. The new print Journal is lean and easy to read. A glossary of symbols serves as a roadmap for icons that will mark certain article categories and internal cross-references. The goal of the print version is to concisely inform the reader, who may then visit our website for the full article, supplementary information and extra features. AJOG authors can be assured that their articles will appear in PDF form for printing anywhere, thereby providing the work with physical existence and maximizing distribution. More people than ever will be able to hold the printed article in their hands."

----------------------------
Article adapted by Medical News Today from original press release.
----------------------------

ABOUT THE AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY

The American Journal of Obstetrics & Gynecology (http://www.ajog.org/), known as "The Gray Journal," presents coverage of the entire spectrum of the field, from the newest diagnostic procedures to leading-edge research. The Journal provides comprehensive coverage of the specialty, including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. It also publishes the annual meeting papers of several of its more than 30 sponsoring societies, including the Society for Maternal-Fetal Medicine and the Society of Gynecologic Surgeons. The American Journal of Obstetrics & Gynecology has the highest ranking for citation frequency of any ob/gyn journal and ranks in the top 1.7% of the 5,684 journals listed in the most recent Science Citation Index.

A new study published in BJOG: An International Journal of Obstetrics and Gynaecology has found that, contrary to the findings in other recent research, a previous caesarean section does not increase the risk of stillbirth in the second pregnancy.

The researchers, from the University of Calgary in Alberta, Canada, investigated the connection because they were concerned that previous research had failed to account for the effect of maternal obesity which is associated with both caesarean birth and stillbirth.

The study included 157, 929 second births with information obtained on demographic characteristics, pregnancy complications, mode of delivery and outcome of live or stillbirth. Information on factors that could impact on the results such as maternal diabetes, maternal weight, hypertension and smoking during pregnancy was also extracted. However, exact maternal weight data was not available therefore women were categorised as less than or greater than 91 kg.

Initially the study looked at the total number of antepartum stillbirths in both groups. Overall there were 331 antepartum stillbirths giving a rate of 3.0/1000 in the previous caesarean group compared to 2.7/1000 in the previous vaginal delivery group.

The data were than adjusted to exclude other potential contributing factors such as significant fetal abnormality, maternal trauma such as a motor vehicle accident during pregnancy and infection such as cytomegalovirus. Once these factors were taken into account, there were a total of 265 antenatal stillbirths, 63 (2.1/1000) in the previous caesarean group and 202 (1.6/1000) in the previous vaginal birth group.

Further, the data prior to 1996 did not include complete information on a number of significant factors such as maternal weight, smoking during pregnancy, pre-pregnancy diabetes and hypertension, the data was then adjusted to exclude these participants from the final analysis. Thus the sample size reduced from 157, 929 to 132, 590 and the stillbirth number reduced from 265 to 210. In this analysis, previous caesarean section did not demonstrate a statistically significant increase in stillbirth risk.

Dr Stephen Wood, Department of Obstetrics and Gynaecology, University of Calgary, said "Our study strongly suggests that previous caesarean section does not increase the risk of stillbirth in subsequent pregnancies. Although previous research has made a link between the two, it is likely that maternal obesity played a part as it was not controlled for.

"Obesity has been a consistently observed risk factor for both stillbirth and caesarean section. It has been difficult for investigators, including us, to adequately control for this factor as good anthropometric data is often not available in large perinatal databases. Indeed we were limited to using maternal weight of 91kg or more as a cut-off for obesity, however this is more than other studies have done. As caesarean section is increasingly common and stillbirth is a very important outcome further research in this area is required."

Professor Philip Steer, BJOG editor-in-chief, said: "Caesarean section rates are increasing across the developed world and the increase in risks for subsequent pregnancies have been well-documented. The increase in stillbirth risk previously reported was especially concerning, so it is somewhat reassuring that the study by Dr Wood and his team suggests that this may have been due to the confounding factor of maternal obesity. Because of the growing prevalence of caesarean section, further research is needed to ascertain in more detail the pros and cons of c-section delivery".

Notes

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

Reference

The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy.
Wood SL, Chen S, Ross S, Sauve R.
BJOG 2008 115:726-731.

Royal College of Obstetricians and Gynaecologists

Pregnancies that suffer a premature rupture of the membranes at 24 weeks or less are usually prolonged. Neonatal outcome is still poor, say researchers.

A study published in the American Journal of Obstetrics and Gynecology found that preterm premature rupture of the membranes (PPROM) occurs in as many as 4.5% of pregnancies.

To establish neonatal short-term outcome following such particularly early PPROM, the authors analysed databases and identified 46 patients.

All were hospitalized at 24 weeks and given antibiotics and antenatal steroids.

Twenty seven of 57 infants (47%) survived after a median hospital stay of 71 days. Most deaths (63%) were ascribed to extreme prematurity. Ten of the survivors (37%) had serious sequelae such as bronchopulmonary dysplasia.

The authors say the routine use of antibiotics and steroids appears to have led to an improvement in survival after early PPROM but 'morbidity remains high.'

Reference: Dinsmoor M et al (2004) Outcomes after expectant management of extremely preterm premature rupture of the membranes Am J Obstet Gynecol 190 (1) 183-187

The Royal College of Obstetricians and Gynaecologists (RCOG) is aware of the issues highlighted by PMETB's recent survey . Many of these issues were previously identified in the report A Career in Obstetrics and Gynaecology. Recruitment and Retention in the Specialty (RCOG, 2006).

There are specific reasons for the lack of supervision in obstetrics and gynaecology and the perceived low satisfaction rate among trainees. On the whole, these have been systematically addressed by the RCOG since the publication of the above RCOG report. For instance, the RCOG has set up a network of 170 recruitment champions around the country to ensure that trainees receive the support they require. We have also appointed a junior and senior Careers Advisor and a Recruitment Champion to ensure the momentum needed to carry forward the recommendations of the report and to improve trainees' experience of the specialty.

The bulk of the workload in obstetrics within the hospital is related to the labour ward. The 1999, we recommended 40-hour consultant presence in the labour ward to provide better supervised training and to increase patient safety in the document Towards Safer Childbirth . Only 50% of hospitals were able to fulfil this requirement when audited in 2006. The RCOG has looked at service and training issues and published The Future Role of the Consultant , where we recommended increase consultant numbers to provide better supervision and safer delivery of services.

The RCOG has also been working closely with colleagues in the Royal College of Midwives to explore multidisciplinary team working in maternity services and will publish the report The Clinical Learning Environment and Recruitment: A Report of the Joint RCM/RCOG Working Party in due course. This report will look at better collaboration between the different disciplines to ensure that trainees receive the attention they need.

The RCOG's Trainees Committee is at the moment conducting its own research into trainees' experience and attitudes in obstetrics and gynaecology across the country. This research is expected to be expansive in its data collection, and will include an examination of specific training and supervision issues.

RCOG Vice President Professor Sabaratnam Arulkumaran said "We recognise it is important that trainees have ample support and are satisfied with the supervision they receive. We are doing all we can and are currently surveying our trainees across the regions on their training experiences in order to better understand their needs."

"Better supervision of training in our acute specialty where activity takes place 24hours of the day is only possible with increased consultant presence in the labour ward. We look forward to working with the Department of Health to achieve the aim of safer childbirth."

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