The impact of hypertensive disorders on shock index in deliveries complicated by postpartum hemorrhage

Pregnancy hypertensive disorders such as Preeclampsia (PE) are strongly correlated with insulin resistance, a condition in which the metabolic handling of D-glucose is deficient. In addition, the impact of preeclampsia is enhanced by other insulin-resistant disorders, including polycystic ovary syndrome and obesity. For this reason, there is a clear association between maternal insulin resistance, polycystic ovary syndrome, obesity and the development of PE. However, whether PE is a consequence or the cause of these disorders is still unclear. Insulin therapy is usually recommended to pregnant women with diabetes mellitus when dietary and lifestyle measures have failed. The advantage of insulin therapy for Gestational Diabetes Mellitus (GDM) patients with hypertension is still controversial; surprisingly, there are no studies in which insulin therapy has been used in patients with hypertension in pregnancy without or with an established GDM. This review is focused on the use of insulin therapy in hypertensive disorders in the pregnancy and its effect on offspring and mother later in life. PubMed and relevant medical databases have been screened for literature covering research in the field especially in the last 5-10 years.

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Small animal Review

Companion Animal ◽

10.12968/coan.2021.0008 ◽

2021 ◽

Vol 26 (3) ◽

pp. 5-5

Author(s):

Alex Gough

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulmonary Oedema ◽

Potential Role ◽

Lung Ultrasound ◽

Small Animal ◽

Shock Index ◽

Cardiogenic Pulmonary Oedema ◽

The Impact

Summary In this month's Small Animal Review, we summarise three recently published papers from other veterinary journals. The papers for this issue explore the impact of open registries on inbreeding, in the working Australian Kelpie population particularly, and the impact of vehicle trauma on the canine shock index, as well as the potential role for lung ultrasound in monitoring for cardiogenic pulmonary oedema in dogs being treated for left-sided congestive heart failure.

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The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

American Journal of Perinatology ◽

10.1055/s-0040-1718574 ◽

2020 ◽

Author(s):

Aleksandra Polic ◽

Tierra L. Curry ◽

Judette M. Louis

Keyword(s):

Interventional Radiology ◽

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Tertiary Care ◽

P Value ◽

Obese Women ◽

Severe Morbidity ◽

The Impact ◽

To Receive

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

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The impact of the using high-fidelity simulation and standardized patients to management of postpartum hemorrhage in undergraduate nursing students: A randomized controlled study in Turkey

Health Care For Women International ◽

10.1080/07399332.2019.1583229 ◽

2019 ◽

Vol 40 (5) ◽

pp. 597-612

Author(s):

Merve Mert Karadas ◽

Fusun Terzioglu

Keyword(s):

Nursing Students ◽

Postpartum Hemorrhage ◽

Standardized Patients ◽

Controlled Study ◽

High Fidelity ◽

High Fidelity Simulation ◽

Undergraduate Nursing Students ◽

Randomized Controlled ◽

Undergraduate Nursing ◽

The Impact

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Calculated blood loss overestimates diagnosis of postpartum hemorrhage in patients with hypertensive disorders of pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.553 ◽

2022 ◽

Vol 226 (1) ◽

pp. S329

Author(s):

Gabriela Dellapiana ◽

Savannah Gonzales ◽

Richard M. Burwick

Keyword(s):

Blood Loss ◽

Postpartum Hemorrhage ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders

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Transarterial embolization for postpartum hemorrhage: lessons learned

Acta Radiologica ◽

10.1177/0284185118769691 ◽

2018 ◽

Vol 59 (12) ◽

pp. 1451-1457

Author(s):

Chen-Ju Fu ◽

Wiwan Irama ◽

Yon-Cheong Wong ◽

Hsiao-Jung Tseng ◽

Li-Jen Wang ◽

...

Keyword(s):

Risk Factors ◽

Postpartum Hemorrhage ◽

Transarterial Embolization ◽

Laboratory Data ◽

Vital Signs ◽

International Normalized Ratio ◽

Lessons Learned ◽

Clinical Failure ◽

Shock Index ◽

Independent Risk Factors

Background Although transarterial embolization (TAE) can powerfully control postpartum hemorrhage (PPH), clinical failure of TAE is not uncommon. Purpose To discover whether any parameters could predict timely clinical failure of TAE, then whether a supplementary intervention could be promptly initiated. Material and Methods We retrospectively analyzed 118 TAE procedures in 113 patients with PPH performed at our institution between January 2012 and May 2015. The patients were divided into the following groups: clinically successful TAE and failed TAE. Successful TAE was defined as obviation of supplementary embolization or surgical intervention for hemostasis. Gestational conditions, angiographic factors, maternal vital signs, and laboratory data were compared between the two groups. Results In total, 100 (84.8%) TAEs were clinically successful. Multivariate logistic regression analyses revealed independent risk factors of TAE clinical failure, including the requirement for augmented embolic agents, placental retention, and international normalized ratio > 1.3 ( P = 0.009, 0.001, and 0.005, respectively). The post-TAE shock index was significantly associated with TAE failure, using a cut-off value of 0.8. Conclusion The discovered independent risk factors of TAE clinical failure existed before or during the TAE procedure and could not reflect the post-TAE conditions. Although the post-TAE shock index was not an independent factor, it reflected the conditions after TAE and could indicate TAE clinical failure timely.

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