Classroom Management: Beobachtung einer 5. Grundschulklasse (German Edition)

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A Festschrift for Richard M. Emerging adults' commitment to effectively supportive friendships: Uncertainty, decision science, and policy making: A manifesto for a research agenda.

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Zusammenfassung

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The lives of others: Social rationality in animals. Rational analysis of the adaptive and predictive nature of memory. Journal of Applied Research in Memory and Cognition , 2 , Presenting quantitative information about decision outcomes: A risk communication primer for patient decision aid developers. On noise-robust strategies in the emergence of cooperation. Therapeutische Umschau , 70 , Statistical illiteracy in residents: What they do not learn today will hurt their patients tomorrow. Journal of Graduate Medical Education , 5 , Evaluation of what physicians tell patients about screening harms.

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Are rational actor models "rational" outside small worlds?

Decisions, co-operation and strategic behaviour pp. Homo heuristicus and the bias-variance dilemma. Adaptation and cephalic expression pp. Less-is-more effects in adaptive cognition. Malaysian Journal of Medical Sciences , 19 , How heuristics handle uncertainty. The Berlin Numeracy Test. Judgment and Decision Making , 7 , Full text Durand, M. Design and usability of heuristic-based deliberation tools for women facing amniocentesis. Health Expectations , 15 , The philosophical personality argument.

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Numbers can be worth a thousand pictures: Individual differences in understanding graphical and numerical representations of health-related information. Health Psychology , 31 , The risks we dread: A social circle account. Social sampling explains apparent biases in judgments of social environments. Advances in efficient health communication: Promoting prevention and detection of STDs. Current HIV Research , 10 , Doc, what would you do if you were me? On self-other discrepancies in medical decision making.

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All of the employed methods had high success rates in terms of preventing hysterectomy which would otherwise have been necessary. The choice of the appropriate suture method depends on the indication atony, bleeding from the placental bed, diffuse bleeding In addition to simple ligature of the uterine artery 86 stepwise uterine devascularisation can also be used for haemostasis. Catheter embolisation may be used as a last resort to treat persistent diffuse bleeding in the lesser pelvis after postpartum hysterectomy Understanding and recognising the most probable pathophysiology of the bleeding is important, as this will offer pointers for different therapeutic approaches.

The problem associated with haemostatic management is the difficulty in differentiating between increased bleeding caused by a major injury and protracted bleeding where the composition of blood has changed i. It is therefore necessary to distinguish between:. Based on the current state of knowledge, f ibrinogen plays a key role.

The mean time until the results of standard laboratory parameters are available in the operating room is at least 45 minutes Currently, two procedures are used for point-of-care POC diagnostics offering prompt, bedside recognition of clotting disorders based on VET: At present there are no class 1 recommendations on the use of these procedures Peripartal haemorrhage, diagnosis and therapy. Die Methodik zur Erstellung dieser Leitlinie wird durch die Vergabe der Stufenklassifikation vorgegeben.

Im Jahr wurde die Stufe S2 in die systematische evidenzrecherchebasierte S2e oder strukturelle konsensbasierte Unterstufe S2k gegliedert. Die Evidenzgraduierung und Empfehlungsgraduierung einer Leitlinie auf S2k-Niveau ist nicht vorgesehen. Es werden die einzelnen Statements und Empfehlungen nur sprachlich — nicht symbolisch — unterschieden Tab. Lebensbedrohliche postpartale Blutungen betreffen in der westlichen Welt ca. Derzeit kann keine Aussage in Bezug auf die optimale Wirksamkeit einer Nahtmethode getroffen werden. Es sollten jedoch je nach Indikation Atonie, Blutung aus dem Plazentabett, diffuse Blutung eine geeignete Nahttechnik zum Einsatz kommen Neben der einfachen Ligatur der A.

Die Katheterembolisation kann evtl. Stock, AT Innsbruck stephanie. National Center for Biotechnology Information , U. Published online Apr Gallen, Switzerland Find articles by Wolfgang Korte. Author information Article notes Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

Methods This S2k guideline was developed from the structured consensus of representative members of the various professional associations and professions commissioned by the Guideline Commission of the DGGG. Recommendations The guideline encompasses recommendations on definitions, risk stratification, prevention and management. Citation format Peripartum haemorrhage, diagnosis and therapy. Guideline documents The complete long version in German , a PDF slideshow for PowerPoint presentations and a summary of the conflicts of interest of all the authors is available on the AWMF homepage under: Open in a separate window.

Targeted areas of patient care Outpatient care. This guideline is classified as: Grading of recommendations The grading of evidence and the grading of recommendations was not envisaged for S2k class guidelines. Statements Expert statements included in this guideline which are not recommendations for action but simple statements of fact are referred to as statements. If necessary, patients with low-lying placenta should undergo an additional ultrasound scan to screen for vasa praevia and the findings should be documented Adequate venous access for every woman in labour, adequate intravenous access in case of complications of bleeding.

Uterotonics must be available oxytocin, e. Obstetrician and anaesthesiologist must be on site, experienced obstetrician and experienced anaesthesiologist on call. Check availability of blood products: Initial volume substitution to maintain normovolaemia: Order packed red blood cells and fresh frozen plasma, provide blood products if required delivery room, operating theatre.

Timely surgical intervention when conservative measures fail see below for appropriate procedures. After vaginal delivery uterotonics, tranexamic acid if required. Approach for antenatal diagnosis If an advanced implantation disorder placenta increta, percreta is diagnosed in the antenatal period, delivery must always be by Caesarean section. Caesarean section with hysterectomy; alternatively, consider expectant management e. Approach for intrapartum diagnosis Vaginal delivery:.

If the placenta fails to separate and bleeding is present: If severe bleeding from the placental bed persists: Perform Caesarean section with hysterectomy or alternatively consider expectant management e. The goal is the reposition of the uterus and treatment of the symptoms of haemorrhagic shock. The following procedures must be carried out immediately after making the diagnosis in the order stated below: Stop administration of any uterotonic drug. If attempts at repositioning are unsuccessful, administer uterine relaxants e.

In this situation the side effects and contraindications must be carefully considered benefits and drawbacks weighed up. Close haemodynamic monitoring is necessary when prostaglandin derivatives are administered. Because of its delayed onset of action and the availability of better and approved alternatives, misoprostol is not suitable to treat persistent PPH. The use of misoprostol to treat moderately persistent PPH after the administration of oxytocin may be considered off-label use! However, the current data is still insufficient to make a final recommendation.

In this context the side effects and contraindications must be carefully considered benefits and drawbacks weighed up. Close haemodynamic monitoring is essential when misoprostol is administered. Use a liquid 0. Early surgical haemostasis carried out by the attending surgical obstetrician using a Pfannenstiel incision or median laparotomy, eventeration of the uterus with cranial traction and uterine compression, and atraumatic clamping of the uterine arteries to minimise perfusion.

Placement of uterine compression sutures and application of a uterine tamponade. Parallel correction of hypovolaemia, temperature, disturbed acid-base balance and coagulopathy by the anaesthesiologist; if possible, surgery should then be paused until stabilisation. Definitive surgical treatment of the now haemodynamically stable patient by a surgeon with the appropriate surgical expertise. The decision that hysterectomy is indicated must not be delayed or left too late. Total hysterectomy should be considered for placental implantation disorders of the lower uterine segment; visualisation of the ureters during this procedure is recommended.

Relative contraindications for uterus-preserving measures are: If it is clear that the haemorrhage cannot be controlled by hysterectomy or is continuing even though hysterectomy has been carried out, the lesser pelvis and abdomen should be packed with sufficient moistened abdominal cloths. The precondition for transfer is that the patient is haemodynamically stable and does not have massive bleeding. Because of the range of side effects, medical and surgical treatment options should be largely exhausted.

The time of transfer to the radiology department is also determined by how important it is to preserve the uterus. It is therefore necessary to distinguish between: The aim must be to identify haemorrhaging patients early on and describe the appropriate interdisciplinary surgical, interventional and haemostatic treatment to manage the bleeding. This algorithm should define the approach for the treatment process based on the clinical situation and take account of all available treatment options pharmacological therapies, interventional procedures, surgical interventions.

In the ESA issued a strong recommendation based on moderate evidence for the administration of tranexamic acid to treat obstetric bleeding to reduce blood loss, bleeding duration and the number of transfusions Because of the reduced antithrombin activity absolute activity may even be less than 0. After the administration of individual coagulation factor concentrates or complex preparations e.

PCC , antithrombin activity can be determined on the intensive care unit and substituted if necessary For patients receiving regional anaesthesia spinal anaesthesia, epidural anaesthesia: If there is a loss of protective reflexes, endotracheal intubation to secure the airway and ensure sufficient oxygenation must take priority. In the emergency setting of PPH the following caveats must be taken into consideration: Cell-saver blood does not contain clotting factors or platelets. Coagulation factors should be substituted to prevent coagulopathy when administering high transfusion volumes Cases of hypotension have been reported following the re-transfusion of cell-saver blood with a leukocyte depletion filter Pharmacological thromboprophylaxis within 24 hours after the pathology causing the bleeding has been treated Stabilise general conditions prophylaxis and therapy!

Substitution of oxygen carriers RBC administration Haemostatic target in patients with severe bleeding: Platelet substitution for primary haemostasis Platelet concentrate target for haemorrhage requiring transfusion: If necessary, thrombin burst with platelet and coagulation activation consider general haemostatic conditions!

Thrombosis prophylaxis is mandatory within 24 hours after cessation of the pathology causing the bleeding! It is important that the facility transferring the patient and the facility accepting the patient agree about timing and staff coverage during transportation of the patient in the run-up to the patient transfer and record what the two facilities have agreed upon in writing It is recommended to use the special forms developed for the respective organisational unit for documentation.

Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France. Int J Obstet Anesth. Trends in postpartum hemorrhage in high resource countries: The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Trends in postpartum hemorrhage: Am J Obstet Gynecol. Incidence, risk factors, and temporal trends in severe postpartum hemorrhage. Investigation of an increase in postpartum haemorrhage in Canada. Factors relating to a rising incidence of major postpartum haemorrhage BJOG author reply — [ PubMed ].

Risk factors for postpartum hemorrhage: J Obstet Gynaecol Can. Trends and morbidity associated with oxytocin use in labour in nulliparas at term. Gestational age-specific severe maternal morbidity associated with labor induction. Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: Mousa H A, Walkinshaw S. Curr Opin Obstet Gynecol. Incidence and predictors of severe obstetric morbidity: Global burden of maternal death and disability. The World Health Report Scand J Public Health. American College of Obstetricians and Gynecologists.

WHO analysis of causes of maternal death: Trends in adverse maternal outcomes during childbirth: Lancet Maternal Survival Series steering group. Ronsmans C, Graham W J. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. Haeri S, Dildy G A. Frequency of and factors associated with severe maternal morbidity. Prevention and management of postpartum haemorrhage Ten years of confidential inquiries into maternal deaths in France, — Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery.

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. Rath W, Schneider M. Treatments for secondary postpartum haemorrhage. Cochrane Database Syst Rev. Successful reduction of massive postpartum haemorrhage by use of guidelines and staff education. Upadhyay K, Scholefield H. Risk management and medicolegal issues related to postpartum haemorrhage.

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Postpartum hemorrhage resulting from uterine atony after vaginal delivery: National partnership for maternal safety: Prevalence and risk factors of severe obstetric haemorrhage. Risk factors for postpartum hemorrhage in vaginal deliveries in a Latin-American population. Evaluation and management of postpartum hemorrhage: Antenatal diagnosis of placenta accreta: The antenatal diagnosis of placenta accreta BJOG — Prenatal sonography can predict degree of placental invasion.

Kluckow M, Hooper S B.

Using physiology to guide time to cord clamping. Semin Fetal Neonatal Med. Rath W, Bohlmann M K. Management of severe perioperative bleeding: Severe postpartum hemorrhage from uterine atony: The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: Puerperal uterine inversion in the Netherlands: Acta Obstet Gynecol Scand. High-dose versus low-dose oxytocin for augmentation of delayed labour.

Oral misoprostol for third stage of labor: Misoprostol to treat postpartum haemorrhage: Misoprostol in preventing postpartum hemorrhage: Int J Gynaecol Obstet. Treatment for primary postpartum haemorrhage. Management der postpartalen Blutung. Use of Bakri balloon tamponade in the treatment of postpartum hemorrhage: Use of second-line therapies for management of massive primary postpartum hemorrhage.

Incidence, indications, and predictors of adverse outcomes of postpartum hysterectomies: Intrauterine balloon tamponade in the management of postpartum hemorrhage. Intrauterine balloon tamponade as management of postpartum haemorrhage and prevention of haemorrhage related to low-lying placenta.

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