Postpartum haemorrhage is a major cause of maternal morbidity and mortality worldwide. A recent Cochrane review of carbetocin (long-acting oxytocin analogue) concluded that its use decreased additional uterotonic requirements, however, no included studies compared its use against intravenous bolus oxytocin. The majority of studies of carbetocin have considered its use in vaginal delivery; no studies have examined the economic implications of its use. This study describes a clinical and financial evaluation undertaken at a United Kingdom District General Hospital surrounding the introduction of carbetocin for prophylaxis against postpartum haemorrhage at caesarean deliveries. A range of clinical outcomes were observed including frequency of postpartum haemorrhage, estimated blood loss, transfusion requirements, change in haemoglobin or haemodynamics, use of additional uterotonics and perioperative recovery. Finally, a composite financial analysis was performed. No clinically significant benefit was found, however associated costs increased by £18.52/patient.

Objective To test the hypothesis that intravenous antibiotics given intra-operatively reduce the failure Design A single blind, randomised controlled trial.Setting A district hospital in Benin, West Africa.Population Seventy-nine women undergoing repair of an obstetric vesico-vaginal fistula by a single surgeon at Hopital Evangelique; two women had repeat operations.Methods Participants in the treatment group (n = 41) received ampicillin 500 mg intra-operatively. Controls (n = 40) received no prophylactic antibiotics.Main outcome measures Failure of fistula closure and objective incontinence (a positive pad test) at hospital discharge. Secondary outcomes included febrile morbidity, other antibiotic use and urinary infection.Results Antibiotic prophylaxis did not reduce the odds of failed repair (OR 2.1 95% CI 0.75-6.1) or of objective incontinence (OR 1.9; 95% CI 0.72-51). The women in the antibiotic prophylaxis group received less post-operative antibiotics and had less urinary infections at day 10.Prophylactic antibiotics should not be used in vesico-vaginal fistulae repair in the developing world outside randomised controlled trials. rate of vesico-vaginal fistula repair. Conclusions

Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size.

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Objective To review the IOL pathway by a multi-disciplinary team in March 2011 using BICS as the number of IOLs was anticipated to increase from 900 to 1500 due to merging with 2 neighbouring units. Findings Inconsistency in practice in offering membrane sweep Inconsistency in dates for IOL for postdates No information leaflet for IOL Difficult to obtain slot in IOL dairy (6 spaces on weekdays and 2 on weekend) Delays in prescription of Propess Actions Offer membrane sweeps to nulliparous women at 40 weeks and to all women at 41 weeks (NICE recommendation) IOL for postdates ≥ term + 11 days Design IOL leaflet Update IOL guideline Check IOL diary daily to free slots by removing delivered women Patient Group Directive for Propess for midwives Conclusion There was improvement in the IOL pathway with decreased delays and more spaces in IOL dairy. There was decrease in % of IOL for postdates, increase in membrane sweeps offered and increase in IOL after ≥ term + 11. However, there was decrease in vaginal delivery, instrumental delivery rate and increase in section rate. Abstract PP.49 Table February'11 June'11 Total IOLs 24.4% 20.4% Total IOL for postdates 8.5% 6.29% % IOL for postdates 34.8% 30.8% Membrane sweep 61.8% 76.1% IOL ≥ T + 11 81% 95.2% Vaginal delivery (%) 57% 38% Instrumental delivery (%) 28.5% 23.8% Caesarean section (%) 14.2% 42.8% Neonatal unit admission x 2 (Sepsis)