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ABSTRACT: There is very limited literature available on the use of Kielland's forceps in the management of deep transverse arrest, and currently no studies looking at the correlation between obstetricians' personality traits and Kielland's forceps use. This study, therefore, aims to explore this relationship. All practicing consultant obstetricians in Wales received a postal invitation, including a psychometric questionnaire. The results showed that 32.7% currently use Kielland's compared with 36.7% who have never used Kielland's forceps. The remainder (30.6%) have used Kielland's in the past, but have since abandoned their use. Anxiety levels were actually lowest in those consultants who have never used Kielland's and highest in those who have abandoned their use. This could reflect the fact that Kielland's users tend to be the more senior consultants, who have perhaps become discouraged by recent changes in practice.
Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 11/2008; 28(7):700-2. · 0.43 Impact Factor
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ABSTRACT: Anecdotally, it has been suggested that obstetricians of similar training and experience have different intervention rates on the labour ward. This phenomenon has not been studied in depth. The aim of this study was to record the intra-partum intervention rates for third on-call registrars and correlate this with the anxiety traits of the corresponding registrars. An analysis of births occurring during out-of-hours in the main delivery unit of a large teaching hospital during the period September 2005-September 2006 was carried out. The rate of interventions per cumulative number of deliveries that occurred specific to each doctor on-call was calculated. Anxiety traits were calculated with a validated questionnaire. There is a significant difference in the caesarean section rates between registrars of similar experience. There is also a strong correlation between the registrar's anxiety trait level and the registrar's emergency caesarean section rates (Pearsons correlate 0.722, p<0.01).
Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 05/2008; 28(4):390-3. · 0.43 Impact Factor
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BJOG An International Journal of Obstetrics & Gynaecology 03/2008; 115(3):414; author reply 414-5. · 3.41 Impact Factor
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ABSTRACT: To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery.
Prospective observational study.
A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology.
Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population.
Prospective observational study.
The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women.
Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies.
Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.
BJOG An International Journal of Obstetrics & Gynaecology 05/2007; 114(4):430-6. · 3.41 Impact Factor
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Obstetrical & Gynecological Survey - OBSTET GYNECOL SURV. 01/2007; 62(7):445-446.
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ABSTRACT: There was little controversy in the management of ovarian cysts until 15 years ago when operative endoscopy gained popularity. Before this time, laparotomy was the standard form of treatment for pelvic masses. Simple cysts were treated laproscopically by aspiration and solid or large tumors with any malignant potential by laparotomy. Constantly improving technology and instrumentation has allowed more and more operations to be performed laparoscopically. The gynecological oncologist has been wary of adopting this form of surgery for potential gynecological malignancies because of the safety and efficacy issues. Pelvic pathology, particularly ovarian tumors, pose a difficult problem. Apart from difficulty in screening, it is also difficult to confirm the nature of an ovarian pathology using the currently available investigative modalities. If the nature of an ovarian cyst can be ascertained beyond doubt, then the treatment can be simple, laparoscopy for benign and laparotomy for malignant. Having said that, more enthusiastic operative laparoscopists are using this approach to treat gynecological malignancies. We discuss the role of laparoscopy in the management of ovarian cysts.
Seminars in Laparoscopic Surgery 07/1999; 6(2):104-11.
