No abstract

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician–gynecologists, maternal–fetal medicine subspecialists, certified nurse–midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

The author describes an obstetrical forceps-like device that may be successful in removing surgical specimens following a laparoscopic procedure.

No abstract

Transvaginal ultrasonography was performed on 113 women prior to laparoscopic sterilization. The amount and character of the peritoneal fluid present in the pelvis was assessed at the end of the operative procedure. Sonographically, free pelvic peritoneal fluid was seen in 42.5% of the patients. Laparoscopically, the average amount of fluid present was 11.2 ml with an average of 16.5 ml present in patients with FPPF and 7.2 ml present in patients without FPPF (P < 0.0001). Sonographic measurement of fluid volume was found to significantly underestimate the amount of fluid present at laparoscopy (P < 0.0001). Endometriosis and pelvic adhesions significantly changed the sonographic findings.