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Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Transfer to a CEmONC facility, while providing resuscitation to the mother as necessary with IV access and fluids, oxygen and close monitoring. Postpartum haemorrhage is more likely following antenatal haemorrhage, so be prepared after birth.
Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Upon recognition of an immediate (early) postpartum hemorrhage, several factors must be assessed virtually simultaneously. To accomplish this, it is recommended that help be requested immediately. Initial assessment should include an evaluation of uterine tone through bimanual examination, evaluation of the placenta and membranes for any evidence of incomplete removal, and inspection of the cervix, vagina, perineum, and rectum to evaluate for laceration.
Obstetrics in Limited-Resource Settings
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Carlos Pilasi Menichetti, Rebekka Troller
Postpartum haemorrhage, the loss of more than 500 mL of blood after delivery, is the most common maternal morbidity in developed countries. It may be caused by uterine atony after delivery, partial or complete placenta separation disorder, laceration of the genital tract, or uterine rupture.
Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section
Published in Annals of Medicine, 2023
Patchareya Nivatpumin, Tripop Lertbunnaphong, Siritorn Maneewan, Nutha Vittayaprechapon
‘Difficult intubation’ was defined as three or more attempts at intubation. ‘Desaturation’ was defined as maternal oxygen saturation of <90% recorded for ≥5 min. ‘Hypotension’ was defined as systolic blood pressure (SBP) <20% of the SBP before the induction of anesthesia or use of a vasopressor agent. Episodes of hypotension were retrieved from the anesthetic records or counted by the number of boluses of any vasopressor. ‘Bradycardia’ was defined as a heart rate <50 beats per minute or when atropine was administered. ‘Postpartum hemorrhage’ was defined according to the American College of Obstetricians and Gynecologists criteria: bleeding exceeding 1,000 ml after delivery [16]. The intraoperative blood loss was determined by visual estimation by the attending anesthesiologist in the operating theatre. All patients received a uterotonic agent (intravenous oxytocin or carbetocin) after delivery; ‘uterine atony’ was defined as the need to use an additional agent (e.g. methylergonovine or prostaglandin). ‘Failure of regional anesthesia’ was defined as the need to convert to general anesthesia with an endotracheal tube. ‘Neonatal birth asphyxia’ was defined as a neonatal Apgar score <7 five minutes after delivery.
Baseline rotational thromboelastometry (ROTEM) values in a healthy, diverse obstetric population and parameter changes by pregnancy-induced comorbidities
Published in Baylor University Medical Center Proceedings, 2023
Antonio Gonzalez Fiol, Jin Yoo, David Yanez, Kristen L. Fardelmann, Nayema Salimi, Marah Alian, Peter Mancini, Aymen Alian
Postpartum hemorrhage remains a worldwide leading cause of maternal morbidity and mortality.1 Decades of research have identified fibrinogen as an early biomarker to predict postpartum hemorrhage (PPH). A plasma fibrinogen level 2–5 Hence, early recognition and replacement of this factor is critical for PPH management.3–7 Over the last decade, obstetric anesthesiologists have relied on fibrinogen values to indicate an increased risk, and thus preparation, for bleeding.2,3,5,8 For each 1 g/L decrease in fibrinogen, the odds ratio for PPH was 2.63 (1.66–4.16; P < 0.0001).2 With the emphasis on early recognition, some experts have scrutinized the efficiency of the laboratory Clauss fibrinogen, which can have a turnaround of 45 to 60 minutes.9 Clinically, the inability of early recognition may result in improper management of hemorrhage, with either underutilization providing insufficient control or overutilization increasing risk for transfusion-related reactions.10–12 The rotational thromboelastometry (ROTEM®) generates results within 15 minutes, which is seemingly more practical for point-of-care assessment relative to its gold standard counterpart, Clauss fibrinogen. As a result, ROTEM has become widely accepted in practice for PPH, and several PPH algorithms utilize ROTEM for guiding blood product management in cases of PPH.3,9,12–14
Effect of a placenta accreta spectrum multidisciplinary team and checklist on maternal outcomes for planned hysterectomy at time of cesarean delivery
Published in Baylor University Medical Center Proceedings, 2022
Hadley Young, Jessica C. Ehrig, Kendall Hammonds, Michael P. Hofkamp
The main limitation of our study was that only 9 and 21 patients had planned C-HYST before and after implementation of our multidisciplinary PAS team, respectively. Even in a tertiary care referral center, C-HYST is a relatively uncommon procedure and statistical significance is difficult to demonstrate in single-center studies. Another limitation of our study was that we transitioned from estimated blood loss to quantitative blood loss for cesarean deliveries in 2018. Quantitative blood loss has been shown to more accurately predict postpartum hemorrhage.5 A final limitation of our study was that we had higher volume and increased complexity of PAS cases after implantation of our multidisciplinary PAS team. Over half of the cases performed before the multidisciplinary team were diagnosed as accreta in the postoperative period, while more than half the cases after implementation were postoperatively diagnosed as increta or percreta.