The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · May 1995
ReviewContemporary transatlantic developments concerning compelled medical treatment of pregnant women.
This paper had identified a contemporary ethicolegal dilemma concerning the circumstances, if any, in which a pregnant woman's refusal of medical treatment may be judicially overridden either in her interests or those of the unborn child. On the one hand, the obstetrician will be concerned about the interests of both his patients in potentially life-threatening situations when they can be protected by what might be regarded as relatively straightforward procedures and where to fail to take those steps might expose the practitioner (at least outside New Zealand where its accident compensation legislation has impact in this regard) to allegations of negligence. ⋯ In such cases also, the conduct of medical procedures in the face of an express prohibition by the woman may give rise to liability for battery. (In New Zealand, such a potential liability would not, in the writer's view, be affected by the prohibition on proceedings for damages for medical misadventure as contained in the Accident Rehabilitation and Compensation Insurance Act 1992.) At the heart of an analysis of this issue is the status of the fetus as it is the fact of the woman patient's pregnancy which distinguishes the cases discussed in this paper from others in which the Courts have had to deal with refusals of treatment by those competent to do so. In regard to this aspect, the approach of the Courts in various jurisdictions has arguably been confused and contradictory.(ABSTRACT TRUNCATED AT 250 WORDS)
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Aust N Z J Obstet Gynaecol · May 1995
Routine voluntary antenatal anti-HIV screening in Bangkok, Thailand.
The following recommendations are made as a result of this study. 1. Routine voluntary screening for HIV infection in all pregnant women is feasible and worthwhile. 2. Every seropositive result should be repeated for confirmation before coming to a definitive conclusion to avoid a misdiagnosis. 3. ⋯ Special or anonymous clinics may create an atmosphere of uneasy feelings among the women who could be made to feel alienated and discriminated against. (iv) P--Provision of care. Comprehensive services must be available. These include an experienced counselling team, adequate laboratory services, services for safe first and second trimester therapeutic abortions, appropriate facility in the delivery suite (including Caesarean section) for infected cases, and dedicated paediatricians.
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Aust N Z J Obstet Gynaecol · Feb 1995
Comparative StudyVariation in caesarean and instrumental delivery rates in New Zealand hospitals.
A study of Caesarean section and instrumental delivery rates in the maternity hospitals in New Zealand delivering over 1,000 women per year was undertaken. The results at Middlemore Hospital were compared with those seen elsewhere. The Caesarean section rate at Middlemore Hospital in 1993 was significantly lower than the other large maternity hospitals in New Zealand. ⋯ The spontaneous vaginal delivery rates at Middlemore Hospital were higher than at other New Zealand hospitals between 1988 and 1993. We conclude that Middlemore Hospital has been successful in maintaining low interventional delivery rates by New Zealand and international standards--the Caesarean section rate remains below 10% and the spontaneous vaginal delivery rate approaches 85%. This is likely to be a consequence of a number of factors operating together but there is evidence to suggest that obstetric management policies at Middlemore do play a role in this.
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Aust N Z J Obstet Gynaecol · Feb 1995
Practice Guideline GuidelineAspirin and prevention of preeclampsia. Position statement of the use of low-dose aspirin in pregnancy by the Australasian Society for the Study of Hypertension in Pregnancy.
1. A heterogeneous group of randomized trials have been conducted using low-dose aspirin to prevent preeclampsia. ⋯ On the basis of existing literature, it is recommended that aspirin not be used in the following groups: (i) Healthy nulliparous women (ii) Women with mild chronic hypertension (iii) Women with established preeclampsia. 4. The data are sufficient to support further trials in more homogeneous select subgroups of women considered at risk of developing preeclampsia.
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Aust N Z J Obstet Gynaecol · Feb 1995
Comparative StudyNulliparous caesarean section in the home of active management of labour.
The world-wide incidence of Caesarean section continues to rise with dystocia recognized as the major indication. Active management of labour has been proposed as an alternative treatment to Caesarean section for dystocia. At the National Maternity Hospital, Dublin, a recent increase in the Caesarean section rate has been observed. This retrospective review reveals this to be due to other indications.