Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion: The definition persistent postpartum haemo

Interim progress report addendun - environmental geophysics: Building E5032 decommissioning, Aberdeen Proving Ground, January 1994 resurvey

Geophysical surveying around Building E5032 using three new continuously recording geophysical instruments - two types of electromagnetic induction instruments and a cesium vapor magnetometer that were unavailable at the time of the original survey - has provided additional information for defining the location of buried debris, vaults, tanks, and the drainage/sump system near the building. The dominant geophysical signature around Building E5032 consists of a complex pattern of linear magnetic, electrical-conductivity, and electromagnetic field anomalies that appear to be associated with drainage/sewer systems, ditches, past railway activity, the location for Building T5033 (old number 99A), and the probable location of Building 91. Integrated analysis of data acquired using the three techniques, plus a review of the existing ground-penetrating-radar data, allow a more thorough definition of the sources for the observed anomalies