Best practice & research. Clinical obstetrics & gynaecology
-
Best Pract Res Clin Obstet Gynaecol · Apr 2001
ReviewAcute and chronic pain management in palliative care.
Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. ⋯ Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.
-
Quality and choice in anaesthesia for caesarean section have significantly improved over the last two decades. During this time, general anaesthesia usage has decreased to the point where, in some centres, it is an occasionally used technique for severe fetal distress. This change in practice may have been responsible for the fall in anaesthetic deaths in pregnant women that has occurred over the same period. ⋯ Where possible, anaesthetic protocols and guidelines should exist in every centre, with obstetricians clearly informed of relevant features. Such an approach will prevent inconsistent advice being given to patients and dangerous mistakes occurring. With every aspect of maternity care, a multidisciplinary team approach is in patients' best interests, and anaesthesia for caesarean section is no exception.
-
This chapter gives an overview of research relating to psychological aspects of caesarean section. It focuses on four main questions: *What are the psychological effects of caesarean section on the mother, her partner and her relationship with her infant? *What factors (obstetric, psychological, attitudinal, and health care-related) make women more vulnerable to adverse psychological outcomes after a caesarean section? *What are women distressed about when they have had a caesarean section? *How can post-caesarean psychological distress be prevented or managed?A methodological critique of existing studies on psychological aspects of caesarean section is also given. In conclusion, recommendations for practice and for future research are made.
-
The complications and recovery from caesarean section are dominated by the medical condition of the woman pre-operatively. Evidence regarding risks directly attributable to the caesarean section is scanty, and often derived from obstetric practice that differs from the current day. ⋯ Data regarding placenta praevia and placenta praevia-accreta come from population series where antibiotics were not routinely used for caesarean section, but there is no doubt that previous caesarean section increases the risk of both. Antibiotic and thromboprophylaxis at the time of caesarean section decrease morbidity in the index pregnancy, but can also reasonably be expected to reduce future pregnancy complications.
-
Caesarean section rates continue to be an issue of great concern to many midwives, obstetricians, women, and society as a whole. With an increase in women requesting caesarean sections, the responsibility for the caesarean section rate needs to be re-defined. There is a need to improve the routine information collection on all aspects of childbirth. ⋯ This will require statutory, standardized collection of information. Maternal satisfaction has now become one of the most significant outcome factors after childbirth and must be taken into consideration when implementing any changes in childbirth. Finally, caesarean section rates must no longer be considered in isolation from other changes taking place in society.