A new and feasible uterine compression suture technique in uterine atony to save mothers from postpartum hemorrhage.

BACKGROUND: Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. AIMS: The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. SUBJECTS AND METHODS: In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. RESULTS: All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. CONCLUSIONS: We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.

Towards the 24-hour society--new approaches for aging shift workers?

The new "24-hour society" increases night work and the diversity of flexible work-hour patterns. At the same time, the number of older shift workers is growing in most developed countries due to the general aging of the working population. Together with new experimental and epidemiologic data on the alarming relationship of shift work to fatigue, performance, accidents, and chronic health effects like coronary heart disease, there is reason to believe that shift work may become a major occupational health and safety problem in the near future. The prevention of shiftwork-related health and safety problems will be a major challenge for the employer, employees, and occupational health professionals during the next few decades. The present paper shortly summarizes the current knowledge on the relationship between shift work, aging, and health and outlines practical countermeasures and research needs to improve the health and well-being of aging shift workers.

Circadian adjustment of men and women to night work.

OBJECTIVES: The aims of the present study were to define the adjustment of sleep-wakefulness and other circadian rhythms during consecutive night shifts and to study the effect of gender on the adjustment to night work. METHODS: Twenty experienced shift workers, 9 men and 11 women, were studied under controlled laboratory conditions. After a night of habituation, the subjects worked one day shift and three night shifts. Rectal temperature was measured continuously during the study. Salivary melatonin and cortisol were assessed at 2-h intervals, and subjective sleepiness was checked every hour during the work shifts. Sleep was registered by the static-charge sensitive bed (SCSB) method after the workshifts. RESULTS: Subjective sleepiness varied both between the work shifts and between the men and women. The subjects felt most alert during the day shift and were the sleepiest during the first night shift. Sleepiness decreased during the consecutive night shifts but did not reach the level of the day shift during the three nights. The sleepiness of the women decreased more than that of the men, the difference being significant during the second and third night shifts (P < 0.05). The circadian rhythm of body temperature, salivary cortisol, and time in bed changed significantly (P < 0.05) between the workshifts, but no differences were found between the men and women in the circadian adjustment of the physiological variables to night work. CONCLUSIONS: The men felt sleepier than the women during the consecutive night shifts, although no physiological differences were found between the genders. However, since normal social and domestic factors were excluded, the findings cannot be considered as evidence of women's better adaptation to night work in everyday life.

On-call stress among Finnish anaesthetists.

We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.

Orthostatic tolerance at different times of the day in physically average and very fit dayworkers.

We studied the relationship between the physical exercise capacity and the orthostatic tolerance of physically average fit and very fit dayworkers at different times of the day. Six male railroad workers were physically very fit and six were averagely fit (mean of the maximal oxygen consumption 57.4 and 34.6 ml.kg-1.min-1, respectively. The mean age was 32 years. The orthostatic tests were performed with a tilt-table at 2.00, 6.00, 10.00, 14.00, 18.00, and 22.00 hours on six different days. Orthostatic lability at night was seen in both groups. At 14.00 and 18.00 hours the orthostatic tolerance in average fit men was slightly lower than in very fit men. This difference in the orthostatic tolerance between the groups may be a sign of the interdependence of good exercise tolerance and orthostatic tolerance.

Age and adjustment to night work.

OBJECTIVE: The study was designed to examine the effects of age on sleep and the circadian rhythms during consecutive night shifts. METHODS: Two groups of letter sorters (19-29 (n = 7) and 53-59 (n = 7) years of age were studied in a sleep laboratory under closely controlled conditions. After two baseline days, circadian adjustment to three night shifts was monitored by continuous measurement of rectal temperature, salivary melatonin, and sleep-wakefulness during the night shifts. RESULTS: Age was significantly related to the adjustment to night work of rectal temperature minimum and of self rated sleepiness. Young subjects delayed their temperature phase and decreased sleepiness more than the older subjects. Age was also significantly related to an increase of alertness and to the feeling of being refreshed after the day sleep. Although there were basic differences in sleep duration and structure between the age groups, the latter did not change across the night shifts. CONCLUSION: Aging decreases the ability to recover after several, but not after the first night shift.