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Postpartum Hemorrhage: What Every Pregnant Woman Should Know

Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH). 

PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.

The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.

Other risk factors for PPH include:

  • Women with a known placenta previa
  • African-American women
  • Hypertension or preeclampsia
  • Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
  • Mothers with greater than seven children
  • Women with a history of hemophilia

If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Cesarean Section: 6 Ways To Prevent Complications

Although I’ve been a proponent for the prevention of medical errors for years and wrote a book to address those issues, I think my obstetrician-gynecologist (OB/GYN) colleagues are finally catching on.

Dr. Patrick Duff of the University of Florida’s OB/GYN department wrote an article in the December issue of the journal Obstetrics & Gynecology that caught my attention. In his article, “A Simple Checklist for Preventing Major Complications Associated with Cesarean Delivery,” Duff outlines steps that OB/GYNs should take in order to reduce complications during and after a cesarean section. Duff patterns his list after Dr. Atul Gawande’s book, “The Checklist Manifesto: How to Get it Right,” which has set the standard regarding reducing complications after surgery. According to Duff, the following steps should be taken in order to reduce complications after a cesarean section:

1. Clip hair at the surgical site just before making the incision to reduce wound infections. Duff states that there is a greater chance of promoting infections when the hair is shaved the night before the procedure. He also recommends clipping hair as opposed to shaving which reduces the rate of would infections.

2. Cleanse skin with chlorhexidine solution rather than iodine because medical studies have demonstrated a reduction in infections using chlorhexidine solution.

3. Give broad spectrum antibiotics before the surgical incision as opposed to after the newborn’s umbilical cord is clamped. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Miscarriage? Don’t Wait To Get Pregnant Again

About 15 to 20 percent of women who know they are pregnant will have a miscarriage. The loss of a pregnancy before 20 weeks is considered a miscarriage. Many women suffer grief and shock after a miscarriage and fear there is something wrong with them or that they did something to cause it. But the reasons for miscarriage are usually not known. Women are often told to wait “a few months” to get pregnant again to let their bodies recover.

A new study published in the British Medical Journal looked at over 30,000 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant again. They found that women who conceived again within six months were less likely to have another miscarriage or problem pregnancy. They were even less likely to have a cesarean section, preterm delivery or infant of low birth weight. These women were more likely to have an induced labor.

The researchers wrote: “Women wanting to become pregnant soon after a miscarriage should not be discouraged.” These women had the best reproductive outcomes.

*This blog post was originally published at EverythingHealth*

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