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SummaryHirudin is a potent thrombin inhibitor derived from the leech Hirudo medicinalis salivary gland which has considerable potential for therapeutic use in thrombotic disease. The major risk attendant its use is hemorrhage. This study investigates the hypothesis that the prohemostatic effects of DDAVP infusion can curtail the hemorrhagic effect induced by ongoing hirudin administration.In a randomized and blinded manner, rabbits were exposed to a 15-min intravenous infusion of DDAVP or saline midway through a continuous two-h intravenous infusion of hirudin. Bleeding time was monitored by full thickness ear punctures performed before, during and after hirudin exposure.Hirudin induced a significant hemorrhagic state, manifest as a 7-10-fold prolongation of the primary bleeding time. DDAVP reduced the mean duration of primary bleeding from 10.8 min to 5.9 min (p = 0.001) as well as the number of sites which bled for longer than 6 or 20 min (46% vs 27%, p = 0.002; and 18% vs 5%, p = 0.002, respectively). Although there was no difference in the incidence of spontaneous rebleeding from these sites (44 vs 36%, p = 0.21), rebleeding did not persist as long in animals that received DDAVP (8 vs 16 min, p = 0.005), and fewer sites rebled for longer than 20 min (8 vs 27%, p = 0.027). Results were essentially the same for two different commercial recombinant hirudin preparations.DDAVP appears to attenuate the bleeding caused by continuous hirudin infusion in rabbits and establishes a foundation for clinical assessment in patients.

Background Second trimester miscarriage is defined as pregnancy loss after 12 weeks and before 24 weeks gestation. The care that parents receive has been shown to greatly influence the woman's recovery after pregnancy. Aims To explore parents' experiences of hospital care during a second trimester miscarriage, from the time of diagnosis through to follow-up care. Methods A focused ethnographic design to conduct semi-structured interviews with 14 bereaved parents before thematic data analysis. Findings Parents highlighted the need for effective medical care in relation to medical treatment, pain relief and length of hospital stay, going home to prepare for the delivery and follow-up care. Parents emphasised the importance of appropriate facilities and being separate from other parents and babies. Clear communication and finding a cause for their miscarriage was also important for parents. Conclusion Second trimester miscarriage is a significant life event for parents. Effective, individualised clinical care is needed to meet the medical needs of bereaved parents.

Background Second-trimester miscarriage is defined as pregnancy loss after 12 and before 24 weeks' gestation. Little is known about parents' experiences of hospital care during a second trimester miscarriage in Ireland. Aims This study aimed to explore parents' experiences of hospital care during a second-trimester miscarriage. Methods A focused ethnographic design was used. A series of semi-structured interviews were completed with 14 bereaved parents. The data were analysed using thematic network data analysis. Findings This paper discusses the global theme of relational and social experiences of miscarriage. Parents highlighted the need for compassionate care and expressed the importance of empathy and sensitivity from hospital staff to avoid further distress. Conclusions Compassionate care received by bereaved parents positively influenced their hospital experience, whereas a perceived lack of compassion or insensitivity had a lasting negative impact on bereaved parents.

Background Clinical training should be efficient, intellectually rigorous, and integrated into practice. This interactive workshop was developed to support student midwives in bereavement care. Aims To improve student midwives' confidence in providing bereavement care to parents after pregnancy loss and perinatal death. Methods Two focus groups were held, where students' (n=12) discussed their experiences of attending the workshop, barriers and facilitators to gaining confidence, and any further education needs. Findings All students agreed that the workshop increased their confidence, and said that role-plays were the most beneficial aspect of the day. Lack of exposure and support from mentors and senior staff was seen as the largest barrier to gaining further confidence. Conclusions The results suggest that all students could benefit from a workshop to increase confidence in bereavement care. The content of this workshop can be used in other maternity settings in Ireland and is recommended for all staff members caring for parents after perinatal bereavement or pregnancy loss.