scholarly journals A comprehensive digital phenotype for postpartum hemorrhage

2021 ◽  
Author(s):  
Amanda B Zheutlin ◽  
Luciana Vieira ◽  
Shilong Li ◽  
Zichen Wang ◽  
Emilio Schadt ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Chart Review ◽  
Diagnostic Codes ◽  
Treatment Data ◽  
Selected Subset ◽  
And Performance ◽  
Preventative Interventions ◽  
Surgical Treatments ◽  
Current Guidelines

ABSTRACTObjectiveWe aimed to establish a comprehensive digital phenotype for postpartum hemorrhage (PPH). Current guidelines rely primarily on estimates of blood loss, which can be inaccurate and biased, and ignore a suite of complementary information readily available in electronic medical records (EMR). Inaccurate and incomplete phenotyping contribute to ongoing challenges to track PPH outcomes, develop more accurate risk assessments, and identify novel interventions.MethodsWe constructed a cohort of 71,944 deliveries from the Mount Sinai Health System, 2011-2019. Estimates of postpartum blood loss, shifts in hematocrit intra- and postpartum, administration of uterotonics, surgical treatments, and associated diagnostic codes were combined to identify PPH retrospectively. All clinical features were extracted from structured EMR data and mapped to common data models for maximum interoperability across hospitals. Blinded chart review was done on a randomly selected subset of cases and controls for validation and performance was compared to alternate PPH phenotypes.ResultsWe identified 6,639 cases (9% prevalence) using our phenotype – more than three times as many as using blood loss alone (N=1,747), supporting the need to incorporate other diagnostic and treatment data. Blinded chart review revealed our phenotype had 96% sensitivity, 89% precision, 77% specificity, and 89% accuracy to detect PPH. Alternate phenotypes were less accurate, including a common blood loss-based definition (67%) and a previously published digital phenotype (74%).ConclusionWe have developed a scalable, accurate, and valid digital phenotype that may be of significant use for tracking outcomes and ongoing clinical research to deliver better preventative interventions for PPH.

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

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

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

scholarly journals 1 Physiological and performance recovery after fourteen hours of feed restriction or transportation in Holstein bulls fed high concentrate diets

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 2-3
Author(s):  
Sonia Marti ◽  
Elena Garcia ◽  
Christine Gerard ◽  
Joan Grau ◽  
Nicolas Cirier ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Feed Restriction ◽  
Amyloid A ◽  
Performance Recovery ◽  
Treatment Data ◽  
Access To Water ◽  
Holstein Calves ◽  
Holstein Bulls ◽  
And Performance ◽  
Beta Hydroxybutyrate

Abstract One hundred and eight Holstein calves (225 ± 1.1 kg and 187 ± 5.2 d) were used to evaluate the physiological and performance recovery after 14 h transportation or feed restriction. Calves were distributed into 6 pens (2 pens/treatment) according to control (CTR, n = 36) calves with ad libitum access to concentrate, straw and water; restricted (RES, n = 36) calves with concentrate restriction but with access to water and straw for 14 h; and transported (TRA, n = 36) calves that were loaded into a trailer and transported without feed or water for 14 h. On days 0, 7, 21, and 35 BW was recorded. Concentrate intake were recorded daily. Blood samples for non-esterified fatty acids (NEFA), beta-hydroxybutyrate (BHBA), and serum amyloid-A (SAA) were collected at -24, -14, 0 h, and 6, 24, and 168 h post-treatment. Data were analyzed using mixed models with repeated measures. At 24 h, RES and TRA had greater (P &lt; 0.05) concentrate intake compared with CTR. However, from d 7 to 35 after treatments, only TRA had similar concentrate intake than CTR, while RES had lesser (P &lt; 0.05) concentrate intake than CTR and TRA. RES at 6 h had greater (P &lt; 0.05) NEFA concentrations than TRA, and NEFA concentrations were still higher for the RES and TRA groups than those for the CTR after 24 h. After 24 h concentrations of serum BHBA for TRA and RES were significantly greater (P &lt; 0.05) when compared with those for the CTR. Serum concentration of SAA for TRA and RES was greater (P &lt; 0.05) than CTR until 168 h. Results showed similar effects of 14 h of feed restriction and transportation of calves on serum anorexia and inflammation parameters; however, feed intake was recovered after d 35 in transported calves but not in feed restricted calves without transportation.

scholarly journals Emergency Peripartum Hysterectomy as Postpartum Hemorrhage Treatment: Incidence, Risk factors, and Complications

2014 ◽  
Vol 52 (193) ◽  
pp. 668-676 ◽  
Author(s):  
Meena Pradhan ◽  
Yong Shao
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Placenta Previa ◽  
Uterine Atony ◽  
Previous Caesarean Section ◽  
Peripartum Hysterectomy ◽  
Incidence Risk ◽  
Emergency Peripartum Hysterectomy

Introduction: The aim of the research was to investigate incidence, risk factors, and complications associated with emergency peripartum hysterectomy, the ultimate treatment method for intractable postpartum hemorrhage.Methods: This is a single center case-control study conducted in Chongqing city in central China from 1st January 2007 to 31st December 2012 for emergency peripartum hysterectomy performed as a treatment of postpartum hemorrhage both in caesarean and vaginal delivery cases. While the study group included emergency peripartum hysterectomy (n=61) due to intractable postpartum hemorrhage, the control group included no hysterectomy (n=333) during the same study period.Results: We found 61 cases recorded for emergency peripartum hysterectomy for intractable postpartum hemorrhage. Incidence of peripartum hysterectomy was 2.2 per 1000 deliveries. Emergency peripartum hysterectomy as treatment of intractable postpartum hemorrhage include the followings: (i) blood loss 1000-2000 ml, crude odd ratio (OR) =18.48 (95% CI 5.1-65.7), adjusted odd ratio (AOR) = 9.1 (95% CI 2.2-37.7); (ii) blood loss >2000 ml, OR = 152 (95% CI 43.7-528.4), AOR = 45.3 (95% CI 11.6-176.9); (iii) previous caesarean section, OR = 5.5 (95% CI 2.9-9.7), AOR = 3.7(95% CI 1.4-9.9); (iv) uterine atony, OR = 11.9 (95% CI 5.8-24.6), AOR = 7.5 (95% CI 1.8-30.2); (v) placenta previa, OR = 2.04 (95% CI 1.1-3.5), AOR = none. Conclusions: Emergency peripartum hysterectomy is the last resort as treatment of intractable severe postpartum hemorrhage. Our study depicts that severe post partum hemorrhage, further dreaded complex events for emergency peripartum hysterectomy, has significant association with placental factors, previous caesarean section, and uterine atony. Pathologically, placenta accreta remained the most leading cause of hysterectomy.Keywords: caesarean section; hemorrhage; peripartum hysterectomy; placenta previa.

scholarly journals Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Masato Kinugasa ◽  
Hanako Tamai ◽  
Mayu Miyake ◽  
Takashi Shimizu
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Balloon Catheter ◽  
Stable Condition ◽  
Total Blood Loss ◽  
Total Blood ◽  
Balloon Tamponade ◽  
First Case ◽  
Uterine Balloon Tamponade

While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.

Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Labib M. Ghulmiyyah ◽  
Alaa El-Husheimi ◽  
Ihab M. Usta ◽  
Cristina Colon-Aponte ◽  
Ghina Ghazeeri ◽  
...  
Keyword(s):  
Blood Loss ◽  
Vaginal Delivery ◽  
Postpartum Hemorrhage ◽  
Primary Outcome ◽  
Dropout Rate ◽  
Significant Difference ◽  
Uterine Massage ◽  
Secondary Outcomes ◽  
Group 2 ◽  
Group 1

Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery. Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage. Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79). Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery. Key Points

Fibrinolysis after an Elective Caesarean Section without Postpartum Hemorrhage: Pilot Study for Reference Values from the Simultaneous Thrombin and Plasmin Generation Assays

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Ducloy-Bouthors A S ◽  
◽  
Lassalle F ◽  
Gilliot S ◽  
Kyheng M ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Mixed Model ◽  
Elective Caesarean Section ◽  
Individual Variability ◽  
Elective Cesarean Section ◽  
Time Interval ◽  
Simultaneous Generation ◽  
D Dimer ◽  
Over Time

ntroduction: Postpartum Hemorrhage (PPH)-induced coagulopathy should be better explored. An innovative Simultaneous Generation of Thrombin and Plasmin Assay (SGTPA) was developed. Objective: To establish postpartum SGTPA references. Methods: Blood samples collected immediately after delivery (T0) and then 30, 60, 120 and 360 minutes later. Thrombin Generation (TG) and Plasmin Generation (PG) changes over time analyzed in 51 women after elective cesarean section without PPH and compared with Non-Pregnant (NP) women. The SGTPA variables’ correlations with fibrinogen levels, D-dimer levels and physiological blood loss were assessed in a mixed model. Results: 37 women were included. TG and PG were higher in the postpartum group than in the NP group. TG increased early and then remained stable (baseline TG Area Under the Curve (AUC) [95% Confidence Interval (CI)] = 41037 [36850-43537] nM.min). The fibrinogen level varied over time, along with TG (p<0.001). Plasmin generation increased from 30 to 120 minutes (AUC [95% CI]: 2104 [1437; 2613] nM.min), along with a change in the D-dimer level (p=0.018). The time to the plasmin peak and the time interval between the TG and PG peaks showed the greatest inter-individual variability at T0 and were associated with physiological volumes of blood loss during cesarean delivery. Conclusion: Reference SGTPA postpartum range was established. The SGTPA appears to be valuable for measuring TG and PG. TG and coagulation activation increased immediately after delivery, whereas PG and fibrinolysis increased later.

scholarly journals 251: Accuracy of colorimetric quantitative blood loss estimation for identification of postpartum hemorrhage

2019 ◽  
Vol 220 (1) ◽  
pp. S181-S182
Author(s):  
Daniel N. Pasko ◽  
Victoria C. Jauk ◽  
Robin Steele ◽  
Dhong-Jin Kim ◽  
Cherry Neely ◽  
...  
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Loss Estimation ◽  
Blood Loss Estimation
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