Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation.

OBJECTIVE: To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. METHODS: An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. RESULTS: Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. CONCLUSION: We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.

Initial management of primary postpartum hemorrhage: a survey.

OBJECTIVE: The objective of this study is to evaluate the actions taken by obstetricians when faced with postpartum hemorrhage (PPH). MATERIALS AND METHODS: A standardized open-ended survey was applied to 235 physicians at five hospitals and at an obstetrics and gynecology conference, inquiring about which actions are recommended in the initial stages of PPH. We calculated the frequency and confidence intervals of the actions mentioned and correlated the number of actions with the number of clinicians mentioning them using Spearman's rho test. RESULTS: Asking for help was mentioned by 45% of the respondents and 38% asked for vital signs. Only one-fifth of those surveyed asked for blood count, coagulation testing, arterial blood gas, or urinary catheter. Very few mentioned hypothermia prevention, oxygen administration, or blood transfusion. A total of 80% of those interviewed only mentioned 3 of the 16 recommended actions. CONCLUSION: Postpartum hemorrhage training should include instructions on initial steps in order to improve treatment comprehension and outcomes.

A randomized controlled trial comparing isosorbide dinitrate-oxytocin versus misoprostol-oxytocin at management of foetal intrauterine death.

BACKGROUND: The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus. OBJECTIVE: To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD). METHODS: Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. RESULTS: The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. CONCLUSION: This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation. TRIAL REGISTRATION: Clinicaltrials.gov NCT02488642.

[Vaginal impingement of uterine arteries (Zea technique) prior to cervical curettage in cervical ectopic pregnancy: three case report and literature review]. / Pinzamiento de arterias uterinas por vía vaginal previo a legrado cervical en embarazo ectópico cervical: reporte de tres casos y revisión bibliogrifica.

Cervical ectopic pregnancy is a rare and danger clinical presentation because it has high risk of massive bleeding. The incidence is reported in 1:2500 pregnancies and has high relation with a history of cervical dilatation and curettage and assisted reproductive techniques. Advances in ultrasound resolution and use of beta fraction of human chorionic gonadotropin allow early diagnosis and provide conservative treatment with decreased morbidity, mortality and fertility preservation. Various techniques have been reported associated with cervical curettage, to reduce bleeding at the implantation site. In this report three cases of cervical ectopic pregnancy managed with cervical curettage, prior vaginal impingement of uterine arteries (Zea Technique) at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes are described. The Zea technique represents an effective option in the control of obstetric hemorrhage, including patients diagnosed with cervical ectopic pregnancy in who the bleeding volume decrease after its placement. The Zea Technique is easy to apply and preserves fertility. The success of combining this technique with endocervical curettage for the management of cervical ectopic pregnancy is demonstrated. Training for performing this technique does not require highly specialized or highly complex resources since the required material is the usual every area of obstetric care.