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https://www.readbyqxmd.com/read/28409600/postpartum-hemorrhage-prevention-and-treatment
#1
Ann Evensen, Janice M Anderson, Patricia Fontaine
Postpartum hemorrhage is common and can occur in patients without risk factors for hemorrhage. Active management of the third stage of labor should be used routinely to reduce its incidence. Use of oxytocin after delivery of the anterior shoulder is the most important and effective component of this practice. Oxytocin is more effective than misoprostol for prevention and treatment of uterine atony and has fewer adverse effects. Routine episiotomy should be avoided to decrease blood loss and the risk of anal laceration...
April 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28398928/anesthetic-management-of-mitochondrial-encephalopathy-with-lactic-acidosis-and-stroke-like-episodes-melas-syndrome-in-a-high-risk-pregnancy-a-case-report
#2
Josh D Bell, Kushlin Higgie, Mital Joshi, Joshua Rucker, Sahar Farzi, Naveed Siddiqui
MELAS syndrome (mitochondrial encephalopathy, lactic acidosis, and stroke-like symptoms) is a rare and complex mitochondrial disorder. We present the in-hospital course of a 36-year-old gravida 2, para 0 with MELAS syndrome and severe preeclampsia, complicated by hyponatremia, hyperkalemia, and diabetes. A retained placenta with postpartum hemorrhage required urgent instrumental delivery under spinal anesthesia, transfusion, and intensive care unit admission for pulmonary edema, effusions, and atelectasis. Postpartum endometritis and sepsis also were encountered...
April 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28384942/recent-advances-in-the-management-of-major-postpartum-haemorrhage-a-review
#3
REVIEW
P Reddi Rani, Jasmina Begum
Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity worldwide and 75-90% of these haemorrhage results from uterine atony. Delayed and substandard obstetrics care can kill a woman within hours of Major Obstetric Haemorrhage (MOH). Prenatal identification of at risk women, prompt assessment of blood loss, effective management and involvement of multidisciplinary teams is of utmost importance to save the lives of these women. However, even with the best prenatal care, PPH occurs, it can occur without any risk factors...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28383377/evaluation-of-introduction-of-a-delayed-cord-clamping-protocol-for-premature-neonates-in-a-high-volume-maternity-center
#4
Lilly Y Liu, Joe M Feinglass, Janine Y Khan, Susan E Gerber, William A Grobman, Lynn M Yee
OBJECTIVE: To evaluate adherence to a delayed cord clamping protocol for preterm births in the first 2 years after its introduction, perform a quality improvement assessment, and determine neonatal outcomes associated with protocol implementation and adherence. METHODS: This is a retrospective cohort study of women delivering singleton neonates at 23-32 weeks of gestation in the 2 years before (preprotocol) and 2 years after (postprotocol) introduction of a 30-second delayed cord clamping protocol at a large-volume academic center...
May 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28374955/rhd-alleles-among-pregnant-women-with-serologic-discrepant-weak-d-phenotypes-from-a-multiethnic-population-and-risk-of-alloimmunization
#5
Carolina Bonet Bub, Maria Giselda Aravechia, Thiago Henrique Costa, José Mauro Kutner, Lilian Castilho
BACKGROUND: A considerable number of RHD alleles responsible for weak and partial D phenotypes have been identified. Serologic determination of these phenotypes is often doubtful and makes genetic analysis of RHD gene highly desirable in transfusion recipients and pregnant women. We analyzed the RHD gene in a cohort of pregnant women with doubtful D phenotypes. METHODS: RHD genotyping was performed on 104 cases with D typing discrepancies or with history of serologic weak D phenotype...
April 4, 2017: Journal of Clinical Laboratory Analysis
https://www.readbyqxmd.com/read/28367647/risk-for-postpartum-hemorrhage-transfusion-and-hemorrhage-related-morbidity-at-low-moderate-and-high-volume-hospitals
#6
Audrey A Merriam, Jason D Wright, Zainab Siddiq, Mary E D'Alton, Alexander M Friedman, Cande V Ananth, Brian T Bateman
OBJECTIVE: The objective of this study was to characterize risk for and temporal trends in postpartum hemorrhage across hospitals with different delivery volumes. STUDY DESIGN: This study used the Nationwide Inpatient Sample (NIS) to characterize risk for postpartum hemorrhage from 1998 to 2011. Hospitals were classified as having either low, moderate or high delivery volume (≤1000, 1001 to 2000, >2000 deliveries per year, respectively). The primary outcomes included postpartum hemorrhage, transfusion, and related severe maternal morbidity...
April 3, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28367018/blood-transfusion-practices-in-a-tertiary-care-center-in-northern-india
#7
Sonam Kumari
BACKGROUND: Blood transfusion plays vital roles in the medical and surgical practice. To achieve optimum use of blood, transfusion has to be appropriate and judicious consuming minimal resources and manpower. OBJECTIVE: To evaluate the pattern of blood transfusion requests and utilization with the aim of determining transfusion practice. MATERIALS AND METHODS: Blood request forms and cross-match worksheets at the blood bank were analyzed over a 6-month period...
April 2017: Journal of Laboratory Physicians
https://www.readbyqxmd.com/read/28347198/endomyometritis-after-cesarean-delivery-in-the-era-of-antibiotic-prophylaxis-incidence-and-risk-factors
#8
Laura J Moulton, Mark Lachiewicz, Xiaobo Liu, Oluwatosin Goje
PURPOSE: To identify the rate of endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors. METHODS: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically. RESULTS: Among 2419 patients, the rate of PPE was 1.6% (n = 38) and was associated with lower age (27...
March 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28335653/anesthesia-management-of-complete-versus-incomplete-placenta-previa-a-retrospective-cohort-study
#9
Sharon Orbach-Zinger, Carolyn F Weiniger, Amir Aviram, Alexander Balla, S Fein, L A Eidelman, A Ioscovich
PURPOSE: Placenta previa (PP) is a major cause of obstetric hemorrhage. Clinical diagnosis of complete versus incomplete PP has a significant impact on the peripartum outcome. Our study objective is to examine whether distinction between PP classifications effect anesthetic management. METHODS AND MATERIALS: This multi center, retrospective, cohort study was performed in two tertiary university-affiliated medical centers between the years 2005- 2013. Electronic delivery databases were reviewed for demographic, anesthetic, obstetric hemorrhage, and postoperative outcomes for all cases...
March 23, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28331607/-simplified-international-recommendations-for-the-implementation-of-patient-blood-management-sir4pbm
#10
Patrick Meybohm, Bernd Froessler, Lawrence T Goodnough, Andrew A Klein, Manuel Muñoz, Michael F Murphy, Toby Richards, Aryeh Shander, Donat R Spahn, Kai Zacharowski
BACKGROUND: More than 30% of the world's population are anemic with serious medical and economic consequences. Red blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient blood management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28323673/clinical-pearls-of-maternal-critical-care-part-2-sickle-cell-disease-in-pregnancy
#11
Vinod Patil, Gamunu Ratnayake, Galina Fastovets
PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined...
March 18, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28320352/a-comparison-of-intrapartum-interventions-and-adverse-outcomes-by-parity-in-planned-freestanding-midwifery-unit-and-alongside-midwifery-unit-births-secondary-analysis-of-low-risk-births-in-the-birthplace-in-england-cohort
#12
Jennifer Hollowell, Yangmei Li, Kathryn Bunch, Peter Brocklehurst
BACKGROUND: For low risk women, there is good evidence that planned birth in a midwifery unit is associated with a reduced risk of maternal interventions compared with planned birth in an obstetric unit. Findings from the Birthplace cohort study have been interpreted by some as suggesting a reduced risk of interventions in planned births in freestanding midwifery units (FMUs) compared with planned births in alongside midwifery units (AMUs). However, possible differences have not been robustly investigated using individual-level Birthplace data...
March 21, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28320332/assessing-emergency-obstetric-and-newborn-care-can-performance-indicators-capture-health-system-weaknesses
#13
Andrea Solnes Miltenburg, Richard Forget Kiritta, Thabea Benedicto Bishanga, Jos van Roosmalen, Jelle Stekelenburg
BACKGROUND: Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women and newborns. The aim of this study was to perform a district wide assessment of emergency obstetric and newborn care performance and identify ways for improvement. METHODS: Facility assessment of 13 dispensaries, four health centers and one district hospital in a rural district in Tanzania was performed in two data collection periods in 2014...
March 20, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28315018/influence-of-pelvic-volume-on-surgical-outcome-after-low-anterior-resection-for-rectal-cancer
#14
G Zur Hausen, J Gröne, D Kaufmann, S M Niehues, K Aschenbrenner, A Stroux, B Hamm, M E Kreis, Johannes C Lauscher
BACKGROUND: Low anterior resection (LAR) for rectal cancer is a potentially challenging operation due to limited space in the pelvis. CT pelvimetry allows to quantify pelvic space, so that its relationship with outcome after LAR may be assessed. Studies investigating this, however, yielded conflicting results. We hypothesized that a small pelvis is associated with a higher rate of incomplete mesorectal excision, anastomotic leakages, and increased rate of urinary dysfunction in patients operated for rectal cancer...
March 18, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28303733/bi-parametric-magnetic-resonance-imaging-applied-to-obstetrics
#15
Lucia Manganaro, Valeria Vinci, Antonella Giancotti, Sandro Gerli, Denis A Cozzi, Teresa Pusiol, Michele Scialpi, Luca Roncati
Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e...
March 17, 2017: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28291126/strategies-to-reduce-blood-product-utilization-in-obstetric-practice
#16
Holger Neb, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. RECENT FINDINGS: PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine...
March 11, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28290956/multidisciplinary-in-situ-simulation-based-training-as-a-postpartum-hemorrhage-quality-improvement-project
#17
Monica A Lutgendorf, Carmen Spalding, Elizabeth Drake, Dennis Spence, Jason O Heaton, Kristina V Morocco
BACKGROUND: Postpartum hemorrhage is a common obstetric emergency affecting 3 to 5% of deliveries, with significant maternal morbidity and mortality. Effective management of postpartum hemorrhage requires strong teamwork and collaboration. We completed a multidisciplinary in situ postpartum hemorrhage simulation training exercise with structured team debriefing to evaluate hospital protocols, team performance, operational readiness, and real-time identification of system improvements...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285425/total-bilateral-salpingectomy-versus-partial-bilateral-salpingectomy-for-permanent-sterilization-during-cesarean-delivery
#18
Shiri Shinar, Yair Blecher, Sharon Alpern, Ariel Many, Eran Ashwal, Uri Amikam, Aviad Cohen
PURPOSE: Sterilization via bilateral total salpingectomy is slowly replacing partial salpingectomy, as it is believed to decrease the incidence of ovarian cancer. Our objective was to compare short-term intra and post-operative complication rates of bilateral total salpingectomy versus partial salpingectomy performed during the course of a cesarean delivery. METHODS: A large series of tubal sterilizations during cesarean sections were studied in a single tertiary medical center between 1/2014 and 8/2016 before and after a policy change was made, switching from partial salpingectomy to total salpingectomy...
March 11, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28277324/risk-factors-for-severe-postpartum-hemorrhage-after-cesarean-delivery-case-control-studies
#19
Alexander J Butwick, Bharathi Ramachandran, Priya Hegde, Edward T Riley, Yasser Y El-Sayed, Lorene M Nelson
BACKGROUND: Women who undergo intrapartum caesarean delivery (CD) are at increased risk of postpartum hemorrhage (PPH) compared with those undergoing prelabor CD. To determine whether the presence and strength of the associations between individual risk factors and severe PPH vary among women undergoing prelabor CD or intrapartum CD, stratified analyses are needed according to CD subtype. METHODS: To identify risk factors for severe PPH within 2 distinct CD populations, prelabor CD and intrapartum CD, we performed 2 case-control studies...
March 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28274166/serum-endothelin-1-and-placental-alkaline-phosphatase-levels-in-placenta-percreta-and-normal-pregnancies
#20
Hacer Uyanikoglu, Ahmet Berkiz Turp, Nese Gul Hilali, Adnan Incebiyik
PURPOSE: To evaluate the circulatory levels of endothelin 1 (ET-1) and the placental alkaline phosphatase (ALP) in pregnant women with placenta percreta (PP) and a control group. METHODS: This study was carried out in the Obstetrics and Gynecology and in the Biochemistry Departments of Harran University Medical School. Forty-four women who underwent cesarean section (CS) due to PP and 44 women who underwent CS for other obstetric reasons were included in this study...
March 8, 2017: Journal of Maternal-fetal & Neonatal Medicine
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