European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 2013
ReviewChildbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.
The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. ⋯ Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 2013
ReviewCurrent obstetric guidelines on thromboprophylaxis in the United Kingdom: evidence based medicine?
In the United Kingdom, the national guidance from Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Clinical Excellence (NICE) encourages the use of low molecular weight heparin thromboprophylaxis in high risk pregnancies. The recommendation, however, is based largely on expert opinion with almost no evidence from randomised controlled trials or meta-analyses. ⋯ Therefore, large-scale and well-designed studies are urgently needed. We find that health economic assessments, which should be central to any major health policy change, appear entirely absent in this context.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Apr 2013
Comparative StudyRetain singleton or twins? Multifetal pregnancy reduction strategies in triplet pregnancies with monochorionic twins.
To assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins. ⋯ Retaining a singleton is always the best choice when deciding about using MFPR to improve pregnancy outcomes. For patients having a triplet pregnancy with monochorionic twins and strongly desiring to keep twins, MFPR in one monochorionic twin was feasible by aspirating embryonic parts early in gestation (6-8 weeks) with no drug injection. Pregnancy outcomes are similar with twin reduction in trichorionic triplet pregnancy.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Apr 2013
Comparative StudyFetal sheep left ventricle is more sensitive than right ventricle to progressively worsening hypoxemia and acidemia.
In a sheep model we tested the hypothesis that the fetal left ventricle is less tolerant to worsening acidemia than the right ventricle. ⋯ Our results show that signs of cardiac dysfunction develop earlier in the left ventricle than in the right ventricle. The fetal left ventricle seems to be more sensitive to progressively worsening hypoxemia and acidemia than the right ventricle.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section.
To assess whether, among other prognostic factors, a history of Cesarean section is associated with endometrial ablation failure in the treatment of menorrhagia. Study design We compared women who had failed ablation to women who had successful ablation for menorrhagia in a case-control study. Failed ablation was defined as the need for hysterectomy due to persistent heavy menstrual bleeding after ablation. Successful ablation was defined as an ablation for menorrhagia not needing hysterectomy and the woman being satisfied with the result. Both cases and controls were identified from the surgery registration in the Máxima Medical Center between January 1999 and January 2009. Cases were women that had an endometrial ablation and a hysterectomy, whereas controls only had an endometrial ablation. From the medical files we collected for each patient clinical history, including the presence of a previous Cesarean section, baseline characteristics at the moment of initial ablation, data of the ablation technique and follow-up status. We used univariable and multivariable logistic regression to estimate the risk of failure of endometrial ablation. ⋯ A previous Cesarean delivery is not associated with an increased risk of failure of endometrial ablation, but dysmenorrhea, a submucous myoma and longer uterine depth are. This should be incorporated in the counseling of women considering endometrial ablation.