Seminars in perinatology
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Seminars in perinatology · Apr 2009
ReviewUterine atony: definition, prevention, nonsurgical management, and uterine tamponade.
Uterine atony, or failure of the uterus to contract following delivery, is the most common cause of postpartum hemorrhage. This review serves to examine the prevention and treatment of uterine atony, including risk-factor recognition and active management of the third stage of labor. ⋯ Oxytocin and ergot alkaloids represent the cornerstone of uterotonic therapy, while prostaglandin therapy has been studied more recently as an attractive alternative, particularly for resource-poor settings. Newer supplementary medical therapies, such as recombinant factor VII and hemostatic agents, and adjunctive nonsurgical methods aimed at achieving uterine tamponade will be evaluated.
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Postpartum hemorrhage (PPH) is an obstetric emergency that can occur following vaginal or cesarean delivery. Rapid diagnosis of PPH using laboratory and clinical parameters is an important first step in its management. Traditional blood components, including packed red blood cells, platelets, plasma, and cryoprecipitate, should be used in patients with significant bleeding. ⋯ Disseminated intravascular coagulation (DIC) should be considered in severely bleeding obstetric patients and should be treated aggressively using blood components. Newer hemostatic agents, such as activated factor VII, will play significant roles in patients with bleeding that is refractory to standard therapy. Implementation of an obstetric bleeding protocol that integrates new knowledge in coagulation should aid physicians in improving outcomes for the mother and her fetus.
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Seminars in perinatology · Apr 2009
Optimizing outcomes through protocols, multidisciplinary drills, and simulation.
Delay in diagnosis, failure to employ sufficient medical and surgical treatments, and poor teamwork all may contribute to suboptimal outcomes in cases of postpartum hemorrhage. A significant portion of hemorrhage-related maternal morbidity may be prevented through early diagnosis and rapid intervention. There is a small but growing body of literature describing the role of patient safety initiatives and simulation training in optimizing outcomes following postpartum hemorrhage. ⋯ Hemorrhage drills and simulation-based training may help providers achieve timely and coordinated responses in the treatment of postpartum hemorrhage. Protocol may help to standardize management in cases of postpartum hemorrhage, thereby minimizing unnecessary errors or delays in care. Additional research is warranted to further determine the impact of patient safety initiatives and simulation training on outcomes in the setting of obstetric hemorrhage.