Postpartum hemorrhage (PPH) is a major source of maternal morbidity.
This study's objective was to determine whether changes in hemostasis markers during the course of PPH are predictive of its ...severity.
We enrolled 128 women with PPH requiring uterotonic prostaglandin E2 (sulprostone) infusion. Two groups were defined (severe and non-severe PPH) according to the outcome during the first 24 hours. According to our criteria, 50 of the 128 women had severe PPH. Serial coagulation tests were performed at enrollment (H0), and 1, 2, 4 and 24 hours thereafter.
At H0, and through H4, women with severe PPH had significantly lower fibrinogen, factor V, antithrombin activity, protein C antigen, prolonged prothrombin time, and higher D-dimer and TAT complexes than women with non-severe PPH. In multivariate analysis, from H0 to H4, fibrinogen was the only marker associated with the occurrence of severe PPH. At H0, the risk for severe PPH was 2.63-fold higher for each 1 gL(-1) decrease of fibrinogen. The negative predictive value of a fibrinogen concentration >4 gL(-1) was 79% and the positive predictive value of a concentration <or=2 gL(-1) was 100%.
These findings indicate that a simple fibrinogen measurement can anticipate the risk of severe bleeding in PPH.
Objective To assess the efficacy of a new uterine compression suturing technique in reducing postpartum haemorrhage secondary to severe uterine atony.
Design Retrospective study.
Setting ...University hospital between December 2000 and March 2006.
Population Twenty women with uterine atony and postpartum bleeding that did not react to usual medical management.
Methods All these women underwent compression suturing of the uterus, in which the anterior and posterior walls of the uterus were attached so as to compress the uterus.
Main outcome measures Arrest of the bleeding, complications and fertility.
Results Uterine compression suturing was sufficient to stop the bleeding immediately in 95% of the women. None of the women developed complications related to the procedure. All the women recovered normal menstrual cycles. Since uterine compression suturing, eight women have tried to conceive and six (75%) have had a term delivery.
Conclusion Uterine compression suturing is a simple conservative procedure to stop postpartum haemorrhage in the case of failure of the usual management. This surgical technique can be performed quickly and does not seem to decrease fertility.
Trichomonas vaginalis is a very common, sexually transmitted, infection that may sometimes be asymptomatic or cause vaginitis and urethritis. Recently, it has been associated with adverse obstetric ...outcomes such as preterm delivery, low birth weight and premature rupture of membranes. Trichomonas vaginalis can be vertically transmitted at birth. It has been found in pharynx and low respiratory tract of neonates with respiratory disease. It has also been involved in some cases of intellectual disability. The recommended treatment is a 2g metronidazole oral single dose, even for asymptomatic patients. This treatment is effective against Trichomonas and its use is safe during pregnancy. We report here a case of Trichomonas vaginalis infection diagnosed during pregnancy in a patient with severe preterm labor. The patient being allergic to nitroimidazole antibiotics, she did not receive any treatment. She finally gave birth at 34 weeks of gestation (WG) and 5 days, with no other adverse outcome than small prematurity.
Fetal growth restriction (FGR) has been related to several health risks, which have been generally identified in small-for-gestational age (SGA) individuals.
To evaluate the impact of FGR on body ...composition and hormonal status in infants born either small- or appropriate-for-gestational age (AGA).
Fetal growth was assessed by ultrasound every 4 weeks from mid-gestation to birth in 248 high-risk pregnancies for SGA. Fetal growth velocity was calculated as change in the estimated fetal weight percentiles and FGR defined as its reduction by more than 20 percentiles from 22 gestational weeks to birth. Impact of FGR on body composition, cord insulin, IGF-I, IGF binding protein-3 (IGFBP-3), and cortisol concentrations was assessed in SGA and AGA newborns.
Growth-retarded AGA infants showed significantly reduced birth weight, ponderal index, percentage of fat mass, and bone mineral density when compared with AGA newborns with stable intrauterine growth. Cord IGF-I and IGFBP-3 concentrations were significantly decreased in growth-retarded infants in both SGA and AGA groups. Cord insulin concentration was significantly lower and cord cortisol significantly higher in AGA infants with FGR versus AGA newborns with stable intrauterine growth. After adjustment for gestational age and gender, birth weight was directly related to fetal growth velocity and cord IGF-I concentration. The variation in infant's adiposity was best explained by fetal growth velocity and cord insulin concentration.
FGR affects body composition and hormonal parameters in newborns with birth weight within the normal range, suggesting these individuals could be at similar metabolic risks as SGA. .
To assess the effectiveness of elective history-indicated cervical cerclage according to obstetrical history.
We analyzed pregnancy outcome of a retrospective cohort of women who have had ...history-indicated McDonald's cerclage. Principal outcome was gestational age (GA) at delivery.
Between January 2003 and December 2013, 205 women were included. We analyzed population in two risk groups: 1- Low-risk (≤2 prior preterm birth (PTB)/second trimester loss (STL), or prior success of cerclage), 2- High risk (≥3 prior PTB/STL, or prior failure of cerclage). In the high-risk group, there was a higher frequency of deliveries before 37 weeks (47.5% vs. 24.5%, P=0.001, OR=2.79, 95% CI 1.49–5.23). Fifty percent of women (n=6/12) delivered before 37 weeks in case of three or more prior PTB/STL, and 51% (n=24/47) in case of prior failure of cervical cerclage.
Elective cervical cerclage may be indicated for women with≤2 prior PTB/STL, or prior successful cerclage. For women with≥3 prior PTB/STL, trachelorraphy or cervico-isthmic cerclage could be possible alternatives to cervical cerclage.
Abstract Objective To evaluate the obstetric results of trachelorraphy in the prevention of recurrent second trimester loss in cases of prior failed vaginal cerclage. Study design Data were collected ...retrospectively and prospectively from medical records. The analysis examined data for 18 women who underwent trachelorraphy between 2004 and 2013 at a tertiary referral unit in France. All patients in this high-risk population had a history of two or more second trimester losses, or one second trimester loss and one preterm labour, and at least one prior failed transvaginal cerclage. The main outcome measures were: livebirth rate; rate of second trimester loss; and surgical complications. Results Twenty pregnancies were conceived in 16 patients following trachelorraphy. Three patients experienced two pregnancies. Among the 20 pregnancies, there was one case of fetal loss in the first trimester; this pregnancy was excluded from the analysis. Of the remaining 19 pregnancies, there were nine (47%) term deliveries (after 37 weeks of gestation), seven (32%) preterm deliveries and three (16%) second trimester losses. The overall fetal survival rate was 84%. Surgical outcomes were excellent, with no complications. Conclusion Trachelorraphy is a safe, reproducible, easy-to-learn procedure for the prevention of recurrent second trimester loss in cases of prior failed vaginal cerclage. The procedure has encouraging and favourable perinatal outcomes in patients with a poor obstetric history.
Please cite this paper as: Boulkedid R, Sibony O, Bossu‐Salvador C, Oury J, Alberti C. Monitoring healthcare quality in an obstetrics and gynaecology department using a CUSUM chart. BJOG ...2010;117:1225–1235.
Objective To use cumulative sum (CUSUM) charts for the early detection of variations in quality of care in a maternity department.
Design Retrospective analysis of prospectively collected data.
Setting Maternity department of a teaching hospital in Paris (France).
Population Data from 20 519 women and 21 448 infants were collected between January 2000 and December 2007.
Methods CUSUM charts were used to monitor the rate of 19 pre‐selected quality indicators over 3 years (2005–2007), against standards developed by department obstetrician gynaecologists. Periods with adverse event rates that did not meet the standards were identified.
Main outcome measures Quality indicator rates.
Results Indicators fell into three groups based on the number of periods with unacceptable rates: less than one per year e.g. the rate of intensive care unit (ICU) admission of mothers and rate of third‐ or fourth‐degree perineal tears; one every 2–12 months on average (e.g. blood transfusion and sulprostone use in the overall population of women); and at least one per month (insufficient availability of epidural analgesia).
Conclusion CUSUM charts for a broad range of quality indicators can be used to monitor the quality of care in an obstetrics department. A prospective study investigating the ability of CUSUM‐based monitoring to improve maternal and neonatal outcomes would be of interest.
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