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Mousa HA, Alfirevic Z. Treatment for primary postpartum haemorrhage . Cochrane Database Syst Rev 2007; 24: CD003249 .
Abstract

BACKGROUND: Primary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries. OBJECTIVES: To assess the effectiveness and safety of pharmacological, surgical and radiological interventions used for the treatment of primary PPH. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2006). SELECTION CRITERIA: Randomised controlled trials comparing pharmacological, surgical techniques and radiological interventions for the treatment of PPH. DATA COLLECTION AND ANALYSIS: We assessed studies for eligibility and quality, and extracted data, independently. We contacted authors of the included studies for more information. MAIN RESULTS: Three studies (462 participants) were included. Two placebo-controlled randomised trials compared misoprostol (dose 600 to 1000 mcg) with placebo and showed that misoprostol use was not associated with any significant reduction of maternal mortality (two trials, 398 women; relative risk (RR) 7.24, 95% confidence interval (CI) 0.38 to 138.6), hysterectomy (two trials, 398 women; RR 1.24, 95% CI 0.04 to 40.78), the additional use of uterotonics (two trials, 398 women; RR 0.98, 95% CI 0.78 to 1.24), blood transfusion (two trials, 394 women; RR 1.33, 95% CI 0.81 to 2.18), or evacuation of retained products (one trial, 238 women; RR 5.17, 95% CI 0.25 to 107). Misoprostol use was associated with a significant increase of maternal pyrexia (two trials, 392 women; RR 6.40, 95% CI 1.71 to 23.96) and shivering (two trials, 394 women; RR 2.31, 95% CI 1.68 to 3.18).One unblinded trial showed better clinical response to rectal misoprostol compared with a combination of syntometrine and oxytocin. We did not identify any trial dealing with surgical techniques, radiological interventions or haemostatic drugs for women with primary PPH unresponsive to uterotonics. AUTHORS' CONCLUSIONS: There is insufficient evidence to show that the addition of misoprostol is superior to the combination of oxytocin and ergometrine alone for the treatment of primary PPH. Large multi-centre, double-blind, randomised controlled trials are required to identify the best drug combinations, route, and dose of uterotonics for the treatment of primary PPH. Further work is required to assess the best way of managing women who fail to respond to uterotonics therapy.

 
Chichester M. When your patient is from the obstetric department: postpartum hemorrhage and massive transfusion. J Perianesth Nurs Jun 2005; 20: 167-76.
Abstract

When caring for patients receiving massive transfusion, the nurse will be required to perform ongoing assessments and apply critical thinking to provide optimum care and avoid further complications. The perianesthesia nurse must be aware of the hemodynamic and coagulation changes of pregnancy when caring for an obstetric patient in the PACU to optimize patient outcomes. Understanding the causes of obstetric hemorrhage, which may result in the need for massive transfusion, will enable the nurse to anticipate and prevent potentially deadly complications.

 
Mello MM, Studdert DM, Kachalia AB, Brennan TA. "Health courts" and accountability for patient safety. Milbank Q 84: 459-92.
Abstract

Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations.

 
Stoll K, Fairbrother N, Carty E, Jordan N, Miceli C, Vostrcil Y, Willihnganz L . "It's All the Rage These Days": University Students' Attitudes Toward Vaginal and Cesarean Birth. Birth 36: 133-140.
Abstract

Background: At 30 percent, British Columbia has the highest cesarean section
rate in Canada. Little is known about the childbirth views and birthing preferences of college aged women and men. The objectives of this study were to document (a) the prevalence of cesarean versus vaginal delivery as the preferred mode of delivery among nonpregnant university students without a history of childbirth, (b) the reasons for reported childbirth preferences, and (c) confidence in vaginal birth as a predictor of childbirth preference.
Methods: A cohort of 3,680 male and female university students without a history of childbirth participated in an online survey of childbirth preferences. The study used a mixed methods approach (quantitative thematic analysis and logistic regression modeling). Prevalence of, and reasons for, preferred mode of delivery were analyzed separately for male and female respondents.
Results: Most men and women responded that they preferred vaginal delivery, with 9 percent stating a preference for cesarean delivery. Reasons for preferred mode of delivery were similar for men and women. For women, confidence in vaginal birth emerged as a significant predictor of childbirth preference.
Conclusions: Results indicate that a preference for cesarean section is linked to fear of childbirth and driven by low confidence in vaginal birth. Educational
strategies targeting university-aged men and women may be helpful in alleviating fears of vaginal birth and providing evidence-based information about different birth options.

 
DeFrances CJ, Hall MJ, . 2005 National Hospital Discharge Data. CDC Dept of Health and Human Services 385: 1-20.
Abstract

Objectives—This report presents national estimates of the use of nonfederal short-stay hospitals in the United States during 2005 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex.
Methods—The estimates are based on data collected through the 2005 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by NCHS since 1965. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM).
Results—Trends in the utilization of nonfederal short-stay hospitals show that the overall average length of a hospital stay has declined significantly. In 2005, the average length of stay for all inpatients was 4.8 days compared with 7.8 days in 1970. Stays for discharges aged 15–44, 45–64 and 65 years and over also declined, but the average lengths of stay for those under 15 years of age were the same in 1970 and 2005.
In 2005, there were an estimated
34.7 million hospital discharges, excluding newborn infants. Persons aged 65 years and over comprised 38 percent of all inpatients. One notable trend for elderly people is that their rate of hospitalization for septicemia increased 47 percent from 2000 to 2005.
There were 45 million procedures performed on inpatients during 2005. Obstetrical procedures (6.9 million) comprised 25 percent of all procedures performed on females. Cesarean section (18 percent), repair of current obstetric laceration (18 percent), and artificial rupture of membranes (14 percent) accounted for one-half of all obstetrical procedures. Males had more cardiovascular procedures than females (4.1 million compared with
2.9 million), whereas females had more operations on the digestive system than males (3.2 million compared with 2.4 million).

CDC. 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients.
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SUMMARY: Likely the best and most comprehensive vaccine Q+A sheet for pregnant women.

CDC. 2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers.
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SUMMARY: very comprehensive set of Q+A for clinicians about the use of H1N1 vaccine in pregnancy.

 
Louis JK, Jamieson DJD, Rasmussen SA. 2009 pandemic influenze A (H1N1) virus infection in postpartum women in California. AJOG 204: 144.e1-6.
Abstract

OBJECTIVE: The objective of the study was to characterize severe illness because of the 2009 pandemic influenza A (H1N1) infection in postpartum women.
STUDY DESIGN: We reviewed case reports of infected hospitalized postpartum (6 months from delivery) women identified through statewide surveillance in California. From April 23 through August 11, 2009, all hospitalizations and/or deaths were reported. After August 11, reporting was limited to cases requiring intensive care or deaths.
RESULTS: From April 23 to December 31, 2009, 15 cases were reported; 11 (73%) had symptom onset within 7 days postpartum. Of 10 hospitalized cases reported through August 11, 4 required intensive care, 3 required mechanical ventilation, and 2 died. Of 5 cases requiring intensive care reported after August 11, all required mechanical ventilation and 1 died. Overall, 6 (43%) received antivirals within 48 hours of symptom onset.
CONCLUSION: The 2009 H1N1 can cause severe illness in postpartum women, especially in the first week following delivery.

 
CDC, Emory School of Medicine. 2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness .
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SUMMARY: This is an algorithm developed by the Emory School of Medicine and used widely on the East Coast. ACOG has adopted it with minor modifications for use in telephone triage for OB's offices. Teo key elements for OB's are: 1) be sure the patient knows to call back and seek care if she worsens or does not improve, and 2) there needs to be a clear plan and site for evaluation other than the OB's office.

ACOG. 2009–2010 Influenza Season Assessment and Treatment for Pregnant Women with Influenza-Like Illness.
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This guideline represents a tweaking of the CDC/Emory evaluation algorithm to be pregnancy specific. It is an excellent summary of current thinking.