Effects of a new patient safety-driven oxytocin dosing protocol on postpartum hemorrhage.

Objective. To determine if there was an increase in postpartum (PP) hemorrhage after decreasing the PP oxytocin dose from 40 to 30 units. Study Design. Retrospective cohort study comparing 8 months before to 8 months after the change. PP day 1 hemoglobin was subtracted from admission hemoglobin. Mean change was compared by Student's t-test. The best fit polynomial was analyzed for trends between the two time frames. Women who received blood transfusions were excluded. Results. 73/3564 (2.0%) women received blood transfusions in the pre group and 64/3295 (1.9%) women in the post group, P = 0.8. Mean hemoglobin change ± standard deviation was 1.53 ± 0.03 g/dL for pre versus 1.52 ± 0.05 g/dL for post, P = 0.68. 1003/3114 (32.2%) in the pre group had a hemoglobin decrease of ≥2 g/dL compared to 918/2895 (31.7%) in the post group, P = 0.7. 261/3114 (8.4%) in the pre group had a hemoglobin decrease of ≥3 g/dL compared to 252/2895 (8.7%), P = 0.7. There were no significant trends between the two time frames. Conclusion. The change in the dose of PP oxytocin did not result in an increase in postpartum hemorrhage or an increase in the need for blood transfusion.

Lethal neonatal coagulopathy after maternal ingestion of a superwarfarin.

BACKGROUND: Brodifacoum, a superwarfarin, is a common household agent used for rodenticides. We present a case of maternal brodifacoum ingestion that resulted in neonatal death. CASE: A 19-year-old primigravid woman presented at 32 weeks of gestation with spontaneous mucosal bleeding. Her fetus showed evidence of acidosis on external fetal monitoring. Laboratory values were consistent with maternal coagulopathy. After correction of the coagulopathy, the patient was taken for urgent cesarean delivery. The neonate showed evidence of fetal coagulopathy and died at 4 days of life. CONCLUSION: Brodifacoum is a dangerous household chemical that, if ingested, can result in significant morbidity and mortality for both mother and neonate. Increased awareness of the serious and potentially lethal effects of brodifacoum is important.

Differential regulation of myometrial prostaglandin production by changes in length.

OBJECTIVE: The purpose of this study was to determine whether stretching and shortening of human myometrial strips alters prostaglandin production. STUDY DESIGN: We measured 6-keto prostaglandin F1alpha (PGF1alpha; a PGI2 metabolite) and PGF2alpha in the contraction baths of myometrial strips that were obtained at cesarean delivery from 5 term pregnant women. Fluid was collected after the stretching and after the strip lengths were decreased by 4%, 6%, or 8%. Prostaglandin concentrations were measured in triplicate by competitive enzyme immunoassay and compared by Kruskal-Wallis tests. RESULTS: Stretching myometrial strips increased the production of 6-keto PGF1alpha by 31%, but not PGF2alpha. Shortening strips had little effect on 6-keto PGF1alpha production, but increased PGF2alpha production by 158%. CONCLUSION: Stretching myometrial strips from pregnant women increases synthesis of PGI2; shortening strips increases synthesis of PGF2alpha. Differential prostaglandin synthesis that is related to myometrial stretching and shortening could play a role in uterine quiescence during gestation and increased contractility during parturition.