Search

In 2003 The National Board of Health, Denmark, enforced a compulsory training course in academic research as part of the specialist training for doctors. The trainees must learn to search and evaluate relevant literature and be able to implement the results in clinical practice. The structure of the 20 days of academic training in gynaecology and obstetrics is described. In 2008, 17 doctors participated in these sessions. We performed a questionnaire survey to explore the implementation. The academic training was well rated by the participants with respect to content, form and outcome.

The course of delivery in 1,545 primiparae who were considered to be in the low-risk group at the commencement of labour as assessed by the previous directives issued by the Danish Ministry of Health (1976) were reviewed. 2/3 were delivered normally as episiotomy was not regarded as a complication. 1/3 had complicated deliveries. In 350, the contractions were abnormal and intervention was required. 1/3 of these were delivered instrumentally. Haemorrhage of more than 500 ml, intrauterine asphyxia and Apgar score less than or equal to 7 at 1 minute occurred frequently in this group. A total of 1,195 did not receive treatment to improve contractions and, in this group, instrumental delivery was undertaken in 10%. Following normal labour pains and spontaneous delivery, complications in the third stage were observed in 77 out of 1,075 patients, including haemorrhage of more than 500 ml in 38 patients. Six infants in this group had Apgar scores less than or equal to 7 at 5 minutes. In the group with abnormal contractions and/or instrumental delivery, haemorrhage of more than 500 ml, retention of the placenta and signs of perinatal asphyxia occurred, however, significantly more frequently. The authors consider that home deliveries in primiparae cannot be recommended. Primiparae should be advised to be delivered in hospital as it is not always possible to predict complications.

A total of 5,519 consecutive single deliveries at term were analysed for maternal and foetal factors associated with breech presentation (UK). The protocol in this department for breech deliveries which permits vaginal delivery of foetuses estimated to be between 2,400 and 3,800 g in cases where the pelvis was considered to be clinically normal, was also evaluated. Breech presentation was found in 173 cases. In 102 of these circumstances were present which permitted trial of vaginal delivery. Seventy-seven were delivered vaginally. An increased frequency of low Apgar scores (less than 8) after one minute was demonstrated among infants delivered vaginally in the breech presentation on comparison with infants delivered by Caesarean section, whereas low scoring after five minutes occurred with the same frequency. One infant died during delivery. Follow-up of infants delivered in breech presentation (mean period of observation two years) showed developmental disturbances in three of the vaginally delivered infants and in five of those delivered abdominally. Two of the infants delivered abdominally had severe cerebral paresis and psychomotor retardation without evidence of intrauterine or severe neonatal asphyxia. On comparison with the population delivered in cephalic presentation (HST), significantly increased frequencies of primiparity and light-for-dates infants were found in the breech presentations. Low Apgar score after one minute was significantly more frequent in breech presentations while low Apgar scoring after five minutes occurred with the same frequency. The perinatal mortality rates in breech and cephalic presentations were 17.3 and 4.7 per 1,000 respectively. Following correction for lethal malformations, the rates were 5.8 and 3.8 per 1,000, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)