Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study w...Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study was aimed at identifying possible risk factors and also to compare the relative prevention efficacies of oxytocin or misoprostol within the matrix of these factors. Method: A total of 1800 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as a prophylaxis of postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after, during which blood lost was estimated to the nearest millilitres. Demographic characteristics were recorded in a structured proforma. The relationship of the occurrence of PPH (occurrence of blood loss > 500 ml) and mean blood loss (MBL) was studied with respect to the prophylactic medication used and some demographic factors. Results: The incidence of PPH was higher in Igbo, and some “minority” tribes of Borno state (Babur, Bura, Mafa). The tribes that constituted the majority of the study population (Kanuri, and Hausa) exhibited low incidences of PPH. Significant relationships were demonstrated between PPH and educational levels and occupations of participants. Conclussions: It was concluded that PPH occurrence is related to tribal affiliation, educational level and occupation, and the relative efficacies of oxytocin and misoprostol varies between the tribal groups.展开更多
Objective: To evaluate the efficacy of tranexamic acid for prevention of postpartum haemorrhage among women undergoing cesarean section who were at high risk of postpartum hemorrhage. Materials and Method: This was a ...Objective: To evaluate the efficacy of tranexamic acid for prevention of postpartum haemorrhage among women undergoing cesarean section who were at high risk of postpartum hemorrhage. Materials and Method: This was a double blind randomized controlled trial conducted at the Alex Ekwueme Federal University Teaching Hospital Abakaliki from January 2016 to December 2017. One hundred and sixty-eight parturients at high risk of postpartum haemorrhage who underwent caesarean section were randomly assigned to receive either tranexamic acid or placebo prior to skin incision. Results: The result of the study showed that the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively). The incidence of primary post-partum hemorrhage (blood loss > 1000 ml) was significantly lower in the tranexamic acid group compared to placebo group (11.9% versus 50%, respectively, P-value Conclusion: Intravenous tranexamic acid given prior to skin incision at caesarean section reduced the need for additional uterotonics and incidence of primary postpartum among high risk women.展开更多
Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on th...Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.展开更多
Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage const...Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage constitutes 25% of all maternal deaths worldwide. In situations where medical line of management fails to control postpartum haemorrhage, anterior division of internal iliac artery ligation can play an important role as a lifesaving and fertility preserving surgical procedure. Keeping this in mind, our study aimed to analyze indications and efficacy of anterior division of Internal Iliac artery ligation in the form of uterine salvage and saving maternal life. Study design: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad during the period of July 2014-January 2016. A total of 57 cases that had undergone ligation of anterior division of internal iliac artery were included in the study and different indications and efficacy were studied. Results: Atonic PPH (52.63%) leads the list of indications for ligation anterior division of internal iliac artery ligation followed by traumatic (19.29%), adherent placenta (12.2%), mixed variety (10.52%) and coagulopathy (5.26). Maximum efficacy in terms of preserving fertility and saving maternal life was 73.33% and 93.3% respectively in atonic PPH. Overall efficacy of this procedure in terms of uterine salvage was 54.38% and in terms of saving maternal life was 87.71%. Conclusion: Anterior division of IIAL was effective method in controlling refractory PPH, reducing morbidity and preserving uterus and future fertility. It is safe life saving procedure at experienced hands.展开更多
The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour....The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour. A total of 1865 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as prophylaxis for postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after during which oral interviews were conducted and clinical notes studied. The oxytocin medication group exhibited higher abdominal pains (7.1% versus 0.0%;p 0.05) difference in patients acceptability of injectable oxytocin (99.3%) and oral misoprostol (98.3%). Oxytocin usage in the prevention of PPH was associated with abdominal pains and headache while misoprostol was associated with shivering and fever. Patients from this study have demonstrated high level of acceptability of both parenteral oxytocin and oral misopristol prevention of post-partum haemorrhage.展开更多
Introduction: Severe postpartum hemorrhage (PPH) is the main cause of death in Tunisia. Its management is multidisciplinary and requires perfect knowledge of a regularly updated protocol and consistent with available ...Introduction: Severe postpartum hemorrhage (PPH) is the main cause of death in Tunisia. Its management is multidisciplinary and requires perfect knowledge of a regularly updated protocol and consistent with available resources. We propose an evaluation of the impact of different therapeutic attitudes, in particular the combination of tranexamic acid and fibrinogen concentrates in the management of this hemorrhage. Material and Methods: This was a retrospective, descriptive and analytical study, conducted in the departments of Gynecology-Obstetrics and Surgical Resuscitation anesthesia of the Farhat Hached University Hospital, Sousse, Tunisia. The study was conducted over six years (2009-2014), and included all parturients who were treated for severe PPH that occurred on a term greater than 24 weeks of amenorrhea. Patients were divided into two groups according to the study period: 1) Group 1 (G1): from 1 January 2009 to 31 December 2011, 2) Group 2 (G2): from January 1, 2012 to December 31, 2014, a group that benefited particularly from the combination of tranexamic acid and fibrinogen concentrates for the management of their PPH. Results: 166 patients were included: 57 in G1 and 109 in G2. The overall incidence of severe PPH was 3.15/1000 deliveries. We noted a significant decrease in the fall of hemoglobin in per and post haemorrhagic manifestations in favor of G2 with a p value of 0.003 and p = 0.025, respectively. The use of blood transfusion decreased significantly, in frequency and in number of packed red cells per patient, between the two groups;transfusion ratio was 1/1.7/1.5 for G1, and 1/2/1.8 for G2. Fluid therapy, use of macromolecules and catecholamines were less important in G2. The use of tranexamic acid, fibrinogen and the association of both increased significantly between the two groups (p 10-4). Haemostasis hysterectomies were less performed (p 10-3) in G2. Conclusion: The management of PPH has evolved over the years. The use of tranexamic acid in association with fibrinogen concentrates had proved his interest.展开更多
<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpart...<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.展开更多
Introduction: Immediate postpartum hemorrhages constitute a frequent maternal complication and remain at the forefront of maternal death in our countries. Objective: Contribute to improving the management of immediate...Introduction: Immediate postpartum hemorrhages constitute a frequent maternal complication and remain at the forefront of maternal death in our countries. Objective: Contribute to improving the management of immediate postpartum hemorrhage in our context with a view to reducing maternal mortality. Patients and Methods: We conducted a retrospective descriptive and analytical study over a period of 12 months from January 1<sup>st</sup> to December 31<sup>st</sup> 2020. Results: We collected a total of 109 files on a total of 4360 deliveries. The frequency of postpartum haemorrhages was of the order of 2.5%. The most represented age group was between 20 and 24 years old. Pauciparas represented the majority of our study population. 64.5% of patients were uneducated. These hemorrhages occurred in patients who often gave birth outside the department with 63.8%. The main causes of postpartum hemorrhage were cervical tears (51.2%) and partial placental retention (30.7%). The majority of these deliveries (48.8%) were carried out by midwives followed by assistant midwives (33.2%). Active management of the third period of delivery was systematic and immediate followed by the valve examination completed by the infusion of oxytocin in case of uterine atony, tranexamic acid ans misoprostol intrarectally. In the event of persistent hemorrhage, suture of the cervical lesions, ligation of the cervical vessels or even laparotomy either for the selective ligation of the blood vessels or for the hysterectomy for hemostasis were practiced. We do not have a Nalador, nor a Bakry balloon, nor an Interventional Radiology service for embolization of the uterine arteries. We deplore 1.3% of deaths from afibrinogenemia. Conclusion: The frequency of immediate postpartum hemorrhages is lower in our health facility. This is due to the rapid handling of cases. Improving the quality of services offered to women during childbirth can further help reduce the frequency of these hemorrhages.展开更多
目的系统评价Hayman与B-Lynch缝合术治疗产后出血的效果。方法通过计算机检索PubMed、Embase、WebofScience、知网、万方数据库,检索时间为建库至2024年1月,搜集Hayman与B-Lynch缝合术治疗产后出血的随机对照试验和队列研究,采用Rev Man...目的系统评价Hayman与B-Lynch缝合术治疗产后出血的效果。方法通过计算机检索PubMed、Embase、WebofScience、知网、万方数据库,检索时间为建库至2024年1月,搜集Hayman与B-Lynch缝合术治疗产后出血的随机对照试验和队列研究,采用Rev Man 5.3软件进行meta分析。结果经筛选最终纳入7篇文献,共525例患者。meta分析结果显示,试验组剖宫产手术时间较对照组短[MD=-15.99,95%CI(-19.99,-12.00),P<0.00001],剖宫产术中出血量较对照组少[MD=-252.13,95%CI(-325.39,-178.88),P<0.00001],剖宫产分娩后24 h内阴道出血量较对照组少[MD=-196.93,95%CI(-285.90,-107.95),P<0.0001],剖宫产术后并发症发生率较对照组低[OR=0.20,95%CI(0.10,0.40),P<0.00001]。结论Hayman缝合术治疗产后出血的效果优于B-Lynch缝合术。展开更多
<strong>Objective:</strong> <span style="font-family:""><span style="font-family:Verdana;">We introduced two novel hemostatic techniques to achieve hemostasis for postp...<strong>Objective:</strong> <span style="font-family:""><span style="font-family:Verdana;">We introduced two novel hemostatic techniques to achieve hemostasis for postpartum hemorrhage (PPH). The first one (A: Uterus Isthmic Plication) was a new uterine compression suture, which compresses the hysterotomy site. In a severe case, we further added vessel ligation suture after </span><span style="font-family:Verdana;">performing A-suture (B-combination suture: B-suture: A + Wide Lateral Uterine </span><span style="font-family:Verdana;">Vascular Ligation). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Of 140 PPH cases, 90 were with mild PPH and 40 were with severe PPH. Our policy was: perform A-suture to mild PPH and perform B (combination) to severe PPH. Study was performed during 2018-2019. The primary endpoint to evaluate the efficacy of the</span><span><span style="font-family:Verdana;"> procedures was preserving the uterus (no hysterectomy). </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A-procedure,</span></span><span style="font-family:Verdana;"> performed to 90 patients with mild PPH, was effective to all 90 patients, with all preserving the uterus. B-procedure, performed 38 patients with severe PPH (excluding two patients with uterine rupture), was effective in 37 patients, with one having undergone hysterectomy due to coagulopathy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Uterus Isthmic Plication (A-procedure) and addition of Wide Lateral Uterine Vascular Ligation to procedure-A (B-procedure) achieved hemostasis in patients with PPH. Prospective study is necessary to confirm the present data.</span></span>展开更多
Objective: To determine the incidence of primary postpartum haemorrhage, identify risk/aetiological factors contributing to primary postpartum haemorrhage and review the different therapeutic approaches in the managem...Objective: To determine the incidence of primary postpartum haemorrhage, identify risk/aetiological factors contributing to primary postpartum haemorrhage and review the different therapeutic approaches in the management of primary postpartum haemorrhage. Method: A retrospective case-control study of all patients with primary postpartum haemorrhage from January 1, 2001 to December 31, 2010 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Result: In the period under review, 272 cases of primary postpartum haemorrhage were documented while there were a total of 5929 deliveries, giving an incidence of 1 in 26 (25.6%). The average blood loss in the cases reviewed was 1550 mls whilst in the controls, the average blood loss was 200 mls. There was statistical significant difference between the grandmultiparous cases and grandmultiparous controls (58.4% versus 16.5%, OR = 6.74, p < 0.05), suggesting that grandmultiparity may be an implicated factor in primary postpartum haemorrhage. In the unbooked cases, retained placenta was the major cause of primary postpartum haemorrhage constituting 109 (51.7%), whereas in booked cases, uterine atony contributed 70.5% to primary postpartum haemorrhage. Four maternal deaths were recorded giving a case fatality rate of 1.5%;all were unbooked. Conclusion: Postpartum haemorrhage ranks high in the list of causes of maternal death and the case fatality rate can be very high. Prevention is the key to reducing the incidence of PPH and its sequale, with preventive measures based upon the identification of risk factors, surveillance of women at risk and seemingly not at risk and avoidance of procedure during delivery which could potentially result in complications.展开更多
The incidence of Postpartum Hemorrhage (PPH) is increasing in the western world. We hypothesize that magnesium sulfate (MgSO4) could be a contributing factor. MgSO4 might increase the incidence of PPH by induction of ...The incidence of Postpartum Hemorrhage (PPH) is increasing in the western world. We hypothesize that magnesium sulfate (MgSO4) could be a contributing factor. MgSO4 might increase the incidence of PPH by induction of vasodilation, tocolytic effects, and effects on the blood like red cell deformity, platelet activity inhibition and a prolonged bleeding time. Based on these effects of MgSO4 a correlation with PPH is suspected. MgSO4 is widely used in the prevention of eclampsia. However, the working mechanism of this effective drug is largely unknown. We performed a systematic search to find all Randomized Controlled trials (RCTs) containing MgSO4 in preeclamsia as well as all MgSO4 studies with information on PPH. Titles, abstracts and references of publications were evaluated for appropriateness and whether they met the inclusion criteria. RCTs about MgSO4 with original data on PPH prevalence were included in our systematic review. We calculated the relative risk of PPH in every study as well as an overall relative risk. Four relevant and valid RCTs were found, totalling 11,621 relevant patients. The relative risk of PPH in women treated with MgSO4 is 0.964 (95% CI 0.886 - 1.050) In this systematic review we found no significant increase in PPH in women treated with MgSO4. However, there is still room for discussion due to the heterogeneity in methods (dosage and duration of treatment), results, and tertiary outcomes, as well as the small number of studies found with respect to this important issue.展开更多
<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage ...<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and </span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">value <</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.05.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">35 years aOR = 4.52;95% CI = 2.65</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.021);unemployment (aOR = 4.74;95% CI = 2.91</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">6.02;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.001);being multigravida (aOR = 9.21;95% CI = 6.43</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">12.48;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.035);history of abortion (aOR = 5.11;95% CI = 2.05</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.29;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.004);preterm delivery (aOR = 6.88;95% CI = 2.72</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">9.06;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.002);duration of labour</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">> 12 hours (aOR = 4.05;95% CI = 2.46</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003) and macrosomia (aOR = 3.27;95% CI = 1.03</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">68;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.041).</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH);Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.</span></span></span>展开更多
Background: Postpartum maternal morbidity is becoming a major public health concern worldwide due to impact of modern development in feto-maternal medicine and maternal care. Major acute and long term maternal morbidi...Background: Postpartum maternal morbidity is becoming a major public health concern worldwide due to impact of modern development in feto-maternal medicine and maternal care. Major acute and long term maternal morbidities which may occur during obstetric management affect the life and reproductive career of women. Objective: To assess the trends, risk factors and pattern of postpartum maternal morbidity in Ikot Ekpene a local community in southern Nigeria. Materials and Methods: This was a 4-year prospective cross sectional observational study carried out in the maternity section of General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria between 2008 and 2011. Parturients managed in the hospital for postpartum morbidity were recruited for the study. Relevant information was obtained from structured questionnaire administered to the patients and those extracted from other medical records in the course of managing the patients. This was analysed using the SPSS computer statistical package. Result: A total of 5760 women delivered during the period, of which 296 (5.1%) were treated for postpartum morbidity. Most of the patients (46.9%) were between 31 and 40 years old and 68.8% were of low educational background. Half of the deliveries with morbidity were conducted by unskilled attendants. The most common maternal morbidity encountered included primary postpartum haemorrhage (22.2%), genital sepsis (16.1%), and hypertensive disorders (12.8%). Anaemia (12.8%) and malaria (11.1%) were the commonest non obstetrics causes of morbidity. It was relatively more common with delivery attended by untrained personnel. There was significant reduction in morbidity in the last 2 years of this study. Conclusion: The incidence of postpartum morbidity in the Ikot Ekpene is still high with a downward trend over the years. Obstetric haemorrhage, hypertensive disorders, anaemia and genital tract sepsis were the common causes and were commoner with delivery attended by unskilled personnel. It is hoped that supervision of deliveries by skilled medical attendants, improvement in general health and educational level will reduce postpartum morbidity in this rural community.展开更多
Objectives: To determine the feasibility of measuring intra-uterine pressure prior to placental delivery, using a novel minimally invasive method. Design: A prospective exploratory physiological study. Methods: Thirty...Objectives: To determine the feasibility of measuring intra-uterine pressure prior to placental delivery, using a novel minimally invasive method. Design: A prospective exploratory physiological study. Methods: Thirty-six low risk women undergoing normal vaginal delivery were randomly allocated to four groups. Group A received 600 mcg rectal misoprostol;group B received 600 mcg oral misoprostol;group C received 10 international units oxytocin intramuscularly after delivery of the anterior shoulder;group D received intramuscular oxytocin, 30 minutes after delivery of the baby. A calibrated catheter-tip intrauterine pressure transducer was used to measure the intrauterine pressure. This was introduced into the placenta via the umbilical vein, and recorded on a standard tocograph. Results: It was technically easy to introduce the catheter through the umbilical vessels in all mothers. On assessment of the tocograms, it was possible to interpret 95 out of 108 recordings (88%). Conclusions: This study demonstrated the simplicity of a novel, minimally invasive method of measuring the duration and frequency of postpartum uterine contractions prior to delivery of the placenta.展开更多
文摘Aim: The following work studied how tribal affiliation, educational level and occupation of some women that had PPH in Maiduguri metropolis between September 2007 and March 2009 relate with PPH occurrence. The study was aimed at identifying possible risk factors and also to compare the relative prevention efficacies of oxytocin or misoprostol within the matrix of these factors. Method: A total of 1800 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as a prophylaxis of postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after, during which blood lost was estimated to the nearest millilitres. Demographic characteristics were recorded in a structured proforma. The relationship of the occurrence of PPH (occurrence of blood loss > 500 ml) and mean blood loss (MBL) was studied with respect to the prophylactic medication used and some demographic factors. Results: The incidence of PPH was higher in Igbo, and some “minority” tribes of Borno state (Babur, Bura, Mafa). The tribes that constituted the majority of the study population (Kanuri, and Hausa) exhibited low incidences of PPH. Significant relationships were demonstrated between PPH and educational levels and occupations of participants. Conclussions: It was concluded that PPH occurrence is related to tribal affiliation, educational level and occupation, and the relative efficacies of oxytocin and misoprostol varies between the tribal groups.
文摘Objective: To evaluate the efficacy of tranexamic acid for prevention of postpartum haemorrhage among women undergoing cesarean section who were at high risk of postpartum hemorrhage. Materials and Method: This was a double blind randomized controlled trial conducted at the Alex Ekwueme Federal University Teaching Hospital Abakaliki from January 2016 to December 2017. One hundred and sixty-eight parturients at high risk of postpartum haemorrhage who underwent caesarean section were randomly assigned to receive either tranexamic acid or placebo prior to skin incision. Results: The result of the study showed that the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively). The incidence of primary post-partum hemorrhage (blood loss > 1000 ml) was significantly lower in the tranexamic acid group compared to placebo group (11.9% versus 50%, respectively, P-value Conclusion: Intravenous tranexamic acid given prior to skin incision at caesarean section reduced the need for additional uterotonics and incidence of primary postpartum among high risk women.
文摘Objective: To assess a training approach in Emergency Obstetric and Neonatal Care (EmONC) to strengthen skills of healthcare providers and reduce maternal mortality. Materials and methods: The approach was based on the skills training using the so-called “humanist” method and “life saving skills”. Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner. Results: We trained 432 providers in 10 months. The increase in technical achievements of each participant was documented through a database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills particularly postpartum haemorrhage management and reduced missed learning opportunities. Conclusion: The impact of training on postpartum haemorrhage management and maternal mortality is a major challenge in terms of prospects.
文摘Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage constitutes 25% of all maternal deaths worldwide. In situations where medical line of management fails to control postpartum haemorrhage, anterior division of internal iliac artery ligation can play an important role as a lifesaving and fertility preserving surgical procedure. Keeping this in mind, our study aimed to analyze indications and efficacy of anterior division of Internal Iliac artery ligation in the form of uterine salvage and saving maternal life. Study design: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad during the period of July 2014-January 2016. A total of 57 cases that had undergone ligation of anterior division of internal iliac artery were included in the study and different indications and efficacy were studied. Results: Atonic PPH (52.63%) leads the list of indications for ligation anterior division of internal iliac artery ligation followed by traumatic (19.29%), adherent placenta (12.2%), mixed variety (10.52%) and coagulopathy (5.26). Maximum efficacy in terms of preserving fertility and saving maternal life was 73.33% and 93.3% respectively in atonic PPH. Overall efficacy of this procedure in terms of uterine salvage was 54.38% and in terms of saving maternal life was 87.71%. Conclusion: Anterior division of IIAL was effective method in controlling refractory PPH, reducing morbidity and preserving uterus and future fertility. It is safe life saving procedure at experienced hands.
文摘The following work compared adverse effects profile and patients’ acceptability of intra-venous oxytocin 10 iu and oral misoprostol 600 ug used in the prevention of postpartum hemorrhage in the third stage of labour. A total of 1865 pregnant women who have received either oxytocin injection or oral misoprostol in third stage of labour as prophylaxis for postpartum haemorrhage, were enrolled within three health care facilities in Maiduguri, Nigeria. Each patient was observed at parturition and for 24 h after during which oral interviews were conducted and clinical notes studied. The oxytocin medication group exhibited higher abdominal pains (7.1% versus 0.0%;p 0.05) difference in patients acceptability of injectable oxytocin (99.3%) and oral misoprostol (98.3%). Oxytocin usage in the prevention of PPH was associated with abdominal pains and headache while misoprostol was associated with shivering and fever. Patients from this study have demonstrated high level of acceptability of both parenteral oxytocin and oral misopristol prevention of post-partum haemorrhage.
文摘Introduction: Severe postpartum hemorrhage (PPH) is the main cause of death in Tunisia. Its management is multidisciplinary and requires perfect knowledge of a regularly updated protocol and consistent with available resources. We propose an evaluation of the impact of different therapeutic attitudes, in particular the combination of tranexamic acid and fibrinogen concentrates in the management of this hemorrhage. Material and Methods: This was a retrospective, descriptive and analytical study, conducted in the departments of Gynecology-Obstetrics and Surgical Resuscitation anesthesia of the Farhat Hached University Hospital, Sousse, Tunisia. The study was conducted over six years (2009-2014), and included all parturients who were treated for severe PPH that occurred on a term greater than 24 weeks of amenorrhea. Patients were divided into two groups according to the study period: 1) Group 1 (G1): from 1 January 2009 to 31 December 2011, 2) Group 2 (G2): from January 1, 2012 to December 31, 2014, a group that benefited particularly from the combination of tranexamic acid and fibrinogen concentrates for the management of their PPH. Results: 166 patients were included: 57 in G1 and 109 in G2. The overall incidence of severe PPH was 3.15/1000 deliveries. We noted a significant decrease in the fall of hemoglobin in per and post haemorrhagic manifestations in favor of G2 with a p value of 0.003 and p = 0.025, respectively. The use of blood transfusion decreased significantly, in frequency and in number of packed red cells per patient, between the two groups;transfusion ratio was 1/1.7/1.5 for G1, and 1/2/1.8 for G2. Fluid therapy, use of macromolecules and catecholamines were less important in G2. The use of tranexamic acid, fibrinogen and the association of both increased significantly between the two groups (p 10-4). Haemostasis hysterectomies were less performed (p 10-3) in G2. Conclusion: The management of PPH has evolved over the years. The use of tranexamic acid in association with fibrinogen concentrates had proved his interest.
文摘<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.
文摘Introduction: Immediate postpartum hemorrhages constitute a frequent maternal complication and remain at the forefront of maternal death in our countries. Objective: Contribute to improving the management of immediate postpartum hemorrhage in our context with a view to reducing maternal mortality. Patients and Methods: We conducted a retrospective descriptive and analytical study over a period of 12 months from January 1<sup>st</sup> to December 31<sup>st</sup> 2020. Results: We collected a total of 109 files on a total of 4360 deliveries. The frequency of postpartum haemorrhages was of the order of 2.5%. The most represented age group was between 20 and 24 years old. Pauciparas represented the majority of our study population. 64.5% of patients were uneducated. These hemorrhages occurred in patients who often gave birth outside the department with 63.8%. The main causes of postpartum hemorrhage were cervical tears (51.2%) and partial placental retention (30.7%). The majority of these deliveries (48.8%) were carried out by midwives followed by assistant midwives (33.2%). Active management of the third period of delivery was systematic and immediate followed by the valve examination completed by the infusion of oxytocin in case of uterine atony, tranexamic acid ans misoprostol intrarectally. In the event of persistent hemorrhage, suture of the cervical lesions, ligation of the cervical vessels or even laparotomy either for the selective ligation of the blood vessels or for the hysterectomy for hemostasis were practiced. We do not have a Nalador, nor a Bakry balloon, nor an Interventional Radiology service for embolization of the uterine arteries. We deplore 1.3% of deaths from afibrinogenemia. Conclusion: The frequency of immediate postpartum hemorrhages is lower in our health facility. This is due to the rapid handling of cases. Improving the quality of services offered to women during childbirth can further help reduce the frequency of these hemorrhages.
文摘目的系统评价Hayman与B-Lynch缝合术治疗产后出血的效果。方法通过计算机检索PubMed、Embase、WebofScience、知网、万方数据库,检索时间为建库至2024年1月,搜集Hayman与B-Lynch缝合术治疗产后出血的随机对照试验和队列研究,采用Rev Man 5.3软件进行meta分析。结果经筛选最终纳入7篇文献,共525例患者。meta分析结果显示,试验组剖宫产手术时间较对照组短[MD=-15.99,95%CI(-19.99,-12.00),P<0.00001],剖宫产术中出血量较对照组少[MD=-252.13,95%CI(-325.39,-178.88),P<0.00001],剖宫产分娩后24 h内阴道出血量较对照组少[MD=-196.93,95%CI(-285.90,-107.95),P<0.0001],剖宫产术后并发症发生率较对照组低[OR=0.20,95%CI(0.10,0.40),P<0.00001]。结论Hayman缝合术治疗产后出血的效果优于B-Lynch缝合术。
文摘<strong>Objective:</strong> <span style="font-family:""><span style="font-family:Verdana;">We introduced two novel hemostatic techniques to achieve hemostasis for postpartum hemorrhage (PPH). The first one (A: Uterus Isthmic Plication) was a new uterine compression suture, which compresses the hysterotomy site. In a severe case, we further added vessel ligation suture after </span><span style="font-family:Verdana;">performing A-suture (B-combination suture: B-suture: A + Wide Lateral Uterine </span><span style="font-family:Verdana;">Vascular Ligation). </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Of 140 PPH cases, 90 were with mild PPH and 40 were with severe PPH. Our policy was: perform A-suture to mild PPH and perform B (combination) to severe PPH. Study was performed during 2018-2019. The primary endpoint to evaluate the efficacy of the</span><span><span style="font-family:Verdana;"> procedures was preserving the uterus (no hysterectomy). </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> A-procedure,</span></span><span style="font-family:Verdana;"> performed to 90 patients with mild PPH, was effective to all 90 patients, with all preserving the uterus. B-procedure, performed 38 patients with severe PPH (excluding two patients with uterine rupture), was effective in 37 patients, with one having undergone hysterectomy due to coagulopathy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Uterus Isthmic Plication (A-procedure) and addition of Wide Lateral Uterine Vascular Ligation to procedure-A (B-procedure) achieved hemostasis in patients with PPH. Prospective study is necessary to confirm the present data.</span></span>
文摘Objective: To determine the incidence of primary postpartum haemorrhage, identify risk/aetiological factors contributing to primary postpartum haemorrhage and review the different therapeutic approaches in the management of primary postpartum haemorrhage. Method: A retrospective case-control study of all patients with primary postpartum haemorrhage from January 1, 2001 to December 31, 2010 at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Result: In the period under review, 272 cases of primary postpartum haemorrhage were documented while there were a total of 5929 deliveries, giving an incidence of 1 in 26 (25.6%). The average blood loss in the cases reviewed was 1550 mls whilst in the controls, the average blood loss was 200 mls. There was statistical significant difference between the grandmultiparous cases and grandmultiparous controls (58.4% versus 16.5%, OR = 6.74, p < 0.05), suggesting that grandmultiparity may be an implicated factor in primary postpartum haemorrhage. In the unbooked cases, retained placenta was the major cause of primary postpartum haemorrhage constituting 109 (51.7%), whereas in booked cases, uterine atony contributed 70.5% to primary postpartum haemorrhage. Four maternal deaths were recorded giving a case fatality rate of 1.5%;all were unbooked. Conclusion: Postpartum haemorrhage ranks high in the list of causes of maternal death and the case fatality rate can be very high. Prevention is the key to reducing the incidence of PPH and its sequale, with preventive measures based upon the identification of risk factors, surveillance of women at risk and seemingly not at risk and avoidance of procedure during delivery which could potentially result in complications.
文摘The incidence of Postpartum Hemorrhage (PPH) is increasing in the western world. We hypothesize that magnesium sulfate (MgSO4) could be a contributing factor. MgSO4 might increase the incidence of PPH by induction of vasodilation, tocolytic effects, and effects on the blood like red cell deformity, platelet activity inhibition and a prolonged bleeding time. Based on these effects of MgSO4 a correlation with PPH is suspected. MgSO4 is widely used in the prevention of eclampsia. However, the working mechanism of this effective drug is largely unknown. We performed a systematic search to find all Randomized Controlled trials (RCTs) containing MgSO4 in preeclamsia as well as all MgSO4 studies with information on PPH. Titles, abstracts and references of publications were evaluated for appropriateness and whether they met the inclusion criteria. RCTs about MgSO4 with original data on PPH prevalence were included in our systematic review. We calculated the relative risk of PPH in every study as well as an overall relative risk. Four relevant and valid RCTs were found, totalling 11,621 relevant patients. The relative risk of PPH in women treated with MgSO4 is 0.964 (95% CI 0.886 - 1.050) In this systematic review we found no significant increase in PPH in women treated with MgSO4. However, there is still room for discussion due to the heterogeneity in methods (dosage and duration of treatment), results, and tertiary outcomes, as well as the small number of studies found with respect to this important issue.
文摘<strong>Background:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Postpartum haemorrhage is one of the leading causes of maternal morbidity and mortality worldwide. It occurs predominantly in developing countries due to poorly developed infrastructures and lack of skilled birth attendants.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Objective:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">To identify the prevalence, causes and risk factors of primary postpartum haemorrhage following vaginal deliveries in a referral hospital (Douala General Hospital-Cameroon).</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Methods:</span></b></span></span><span><span><b><span style="font-family:""> </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">This was a descriptive and analytical study carried in the Douala General Hospital (DGH) for which socio-demographic, clinical, obstetric and post-partum data were collected using a pre-tested questionnaire. Descriptive statistics, multivariate analysis and logistic regression allowed us to present and discuss our results, with a 95% confidence interval (CI) and </span><i><span style="font-family:Verdana;">p </span></i><span style="font-family:Verdana;">value <</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.05.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Results:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> The prevalence of Primary Postpartum Haemorrhage was 1.33%. Quantification of bleeding was reported in only 13.15% of cases. The main causes were: uterine atony (36.18%), placental retention (25.65%), cervical tears (12.50%), perineal tears (10.52%) and cervico-vaginal tears (08.52%). The risk factors were: age between 19</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">35 years aOR = 4.52;95% CI = 2.65</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.021);unemployment (aOR = 4.74;95% CI = 2.91</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">6.02;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.001);being multigravida (aOR = 9.21;95% CI = 6.43</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">12.48;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.035);history of abortion (aOR = 5.11;95% CI = 2.05</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.29;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.004);preterm delivery (aOR = 6.88;95% CI = 2.72</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">9.06;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.002);duration of labour</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">> 12 hours (aOR = 4.05;95% CI = 2.46</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">7.98;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003) and macrosomia (aOR = 3.27;95% CI = 1.03</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">68;</span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.041).</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Conclusion:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Primary postpartum haemorrhage remains a poorly assessed obstetric complication in the maternity ward of the Douala General Hospital (DGH);Training staff on quantifying postpartum blood loss and monitoring the second and third stages of labour can help to better manage and reduce its occurrence.</span></span></span>
文摘Background: Postpartum maternal morbidity is becoming a major public health concern worldwide due to impact of modern development in feto-maternal medicine and maternal care. Major acute and long term maternal morbidities which may occur during obstetric management affect the life and reproductive career of women. Objective: To assess the trends, risk factors and pattern of postpartum maternal morbidity in Ikot Ekpene a local community in southern Nigeria. Materials and Methods: This was a 4-year prospective cross sectional observational study carried out in the maternity section of General Hospital Ikot Ekpene, Akwa Ibom State, Nigeria between 2008 and 2011. Parturients managed in the hospital for postpartum morbidity were recruited for the study. Relevant information was obtained from structured questionnaire administered to the patients and those extracted from other medical records in the course of managing the patients. This was analysed using the SPSS computer statistical package. Result: A total of 5760 women delivered during the period, of which 296 (5.1%) were treated for postpartum morbidity. Most of the patients (46.9%) were between 31 and 40 years old and 68.8% were of low educational background. Half of the deliveries with morbidity were conducted by unskilled attendants. The most common maternal morbidity encountered included primary postpartum haemorrhage (22.2%), genital sepsis (16.1%), and hypertensive disorders (12.8%). Anaemia (12.8%) and malaria (11.1%) were the commonest non obstetrics causes of morbidity. It was relatively more common with delivery attended by untrained personnel. There was significant reduction in morbidity in the last 2 years of this study. Conclusion: The incidence of postpartum morbidity in the Ikot Ekpene is still high with a downward trend over the years. Obstetric haemorrhage, hypertensive disorders, anaemia and genital tract sepsis were the common causes and were commoner with delivery attended by unskilled personnel. It is hoped that supervision of deliveries by skilled medical attendants, improvement in general health and educational level will reduce postpartum morbidity in this rural community.
文摘Objectives: To determine the feasibility of measuring intra-uterine pressure prior to placental delivery, using a novel minimally invasive method. Design: A prospective exploratory physiological study. Methods: Thirty-six low risk women undergoing normal vaginal delivery were randomly allocated to four groups. Group A received 600 mcg rectal misoprostol;group B received 600 mcg oral misoprostol;group C received 10 international units oxytocin intramuscularly after delivery of the anterior shoulder;group D received intramuscular oxytocin, 30 minutes after delivery of the baby. A calibrated catheter-tip intrauterine pressure transducer was used to measure the intrauterine pressure. This was introduced into the placenta via the umbilical vein, and recorded on a standard tocograph. Results: It was technically easy to introduce the catheter through the umbilical vessels in all mothers. On assessment of the tocograms, it was possible to interpret 95 out of 108 recordings (88%). Conclusions: This study demonstrated the simplicity of a novel, minimally invasive method of measuring the duration and frequency of postpartum uterine contractions prior to delivery of the placenta.
