Abstract:
:A study was undertaken in 372 consecutive patients undergoing non-elective cesarean delivery to explore the incidence and nature of conflicts between physician and patient surrounding the decision to undergo non-elective cesarean delivery; to examine the adequacy of informed consent at the time of non-elective cesarean delivery; and to describe the importance of a preventive ethics approach to non-elective cesarean delivery. During a 6-month interval, all patients who underwent non-elective cesarean delivery and their physicians were asked to take part in a survey in the early postpartum period concerning their response to recommendations for cesarean delivery. The survey included demographics as well as questions pertaining to informed consent and the presence and nature of patient-physician conflict. Of the 326 patients who were interviewed, 319 (98%) agreed to the recommendation for non-elective cesarean delivery and 7 patients (2%) initially disagreed. Reasons for disagreeing included: feared surgery (4 of 7), needed husband's approval (1 of 7), and questioned the medical necessity of surgery (2 of 7). In all 7 cases of initial disagreement, cesarean delivery was eventually performed with the patient's consent. The mean age of patients who initially disagreed was younger (24.7 +/- 6) than that of those who agreed (31.0 +/- 4 [p < 0.05]). Conflicts were present in 7 of 113 clinic patients and 0 of 213 private patients (p < 0.05). Of those surveyed, 26 (8.7%) indicated that they did not have adequate input in the decision for non-elective cesarean delivery. Patients with inadequate input expressed significantly more concerns with regard to the effect of surgery on their own health (p < 0.05) as well as its effect on the baby (p < 0.05). Our findings suggest that even though the incidence of physician-patient conflict about non-elective cesarean delivery was quite low, a significant number of patients (1 in 12) may have reservations concerning the informed consent process at the time of non-elective cesarean delivery. Patients with reservations are more likely to have greater concerns with regard to maternal and fetal risks, suggesting that a more detailed risk disclosure prior to the procedure is warranted for all pregnant patients. Perhaps by incorporating the preventive strategies discussed, the adequacy of informed consent and therefore the patient's autonomy could be enhanced, thus diminishing patient reservations and preventing physician-patient conflict in the intrapartum period.
journal_name
Am J Perinatoljournal_title
American journal of perinatologyauthors
Lescale KB,Inglis SR,Eddleman KA,Peeper EQ,Chervenak FA,McCullough LBdoi
10.1055/s-2007-994319subject
Has Abstractpub_date
1996-04-01 00:00:00pages
171-6issue
3eissn
0735-1631issn
1098-8785journal_volume
13pub_type
杂志文章abstract::The estimation of plasma bilirubin concentration in neonates, using a transcutaneous, noninvasive jaundice meter, is significantly affected by many factors, such as gestational age, birthweight, phototherapy, and skin pigmentation. In an attempt to minimize the influence of skin color and hence circumvent the need for...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2008-1040751
更新日期:1994-05-01 00:00:00
abstract::Two cases of inadvertent third trimester amniocenteses occurring during attempted spinal tap and culdocentesis are presented. These hitherto undescribed occurrences stress potential complications of these invasive diagnostic procedures in the gravid woman. ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994618
更新日期:1993-11-01 00:00:00
abstract:OBJECTIVE:Systemic lupus erythematosus (SLE) increases the risk of complications in pregnancy. Hydroxychloroquine (HCQ) decreases flares and neonatal lupus syndrome. Limited evidence suggests that HCQ also reduces preeclampsia and preterm birth in SLE pregnancies. We studied whether HCQ was associated with lower odds o...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-3402752
更新日期:2020-07-01 00:00:00
abstract::Infantile polycystic kidney disease (Potter's Type 1) is an autosomal recessive disorder that affects the kidneys and liver. Use of ultrasound to make the diagnosis prenatally is well documented and, in fact, it is advocated as a screening device for second-trimester identification of potentially affected fetuses. The...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999726
更新日期:1987-01-01 00:00:00
abstract::The ultrastructural architecture of colostral cells of mothers of pre- and full-term infants is described. The polymorphonuclears were engaged in vivid phagocytosis of fat droplets. Similar findings were observed on the macrophages. The lymphocytes appeared normal in size and ultrastructure. A small number of eosinoph...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994162
更新日期:1997-07-01 00:00:00
abstract::Objective Our objective was to review the literature in relationship to diabetes in pregnancy in low and middle income countries. Study Design We reviewed the English language literature related to diabetes and obesity during pregnancy in low and middle income countries published over the last 20 years. Results The gl...
journal_title:American journal of perinatology
pub_type: 杂志文章,评审
doi:10.1055/s-0036-1584152
更新日期:2016-11-01 00:00:00
abstract::Our objective was to describe the change in the level of troponin I in patients who undergo a vaginal or cesarean delivery. We obtained troponin I levels on admission and 1 hour after delivery in women undergoing vaginal and cesarean deliveries. Exclusion criteria included <37 weeks' gestation, a history of cardiac di...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2004-820507
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB). STUDY DESIGN:In this study trocar location was documented in the operat...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0037-1620268
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:Neonatal biomarkers of inflammation were examined in relation to early neurodevelopment and gait in very-low-birth-weight (VLBW) preterm children. We hypothesized that preterm infants exposed to higher levels of neonatal inflammation would demonstrate lower scores on Bayley Scales of Infant Toddler Developmen...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0035-1557106
更新日期:2016-01-01 00:00:00
abstract::Although various authors recommend screening for hypoglycemia in large for gestational age (LGA) and small for gestational age (SGA) newborns, the frequency of hypoglycemia in these infants, using a recent definition of hypoglycemia, and the proper duration of screening are not documented. We determined chromogen test...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994649
更新日期:1993-03-01 00:00:00
abstract::Twenty-five patients undergoing nipple stimulation contraction stress tests were enrolled in this study. Plasma 13,14-dihydro, 15-keto prostaglandin F2 alpha and plasma prolactin concentrations were analyzed before and during the contraction stress tests. Prolactin concentrations were significantly higher (p less than...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999444
更新日期:1990-01-01 00:00:00
abstract::End-stage renal disease complicates only a small percentage of pregnancies, but, of these, virtually all become anemic due to a deficiency in erythropoietin. Erythropoietin has been shown to correct anemia due to renal disease in nonpregnant patients. We report two cases of erythropoietin use during pregnancy complica...
journal_title:American journal of perinatology
pub_type: 杂志文章,评审
doi:10.1055/s-2007-994392
更新日期:1995-01-01 00:00:00
abstract::Four cases of transient polyhydramnios are reviewed. It is proposed that by taking note of changes in amniotic fluid volume, one can more accurately assess a fetal-maternal unit that is affected by a number of specific disease processes. ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999656
更新日期:1988-01-01 00:00:00
abstract::Hepatoblastoma is a rare childhood embryonal malignancy. Recent reports suggested a linkage between premature birth and later development of hepatoblastoma. In August 2000, we encountered a 24-month-old boy with extremely low birth weight who developed hepatoblastoma with an unfavorable histology. His birth weight was...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2002-25309
更新日期:2002-04-01 00:00:00
abstract::Community-acquired pneumonia (CAP) is the leading cause of death in children < 5 years of age worldwide. It is also one of the most frequent infectious diseases in children, leading to large antibiotic use and hospitalization even in the industrialized countries. However, the optimal management of CAP in children is s...
journal_title:American journal of perinatology
pub_type: 杂志文章,评审
doi:10.1055/s-0039-1691801
更新日期:2019-07-01 00:00:00
abstract::The effect of active management on latent phase labor was assessed in 197 consecutive nulliparous women. Active management resulted in a significant shortening of the latent phase but had no effect on active phase labor. Patients undergoing induction of labor had latent phases that were almost identical to the accepte...
journal_title:American journal of perinatology
pub_type: 临床试验,杂志文章
doi:10.1055/s-2007-999524
更新日期:1990-10-01 00:00:00
abstract::Managing preterm rupture of membranes (PPROM) is a balance between benefits of prolonging gestation and the risks of perinatal infection. This study evaluates a real-time polymerase chain reaction (PCR) for the detection of amniotic fluid infection and neonatal complications by amniocentesis following PPROM. A total o...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0030-1271212
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization. STUDY DESIGN:We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012....
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1649481
更新日期:2018-11-01 00:00:00
abstract::The purpose of this study was to examine factors that were associated with uterine rupture in patients attempting vaginal birth after cesarean delivery. We analyzed the results of all patients attempting vaginal birth after cesarean delivery between September 1996 to December 1999 at a single institution using a conte...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2004-828608
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE: This study aimed to identify differences in sequential integrated screening and early ultrasound markers in monochorionic/diamniotic (MC/DA) pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and unequal placental sharing (UPS). STUDY DESIGN: Retrospective cohort study of MC/DA pregnancies ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0040-1718371
更新日期:2020-10-08 00:00:00
abstract:OBJECTIVE:The objective of this article is to evaluate the implementation and acceptability of a universal cervical length (CL) screening program for prediction and prevention of preterm birth (PTB). STUDY DESIGN:We performed a prospective observational study to evaluate the implementation and acceptability of a unive...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0034-1371710
更新日期:2014-12-01 00:00:00
abstract::Introduction First-trimester ultrasound (US) for anatomy assessment may improve anomaly detection, but it may also increase overall US utilization. We sought to assess the utility of first-trimester US for evaluation of fetal anatomy. Materials and Methods A decision analytic model was created to compare first- plus s...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0036-1579652
更新日期:2016-08-01 00:00:00
abstract::This study considers whether admission to the hospital of a patient diagnosed with a short cervix delayed delivery, prevented preterm delivery, and/or decreased the rate of change in the cervical length (CL) on follow-up measurements. The design was a retrospective cohort study of women carrying singleton pregnancies ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2006-958164
更新日期:2007-01-01 00:00:00
abstract::The objective of this paper is to determine if phenobarbital exposure during pregnancy affects developmental outcome at age 2 years. Between 1991 and 1994, 401 pregnant patients at risk for delivery prior to 34 weeks' gestation were invited to participate; 48 mothers declined entry. Before delivery, pharmacy randomize...
journal_title:American journal of perinatology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1055/s-2007-993836
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVE:The management of breech presentation may improve perinatal outcomes. The aim of this study was to synthesize and compare published evidence of four national guidelines on breech presentation. STUDY DESIGN:A descriptive review of four recently published national guidelines on breech presentation and external...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-1692391
更新日期:2020-09-01 00:00:00
abstract::The purpose of this study is to compare the effectiveness of double phototherapy versus single conventional phototherapy in decreasing serum bilirubin levels in jaundiced neonates. Forty-two preterm infants who were less than 37 weeks' gestational age and less than 2000 g birthweight with nonhemolytic jaundice were al...
journal_title:American journal of perinatology
pub_type: 临床试验,杂志文章
doi:10.1055/s-2007-994446
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE: Sepsis is a major cause of neonatal mortality. The gold standard for diagnosis is blood culture which suffers from low sensitivity and huge turn-around time. Flow cytometry has been extensively applied to malignant disorders and is an upcoming tool for diagnosis of nonmalignant disorders due to its rapidity ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0040-1718370
更新日期:2020-09-29 00:00:00
abstract:OBJECTIVE: Potentially avoidable maternity complications (PAMCs) have been validated as an indicator of access to quality prenatal care. African-American mothers have exhibited a higher incidence of PAMCs, which has been attributed to unequal health coverage. The objective of this study was to assess if racial disparit...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0040-1701195
更新日期:2020-01-27 00:00:00
abstract:INTRODUCTION:Although guidelines recommend repeat ultrasound in the setting of an incomplete fetal anatomic survey, the clinical utility of this practice has not been established. As such, we aimed to assess the yield of repeat ultrasound for anomaly detection following an incomplete survey. MATERIALS AND METHODS:This...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1626715
更新日期:2018-12-01 00:00:00
abstract::Trichosporon beigelii is an uncommon cause of sepsis in low-birth-weight infants. We present two cases of neonatal trichosporonosis and two cases of neonatal trichosporon colonization to familiarize neonatologists with this entity and to discuss management considerations. A 23-week-gestation male developed clinical ev...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994109
更新日期:1997-02-01 00:00:00