[6 MIN READ]

After reading the case with perspective on how to recognize secondary postpartum hemorrhage, it's critical to understand why it occurs and how to treat it.

Etiology of Secondary PPH

Why does secondary PPH occur? The normal physiologic changes associated with pregnancy are the perfect predisposition for an unrecognized hemorrhage. Typically, pregnant women are young and healthy with increases in circulating blood volume and hormonal and vascular changes specific to pregnancy. All of this creates the perfect environment for hemorrhage.

[4 MIN READ]

Your Postpartum Patient

Your postpartum patient was not complaining. Her vital signs were stable. She had experienced a prolonged labor, but to your knowledge, her vaginal delivery the previous day went well. Her recovery seemed to be progressing nicely. The morning report did not reveal that she was at any risk.

[3 MIN READ]

Correct patient identification has long been at the top of the list regarding safety.

A recent TSG article by Dr. Tom Syzek entitled “Medical Errors, Communication, Teamwork and End of Life: Lessons from Angola” speaks to the importance of correct patient identification and the safety implications surrounding it. This article dovetails nicely with the new 2019 Joint Commission National Patient Safety Goal (NPSG) regarding newborn identification, so I thought this would be the perfect opportunity to keep the conversation relevant and on-topic by addressing this new NPSG.

World Breastfeeding Month gives us an opportunity to highlight the benefits of breastfeeding as a life-saving infant feeding practice. In support of the importance of breastfeeding exclusivity and skin-to-skin (STS) for the reduction of infant morbidity and mortality, Bill Gates recently wrote, “Some of the best breakthrough ideas don’t involve technology at all. There is a solution that is readily available, requires no special equipment, and is so cheap any government can support it.”

[8 MIN READ]

“Maternal Death”

The words are bone-chilling. Nothing can describe being witness to it. Such an event encompasses the ultimate emotional spectrum – the highest of highs at the time of the newborn’s birth to the lowest of lows as the mother succumbs to maternal emergency. The lasting impact of watching a new father and family members exit the hospital OB unit or ICU to head home with a new infant in tow with conspicuous absence of the child’s mother creates palpable heartache. The emotional ripple-effect impacts friends, family, and medical staff for years to come.

Have you ever wondered as an Labor and Delivery RN how many hours during your shift you spend staring at fetal heart tracings? I’ll bet you have never tried to tally such a figure, but I’d venture to guess it encompasses not only a large portion of your daily practice, but an enormous part of your career as well. During a 12-hour shift of managing labor induction, you could easily spend approximately 5-6 hours or more actually staring at the monitor. That’s 50% of your shift! This translates into the possibility that half of your intrapartum career is immersed in FHR tracings!

There is only one thing that frightens an obstetrician more than a difficult shoulder dystocia delivery—getting a letter from a plaintiff attorney notifying you that you are being sued for alleged malpractice in a shoulder dystocia delivery you did several years ago. 

What is especially upsetting is that you remember that delivery, how quickly everything happened, and how well you performed in the heat of the moment to save that baby's life. You did your best, but the result was still a brachial plexus injury. 

The Maternal Fetal Triage Index (MFTI) tool developed by obstetric experts at AWHONN is a recent advance that deserves attention from all obstetric professionals. If you haven’t yet learned of it, stay tuned, because you will be hearing much about it as it goes “live” in the EMR of many institutions around the country.

You have been following this 22-year-old primigravida patient since she transferred into your practice at 18 weeks gestation. She tells you that she started her pregnancy weighing 195 pounds; it is now two weeks before her due date and she weighs 248 pounds. She failed her 28-week glucose screen; after the 3-hour oral glucose tolerance test, she was diagnosed as being a gestational diabetic. Despite referrals to a dietitian and to the Diabetes Clinic, her blood sugar control and dietary compliance have not been good. At her prenatal visit last week, her fundal height was measured at 43 cm.

With preeclampsia affecting 10% of all pregnancies and rates rising by 25% in the past two decades, it is important to test your knowledge and ensure that all your patients have a strong understanding of the dangers of preeclampsia. This is part II of a two-part series. Part I focused on definitions, risks, prevention and diagnosis of preeclampsia; part II focuses on HELLP syndrome, treatment, eclampsia, future risk and resources.