Affiliations: [a] Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| [b] Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
Address for correspondence: Homa Khorrami Ahmadzia, MD, MPH, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC 3967, Durham, NC 27710, USA. Tel.: +1 919 681 5220; Fax: +1 919 681 7861; E-mail: [email protected].
Abstract: OBJECTIVE: To evaluate experiences related to obstetric hemorrhage and suspected abnormal placentation among first year maternal-fetal medicine fellows. STUDY DESIGN: A cross-sectional anonymous survey was administered at the Society for Maternal-Fetal Medicine fellow retreat in March 2013. Fellows were asked about management strategies that reflected both their individual and institutional practices. RESULTS: There was a 56% response rate (55/98). In cases of postpartum hemorrhage due to uterine atony, there was variable use of the uterine tamponade device. The median incremental time for balloon deflation was every 5 hours (IQR = 2–12). Compared to the east coast, fellows from the west coast performed more hysterectomies (mean±SD; 2.9±2.4 vs. 1.2±1.2, p = 0.004). During a peripartum hysterectomy, 29% of fellows used a handheld cautery device such as Ligasure® or Gyrus®. Fifty-six percent responded that their institution never recommend planned delayed hysterectomies for abnormal placental implantation. CONCLUSION: There is wide variation in practice among first year maternal-fetal medicine fellows in management of peripartum hysterectomy and postpartum hemorrhage.
Keywords: Obstetric hemorrhage, abnormal placentation, maternal-fetal medicine, survey study