DOCSLIB.ORG

Active Management of Third Stage of Labor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Active Management of Third Stage of Labor Active Management of Third Stage of Labor Cheyanne D. Franklin, BSN Senior Nursing Student School of Nursing, Usha Kundu MD College of Health, University of West Florida SYNTHESIS OF THE EVIDENCE BACKGROUND/SIGNIFICANCE FINDINGS • Healthy People 2020 Goal: Improve the health • Uterine massage did not significantly decrease and well-being of women, infants, children and Article Author Evidence Sample Study Findings Limitations Rating postpartum blood loss, but is still recommended. # & Date Type Size families. • Oxytocin is the first line drug of choice. Level/Quality • Postpartum hemorrhage (PPH) is the leading 1 Saccone et Systematic 3842 Uterine massage was not associated with a significant reduction in Limited | A • Controlled cord traction had no significant effect on cause of maternal morbidity and mortality al, 2017 review and singleton the incidence of postpartum hemorrhage. Administration of evidence postpartum hemorrhage. meta-analysis gestation prophylactic oxytocin at any dose decreases PPH and the need for • Preventable of RCTs therapeutic uterotonics compared with placebo alone. Controlled • Placental blood drainage reduced the duration, • Most cases of morbidity and mortality due to PPH cord traction has the advantage of reducing the risk of manual blood loss, and incidence of postpartum removal of the placenta and of blood loss. Delayed cord clamping occur in the first 24 hours after delivery has been associated with neonatal benefits with no effects on hemorrhage. blood loss. Due to lack of evidence, three standard interventions should be followed: prophylactic oxytocin, DCC, and CCT. 2 WHO, 2012 Systematic Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug for the | A review prevention of PPH. In settings where skilled birth attendants are available, CCT is recommended for vaginal births if the care CLINICAL QUESTION provider and the parturient woman regard a small reduction in • In postpartum patients (P), is active management blood loss and a small reduction in the duration of the third stage of labor as important. Late cord clamping is recommended for all of the third stage of labor (I) effective in reducing births while initiating simultaneous essential newborn care. postpartum hemorrhage occurrences (O)? Sustained uterine massage is not recommended as an intervention SUMMARY to prevent PPH in women who have received prophylactic I. Recommendation for a more concise definition of oxytocin. Postpartum abdominal uterine tonus assessment for early identification of uterine atony is recommended for all women. AMTSL Uterine massage is recommended for the treatment of PPH. II. Possible research using single interventions to measure if one intervention alone decreases 3 Deneux- Multicentre, CCT: Controlled cord traction for the management of placental expulsion The study || A SEARCH STRATEGY Tharaux et RCT had no significant effect on the incidence of postpartum was not postpartum hemorrhage versus multiple 2175 al, 2013 hemorrhage and other markers of postpartum hemorrhage. blinded • An online literature review was conducted. Standard interventions used in combination. • Search Terms: Active management of the placental III. Further research needed on all intervention to assess expulsion effectiveness due to differing results and lack of third stage of labor, interventions, postpartum : 2180 hemorrhage, AMTSL literature. 4 Gülmezoglu RC, non- Simplified The omission of controlled cord traction results in very little || A • EBSCO et al, 2017 inferiority trial package increased risk of severe hemorrhage. Controlled cord traction is • Inclusion criteria: written in English, vaginal group: safe and its use can continue in settings that practice it. Effective 11861 prevention of postpartum hemorrhage can be accomplished with deliveries, peer reviewed, and published from Full an IM injection of oxytocin 10 IU after delivery of the baby. 2008 to 2018. package Teaching of controlled cord traction in medical and midwifery group: curricula should continue. There is a need to focus on strategies to 11820 scale up the use of oxytocin as the primary component of AMTSL. This study did not examine the role of uterine massage in reducing REFERENCES blood loss. Deneux-Tharaux, C., Sentilhes, L., Maillard, F., Closset, E., Vardon, D., Lepercq, J., & Goffinet, F. (2013). Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial (TRACOR). BMJ: British Medical Journal, 14. 5 Roy, 2016 Prospective Study Placental blood drainage as part of active management of the third || A Gülmezoglu, A. M., Lumbiganon, P., Landoulsi, S., Widmer, M., Abdel-Aleem, H., Festin, M., … Elbourne, D. (2012). Articles: RCT Group: stage of labor was effective in reducing he duration, the blood loss, Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, IMPLICATIONS FOR PRACTICE non-inferiority trial. The Lancet, 379, 1721–1727. https://doi.org/10.1016/S0140-6736(12)60206-2 100 and also the incidence of postpartum hemorrhage. Roy, P., Sujatha, M. S., Bhandiwad, A., Biswas, B., & Chatterjee, A. (2016). Placental Blood Drainage as a Part of Active Management of Third Stage of Labour After Spontaneous Vaginal Delivery. Journal of Obstetrics and Gynecology of • Assess physician adherence to guidelines Control India, (1), 242. Group: Saccone, G., Caissutti, C., Ciardulli, A., Abdel-Aleem, H., Hofmeyr, G., & Berghella, V. (2018). Uterine massage as part of • Healthcare facilities should adopt a formal protocol active management of the third stage of labour for preventing postpartum haemorrhage during vaginal delivery: a 100 systematic review and meta-analysis of randomised trials. BJOG: An International Journal of Obstetrics and for the management of PPH Gynaecology, (7), 778. 6 Tenaw, Cross Sectional 528 The knowledge and practice of obstetric care providers towards ||| A World Health Organization. (2012). WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Retrieved from • Simulations of PPH and treatment may be included Zelalem et al, Study Obstetric active management of third stage of labor can be improved with https://login.ezproxy.lib.uwf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=235 2017 care appropriate interventions like in-service trainings. The level of 86122&site=eds-live in pre-service and in-service training programs Zelalem Tenaw, Zemenu Yohannes, & Abdela Amano. (2017). Obstetric care providers’ knowledge, practice and associated providers knowledge and practice needs immediate attention of universities factors towards active management of third stage of labor in Sidama Zone, South Ethiopia. BMC Pregnancy and • Education of controlled cord traction should and health science colleges to revise obstetrics course content. Childbirth, Vol 17, Iss 1, Pp 1-7 (2017), (1), 1. https://doi.org/10.1186/s12884-017-1480-8 continue in medical and midwifery curricula.
Load more

Recommended publications
  • Medical Abortion Reference Guide INDUCED ABORTION and POSTABORTION CARE at OR AFTER 13 WEEKS GESTATION (‘SECOND TRIMESTER’) © 2017, 2018 Ipas
    Medical Abortion Reference Guide INDUCED ABORTION AND POSTABORTION CARE AT OR AFTER 13 WEEKS GESTATION (‘SECOND TRIMESTER’) © 2017, 2018 Ipas ISBN: 1-933095-97-0 Citation: Edelman, A. & Mark, A. (2018). Medical Abortion Reference Guide: Induced abortion and postabortion care at or after 13 weeks gestation (‘second trimester’). Chapel Hill, NC: Ipas. Ipas works globally so that women and girls have improved sexual and reproductive health and rights through enhanced access to and use of safe abortion and contraceptive care. We believe in a world where every woman and girl has the right and ability to determine her own sexuality and reproductive health. Ipas is a registered 501(c)(3) nonprofit organization. All contributions to Ipas are tax deductible to the full extent allowed by law. For more information or to donate to Ipas: Ipas P.O. Box 9990 Chapel Hill, NC 27515 USA 1-919-967-7052 [email protected] www.ipas.org Cover photo: © Ipas The photographs used in this publication are for illustrative purposes only; they do not imply any particular attitudes, behaviors, or actions on the part of any person who appears in the photographs. Printed on recycled paper. Medical Abortion Reference Guide INDUCED ABORTION AND POSTABORTION CARE AT OR AFTER 13 WEEKS GESTATION (‘SECOND TRIMESTER’) Alison Edelman Senior Clinical Consultant, Ipas Professor, OB/GYN Oregon Health & Science University Alice Mark Associate Medical Director National Abortion Federation About Ipas Ipas works globally so that women and girls have improved sexual and reproductive health and rights through enhanced access to and use of safe abortion and contraceptive care.
    [Show full text]
  • Uterine Atony: an Innovative Dutta's Scoring System for Elective
    JSAFOG Uterine Atony: An Innovative Dutta’s Scoring 10.5005/jp-journals-10006-1339System for Elective Cesarean Section ORIGINAL ARTICLE Uterine Atony: An Innovative Dutta’s Scoring System for Elective Cesarean Section 1Dilip Kumar Dutta, 2Indranil Dutta ABSTRACT in all groups were found to be uneventful. Maternal mortality was found to be nil. Uterine atony appears suddenly and is mostly unpredictable and accounts for 80% of causes of postpartum hemorrhage Conclusion: Early diagnosis and management of uterine atony (PPH), it is also one of the important causes of maternal death. during elective LSCS after adopting Dutta’s score were found to be not only reduce intra- and postoperative blood loss but Objective: To analyze the efficacy of Dutta’s score for early also was found to maintain a satisfactory hemoglobin level diagnosis and management of uterine atony during elective and hemodynamic status. Maternal mortality was found to be lower segment cesarean section (LSCS) to prevent PPH. nil. This randomized trial highlighted the importance of prompt Study methods: This study was undertaken at JNM, NSGH, treatment in group C to reduce intra- and postoperative blood CN at Kalyani, Nadia, West Bengal, India, from 1st June 2008 loss and maternal mobidity and mortality. to 31st Dec 2012. Six hundred cases undergoing elective LSCS Keywords: Dutta’s score, MMR, PPH, Pregnancy scoring, were selected for randomized trial. Clinical observations were Uterine atony. made after placental expulsion for scoring which includes shape and size of uterus, rugosity, tone, placental localization How to cite this article: Dutta DK, Dutta I. Uterine Atony: and time of placental expulsion.
    [Show full text]
  • Prophylactic Oxytocin Before Versus After Placental Delivery to Reduce
    Research Article iMedPub Journals 2017 www.imedpub.com Womens Health and Reproductive Medicine Vol.1 No.1:6 Prophylactic Oxytocin before Versus Amr AA Nadim, after Placental Delivery to Reduce Amr H Yehia and Reham Marie Farghal* Blood Loss in Vaginal Delivery: A Randomized Controlled Trial Department of Obstetrics and Gynecology, Ain Shams University, Egypt *Corresponding author: Abstract Reham Marie Farghal Background: PPH has been a leading cause of maternal death around the globe. Prophylactic oxytocin is one of the main components of the active management [email protected] of the third stage of labor to reduce blood loss. The timing of administration of prophylactic oxytocin varies considerably worldwide and it may have significant Department of Obstetrics and Gynecology, impact on the maternal and neonatal well-being. Ain Shams University, Egypt. Objectives: To assess the efficacy and safety of the timing of administration of prophylactic oxytocin via intramuscular route (before compared to after placental Tel: +20226831474 delivery) on blood loss in vaginal delivery. Methods: It is a double blinded study in which 403 patients were randomized in two groups to receive oxytocin 10 IU IM either before or after placental delivery. Citation: Nadim AAA, Yehia AH, Farghal RM Primiparous patients, patients with high risk for PPH and those with multiple (2017) Prophylactic Oxytocin before Versus vaginal or cervical tears were excluded from the study. All patients underwent after Placental Delivery to Reduce Blood controlled cord traction, immediate cord clamping. Results: Our results have Loss in Vaginal Delivery: A Randomized shown that there were no statistically significant differences between the two Controlled Trial.
    [Show full text]
  • Active Management of the Third Stage of Labor: a Brief Overview of Key Issues Doğumun Üçüncü Evresinin Aktif Yönetimi: Kilit Konulara Kısa Bir Bakış
    Review / Derleme DOI: 10.4274/tjod.39049 Turk J Obstet Gynecol 2018;15:188-92 Active management of the third stage of labor: A brief overview of key issues Doğumun üçüncü evresinin aktif yönetimi: Kilit konulara kısa bir bakış Kemal Güngördük1, Yusuf Olgaç2, Varol Gülseren3, Mustafa Kocaer4 1Muğla Sıtkı Koçman University, Training and Research Hospital, Clinic of Gynecology and Oncology, Muğla, Turkey 2Bilim University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey 3Kaman State Hospital, Clinic of Obstetrics and Gynecology, Kırşehir, Turkey 4University of Health Sciences, İzmir Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, İzmir, Turkey Abstract Postpartum hemorrhage is a potentially life-threatening, albeit preventable, condition that persists as a leading cause of maternal death. It occurs mostly during the third stage of labor, and active management of the third stage of labor (AMTSL) can prevent its occurrence. AMTSL is a recommended series of steps, including the provision of uterotonic drugs immediately upon fetal delivery, controlled cord traction, and massage of the uterine fundus, as developed by the World Health Organization. Here, we present current opinion and protocols for AMTSL. Keywords: Postpartum hemorrhage, active management of the third stage of labor, uterotonic agents Öz Postpartum kanama, hayatı tehdit eden, önlenebilir bir durumdur, anne ölümünün önde gelen nedenini oluşturan bir durumdur. Çoğunlukla doğumun üçüncü evresi sırasında ortaya çıkar ve doğumun üçüncü evresinin aktif yönetimi (AMTSL) ortaya çıkmasını engelleyebilir. AMTSL, uterotonik ilaçların hemen fetal doğum üzerine uygulanması, kontrollü kordon traksiyonu ve Dünya Sağlık Örgütü tarafından geliştirilen rahim fundus masajı dahil olmak üzere önerilen bir dizi adımdır.
    [Show full text]
  • Physiology and Management of Normal Third Stage of Labour
    PHYSIOLOGY AND MANAGEMENT OF NORMAL THIRD STAGE OF LABOUR BY K. BHASKAR RAo, M.D., Resident Medical Officer, Govt. Raja Sir Ramaswamy Mudaliar's Lying-in Hospital, and Asst. Professor of Midwifery, Stanley Medical College, Madras. For the past two centuries inches x 7 inches to 4 inches x 4 clinicians have thought over the inches without causing separation, mechanism of separation and ex- and maintained that the contraction pulsion of the placenta, because, till of the uterus, superimposed on this a clear understanding of this stage retraction, was the factor which of labour is reached, its management brought about placental separation. cannot be perfected. According to According to Eastman, placenta is Macafee, haemorrhage in the third torn off at the level of spongy layer stage of labour causes more deaths of the decidua "just as from the than any other obstetric complication. p e r f o r a t i o n s between postage In the Lying-in Hospital, Madras, · stamps." Shaw considers that the 18j~ of the maternal deaths in 1951 glands lie deeper still and take no were due to this complication. Apart part in the mechanism of separation. from the mortality, excessive blood The plane of cleavage occurs below loss during the third stage predis- the layer of Nitabusch in a layer of poses to increased puerperal mor- loose cells which are spread over the bidity. whole placenta and decidua vera. The physiology of the third stage Freeland observed that the peri­ covers two phases-separation of the phery of the placenta is the most placenta and its expulsion.
    [Show full text]
  • Sonographic Diagnosis of Uterine Rupture
    ACTA RADIOLÓGICA PORTUGUESA Janeiro-Abril 2014 nº 101 Volume XXVI 39-41 Caso Clínico / Radiological Case Report SONOGRAPHIC DIAGNOSIS OF UTERINE RUPTURE DIAGNÓSTICO ECOGRÁFICO DE ROTURA UTERINA Gonçalo Inocêncio1, José Romo2, Carlos Mexedo2, Maria Carinhas1, Olinda Rodrigues1 1Centro Hospitalar do Porto – Maternidade Resumo Abstract Júlio Dinis, Porto, Portugal Serviço de Obstetrícia/Ginecologia Apresentamos um caso clínico de uma mulher, We present a case of a 36-year-old woman, with 2Centro Hospitalar do Porto, Portugal 36 anos, com antecedente cirúrgico de cesariana previous history of caesarean section who had Serviço de Anestesia anterior, que teve rotura uterina durante o parto, uterine rupture during labour, induced at 22 weeks induzido às 22 semanas de gestação, devido a uma gestation, due to fetal malformation. The diagnosis malformação fetal. O diagnóstico foi devido a was made because of severe vaginal bleeding after hemorragia vaginal grave imediatamente após a delivery of the fetus and placenta. The uterine Correspondência expulsão do feto e placenta. A rotura uterina foi rupture was verified by ultrasound imaging. Early confirmada por imagem ecográfica diagnosis led immediately to surgical intervention Gonçalo Inocêncio transabdominal. O diagnóstico precoce levou a and resolution of this frightening obstetric Rua Calouste Gulbenkian, n53, 5H5 uma rápida intervenção cirúrgica e resolução desta complication. 4050 – Porto, Portugal emergência Obstétrica. Email: [email protected] Key-words Palavras-chave Pregnancy, previous caesarean, ultrasound Cesariana prévia, gravidez, imagem ecográfica, imaging, uterine rupture. Recebido a 02/03/2014 rotura uterina. Aceite a 08/04/2014 Introduction myomectomy), prostaglandins or oxytocin administration during labour, multiparity, fetal macrosomia or fetal-pelvic The medical termination of pregnancy between the 13th and disproportion, uterine malformations.
    [Show full text]
  • Retained Placenta After Vaginal Birth - Uptodate
    2019/3/17 Retained placenta after vaginal birth - UpToDate Official reprint from UpToDate® www.uptodate.com ©2019 UpToDate, Inc. and/or its affiliates. All Rights Reserved. Retained placenta after vaginal birth Author: Andrew Weeks, MD, MRCOG Section Editor: Vincenzo Berghella, MD Deputy Editor: Vanessa A Barss, MD, FACOG All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Feb 2019. | This topic last updated: Dec 12, 2018. INTRODUCTION The third stage of labor is the interval from delivery of the infant to expulsion of the placenta. Delayed separation and expulsion of the placenta is a potentially life-threatening event because it interferes with normal postpartum contraction of the uterus, which can lead to hemorrhage. This topic will discuss the diagnosis and management of a retained placenta after vaginal birth. Management of retained products of conception after a miscarriage or pregnancy termination is reviewed separately. (See "Retained products of conception".) DEFINITION Retained placenta can be defined as lack of expulsion of the placenta within 30 minutes of delivery of the infant [1,2]. This is a reasonable definition in the third trimester when the third stage of labor is actively managed (ie, administration of a uterotonic agent before delivery of the placenta, controlled cord traction) because 98 percent of placentas are expelled by 30 minutes (figure 1) in this setting [3]. Physiological management of the third stage (ie, delivery of the placenta without the use of uterotonic agents or cord traction) increases the frequency of retained placenta: only 80 percent of placentas are expelled by 30 minutes (figure 1) and it takes about 60 minutes before 98 percent of placentas are expelled.
    [Show full text]
  • Approach to Cases with Postpartum Haemorrhage: Retrospective Analysis of 41 Cases
    18JCEI / 2014; 5 (1): 18-23 Journal of Clinical and Experimental Investigations doi: 10.5799/ahinjs.01.2014.01.0352 ORIGINAL ARTICLE / ÖZGÜN ARAŞTIRMA Approach to cases with postpartum haemorrhage: Retrospective analysis of 41 cases Postpartum hemoraji vakalarına yaklaşım: 41 olgunun retrospektif analizi Adnan İncebıyık1, Aysun Camuzcuoğlu2, Neşe Gül Hilali1, Ahmet Küçük2, Hasan Hüsnü Yüce2, Harun Aydoğan2, Hakan Camuzcuoğlu1, Mehmet Vural1 ABSTRACT ÖZET Objective: To assess treatment approaches and out- Amaç: Kliniğimizde tedavi edilen 41 postpartum hemoraji comes in 41 cases with postpartum haemorrhage (PPH). (PPH) olgusunun tedavi yöntemleri ve sonuçlarını değer- Methods: Screening the electronic database of the hos- lendirmek pital identified 41 cases admitted to the obstetrics clinic Yöntemler: Hastanemiz elektronik kayıt sisteminden 1 with a diagnosis of PPH (ICD codes: O72, O72, O72.2) Ocak 2010 ile 30 Haziran 2013 tarihleri arasında “Interna- between January 1, 2010, and June 30, 2013. The clinical tional Classification of Diseases” hastalık kodlarına göre findings and the results of the surgical and medical treat- Postpartum kanama (O72, O72.1, O72.2) tanısı ile obs- ments used were noted in all the patients. tetri servisine yatışı yapılan hastalar taranarak 41 hasta Results: Forty-one cases with PPH were detected who kaydına ulaşıldı. Tüm hastaların tedavi sırasındaki klinik had been managed at the clinic during a 3-year pe- durumları ve uygulanan cerrahi ve medikal tedavi sonuç- riod. Normal spontaneous vaginal delivery (26 patients; ları not edildi. 63.4%) was the most common type of delivery. Uterine Bulgular: Üç yıllık dönem içerisinde PPH nedeniyle has- atony was the most common cause of PPH in 30 patients tanemizde tedavi altına alınan 41 olgu saptandı.
    [Show full text]
  • Case Analysis of Post-Placenta IUD Expulsion
    Availableonlineat https://ejournal.unisayogya.ac.id/ejournal/index.php/ijhst International Journal of Health Science and Technology, 2 (1), 2020, 105-111 Case Analysis of Post-Placenta IUD Expulsion Dewi Setyoningsih1,* , Evi Nurhidayati2 1,2Faculty of Health Science, ‘Aisyiyah University of Yogyakarta , Indonesia * corresponding author Submission date: 10 Juli 2018, Receipt date: 10 Oktober 2019, Publication date: 1 Juli 2020 Abstract Indonesian Government has launched various programs to overcome population problems. Postpartum Family planning program is included in maternal insurance program, so every partum mother can immediately insert Post-placenta IUD for free. The failure of inserting IUD contraception in Indonesia reached 37.75%. The result of this review can be taken into consideration regarding goverment policy about Postpartum Family Planing Programe. The design of this study is literature review. The selected articles are those relating to IUD Post-placenta expulsion. Database PubMed used to cellecting article. We only take article that published from 2010 – 2018. The analysis of 11 journals showed that the IUD post-placenta have rates of expulsion varies from some article, the lowest 1,4 % and highest 24 %. Then delayed insertion of IUD have expulsion rates 0 % up to 37%. This review supports the evidence that insertion of an IUD Postplacenta after vaginal delivery or caesarean delivery is safe. Expulsion rates should be further studied in larger randomised controlled trials. Keywords: IUD Post-placenta, Immediate IUD insertion, Expulsion, Expelled INTRODUCTION Indonesian Government has launched various programs to overcome population problems. One of the programs is National Family Planning which aims to realize population-oriented development and realize small, happy, and prosperous family.
    [Show full text]
  • Chapter J Postpartum Hemorrhage Ann Evensen, MD Janice Anderson, MD Published February 2015
    Chapter J Postpartum Hemorrhage Ann Evensen, MD Janice Anderson, MD Published February 2015 OBJECTIVES After completing this chapter, participants will be able to: 1. List the important causes of postpartum hemorrhage. 2. Describe methods for preventing postpartum hemorrhage. 3. Discuss the need for early recognition and quick response to postpartum hemorrhage. 4. Describe the treatment of postpartum hemorrhage. INTRODUCTION Postpartum hemorrhage (PPH) is excessive bleeding after delivery of the fetus and may occur before or after delivery of the placenta. Clinicians must learn to recognize excessive bleeding and intervene, preferably before other signs and symptoms of PPH develop (see Table 1). Table 1. Signs and Symptoms of Postpartum Hemorrhage Symptoms Signs Lightheadedness Bleeding over 500 mL with vaginal delivery Weakness Hypotension Palpitations Tachycardia Restlessness Diaphoresis Confusion Syncope Air hunger Pallor Oliguria Hypoxia DEFINITION, EPIDEMIOLOGY, AND SIGNIFICANCE Postpartum hemorrhage (PPH) is traditionally defined as the loss of more than 500 milliliters of blood following vaginal delivery or more than 1000 milliliters following cesarean delivery.1 PPH is considered severe when blood loss exceeds 1000 milliliters after vaginal delivery or results in signs or symptoms of hemodynamic instability.1 However, the definition of PPH is debated as more recent studies have shown that the median blood loss at spontaneous vaginal delivery exceeds 500 mil- liliters.2 Postpartum hemorrhage can be classified as primary, which
    [Show full text]
  • IHS Primary Care Provider Newsletter
    THE IHS PRIMARY CARE PROVIDER A journal for health professionals working with American Indians and Alaska Natives August 2005 Volume 30 Number 8 The Fiftieth Anniversary of the Indian Health Service July 2005 marked the 50th anniversary of the Transfer Act, P.L. 83-568, which officially transferred the Indian health programs from the Bureau of Indian Affairs to the U.S. Public Health Service, effectively establishing the Indian Health Service (IHS). The Transfer Act provided that “all functions, responsibilities, authorities, and duties . relating to the maintenance and operations of hospital and health facilities for Indians, and the conservation of Indian health . shall be administered by the Surgeon General of the United States Public Health Service.” The enactment of the Transfer Act heralded the beginning of the healing of many years of physical and spiritual wounds, the building of a health infrastructure to address the health disparities facing American Indian and Alaska Native people, and the launching of a new era in Indian health care. This was accomplished through a unique partnership between the Indian Health Service and American Indian and Alaska Native people. By listening to the voices of those most aware of the needs of their communities, we have built an Indian health care system that is responsive to those needs and that is culturally acceptable in the provision of health care services. In FY 2005 we have embarked on a special year of celebrations and special events. A 50th Anniversary reference library of historical documents and photographs is being compiled, and will be available on the IHS Website.
    [Show full text]
  • Bakri Balloon Removal Protocol
    Bakri Balloon Removal Protocol Cerebrospinal Terence sometimes prologuised any relict lactating antisocially. Thaddus is contextual condescendingly.tongue-in-cheek.and outgeneral goniometrically Hebephrenic andas sizeable ergative Niccolo Collins floursoverqualified adoringly her and shiner accompanying probating or jutty Other postpartum hemorrhage due to improve care units are available coding systems, bakri balloon removal of blood pressure balloon tamponade, which is inserted in Predictors of failed pelvic arterial embolization for severe postpartum hemorrhage. Emergency postpartum hysterectomy for uncontrolled postpartum bleeding: a systematic review. They also provide good conditions to facilitate this painful procedure. In three women, PAE was performed after hysterectomy due to continual bleeding, and in three women, hysterectomy was performed after PAE failure. Our results provided new information about BBT in a larger cohort managed in a single tertiary center. Bakri balloon tamponade for intractable hemorrhage due to complete placenta previa. Takata T, Kumasawa K, et al. Use the enclosed syringe or rapid instillation components to fill the balloon to the predetermined volume through the stopcock. Pressure was applied on the bleeding area to temporarily control the bleeding, after which decision was taken for bilateral uterine artery ligation which resulted in some control of the bleeding. Hwu YM, Chen CP, Chen HS, Su TH. Blum J, Winikoff B, Raghaven S, Dabash R, Ramadan MC, Dilbaz B, Durocher J, Yalvac S, Diop A, Dzuba IG, Ngoc NTN. Timing of delivery decisions need to balance maternal risks and benefits with those of the fetus or neonate. We established our initial key questions based on our preliminary review of the literature, information from the review nominator, and information in the topic nomination.
    [Show full text]