AI Article Synopsis

  • The study aimed to evaluate how obstetricians manage severe postpartum hemorrhage (PPH) in similar and varying scenarios.
  • A survey with two case vignettes was sent to obstetricians to assess their management choices, revealing significant inconsistencies in treatment and timing across different situations.
  • The findings highlighted a need for standardized protocols in maternity units to address the variations in care that can contribute to delayed management and increase risks for maternal health.

Article Abstract

Objectives: To assess variations in management of severe postpartum hemorrhage: 1) between obstetricians in the same situation 2) by the same obstetrician in different situations.

Study Design: A link to a vignette-based survey was emailed to obstetricians of 215 maternity units; the questionnaire asked them to report how they would manage the PPH described in 2 previously validated case-vignettes of different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. Variations in PPH were assessed in a descriptive analysis; agreement about management and its timing between vignette 1 and vignette 2 was assessed with the Kappa coefficient.

Results: Analysis of complete responses from 119 (43.4%) obstetricians from 53 (24.6%) maternity units showed delayed or inadequate management in both vignettes. While 82.3% and 83.2% of obstetricians (in vignettes 1 and 2, respectively) would administer oxytocin 15 minutes after PPH diagnosis, only 52.9% and 29.4% would alert other team members. Management by obstetricians of the two vignette situations was inconsistent in terms of choice of treatment and timing of almost all treatments.

Conclusion: Case vignettes demonstrated inadequate management as well as variations in management between obstetricians and in different PPH situations. Protocols or procedures are necessary in all maternity units to reduce the variations in practices that may explain a part of the delay in management that leads to PPH-related maternal mortality and morbidity.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292622PMC
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209074PLOS

Publication Analysis

Top Keywords

maternity units
12
severe postpartum
8
postpartum hemorrhage
8
management
8
variations management
8
severe pph
8
pph vignette
8
inadequate management
8
management obstetricians
8
pph
7

Similar Publications

Background: Occiput-posterior (OP) position is associated with labor arrest, need of operative delivery and failed instrumental vaginal delivery with resulting adverse peripartum outcomes. Vacuum extraction (VE) is the most commonly performed type of instrumental delivery worldwide. This study aimed to investigate the outcome of VE in fetuses with sonographically confirmed OP position prior to the procedure.

View Article and Find Full Text PDF

Background: Around one in three pregnant women undergoes induction of labour in the United Kingdom, usually preceded by in-hospital cervical ripening to soften and open the cervix.

Objectives: This study set out to determine whether cervical ripening at home is within an acceptable safety margin of cervical ripening in hospital, is effective, acceptable and cost-effective from both National Health Service and service user perspectives.

Design: The CHOICE study comprised a prospective multicentre observational cohort study using routinely collected data (CHOICE cohort), a process evaluation comprising a survey and nested case studies (qCHOICE) and a cost-effectiveness analysis.

View Article and Find Full Text PDF

Objective: This study aims to investigate the risk factors for severe postpartum hemorrhage (SPPH) in patients with placenta accreta spectrum (PAS) undergoing cesarean delivery, despite the prophylactic use of resuscitative endovascular balloon occlusion of the aorta (REBOA).

Materials And Methods: We conducted a retrospective case-control study on PAS patients who underwent cesarean delivery with prophylactic REBOA at the First Affiliated Hospital of Chongqing Medical University from January 2017 to December 2021. Prophylactic REBOA placement was determined by a prenatal ultrasound scoring system.

View Article and Find Full Text PDF

Cycled light in the intensive care unit for preterm and low birth weight infants.

Cochrane Database Syst Rev

December 2024

Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden, Lund, Sweden.

Background: Preterm and low birth weight infants are at an early stage of development, and do not receive adequate maternal circadian signals. They are often cared for over prolonged periods of hospitalisation in neonatal intensive care units (NICU), where environmental circadian stimuli are lacking. Exposure to artificial light-dark cycles may stimulate the development of the circadian system and improve clinical outcomes.

View Article and Find Full Text PDF

Background: Differentiation of patient-specific induced pluripotent stem cells (iPS) helps researchers to study the individual sensibility to drugs. However, differentiation protocols are time-consuming, and not all tissues have been studied. Few works are available regarding pancreatic exocrine differentiation of iPS cells, and little is known on culturing and cryopreserving these cells.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!

A PHP Error was encountered

Severity: Notice

Message: fwrite(): Write of 34 bytes failed with errno=28 No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 272

Backtrace:

A PHP Error was encountered

Severity: Warning

Message: session_write_close(): Failed to write session data using user defined save handler. (session.save_path: /var/lib/php/sessions)

Filename: Unknown

Line Number: 0

Backtrace: