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Escobar MF, Valencia P, Jaimes LM, Hincapié LC, Pulgarín EE, Nasner D, Carvajal J, Echavarría MP, Burke T, Prada S. Resource use decrease after implementation of care bundles for treatment of postpartum hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7874-7881. [PMID: 34112062 DOI: 10.1080/14767058.2021.1937989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). METHODS Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011-2014 and 2015-2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. RESULTS The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). CONCLUSIONS The use of PPH care bundles may be associated with lower resource use and fewer interventions.
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Affiliation(s)
- María Fernanda Escobar
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paola Valencia
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia
| | | | | | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Paula Echavarría
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Thomas Burke
- Department of Emergency Medicine Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sergio Prada
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.,Centro PROESA, Universidad Icesi, Cali, Colombia
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Giurazza F, Angileri SA, Corvino F, Granata G, Grillo P, Savoldi AP, Albano G, Bracchi L, Carrafiello G, Niola R. Postpartum Hemorrhages: Prevention. Semin Ultrasound CT MR 2021; 42:85-94. [PMID: 33541592 DOI: 10.1053/j.sult.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The strict correlation between abnormal invasive placentation and postpartum hemorrhage suggests that a widespread antenatal diagnosis of placental anomalies would improve the management of these challenging patients; acting preventive solutions at the moment of delivery reduces blood loss and avoid hysterectomies. The role of endovascular procedures in this field has been encouraged by multiple studies reporting prophylactic uterine arteries embolization and iliac/aortic balloon catheters positioning. This paper aims to review the main imaging diagnostic findings of placental implant anomalies and summarize the principal preventive endovascular strategies proposed in literature.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy.
| | | | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | - Giuseppe Granata
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Pasquale Grillo
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | - Anna Paola Savoldi
- Postgraduate School in Radiodiagnostic, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan, Italy
| | | | - Laura Bracchi
- Diagnostic and Therapeutic Imaging Department, Cerba Healthcare Italia, Milan, Italy
| | | | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
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3
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Diaz-Martinez A, Mas-Cabo J, Prats-Boluda G, Garcia-Casado J, Cardona-Urrego K, Monfort-Ortiz R, Lopez-Corral A, De Arriba-Garcia M, Perales A, Ye-Lin Y. A Comparative Study of Vaginal Labor and Caesarean Section Postpartum Uterine Myoelectrical Activity. SENSORS 2020; 20:s20113023. [PMID: 32466584 PMCID: PMC7308960 DOI: 10.3390/s20113023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 05/23/2020] [Indexed: 11/16/2022]
Abstract
Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality and morbidity worldwide, with uterine atony being the most common origin. Currently there are no obstetrical techniques available for monitoring postpartum uterine dynamics, as tocodynamometry is not able to detect weak uterine contractions. In this study, we explored the feasibility of monitoring postpartum uterine activity by non-invasive electrohysterography (EHG), which has been proven to outperform tocodynamometry in detecting uterine contractions during pregnancy. A comparison was made of the temporal, spectral, and non-linear parameters of postpartum EHG characteristics of vaginal deliveries and elective cesareans. In the vaginal delivery group, EHG obtained a significantly higher amplitude and lower kurtosis of the Hilbert envelope, and spectral content was shifted toward higher frequencies than in the cesarean group. In the non-linear parameters, higher values were found for the fractal dimension and lower values for Lempel-Ziv, sample entropy and spectral entropy in vaginal deliveries suggesting that the postpartum EHG signal is extremely non-linear but more regular and predictable than in a cesarean. The results obtained indicate that postpartum EHG recording could be a helpful tool for earlier detection of uterine atony and contribute to better management of prophylactic uterotonic treatment for PPH prevention.
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Affiliation(s)
- Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Javier Mas-Cabo
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Karen Cardona-Urrego
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Rogelio Monfort-Ortiz
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Angel Lopez-Corral
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Maria De Arriba-Garcia
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Alfredo Perales
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
- Correspondence: ; Tel.: +34-96-387-70-00 (ext. 76026)
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Poder TG. Water immersion during labor and birth: is there an extra cost for hospitals? J Eval Clin Pract 2017; 23:498-501. [PMID: 27592846 DOI: 10.1111/jep.12636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Water immersion during labor and birth is growing in popularity, and many hospitals are now considering offering this service to laboring women. Some advantages of water immersion are demonstrated, but others remain uncertain, and particularly, few studies have examined the financial impact of such a device on hospitals. This study simulated what could be the extra cost of water immersion for hospitals. MATERIALS AND METHODS Clinical outcomes were drawn from the results of systematic reviews already published, and cost units were those used in the Quebec health network. A decision tree was used with microsimulations of representative laboring women. Sensitivity analyses were performed as regards analgesic use and labor duration. RESULTS Microsimulations indicated an extra cost between $166.41 and $274.76 (2014 Canadian dollars) for each laboring woman as regards the scenario considered. The average extra cost was $221.12 (95% confidence interval, 219.97-222.28). CONCLUSION While water immersion allows better clinical outcomes, implementation and other costs are higher than the savings generated, which leads to a small extra cost to allow women to potentially have more relaxation and less pain.
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Affiliation(s)
- Thomas G Poder
- UETMIS and CRCHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
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5
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Predelivery uterine arteries embolization in patients with placental implant anomalies: a cost-effective procedure. Radiol Med 2016; 122:77-79. [DOI: 10.1007/s11547-016-0690-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
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Systematic prophylactic oxytocin injection and the incidence of postpartum hemorrhage: A before-and-after study. ACTA ACUST UNITED AC 2016; 45:147-54. [PMID: 26747233 DOI: 10.1016/j.jgyn.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Assess the impact of routine injection of 5 units of oxytocin as soon as the anterior shoulder is delivered on the incidence of postpartum haemorrhage (PPH) in a context of daily practice. MATERIALS AND METHODS Single-centre before-and-after study evaluating the effect of a change in the protocol for PPH prevention as applied in our obstetrical unit. During the first period, oxytocin (5 units) was to be injected only in case of PPH risk factors. During the second period, the injection was systematic. RESULTS In the "before" study period, there were 1953 patients vaginal deliveries and 843 (43%) oxytocin injections, with a protocol compliance of 85%. In the "after" study period, 2018 women had vaginal deliveries and 1911 (95%) had an oxytocin injection (protocol compliance: 95%). The whole study period was associated with a reduced risk of moderate haemorrhage (13.4% vs. 9.2%, P<0.001), but no significant reduced risk of severe haemorrhage was observed (2.1% vs. 2.0%, P=0.79). After logistic regression, the study period remained associated with a significant reduction in the risk of moderate PPH (OR=0.72 [0.58-0.89]). CONCLUSION Routine injection of 5 units of oxytocin makes it possible to reduce the risk of moderate PPH, but it does not affect the risk of severe PPH.
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Chapman E, Reveiz L, Chambliss A, Sangalang S, Bonfill X. Cochrane systematic reviews are useful to map research gaps for decreasing maternal mortality. J Clin Epidemiol 2013. [PMID: 23177899 DOI: 10.1016/j.jclinepi.2012.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To use an "evidence-mapping" approach to assess the usefulness of Cochrane reviews in identifying research gaps in the maternal health. STUDY DESIGN AND SETTING The article describes the general mapping, prioritizing, reconciling, and updating approach: (1) identifying gaps in the maternal health research using published systematic reviews and formulating research questions, (2) prioritizing questions using Delphi method, (3) reconciling identified research priorities with the existing literature (i.e., searching of ongoing trials in trials registries), (4) updating the process. A comprehensive search of Cochrane systematic reviews published or updated from January 2006 to March 2011 was performed. We evaluated the "Implications for Research" section to identify gaps in the research. RESULTS Our search strategy identified 695 references; 178 systematic reviews identifying at least one research gap were used. We formulated 319 research questions, which were classified into 11 different categories based on the direct and indirect causes of maternal mortality: postpartum hemorrhage, abortion, hypertensive disorders, infection/sepsis, caesarean section, diabetes, pregnancy prevention, preterm labor, other direct causes, indirect causes, and health policies and systems. Most research questions concerned the effectiveness of clinical interventions, including drugs (42.6%), nonpharmacologic interventions (16.3%), and health system (14.7%). CONCLUSION It is possible to identify gaps in the maternal health research by using this approach.
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Affiliation(s)
- Evelina Chapman
- Public Policies and Research for Health, Health Systems Based on Primary Health Care, Pan American Health Organization (PAHO/WHO), Washington, DC 20037, USA.
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Bréchat PH, Castiel D. Réponse de P.-H. Bréchat et de D. Castiel à l’article de L. Marpeau. ACTA ACUST UNITED AC 2008; 36:831-3. [DOI: 10.1016/j.gyobfe.2008.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bréchat PH, Rymer R, Grenouilleau MC, Jourdain A. Éléments pour un premier bilan et des perspectives du plan Hôpital 2007. SANTE PUBLIQUE 2008; 20:611-21. [DOI: 10.3917/spub.086.0611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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