Patient blood management to minimize transfusions during the postpartum period.

Patient blood management is an evidence-based concept that seeks to minimize blood loss by maintaining adequate hemoglobin levels and optimizing hemostasis during surgery. Since the coronavirus disease 2019 pandemic, patient blood management has gained significance due to fewer blood donations and reduced amounts of blood stored for transfusion. Recently, the prevalence of postpartum hemorrhage (PPH), as well as the frequency of PPH-associated transfusions, has steadily increased. Therefore, proper blood transfusion is required to minimize PPH-associated complications while saving the patient's life. Several guidelines have attempted to apply this concept to minimize anemia during pregnancy and bleeding during delivery, prevent bleeding after delivery, and optimize recovery methods from anemia. This study systematically reviewed various guidelines to determine blood loss management in pregnant women.

Prediction of Adverse Pregnancy Outcomes Using Crown-Rump Length at 11 to 13 + 6 Weeks of Gestation.

OBJECTIVES: To assess the risk of a fetus with a smaller or larger than expected crown-rump length (CRL) for adverse pregnancy outcomes. METHODS: The data of 960 healthy singleton pregnancies conceived via in vitro fertilization were retrospectively collected. Fetal CRL was measured between 11 and 13 + 6 weeks of gestation, and small and large fetal CRLs were defined as fetuses below the 10th and above the 90th centiles, respectively. Multiple logistic regression analysis was performed to assess the risk for adverse pregnancy outcomes. RESULTS: The mean birth weights of fetuses with small, normal, and large CRLs were 3002 g, 3205 g, and 3378 g, respectively. A small fetal CRL was associated with an increased risk of smaller-than-gestational-age neonates (adjusted odds ratio [aOR], 2.79; 95% confidence interval [CI], 1.53-5.08; P < .001) and preterm delivery before 34 gestational weeks (aOR, 6.48; 95% CI, 1.36-30.79; P = .019). A large fetal CRL was associated with an increased risk of large-for-gestational-age (LGA) neonates, and the risk persisted even after adjustment for well-known risk factors of macrosomia, such as pre-pregnancy body mass index, gestational diabetes, and excessive gestational weight gain (aOR, 3.67; 95% CI, 2.04-6.59; P < .001). However, a large fetal CRL was associated with a decreased risk of gestational diabetes (aOR, 0.10; 95% CI, 0.01-0.76; P = .026). CONCLUSIONS: Fetal CRL measured at 11 to 13 + 6 weeks gestation is worth using as a predictor of LGA as well as small for gestational age or preterm delivery.

Clinical characteristics and prognostic inflection points among long-term survivors of advanced epithelial ovarian cancer.

OBJECTIVE: To assess clinical characteristics of long-term survivors of advanced epithelial ovarian cancer (EOC) to define a prognostic inflection point for long-term survival. METHODS: A retrospective analysis was undertaken of patients with FIGO stage III or IV EOC treated at one center in South Korea from 2000 to 2012. Patients who survived 5 years or more were identified, and the periods of disease-free survival and overall survival were evaluated for prognostic inflection points to indicate long-term survival. Clinicopathologic data and treatment-associated factors were assessed. RESULTS: In total, 60 patients survived more than 5 years. Thirty-three (55%) patients experienced disease recurrence and 11 (18%) died due to advanced EOC during a median follow-up period of 92 months (range 61-205). Most recurrence events (32/33, 97%) and deaths (10/11, 91%) occurred within 6 years and 8 years, respectively. Although half the long-term (>8 year) survivors with stage IIIC-IV disease experienced disease recurrence, they had a significantly longer platinum-free interval (P=0.007) and tended to have received aggressive surgical treatments after disease recurrence (P=0.054), as compared with survivors for 5-8 years. CONCLUSION: Survival for 8 years might represent a prognostic inflection point for long-term survival in advanced EOC.