ABSTRACT
OBJECTIVE: To determine if quantification of blood loss (QBL) would result in fewer activations of postpartum hemorrhage (PPH) protocols than visual estimation of blood loss (EBL) after cesarean birth and to track the use of related resources. DESIGN: Prospective observational trial. SETTING: A tertiary academic medical center in the midwestern United States. PARTICIPANTS: A total of 42 cases of cesarean birth. METHODS: We visually estimated blood loss during cesarean birth and quantified blood loss with colorimetric testing after the surgery. We compared EBL to QBL in four categories, from no hemorrhage to severe PPH, and documented resources used for women placed on the institutional PPH protocol by EBL who did not meet criteria for PPH by QBL. RESULTS: The median EBL was 1,275 ml (interquartile range = 1,100-1,510 ml), and the median QBL was 948 ml (interquartile range = 700-1,267 ml, p < .001). Twenty-four (57%) instances of PPH based on visual EBL would not have been classified as such based on QBL. The most frequently used resources in these cases included laboratory testing and administration of uterotonics. CONCLUSION: Use of QBL during cesarean births would have reduced the number of identified PPHs by more than 50% over visual EBL and may have reduced the resources used as part of care.
Subject(s)
Blood Loss, Surgical/nursing , Guidelines as Topic/standards , Postpartum Hemorrhage/therapy , Weights and Measures/standards , Adult , Female , Humans , Postpartum Hemorrhage/nursing , Pregnancy , Prospective Studies , Weights and Measures/instrumentationABSTRACT
Incarceration of the gravid uterus may pose significant risks to both maternal and fetal health. Anesthetic management for these patients is variable, and the ideal anesthetic technique is unknown. The patient presented to the labor and delivery unit with pelvic pain and urinary retention in the setting of a gravid incarcerated uterus. Previous attempts at manual reduction in the outpatient setting were unsuccessful. A combined spinal-epidural anesthetic was administered, followed by spontaneous resolution of the incarcerated uterus. In addition to providing analgesia, neuraxial blockade may occasionally be an adequate therapeutic technique for reduction of a gravid incarcerated uterus.
Subject(s)
Analgesics/administration & dosage , Obstetric Labor Complications/therapy , Uterine Retroversion/therapy , Adult , Analgesics/therapeutic use , Anesthesia, Epidural , Anesthesia, Spinal , Female , Humans , Nerve Block , PregnancyABSTRACT
Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. One of the most feared sequelae of hyperthyroidism is thyroid storm, which has a mortality rate >10%. Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.
