Assessment of quality of life indicators in the postpartum period.

BACKGROUND: Quality of life assessments are increasingly recognised in healthcare. The aim of this study was to evaluate psychometric characteristics of Nottingham Health Profile in the postpartum period. METHODS: A random sample of 133 English speaking women completed the scale in hospital between 24 and 48h of delivery and again at 7days postpartum. Descriptive analysis was used to evaluate psychometric parameters of the questionnaire. RESULTS: The questionnaire indicated that in the acute setting, physical ability, energy level and pain were most affected. At follow-up, women described greatest difficulties with energy level and pain domains. The scores for physical ability, pain, sleep and energy level improved compared to baseline (P<0.05). Women who had caesarean delivery had lower scores for physical ability, pain and energy level domains at 1-2week follow-up compared to the vaginal delivery group (P<0.05). CONCLUSIONS: The scale was found to be suitable for evaluation of quality of life in a population of postpartum women. However a more culturally and geographically diverse population is needed to test reliability and validity of the instrument.

Anesthetic considerations for placenta accreta.

BACKGROUND: When diagnosed antenatally placenta accreta has often been managed by cesarean hysterectomy, but recently techniques involving uterine preservation have been developed. Uterine artery embolization has become an adjuvant treatment, although the potential for obstetric hemorrhage still exists. A multidisciplinary approach has permitted the development of anesthetic strategies for these patients. METHODS: A retrospective case note review of patients with placenta accreta between 2000 and 2008 at our institution was conducted. Anesthetic technique, estimated blood loss, requirement for blood products and disposition of patients postoperatively were recorded. RESULTS: A total of 23 cases were identified. In six, epidural anesthesia with progression to general anesthesia was planned. In 17 cases, neuraxial anesthesia was planned and in five of these (29%) excessive blood loss necessitated conversion to general anesthesia. Nine patients (39%) had intraoperative blood loss estimated at > 2L, and six required intraoperative blood transfusion. Eleven patients (48%) required hysterectomy, seven of which were performed on the day of delivery. CONCLUSION: In this case series, the expectation of major blood loss at cesarean delivery in the presence of placenta accreta and attempts at uterine conservation surgery initially prompted a conservative approach using general anesthesia. Greater experience has permitted modification of this approach and neuraxial anesthesia is now employed more frequently. When managed appropriately, most patients are able to tolerate both prolonged surgery and significant blood loss under epidural anesthesia.