The strength of this study lies in its large sample size, as
outcomes from approximately 6000 deliveries were included
in analysis. In addition, the use of the electronic medical
record allowed for accuracy in assessment of pre and postpartum
hemoglobin levels as well as rates of transfusions.
This study had several limitations which are attributable to
the retrospective design: (1) the subjects were not stratified
by mode of delivery; however, the percentage of cesarean
deliveries during the two periods were not significantly
different, (2) the baseline characteristics of the sample
populations were not examined in detail, and (3) general
assumptions are made regarding similarities between the
cohorts studied. The two cohorts were not evaluated with
respect to any differences regarding the existence of maternal
bleeding disorders or other factor such as antepartum or
intra-partum complications, which might increase the risk
of postpartum hemorrhage. The study does not take into
account changes in provider practice over time, repeated
administration of oxytocin in the postpartumperiod, nor the
use of additional uterotonics.Many of these limitations could
be overcome with a prospective study. The use of admission
and postpartum day 1 hemoglobin values also has some
limitations as it is not a direct measurement of blood loss, but
its use has been reported in the literature as a surrogate to
measuring actual blood loss [12–14].
We have demonstrated that standardized oxytocin dosing
resulting in a total decreased amount of medication
delivered in the postpartum period does not result in an
increased amount of postpartum hemorrhage. While this
study exemplifies one aspect of obstetric care that has not
been affected by medication standardization, many more
avenues for research exist. Certainly, as quality improvement
moves to the forefront of hospital evaluation and performance
measurements, one can expect to see more and more
implementations meant to simplify procedure and minimize
error. It is imperative that we remain cognizant of the
potential unanticipated adverse effects that may occur with
new protocols.
The strength of this study lies in its large sample size, as
outcomes from approximately 6000 deliveries were included
in analysis. In addition, the use of the electronic medical
record allowed for accuracy in assessment of pre and postpartum
hemoglobin levels as well as rates of transfusions.
This study had several limitations which are attributable to
the retrospective design: (1) the subjects were not stratified
by mode of delivery; however, the percentage of cesarean
deliveries during the two periods were not significantly
different, (2) the baseline characteristics of the sample
populations were not examined in detail, and (3) general
assumptions are made regarding similarities between the
cohorts studied. The two cohorts were not evaluated with
respect to any differences regarding the existence of maternal
bleeding disorders or other factor such as antepartum or
intra-partum complications, which might increase the risk
of postpartum hemorrhage. The study does not take into
account changes in provider practice over time, repeated
administration of oxytocin in the postpartumperiod, nor the
use of additional uterotonics.Many of these limitations could
be overcome with a prospective study. The use of admission
and postpartum day 1 hemoglobin values also has some
limitations as it is not a direct measurement of blood loss, but
its use has been reported in the literature as a surrogate to
measuring actual blood loss [12–14].
We have demonstrated that standardized oxytocin dosing
resulting in a total decreased amount of medication
delivered in the postpartum period does not result in an
increased amount of postpartum hemorrhage. While this
study exemplifies one aspect of obstetric care that has not
been affected by medication standardization, many more
avenues for research exist. Certainly, as quality improvement
moves to the forefront of hospital evaluation and performance
measurements, one can expect to see more and more
implementations meant to simplify procedure and minimize
error. It is imperative that we remain cognizant of the
potential unanticipated adverse effects that may occur with
new protocols.
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The strength of this study lies in its large sample size, as
outcomes from approximately 6000 deliveries were included
in analysis. In addition, the use of the electronic medical
record allowed for accuracy in assessment of pre and postpartum
hemoglobin levels as well as rates of transfusions.
This study had several limitations which are attributable to
the retrospective design: (1) the subjects were not stratified
by mode of delivery; however, the percentage of cesarean
deliveries during the two periods were not significantly
different, (2) the baseline characteristics of the sample
populations were not examined in detail, and (3) general
assumptions are made regarding similarities between the
cohorts studied. The two cohorts were not evaluated with
respect to any differences regarding the existence of maternal
bleeding disorders or other factor such as antepartum or
intra-partum complications, which might increase the risk
of postpartum hemorrhage. The study does not take into
account changes in provider practice over time, repeated
administration of oxytocin in the postpartumperiod, nor the
use of additional uterotonics.Many of these limitations could
be overcome with a prospective study. The use of admission
and postpartum day 1 hemoglobin values also has some
limitations as it is not a direct measurement of blood loss, but
its use has been reported in the literature as a surrogate to
measuring actual blood loss [12–14].
We have demonstrated that standardized oxytocin dosing
resulting in a total decreased amount of medication
delivered in the postpartum period does not result in an
increased amount of postpartum hemorrhage. While this
study exemplifies one aspect of obstetric care that has not
been affected by medication standardization, many more
avenues for research exist. Certainly, as quality improvement
moves to the forefront of hospital evaluation and performance
measurements, one can expect to see more and more
implementations meant to simplify procedure and minimize
error. It is imperative that we remain cognizant of the
potential unanticipated adverse effects that may occur with
new protocols.
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