Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Clinical Trial
Effect of nalbuphine hydrochloride on the active phase during first stage of labour: a pilot study.
The aim of this pilot study was to determine whether nalbuphine shortens the duration of the active phase during the first stage of labour in pregnant women. Among 1,619 deliveries, we enrolled 302 pregnant women between March 2003 and August 2005. ⋯ The average duration of the initial active phase was 75 and 160 min for the case and control groups, respectively. The reduced duration of the active phase in the case group occurred regardless of oxytocin infusion (p < 0.01) and was without significant risks.
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Comparative Study
Does carbetocin for prevention of postpartum haemorrhage at caesarean section provide clinical or financial benefit compared with oxytocin?
Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. ⋯ A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.
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On the labour ward, the key to achieving patient safety is the intershift handover, which affords an opportunity for the team to undertake a baseline assessment of the current situation, anticipate problems, plan contingencies and subsequently maintain situational awareness. If optimised, the handover has immense potential not only for enhancing patient safety but also for reducing stress to staff. ⋯ Each maternity unit should have a Structured Multidisciplinary Intershift Handover (SMITH) protocol, which encompasses pre-handover, handover and post-handover guidance. This paper describes the underlying principles, benefits and content of a SMITH protocol.