2. Methods
This is a retrospective, cohort study comparing the eight
months preceding the change inmedication protocol to eight
months following the change in protocol.The study protocol
was approved by the Miami Valley Hospital Institutional
Review Board. As the study was of existing data and there
was little or no risk for compromise of protected health care
information, the requirement for written performed consent
was waived. A search for the electronic medical record was
performed in order to extract the pre and posthemoglobin
values of all deliveries for the months of February 2009 until
September 2009 “pre” and November 2009 through June
2010 “post,” omitting the month between these selected time
frames to allow for education and adjustment to the protocol.
All singleton and multiple gestation admissions resulting in
vaginal or cesarean delivery were included. In addition, all
patients who had a vaginal or cesarean delivery and received
blood transfusions during admission were identified.
In the setting of a vaginal delivery, standard orders after
the delivery of the placenta included a dose of 40 units of
oxytocin in 1000mL of lactated Ringers (LR) prior to the
change and 30 units of oxytocin in 500mL of LR after the
change. The oxytocin infusion was administered at 333 cc
per hour for the duration of the third stage of labor and
then reduced to 150 cc/hr for the remainder of the infusion.
Women undergoing a cesarean delivery received the same
amount of oxytocin (either 40 units in 1000mLLR or 30
units in 500mLLR) which was begun in the operating
room at 333 cc/hr and then completed in the recovery room
at 150 cc/hr. Total time for oxytocin for both vaginal and
cesarean deliveries was 2-3 hours. Per anesthesia protocol,
women undergoing a cesarean delivery received an additional
20 units of oxytocin in the operating room after delivery of
the placenta. The practice of administering an extra 20 units
of oxytocin in the operating room did not change between
the two-time periods.Women with postpartum hemorrhage
received additional doses of oxytocin and other uterotonic
agents including methylergonovine, prostaglandin F2 alpha,
and prostaglandin E1, per the obstetrician’s discretion.
Per preset admission orders on the electronic medical
record (EMR), all inpatient deliveries obtain a complete blood
count (CBC) on admission and a CBC on postpartum day 1
(PPD 1).The time that elapsed between the CBC obtained on
admission and the PPD 1 CBC varied from 12 to 24 hours.
Women who received a blood transfusion or who lacked an
admission or PPD 1 hemoglobin were excluded.
2. MethodsThis is a retrospective, cohort study comparing the eightmonths preceding the change inmedication protocol to eightmonths following the change in protocol.The study protocolwas approved by the Miami Valley Hospital InstitutionalReview Board. As the study was of existing data and therewas little or no risk for compromise of protected health careinformation, the requirement for written performed consentwas waived. A search for the electronic medical record wasperformed in order to extract the pre and posthemoglobinvalues of all deliveries for the months of February 2009 untilSeptember 2009 “pre” and November 2009 through June2010 “post,” omitting the month between these selected timeframes to allow for education and adjustment to the protocol.All singleton and multiple gestation admissions resulting invaginal or cesarean delivery were included. In addition, allpatients who had a vaginal or cesarean delivery and receivedblood transfusions during admission were identified.In the setting of a vaginal delivery, standard orders afterthe delivery of the placenta included a dose of 40 units ofoxytocin in 1000mL of lactated Ringers (LR) prior to thechange and 30 units of oxytocin in 500mL of LR after thechange. The oxytocin infusion was administered at 333 ccper hour for the duration of the third stage of labor andthen reduced to 150 cc/hr for the remainder of the infusion.Women undergoing a cesarean delivery received the sameamount of oxytocin (either 40 units in 1000mLLR or 30units in 500mLLR) which was begun in the operatingroom at 333 cc/hr and then completed in the recovery roomat 150 cc/hr. Total time for oxytocin for both vaginal andcesarean deliveries was 2-3 hours. Per anesthesia protocol,women undergoing a cesarean delivery received an additional20 units of oxytocin in the operating room after delivery ofthe placenta. The practice of administering an extra 20 unitsof oxytocin in the operating room did not change betweenthe two-time periods.Women with postpartum hemorrhagereceived additional doses of oxytocin and other uterotonicagents including methylergonovine, prostaglandin F2 alpha,and prostaglandin E1, per the obstetrician’s discretion.Per preset admission orders on the electronic medicalrecord (EMR), all inpatient deliveries obtain a complete bloodcount (CBC) on admission and a CBC on postpartum day 1(PPD 1).The time that elapsed between the CBC obtained onadmission and the PPD 1 CBC varied from 12 to 24 hours.Women who received a blood transfusion or who lacked anadmission or PPD 1 hemoglobin were excluded.
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