Use of histograms to assess the efficacy of uterotonic treatment for post-partum haemorrhage: A feasibility study.

Post-partum haemorrhage (PPH) is a major pathological condition leading to mortality of women worldwide. Its initial treatment has largely been focused on uterotonics. This paper examines the use of histograms to assess the efficacy of uterotonic treatment for PPH. Previous examinations of large datasets in which women were treated at 700 ml of measured blood loss according to strict protocols have shown a quantifiable peak in the histogram at 700-800 ml following treatment. It is not clear whether this is commonly seen in other studies. The main aim was therefore to assess whether post-treatment peaks are routinely seen in postpartum blood loss histograms and whether the peaks are seen only in treated women. Four datasets of more than 1000 women with measured blood loss were identified and the original data examined. The secondary peak was not only seen in histograms attributed to treatment, but also many of the histograms where women had not received uterotonic treatment. Many women received treatment despite having blood loss of less than 500 ml, and many women who stopped bleeding with final blood losses of more than 500 ml did not receive any uterotonics. The routine use of histogram analysis to assess the efficiency of uterotonic therapy is not recommended. The paper also provides further insights into clinical practice, with clinicians frequently using uterotonic therapies even when the volume of the blood loss is low. This demonstrates how uterotonic use in practice is often not linked to the standard 500 ml definition of post-partum haemorrhage.

A hundred years of induction of labour methods.

OBJECTIVES: Induction of labour is the process of artificially initiating labour in order to end a pregnancy. We sought to explore changes in practice as documented in 'Ten Teachers', an undergraduate textbook that was first published in 1917 and is now in its 19th edition. STUDY DESIGN: The description of labour induction methods from each edition were described and tabulated. RESULTS: Historically, the dangers of induction meant that it was only conducted in the event of life-threatening maternal disease. However, with improved methods, the threshold for intervention has reduced and it is now one of the most common interventions in pregnancy. Induction methods have changed over the last century from vaginal caesarean section, castor oil and De Ribes' bag at the start of the century to prostaglandins and oxytocin today. CONCLUSIONS: Techniques for labour induction have changed markedly over the last century.