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Fabbri M, Sahu A. Challenges and opportunities in patients with adult congenital heart disease, a narrative review. Front Cardiovasc Med 2024; 11:1366572. [PMID: 38873271 PMCID: PMC11171728 DOI: 10.3389/fcvm.2024.1366572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Adult congenital heart disease Pregnancy Transition of care Challenges heart failure.
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Affiliation(s)
- Matteo Fabbri
- Department of Cardiovascular Disease, Inova Heart and Vascular Institute, Falls Church, VA, United States
| | - Anurag Sahu
- Department of Cardiovascular Disease, Inova Heart and Vascular Institute, Falls Church, VA, United States
- Department of Cardiovascular Imaging, NIH/NHLBI Cardiovascular Imaging Lab, Bethesda, MD, United States
- Department of Cardiovascular Disease, University of Virginia School of Medicine, Charlottesville, VA, United States
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2
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Turkoglu O, Friedman P. Evaluation During Postpartum Hemorrhage. Clin Obstet Gynecol 2023; 66:357-366. [PMID: 37130377 DOI: 10.1097/grf.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Postpartum hemorrhage is an obstetric emergency that is the leading and the most preventable cause of maternal death that occurs on the day of birth. The treatment of postpartum hemorrhage in a timely fashion is crucial to prevent morbidity and mortality. The accurate assessment of blood loss during delivery and the postpartum period remains a major challenge. Hence, it is imperative to have a standardized evaluation strategy for accurate assessment of blood loss, adequate classification of hemorrhage, and timely initiated interventions. The multidisciplinary evaluation strategy should be in place regardless of the delivery route.
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Affiliation(s)
- Onur Turkoglu
- Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Perry Friedman
- Beaumont Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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3
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The prevalence of blood product transfusion after the implementation of a postpartum hemorrhage bundle: a retrospective cohort at a single safety net academic institution. Am J Obstet Gynecol MFM 2022; 4:100662. [PMID: 35577315 DOI: 10.1016/j.ajogmf.2022.100662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Postpartum hemorrhage, defined as blood loss of ≥1000 mL within 24 hours after birth, is a leading cause of maternal morbidity and is associated with substantial financial and emotional burden. Based on societal and regulatory guidelines, in 2019, our institution adopted a postpartum hemorrhage prevention and management bundle based on the California Maternal Quality Care Collaborative initiatives. OBJECTIVE The study aimed to compare the prevalence of maternal blood product transfusion before and after the implementation of the bundle. STUDY DESIGN This was a retrospective cohort study comparing the prevalence of blood product transfusion before and after the implementation of a California Maternal Quality Care Collaborative-based postpartum hemorrhage management bundle at a single safety net teaching hospital between October 2017 and December 2019 excluding a 4-month rollout period between September 2018 and December 2018. The study included all patients ≥18 years of age and at >20 weeks' gestation. Exclusion criteria were out-born deliveries, delivery at time of significant nonobstetrical trauma, and refusal of blood transfusion. The primary outcome was the frequency of any blood product transfusion in the pre- and postbundle implementation cohorts. Secondary outcomes included blood product transfusion type and amount, maternal death, intrauterine balloon placement, uterine artery embolization, unplanned peripartum hysterectomy, intensive care admission, and length of stay among all deliveries complicated by postpartum hemorrhage. We further evaluated compliance with bundle measures for all postpartum hemorrhage cases. Cohort characteristics were compared using chi-square tests or Fisher exact tests for categorical data and Satterthwaite or Wilcoxon 2-sample tests for continuous variables based on data distributions. The proportion of blood product transfusion were evaluated using a chi-square test. RESULTS A total of 6744 deliveries were included with 3310 in the pre- and 3425 in the postbundle cohort. The prevalence of any blood product transfusion was similar between the pre- and postbundle cohorts (3.41%; 113/3310 vs 3.47%; 119/3425; P=.892). The prevalence of postpartum hemorrhage was 7.05% (233/3310) in the prebundle cohort and 10.34% (354/3434) in the postbundle cohort (P<.001). Among women with postpartum hemorrhage, those in the prebundle cohort had a higher rate of blood product transfusion than those in the postbundle cohort (36.05%; 84/233 vs 26.84%; 95/354; P=.018). Compared with the prebundle counterparts, patients with postpartum hemorrhage in the postbundle cohort had higher rates of utilization of intrauterine balloon placement (10.30%; 24/233 vs 16.95%; 60/354; P=.024). There were no significant differences among other secondary outcomes. The overall compliance with the bundle among those with blood loss ≥1000 mL was 92.1%. CONCLUSION The implementation of the postpartum hemorrhage bundle did not decrease the overall prevalence of blood product transfusion and may have led to higher rates of utilization of resources.
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Gari A, Hussein K, Daghestani M, Aljuhani S, Bukhari M, Alqahtani A, Almarwani M. Estimating blood loss during cesarean delivery: A comparison of methods. J Taibah Univ Med Sci 2022; 17:732-736. [PMID: 36050944 PMCID: PMC9396066 DOI: 10.1016/j.jtumed.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/03/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Obstetrical hemorrhage contributes significantly to maternal morbidity and mortality. Assessment of blood loss while undergoing cesarean sections (CS) is essential in lowering the morbidity and mortality, however this amount is commonly underestimated by the surgeon and probably the anesthetist too. Methods This study addresses this issue by comparing three separate ways of assessing blood loss during cesarean sections. For each of 97 full-term pregnant women undergoing elective CS, blood loss was measured by the following: visual estimation by both the obstetrician and the anesthetist, weighing surgical pads pre operatively and post operatively and by calculations (multiplying the difference of pre-operative and postoperative hemoglobin values by the patient's estimated blood volume). Results The results of this study indicated that the lowest estimated value for blood loss came from visual estimation, while the highest value came from the mathematical formula. Anesthetists were more accurate in their visual estimation of blood loss than were obstetricians. Conclusion This study found the amount of blood loss during CS to be overestimated by the mathematical calculation and underestimated by obstetricians. However, the estimate given by anesthetists was close to that obtained by weighing pads. This underscores the need for more accurate methods of blood loss estimation in cesarean sections to be adopted.
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Zheutlin AB, Vieira L, Shewcraft RA, Li S, Wang Z, Schadt E, Kao YH, Gross S, Dolan SM, Stone J, Schadt E, Li L. A comprehensive digital phenotype for postpartum hemorrhage. J Am Med Inform Assoc 2022; 29:321-328. [PMID: 34559880 PMCID: PMC8757293 DOI: 10.1093/jamia/ocab181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to establish a comprehensive digital phenotype for postpartum hemorrhage (PPH). Current guidelines rely primarily on estimates of blood loss, which can be inaccurate and biased and ignore complementary information readily available in electronic medical records (EMR). Inaccurate and incomplete phenotyping contributes to ongoing challenges in tracking PPH outcomes, developing more accurate risk assessments, and identifying novel interventions. MATERIALS AND METHODS We constructed a cohort of 71 944 deliveries from the Mount Sinai Health System. Estimates of postpartum blood loss, shifts in hematocrit, administration of uterotonics, surgical interventions, and diagnostic codes were combined to identify PPH, retrospectively. Clinical features were extracted from EMRs and mapped to common data models for maximum interoperability across hospitals. Blinded chart review was done by a physician on a subset of PPH and non-PPH patients and performance was compared to alternate PPH phenotypes. PPH was defined as clinical diagnosis of postpartum hemorrhage documented in the patient's chart upon chart review. RESULTS We identified 6639 PPH deliveries (9% prevalence) using our phenotype-more than 3 times as many as using blood loss alone (N = 1,747), supporting the need to incorporate other diagnostic and intervention data. Chart review revealed our phenotype had 89% accuracy and an F1-score of 0.92. Alternate phenotypes were less accurate, including a common blood loss-based definition (67%) and a previously published digital phenotype (74%). CONCLUSION We have developed a scalable, accurate, and valid digital phenotype that may be of significant use for tracking outcomes and ongoing clinical research to deliver better preventative interventions for PPH.
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Affiliation(s)
| | - Luciana Vieira
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | - Susan Gross
- Sema4, Stamford, Connecticut, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Siobhan M Dolan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joanne Stone
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Schadt
- Sema4, Stamford, Connecticut, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Li Li
- Sema4, Stamford, Connecticut, USA
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Utilization and Comparative Effectiveness of Uterine Artery Embolization vs. Hysterectomy for Severe Postpartum Hemorrhage: A National Inpatient Sample Study. J Vasc Interv Radiol 2021; 33:427-435.e4. [PMID: 34915166 DOI: 10.1016/j.jvir.2021.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess if uterine artery embolization conferred a lower risk of mortality or prolonged hospital stay compared to hysterectomy in severe post-partum hemorrhage (PPH) and to analyze if geographical or clinical determinants affected which therapy was received. MATERIALS AND METHODS This National Inpatient Sample study from 2005-2017 included all patients with live-birth deliveries. Severe PPH was defined as those requiring transfusion, hysterectomy, or uterine artery embolization (UAE). Propensity score weighting adjusted demographic, maternal, and delivery risk factors were used to assess mortality and prolonged hospital stay. RESULTS Of 9.8 million identified live births, PPH occurred in 31.0 per 1,000. The most common intervention for PPH was transfusion (116.4 per 1,000 cases of PPH). Hysterectomy was used more frequently than UAE (20.4 vs 12.9 per 1,000). The following factors predicted hysterectomy would be used more commonly than UAE: previous cesarean delivery, breech fetal position, placenta previa, transient hypertension of pregnancy without pre-eclampsia, pre-existing hypertension without pre-eclampsia, pre-existing hypertension with pre-eclampsia, unspecified maternal hypertension, and gestational diabetes (all p<0.001). Delivery risk factors associated with greater utilization of hysterectomy over UAE included post-dates pregnancy, premature rupture of membranes, cervical laceration, forceps vaginal delivery, and shock (all p<0.001). There was no difference in mortality between hysterectomy and UAE. After balancing demographic, maternal, and delivery risk factors, the odds of prolonged hospital stay were 0.38 times lower with UAE than hysterectomy (p<0.001). CONCLUSION Despite similar mortality and shorter hospital stays, UAE is used far less than hysterectomy in the management of severe PPH.
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D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada® System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices 2021; 18:849-853. [PMID: 34355991 DOI: 10.1080/17434440.2021.1962288] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Abnormal postpartum uterine bleeding occurs commonly after birth and can quickly become an obstetric emergency. With postpartum hemorrhage representing the leading cause of maternal mortality, accounting for 25% of maternal deaths due to obstetric complications, there is a critical need for effective and easy to use treatment options. AREAS COVERED This profile describes the Jada System, a novel intrauterine vacuum-induced hemorrhage control device that provides a rapid and effective treatment option for abnormal postpartum uterine bleeding and postpartum hemorrhage. In addition to explaining the mechanism of action of vacuum-induced hemorrhage control and reviewing the device's safety and effectiveness, this profile elucidates how the Jada System compares to currently available medications and devices for treatment of this obstetric emergency. EXPERT OPINION New therapies to address this life-threatening condition are needed to reduce the risk of maternal mortality and severe maternal morbidity. Data demonstrate that the Jada System provides rapid, effective control of abnormal postpartum uterine bleeding and postpartum hemorrhage, while offering reported ease of use and short treatment duration. These results suggest that use of the Jada System in treatment algorithms may improve outcomes.
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Affiliation(s)
- Mary D'Alton
- Department of Obstetrics and Gynecology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Kara Rood
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Dena Goffman
- Department of Obstetrics and Gynecology, New York Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Almutairi WM. Literature Review: Physiological Management for Preventing Postpartum Hemorrhage. Healthcare (Basel) 2021; 9:658. [PMID: 34073073 PMCID: PMC8227540 DOI: 10.3390/healthcare9060658] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper was to summarize the existing literature regarding postpartum hemorrhage (PPH) and its physiological management (i.e., skin-to-skin contact and breastfeeding). The background surrounding PPH and the role of skin-to-skin contact (SSC) and breastfeeding (BF) in PPH are identified, and these interventions are supported as a crucial means of preventing or minimizing the incidence of PPH. Despite its importance, to the best of my knowledge, an evaluation of this relationship has not yet been undertaken. The narrative literature review approach was used to summarize topic related researches. The search included three databases: CINAHL, PubMed, and Google Scholar. All articles related to the role of SSC and BF in PPH were chosen from the different databases. The findings demonstrate that SSC and BF are cost-effective methods that could be considered practices for the prevention of PPH. Immediate Skin-to-skin contact (SSC) and breastfeeding (BF) are central mediators of the psychophysiological process during the first hour after delivery (the third and fourth stages of labor).
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Affiliation(s)
- Wedad M Almutairi
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Miner J. Implementing E-Learning to Enhance the Management of Postpartum Hemorrhage. Nurs Womens Health 2020; 24:421-430. [PMID: 33144088 DOI: 10.1016/j.nwh.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine if perinatal outcomes related to postpartum hemorrhage could be improved by blending existing strategies with the use of an online, assessment-driven electronic learning (e-learning) platform. DESIGN The Institute for Healthcare Improvement's Model for Improvement provided a structure for this performance improvement project. Outcome evaluation was further supported by the Kirkpatrick model. SETTING/LOCAL PROBLEM Reports of rising maternal morbidity and mortality in the United States prompted action within a multisite health system. Maternity care teams were determined to proactively support excellence in practice through enhancements to continuing education. PARTICIPANTS Maternity providers and nurses practicing within the organization completed the training. INTERVENTION/MEASUREMENTS Online, assessment-driven learning modules for maternity emergencies were blended with existing instructor-led courses, simulation, and Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) training in early 2017. In addition, a postpartum hemorrhage safety bundle was implemented. Outcome measures included rates of hemorrhage, massive transfusion, and intensive care unit admission for women admitted for childbirth. Outcome measures were tracked using retrospective chart review with baseline period October 1, 2016, through March 31, 2017, and performance period April 1, 2017, through March 31, 2018. RESULTS Improvements in perinatal outcomes were observed. The average rate of hemorrhage decreased by 3% (from 56.4/1,000 to 54.7/1,000). Median massive transfusion rates decreased by 35% (from 2.3/1,000 to 1.5/1,000). Similarly, the median rate of maternal intensive care unit admissions decreased by 77% (from 3.1/1,000 to 0.7/1,000). A downward shift was supported with zero intensive care unit admissions for 6 of the last 7 months (n = 4,422 pregnant women or women who experienced birth during the current admission). CONCLUSION Excellence in the management of postpartum hemorrhage was supported through a multipronged approach that included the use of an online e-learning platform for maternity emergencies.
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Walker DM, DePuccio MJ, Huerta TR, McAlearney AS. Designing Quality Improvement Collaboratives for Dissemination: Lessons from a Multiple Case Study of the Implementation of Obstetric Emergency Safety Bundles. Jt Comm J Qual Patient Saf 2019; 46:136-145. [PMID: 31839423 DOI: 10.1016/j.jcjq.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Quality improvement collaboratives (QICs) can help to disseminate evidence-based practices, but there is limited guidance from the perspectives of QIC organizers and participants of best practices to support practice change. To address this gap, this study aimed to identify key structures and processes of QICs that support dissemination and implementation of quality improvement projects. METHODS Semistructured one-on-one and group interviews were conducted from December 2017 to May 2018 with project administrators (n = 28) at three QICs that had been funded to develop and disseminate obstetric emergency safety bundles in more than 300 hospitals across five states. For further study, the project leads (n = 25) at six hospitals nominated by each QIC were interviewed. A multiple case study design was used to evaluate the dissemination strategies of each of the three QICs. For the QIC interviews, questions asked about dissemination approach, and for the hospital interviews, questions asked about implementation facilitators and barriers. All interviews were transcribed, coded, and analyzed using both deductive and inductive methods. RESULTS A key element supporting the dissemination strategy of each QIC was leveraging existing partnerships and relationships and promoting a shared vision with participating hospitals. A robust data infrastructure to support the project was identified as a critical element to support dissemination, yet was a challenge for the QICs. CONCLUSION These findings highlight specific elements of a dissemination approach that QICs can deploy to support their dissemination efforts. In particular, building data infrastructure may be a useful strategy to support ongoing quality improvement projects.
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Vamos CA, Cantor A, Thompson EL, Detman LA, Bronson EA, Phelps A, Louis JM, Gregg AR, Curran JS, Sappenfield WM. The Obstetric Hemorrhage Initiative (OHI) in Florida: The Role of Intervention Characteristics in Influencing Implementation Experiences among Multidisciplinary Hospital Staff. Matern Child Health J 2017; 20:2003-11. [PMID: 27178428 DOI: 10.1007/s10995-016-2020-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives Obstetric hemorrhage is one of the leading causes of maternal mortality. The Florida Perinatal Quality Collaborative coordinates a state-wide Obstetric Hemorrhage Initiative (OHI) to assist hospitals in implementing best practices related to this preventable condition. This study examined intervention characteristics that influenced the OHI implementation experiences among Florida hospitals. Methods Purposive sampling was employed to recruit diverse hospitals and multidisciplinary staff members. A semi-structured interview guide was developed based on the following constructs from the intervention characteristics domain of the Consolidated Framework for Implementation Research: evidence strength; complexity; adaptability; and packaging. Interviews were audio-recorded, transcribed and analyzed using Atlas.ti. Results Participants (n = 50) across 12 hospitals agreed that OHI is evidence-based and supported by various information sources (scientific literature, experience, and other epidemiologic or quality improvement data). Participants believed the OHI was 'average' in complexity, with variation depending on participant's role and intervention component. Participants discussed how the OHI is flexible and can be easily adapted and integrated into different hospital settings, policies and resources. The packaging was also found to be valuable in providing materials and supports (e.g., toolkit; webinars; forms; technical assistance) that assisted implementation across activities. Conclusions for Practice Participants reflected positively with regards to the evidence strength, adaptability, and packaging of the OHI. However, the complexity of the initiative adversely affected implementation experiences and required additional efforts to maximize the initiative effectiveness. Findings will inform future efforts to facilitate implementation experiences of evidence-based practices for hemorrhage prevention, ultimately decreasing maternal morbidity and mortality.
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Affiliation(s)
- Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA. .,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.
| | - Allison Cantor
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA
| | - Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Linda A Detman
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Emily A Bronson
- The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Annette Phelps
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
| | - Judette M Louis
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL, 33606, USA
| | - Anthony R Gregg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, P.O Box 100294, Gainesville, FL, 32610, USA
| | - John S Curran
- Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Faculty and Academic Affairs, USF Health, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd, Tampa, FL, 33612, USA
| | - William M Sappenfield
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL, 33612, USA.,The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA.,Florida Perinatal Quality Collaborative, The Chiles Center, College of Public Health, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL, 33613, USA
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Using High-Fidelity Simulation and Video-Assisted Debriefing to Enhance Obstetrical Hemorrhage Mock Code Training. J Nurses Prof Dev 2017; 33:234-239. [PMID: 28891878 DOI: 10.1097/nnd.0000000000000387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this descriptive, one-group posttest study was to explore the nursing staff's perception of the benefits of using high-fidelity simulation during mandated obstetrical hemorrhage mock code training. In addition, the use of video-assisted debriefing was used to enhance the nursing staff's evaluation of their communication and teamwork processes during a simulated obstetrical crisis. The convenience sample of 84 members of the nursing staff consented to completing data collection forms and being videotaped during the simulation. Quantitative results for the postsimulation survey showed that 93% of participants agreed or totally agreed that the use of SimMan made the simulation more realistic and enhanced learning and that debriefing and the use of videotaped playback improved their evaluation of team communication. Participants derived greatest benefit from reviewing their performance on videotape and discussing it during postsimulation debriefing. Simulation with video-assisted debriefing offers hospital educators the ability to evaluate team processes and offer support to improve teamwork with the ultimate goal of improving patient outcomes during obstetrical hemorrhage.
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Saintrain SV, Oliveira JGRD, Saintrain MVDL, Bruno ZV, Borges JLN, Daher EDF, Silva GBD. Factors associated with maternal death in an intensive care unit. Rev Bras Ter Intensiva 2017; 28:397-404. [PMID: 28099637 PMCID: PMC5225914 DOI: 10.5935/0103-507x.20160073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To identify factors associated with maternal death in patients admitted to an
intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All
medical records of patients admitted from January 2012 to December 2014 were
reviewed. Pregnant and puerperal women were included; those with diagnoses
of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were
excluded, as were patients admitted for non-obstetrical reasons. Death and
hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for
admission to the intensive care unit were hypertensive disorders of
pregnancy, followed by heart disease, respiratory failure, and sepsis;
complications included acute kidney injury (24.1%), hypotension (15.5%),
bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%).
Causes of death were hemorrhagic shock, multiple organ failure, respiratory
failure, and sepsis. The independent risk factors associated with death were
acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and
respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and
respiratory insufficiency were independent risk factors for maternal
death.
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Affiliation(s)
- Suzanne Vieira Saintrain
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza - Fortaleza (CE), Brasil.,Maternidade Escola Assis Chateaubriand, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | | | | | - Zenilda Vieira Bruno
- Maternidade Escola Assis Chateaubriand, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | - Juliana Lima Nogueira Borges
- Maternidade Escola Assis Chateaubriand, Faculdade de Medicina, Universidade Federal do Ceará - Fortaleza (CE), Brasil
| | | | - Geraldo Bezerra da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza - Fortaleza (CE), Brasil.,Curso de Medicina, Universidade de Fortaleza - Fortaleza (CE), Brasil
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Dillard AC. Obstetric Hemorrhage in the Rural Emergency Department: Rapid Response. J Emerg Nurs 2017; 43:15-20. [PMID: 28131345 DOI: 10.1016/j.jen.2016.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 09/20/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
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Green M, Rider C, Ratcliff D, Woodring BC. Developing a Systematic Approach to Obstetric Emergencies. J Obstet Gynecol Neonatal Nurs 2015; 44:677-82. [DOI: 10.1111/1552-6909.12729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Current World Literature. Curr Opin Obstet Gynecol 2013. [DOI: 10.1097/gco.0b013e32835f3eec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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