title: Obstetric hemorrhage survey: Attitudes and practices of maternal-fetal medicine fellows.
abstract: OBJECTIVE
  To evaluate experiences related to obstetric hemorrhage and suspected abnormal placentation among first year maternal-fetal medicine fellows.
  
  
  METHODS
  A cross-sectional anonymous survey was administered at the Society for Maternal-Fetal Medicine fellow retreat in March 2013. Fellows were asked about management strategies that reflected both their individual and institutional practices.
  
  
  RESULTS
  There was a 56% response rate (55/98). In cases of postpartum hemorrhage due to uterine atony, there was variable use of the uterine tamponade device. The median incremental time for balloon deflation was every 5 hours (IQR = 2-12). Compared to the east coast, fellows from the west coast performed more hysterectomies (mean±SD; 2.9±2.4 vs. 1.2±1.2, p = 0.004). During a peripartum hysterectomy, 29% of fellows used a handheld cautery device such as Ligasure® or Gyrus®. Fifty-six percent responded that their institution never recommend planned delayed hysterectomies for abnormal placental implantation.
  
  
  CONCLUSIONS
  There is wide variation in practice among first year maternal-fetal medicine fellows in management of peripartum hysterectomy and postpartum hemorrhage.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: H K
authors.initials: HK
authors.lastname: Ahmadzia
authors.affiliation: Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Murtha
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Heine
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Brancazio
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D009774:Obstetrics / Q000193:education* / Q000706:statistics & numerical data; D058725:Peripartum Period; D010820:Physicians / Q000523:psychology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D058738:Uterine Balloon Tamponade / Q000295:instrumentation / Q000706:statistics & numerical data*; D014593:Uterine Inertia / Q000453:epidemiology / Q000628:therapy*
keywords: Obstetric hemorrhage; abnormal placentation; maternal-fetal medicine; survey study