International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2022
Multicenter StudyQuantitative blood loss after vaginal delivery: a retrospective analysis of 104 079 measurements at 41 institutions.
Peripartum quantitative blood loss (QBL) measurement is recommended over visual estimation. However, QBL measurement after vaginal delivery has been inadequately evaluated. The primary aim of this study was to determine the characteristics of QBL measurements from a large, multicenter cohort of patients having vaginal deliveries. We also determined the incidence of postpartum hemorrhage (PPH) and the relationship between gravimetric QBL from weighed sponges vs. volumetric QBL from liquid drape or suction cannister contents. ⋯ Results from this large set of QBL measurements and the PPH incidence provide normative "real-world" clinical care values that can be expected as hospitals transition from estimated blood loss to QBL to assess the blood loss at vaginal delivery.
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Int J Obstet Anesth · Aug 2022
Randomized Controlled TrialThe incidence of breakthrough pain associated with programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trial.
In this randomized, blinded study, we evaluated the effects of different programmed intermittent epidural bolus (PIEB) volumes for labor analgesia on the incidence of breakthrough pain and other analgesic outcomes. ⋯ The larger PIEB volumes were preferred for epidural labor analgesia compared with a smaller volume because of improved analgesia without clinically significant increases in adverse effects.
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Int J Obstet Anesth · Aug 2022
Development of clinical risk-prediction models for uterine atony following vaginal and cesarean delivery.
Uterine atony is the most common cause of postpartum hemorrhage and is associated with substantial morbidity. Prospectively identifying women at increased risk of atony may reduce the incidence of subsequent adverse events. We sought to develop and evaluate clinical risk-prediction models for uterine atony following vaginal and cesarean delivery, using prespecified risk factors identified from systematic review. ⋯ We identified antepartum and intrapartum risk-prediction models to quantify patients' risk of uterine atony. Models performed similarly for all delivery modes, races, and ethnic groups. Future work should further improve these models through inclusion of more comprehensive prediction data.
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Int J Obstet Anesth · Aug 2022
The effect of open-end versus closed-end epidural catheter design on injection pressure and dye diffusion under various programmed intermittent epidural delivery rates: an in vitro study.
Epidural catheter design may impact injection pressure and analgesic outcomes under programmed intermittent epidural bolus regimens. This in vitro study aimed to compare the injection pressure and dye diffusion between open-end and closed-end catheters at varying delivery rates. ⋯ At high delivery rates (>360 mL/h), the closed-end catheter had no advantages over the open-end catheters in diffusion distance or area. When using a close-ended catheter and high delivery rates, the peak pressure generated might trigger the occlusion alarm.