A fast-track programme can be implemented safely and effectively if the appropriate support including a step-down ward area is put in place. Greater experience with this type of protocol leads to reductions in the length of hospital stay for children aged over 6 months undergoing uncomplicated open-heart surgery. Fast-track cases should be performed in the morning.
The spontaneous and operative delivery rates on a labour ward are compared in the years before and after the initiation of an epidural analgesia service. An epidural rate of 27% of all deliveries in the first year is the only influence affecting an otherwise almost steady obstetric background. Despite this major impact, the changes in operative delivery rates are small and fail to reach statistical significance, although the decrease in spontaneous deliveries is significant. In later years the epidural rate rose to involve 72% of primiparae and 26% of multiparae, yet the pattern of deliveries tended to return toward the pre-epidural picture.
MRCOG, Consultant Obstetrician. Doncaster Royal Infirmary, Doncaster DN2 SLT slrvy lXe spontaneous and operative delivery rates on a labour ward are compared in the years before and afier the initiatim of an epi&al analgesia service. An epidural rate of 27% of all deliveries in the first year is the only mjuence Gecting an otherwise almost steady obstetric hukgrmmd. Despite this major impact, the changes in operative &limy rates are small and fd to reach statittical signfmmce, although the &crease in spontaneous &liveries is s&niJicant. In h e r years the e p a r a l rate rose to involve 7P/, of primiparae and 2@/, of multiparae. yet the partern of &liveries te& to return toward he pre-ep&d picture.
Control of persistent primary postpartum haemorrhage due to uterine atony with intravenous prostaglandin E,. Case report Dear Sir,In their case report [Br J Obstet Gynaecol(l983) 90, Henson et at. remark that prostaglandins (PG) 'have rarely been used in the third stage of labour'. Although it is correct that reported evidence is scant and tends to be rather casuistic, I doubt whether the actual use of PG to prevent or check postpartum haemorrhage is really as unusual as the authors surmise. For several years it has been routine practice in our department to administer natural uterotonic PG (PGE, or PGF,a) or synthetic analogues (15-methyl-PGF2a and, recently, sulprostone as well) to combat postpartum blood loss due to uterine hypotonia. The routes and compounds most frequently used are intravenous infusion of PGE, or injection of 1 5-methyl-PGF2a into the cervical stroma, whereas during caesarean section these compounds are injected directly into the myometrium. Results have been extremely rewarding, and no specific maternal side effects have been noted (Thiery et al. 1978
Author's replyDear Sir, We are grateful to Professor Thiery for bringing to our attention his publications on the use of prostaglandins in the third stage of labour. We did reference several publications on the use of prostaglandins for the control of postpartum haemorrhage but were, and still are, of the view that this treatment is seldom used in Britain. We therefore felt that it would be worth making our experience with prostaglandin E, solution more widely known.
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