Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a terti...Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.展开更多
BACKGROUND Transcatheter arterial embolization(TAE)has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management,but there are limited studies on the ...BACKGROUND Transcatheter arterial embolization(TAE)has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management,but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage(PPH).AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings.METHODS We conducted a research from January 2008 to July 2022 on all 83 patients(mean:32 years,range:24-43 years)presented with secondary PPH and they were treated with TAE in two university hospitals.The medical records and angiography were retrospective reviewed in order to evaluate the patients’characteristics,delivery details,clinical status and peri-embolization management,angiography and embolization details,technical/clinical success and complications.The group with active bleeding sign and the group without it were also compared and analyzed.RESULTS On angiography,46(55.4%)patients showed active bleeding signs such as contrast extravasation(n=37)or pseudoaneurysm(n=8)or both(n=1),and 37(44.6%)patients showed non-active bleeding signs such as only spastic uterine artery(n=2)or hyperemia(n=35).In the active bleeding sign group there were more multiparous patients,low platelet count,prothrombin time prolongation,and high transfusion requirements.The technical success rates were 97.8%(45/46)in active bleeding sign group and 91.9%(34/37)in non-active bleeding sign group,and the overall clinical success rates were 95.7%(44/46)and 97.3%(36/37).An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization,therefore hysterostomy and retained placenta removal were performed which was a major complication.CONCLUSION TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.展开更多
In the immediate postpartum period, women need to be observed by the obstetric nurse so that measures can be taken to prevent hemorrhages and reduce its complications. Most maternal deaths from hemorrhage are preventa...In the immediate postpartum period, women need to be observed by the obstetric nurse so that measures can be taken to prevent hemorrhages and reduce its complications. Most maternal deaths from hemorrhage are preventable with support measures for clinical practice, such as: guiding protocols, training of professionals, organization and management of health services and provision of adequate conditions for the parturition process. Objective: To validate Rangel’s instrument with its application in the Maternity Ward of the General Hospital of Huambo, Angola. Methodology: This is a descriptive study with a quantitative approach. This is the sixth stage, called pre-test, of the Translation and Cultural Adaptation process. This instrument was sent for evaluation by the validators using the electronic data collection form named Google forms, with a seven-point Likert-type scale (from 7—totally agree to 1—totally disagree). The analysis was performed with the Cronbach’s Alpha coefficient index (>0.91) and the Content Validity Index (CVI > 0.98). Results: Of the 10 items of evaluation criteria of the instrument analyzed by the 20 validators, 100% of them obtained a Cronbach’s Alpha index rating of 0.91: clarity;coherence;scientific writing;relevance;sequence;uniqueness and updating. Coverage, item criticality and objectivity reached a Cronbach’s Alpha of 0.95. The Content Validity Index was 0.95 for coverage, coherence, item criticality, scientific writing, relevance and updating. Conclusion: Rangel’s instrument for nursing care aimed at preventing and controlling hemorrhage in the third period of birth, translated into Angolan Portuguese and validated by nurses, through the statistical results obtained in the validation, was considered reliable and necessary for clinical nursing practice in Huambo, Angola. .展开更多
Background: Postpartum hemorrhage is one of the main causes of maternal mortality, mainly in underdeveloped countries. Deaths are mostly preventable, and are related to socioeconomic development, organization of healt...Background: Postpartum hemorrhage is one of the main causes of maternal mortality, mainly in underdeveloped countries. Deaths are mostly preventable, and are related to socioeconomic development, organization of health services and professional training. Objective: To systematize alerts for the prevention of postpartum hemorrhage. Method: This is a technical essay developed from reflections on previously produced and published texts about maternal mortality and has hemorrhage as the focus of this study. Results: It presents the concept, classification of hemorrhage, risk factors and their classification, prevention strategies, universal recommendations, pharmacological and non-pharmacological interventions when hemorrhage already exists, bleeding assessment techniques;clinical evaluation, by laboratory examination and by shock index. Conclusions: Hemorrhage is a preventable cause of maternal death through the accomplishment of multiple care. Hospital care must be conducted by qualified professionals and in adequate numbers. The risk diagnosis must be carried out during prenatal care with the recording of clinical data accessible in the health care network. All references studied are not specific to nursing, as hemorrhage prevention requires multidisciplinary action.展开更多
Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1...Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the study period. The leading cause of postpartum hemorrhage was genital tears, followed by uterine atony with a significant increase in adverse maternal outcomes over the years. Continuous health education to medical personnel to improve timely and proper diagnosis of women in danger of PPH and timely referral, thus improve maternal morbidity and mortality.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
Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an ear...Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.展开更多
Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during child...Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.展开更多
Introduction: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death in the world and it is reported to occur in 5% - 8% of pregnancies. Objective: This study aimed to present a single centre’s ex...Introduction: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death in the world and it is reported to occur in 5% - 8% of pregnancies. Objective: This study aimed to present a single centre’s experience in treating PPH by balloon tamponade. Methods: During the time period between January 2013 and March 2016, 50 patients who had undergone balloon tamponade for postpartum hemorrhage in our clinic were evaluated retrospectively. The patients’ age, parity, type of delivery, birth weight, hemoglobin and platelet values, total blood loss from catheter, balloon’s staying time, blood and platelet transfusion status, the presence of placenta anomalies and the Bakri balloon hemostasis success rate were evaluated. Results: During the study period, there were 27,249 deliveries. The frequency of massive postpartum hemorrhage was 0.61% (n = 168). Among the 168 patients with massive postpartum hemorrhage, there were 50 patients in whom the Bakri balloon catheter was used. Bakri balloons were placed via cesarean section incision in 19 patients and via vagina in 31 patients. The mean staying time of Bakri balloon was 18 hours. In 8 patients, balloon tamponade failed. Two patients underwent hysterectomy;other two patients had surgical ligation of the hypogastric artery. Four cases were referred to a tertiary center. Placental invasion abnormalities were observed in five patients. The overall Bakri balloon hemostasis successful rate was found to be as 84% in all cases. Conclusion: Bakri balloon tamponade is an effective, safe and practical approach in the treatment of postpartum hemorrhage.展开更多
Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum h...Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to different treatment methods,they were divided into control group(treated with misoprostol combined with oxytocin,40 cases)and observation group(treated with misoprostol and oxytocin combined with calcium gluconate,40 cases),compared the clinical efficacy,delivery time,postpartum hemorrhage 2 hour after delivery,postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth.Results:The total effective rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).The third delivery stage in the observation group was shorter than that in the control group,and the postpartum hemorrhage volume was less than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in Apgar score of the two groups of newborns(P>0.05).Conclusion:Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient,which not only can effectively reduce postpartum hemorrhage and shorten the delivery time,but also is beneficial for neonatal outcome and worthy of clinical application.展开更多
Postpartum hemorrhage is a serious complication of preeclampsia.The main influencing factors of Preeclampsia on postpartum hemorrhage include vascular disease,trophoblast differentiation and infiltration disorder,the ...Postpartum hemorrhage is a serious complication of preeclampsia.The main influencing factors of Preeclampsia on postpartum hemorrhage include vascular disease,trophoblast differentiation and infiltration disorder,the influence of antispasmodic,sedative and antihypertensive drugs,the incidence of hypertensive disorder complicating pregnancy related to calcium deficiency,coagulation dysfunction,and decreased blood volume during pregnancy.In recent years,postpartum hemorrhage has been the leading cause of maternal death in the world.Therefore,it is critical to understand the influencing factors of preeclampsia on postpartum hemorrhage.Based on the research and guidelines of preeclampsia and postpartum hemorrhage in recent years,this paper analyzes the influencing factors of preeclampsia on postpartum hemorrhage,and provides new ideas for clinical reduction of postpartum hemorrhage.展开更多
Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical re...Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.展开更多
Objective: To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage (PPH). Methods: Retrospective review of 58 women who underwent balloon tamponade for severe PPH, during a period...Objective: To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage (PPH). Methods: Retrospective review of 58 women who underwent balloon tamponade for severe PPH, during a period of 5 years and 10 months, at Russells Hall Hospital, a busy district general hospital in UK. Clinical success was defined as control of bleeding without need for further intervention. Results: Fifty-eight women (mean age, 30 years;range, 18 - 42) underwent balloon tamponade, of which twenty seven (46.5%) women delivered vaginally and 31 (53.5%) women were delivered by cesarean section. Uterine atony was the main cause of PPH (31 cases). Balloon tamponade was used prophylactically in 11 high risk women in anticipation of potential PPH. Rusch balloon was used in 48 cases and Bakri balloon in 10 cases. Clinical success rate of balloon tamponade was 87.2%. Three patients in this study required hysterectomy. Conclusion: Balloon tamponade is an effective means of controlling severe PPH with success rates of around 87%. There should also be a low threshold for prophylactic use of balloon tamponade in women at high risk of PPH, considering its ease of use, low complication rate and ability to maintain reproductive ability.展开更多
Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpo...Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpose, 1000 μg intrarectal (insertion of five 200 μg tablets) has been recommended as the third line after injectable oxytocin and methylergometrine. We proposed to manufacture a 1000 μg misoprostol suppository by determining formulation, release and stability. The administration facility was also evaluated. Several formulations of misoprostol suppositories were set up and evaluated. Misoprostol tablets and lipophilic bases (Hard fat—Adeps solidus Ph. Eur., Witepsol? H15 and Suppocire? AM and AS2X) were used to obtain suppositories. Surfactants were also tested (polysorbates Tween? 20, Tween? 80 and sodium lauryl sulfate (SLS)). The formula was monitored by the misoprostol release curve with an in vitro test and dosed by a HPLC method. Stability was determined by evaluating the percentage of misoprostol content remaining over the time in suppositories stored at 4℃ and 25℃. Facility of use versus tablets was evaluated by obstetricians of a Swiss regional hospital using a questionnaire. Misoprostol release was facilitated by adding surfactant to the lipophilic base. After 30 minutes, 59% ± 1.4% and 57% ± 8.2% of misoprostol was released with Adeps solidus + 1% SLS and Adeps solidus + 5% Tween 20 respectively. SLS was discarded to the final formula because of its irritating effect. After 7 months, suppositories still contained 94% ± 3.7% misoprostol with storage at 4℃. The administration was considered easier and faster compared with intra rectal use of tablets. The formula, consisting of 5 crushed misoprostol tablets dispersed in a suppository base made of Adeps solidus + 5% Tween? 20, is stable for at least 7 months at 4?C and facilitates the rectal administration of misoprostol in the treatment of PPH.展开更多
Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to des...Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios;however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.展开更多
Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years...Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).展开更多
Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospe...Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.展开更多
Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum tim...Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.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
文摘Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.
文摘BACKGROUND Transcatheter arterial embolization(TAE)has been widely used as an effective and a safe treatment method and was often used as an alternative to the surgical management,but there are limited studies on the efficacy and the safety for patients undergoing their secondary postpartum hemorrhage(PPH).AIM To evaluate the usefulness of TAE for secondary PPH focusing on the angiographic findings.METHODS We conducted a research from January 2008 to July 2022 on all 83 patients(mean:32 years,range:24-43 years)presented with secondary PPH and they were treated with TAE in two university hospitals.The medical records and angiography were retrospective reviewed in order to evaluate the patients’characteristics,delivery details,clinical status and peri-embolization management,angiography and embolization details,technical/clinical success and complications.The group with active bleeding sign and the group without it were also compared and analyzed.RESULTS On angiography,46(55.4%)patients showed active bleeding signs such as contrast extravasation(n=37)or pseudoaneurysm(n=8)or both(n=1),and 37(44.6%)patients showed non-active bleeding signs such as only spastic uterine artery(n=2)or hyperemia(n=35).In the active bleeding sign group there were more multiparous patients,low platelet count,prothrombin time prolongation,and high transfusion requirements.The technical success rates were 97.8%(45/46)in active bleeding sign group and 91.9%(34/37)in non-active bleeding sign group,and the overall clinical success rates were 95.7%(44/46)and 97.3%(36/37).An uterine rupture with peritonitis and abscess formation occurred to one patient after the embolization,therefore hysterostomy and retained placenta removal were performed which was a major complication.CONCLUSION TAE is an effective and a safe treatment method for controlling secondary PPH regardless of angiographic findings.
文摘In the immediate postpartum period, women need to be observed by the obstetric nurse so that measures can be taken to prevent hemorrhages and reduce its complications. Most maternal deaths from hemorrhage are preventable with support measures for clinical practice, such as: guiding protocols, training of professionals, organization and management of health services and provision of adequate conditions for the parturition process. Objective: To validate Rangel’s instrument with its application in the Maternity Ward of the General Hospital of Huambo, Angola. Methodology: This is a descriptive study with a quantitative approach. This is the sixth stage, called pre-test, of the Translation and Cultural Adaptation process. This instrument was sent for evaluation by the validators using the electronic data collection form named Google forms, with a seven-point Likert-type scale (from 7—totally agree to 1—totally disagree). The analysis was performed with the Cronbach’s Alpha coefficient index (>0.91) and the Content Validity Index (CVI > 0.98). Results: Of the 10 items of evaluation criteria of the instrument analyzed by the 20 validators, 100% of them obtained a Cronbach’s Alpha index rating of 0.91: clarity;coherence;scientific writing;relevance;sequence;uniqueness and updating. Coverage, item criticality and objectivity reached a Cronbach’s Alpha of 0.95. The Content Validity Index was 0.95 for coverage, coherence, item criticality, scientific writing, relevance and updating. Conclusion: Rangel’s instrument for nursing care aimed at preventing and controlling hemorrhage in the third period of birth, translated into Angolan Portuguese and validated by nurses, through the statistical results obtained in the validation, was considered reliable and necessary for clinical nursing practice in Huambo, Angola. .
文摘Background: Postpartum hemorrhage is one of the main causes of maternal mortality, mainly in underdeveloped countries. Deaths are mostly preventable, and are related to socioeconomic development, organization of health services and professional training. Objective: To systematize alerts for the prevention of postpartum hemorrhage. Method: This is a technical essay developed from reflections on previously produced and published texts about maternal mortality and has hemorrhage as the focus of this study. Results: It presents the concept, classification of hemorrhage, risk factors and their classification, prevention strategies, universal recommendations, pharmacological and non-pharmacological interventions when hemorrhage already exists, bleeding assessment techniques;clinical evaluation, by laboratory examination and by shock index. Conclusions: Hemorrhage is a preventable cause of maternal death through the accomplishment of multiple care. Hospital care must be conducted by qualified professionals and in adequate numbers. The risk diagnosis must be carried out during prenatal care with the recording of clinical data accessible in the health care network. All references studied are not specific to nursing, as hemorrhage prevention requires multidisciplinary action.
文摘Worldwide obstetric hemorrhage remains the leading cause of maternal mortality, accounting for over one quarter of maternal deaths. Over half of these deaths occur in Sub-Saharan Africa with mortality rates of 500 - 1000 per 100,000 births, compared to approximately 5 - 10 in developed countries. Over decades in Sub Saharan Africa preventive measures and treatment protocols have been made to reduce maternal mortality caused by PPH. While rates of postpartum hemorrhage have continued to rise, there is a need to evaluate if its etiology and patterns have changed over time. Broad Objective: This study aims at describing trends in incidence, causes and maternal outcomes of Postpartum Hemorrhage at Muhimbili National Hospital for a period of 7 years. Methodology: This is a retrospective descriptive hospital-based study that has included all cases of postpartum hemorrhage at Muhimbili National Hospital, a tertiary hospital in Tanzania from 2014 to 2020. The data was analyzed using SPSS Version 26 and presented using frequency tables, figures and percentages. The trends of postpartum hemorrhage over time were determined using chi-square test and P-value where less than 0.05 was considered statistically significant. Results: Overall, the incidence of postpartum hemorrhage has been fluctuating over the years with minimum of 1.78% and maximum of 2.87% with no statistical significance. Out of 1113 enrolled cases of PPH, 422 (37.9%) were attributed to genital tears followed by uterine atony 285 (25.6%). A statistically significant increase in linear trend was observed in the postpartum hemorrhage cases due to uterine atony, uterine rupture and sub analysis on genital tears (cervical tear). Overall, there was a statistically significant change in trend of maternal outcomes throughout the years, with a P-value < 0.001 and likelihood of complications increasing over time. Conclusion: The trend in the incidence of postpartum hemorrhage has been fluctuating over the years during the study period. The leading cause of postpartum hemorrhage was genital tears, followed by uterine atony with a significant increase in adverse maternal outcomes over the years. Continuous health education to medical personnel to improve timely and proper diagnosis of women in danger of PPH and timely referral, thus improve maternal morbidity and mortality.
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.
基金supported by Nursing Research Program of Shanghai Nursing Association(No.2016SD-B03)
文摘Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.
文摘Among the most consolidated dogmas in obstetrics, we have the essential role of oxytocin during: labor by regulating, consolidating uterine contractions, by supporting the expulsive efforts of the patient during childbirth and after childbirth by preventing postpartum hemorrhage. But what challenged us to conduct our study is the large and increasing number of surgical operations for postpartum hemorrhage in patients who received oxytocin during labor. We assumed that the generalization use of oxytocin in all patients during labor is probably responsible of this increasing rate of incidents. To verify this assumption, we carried out a prospective randomized comparative study, involving 3990 pregnant patients admitted at the start of labor at term, with no contraindication for giving birth by normal ways, during a period of 10 months (January-October 2022). The patients have been divided into 2 groups. The first group comprises 1991 patients who were placed on admission on a glucose serum infusion with 4 ampoules of a non-anticholinergic musculotropic antispasmodic: “Hydrated phloroglucinol + trimethylphloroglucinol” (Each ampoule contains 40 mg of hydrated phloroglucinol and 0.04 mg of trimethylphloroglucinol) instead of receiving oxytocin during the active phase of their labor and a second group consisting of 1999 patients who received oxytocin during the active phase of their labor. The results were very surprising and contrary to the already consolidated evidence in our specialty. Indeed, the rate of postpartum hemorrhages was 10 patients (0.5%) in the 1st group vs 30 patients (1.5%) in the 2nd group, 9 patients (0.4%) presented fetal heart rate abnormalities in the 1st group vs 90 (4.5%) in the 2nd group, 8 cases (0.4%) of dynamic dystocia in the 1st group vs 132 cases (6.6%) in the 2nd group and 99 caesareans (5%) in the 1st group vs 299 (15%) in the 2nd group. Against all expectations the results were very surprising, with more details in the article.
文摘Introduction: Postpartum hemorrhage (PPH) is one of the leading causes of maternal death in the world and it is reported to occur in 5% - 8% of pregnancies. Objective: This study aimed to present a single centre’s experience in treating PPH by balloon tamponade. Methods: During the time period between January 2013 and March 2016, 50 patients who had undergone balloon tamponade for postpartum hemorrhage in our clinic were evaluated retrospectively. The patients’ age, parity, type of delivery, birth weight, hemoglobin and platelet values, total blood loss from catheter, balloon’s staying time, blood and platelet transfusion status, the presence of placenta anomalies and the Bakri balloon hemostasis success rate were evaluated. Results: During the study period, there were 27,249 deliveries. The frequency of massive postpartum hemorrhage was 0.61% (n = 168). Among the 168 patients with massive postpartum hemorrhage, there were 50 patients in whom the Bakri balloon catheter was used. Bakri balloons were placed via cesarean section incision in 19 patients and via vagina in 31 patients. The mean staying time of Bakri balloon was 18 hours. In 8 patients, balloon tamponade failed. Two patients underwent hysterectomy;other two patients had surgical ligation of the hypogastric artery. Four cases were referred to a tertiary center. Placental invasion abnormalities were observed in five patients. The overall Bakri balloon hemostasis successful rate was found to be as 84% in all cases. Conclusion: Bakri balloon tamponade is an effective, safe and practical approach in the treatment of postpartum hemorrhage.
文摘Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to different treatment methods,they were divided into control group(treated with misoprostol combined with oxytocin,40 cases)and observation group(treated with misoprostol and oxytocin combined with calcium gluconate,40 cases),compared the clinical efficacy,delivery time,postpartum hemorrhage 2 hour after delivery,postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth.Results:The total effective rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).The third delivery stage in the observation group was shorter than that in the control group,and the postpartum hemorrhage volume was less than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in Apgar score of the two groups of newborns(P>0.05).Conclusion:Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient,which not only can effectively reduce postpartum hemorrhage and shorten the delivery time,but also is beneficial for neonatal outcome and worthy of clinical application.
文摘Postpartum hemorrhage is a serious complication of preeclampsia.The main influencing factors of Preeclampsia on postpartum hemorrhage include vascular disease,trophoblast differentiation and infiltration disorder,the influence of antispasmodic,sedative and antihypertensive drugs,the incidence of hypertensive disorder complicating pregnancy related to calcium deficiency,coagulation dysfunction,and decreased blood volume during pregnancy.In recent years,postpartum hemorrhage has been the leading cause of maternal death in the world.Therefore,it is critical to understand the influencing factors of preeclampsia on postpartum hemorrhage.Based on the research and guidelines of preeclampsia and postpartum hemorrhage in recent years,this paper analyzes the influencing factors of preeclampsia on postpartum hemorrhage,and provides new ideas for clinical reduction of postpartum hemorrhage.
文摘Objective To evaluate the efficacy and safety of uterine artery embolization(UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women(mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients(94%) during follow-up period(median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
文摘Objective: To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage (PPH). Methods: Retrospective review of 58 women who underwent balloon tamponade for severe PPH, during a period of 5 years and 10 months, at Russells Hall Hospital, a busy district general hospital in UK. Clinical success was defined as control of bleeding without need for further intervention. Results: Fifty-eight women (mean age, 30 years;range, 18 - 42) underwent balloon tamponade, of which twenty seven (46.5%) women delivered vaginally and 31 (53.5%) women were delivered by cesarean section. Uterine atony was the main cause of PPH (31 cases). Balloon tamponade was used prophylactically in 11 high risk women in anticipation of potential PPH. Rusch balloon was used in 48 cases and Bakri balloon in 10 cases. Clinical success rate of balloon tamponade was 87.2%. Three patients in this study required hysterectomy. Conclusion: Balloon tamponade is an effective means of controlling severe PPH with success rates of around 87%. There should also be a low threshold for prophylactic use of balloon tamponade in women at high risk of PPH, considering its ease of use, low complication rate and ability to maintain reproductive ability.
文摘Misoprostol is a prostaglandin E1 analogue used to prevent and treat gastric ulcers. It has been commonly used in gynecology and obstetrics, especially for the management of postpartum hemorrhage (PPH). For this purpose, 1000 μg intrarectal (insertion of five 200 μg tablets) has been recommended as the third line after injectable oxytocin and methylergometrine. We proposed to manufacture a 1000 μg misoprostol suppository by determining formulation, release and stability. The administration facility was also evaluated. Several formulations of misoprostol suppositories were set up and evaluated. Misoprostol tablets and lipophilic bases (Hard fat—Adeps solidus Ph. Eur., Witepsol? H15 and Suppocire? AM and AS2X) were used to obtain suppositories. Surfactants were also tested (polysorbates Tween? 20, Tween? 80 and sodium lauryl sulfate (SLS)). The formula was monitored by the misoprostol release curve with an in vitro test and dosed by a HPLC method. Stability was determined by evaluating the percentage of misoprostol content remaining over the time in suppositories stored at 4℃ and 25℃. Facility of use versus tablets was evaluated by obstetricians of a Swiss regional hospital using a questionnaire. Misoprostol release was facilitated by adding surfactant to the lipophilic base. After 30 minutes, 59% ± 1.4% and 57% ± 8.2% of misoprostol was released with Adeps solidus + 1% SLS and Adeps solidus + 5% Tween 20 respectively. SLS was discarded to the final formula because of its irritating effect. After 7 months, suppositories still contained 94% ± 3.7% misoprostol with storage at 4℃. The administration was considered easier and faster compared with intra rectal use of tablets. The formula, consisting of 5 crushed misoprostol tablets dispersed in a suppository base made of Adeps solidus + 5% Tween? 20, is stable for at least 7 months at 4?C and facilitates the rectal administration of misoprostol in the treatment of PPH.
文摘Objective: To identify current treatment strategies for postpartum hemorrhage used by obstetricians (OB/GYNs) and hematologists (HEMs). Study Design: We conducted a survey of OB/GYNs (n = 220) and HEMs (n = 30) to describe the characteristics of current treatment strategies for postpartum hemorrhage. Surveys were administered via a structured questionnaire on a secure internet website from 5 - 12 October 2009. Results: The majority of OB/GYN and HEM respondents were practicing in a community hospital environment (77%). Of the OB/GYNs, the majority practiced at hospitals with over 2000 deliveries per year (77%). A majority (58%) of OB/GYNs were affiliated with hospitals that lacked a massive transfusion protocol to treat severe postpartum hemorrhage. Subsequent to uterine massage and additional oxytocin, the majority of OB/GYNs (73%), preferred the administration of Methergine? as the next level of intervention for postpartum hemorrhage. There was considerable variability in response to specific treatment strategies for several hypothetical case scenarios;however, the large majority of OB/GYNs favored obstetrical procedures over interventional radiology or administration of rFVIIa. A large majority (77%) of physicians who are familiar with rRVIIa as treatment for postpartum hemorrhage reported being very satisfied with the agent for this indication. Conclusions: An established, systematic treatment strategy among OB/GYNs emerged only in the case of mild postpartum hemorrhage.
文摘Purpose: To investigate the efficacy of uterine arterial embolization (UAE) in patients with post-partum hemorrhage (PPH). Materials and Methods: The subjects were 40 women (mean age, 33 years;age range, 21 - 42 years) who underwent UAE for PPH at two institutes from June 2001 to May 2011. The rates of clinical success (avoidance of hysterectomy) and complications were calculated. Differences in related factors between primary PPH and secondary PPH and between caesarean section and vaginal delivery were examined. The risk factors associated with hysterectomy were also examined. Results: The overall clinical success rate was 90% (93% of primary PPH, 77% of secondary PPH, and 87.5% of PPH with cesarean section), and the overall complication rate was 10%. There were significant differences in time to PPH (P < 0.0001) and in blood infusion after UAE (P = 0.0158) between subtypes of primary and secondary PPH and in blood infusion before UAE (P = 0.0052) between delivery methods. The significant factors associated with hysterectomy were cesarean section (P = 0.02), severe PPH (>1000 mL bleeding, P = 0.03), and embolization of non-uterine arteries (P = 0.02).
文摘Objective: To evaluate the management process and the guidelines for management of postpartum hemorrhage due to uterine atony at the General Hospital Vienna, Medical University Vienna. Material and Methods: A retrospective analysis was carried out on all 24 cases of postpartum hemorrhage due to uterine atony with an estimated blood loss of more than 800 mL, in which standardized guidelines were obtained. We included all women who gave birth at the General Hospital of Vienna, the Medical University Vienna, during the period from January 1st 2003 and December 31st 2009 and who suffered blood loss 800 mL at minimum due to uterine atony. Results: The guidelines were in use for 14% - 71%. The average blood loss of the 24 cases with uterine atony was 1342 mL. Conclusion: The management process of postpartum hemorrhage due to uterine atony deviates from the hospital’s guidelines in many cases.
文摘Background: Blood loss is one of the important complications during cesarean section (CS). Previous reports have shown that misoprostol is effective in reducing blood loss during and after CS. However, the optimum time for its administration to decrease the amount of PPH is still under discussion. Objective: To compare the effect of preoperative and postoperative administration of sublingual misoprostol (400 μg) in reducing the amount of blood loss during and 24 hours after CS. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt, between January 2017 and July 2018. Study Design: A prospective, randomized clinical trial. Methods: Four-hundred thirty women fulfilling the inclusions criteria: elective lower segment CS at term (≥37 weeks) with normal fetal heart tracing who accepted to participate in the study. Patients were divided into two groups;Patients assigned to group 1 received 400 μg sublingual misoprostol immediately after urinary catheterization and before skin incision, while patients assigned to group 2 received sublingual misoprostol immediately after skin closure. The primary outcome was the estimation of intraoperative and postoperative blood loss for 24 hours. Results: There was a significant reduction in the intraoperative blood loss in group 1 compared with group 2 (403.51 ± 72.99 vs. 460.99 ± 74.66 ml, respectively). Also, there was a significant reduction in postoperative blood loss in group 1 compared with group 2 with a statistical significance (169.45 ± 12.03 vs. 195.77 ± 13.34 ml, respectively). Postoperative hemoglobin and Hematocrit values were significantly higher in group 1 compared with group 2. Conclusions: Preoperative administration of sublingual misoprostol (400 μg) during CS is better than postoperative administration as it is associated with a reduction in the amount of intraoperative and postoperative blood loss and drop in hemoglobin level.
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.
