To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province.
Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10-year period 1988-1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail.
Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P
We undertook a prospective study to estimate the risk in Montreal of developing hepatitis following transfusion of blood with an elevated alanine aminotransferase (ALT) level. Two thousand consecutive donor units were screened for ALT activity; 133 (6.7%) had values greater than or equal to 51 IU 1(-1). Twenty-four patients received one or more units with elevated ALT levels and completed follow-up; two (8%) developed hepatitis (one of these was type B hepatitis). One of the 10 'control' patients who received only units with normal ALT levels also developed hepatitis. In this study, the risk of transfusion-transmitted hepatitis was the same in recipients of blood units with abnormal ALT levels as in those who received only blood with normal ALT, and very similar to the risk reported in other studies for recipients of volunteer donor blood with normal ALT. These findings require confirmation by a larger study, but suggest that the hepatitis risk associated with transfusion of high-ALT blood may be lower in Montreal than has been reported in several centers in the U.S.
Declining haemoglobin concentrations are accepted in order to avoid allogeneic blood transfusions in surgical patients. A questionnaire was sent to all members of the Norwegian Association of Anaesthesiologists addressing the question of safe blood levels of haemoglobin in different patient groups, and the different blood conservation techniques used in their hospital. 206 questionnaires (49%) were returned. Intraoperative and postoperative autotransfusions were the two most frequently used methods of saving blood. The survey demonstrates a wide diversity in the accepted lower haemoglobin levels, especially in children, and in spite of its limitations sheds light on Norwegian anaesthetists' routines as regards the indications for blood transfusion and blood conservation in the perioperative period.
To determine the antecedent factors, morbidity, and mortality associated with disseminated intravascular coagulation (DIC) in a Nova Scotia tertiary maternity hospital over a 30-year period.
Cases of DIC were identified from the Nova Scotia Atlee Perinatal Database for the years 1980 to 2009 and the hospital charts reviewed. The clinical diagnosis of DIC was confirmed or refuted using a combination of the International Society of Thrombosis and Haemostasis scoring system and an obstetrical DIC-severity staging system. The cause of DIC was determined from chart review. Maternal outcomes included massive transfusion (= 5 units), hysterectomy, admission to ICU, acute tubular necrosis (ATN) requiring dialysis, and death. Neonatal outcomes included Apgar scores, birth weight, NICU admission, and death. Treatment of DIC was assessed by blood products administered, postpartum hemorrhage management, and laboratory measurements.
There were 49 cases of DIC in 151 678 deliveries (3 per 10,000) over the 30 years. Antecedent causes included placental abruption (37%), postpartum hemorrhage or hypovolemia (29%), preeclampsia/HELLP (14%), acute fatty liver (8%), sepsis (6%), and amniotic fluid embolism (6%). The associated maternal morbidity included transfusion = 5 units (59%), hysterectomy (18%), ICU admission (41%), and ATN requiring dialysis (6%). There were three maternal deaths, giving a case fatality rate of 1 in 16. The perinatal outcomes included stillbirth (25%), neonatal death (5%), and NICU admission (72.5%).
Obstetrical DIC is an uncommon condition associated with high maternal and perinatal morbidity and mortality. Prompt recognition and treatment with timely administration of blood products is crucial in the management of this life-threatening disorder.
In 1966-72 in Saskatchewan there was a significant improvement in survival of patients up to 16 years old with acute leukemia treated intensively. The rate of complications was low. Attention to the emotional needs of the patients and parents and formation of parent mutual-support groups improved the acceptibility of intensive therapy.
To determine the incidence, complications, and risk of recurrence of acute uterine inversion.
A retrospective chart review was conducted of all cases of acute uterine inversion recorded at the Grace Maternity Hospital in Halifax, Nova Scotia, from 1977 to 2000.
During the 24-year period studied, 40 cases of acute uterine inversion occurred following 125,081 births. The incidence of acute uterine inversion following vaginal birth was 1 in 3737, and following Caesarean section, 1 in 1860. Post-partum hemorrhage complicated 65% of cases of acute uterine inversion, and 47.5% required blood transfusion. There was no recurrence in 26 subsequent deliveries. Following the institution of active management of the third stage of labour in 1988, the incidence of acute uterine inversion following vaginal delivery fell 4.4-fold.
Acute uterine inversion is rare but accompanied by high risk of postpartum hemorrhage and the need for blood transfusion. Active management of the third stage of labour may reduce the incidence of uterine inversion.