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Title: WIN-PAK PRO A & E SPECIFICATIONS Author: Patrick R. French Last modified by: ademco Created Date: 6/16/2006 5:54:00 PM Company: Northern Computers, Inc. Pakistan Penal Code (Act XLV. Women (Criminal Laws Amendment) Act, 2006,Criminal Laws. servant or person authorised to administer an oath or. © 2006 Cisco Systems, Inc. All rights reserved. Cisco Confidential BRKRST-3437 14458_04_2008_c2 8 One Universal Image for E-Series. Department of Midwifery. * Re‐administer Anti‐D IG q 12 weeks up to birth. J Coll Physicians Surg Pak. 2006;16(2). The decision to administer factor VII in these patients was made in consultation with the hematologist, anesthesiologist and obstetrician. The intention of giving factor VII in. Genome Prot. Map. Genome Workbench. Primer- BLASTPro. Splign. Pub. Chem Structure Search. SNP Submission Tool. Splign. Vector Alignment Search Tool (VAST)All Data & Software Resources.. Domains & Structures. Bio. Systems. Cn. 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Chemicals & Bioassays. DNA & RNAData & Software. Domains & Structures. Genes & Expression. Genetics & Medicine. Genomes & Maps. Homology. Literature. Proteins. Sequence Analysis. Taxonomy. Training & Tutorials. Variation. Skip to main content. Skip to navigation. About NCBI Accesskeys. My NCBISign In. Sign Out. PMCUS National Library of Medicine. National Institutes of Health. Search term Search database All Databases Pub. Med Protein Nucleotide GSS EST Structure Genome Bio. Project Bio. Sample Bio. Systems Books Conserved Domains Clone db. Ga. P db. Var Epigenomics Gene GEO Data. Sets GEO Profiles Homolo. Gene Me. SH NCBI Web Site NLM Catalog OMIA OMIM PMC Pop. Set Probe Protein Clusters Pub. Chem Bio. Assay Pub. Chem Compound Pub. Chem Substance Pub. Med Health SNP SRA Taxonomy Tool. Kit Tool. Kit. All Uni. Gene Uni. STS Search Limits Advanced Journal list Help. Journal List > BMC Pregnancy Childbirth > v. PMC3. 08. 76. 91. BMC Pregnancy Childbirth. Published online 2. April 1. 3. doi: 1. PMCID: PMC3. 08. 76. Evaluation of compliance and outcomes of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in Pakistan. Lumaan Sheikh,1 Nida Najmi,1 Umair Khalid,2 and Taimur Saleem. Department of Gynecology and Obstetrics, Aga Khan University, Stadium Road, Karachi 7. Pakistan. 2. Medical College, Aga Khan University, Aga Khan University, Stadium Road, Karachi 7. Pakistan. Corresponding author. Lumaan Sheikh: lumaan. Nida Najmi: nida. Umair Khalid: uk. Taimur Saleem: taimur@gmail. Author information ► Article notes ► Copyright and License information ►. Received October 2. Accepted April 1. Copyright ©2. 01. Sheikh et al; licensee Bio. Med Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http: //creativecommons. Go to: Abstract. Background. Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step- wise management protocol should be immediately initiated. An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss ≥ 1. January, 2. 00. 8 to December, 2. Information regarding mortality, mode of delivery, possible cause of postpartum hemorrhage and medical or surgical intervention was collected. The estimation of blood loss was made via subjective and objective assessment. During 2. 00. 8, massive postpartum hemorrhage occurred in 0. No deaths were reported. The mean blood loss was 2. Emergency cesarean section was the most common mode of delivery (1. B- lynch suture (2. Cesarean hysterectomy was performed in 3 cases (1. More than 8. 0% compliance was observed in 8 out of 1. Initiation of blood transfusion at 1. This report details our experience with the practical implementation of a management protocol for massive postpartum hemorrhage at a tertiary care hospital in a developing country. With the exception of arterial embolization, relatively newer, simpler and potentially safer techniques are now being employed for the management of massive postpartum hemorrhage at our institution. Particular attention should be paid to the documentation of the management steps while ensuring a stricter adherence to the formulated protocols and guidelines in order to further ameliorate patient outcomes in emergency obstetrical practice. More audits like the one we performed are important to recognize and rectify any deficiencies in obstetrical practice in developing countries. Dissemination of the same is pivotal to enable an open discourse on the improvement of existing obstetrical strategies. Go to: Background. Primary postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality especially in developing countries where the availability of safe cesarean procedures is not universal [1]. The incidence of primary PPH (blood loss ≥ 5. Loss of 5. 00 ml of blood in the first 2. PPH. Significant clinical deterioration usually does not occur until there is a blood loss of > 1. Massive" primary PPH occurs when there has been an estimated blood loss of ≥ 1. In our experience at a tertiary care hospital in Pakistan, a developing country; massive PPH was reported in 0. Massive primary PPH can result in maternal complications like hypovolemic shock, disseminated intravascular coagulation, hepatic dysfunction, adult respiratory distress syndrome and renal failure. In order to prevent these complications, an organized and step- wise management protocol should be immediately initiated. It is important to be cognizant of the fact that despite the growing body of literature on the known risk factors for primary PPH, it maybe inevitable in some cases. Hence, active management of the third stage of labor should be offered to all women. This includes the administration of uterotonic agents, controlled cord traction, and uterine massage after delivery of the placenta [6]. Immediate resuscitation with attempts to treat the cause forms the cornerstone of management of PPH. Evidence- based guidelines for the management of PPH have been formulated in order to provide an organized and standardized plan of care for the different scenarios encountered in clinical practice [7]. We conducted a cross- sectional study in 2. Karachi whereby we retrospectively reviewed the patient records to assess the current practices of the management of massive primary PPH in the setting of a developing country. An indigenous protocol was then devised based on the results of this audit to set up a standard of care [see additional file 1] which was applied at our institution. This protocol was implemented by sensitizing the obstetric and other related staff through multiple presentations, drills and simulated scenarios. They were also taught the proper techniques and skills for performing the different steps of the protocol. This current paper aims to evaluate the compliance and impact of our proposed management protocol three years after its introduction at our institution. Go to: Methods. Study setting and design.
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