OBJECTIVE: Assess whether inclusion of intrapartum risk factors improves our obstetric hemorrhage risk stratification tool in predicting obstetric hemorrhage, transfusion, and related severe morbidity. STUDY DESIGN: This is a retrospective cohort study using all live deliveries at a single institution over a two-year period (n = 5,332). Obstetric hemorrhage risk factors, hemorrhage burden, and severe maternal morbidity index outcomes were assessed through chart abstraction. Hemorrhage risk was assessed at: 1. “Time of Admission” through chart abstraction and 2. “Pre-delivery” by calculation after inclusion of all abstracted intrapartum risk factors. Admission high-risk was compared to pre-delivery high-risk for sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio in predicting obstetric hemorrhage, obstetric hemorrhage requiring transfusion, and obstetric hemorrhage related severe morbidity. Significance levels were calculated using descriptive statistical methods including chi-squared tests and McNemar tests. RESULTS: The sensitivities of the risk assessment tool using admission risk classification for high-risk patients is: 25% for obstetric hemorrhage, 37% for obstetric hemorrhage requiring transfusion, and 22% for obstetric hemorrhage related severe morbidity. After intrapartum factor inclusion, the sensitivities increase to: 55% for obstetric hemorrhage, 59% for obstetric hemorrhage requiring transfusion, and 47% for obstetric hemorrhage related severe morbidity. This “pre-delivery” risk assessment is significantly more sensitive across all three end points (p < 0.001 for all three outcomes). While the positive likelihood ratios for obstetric hemorrhage are equal on admission and pre-delivery (2.10 on admission and pre-delivery), they increase after intrapartum factor inclusion for obstetric hemorrhage requiring transfusion and obstetric hemorrhage related severe morbidity (on admission, 2.74 and 1.6, respectively, and pre-delivery: 4.57 and 3.58, respectively). CONCLUSION: Inclusion of intrapartum risk factors increases the accuracy of this obstetric hemorrhage risk stratification tool in predicting patients requiring hemorrhage management with transfusion and obstetric hemorrhage related severe morbidity.

Purpose: Prolonged duration of intrapartum oxytocin exposure is included as a risk factor within widely adopted obstetric hemorrhage risk strati cation tools. However, the duration of exposure that confers increased risk is poorly understood. This study aimed to assess the association between duration of intrapartum oxytocin exposure and obstetric blood loss, as measured by quantitative blood loss, and hemorrhage-related maternal morbidity.Methods: This was a retrospective cohort study of all deliveries from 2018 to 2019 at a single medical center. We included patients who had received any intrapartum oxytocin, and we categorized them into 1 of 5 groups: >0-2, ≥2-4, ≥4-6, ≥6-12, and ≥12 hours of intrapartum oxytocin exposure. The primary outcomes were mean quantitative blood loss, proportion with obstetric hemorrhage (de ned as quantitative blood loss ≥ 1000 mL), and proportion with obstetric hemorrhage-related morbidity, a composite of hemorrhage-related morbidity outcomes. Secondary outcomes were hemorrhage-related pharmacologic and procedural interventions. A strati ed analysis was also conducted to examine primary and secondary outcomes by delivery mode.

Previous literature on women's representation in the Ugandan Parliament painted a grim picture of women exploited by political leaders, and brought into Parliament and other political spaces by a benevolent dictator who allowed their entry to extend and deepen his political networks. These women were expected to accept a subordinate and inferior place, and to defer to male authority. Female members cooperated dutifully by ‘knowing their place’ and by actively supporting the ‘hand that fed them’. Studies noted that women lacked gender consciousness and even the analytical power to understand the implications of the policies they helped pass. There was a general consensus that patriarchal attitudes in Parliament diminished women's influence and undermined their political efficacy. This paper analyses gender relations, and examines the status of female members through their words, actions and behaviours in the Ugandan Parliament. The three primary sources of data for this study were surveys, semi-structured interviews of male and female members of Parliament, and the proceedings of parliamentary debates in 2014. Analysis of parliamentary debates and personal accounts of gender relations in the 9th Parliament reveal a changing landscape. Women are moving from marginal roles to more central roles in Parliament, and are becoming active participants in shaping parliamentary discourse and policy outcomes. There is a newfound sense of empowerment among respondents. Women articulated a new sense of being respected in Parliament, a sense of self- and collective efficacy that they can advance policy priorities. There is a change in women's performance on the Chamber's floor. Parliamentary proceedings offer evidence of an ability to successfully engage in vigorous debates, effectively advance their policy agendas, and utilise sophisticated political strategising and manoeuvring. While there are still elements of continuity, a new gender schema is emerging – a schema that challenges traditional values and attempts to reconcile these values with requirements for running a modern government.

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