The management of critical bleeding in obstetrics

Post-partum hemorrhage (PPH) is one of the most frequent causes of maternal death: worldwide it contributes for a 25% of deaths. The risk of death from pregnancy complications has decreased dramatically over the last few decades, but several evidences show they have not yet been reduced to a minimum. There is therefore the need for a further improvement in the quality of medical care. Purpose of this paper is to briefly outline an overview of the definition of PPH, with an illustration of the possible causes and treatments currently available. WHO defined PPH as excessive bleeding > 500 ml after vaginal delivery and severe PPH as bleeding in excess of 1,000 ml after vaginal delivery, but a variety of definitions for PPH have been proposed, yet no single satisfactory definition exists. Another crucial item regards the estimation of blood loss, too often based on a visual assessment and, therefore, inaccurate and minimized. However, in medical literature there are no specific classifications for severe bleeding in obstetrics. During pregnancy there are several changes in coagulation state: because haemostatic reference intervals are generally based on samples from non-pregnant women, this can cause a further difficulty in doing an accurate diagnosis and treatment of haemostatic disorders during pregnancy. In the treatment of critical bleeding in trauma patients have been developed some new insights that may be applied, at least partially, in the management of bleeding patients in obstetrics. In recent years it has been developed an approach called “Damage control resuscitation”, which combines to the surgery a medical treatment aimed at correcting the underlying coagulopathy. This approach is based on three items: minimise use of crystalloids and colloids; optimise fresh frozen plasma (FFP) to red blood cells (RBC) ratio; make an appropriate use of antifibrinolitic agents, fibrinogen and cryoprecipitate

Introduction : Le réseau de recherche transfrontalier sur l’intercompréhension et l’interculturalité

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Mehrsprachigkeit und Ökonomie

Welche Sprachausbildung ist für die heutige mehrsprachige Arbeitswelt erforderlich? Wie kann die berufliche Wertschöpfung migrationsbedingter Mehrsprachigkeit gelingen? Welche mehrsprachigen Ressourcen können im schulischen Fremdsprachenunterricht ausgeschöpft werden? Wie können elektronische Lernapps zur Entwicklung romanischer Mehrsprachigkeit beitragen? In welcher ökonomischen Situation befanden sich Sprachmeister im 18. Jahrhundert? Welchen Marktwert besaßen Spanisch und Italienisch nach Maßgabe des frühneuzeitlichen Buchdrucks? Ausgehend von diesen Fragen spannt vorliegender Band einen Bogen von der Frühen Neuzeit bis in die Gegenwart, um die vielfältigen Wechselbeziehungen zwischen Mehrsprachigkeit und Ökonomie aus linguistischer, fachdidaktischer und sprachhistorischer Perspektive zu beleuchten. Die primär romanistische Ausrichtung der Aufsätze, die aus der Sektion «Ökonomische Aspekte von Mehrsprachigkeit» des XXXIV. Deutschen Romanistentags hervorgegangen sind, wird von synchronen und historischen Beiträgen aus Nachbardisziplinen abgerunde

Quantitative assessment of cardiac load-responsiveness during extracorporeal life support: case and rationale

We describe a case of a patient assisted by extracorporeal life support, in which we obtained the dynamic filling index, a measure for venous volume during extracorporeal life support, and used this index to assess cardiac load-responsiveness during acute reloading. While reloading, the obtained findings on cardiac pump function by the dynamic filling index were supported by trans-esophageal echocardiography and standard pressure measurement. This suggests that the dynamic filling index can be used to assess cardiac load-responsiveness during extracorporeal life support