International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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Int J Gynaecol Obstet · Nov 2012
Clinical characteristics and outcomes of obstetric patients admitted to the intensive care unit.
To identify the reasons for admitting pregnant women to intensive care units (ICUs) in Buenos Aires, Argentina. ⋯ Postpartum hemorrhage and hypertensive disorders were the most common reasons for admitting pregnant women to an ICU, followed by sepsis. Nonobstetric causes of admission were associated with higher morbidity and mortality rates.
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Int J Gynaecol Obstet · Oct 2012
Misoprostol for prevention and treatment of postpartum hemorrhage: what do we know? What is next?
Misoprostol is an effective and safe uterotonic for the prevention and treatment of postpartum hemorrhage (PPH). A 600-μg oral dose of misoprostol has been shown to prevent PPH in community-based randomized controlled trials. ⋯ These effects are transient, resolve on their own, and are not life threatening. Misoprostol can play an important role in settings with limited access to oxytocin, and where there is no other option for PPH care.
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Int J Gynaecol Obstet · Oct 2012
Randomized Controlled TrialPreoperative music intervention for patients undergoing cesarean delivery.
To evaluate the effects of music played preoperatively in women undergoing elective cesarean delivery. ⋯ A preoperative music intervention can reduce anxiety and pain in women undergoing cesarean delivery.
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Int J Gynaecol Obstet · Oct 2012
Applying human rights to improve access to reproductive health services.
Universal access to reproductive health is a target of Millennium Development Goal (MDG) 5B, and along with MDG 5A to reduce maternal mortality by three-quarters, progress is currently too slow for most countries to achieve these targets by 2015. Critical to success are increased and sustainable numbers of skilled healthcare workers and financing of essential medicines by governments, who have made political commitments in United Nations forums to renew their efforts to reduce maternal mortality. ⋯ Health advocates are using human rights mechanisms to ensure governments honor their legal commitments to ensure access to services essential for reproductive health. Maternal mortality is recognized as a human rights violation by the United Nations and constitutional and human rights are being used, and could be used more effectively, to improve maternity services and to ensure access to drugs essential for reproductive health.
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Transfusion therapy in postpartum hemorrhage (PPH) traditionally has been modeled after precedents set in the Vietnam and Korean wars. However, data from recent military combat casualties suggest a different transfusion strategy. Transfusion of packed red blood cells, fresh frozen plasma, and platelets in a ratio of 1:1:1 improves dilutional coagulopathy and survival. ⋯ Observational data suggest that the use of recombinant factor VIIa should be limited to bleeding that has not responded to an optimal transfusion strategy. Point-of-care testing using thromboelastography is helpful in guiding the selection of blood products to be transfused. Additionally, massive transfusion protocols can decrease the overall number of products transfused and improve outcomes.