Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle.Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle.Results: A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).Conclusions: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery

Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage

Background: Delays in the detection or treatment of postpartum hemorrhage can result in complications or death. A blood-collection drape can help provide objective, accurate, and early diagnosis of postpartum hemorrhage, and delayed or inconsistent use of effective interventions may be able to be addressed by a treatment bundle.Methods: We conducted an international, cluster-randomized trial to assess a multicomponent clinical intervention for postpartum hemorrhage in patients having vaginal delivery. The intervention included a calibrated blood-collection drape for early detection of postpartum hemorrhage and a bundle of first-response treatments (uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation), supported by an implementation strategy (intervention group). Hospitals in the control group provided usual care. The primary outcome was a composite of severe postpartum hemorrhage (blood loss, ≥1000 ml), laparotomy for bleeding, or maternal death from bleeding. Key secondary implementation outcomes were the detection of postpartum hemorrhage and adherence to the treatment bundle.Results: A total of 80 secondary-level hospitals across Kenya, Nigeria, South Africa, and Tanzania, in which 210,132 patients underwent vaginal delivery, were randomly assigned to the intervention group or the usual-care group. Among hospitals and patients with data, a primary-outcome event occurred in 1.6% of the patients in the intervention group, as compared with 4.3% of those in the usual-care group (risk ratio, 0.40; 95% confidence interval [CI], 0.32 to 0.50; P<0.001). Postpartum hemorrhage was detected in 93.1% of the patients in the intervention group and in 51.1% of those in the usual-care group (rate ratio, 1.58; 95% CI, 1.41 to 1.76), and the treatment bundle was used in 91.2% and 19.4%, respectively (rate ratio, 4.94; 95% CI, 3.88 to 6.28).Conclusions: Early detection of postpartum hemorrhage and use of bundled treatment led to a lower risk of the primary outcome, a composite of severe postpartum hemorrhage, laparotomy for bleeding, or death from bleeding, than usual care among patients having vaginal delivery

Forced marriage among men: An unrecognized problem

Forced marriage is generally viewed as a clash between culture and gender and the fact that men are also victims, in a small number of cases, escapes attention of policy makers and activists. While the overall approach to forced marriage has helped men as well they, however, have remained below the radar of public concern. A problem particular to men is their unwillingness to articulate in public forums their predicament as questions of masculinity are then raised. Ultimately men will have to break the silence, organize and mobilize collectively if they wish to see specific policies that target men

TRAUMA HEALING DAN PENDEKATAN KONSELING DALAM MENGHADAPI QADARULLAH

Pada zaman sekarang ini, para muda-mudi sering membicarakan topik berupa healing dan self-healing. Terutama bagi mereka yang tengah berada di situasi terpuruk, misalnya putus cinta, perceraian, terkena musibah, dan peristiwa traumatis apapun itu. Bahkan perasaan lelah akan beban kerja di kantor juga sering menjadikan mereka melakukan proses healing ini. Mereka berupaya serius supaya situasi terpuruk tersebut dapat “lepas” dari kehidupan sehari-hari. Banyak cara yang dilakukan dalam upaya healing ini, salah satunya yang paling kerap dilakukan adalah berlibur. Trauma adalah reaksi emosional terhadap peristiwa mengerikan seperti kecelakaan, pemerkosaan, dan bencana alam. Itu tergantung pada metode perawatannya, yaitu penyembuhan trauma atau trauma healing. Setelah mengalami salah satu dari peristiwa ini, seseorang cenderung penuh dengan keterkejutan dan penolakan. Reaksi jangka panjang dapat mencakup emosi yang tidak terduga, kilas balik, hubungan yang tegang, dan bahkan gejala fisik seperti sakit kepala dan mual. Kondisi ini normal karena trauma dapat menyerang siapa saja, tetapi beberapa orang mungkin mengalami kesulitan untuk melanjutkan hidupnya. Trauma healing adalah suatu proses memulihkan emosi korban dari ketakutan di masa lalu. Dengan cara ini, mereka bisa bertahan hidup kembali tanpa bayang-bayang masa lalu. Pada umumnya, para korban sering merasa mengenang kembali peristiwa itu, mengingatnya dengan mimpi buruk, dan menghindari dikaitkan dengan peristiwa traumatis. Untuk mengatasinya, ada terapi trauma psikologis yang bisa diikuti. Oleh karena itu, salah satu cara untuk mengatasinya adalah dengan menyembuhkan trauma tersebut. Jadi, trauma healing merupakan proses penyembuhan pasca trauma yang memungkinkan seseorang untuk melanjutkan hidupnya tanpa bayang-bayang suatu kejadian tersebut lagi