Rethinking our approach to postpartum haemorrhage and uterotonics

Analysis Rethinking our approach to postpartum haemorrhage and uterotonics BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3251 (Published 08 July 2015) Cite this as: BMJ 2015;351:h3251 Article Related content Metrics Responses Peer review Andrew D Weeks, professor of international maternal health1, James P Neilson, professor of obstetrics and gynaecology1 Author affiliations Correspondence to: AD Weeks [email protected] Accepted 30 March 2015 Andrew Weeks and James Neilson suggest that we have inappropriately generalised evidence on the use of uterotonics from uncomplicated births to all births. They call for stronger focus on women with complex births to reduce deaths from postpartum haemorrhage Postpartum haemorrhage (defined as a bleed >500 mL) is estimated to affect 1-15% of vaginal births, depending on the definition used, the method of assessing blood loss, the setting, and the population studied. Risk factors include Asian ethnicity, obesity, previous postpartum haemorrhage, multiple pregnancy, anaemia, large baby, age over 40, induction of labour, prolonged labour, placental abruption, and caesarean delivery.1 Although global mortality from postpartum haemorrhage is falling, its incidence is increasing in high resource settings, the reasons for which are unclear.2 3 4 Many of those who survive have severe anaemia, renal failure, or psychological trauma, and the offspring may have difficulties in breast feeding and bonding. Current best practice globally is for all pregnant women to receive a uterotonic drug at the time of childbirth to prevent postpartum haemorrhage. This recommendation has been in place since the 1980s when randomised trials showed that routine prophylaxis with oxytocin based uterotonic drugs reduced the rate of postpartum haemorrhage.5 The assumption that this would translate into fewer maternal deaths—based on the understanding that atony was the most common cause of haemorrhage related deaths—led to the promotion of active management of the third stage of labour, which comprises a prophylactic uterotonic drug, early cord clamping, and controlled cord traction. Here we discuss the problems with generalising data from spontaneous vaginal (“normal”) births to complex births, and call for a change in global strategy on postpartum haemorrhage

A Sketch-based Language for Representing Uncertainty in the Locations of Origin of Herbarium Specimens

Uncertainty fields have been suggested as an appropriate model for retrospective georeferencing of herbarium specimens. Previous work has focused only on automated data capture methods, but techniques for manual data specification may be able to harness human spatial cognition skills to quickly interpret complex spatial propositions. This paper develops a formal modeling language by which location uncertainty fields can be derived from manually sketched features. The language consists of low-level specification of critical probability isolines from which a surface can be uniquely derived, and high-level specification of features and predicates from which low-level isolines can be derived. In a case study, five specimens of Kolsteletzkya pentacarpos housed in the Ted Bradley Herbarium at George Mason University are retrospectively georeferenced, and locational uncertainties of error distance, possibility region and uncertainty field representations are compared

A Sketch-based Language for Representing Uncertainty in the Locations of Origin of Herbarium Specimens

Uncertainty fields have been suggested as an appropriate model for retrospective georeferencing of herbarium specimens. Previous work has focused only on automated data capture methods, but techniques for manual data specification may be able to harness human spatial cognition skills to quickly interpret complex spatial propositions. This paper develops a formal modeling language by which location uncertainty fields can be derived from manually sketched features. The language consists of low-level specification of critical probability isolines from which a surface can be uniquely derived, and high-level specification of features and predicates from which low-level isolines can be derived. In a case study, five specimens of Kolsteletzkya pentacarpos housed in the Ted Bradley Herbarium at George Mason University are retrospectively georeferenced, and locational uncertainties of error distance, possibility region and uncertainty field representations are compared

Depictions of women in stalinist sovet film, 1934-1953

Popular films in the Soviet Union were the products of the implementation of propagandistic messages into storylines that were both ideologically and aesthetically consistent with of the interests of the State and Party apparatuses. Beginning in the 1930s, following declaration of the doctrine on socialist realism as the official form of cultural production, Soviet authorities and filmmakers tailored films to the circumstances in the USSR at that given moment in order to influence and shape popular opinion; however, this often resulted in inconsistent and outright contradictory messages. Given the transformation that gender relations were undergoing in the early stages of development, one area that was particularly problematic in Soviet cinema was the portrayals of women. Focusing primarily on the Stalinist period of the Soviet History (1934-1953), I plan to look at the ways in which women were portrayed in popular Soviet cinema and specifically the ways in which these presentations shifted before, during, and after World War II

A Legacy of Community and Mourning: AIDS & HIV in Central Florida, 1983-1993

Given the primacy of Florida, and in particular Orlando, as an urban center with an above average rate of AIDS and HIV, this study examines how the outbreak of a deadly disease can affect a community. Complicating the response to this scourge, those who were most at-risk were marginalized groups such as those in the LGBTQ community, drug users, and often people of color. As a result, those who occupied positions of political power felt little incentive to curb the epidemic and mocked it by deeming it the gay disease. As a result of neglect and the lack of investment in scientific and medical research to better understand the epidemiological contours of this deadly dis-ease, its growth and spread were exacerbated. Given the significant social stigma associated with AIDS, an analysis of the epidemic must be examined both an epidemiological as well as a social phenomenon. In Orlando and elsewhere, the refusal of the government and institutions to adequately address the AIDS epidemic, some people in the community formed grassroots organizations to help find relief for their community, family and friends. Whereas in previous generations, separation from the mainstream society was an explicit objective of many gay activists, in this era the gay community worked toward forming an inclusive coalition out of necessity to combat AIDS. Eventually, this effort forced the broader population and political establishment to begin taking decisive action. Eventually, declining rates of infection suggest that the resources invested in this effort, including scientific research and public information campaigns, worked. The public became more knowledgeable about AIDS and HIV, the virus that leads to AIDS, even became manageable to the point that it no longer the equivalent to a death sentence; however, the AIDS epidemic left a legacy on communities across the country and globe. This analysis of the experience of Orlando, Florida, illustrates the effect of its aftermath; grief and mourning remains an ever-present reminder of this dark chapter in this community\u27s history. Further, the grassroots organizations, strategies, and resources developed out of necessity during the 1980s remained and became important pillars of the community. The response to the PULSE Nightclub mass shooting that occurred decades after the height of the AIDS epidemic demonstrated the persistence and importance of these community organizations to the Orlando community