Clinical obstetrics and gynecology
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Obstetrical emergencies require the rapid formation of a team with clear communication, strong leadership, and appropriate decision-making to ensure a positive patient outcome. Obstetric teams can improve their emergency response capability and efficiency through team and simulation training. Postpartum hemorrhage is an ideal model for team and simulation training, as postpartum hemorrhage requires a multidisciplinary team with the capability to produce a protocol-driven, rapid response. This article provides an overview of team and simulation training and focuses on applications within obstetrics, particularly preparation for postpartum hemorrhage.
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Disorders of coagulation are relatively uncommon as a sole cause of postpartum hemorrhage. Coagulation disturbances should be suspected in patients with a family history of such abnormalities and patients with a history of menorrhagia. Clinical circumstances may also suggest coagulation defect as a cause of postpartum hemorrhage. Diagnosis of a coagulation disorder often requires a high index of suspicion and should not be overlooked in the evaluation of obstetric hemorrhage.
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Clin Obstet Gynecol · Mar 2010
ReviewPostpartum hemorrhage: epidemiology, risk factors, and causes.
Postpartum hemorrhage (PPH) is a leading cause of death and morbidity relating to pregnancy. Uterine atony is the leading cause of PPH, and trauma, including iatrogenic trauma, increases the risk for postpartum hemorrhage. ⋯ Awareness of these facts, and anticipation and prevention of uterine atony, as well as avoiding unnecessary cesareans, episiotomies, and other genital tract trauma have the potential to significantly reduce the mortality and morbidity from postpartum hemorrhage. The epidemiology of postpartum hemorrhage, including the incidence and temporal trends as well as the causes and risk factors associated with it are presented.
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In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. ⋯ Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record.
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This study reviews issues that complicate surgery in obese pregnant patients. Maternal obesity is prevalent in the United States and is associated with numerous adverse health outcomes. ⋯ Specific risks are identified and strategies to avoid them are evaluated. The prognosis and management of pregnant women who have undergone bariatric surgery are also discussed, and practical guidelines for obstetric management of these patients are presented.