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Background: The postpartum hemorrhage (PPH) is the leading cause of maternal mortality in the world. Human factors and especially situation awareness has primarily responsibility to explain suboptimal cares. Based on eye tracking and behavior analysis in high fidelity simulation of PPH management, the goal of this study is to identify perceptual and cognitive key parameters of the expertise. Methods: Two groups of fifteen anesthetists (residents and experienced anesthetists) watched the beginning of a severe simulated PPH management. During this first experimental phase, situation awareness was assessed using SAGAT (Situation Awareness Global Assessment Technique) questionnaire and visual behavior was analyzed with eye tracking. In the continuity of the video sequence, they have to step in the PPH situation and to provide care to the simulated patient. Performance of cares was evaluated and self-assessed as well as cognitive load. Results: No statistical difference between the residents and experienced anesthetists was observed on performance of simulated PPH management. The mean expected practice score was 76.9 ± 13.9%). Assessment of situation awareness (65 ± 7%), cognitive load (74.4 ± 11.3%) and theoretical knowledge of PPH (52.4 ± 3.5%) were also not statistically different between the two groups. Only results of self-assessed performance (respectively 66.1 ± 16.6 and 47.0 ± 20.8 for experts and residents) and eye-tracking data revealed that experts tended to get accurate evaluation of their performance and to monitor more the blood loss of the patient. Experts have in average 8.28% more fixating points than Novices and gazed the blood loss region longer (865 ms ± 439 vs. 717 ms ± 362). Conclusions: This study pointed out the limits of classical assessment of performance, and human factors based on questionnaires to identify expertise in simulated PPH care. A neuroscientific approach with new technology like eye tracking could provide new objective and more sensitive insights on human factors in simulated medical emergency situations. [ABSTRACT FROM AUTHOR]

Background: Pregnant women have been identified as a group at risk, both for respiratory complications than for the admissions to the Intensive Care Unit (ICU) during the 2009 H1N1 influenza pandemic (pdm). The purpose of this prospective register-based cohort-study was to characterize the clinical virulence of the pdm (H1N1/09)v during pregnancy in La Réunion. Methods/Principal Findings: Over a twelve-week pdm wave (13 July to 3 October 2009), 294 pregnant women presented with an influenza-like illness (ILI) to one of the three maternity departments of the South Reunion area, Indian Ocean. Out of these, 278 were checked by RT-PCR for influenza viruses (157 positive and 121 negative, of whom, 141 with pdm flu and 132 with ILIs of non pdm origin, 5 untyped). The median body temperature was higher in women experiencing pdm flu than in those with non pdm ILI (38.9°C versus 38.3°C, P<0.0001), without evidence linked to circulating viremia. Oseltamivir was given for 86% of pdm flu cases in a median time inferior than 48 hrs (range 0-7 days). The hospitalization rate for pdm flu was of 60% and not associated with underlying conditions. Six viral pneumonia and fourteen asthma attacks were observed among 84 hospitalized pdm flu cases, of whom, only one led to the ICU for an acute lung injury. No maternal death occurred during the pdm wave. None adverse pregnancy outcome was associated with pdm flu. No congenital birth defect, nor early-onset neonatal influenza infection was attributable to pdm flu exposure. Conclusions/Significance: This report mitigates substantially the presumed severity of pandemic H1N1/09 influenza infection during pregnancy. The reasons for which the clinical burden of H1N1/09 influenza virus may differ worldwide raise questions about a differential local viral-strain effect and public health preparedness, notably in timely access to special care and antiviral treatments. [ABSTRACT FROM AUTHOR]