Abstract：
BACKGROUND:A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. METHODS:A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records. RESULTS:There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55-95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively. CONCLUSIONS:Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.
journal_name
Int J Obstet Anesthjournal_title
International journal of obstetric anesthesiaauthors
Margarido C,Ferns J,Chin V,Ribeiro T,Nascimento B,Barrett J,Herer E,Halpern S,Andrews L,Ballatyne G,Chapmam M,Gomes J,Callum Jdoi
10.1016/j.ijoa.2018.10.004subject
Has Abstractpub_date
2019-05-01 00:00:00pages
37-45eissn
0959-289Xissn
1532-3374pii
S0959-289X(18)30193-6journal_volume
38pub_type
杂志文章abstract：:Current pain and analgesic management strategies apply a standardized one-size-fits-all approach to women undergoing cesarean delivery. These standardized protocols do not account for significant variability in women's pain and may lead to under-treatment in patients with high analgesic needs and overtreatment, associ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2019.02.124
更新日期：2019-11-01 00:00:00
abstract：:Urticaria pigmentosa is a cutaneous variant of mastocytosis. This is a complex group of diseases distinguished by abnormal aggregation of mast cells within the skin and other organs. Mast cell degranulation and subsequent release of vasoactive amines may occur in response to a variety of non-immune triggers leading to...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(98)80049-6
更新日期：1998-10-01 00:00:00
abstract：:Kartagener's syndrome is an inherited disease characterized by a triad of symptoms: bronchiectasis, situs inversus and sinusitis resulting from defective cilial motility. There are few reports in the literature regarding the optimum anesthetic technique in patients with Kartagener's syndrome. The main anesthetic consi...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2006.11.014
更新日期：2007-07-01 00:00:00
abstract：:We present a case in which remifentanil infusion was used to provide analgesia during epidural catheter placement in a parturient who was experiencing great difficulty staying motionless because of extremely painful uterine contractions. Remifentanil may provide certain advantages in this setting, including improved a...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(98)90009-7
更新日期：1998-04-01 00:00:00
abstract：BACKGROUND:We have previously reported that measurement of non-invasive blood pressure during caesarean section under spinal anaesthesia fails in over 50% of cases. We felt that errors would be less likely if blood pressure could be measured at the ankle as it is immobile during caesarean section. The purpose of our st...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2005.04.016
更新日期：2006-01-01 00:00:00
abstract：BACKGROUND:Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. METHODS:We used a root cause ana...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2018.05.007
更新日期：2018-11-01 00:00:00
abstract：BACKGROUND:Intrathecal tramadol combined with local anaesthetics has been used for postoperative analgesia following lower abdominal and perineal surgery. The present study evaluated the effect of intrathecal tramadol on spinal block characteristics and neonatal outcome after elective caesarean section. METHODS:Eighty...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2013.05.009
更新日期：2013-11-01 00:00:00
abstract：:Primary pulmonary hypertension, though uncommon, is found relatively frequently in women of childbearing age and carries a high peripartum mortality. We present a patient with severe primary pulmonary hypertension who underwent two cesarean sections 3 and 6 years after the diagnosis of primary pulmonary hypertension w...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(96)80072-0
更新日期：1996-01-01 00:00:00
abstract：:A 30-year-old woman was admitted to the labour ward at term complaining of symptoms suggestive of raised intracranial pressure which were overlooked. Epidural analgesia was administered following induction of labour and was associated with a clear exacerbation of symptoms. After delivery a CT scan revealed a large cer...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(95)83004-2
更新日期：1995-04-01 00:00:00
abstract：BACKGROUND:Early studies suggested that ropivacaine had clinical advantages over bupivacaine with respect to cardiotoxicity and motor block, and that it was suitable for epidural caesarean section. This study was set up to compare epidural 0.75% ropivacaine with a popular bupivacaine/fentanyl mixture for elective caesa...
journal_title：International journal of obstetric anesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/j.ijoa.2005.01.002
更新日期：2005-07-01 00:00:00
abstract：BACKGROUND:This systematic review and meta-analysis evaluates evidence for seven risk factors associated with failed conversion of labor epidural analgesia to cesarean delivery anesthesia. METHODS:Online scientific literature databases were searched using a strategy which identified observational trials, published bet...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,meta分析,评审
doi：10.1016/j.ijoa.2012.05.007
更新日期：2012-10-01 00:00:00
abstract：:Paracetamol is the most frequently used analgesic during pregnancy and the most common drug involved in suicidal overdose in the UK. Manifestation of toxicity classically occurs over four phases with clinical and laboratory features resembling HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We repo...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2014.01.006
更新日期：2014-05-01 00:00:00
abstract：:In order to estimate how long a medication can remain prepared before the integrity or concentration of the drug is compromised, we assessed the sterility and potency of medications commonly used in our obstetric anesthesia practice. Our goal was to evaluate the following drugs over a 30-day period: epinephrine, atrop...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.2002.0983
更新日期：2002-10-01 00:00:00
abstract：BACKGROUND:A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread o...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2015.08.004
更新日期：2015-11-01 00:00:00
abstract：:Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. It is usually self-limiting or relatively easily treate...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2013.08.012
更新日期：2014-02-01 00:00:00
abstract：:Neurofibromatosis type 2 is an extremely rare form of neurofibromatosis characterized by central nervous system involvement with bilateral vestibular schwannomas and spinal tumors. Anesthetic management of a parturient with neurofibromatosis type 2 has not been fully reported, and the condition is challenging to obste...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2005.02.007
更新日期：2005-10-01 00:00:00
abstract：:The aim of the 2012 "What's new in obstetric anesthesia?" review is to highlight important scientific and medical advances in the fields of obstetric anesthesiology, obstetrics and perinatology from literature published in 2011. This review will consider advances in the prevention and treatment of important obstetric ...
journal_title：International journal of obstetric anesthesia
pub_type：
doi：10.1016/j.ijoa.2012.08.005
更新日期：2012-10-01 00:00:00
abstract：BACKGROUND:The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, ar...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2016.01.004
更新日期：2016-05-01 00:00:00
abstract：:We review the evidence base for fluid management in pre-eclampsia. Current understanding of the relevant pathophysiology and the possible impact of styles of fluid management on maternal and fetal outcome are presented. There is little evidence upon which to base the management of fluid balance in pre-eclampsia. Repor...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(99)80106-x
更新日期：1999-10-01 00:00:00
abstract：:In the following case there was delay in diagnosing uterine rupture in a patient with an epidural in situ. The danger of using large doses of local anaesthetics and opioids epidurally in patients who have had previous caesarean sections is discussed. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(95)82920-6
更新日期：1995-10-01 00:00:00
abstract：BACKGROUND:Although persistent pain has been described to occur after various types of surgery, little is known about this entity following caesarean section or vaginal birth. We sought to examine the association between mode of delivery and development of persistent pain, as well as the nature and intensity of the pai...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.03.013
更新日期：2010-01-01 00:00:00
abstract：BACKGROUND:Onset times and conditions for intubation after rocuronium versus suxamethonium at cesarean section have been evaluated, but no study thus far has examined the influence of these neuromuscular blocking drugs on the surgical conditions or their effect on the duration of surgery and the ease of fetal delivery....
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2019.08.005
更新日期：2020-02-01 00:00:00
abstract：:Rupture of an aneurysm of the renal or splenic arteries remains a rare but catastrophic complication of pregnancy with a generally dismal prognosis for both mother and fetus. Improvements in abdominal imaging for incidental conditions are unlikely to lead to earlier diagnosis of such abnormalities antenatally, hence c...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/S0959-289X(02)00187-5
更新日期：2003-04-01 00:00:00
abstract：:The opioid crisis has reached an unprecedented magnitude in the United States and worldwide, and data on opioid use and misuse in the obstetric population are extremely concerning. Despite an abundant number of studies evaluating strategies to prevent neonatal opioid withdrawal syndrome in babies born to mothers who a...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,评审
doi：10.1016/j.ijoa.2019.01.011
更新日期：2019-08-01 00:00:00
abstract：:We report a case of akathisia developed after administration of 2.5 mg metoclopramide for treatment of nausea during cesarean section. The relevant literature as well as options for prevention and treatment of this phenomenon are reviewed. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1054/ijoa.1999.0346
更新日期：2000-04-01 00:00:00
abstract：BACKGROUND:Clinically overt infections of the epidural catheter skin entry site occur in approximately 1-5% of patients after a few days of catheterization but serious complications such as deep tissue infection or epidural abscess appear rare in the obstetric population. In recent years, sporadic reports and small ser...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/j.ijoa.2009.06.001
更新日期：2010-01-01 00:00:00
abstract：BACKGROUND:After accidental dural puncture in labour it is suggested that inserting an intrathecal catheter and converting to spinal analgesia reduces postdural puncture headache and epidural blood patch rates. This treatment has never been tested in a controlled manner. METHODS:Thirty-four hospitals were randomised t...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ijoa.2011.10.005
更新日期：2012-01-01 00:00:00
abstract：:Patients with dystrophia myotonica requiring caesarean section pose significant problems for the anaesthetist. This report describes the successful use of a combined spinal-epidural technique for anaesthesia and postoperative analgesia in such a patient. ...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/s0959-289x(96)80051-3
更新日期：1996-10-01 00:00:00
abstract：:Any convulsion during labour requires immediate action, but before this can occur a correct diagnosis must be made. Here we describe a case where a 'fit' was wrongly attributed to epidural analgesia. This was in fact a dystonic reaction secondary to undeclared self-medication with metoclopramide. It is therefore impor...
journal_title：International journal of obstetric anesthesia
pub_type： 杂志文章
doi：10.1016/0959-289x(93)90088-y
更新日期：1993-01-01 00:00:00
abstract：:Congenital complete heart block is a rare phenomenon that may be discovered during pregnancy in patients who were previously asymptomatic. Peripartum management of these patients mandates a multidisciplinary approach with careful planning regarding indications for pacing, appropriate anesthetic technique, and continge...
journal_title：International journal of obstetric anesthesia
pub_type：
doi：10.1016/j.ijoa.2020.07.012
更新日期：2020-11-01 00:00:00
