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UKOSS Peripartum Haemorrhage RCOG
UKOSS Peripartum Haemorrhage RCOG
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Therapies or Prophylaxis for Peripartum
Haemorrhage
A L Study 04/07
Data Collection Form - CASE
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Please report all women delivering after 1st September 2007
and before 1st October 2008
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Case Definition:
UKOSS
National Perinatal Epidemiology Unit
University of Oxford
Old Road Campus
Oxford
OX3 7LF
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6. If codes or examples are required, some lists (not exhaustive) are included on the back
page of the form.
7. If you do not know the answers to some questions, please indicate this in section 7.
A L8. If you encounter any problems with completing the form please contact the UKOSS
Administrator or use the space in section 7 to describe the problem.
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Other4* Yes Number
If Other, please specify
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3.3 Previous uterine perforation
If Yes, please specify treatment of perforation, if any
Yes No
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Section 4: This Pregnancy
4.1 Final Estimated Date of Delivery (EDD)5* D D / M M / Y Y
4.2 Was this pregnancy a multiple pregnancy? Yes No
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If Yes, please specify number of fetuses
4.3 Were there problems in this pregnancy?2* Yes No
If Yes, please specify
4.4 Was placenta praevia diagnosed prior to delivery? Yes No
If Yes, please specify grade
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Section 5: Delivery
5.1 Was delivery induced? Yes No
If Yes, please state indication
Was vaginal prostaglandin/misoprostol used? Yes No
5.2 Did the woman labour? Yes No
If Yes, please state date and time of diagnosis of labour D D / M M / Y Y h h : m m
24hr
Haemorrhage
5.5 What was the estimated blood loss (total mls)?
5.6 Please indicate what treatments were undertaken
Was this therapy used for
Tick Please rank the therapies prophylaxis (P) or treatment
all that in the order in which they (T)6*. Please tick (P) or (T)
apply were first used (1, 2, 3 etc)
(P) (T)
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Syntocinon infusion
Ergometrine
Prostaglandin F2
A L Misoprostol
Intra-abdominal packing
Intrauterine balloons
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Intrauterine packing
Intra-arterial balloons
Total Subtotal
Other (please specify)
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What was the time between the decision to use rfVIIa
and the time it was first given? (min)
Total number of doses Total dose given (mg) .
5.9 Is arterial embolisation (interventional radiology) routinely available
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If Yes, when and where is it available (tick all that apply)
Yes No
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Platelets
Cryoprecipitate
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5.14 Was the woman actively warmed during treatment for
haemorrhage? Yes No
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5.15 Were the intravenous fluids actively warmed? Yes No
5.16 Was the womans temperature monitored? Yes No
If Yes, what was her lowest recorded temperature? .
5.17 Was CVP monitoring used? Yes No
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5.18 Was intra-arterial monitoring used? Yes No
Section 6: Outcomes
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24hr
6b.2 Mode of delivery
spontaneous vaginal ventouse lift-out forceps rotational forceps
breech pre-labour caesarean section caesarean section after onset of labour
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6b.3 Birthweight (g)
6b.4 Was the infant stillborn?
If Yes, was this
Please go to section 7
Yes No
Antepartum OR Intrapartum
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6b.5 Was the infant admitted to the neonatal unit? Yes No
Section 7
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Please use this space to enter any other information you feel may be important
Section 8:
Name of person completing the form
Designation
Todays date D D / M M / Y Y
You may find it useful in the case of queries to keep a copy of this form.
If you are unable to make a copy please tick the box
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ASIAN OR ASIAN BRITISH
08. Indian gestation
09. Pakistani 6. Definition of prophylaxis and treatment:
10. Bangladeshi
(P) Prophylaxis or support: following haemorrhage,
11. Any other Asian background
other treatments given and considered successful,
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BLACK OR BLACK BRITISH
12. Caribbean
13. African
14. Any other black background
but this therapy add just in case to support other
interventions.
(T) Treament/rescue: following haemorrhage, other
treatments given and considered to have failed, so
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CHINESE OR OTHER ETHNIC GROUP
15. Chinese this therapy is given as rescue.
16. Any other ethnic group 7. Major maternal medical complications,
2. Current or previous pregnancy problems, including:
including: Persistent vegetative state
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Pre-eclampsia (hypertension and proteinuria) Cerebrovascular accident
Eclampsia Pulmonary oedema
Thrombotic event Mendelsons syndrome
Amniotic fluid embolism Renal failure
3 or more miscarriages Thrombotic event
Septicaemia
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