ABSTRACT
The objective of this paper was to determine if routine postpartum hemoglobin (Hb) determination changes patient management. One thousand patients with a vaginal delivery at Hermann Hospital, Houston, TX, had antepartum Hb testing, and a postpartum Hb for: (1) an antepartum Hb <9.0 mg/dL, (2) an estimated blood loss (EBL) >500 mL, (3) abnormal orthostatic vital signs, and (4) physician discretion. Data collected included: antepartum and postpartum Hb, EBL at delivery, the indication for Hb determination, and orthostatic vital sign results. Three-hundred fifty-eight postpartum hemoglobins were performed, most were "routine." Patients whose EBL was >500 mL were twice as likely to be anemic after delivery (RR 2.39, 95% CI 1.40, 4.08). Orthostatic hypotension had a PPV of only 21% for postpartum anemia. With the exception of an EBL >500 mL, risk factors for postpartum anemia are poorly predictive. Orthostatic vital signs are an insensitive test for the detection of anemia. Minimizing routine Hb testing following vaginal deliveries appears safe without an impact on patient management.
Subject(s)
Hemoglobins/analysis , Postpartum Period/blood , Anemia/etiology , Blood Loss, Surgical , Cohort Studies , Confidence Intervals , Delivery, Obstetric , Female , Humans , Hypotension, Orthostatic/blood , Odds Ratio , Patient Care , Predictive Value of Tests , Pregnancy/blood , Prospective Studies , Puerperal Disorders/etiology , SafetyABSTRACT
OBJECTIVE: To determine the mean umbilical arterial (UA) pH and incidence of UA pH less than 7.10 in infants born to women with histories of prior cesareans. METHODS: Three groups were studied retrospectively. Elective repeat cesarean (n = 113), cesarean after labor (n = 58), and successful vaginal birth after cesarean (VBAC) (n = 135). Comparisons were made across all groups and between elective cesarean and patients who labored. RESULTS: The mean UA pH values were 7.22 for elective cesarean, 7.20 for cesarean after labor, and 7.24 for VBAC (P = .04). Among the patients who had elective cesareans, 11 (10%) of 110 had a UA pH of less than 7.10, compared with 11 (6%) of 185 among patients who labored, P = .25, odds ratio 0.6, 95% confidence interval 0.22, 1.47. CONCLUSION: Comparing neonates who underwent trials of labor with those delivered by cesarean, there was no significant difference in the percentage with UA pH values less than 7.10, suggesting vaginal delivery after previous cesarean does not have a deleterious effect on umbilical cord gases. However, our sample size precluded us from examining lower cut points for UA pH, which are of greater clinical significance. Therefore, these results should be interpreted cautiously until confirmed by other studies.
Subject(s)
Cesarean Section , Fetal Blood/chemistry , Cesarean Section/statistics & numerical data , Female , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Retrospective Studies , Vaginal Birth after CesareanABSTRACT
BACKGROUND: Interstitial pregnancies are often associated with significant morbidity. The surgical treatment of such ectopic gestations often requires laparotomy and cornual resection, thus obliterating tubal and uterine continuity. Methotrexate has been shown to be 94% successful in the management of tubally implanted ectopic gestations, but few reports describe its use in interstitial pregnancies. CASE: An 18-year-old woman who presented with an asymptomatic interstitial pregnancy was treated successfully with intramuscular methotrexate. Laparotomy and cornual resection were avoided. No adverse effects were noted. CONCLUSION: Interstitial pregnancies can be treated successfully with intramuscular methotrexate.
