Emergency surgery for <scp>PPH</scp> in women declining blood transfusion or when allogeneic blood is not available
Bibliographic record
Abstract
Currently, the multiplicity of procedures described for surgical management of postpartum hemorrhage (PPH) might cause some hesitancy in the less experienced operator. However, delay in taking definitive action to control bleeding could be disastrous. This is particularly so when treating one of the increasing numbers of women who decline blood transfusion for personal or religious reasons (predominantly Jehovah's Witnesses) and in situations where allogeneic blood is not available. At vaginal delivery, if oxytocics are proving inadequate, the uterine cavity is empty, and bleeding from lacerations has been ruled out, then the combination of intrauterine balloon tamponade and the technique of “holding the cervix” with ring forceps 1, 2 can control hemorrhage. However, should laparotomy be required or for PPH following cesarean section (used judiciously after careful consideration of the risks and benefits for patients who object to transfusion), the following modification of a previously proposed maneuver 3 should be considered. While the assistant elevates the uterus in performing bimanual compression, the surgeon temporarily applies non-toothed, non-crushing artery forceps to the lower end of the ascending branch of each uterine artery, and then to the upper ends just below the ovarian artery. Hemorrhage should cease or be significantly reduced, allowing time for assessment of the site and the cause of the bleeding, leading to an appropriate choice of further surgical procedures. Such procedures may or may not include ligation in continuity of one or more of the previously clamped arteries using rapidly absorbable sutures, and eventually removing all remaining forceps. Awareness of this combination of relatively simple and effective techniques to control PPH, if applied promptly, may be lifesaving.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.016 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".