Melanie Chichester

Maternal risk factors for peripartum transfusion.

BACKGROUND Postpartum hemorrhage remains one of the most significant maternal complications of childbirth in the United States, with peripartum transfusion the most commonly identified morbidity. METHODS We completed a retrospective cohort study of women delivering at 20+ weeks at a large regional obstetric hospital between 2000 and 2008. Data were extracted from the institutional data warehouse; women with a potential coagulopathy were excluded. The association of maternal and obstetric factors with odds of transfusion was explored using univariate and multivariable logistic regression. RESULTS We identified 59,282 deliveries and 614 cases of transfusion, an incidence rate of 10.4/1,000 deliveries. Rates were highest for black (14.1/1,000 deliveries) and lowest for white (8.4/1,000 deliveries) women. Increased odds of perinatal transfusion were seen for women with anemia at entry to labor and delivery (odds ratio [OR] 3.03, 95% confidence interval [CI] 2.43-3.79 for hemoglobin (Hgb) 9.5-10.5 g/dL; OR 12.65, 95% CI 10.35-15.46 for Hgb<9.5 g/dL) and those undergoing a cesarean delivery (OR 4.28, 95% CI 3.62-5.05). The excess risk associated with black race was eliminated after adjusting for anemia and other covariates. A synergistic effect of anemia with delivery method was observed. Anemia was estimated to account for 31.7% of transfusions. CONCLUSIONS Potentially modifiable factors most strongly associated with risk for transfusion were antenatal anemia and cesarean delivery, and their co-occurrence was synergistic. Anemia is an easily identified and treatable risk factor and warrants focus as part of preconception and interconception care in childbearing women.

Multicultural Issues in Perinatal Loss

Infant loss is frequently invisible to the rest of society. Parents may become frustrated when they are denied mourning time or asked why they are not “over it” yet. Nurses’ demonstration of cultural sensitivity during perinatal loss facilitates grieving by validating each familys “right” way to mourn their infants death.

Bed Rest and Gestational Diabetes: More Reasons to Get Out of Bed in the Morning

INTRODUCTION: Activity restriction or “bed rest” is a commonly prescribed obstetric intervention, which lacks data demonstrating efficacy. Complications including bone demineralization, pulmonary atelectasis, venous thromboembolism, and muscle deconditioning have been attributed to bed rest. Exercise has a known beneficial effect toward achieving good glycemic control in women with gestational diabetes mellitus (GDM). We sought to quantitate the effect that bed rest has on GDM. METHODS: We performed a retrospective cohort study from 2007 to 2012 at a large tertiary hospital. Charts for women with singleton pregnancies who were admitted for 7 days or longer with diagnosis codes for preterm labor, cervical shortening, preterm premature rupture of membranes, advanced cervical dilation, and preeclampsia were identified. Those who had their 1-hour screening Glucola test during admission were included. Logistic regression analysis was done to determine the effect of bed rest on GDM. RESULTS: Five hundred nine women were available for inclusion. Fifty-four were diagnosed with gestational diabetes during a prolonged hospital stay (10.6%). Patient characteristics between the two groups were similar. Maternal age (relative risk 2.66, P=.008) and maternal length of stay (relative risk 6.13, P=0.00) were associated with the development of GDM. For every day a patient was admitted to the hospital on bed rest, their risk of GDM increased 1.04 times. CONCLUSION: Antenatal bed rest increases the risk of acquiring GDM. The association between bed rest and GDM is biologically plausible because skeletal muscle is the primary site of maternal insulin resistance. Activation of these muscles has been shown to increase insulin sensitivity and decrease blood glucose levels. This finding supports the mounting evidence that bed rest does more harm than good.

Making Connections to Develop a Professional Network

Developing a professional network is important for career growth and professional development. Networking can open doors for countless opportunities to gain new knowledge, meet new people, visit new places and advance your career. Successful networking involves identifying opportunities to meet and interact with people and to do so in a genuine way that fosters the development of a professional relationship.

A Cost‐Effective Approach to Simulation‐Based Team Training in Obstetrics

Many larger facilities regularly stage obstetric drills in modern simulation departments equipped with expensive simulators. Despite lacking these resources, we wanted to provide effective simulation training at our rural hospital. A team of clinicians and educators developed a cost-effective and time-efficient simulation drill for nurses, which included both a didactic review and a simulation day. The drill included obstetric providers and incorporated scenarios for shoulder dystocia, neonatal resuscitation and postpartum hemorrhage. This was a successful multidisciplinary learning experience that was high in creativity and teamwork, but low in cost.

Approaching Menopause (But Not There Yet!): Caring for Women in Midlife

iIn a study by Beyene, Gilliss, and Lee (2007), 40to 48-year-old women, when questioned about what they considered “middle age,” identified 45 to 60 years as “middle-aged.” Many women, although they may no longer consider themselves “young,” don’t consider themselves “old,” either. Rather, they look at their mothers and describe them as old (Im, Liu, Dormaire, & Chee, 2008). According to Shilling (2011), “Sixty is the new forty” is a common refrain and 45 no longer feels “old.” While it’s great to be young at heart, it’s still important for women to be aware of the health issues they may encounter as they enter middle age. Yet, many may not be thinking about the approach of menopause and its concomitant health changes until noticeable physical alterations occur (Im et al., 2008; Weismiller, 2009). Perimenopause and Menopause Menopause is a natural and normal part of a woman’s life, a transition to the part of life when she is no longer able to bear children. For most women, perimenopause, or the time period from the onset of menopausal signs and symptoms through the cessation of menses for greater than 1 year, usually begins around age 47, and is complete by age 55 (Weismiller, 2009; Zender & Olshansky, 2009). Many women see this as a positive time in their lives, with decreasing worries about contraception or menses; however, other women may see it as an end to their unique Approaching Menopause (But Not There Yet!)

When the Pregnant Jehovah's Witness Patient Refuses Blood: Implications for Nurses

One aspect of the Jehovahs Witness faith that is particularly well-known to health care professionals is the refusal to accept blood or blood products. The right to refuse treatment is one of a patients fundamental rights that can produce moral distress for nurses caring for women and newborns.

The Meaning of Food and Multicultural Implications for Perinatal Palliative Care

Feeding an infant is a bonding experience for parents, particularly for women from cultures in which breastfeeding is the norm. When an infant is unexpectedly ill, or his or her life is expected to be brief, challenges surrounding infant feeding can occur. Regardless of ethnicity or culture, parents facing the death of their infant have difficult decisions to make and need time to process those decisions. Given the social, cultural and spiritual nature of food and water, withdrawing or withholding nutrition and/or hydration for infants can be one of the most difficult decisions for parents. This article considers the clinical and cultural ramifications of infant feeding decisions when a shift occurs from curative interventions to palliative care.

The Rewards and Challenges of Becoming a Clinical Instructor

Frontline nurses working in the clinical area are a vital component to nursing education. Taking on the role of adjunct clinical instructor can be a rewarding way to increase ones own knowledge while performing the important task of educating the next generation of nurses.

Lifelong learning: how to make continuing education a part of your career path.

lifelong endeavor nNever turn down an opportunity for continuing education, no matter how obscure the topic might initially appear. This is a lesson I learned recently, when I received an ad for a breakfast educational meeting sponsored by a home health care agency on tracheostomy care. While at the time I couldn’t imagine ever needing this knowledge, the session was on my way home after a night shift, only an hour long, plus it was free and provided breakfast. I figured, why not? Less than 4 months later, my morning admission for a planned repeat cesarean delivery arrived. She had a tracheostomy, and the orders said to ensure a #4 unfenestrated Shiley tube to be available at the bedside. Had I not attended the home care conference, I would have been at a loss. Although the phrase is a cliché, you are a student in the school of life. The joke in nursing school was that 50 percent of what you learned in school would be obsolete in 5 years, but the instructor couldn’t tell you which 50 percent. In today’s world of evidence-based practice, continuing to learn must be a lifelong endeavor, because you never know which “we have always done it that way” is really the right way and Melanie Chichester, BSN, RNC Lifelong Learning