International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2022
Observational StudyAccuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study.
Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss vs. actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status. ⋯ Most providers significantly overestimated blood loss volumes (by nearly 700 mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training.
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Int J Obstet Anesth · May 2022
Maternal serum C-reactive protein and white blood cell count at hospital admission as predictors of intrapartum maternal fever: a retrospective case-control study in women having epidural labor analgesia.
Non-infectious inflammation has been proposed as a major contributor to epidural-related maternal fever. We hypothesized that maternal serum C-reactive protein (CRP) and white blood cell (WBC) count at hospital admission predict intrapartum maternal fever. ⋯ Maternal serum CRP and WBC at hospital admission do not predict intrapartum fever in women having epidural labor analgesia at term.
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Int J Obstet Anesth · May 2022
Comparison of neonatal outcomes of cesarean sections performed under primary or secondary general anesthesia: a retrospective study.
The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). ⋯ Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.
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Int J Obstet Anesth · May 2022
Comparative performance of obstetric comorbidity indices within categories of race and ethnicity: an external validation study.
Existing obstetric comorbidity adjustment indices were created without explicitly accounting for sociodemographic diversity in the development populations, which could lead to imprecise estimates if these indices are applied to populations different from the ones in which they were developed. The objective of this study was to validate two obstetric comorbidity indices (one using severe maternal morbidity [SMM] and one using end-organ injury or mortality) within categories of race/ethnicity. ⋯ Users of these indices should consider performance data in totality when choosing a measure for obstetric comorbidity adjustment. There were no marked differences in model performance observed across race/ethnicity groups within each index.