Hemorragia obstétrica / Obstetric hemorrhage

Abril 21, 2017. No. 2666

Manejo del sangrado masivo en pacientes obstétricas Testigos de Jehova. La abrumadora importancia de un protocolo multidisciplinario preestablecido. Management of massive bleeding in a Jehovah's Witness obstetric patient: the overwhelming importance of a pre-established multidisciplinary protocol. Belaouchi M1, Romero E1, Mazzinari G1, Esparza M1, García-Cebrían C1, Gil F2, Muñoz M3. Blood Transfus. 2016 Jul 12;14(6):541-544. doi: 10.2450/2016.0229-15. [Epub ahead of print] Introduction Life-threatening massive bleeding is doubtlessly one of the biggest challenges in health care, especially in patients who reject allogeneic transfusion, such as Jehovah's Witnesses. However, according to the principle of patients' autonomy, our job is to accept their decision and provide them with the best possible assistance. We present a protocol for the management of massive post-operative bleeding successfully applied in a Jehovah's Witness after a Caesarean section (CS). PDF Listas de verificación y desempeño multidisciplinario del equipo durante la hemorragia obstétrica simulada. Checklists and multidisciplinary team performance during simulated obstetric hemorrhage. Hilton G1, Daniels K2, Goldhaber-Fiebert SN3, Lipman S3, Carvalho B3, Butwick A3. Int J Obstet Anesth. 2016 Feb;25:9-16. doi: 10.1016/j.ijoa.2015.08.011. Epub 2015 Aug 21. Abstract BACKGROUND: Checklists can optimize team performance during medical crises. However, there has been limited examination of checklist use during obstetric crises. In this simulation study we exposed multidisciplinary teams to checklist training to evaluate checklist use and team performance during a severe postpartum hemorrhage. METHODS: Fourteen multidisciplinary teams participated in a postpartum hemorrhage simulation occurring after vaginal delivery. Before participating, each team received checklist training. The primary study outcome was whether each team used the checklist during the simulation. Secondary outcomes were the times taken to activate our institution-specific massive transfusion protocol and commence red blood cell transfusion, and whether a designated checklist reader was used. RESULTS: The majority of teams (12/14 (86%)) used the checklist. Red blood cell transfusion was administered by all teams. The median [IQR] times taken to activate the massive transfusion protocol and transfuse red blood cells were 5min 14s [3:23-6:43] and 14min 40s [12:56-17:28], respectively. A designated checklist reader was used by 7/12 (58%) teams that used the checklist. Among teams that used a checklist with versus without a designated reader, we observed no differences in the times to activate the massive transfusion protocol or to commence red blood cell transfusion (P>0.05). CONCLUSIONS: Although checklist training was effective in promoting checklist use, multidisciplinary teams varied in their scope of checklist use during a postpartum hemorrhage simulation. Future studies are required to determine whether structured checklist training can result in more standardized checklist use during a postpartum hemorrhage. KEYWORDS: Checklist; Multidisciplinary; Obstetrics; Postpartum hemorrhage; Simulation PDF  Manejo transfusional y de la coagulación en hemorragia obstétrica severa Transfusion and coagulation management in major obstetric hemorrhage. Butwick AJ1, Goodnough LT. Curr Opin Anaesthesiol. 2015 Jun;28(3):275-84. doi: 10.1097/ACO.0000000000000180. Abstract PURPOSE OF REVIEW: Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. RECENT FINDINGS: Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin clot quality during PPH, which correlate with low fibrinogen levels. SUMMARY: A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH. PDF Foro Internacional de Medicina Crítica Ciudad de México, Julio 13-15, 2017 Información / Information

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Más de hemorragia obstétrica / More on obstetric hemorrhage

Abril 22, 2017. No. 2667

Actualización del protocolo de tratamiento de la hemorragia obstétrica. An update of the obstetrics hemorrhage treatment protocol. Morillas-Ramírez F1, Ortiz-Gómez JR2, Palacio-Abizanda FJ3, Fornet-Ruiz I4, Pérez-Lucas R5, Bermejo-Albares L Rev Esp Anestesiol Reanim. 2015 Apr;62(4):229-31. doi: 10.1016/j.redar.2014.09.008. Epub 2014 Dec 17. Resumen La hemorragia obstétrica es aún hoy día una importante causa de morbimortalidad maternofetal en los países desarrollados. Se trata de un problema infraestimado, que generalmente aparece de forma impredecible. La morbimortalidad de la hemorragia obstétrica se considera evitable en una elevada proporción si el manejo es adecuado. Las guías clínicas de mayor difusión mundial recomiendan por consenso protocolizar el manejo, adaptarlo al ámbito local y mantenerlo actualizado en función de la experiencia y de las nuevas publicaciones científicas. Exponemos un protocolo actualizado conforme a las últimas recomendaciones y a nuestra propia experiencia, para que pueda ser utilizado como elemento base por aquellos anestesiólogos que así lo deseen, adaptado a su ámbito local de trabajo diario. Este último aspecto es muy importante para que sea eficaz, y es una labor que debe realizarse en cada centro conforme a la disponibilidad de medios, personal y características arquitectónicas. PDF Prácticas de transfusión de sangre en anestesia obstétrica. Blood transfusion practices in obstetric anaesthesia. Jadon A1, Bagai R2. Indian J Anaesth. 2014 Sep;58(5):629-36. doi: 10.4103/0019-5049.144674. Abstract Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective. KEYWORDS: Obstetric anaesthesia; obstetric haemorrhage; postpartum haemorrhage; transfusion practices; transfusion protocol PDF Evaluación del cumplimiento y los resultados de un protocolo de tratamiento de hemorragia postparto masiva en un hospital de tercer nivel en Pakistán. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. Sheikh L1, Najmi N, Khalid U, Saleem T. BMC Pregnancy Childbirth. 2011 Apr 13;11:28. doi: 10.1186/1471-2393-11-28. Abstract BACKGROUND: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated. METHODS: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. RESULTS: During 2008, massive postpartum hemorrhage occurred in 0.64% cases (26/4,052). No deaths were reported. The mean blood loss was 2431 ± 1817 ml (range: 1500-9000 ml). Emergency cesarean section was the most common mode of delivery (13/26; 50%) while uterine atony was the most common cause of massive postpartum hemorrhage (14/26; 54%). B-lynch suture (24%) and balloon tamponade (60%) were used more commonly as compared to our previously reported experience. Cesarean hysterectomy was performed in 3 cases (12%) for control of massive postpartum hemorrhage. More than 80% compliance was observed in 8 out of 10 steps of the management protocol. Initiation of blood transfusion at 1500 ml blood loss (89%) and overall documentation of management (92%) were favorably observed in most cases. CONCLUSION: This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies. PDF Vacante para Anestesiología Pediátrica El Hospital de Especialidades Pediátricas de León, Guanajuato México  ofrece un contrato laboral en el departamento de anestesiología  Informes con la Dra Angélica García Álvarez  angy.coachanestped@gmail.com o al teléfono 477 101 8700 Ext 1028 Foro Internacional de Medicina Crítica Ciudad de México, Julio 13-15, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org