Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe

BACKGROUND

The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe.

OBJECTIVES

The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth.

DESIGN

Survey of policies.

SETTING

The project was a European collaboration, with participants in 14 European countries.

SAMPLE

All maternity units in 12 countries and in selected regions of two countries in Europe.

METHODS

A postal questionnaire was sent to all or a defined sample of maternity units in each participating country.

MAIN OUTCOME MEASURES

Stated policies for management of the third stage of labour and the immediate management of postpartum haemorrhage.

RESULTS

Policies of using uterotonics for the management of the third stage were widespread, but policies about agents, timing, clamping and cutting the umbilical cord and the use of controlled cord traction differed widely. For immediate management of postpartum haemorrhage, policies of massaging the uterus were widespread. Policies of catheterising the bladder, bimanual compression and in the choice of drugs administered were much more variable.

CONCLUSIONS

Considerable variations were observed between and within countries in policies for management of the third stage of labour. Variations were observed, but to a lesser extent, in policies for the immediate management of postpartum haemorrhage after vaginal birth. In both cases, policies about the pharmacological agents to be used varied widely.

Stopping antiepileptic drugs after epilepsy surgery: a survey of U.S. epilepsy center neurologists

One hundred fifty-one neurologists at U.S. epilepsy centers responded to a survey on stopping medications in patients following successful resective epilepsy surgery. Sixty-two percent said patients should be > or = 2 years seizure-free before stopping medication. Although respondents tended to agree about the importance of many of the queried factors (e.g., focal pathology in favor of and persistent auras against stopping antiepileptic drugs), it is unclear how well these factors determine seizure outcome in this setting.

Assessing impacts of bycatch policies and fishers' heterogeneous information on food webs and fishery sustainability

Ecosystem-based fisheries management (EBFM) has emerged as a promising framework for understanding and managing the long-term interactions between fisheries and the larger marine ecosystems in which they are nested. However, successful implementation of EBFM has been elusive because we still lack a comprehensive understanding of the network of interacting species in marine ecosystems (the food web) and the dynamic relationship between the food web and the humans who harvest those ecosystems. Here, we advance such understanding by developing a network framework that integrates the complexity of food webs with the economic dynamics of different management policies. Specifically, we generate hundreds of different food web models with 20-30 species, each harvested by five different fishers extracting the biomass of a target and a bycatch species, subject to two different management scenarios and exhibiting different information in terms of avoiding bycatch when harvesting the target species. We assess the different ecological and economic consequences of these policy alternatives as species extinctions and profit from sustaining the fishery. We present the results of different policies relative to a benchmark open access scenario where there are no management policies in place. The framework of our network model would allow policymakers to evaluate different management approaches without compromising on the ecological complexities of a fishery.This article is part of the theme issue 'Connected interactions: enriching food web research by spatial and social interactions'.

The Roman Catholic Church: A Centuries Old History of Awareness of Clerical Child Sexual Abuse (from the First to the 19th Century)

Debates in international forums and in mainstream media on the role, responsibility, liability, and response of ecclesiastical authorities of the Roman Catholic Church (RCC) toward clerical child sexual abuse (cCSA) fail to take into account the historical roots and awareness of the problem. Reports also fail to mention the historic organizational laws RCC developed over centuries. In contrast, RCC documents evidence that the Catholic Church not only carried century's old history of cCSA, but also repeatedly condemned cCSA by successive papal authorities, organizational laws, and institutional management mechanisms. During the first millennium, however, church laws remained confined to the bookshelves and were not converted into appropriate management policies and infrastructural models. This was largely due to the absence of a central administrative organizational structure, which developed later in the 12th century, following the Second Council of Lateran (1139) when the Papacy asserted its authority to establish administrative control over the organizational church. It was only then that management policies started to be framed and institutional structures enacted to deal more appropriately with cCSA from the 14th to 20th centuries. Despite this, RCC developed a culture of secrecy using clandestine organizational management models and institutional laws prescribed in 1568, 1622, 1741, 1866, 1922, and 1962 which aimed to manage cCSA. The current study traces reported cCSA as far back as the first century and critically examines the organizational laws, and institutional policies developed by RCC to address clerical sexual misconduct up to the end of the 19th century.