Improving blood product management in placenta accreta patients with severe bleeding: institutional experience.

BACKGROUND: Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. METHODS: A retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. RESULTS: A total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. CONCLUSION: Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.

Comparative study of the retentive strengths of dowels of three different diameters in combination with one or two different-sized threaded pins.

Vented parallel-sided, serrated posts cemented into matching precision channels provide excellent retentive strength; however, they do not offer significant resistance to rotational forces. This article explores the effectiveness of using supplementary pins to compensate for this deficiency. A standardized method was used to place combinations of parallel-sided posts and screw-type pins in prepared root canals of extracted human teeth. Standardized composite resin cores were made for the posts. Results indicate that the dentist must take note of the amount of dentin available for pin placement and, with reference to the provided graphs, determine the ideal size and number of pin(s) to be inserted.

The relationship of the position of crown margins to gingival health.

A survey was conducted of 423 crown margins that were divided into 355 subgingival margins and 68 supragingival margins. The plaque index, gingival bleeding, and recession surrounding the artificial crown were recorded and compared to the unprepared contralateral tooth. Gingival tissues tended to bleed 2.42 times more frequently with subgingival margins and have a 2.65 times higher chance of gingival recession. Crowns with supragingival margins did not differ significantly compared with the contralateral tooth, but crowns with subgingival margins had greater bleeding and recession compared with the contralateral tooth. It is recommended that supragingival margins become standard clinical procedures when feasible. A further analysis will be instituted to determine whether different crown materials affect the gingivae.

Ossifying fibrous epulis. An abbreviated case report.

A case of a large ossifying fibrous epulis is presented, along with a description of the clinical and histopathologic features and the differential diagnosis of the lesion.