Annotating PDFs for eReturn version 1.0; August 28, 2007; full release
1. Introduction
eProof files are self-contained PDF documents for viewing on-screen and for printing. They contain all appropriate formatting and fonts to ensure correct rendering on-screen and when printing hardcopy. DJS sends eProofs that can be viewed, annotated, and printed using the free version of Acrobat Reader 7 (or greater). These eProofs are “enabled” with commenting rights, therefore they can be modified by using special markup tools in Acrobat Reader that are not normally available unless using the Standard or Professional version. The screen images in this document were captured on a PC running Adobe Acrobat Reader version 8.1.0. Though some of the images may differ in appearance from your platform/version, basic functionality remains similar. At the time of this writing, Acrobat Reader v8.1.0 is freely available and can be downloaded from: http://www.adobe.com/products/acrobat/readstep2.html
2. Comment & Markup toolbar functionality
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A. Sticky Note tool; B. Text Edits tool; C. Stamp tool; D. Highlight Text tool; E. Callout tool; F. Text Box tool; G. Various Object tools; H. Pencil tool
A. Show the Comment & Markup toolbar
To add or remove tools for this toolbar, right-click the toolbar and select the tool. Or, select Tools > Customize Toolbars.
The Comment & Markup toolbar doesn’t appear by default. Do one of the following:
• Select View > Toolbars > Comment & Markup. • Select Tools > Comment & Markup > Show Comment & Markup Toolbar. • Click the Review & Comment button in the Task toolbar, and choose Show Comment & Markup Toolbar.
B. Select a commenting or markup tool Do one of the following:
• Select a tool from the Comment & Markup toolbar. • Select Tools > Comment & Markup > [tool].
Note: After an initial comment is made, the tool changes back to the Select tool so that the comment can be moved, resized, or edited. (The Pencil, Highlight Text, and Line tools stay selected.)
C. Keep a commenting tool selected
Multiple comments can be added without reselecting the tool. Select the tool to use (but don’t use it yet).
• Select View > Toolbars > Properties Bar. • Select Keep Tool Selected.
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Choose Tools > Customize Toolbars to remove unnecessary items from the toolbar (see Section 7 for suggested toolbar layout)
3. The Properties bar
The Properties bar can be used to format text and select options for individual tools. To view the Properties bar, do one of the following:
• Choose View > Toolbars > Properties Bar. • Right-click the toolbar area; choose Properties Bar. • Select [Ctrl-E]
4. Using the comment and markup tools
To insert, delete, or replace text, use the Text Edits tool. Select the Text Edits tool, then select the text with the cursor (or simply position it) and begin typing. A pop-up note will appear based upon the modification (e.g., inserted text, replacement text, etc.). Use the Properties bar to format text in pop-up notes. A pop-up note can be minimized by selecting the button inside it.
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A. Attached file; B. Highlighted text; C. Crossed-out (strike-through) text; D. Inserted text; E. Replaced text 2
5. Inserting symbols or special characters
An ‘insert symbol’ feature is not available for annotations, and copying/pasting symbols or non-keyboard characters from Microsoft Word does not always work. Use angle brackets < > to indicate these special characters (e.g., , ).
6. Editing near watermarks and hyperlinked text
eProof documents often contain watermarks and/or hyperlinked text. Selecting characters near these items can be difficult using the mouse alone. To edit an eProof which contains text in these areas, do the following:
• Without selecting the watermark or hyperlink, place the cursor near the area for editing. • Use the arrow keys to move the cursor beside the text to be edited. • Hold down the shift key while simultaneously using arrow keys to select the block of text, if necessary. • Insert, replace, or delete text, as needed.
7. Summary of main functions Insert text - Use Text Edits tool (position cursor and begin typing) Replace text - Use Text Edits tool (select text and begin typing) Delete text - Use Text Edits tool (select text and press delete key) Highlight text - Use Highlight Text tool (select text) Attach a file - Use the Attach a File with Comment tool (select tool, position cursor and click mouse, select file)
Suggested toolbar layout
8. Reviewing changes
To review all changes, do the following: • Select the Show button on the Comment & Markup toolbar. • Select Show Comments List. Note: Selecting a correction in the list will highlight the corresponding item in the document, and vice versa.
Use the Comments list to review all changes
9. The eReturn process A. An email is received that contains a link to the eProof of the article: http://eproofing.dartmouthjournals.com/pdfproofing/journal1234.pdf B. Click on the link to open the proof with the internet browser. Select “Save As” from the browser’s ‘File’ menu to save a copy of the PDF to the desktop or other folder.
C. Close the browser and open the saved PDF file with Acrobat.
D. Make corrections using Acrobat’s Comment & Markup tools.
E. Save the PDF file, now with annotations, and return according to the instructions provided by the journal manager. 3
FEATURE Third Stage of Labour Care for Women at Low Risk of Postpartum Haemorrhage Kathleen M. Fahy, RN, PhD
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BACKGROUND
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A policy of active management of the third stage of labour has been almost universally adopted for all birthing women in the United Kingdom, Australia, and New Zealand,1–3 and active management is becoming more common in both the United States and Canada.4 The 2003 Cochrane meta-analysis of 4 randomized trials that compared active versus expectant management of third-stage labour has been cited as the ‘‘gold standard’’ on which to base third-stage labour management.1,3,5–8 The major finding of the Cochrane meta-analysis was that active management of the third stage of labour significantly reduces postpartum haemorrhage (PPH) to a rate of 5.2% for actively managed groups compared to 13.5% in the groups assigned to expectant management (relative risk, 0.38; 95% confidence interval, 0.32–0.46).1 It is not clear, however, that this meta-analysis—and the randomised trials on which it is based—should mandate active management of the third stage of labour for women who are at low risk of PPH. This article critiques the Cochrane meta-analysis of active versus physiologic management of third stage care and the randomised controlled trials upon which it is based.
in the developing world because, compared with Western women, women in the developing world are at much greater risk of haemodynamic compromise from relatively small amounts of blood loss. Women in developing countries also have much greater difficulties in gaining timely access to appropriate services if needed.10 Women who live in developing countries are not included in this review because they deserve separate investigation.11 The focus of this article is on healthy women in developed nations who are at low risk for PPH at the end of the second stage of labour.
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INTRODUCTION
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The standard definition of PPH from the World Health Organization is a blood loss of 500 mL following vaginal birth. This 500-mL figure is unrealistically low because the mean blood loss at birth, if carefully measured, is approximately 500 mL.9 At that amount of blood loss, most women in the developed world do not develop clinical symptoms of excessive bleeding. Indeed, healthy women can withstand up to 1000 mL of blood loss before showing early signs of shock, such as tachycardia.3 The 500-mL figure may have been decided upon by the World Health Organization in an attempt to protect women
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ARTICLE IN PRESS
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Address correspondence to Kathleen M. Fahy, RM, RN, PhD, FACM, University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia. E-mail:
[email protected]
Defining Risk of Postpartum Haemorrhage
The accepted obstetric risk factors for PPH are presented in Table 1.3,12–14 A definition of what constitutes low risk for PPH, from a midwifery perspective, adds protective psychological, emotional, and environmental factors to the obstetric understanding of risk (Table 2). These additional factors have been elucidated based the theory that optimal oxytocin release and action during labour occurs when the woman feels safe and loved15–22 and on an understanding of birth physiology and factors that either promote or interfere with optimal physiology. Definitions of Active Management of Third-Stage Labour The randomised trials that were used in the Cochrane analysis were conducted in the 1980s and 90s and used varying definitions of active management that included different component steps. The definition of active management of the third stage of labour that was used in the Cochrane meta-analysis1 is presented in Table 3 along with the 2006 International Confederation of Midwives (ICM) and the International Federation of Gynaecology and Obstetrics (FIGO) joint statement on active management of the third stage of labour.2 There are 3 main differences between the ICM/FIGO joint statement about active management of the third stage of labour and the Cochrane definition. First, the ICM/ FIGO joint statement recommends the ‘‘administration of oxytocin, or another uterotonic drug, within 1 minute
Journal of Midwifery & Women’s Health www.jmwh.org Ó 2009 by the American College of Nurse-Midwives Issued by Elsevier Inc.
1 1526-9523/09/$36.00 doi:10.1016/j.jmwh.2008.12.016
FLA 5.0 DTD jmwh1496 14 January 2009 12:41 am ce 59
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Table 1. Obstetric Risk Factors for Postpartum Haemorrhage
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History of primary postpartum hemorrhage Abnormal uterine anatomy (e.g., fibroids, uterine septum, and previous uterine surgery, including caesarean section) Overdistended uterus (caused, for example, by multiple gestation, a large baby, or polyhydramnios) Parity of $6 or greater Abnormalities of the placenta (e.g., low lying placenta, placenta previa) Antepartum haemorrhage Hemoglobin of
