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1.
Am J Obstet Gynecol ; 224(4): B29-B32, 2021 04.
Article in English | MEDLINE | ID: mdl-33417901

ABSTRACT

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. We also suggest steps that each facility can take to implement the checklist effectively.


Subject(s)
Checklist , Embolism, Amniotic Fluid/diagnosis , Embolism, Amniotic Fluid/therapy , Airway Management , Cesarean Section , Disseminated Intravascular Coagulation/therapy , Female , Heart Arrest/therapy , Humans , Hypertension, Pulmonary/therapy , Postpartum Hemorrhage/therapy , Pregnancy , Uterine Inertia/therapy , Ventricular Dysfunction, Right/therapy
2.
Am J Obstet Gynecol ; 223(3): B7-B11, 2020 09.
Article in English | MEDLINE | ID: mdl-32553909

ABSTRACT

In pregnant individuals with risk factors for preeclampsia, prophylactic low-dose aspirin is recommended to reduce the risk of developing preeclampsia. Fifteen distinct risk factors are recognized, including elements of current and past medical and obstetrical history, family history, and examination findings. We present checklists intended to reduce the chance that risk factors might be inadvertently overlooked and to improve the probability of aspirin being recommended for all appropriate candidates. We also suggest how such a checklist can be implemented into practice.


Subject(s)
Aspirin/administration & dosage , Pre-Eclampsia/diagnosis , Pre-Eclampsia/prevention & control , Checklist , Female , Gestational Age , Health Plan Implementation/methods , Humans , Mass Screening/methods , Pregnancy , Prenatal Care/methods , Risk Factors
3.
Obstet Gynecol ; 134(5): 1117-1118, 2019 11.
Article in English | MEDLINE | ID: mdl-31651820
4.
Am J Obstet Gynecol ; 221(4): 311-317.e1, 2019 10.
Article in English | MEDLINE | ID: mdl-30849353

ABSTRACT

The Centers for Disease Control and Prevention have demonstrated continuous increased risk for maternal mortality and severe morbidity with racial disparities among non-Hispanic black women an important contributing factor. More than 50,000 women experienced severe maternal morbidity in 2014, with a mortality rate of 18.0 per 100,000, higher than in many other developed countries. In 2012, the first "Putting the 'M' back in Maternal-Fetal Medicine" session was held at the Society for Maternal-Fetal Medicine's (SMFM) Annual Meeting. With the realization that rising risk for severe maternal morbidity and mortality required action, the "M in MFM" meeting identified the following urgent needs: (i) to enhance education and training in maternal care for maternal-fetal medicine (MFM) fellows; (ii) to improve the medical care and management of pregnant women across the country; and (iii) to address critical research gaps in maternal medicine. Since that first meeting, a broad collaborative effort has made a number of major steps forward, including the proliferation of maternal mortality review committees, advances in research, increasing educational focus on maternal critical care, and development of comprehensive clinical strategies to reduce maternal risk. Five years later, the 2017 M in MFM meeting served as a "report card" looking back at progress made but also looking forward to what needs to be done over the next 5 years, given that too many mothers still experience preventable harm and adverse outcomes.


Subject(s)
Maternal Mortality/trends , Obstetrics/methods , Perinatology/methods , Pregnancy Complications/prevention & control , Delivery of Health Care , Education, Medical, Graduate/standards , Ethnicity , Fellowships and Scholarships , Female , Health Status Disparities , Humans , Hysterectomy , Maternal Health Services , Maternal Mortality/ethnology , Obstetrics/education , Perinatology/education , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/mortality , Postpartum Hemorrhage/prevention & control , Pre-Eclampsia/epidemiology , Pre-Eclampsia/mortality , Pre-Eclampsia/prevention & control , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/mortality , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Cardiovascular/mortality , Pregnancy Complications, Cardiovascular/prevention & control , Quality Assurance, Health Care , Quality of Health Care , Research , Severity of Illness Index , Simulation Training , United States
6.
Anesth Analg ; 123(4): 942-9, 2016 10.
Article in English | MEDLINE | ID: mdl-27636577

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Death/prevention & control , Patient Safety , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Venous Thromboembolism/epidemiology , Venous Thromboembolism/prevention & control , Delivery, Obstetric/adverse effects , Delivery, Obstetric/methods , Delivery, Obstetric/standards , Female , Humans , Maternal Mortality/trends , Patient Safety/standards , Postpartum Hemorrhage/diagnosis , Postpartum Hemorrhage/epidemiology , Postpartum Hemorrhage/prevention & control , Pregnancy , Pregnancy Complications/diagnosis , Risk Factors , United States/epidemiology , Venous Thromboembolism/diagnosis
7.
Obstet Gynecol ; 128(4): 688-98, 2016 10.
Article in English | MEDLINE | ID: mdl-27607857

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Anticoagulants/administration & dosage , Heparin, Low-Molecular-Weight/administration & dosage , Pregnancy Complications, Cardiovascular/prevention & control , Venous Thromboembolism/prevention & control , Anticoagulants/adverse effects , Cesarean Section , Consensus , Female , Heparin, Low-Molecular-Weight/adverse effects , Humans , Parturition , Peripartum Period , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Cardiovascular/epidemiology , Risk Assessment , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Time Factors , Venous Thromboembolism/epidemiology
8.
J Obstet Gynecol Neonatal Nurs ; 45(5): 706-17, 2016.
Article in English | MEDLINE | ID: mdl-27619099

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into four domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Mortality , Venous Thromboembolism , Consensus , Female , Humans , Maternal Death , Practice Guidelines as Topic , Pregnancy , Risk Factors
9.
J Midwifery Womens Health ; 61(5): 649-657, 2016 09.
Article in English | MEDLINE | ID: mdl-29473681

ABSTRACT

Obstetric venous thromboembolism is a leading cause of severe maternal morbidity and mortality. Maternal death from thromboembolism is amenable to prevention, and thromboprophylaxis is the most readily implementable means of systematically reducing the maternal death rate. Observational data support the benefit of risk-factor-based prophylaxis in reducing obstetric thromboembolism. This bundle, developed by a multidisciplinary working group and published by the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care, supports routine thromboembolism risk assessment for obstetric patients, with appropriate use of pharmacologic and mechanical thromboprophylaxis. Safety bundles outline critical clinical practices that should be implemented in every maternity unit. The safety bundle is organized into 4 domains: Readiness, Recognition, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged.


Subject(s)
Maternal Death , Pregnancy Complications/prevention & control , Venous Thromboembolism/prevention & control , Consensus , Female , Humans , Maternal Mortality , Patient Safety , Pregnancy , Pregnancy Complications/etiology , Risk Factors , Venous Thromboembolism/etiology
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