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Shock in Obstetrics

Moon Seong Baek, Jeongsuk Son, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Hye-Sung Won, Jae-Yoon Shim, Sang-Bum Hong
AIM: Some recent studies have reported that early intervention by a medical emergency team (MET) for clinical deterioration before intensive care unit (ICU) admission was associated with a survival benefit in critically ill cancer patients. We hypothesized that early MET intervention for an obstetric crisis in the general wards would be related to favorable outcomes in critically ill obstetric patients. METHODS: Data of obstetric patients who were managed by a MET were collected retrospectively from 1 March 2008 to 30 April 2015...
October 20, 2016: Journal of Obstetrics and Gynaecology Research
Abha Singh, Ruchi Kishore, Saveri Sarbhai Saxena
AIM: To study the outcomes, benefits and complications of internal iliac artery ligation in both obstetric and gynecological cases. OBJECTIVE: To study the outcomes, effectiveness and complications of internal iliac artery ligation (IIAL). METHOD: This is an analytical longitudinal study done among women who have undergone internal iliac artery ligation in Dr. BRAMH a tertiary referral center from July 2013 to June 2015. Follow-up was done through color Doppler analysis of pelvic arteries before discharge, after 6 weeks and after 6 months...
October 2016: Journal of Obstetrics and Gynaecology of India
Ashakiran T Rathod, K V Malini
PURPOSE: To analyze obstetric admissions to intensive care unit and to identify the risk factors responsible for intensive care admission. METHODS: This is a retrospective study of all obstetric cases admitted to the intensive care unit over a period of 3 years. Data were collected from case records. The risk factors responsible for ICU admission were analyzed. RESULTS: There were 765 obstetric admissions to ICU accounting for 1.24 % of all deliveries...
October 2016: Journal of Obstetrics and Gynaecology of India
Jacquelyn Adams, Jose R Cepeda Brito, Lauren Baker, Patrick G Hughes, M David Gothard, Michele L McCarroll, Jocelyn Davis, Angela Silber, Rami A Ahmed
Objective. To evaluate confidence, knowledge, and competence after a simulation-based curriculum on maternal cardiac arrest in an Obstetrics & Gynecologic (OBGYN) residency program. Methods. Four simulations with structured debriefing focusing on high yield causes and management of maternal cardiac arrest were executed. Pre- and post-individual knowledge tests (KT) and confidence surveys (CS) were collected along with group scores of critical performance steps evaluated by content experts for the first and final simulations...
2016: Critical Care Research and Practice
Colleen D Acosta, David A Harrison, Kathy Rowan, D Nuala Lucas, Jennifer J Kurinczuk, Marian Knight
OBJECTIVES: To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK. DESIGN: National cohort study. SETTING: 198 critical care units in the UK. PARTICIPANTS: 646 pregnant and recently pregnant women who had severe sepsis within the first 24 hours of admission in 2008-2010. PRIMARY AND SECONDARY OUTCOME MEASURES: Septic shock, mortality...
2016: BMJ Open
G Justus Hofmeyr, Zahida Qureshi
Prevention of deaths from obstetric haemorrhage requires effective health systems including family planning, commodities, personnel, infrastructure and ultimately universal access to comprehensive obstetric care for women giving birth. The main causes of death associated with antepartum haemorrhage are placental abruption, placenta praevia and uterine rupture. Preventive measures include preconceptual folate supplementation, management of hypertensive disorders, early diagnosis of placenta praevia and use of uterine stimulants cautiously, particularly misoprostol...
June 23, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Dobrosława L Sikora-Szczęśniak, Grzegorz Szczęśniak, Mieczysław Szatanek, Wacław Sikora
OBJECTIVES: Analysis of obstetric (peripartum and postpartum) hysterectomies with regard to their frequency, indications, complications, and risk factors. MATERIAL AND METHODS: The study included 52 women operated between 1985-2012. Obstetric hysterectomies were performed in 39 (75%) and 13 (25%) women, respectively. The results were statistically analyzed as arithmetic mean and standard deviation (SD). RESULTS: Peri- and postpartum hysterectomies accounted for 0...
2016: Ginekologia Polska
Matthew J G Sigakis, Lisa R Leffert, Hooman Mirzakhani, Nadir Sharawi, Baskar Rajala, William M Callaghan, Elena V Kuklina, Andreea A Creanga, Jill M Mhyre, Brian T Bateman
BACKGROUND: Discharge diagnoses are used to track national trends and patterns of maternal morbidity. There are few data regarding the validity of the International Classification of Diseases (ICD) codes used for this purpose. The goal of our study was to try to better understand the validity of administrative data being used to monitor and assess trends in morbidity. METHODS: Hospital stay billing records were queried to identify all delivery admissions at the Massachusetts General Hospital for the time period 2001 to 2011 and the University of Michigan Health System for the time period 2005 to 2011...
September 2016: Anesthesia and Analgesia
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
Salome Maswime, Eckhart Buchmann
OBJECTIVE: To describe risk factors, clinical events, and avoidable factors in cases of maternal death due to bleeding during and after cesarean delivery. METHODS: A retrospective study was undertaken of the clinical records of women who delivered in seven hospitals in Johannesburg, South Africa, between January 2013 and December 2014. Maternal deaths due to cesarean-related hemorrhage during or within 42days of cesarean delivery at 24weeks or more were selected...
September 2016: International Journal of Gynaecology and Obstetrics
Marco Antonio Avila-Vergara, Alma Rita Peña-Ayón, Luis Enrique Guzmán-Gutiérrez, Jesús Everardo Valenzuela-Verduzco, Carmen Beatriz Caballero-Rodríguez, Felipe Vadillo-Ortega
BACKGROUND: Ovarian pregnancy (OP) is a low-frequency pathology but with devastating effects on women reproductive health. It is often difficult to distinguish from tubal or abdominal pregnancy. Diagnostic procedures and actual medical approaches to the treatment of OP are still a challenge. CLINICAL CASE: In this paper we present a 21 years old woman, seen at the Hospital as emergency abdominal pain and hypovolemic shock, with a pregnancy of 14 weeks of gestational age...
November 2015: Ginecología y Obstetricia de México
Agnieszka Helena Koziołek, Michał Gaca, Krzysztof Szymanowski Szymanowski, Elżbieta Ziętek-Bartlewicz
Amniotic fluid embolism is a rare and diagnostically challenging obstetric disease of high mortality rate. We present a case of a 33-year old parturient after vaginal birth, who presented with severe hemorrhagic shock with low platelet count and coagulopathy resistant to treatment with plasma, platelets and coagulation factors and despite of surgical management of bleeding. Laboratory findings revealed consumptive coagulopathy. Other symptoms included dyspnea and atelectatic changes on chest x-ray, together with augmentation of the heart with no proof of ventricular insufficiency in echocardiographic examination...
2016: Ginekologia Polska
Pınar Kendigelen, Zeynep Kamalak, Deniz Abat
Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section...
March 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Obed Dolo, Alice Clack, Hannah Gibson, Naomi Lewis, David P Southall
PROBLEM: The shortage of doctors in Liberia limits the provision of comprehensive emergency obstetric and neonatal care. APPROACH: In a pilot project, two midwives were trained in advanced obstetric procedures and in the team approach to the in-hospital provision of advanced maternity care. The training took two years and was led by a Liberian consultant obstetrician with support from international experts. LOCAL SETTING: The training took place in CB Dunbar Maternity Hospital...
May 1, 2016: Bulletin of the World Health Organization
S Alfandari, P Cabaret, S Nguyen, D Descamps, A Vachée, C Cattoen, N Van Grunderbeeck
OBJECTIVES: We aimed to update the epidemiology of bacteremia and evaluate their management and short-term outcome. METHODS: We conducted a prospective multicenter survey from October to November 2011. Consecutive patients with at least one positive blood culture (BC) were included in the study. We evaluated the type and adequacy of empirical and documented antibiotic therapy, time to active antibiotic therapy, compliance with guidelines, and 10-day outcome. RESULTS: A total of 23 public and private hospitals and 633 patients (493 true pathogens and 140 contaminants) were included in the study...
June 2016: Médecine et Maladies Infectieuses
Swati Sharma, Sandhya Jain, Shalini Rajaram
Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed...
2016: Infectious Diseases in Obstetrics and Gynecology
Ruth Shaylor, Fayez Saifi, Elyad Davidson, Carolyn F Weiniger
BACKGROUND: Successful neuraxial block performance relies on assessment and palpation of surface landmarks, potentially challenging in patients with a high body mass index (BMI). OBJECTIVES: To evaluate the use of ultrasound-assisted neuraxial bock in a non-obstetric population with BMI above versus below 30 kg/m2. METHODS: Healthy adult patients undergoing extracorporeal shock wave lithotripsy (ESWL) under neuraxial block were observed in this quality assurance study...
January 2016: Israel Medical Association Journal: IMAJ
Sandeep Kumar Mishra, Ravindra R Bhat, Jayaram Kavitha, Pankaj Kundra, Satyen Parida
The physiological changes occurring during pregnancy and labor may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). The addition of obstetric hemorrhage to this presents a unique challenge to the anesthesiologists and intensivists managing these patients in the operation theatres and the Intensive Care Units. Here we present a case of HOCM with automatic implantable cardioverter defibrillator in situ and postpartum hemorrhagic shock.
January 2016: Anesthesia, Essays and Researches
Keely Jordan, Elizabeth Butrick, Gavin Yamey, Suellen Miller
BACKGROUND: Obstetric hemorrhage (OH), which includes hemorrhage from multiple etiologies during pregnancy, childbirth, or postpartum, is the leading cause of maternal mortality and accounts for one-quarter of global maternal deaths. The Non-pneumatic Anti-Shock Garment (NASG) is a first-aid device for obstetric hemorrhage that can be applied for post-partum/post miscarriage and for ectopic pregnancies to buy time for a woman to reach a health care facility for definitive treatment. Despite successful field trials, and endorsement by safe motherhood organizations and the World Health Organization (WHO), scale-up has been slow in some countries...
2016: PloS One
Anupama Dave, Laxmi Maru, Astha Jain
OBJECTIVE: The aim of the study was to find out the role of Serum lactate dehydrogenase in prediction of adverse outcomes of PE & E i.e., severity of disease and occurrence of complications. MATERIALS AND METHODS: This study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore. A total of 200 women were studied; they were divided into control (n = 100), severe pre-eclampsia (n = 32), eclampsia (n = 68). Demographic and hematological parameters were studied including LDH levels...
February 2016: Journal of Obstetrics and Gynaecology of India
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