Evidence-Based Strategies for Maternal Stabilization and Rescue in Obstetric Hemorrhage.

Obstetric hemorrhage is one of the most frequent causes of maternal death in the United States. More than 70% of maternal deaths from hemorrhage are preventable. State and professional quality care organizations have reduced severe maternal morbidity by more than 20% by implementing evidence-based guidelines. Successful hemorrhage management requires collaborative, multidisciplinary teams of trained health care personnel. Hemorrhage management's primary goal is to stop the bleeding before the occurrence of maternal hypovolemia, acidosis, coagulopathy, and death. Uterine atony is the primary cause of obstetric hemorrhage and can be managed with uterotonic agents, placement of noninvasive uterine tamponade balloons, and surgical procedures if needed. Women experiencing massive hemorrhage should be treated according to resuscitation care guidelines with avoidance of hypothermia, acidosis, and coagulopathy. Use of a massive transfusion protocol is warranted for best outcomes. Resources for institutional adoption of current collaborative standards for managing obstetric hemorrhage are identified in this article.

Providing Culturally Sensitive Care for Islamic Patients and Families.

Nurses can expect to care for patients from different cultures and faith traditions and need to develop cultural competence. This article describes what is important in providing culturally and religiously sensitive care to Muslim and Middle Eastern patients. The Crescent of Care Model by Lovering is offered to aid understanding of five key areas of culturally competent care. Jesus' story of the Good Samaritan (Luke 10:25-37) offers guidance for Christian nurses caring for those in need.

Iron deficiency anemia in pregnant women.

Screening for iron deficiency anemia (IDA) in all pregnant women is recommended. IDA is a prevalent cause of nutritional deficiency anemia, and oral iron is the first line of treatment. Other treatments include parenteral iron or blood transfusion(s). Untreated IDA in pregnancy can result in complications for the mother and fetus.

von Willebrand disease in pregnancy.

von Willebrand disease is the most prevalent inherited bleeding disorder, affecting up to 1.3% of the population. It is caused by a defect or deficiency of the von Willebrand factor. Women with the condition may not be aware of their condition at the time of childbirth, but they are at high risk of postpartum hemorrhage even days after birth. In this article we briefly review the condition and specific considerations for the antepartum, intrapartum, and postpartum phases. It is important for nurses who care for women during childbirth to have a keen understanding of this condition.

Stroke and pregnancy: an integrative review with implications for neuroscience nurses.

Stroke in association with pregnancy is an infrequent occurrence, but there is evidence that the incidence is rising. The physiological changes of pregnancy are thought to increase stroke risk, and several conditions specific to pregnancy further increase risk. The provision of optimal care to pregnant and postpartum women who experience stroke requires awareness of how the physiological changes of pregnancy may affect the course of stroke and nursing actions. This article provides an overview of current knowledge about pregnancy-related stroke including underlying pathophysiology, risk factors unique to pregnancy, and treatment issues when stroke is a complication of pregnancy. Implications for the nursing care of women with pregnancy-related stroke and maternal child considerations are discussed.

'This is normal during pregnancy': a qualitative study of anaemia-related perceptions and practices among pregnant women in Mumbai, India.

OBJECTIVES: to explore anaemia-related perceptions and practices among pregnant women in Mumbai, India. DESIGN: descriptive qualitative study using in-depth interviews and focus group discussions. SETTING: three government-run maternity hospitals in Mumbai, India. PARTICIPANTS: 31 pregnant women aged 18-33 years; three women completed higher secondary school; 28 were homemakers. FINDINGS: respondents described anaemia as 'lack of blood in the body' because that was the term used by health providers; yet they did not seem worried about the consequence on their own health. Women perceived anaemia as 'normal during pregnancy' because their body had to simply share resources with the fetus and every female relative had suffered from it during pregnancy. Respondents did recognise weakness and dizziness as symptoms of anaemia. They attributed the cause to a poor diet, but did not know the specific link with iron-deficiency. They listed various negative effects of anaemia on the fetus, but very few stated ill-effects on the mother, and none stated maternal death as an outcome. Women saw their role primarily as child-bearers and prioritised newborn's health over their own. CONCLUSION AND IMPLICATIONS: anaemia stands at the intersection of health, nutrition, culture and gender. Interventions in the country have to go beyond distributing or monitoring compliance with iron-folic acid (IFA) supplements. Health education programmes for women and household members have to highlight the seriousness of anaemia and address socio-cultural norms and gendered behaviours in families with respect to nutrition and health. There is an urgent need in maternal and child health programmes to emphasise the importance of the mother's own health. Anaemia interventions have the potential to become proxies for women's health and empowerment programmes.

We've got it covered! Graduated compression stockings.

Hypercoagulability is a well documented feature of pregnancy and contributes to the increased incidences of venous thromboembolism (VTE) in pregnancy. Thromboembolism remains a leading cause of maternal death in the UK, though it's predicted that up to two thirds of these deaths could be prevented if appropriate thrombophylaxsis is adopted. This article aims to further midwives' knowledge in relation to thromboprophylaxsis, focusing in particular on graduated compression stockings (GCS). It aims to assist midwives in identifying those women at high risk of developing a VTE, explain the way in which compressio stockings can reduce thromboembolism and provide advice on their application and the clinical observations required.

Perinatal implications of sickle cell disease.

Sickle cell disease (SCD) affects millions of people across the globe. In the United States, approximately 70,000 to 100,000 people have the disease, and 2 million have the sickle cell trait. SCD occurs once in every 500 African American births, and once in 36,000 Hispanic American births. Women with SCD can have more adverse maternal outcomes such as preeclampsia, eclampsia, preterm labor, placental abruption, intrauterine growth restriction, and low birthweight. Providing comprehensive nursing care to women with SCD is a challenge, particularly during labor and birth, with nursing management aimed at attaining healthy birth outcomes while preventing or treating manifestations of the disease. Labor and delivery nurses are responsible for specific knowledge and care practices for these women, including differentiating the pain of sickle cell crisis from contraction pain and monitoring maternal and fetal oxygenation, as oxygenation is jeopardized in laboring sickle cell patients. Intrapartum nursing care also requires vigilance in the need for emergency cesarean birth. Nursing interventions include symptom management, pain management, ensuring patient safety, and educating patients. Coordination of care and clear communication between the members of the healthcare team, patient, and family are essential elements to ensure a positive outcome for perinatal patients with SCD.

Factor V Leiden: impact on infusion nursing practice.

As one whose family has been affected by factor V Leiden since 1980, the author knows firsthand the impact of this disease process on patients, outcomes, and practice. In today's healthcare environment, genetic screening for the factor V mutation is routine among pregnant women. Preoperative testing is often done on those "at risk." This article addresses the genetics, the occurrence, the treatment, and practice implications.

Guidelines on anaemia: effect on primary-care midwives in The Netherlands.

OBJECTIVE: To assess the adherence and perceived barriers for implementation of a clinical-practice guideline on anaemia, which was the first national guideline for primary-care midwifery in The Netherlands. DESIGN: Cross-sectional survey study. SETTING: Primary-care midwifery in The Netherlands. PARTICIPANTS: 160 midwives (60% response rate). MEASUREMENTS: Questionnaire on the knowledge of, and attitudes and self-reported adherence to, 14 key recommendations in the guideline; attitudes to guidelines in general; and perceived barriers to implementation. FINDINGS: The number of midwives agreeing with and adhering to specific recommendations varied between 29 and 90%. Most midwives had a positive attitude to the guidelines. The most relevant general barriers were related to the behaviour of general practitioners and obstetricians (32% of the midwives reported this). Larger numbers of midwives mentioned barriers to specific aspects of the guideline, particularly alternative iron supplementation or dietary supplements (59%), and not prescribing iron supplementation if haemoglobin was low but mean corpuscular volume was normal (49%). KEY CONCLUSIONS: The guideline on anaemia was well received by primary-care midwives in The Netherlands, but implementation of specific recommendations needs further attention. IMPLICATIONS FOR PRACTICE: The study provides evidence for the national organisation of midwives to continue with the development and implementation of clinical guidelines.

Management of iron deficiency in pregnancy.

UNLABELLED: This article reviews a study, published in Clinical and Laboratory Haematology (2003), which looked at using iron-rich spa water (Spatone) as a prophylaxis against iron deficiency in pregnancy. Anaemia is a significant problem in pregnant women that can have a detrimental effect on the baby and mother. The problems of non-compliance with oral iron supplements in this population are well-documented. This was a prospective, randomised, double-blind, placebo-controlled trial, and 102 patients were recruited into the study. Inclusion criteria included singleton pregnancy, booking haemoglobin >10.4g/dl and gestational age confirmed by ultrasound at 20 weeks. Primary outcome measures were compliance with treatments during the trial period, ferritin levels at 22 and 28 weeks and dyspepsia scores at 22 and 26 weeks. RESULTS: Mean ferritin levels fell by 24% in the Spatone group compared with a mean fall of 51% in ferritin levels in the control group, p = 0.016. In the Spatone group, 31% of patients raised their ferritin levels during the trial period compared with 11% in the control group. The authors concluded that Spatone is effective in maintaining iron stores in non-anaemic patients and is well-tolerated. The study delivers a clear message to midwives--namely that Spatone has a place in the management of iron-deficient pregnant women, because it is well-tolerated and provides iron in a highly bioavailable form.

Factor V Leiden mutation in pregnancy.

Normal maternal adaptation to pregnancy significantly increases the risk for thrombus formation. Inherited thrombophilias further increase risk for deep venous thrombosis and adverse outcome in pregnancy. Factor V Leiden mutation is the most common inherited thrombophilia, occurring in approximately 5% of the White and 1% of the Black populations. Nurses should be knowledgeable about screening for and diagnosis of factor V Leiden mutation, risk reduction counseling, recommended care of the affected patient, and implications of anticoagulant therapy during the perinatal period.

Alloimmune thrombocytopenia in the fetus: current management theories.

Fetal alloimmune thrombocytopenia (AIT) affects only a small number of fetuses but the consequences may be devastating. Outcomes range from mild thrombocytopenia without signs or symptoms to intracranial hemorrhage (ICH) and fetal or neonatal death. Antenatal screening is available but not used routinely in the United States. The most frequent method of AIT identification is its diagnosis in the neonatal period (index neonate). AIT may be diagnosed antenatally if an ICH is noted on routine obstetric ultrasound. There are accurate predictors of AIT, as well as antenatal therapies, to prevent the occurrence of severe disease and ICH.