International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2020
Observational StudyThe association between the introduction of quantitative assessment of postpartum blood loss and institutional changes in clinical practice: an observational study.
Imprecise visual estimates of blood loss contribute to morbidity from postpartum hemorrhage. We examined the impact of quantitative assessment of postpartum blood loss on clinical practice and outcomes. ⋯ Quantifying blood loss may result in increased vigilance for vaginal and cesarean delivery. We identified an association between quantifying blood loss and improved identification of postpartum hemorrhage, patient management steps and cost savings.
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Int J Obstet Anesth · May 2020
Antisepsis for neuraxial procedures in Irish obstetric units and its possible impact on patient safety. A survey of national practice and associated complications.
The Association of Anaesthetists' guidelines recommend 0.5% chlorhexidine gluconate for skin antisepsis before obstetric neuraxial procedures. In this national survey, we identified the practice of all 19 obstetric units in Ireland. A secondary aim was to investigate complications in units not following guidelines. ⋯ Twenty-one percent of obstetric anaesthesia units in Ireland, catering for one-third of the total deliveries, use the ChloraPrep™ swab-stick and consider it the safest form of application. Chlorhexidine gluconate has been implicated in devastating neurological injury, however there is no evidence that a less concentrated solution such as 0.5% is safer. We suggest a meticulous application technique should be considered more important for patient safety than the concentration of solution.
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Int J Obstet Anesth · May 2020
Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour.
The effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother. ⋯ This study is the first to examine fetal and maternal fentanyl concentrations after subcutaneous administration. This research supports the safe use of fentanyl for labour analgesia for women.