Increases in postpartum hemorrhage are not explained by the changing risk profile of women. It may be that changes in management and/or reporting of postpartum hemorrhage have resulted in higher postpartum hemorrhage rates.

Background Controversy exists whether different continuous positive airway pressure (CPAP) weaning methods infl uence time to wean off CPAP, CPAP duration, oxygen duration, Bronchopulmonary Dysplasia (BPD) or length of admission. Aims In a multicentre randomised controlled trial, the authors have primarily compared CPAP weaning methods impact on time to wean off CPAP and CPAP duration and secondarily their effect on oxygen duration, BPD and time of admission. Methods Between April 2006 and October 2009, 177 infants <30 weeks gestational age (GA) who fulfi lled stability criteria on CPAP were randomised to one of the three CPAP weaning methods (M). M1: Taken 'OFF' CPAP with the view to stay 'OFF'. M2: Cycled on and off CPAP with incremental time 'OFF'. M3: As with M2, cycled on and off CPAP but during 'OFF' periods were supported by 2 mm nasal cannula at a fl ow of 0.5 l/min. Results Based on intention to treat analysis, there was no signifi cant difference in mean GA or birthweight between the groups (27.1±1.4, 26.9±1.6 and 27.3±1.5 (weeks±1SD) and 988±247, 987±249 and 1015±257 (grams±1SD), respectively). Primary outcomes showed M1 produced a signifi cantly shorter time to wean from CPAP (11.3±0.8, 16.8±1.0, 19.4±1.3 (days±1SE) p<0.0001, respectively) and CPAP duration (24.4±0.1, 38.6±0.1, 30.5±0.1 (days±1SE) p<0.0001, respectively). All the secondary outcomes were signifi cantly shorter with M1, (oxygen duration: 24.1±1.5, 45.8±2.2, 34.1±2.0 (days±1SE) p<0.0001, BPD: 7/56 (12.5%), 29/69 (42%), 10/52 (19%) p=0.011 and length of admission: 58.5±0.1, 73.8±0.1 69.5±0.1 (days±1SE) p<0.0001, respectively). Conclusion Method 1 signifi cantly shortens CPAP weaning time, CPAP duration, oxygen duration, BPD and admission time. INTRODUCTIONContinuous positive airway pressure (CPAP) has been used in preterm babies as a mode of respiratory support since the 1970s and is now used in most NICUs. [1][2][3][4][5] Subsequently, it has been shown that CPAP may reduce the need for invasive intubation and ventilation, reduce apnoea of prematurity and postextubation atelectasis. Early use of CPAP reduces the incidence of Bronchopulmonary Dysplasia (BPD (defi ned as an oxygen requirement at 36 weeks corrected gestational age)) and the need for home oxygen. [5][6][7][8][9][10][11] There are several ways of delivering CPAP including head chamber, facemask, nasal prongs and endotracheal tubes. [5][6][7][8] Research and clinical experience have shown that nasal CPAP with nasal prongs is the most effi cient way of delivering continuous distending pressure (CDP) to the alveoli. [5][6][7][8] Once infants are stabilised and breathing adequately on CPAP, the CPAP is usually weaned off gradually. 6 7 Controversy continues over the best method of weaning CPAP and is often approached in an 'ad hoc' manner. 5 7 12-14 Four trials have compared methods of weaning CPAP and its impact on CPAP duration. [15][16][17][18] The fi rst trial studied the changes in respiratory parameters in infants <34 weeks gestational age (GA) requiring CPAP. ...

Objective: To assess trends and outcomes of postpartum haemorrhage (PPH) in New South Wales (NSW). Methods: A population‐based descriptive study of all 52,151 women who had a PPH either during the hospital stay for the birth of their baby or requiring a re‐admission to hospital between 1994 and 2002. Data were obtained from the de‐identified computerised census of NSW hospital in‐patients and analysed to examine trends over time. The outcome measures included maternal death, hysterectomy, admission to intensive care unit (ICU), transfusion and major maternal morbidity, including procedures to reduce blood supply to the uterus, acute renal failure and postpartum coaqulation defects. Results: From 1994 to 2002 both the number and adjusted (for under‐reporting) rate of PPH during the birth admission increased from 8.3% of deliveries to 10.7%. The rate of PPH adjusted for maternal age and mode of delivery was similar to the unadjusted rate. There was a sixfold increase in the rate of transfusions from 1.9% of women who haemorrhaged to 11.7%. Hospital readmissions for PPH declined from 1.2% of deliveries to 0.9%. These were statistically significant changes. There were no significant changes in the rate of hysterectomies, procedures to reduce blood supply to the uterus, admissions to ICU, acute renal failure or coagulation defects. Conclusion: The increased rate of PPH during the birth admission is concerning. The increase in PPH could not be explained by increasing maternal age or caesarean sections. Linked birth and hospital discharge data could determine whether the increase in PPH is caused by other changes in obstetric practices or population.

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