Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2022
ReviewProcedural techniques to control postpartum hemorrhage.
Postpartum hemorrhage can occur unexpectedly and with high dynamics. The mother's life often depends on quick action and good communication within an interdisciplinary team. Knowledge of each other's therapeutic options plays a major role. ⋯ From these two points of view, we discuss here different uterus-preserving and uterus-removing techniques. We describe in detail the advantages and disadvantages of each procedure. Because most therapeutic options are based on small case series and uncontrolled studies, local circumstances and physician experience are critical in setting internal standards.
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Postpartum hemorrhage (PPH) persists as a leading cause of maternal death worldwide, and in the United States, most maternal deaths due to hemorrhage are deemed preventable. While essential preparations for hemorrhage include protocols and checklists, implementation science has revealed that it is not enough to merely introduce these tools into units. Simulation affords safe opportunities for practice and produces reliable behavior change, and it does not always need to be highly expensive and resource consuming. We review how simulation can be applied to address a unit's vulnerabilities in identifying, managing, and resolving PPH, as well as considerations for crafting a comprehensive simulation program for your unit.
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Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency complicating 1-10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. ⋯ A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.
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Best Pract Res Clin Anaesthesiol · Dec 2022
ReviewRisk assessment tools to predict postpartum hemorrhage.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, and accurate risk assessments may allow providers to anticipate and prevent serious hemorrhage-related adverse events. Multiple category-based tools have been developed by national societies through expert consensus, and these tools assign low, medium, or high risk of hemorrhage based on a review of each patient's risk factors. ⋯ However, there are no published studies demonstrating external validation or successful clinical use of such models. Future work should include refinement of these models, study of best practices for implementation, and ultimately linkage of prediction to improved patient outcomes.