Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
-
We studied a random sample of four teams of doctors and midwives who participated in a videotaped simulated obstetric emergency, postpartum haemorrhage, before and after 'on-site' clinical training. We aimed to assess the validity of mixed techniques for the analysis of team communication and whether clinical and non-clinical team training improve communication. Two of the four teams received extra training in specific teamwork behaviours (TW+), the other half received only clinical training (TW-). ⋯ Teams that received additional teamwork training used more directed commands after training. When commands were directed to specific individuals, tasks were more likely to be acknowledged and performed. We conclude that 'on-site' clinical drills can improve team communication in simulated emergencies, and additional teamwork training might improve this further, but it has to be refined and made obstetric specific first.
-
Relationship between visually estimated blood loss at delivery and postpartum change in haematocrit.
This study was to assess blood loss using visual estimation and change in postpartum haematocrit value following vaginal delivery, and to study any relationship that may exist. A total of 152 parturients who had had vaginal delivery were studied. Blood loss at delivery was visually estimated. ⋯ It was concluded that postpartum haematocrit has a significant negative non-linear correlation with VEBL. In the absence of primary postpartum haemorrhage, majority of women have either the same or an increased haematocrit following vaginal delivery. Consequently, routine haematocrit estimation in parturients with visual estimated blood loss of <500 ml barely confers any cost benefit.
-
Randomized Controlled Trial Comparative Study
A randomised controlled trial comparing the efficacy of intramuscular syntometrine and intravenous syntocinon, in preventing postpartum haemorrhage.
This randomised controlled trial aimed to compare the efficacy of intramuscular syntometrine with intravenous syntocinon, in preventing postpartum haemorrhage. A total of 686 women were randomised into two groups; one receiving intramuscular syntometrine and the other receiving intravenous syntocinon, as part of the active management of the third stage of labour. ⋯ However, there was an increased incidence of having a diastolic blood pressure of >90, 30 min after the delivery (p = 0.004), with intramuscular syntometrine. Therefore, it can be concluded that 1 ml of intramuscular syntometrine and 10 units of intravenous syntocinon are equally effective in preventing postpartum haemorrhage.
-
Fetal macrosomia represents a continuing challenge in obstetrics, as it has risk of shoulder dystocia leading to transient or permanent fetal, maternal injury and medicolegal liability. The overall incidence of macrosomia has been rising. Non-diabetic macrosomia is still an obstetric dilemma, as there is no clear consensus regarding its ante-partum prediction and management, as accurate diagnosis is only made retrospectively. ⋯ Pre-pregnancy and ante-partum risk factors and ultrasound have poor predictive value. Induction of labour and prophylactic caesarean delivery has not been shown to alter the incidence of shoulder dystocia among nondiabetic patients. Caesarean section and induction of labour are associated with increased risk of operative morbidity and mortality with added cost implications.
-
Comparative Study
Fetal macrosomia in non-diabetic mothers: antenatal diagnosis and delivery outcome.
This is a retrospective study of 74 non-diabetic women that delivered babies in excess of 4,500 g. The women were divided into two groups, depending on whether there had been suspected macrosomia antenatally or not. ⋯ Women diagnosed with a macrosomic fetus were more likely to have elective caesarean sections or premature induction of labour. Those women in whom macrosomia was not suspected had higher rates of vaginal deliveries without any increase in neonatal morbidity.