732 results on '"Post-partum hemorrhage"'
Search Results
2. Mostafa Maged Maneuver in Comparison With Bimanual Uterine Compression to Control Post-partum Hemorrhage
- Author
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Al-Azhar University and Mostafa Maged Ali, principal investigator
- Published
- 2024
3. The Effect of Uterine Cooling During Cesarean Delivery on Blood Loss in Patients Undergoing Cesarean Section: A Randomized Controlled Trial.
- Author
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Elmizadeh, Khadijeh, Khezri, Marzieh Beigom, Pakniat, Hamideh, Pandamouz, Vahideh, Azh, Nezal, and Molaverdikhani, Simindokht
- Subjects
CESAREAN section ,OBSTETRICS surgery ,RESEARCH funding ,T-test (Statistics) ,INDUCED hypothermia ,STATISTICAL sampling ,HEMOGLOBINS ,SURGICAL blood loss ,TREATMENT effectiveness ,POSTPARTUM hemorrhage ,RANDOMIZED controlled trials ,PREGNANCY outcomes ,DESCRIPTIVE statistics ,MANN Whitney U Test ,CHI-squared test ,CONTROL groups ,PRE-tests & post-tests ,LONGITUDINAL method ,GESTATIONAL age ,SURGICAL sponges ,COMPARATIVE studies ,CONFIDENCE intervals ,DATA analysis software ,UTERUS - Abstract
Background & Objective: Cooling the uterus during cesarean section has emerged as one of the non-pharmacological management for blood loss during cesarean section. The aim of this study was to evaluate the effect of uterine cooling during the cesarean section on decreasing postpartum hemorrhage. Materials & Methods: In this single-blinded randomized clinical trial, a sample of 300 women with a singleton pregnancy, at 37 to 40 weeks gestation, who were scheduled for cesarean section, was divided into two groups of 150 participants. In the intervention group after placental delivery, the uterus was covered with cold saline-soaked surgical sponges at 0-4°C at the time of hysterotomy repair, and the control group received standard cesarean section. The volume of blood loss, the hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocin therapy, and the incidence of adverse effects were recorded. Results: The bleeding volume and hemoglobin concentration reduction were significantly lower in the intervention group than in the control group (260.86± 150.25 Vs 214.35± 83.51, P<0.0001 and 1.24±0.75 Vs 1.54±0.92, P = 0.007 respectively). There were no statistically significant differences between the two groups in the frequency of need for additional uterotonic drugs. (18% vs. 21.33%, P = 0.475.). Conclusion: The use of uterine cooling during cesarean section reduced the volume of blood loss and the rate of decline in hemoglobin concentration. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
4. Comparison of Panicker PPH suction cannula with medical methods in case of intractable PPH.
- Author
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Singh, Shweta, Prajapati, Niranjana, Mishra, Ankita, Tyagi, Smita, and Chaudhary, Neeta
- Subjects
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THIRD stage of labor (Obstetrics) , *DELIVERY (Obstetrics) , *POSTPARTUM hemorrhage , *CESAREAN section , *BLOOD transfusion - Abstract
Background: Postpartum hemorrhage (PPH) is the most dreadful obstetric emergency and is a leading cause of maternal mortality. It accounts for almost one maternal mortality every four minutes. Aims and Objectives: The aims of the present study was to analyze the incidence of atonic PPH, the effectiveness of suction cannula in management of atonic PPH after failure of medical management and the maternal outcome after suction technique. Material and Methods: This study was carried out in Department of Obstetrics and Gynecology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh. All the patients who delivered in Muzaffarnagar Medical College by vaginal or caesarean delivery and underwent PPH were included in this study. Patients requiring PPH management were admitted to the obstetrics ward. Results: This study included 48 patients out of which 30 patients with medical management in Group A and 18 patients managed with medical treatment and Panicker cannula in Group B. All the patients in group A stopped bleeding within a period of 4 minutes. However, in group B patients it took more than four minutes to stop bleeding. Statistical significance was not applicable here as the group B had nothing to compare with. Out of group A patients, 18 patients had loss of upto 250 ml and 12 patients had loss of 251-500 ml blood. Out of group B patients, 10 patients had loss of 501 - 1000 ml blood (Vaginal delivery) and 8 patients had loss of more than 1000 ml blood (Cesarean section). As per Guidelines, 500-1000 ml loss of blood is considered as PPH with vaginal delivery and more than 1000 ml loss of blood is considered as PPH with caesarean section. Out of group A patients, 24 patients did not receive any transfusion and only four patients received one transfusion. Out of group B patients, 8 patients received two transfusions, four patients received three transfusions and six patients received more than three transfusions. Conclusion: Management of intractable PPH is made easier due to Panicker suction cannula. This study concludes that Panicker suction cannula is the safest, cheapest and best method in the treatment of intractable PPH especially in rural settings to reduce the maternal mortality rate due to haemorrhage. [ABSTRACT FROM AUTHOR]
- Published
- 2024
5. MR imaging features of uterine necrosis following modified B-Lynch sutures: a case report
- Author
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Shruti Thakur, Anupam Jhobta, Mukesh Surya, and Ashwani Tomar
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Post-partum hemorrhage ,Modified B-Lynch compressive sutures ,MRI ,Uterine necrosis ,Fertility ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background B-Lynch braided compression sutures are applied as a lifesaving procedure to control atonic post-partum hemorrhage if the patient is not responding to uterotonics and other conservative methods. These sutures are applied to avoid hysterectomy so as to preserve fertility. However, if not applied properly, these can lead to a rare but serious complication of uterine necrosis secondary to uterine ischemia and sepsis. The patient then ends up in hysterectomy defeating the sole purpose of maintaining fertility for which the sutures were applied at the first place. Case presentation Here we describe a case of primipara who had caesarian section complicated by post-partum hemorrhage which was managed with modified B-Lynch compression sutures for achieving hemostasis. The patient presented three weeks post-procedure with signs and symptoms of inflammation and sepsis. The MR imaging revealed features of uterine necrosis. The patient underwent hysterectomy unwillingly as no other option was left to save her life. A detailed MR imaging of this case has been described given the scarcity of MR features of uterine necrosis following compressive sutures in medical literature. Conclusions The case is reported to make the clinicians aware of the possibility of such a dreaded complication following compressive sutures for post-partum hemorrhage and to emphasize on early and timely follow-up of such patients so that uterus could be salvaged.
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- 2024
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6. MR imaging features of uterine necrosis following modified B-Lynch sutures: a case report.
- Author
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Thakur, Shruti, Jhobta, Anupam, Surya, Mukesh, and Tomar, Ashwani
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UTERINE tumors ,HYSTERECTOMY ,CESAREAN section ,RARE diseases ,MAGNETIC resonance imaging ,POSTPARTUM hemorrhage ,SUTURING ,SEPSIS ,FERTILITY preservation ,HEMOSTASIS ,INFLAMMATION - Abstract
Background: B-Lynch braided compression sutures are applied as a lifesaving procedure to control atonic post-partum hemorrhage if the patient is not responding to uterotonics and other conservative methods. These sutures are applied to avoid hysterectomy so as to preserve fertility. However, if not applied properly, these can lead to a rare but serious complication of uterine necrosis secondary to uterine ischemia and sepsis. The patient then ends up in hysterectomy defeating the sole purpose of maintaining fertility for which the sutures were applied at the first place. Case presentation: Here we describe a case of primipara who had caesarian section complicated by post-partum hemorrhage which was managed with modified B-Lynch compression sutures for achieving hemostasis. The patient presented three weeks post-procedure with signs and symptoms of inflammation and sepsis. The MR imaging revealed features of uterine necrosis. The patient underwent hysterectomy unwillingly as no other option was left to save her life. A detailed MR imaging of this case has been described given the scarcity of MR features of uterine necrosis following compressive sutures in medical literature. Conclusions: The case is reported to make the clinicians aware of the possibility of such a dreaded complication following compressive sutures for post-partum hemorrhage and to emphasize on early and timely follow-up of such patients so that uterus could be salvaged. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
7. Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage.
- Author
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Caram-Deelder, Camila, McKinnon Edwards, Hellen, Zdanowicz, Jarmila A., van den Akker, Thomas, Birkegård, Camilla, Blatný, Jan, van der Bom, Johanna G., Colucci, Giuseppe, van Duuren, Derek, van Geloven, Nan, Henriquez, Dacia D. C. A., Knight, Marian, Korsholm, Lars, Landorph, Andrea, Lavigne Lissalde, Géraldine, McQuilten, Zoe K., Surbek, Daniel, Wellard, Cameron, Wood, Erica M., and Mercier, Frederic J.
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POSTPARTUM hemorrhage , *FACTOR analysis , *UTERINE artery , *THERAPEUTIC embolization , *ILIAC artery , *MATERNAL mortality , *ODDS ratio , *UTERINE hemorrhage - Abstract
Background: Despite a range of available treatments, it is still sometimes challenging to treat patients with severe post-partum hemorrhage (sPPH). Objective: This study evaluated the efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 (NCT04723979), OS-2, OS-3, and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligations, arterial embolization, or hysterectomy) and safety (incidence of thromboembolic events (TE) and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa-exposed women only. Results: A total of 446 women exposed to rFVIIa and 1717 non-exposed controls were included. In the RCT, fewer rFVIIa-exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio: 0.11; 95% confidence interval: 0.03–0.35). In OS-1, more rFVIIa-exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio: 2.46; 95% confidence interval: 1.06–5.99). In OS-2, 17% (3/18) of rFVIIa-exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio: 0.33; 95% confidence interval: 0.03–1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa-exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa on the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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8. The clinical significance of cervical tears' anatomical location – A retrospective study.
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Gluck, Ohad, David, Maayan, Kovo, Michal, Mor, Liat, Kleiner, Ilia, Weiner, Eran, and Ginath, Shimon
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DELIVERY (Obstetrics) , *PREMATURE labor , *DISSEMINATED intravascular coagulation , *PREGNANCY complications , *CESAREAN section - Abstract
• Cervical tears are prevalent in up to 4.8% of deliveries and are associated with worse maternal outcomes. • We studied the relationship between the location of the cervical tear and maternal prognosis, comparing posterior to anterior and lateral tears. • Posterior cervical tear bears a higher risk for maternal adverse outcomes compared to cases of anterior or lateral tears. Up to 4.8% of all vaginal deliveries are complicated by significant cervical tears related to maternal compromise, yet the location of the cervical tear and its impact on the attributed risk have not been studied to date. This study aimed to determine the associations between the location and characteristics of cervical tears with short-term maternal complications and outcomes. This is a retrospective cohort study. Included were all patients that delivered vaginally at our institute between the years 2009–2020 and were diagnosed with a cervical tear. Maternal complications were compared between cases with posterior cervical tears and cases with anterior or lateral cervical tears. Exclusion criteria included patients who delivered by cesarean delivery and preterm labor below 37.0 weeks of gestation. Overall, 96 patients were diagnosed with posterior cervical tears, while 117 patients were diagnosed with anterior or lateral tears. Maternal demographics and pregnancy characteristics were similar between the groups. There were also no differences in delivery outcomes between the groups. Patients with posterior cervical tears had a higher rate of disseminated intravascular coagulation (DIC) (6.25 % vs. 0.9 %, p = 0.04) and prolonged hospitalization (35.4 % vs. 23.1 %, p = 0.05), as compared to patients with anterior or lateral tears. There were no differences in other maternal complications. Cases of posterior cervical tears are at higher risk for maternal adverse outcomes (DIC and prolonged hospitalization), as compared to cases of anterior or lateral tears. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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9. Sonographic evaluation of retained products of conception within 48 h following delivery: a retrospective cohort study
- Author
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Ashkar Majadla, Nadine, Abu Shqara, Raneen, Haj, Safaa, Sgayer, Inshirah, Ghanem, Nadir, Lowenstein, Lior, and Odeh, Marwan
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- 2024
- Full Text
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10. Application of shock index-based classification in hypovolemic shock due to obstetric hemorrhage and its comparison with conventional vital sign for prediction of adverse maternal outcome
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Najma Malik, Sarita Bhasker, Vani Aditya, and Ruma Sarkar
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blood pressure ,heart rate ,post-partum hemorrhage ,sepsis ,Medicine - Abstract
Background: At least, 358,000 women worldwide die annually from pregnancy and childbirth-related problems. Obstetric hemorrhage is the single most significant cause of maternal mortality worldwide accounting for 25–30% of all maternal deaths. Aims and Objectives: The objective of the study is to see the usefulness/importance of shock index (SI) in obstetric hemorrhage (antepartum and post-partum hemorrhage) and to compare the performance of SI with conventional vital signs for prediction of maternal outcome. Materials and Methods: The descriptive study was conducted in 100 cases of hemorrhagic shock patients admitted in obstetrics and gynecology at Baba Raghav Das Medical College, Gorakhpur, between June 2020 and May 2021, on 100 subjects. Results: In our study, there were 100 patients. Patients with SI 0.6 to 1 were included in Group II which comprises 74% patients in which all patients required initial resuscitation with IV fluid and then blood transfusion, 21.62% patients require inotropic support, and 9.46% patients needed fresh frozen plasma transfusion. Maternal outcome in Group I patients is that only 15.38% patients required emergency lower segment cesarean section (LSCS). While in Group II, 28.95% patients required emergency LSCS, 5.26% patients required intensive care unit (ICU) admission for ventilator support, 3.95% went for cesarean hysterectomy, while 2.63% patients landed in end organ failure and expired. Conclusion: All patients with obstetric hemorrhage with SI>1 should receive immediate intervention such as blood transfusion need of ICU or surgical intervention. This is higher than the upper limit of normality in non-pregnant population. In low-resource settings, this simple parameter could improve outcomes because it has a significant ability to predict adverse maternal outcomes of hemorrhage.
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- 2024
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11. Application of shock index-based classification in hypovolemic shock due to obstetric hemorrhage and its comparison with conventional vital sign for prediction of adverse maternal outcome.
- Author
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Malik, Najma, Bhasker, Sarita, Aditya, Vani, and Sarkar, Ruma
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HYPOVOLEMIC anemia , *HEMORRHAGIC shock , *VITAL signs , *POSTPARTUM hemorrhage , *INTENSIVE care patients , *RESOURCE-limited settings - Abstract
Background: At least, 358,000 women worldwide die annually from pregnancy and childbirth-related problems. Obstetric hemorrhage is the single most significant cause of maternal mortality worldwide accounting for 25-30% of all maternal deaths. Aims and Objectives: The objective of the study is to see the usefulness/importance of shock index (SI) in obstetric hemorrhage (antepartum and post-partum hemorrhage) and to compare the performance of SI with conventional vital signs for prediction of maternal outcome. Materials and Methods: The descriptive study was conducted in 100 cases of hemorrhagic shock patients admitted in obstetrics and gynecology at Baba Raghav Das Medical College, Gorakhpur, between June 2020 and May 2021, on 100 subjects. Results: In our study, there were 100 patients. Patients with SI 0.6 to <1 were included in Group I which comprises 26% patients in which 57.69% patients required only intravenous (IV) fluid, while 30.77% patients needed blood transfusion. Patients with SI>1 were included in Group II which comprises 74% patients in which all patients required initial resuscitation with IV fluid and then blood transfusion, 21.62% patients require inotropic support, and 9.46% patients needed fresh frozen plasma transfusion. Maternal outcome in Group I patients is that only 15.38% patients required emergency lower segment cesarean section (LSCS). While in Group II, 28.95% patients required emergency LSCS, 5.26% patients required intensive care unit (ICU) admission for ventilator support, 3.95% went for cesarean hysterectomy, while 2.63% patients landed in end organ failure and expired. Conclusion: All patients with obstetric hemorrhage with SI>1 should receive immediate intervention such as blood transfusion need of ICU or surgical intervention. This is higher than the upper limit of normality in nonpregnant population. In low-resource settings, this simple parameter could improve outcomes because it has a significant ability to predict adverse maternal outcomes of hemorrhage. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
12. Comparison of Complication and Post-Operative Infection Rate Between Application of Carbetocin and Oxytocin during Management of Post-Partum Hemorrhage after Caesarean Section.
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Choudhury, Farhana Haque, Noor, Mosammat Salma, Tanzin, Syeda Tania, Ahmed, Shahnaz, and Fatema, Naheed
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OXYTOCIN ,SURGICAL blood loss ,POSTPARTUM hemorrhage ,BLOOD transfusion ,SURGICAL complications ,PREGNANT women ,RANDOMIZED controlled trials ,VOMITING ,T-test (Statistics) ,SURGICAL site infections ,DESCRIPTIVE statistics ,ANEMIA ,CHI-squared test ,CESAREAN section ,STATISTICAL sampling ,DATA analysis software ,WOMEN'S health ,OXYTOCICS ,UTERINE contraction - Abstract
Background: Adverse effects can be produced by carbetocin and oxytocin during management of postpartum hemorrhage after caesarean section. Objective: The purpose of the present study was to compare the adverse effects among women with post-partum hemorrhage after caesarean section. Methodology: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2015 to December 2015 for a period of six months. Pregnant women diagnosed on the standard criteria admitted in BSMMU, Dhaka, Bangladesh were selected as study population by consecutive type of sampling. Randomization was performed according to computer generated simple random sampling method. An Uterotonic was an agent used to induce contraction or greater tonicity of the uterus. Then the patients were monitored per operatively and post operatively. All the information was recorded in data collection sheet. Main outcome variables were estimated blood loss. Results: A total number of 96 pregnant women were recruited for this study of which 48 cases were enrolled in group I and the rest of 48 case were enrolled in group II. The mean age with SD of the group I and group II were 24.4±4.7 years and 24.7±3.7 years. In blood transfusion of the study patients, 2(4.2%) patients need blood transfusion in group I and 5(10.4%) in group II (p>0.05). One (2.1%) patients had anaemia in group I and 5(10.4%) in group II. Forty-six (95.8%) patients had average menstrual flow in group I and 40(83.3%) in group II (p>0.05). Considering the side effect, 1(2.1%) patients had nausea in group I and 4(8.3%) in group II. Two (4.2%) patients had vomiting in group I and 5(10.4%) in group II. One (2.1%) patients had headache in group I and 4(8.3%) in group II. Four (8.3%) patients had infection rate in group I and 5(10.4%) in group II (p>0.05). Conclusion: In conclusion blood transfusion, anaemia, vomiting and infection rate are found less in group I than group II. [ABSTRACT FROM AUTHOR]
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- 2023
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13. Comparison of the frequency of postpartum hemorrhage in induced labour and spontaneous labour in pregnant women.
- Author
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Rafiq, Shazia, Ali, Syeda, Bashir, Humaira, Karim, Sajilah, Mateen, Amtul, and Zia, Sarmad
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PREGNANT women , *POSTPARTUM hemorrhage , *INDUCED labor (Obstetrics) , *DELIVERY (Obstetrics) , *LABOR (Obstetrics) , *GESTATIONAL age - Abstract
Objective: To compare the frequency of postpartum hemorrhage in induced labour and spontaneous labour in pregnant women. Study Design: Cross-sectional study. Setting: Department of Obstetrics and Gynecology, Nishtar Hospital, Multan. Period: January 2023 to June 2023. Material & Methods: A total number of 262 pregnant women aged 20-40 years, having gestational age 37 to 42 weeks were analyzed. Baseline demographic information of patients (age, gestational age, parity, weight and previous history of PPH) was taken. Mode of delivery (spontaneous/induced) was noted in all women and postpartum hemorrhage after delivery was also noted. Results: In a total of 262 pregnant women, the mean age was 31.28±4.96 years while mean gestational age at the time of delivery was 39.74±1.62 weeks. The mean weight was 64.47±7.65 kg. Comparison of the post-partum hemorrhage between modes of labour showed that 28 (21.4%) undergoing induced induction and 10 (7.6%) in spontaneous labour had post-partum hemorrhage (p=0.002). Conclusion: Post-partum hemorrhage is a common complication of induced labour. Postpartum hemorrhage needs to be taken into account especially when induction of labour is being considered. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
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14. Implementing uterine balloon tamponade (UBT) device for immediate postpartum hemorrhage management: Leveraging resource allocation and highlighting noteworthy experiences
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Mian Dehi Boston, Guie Privat, Apollinaire Horo, Aka Edele, Kouakou Konan Virginie, Aholoupke Bruno, Koné Seydou, Rochon Sarah, Boni Serge, and Burke Thomas F
- Subjects
Implementation ,Uterine balloon tamponade ,Post-partum hemorrhage ,Health providers ,Health regions ,Gynecology and obstetrics ,RG1-991 - Abstract
Background: The use of uterine balloon tamponade (UBT) devices for intrauterine packing and management of vaginal bleeding by uterine atony has shown promising results in improving the quality of care and reducing maternal mortality. Objective: This report aims to provide an overview of progress made in implementing UBT devices in northern Cote d'Ivoire. Material and methods: A four-year retrospective study was conducted in the North-East (163,645), North-Center (351,909), and North-West (57,983). In 2017, UBT was adopted by members of the healthcare system. Subsequently, 5 national and 32 regional trainers have been trained. The training session was a theoretical and practical program with a low simulator. UBT is a male condom tied to a urinary catheter, filled with liquid. Positive outcomes included stopping bleeding, avoiding the need for surgery, and preventing maternal deaths (MD). In 2018, 3,515 UBT devices were distributed. In 2019, monitoring tools and transmission circuits of the data were validated. In 2020, the collection of data and local manufacturing was launched. Results: During the process, 978 health workers, mainly midwife (52.0%) and nurses (32.2%) out of the 1,295 assigned were trained. The number of trained individuals decreased from 209 in 2019 to 160 in 2020. A total of 1,715 UBT devices were locally manufactured, adding to the existing gift of 5,080 devices, with total availability of 6,795. The distribution of devices increased from 2017 to 2019 but decreased in 2020. Success rates increased from 87.3% in 2017 (365/418) to 95.0% in 2019 (556/585) and slightly decreased in 2020 to 98.0% (681/695). Adverse outcomes (144/2,193), included MD (35/2,193) and medical evacuation to the surgical center (109/2,193). Conclusion: The implementation of UBT in northern Cote d'Ivoire successfully reduced maternal death rates caused by immediate post-partum hemorrhage (IPPH). However, to ensure sustainability, further improvements are needed, including increased monitoring, ongoing training, and device availability.
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- 2023
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15. Efficacy and Safety Analyses of Recombinant Factor VIIa in Severe Post-Partum Hemorrhage
- Author
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Camila Caram-Deelder, Hellen McKinnon Edwards, Jarmila A. Zdanowicz, Thomas van den Akker, Camilla Birkegård, Jan Blatný, Johanna G. van der Bom, Giuseppe Colucci, Derek van Duuren, Nan van Geloven, Dacia D. C. A. Henriquez, Marian Knight, Lars Korsholm, Andrea Landorph, Géraldine Lavigne Lissalde, Zoe K. McQuilten, Daniel Surbek, Cameron Wellard, Erica M. Wood, and Frederic J. Mercier
- Subjects
recombinant activated factor VII ,post-partum hemorrhage ,pregnancy complications ,hematologic ,coagulants ,therapeutic use ,Medicine - Abstract
Background: Despite a range of available treatments, it is still sometimes challenging to treat patients with severe post-partum hemorrhage (sPPH). Objective: This study evaluated the efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 (NCT04723979), OS-2, OS-3, and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligations, arterial embolization, or hysterectomy) and safety (incidence of thromboembolic events (TE) and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa-exposed women only. Results: A total of 446 women exposed to rFVIIa and 1717 non-exposed controls were included. In the RCT, fewer rFVIIa-exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio: 0.11; 95% confidence interval: 0.03–0.35). In OS-1, more rFVIIa-exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio: 2.46; 95% confidence interval: 1.06–5.99). In OS-2, 17% (3/18) of rFVIIa-exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio: 0.33; 95% confidence interval: 0.03–1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa-exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa on the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment.
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- 2024
- Full Text
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16. IJCM_80A: A Study on Risk factors and outcome of post partum hemorrhage among postnatal mothers attending a tertiary care hospital in Guntur District
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Sankeerti M., Rajesh A. Hani, and Rama A. Sita
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post-partum hemorrhage ,postnatal mothers ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Post Partum Haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. PPH is the most common form of major obstetric haemorrhage. Majority of deaths due to PPH are reported to be in developing countries and the major factors responsible were attributed to lack of access to reproductive health services, availability of skilled health personnel, timely intervention of obstetric emergencies and others such as appropriate equipment and supplies. With increase in rate of institutional deliveries and improvement in quality of services MMR can further be reduced with focus on the factors responsible for maternal deaths. Objective: The study was aimed to identify risk factors of postpartum hemorrhage among postnatal mothers and to analyze various factors and determinants that influence the outcome among mothers with PPH. Methodology: This was a descriptive observational retrospective study conducted in Department of obstetrics and Gynecology, government general hospital, Guntur. The target population included 50 postnatal mothers diagnosed as having PPH. Other causes of hemorrhage not related to delivery such as accidents and women with preexisting medical and other conditions were excluded. Data was collected from the available medical records Results: The prevalence of PPH was 0.96%. The causative factors identified were atonic uterus (80%), traumatic delivery (17.5%) and retained bits (1.7%). Induced labor (16%), prolonged labor (11.1%) and preeclampsia (3.4%) were the risk factors that lead to PPH. The mortality was 4% (2) and the cause of death in the 2 patients was due to shock. Conclusion: In the present study, the prevalence of postpartum hemorrhage (PPH) was recorded at 0.96%. Uterine atony emerged as the primary contributing factor, with induced labor identified as the leading risk factor associated with an increased predisposition to PPH. Shock stood out as the predominant cause of mortality.
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- 2024
- Full Text
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17. Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections.
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Binyamin, Yair, Frenkel, Amit, Gruzman, Igor, Lerman, Sofia, Bichovsky, Yoav, Zlotnik, Alexander, Stav, Michael Y., Erez, Offer, and Orbach-Zinger, Sharon
- Subjects
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RED blood cell transfusion , *CESAREAN section , *TRANEXAMIC acid , *BLOOD products , *CRITICAL care medicine , *POSTPARTUM hemorrhage - Abstract
Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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18. Rare Cases of Puerperal Uterine Inversion.
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Singh, Somya, Sharma, Priya, and Gupta, Uma
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POSTPARTUM hemorrhage , *MIDWIVES , *DIFFERENTIAL diagnosis , *BLOOD transfusion , *ABDOMEN , *UTERINE hemorrhage - Abstract
Uterine inversion is a rare event, out of which chronic puerperal uterine inversion is rarest of all, with only handful of cases reported in literature. We reported two such cases of chronic uterine inversion and one case of acute uterine inversion in our practice of 10 years which were promptly diagnosed and managed surgically. Our 1st case was 34 years old p2l2 lady with history of irregular bleeding per vaginum and heaviness in lower abdomen since last 3 months after delivery of her 2nd child, which was delivered at home in absence of trained birth attendant. 2nd case was p1l1 lady which was attended in OPD as a case of irregular uterine bleeding with heaviness in lower abdomen and something coming out per vaginum on straining, she also gave history of history of post-partum hemorrhage after delivery of her baby 5 months back and 1 unit of blood transfusion in some peripheral center. Both these patients were examined, and a differential diagnosis of uterine inversion and cervical polyp was made for which they were investigated, and an USG followed by MRI was done which confirmed the diagnosis of uterine inversion.3rd case was a patient with acute uterine inversion after home delivery were the diagnosis was made clinical. All these patients were immediately taken up for laparotomy and surgical correction was done by Haultain's method and uterus was preserved. [ABSTRACT FROM AUTHOR]
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- 2023
19. Intra-uterine packing: an effective and affordable tool in the management of post-partum hemorrhage - cohort study.
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Halouani, Ahmed, Masmoudi, Yassine, Hammami, Aymen, Abbassi, Hafedh, Triki, Amel, and Amor, Anissa Ben
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POSTPARTUM hemorrhage , *DELIVERY (Obstetrics) , *PATIENT experience , *COHORT analysis , *MIDDLE-income countries , *UTERINE hemorrhage , *FETOFETAL transfusion - Abstract
Introduction: postpartum hemorrhage is the main cause of maternal death worldwide. Uterine balloon packing has shown promising outcomes in PPH management. Nevertheless, its usage is limited in low- and middle-income countries due to associated costs. Uterine packing using gauzes presents a potentially efficient and cost-effective alternative. This study aims to assess the safety and efficacy of intra-uterine packing with gauzes in managing postpartum hemorrhage. Methods: this was a retrospective study over a period of two years and six months. All patients who experienced PPH due to uterine atony during vaginal delivery, with no response to medical first-line treatment, were included. IUP using gauze was employed as a second-line intervention. The primary outcome was the success of postpartum hemorrhage management. Secondary outcomes included patient vitals, the need for blood transfusion, change in hemoglobin levels (delta Hemoglobin), and maternal morbidity (post-partum infection, Sheehan syndrome, and retained gauzes). Results: the study included 63 patients. The mean age was 30.06 ± 5.6, the mean gravida was 2.65 ± 1.9 and the mean para was 2.12 ± 1.31. None of these patients experienced major complications following gauze insertion. Three patients underwent laparotomy and conservative surgical management was performed. Hysterectomy was not required for any participant, and no maternal deaths were recorded. Conclusion: intra uterine packing is a valuable tool in managing postpartum hemorrhage due to uterine atony. [ABSTRACT FROM AUTHOR]
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- 2023
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20. A Case Series of Uterine Arteriovenous Malformations.
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Sarkar, Dipnarayan, Patra, Kajal Kumar, De, Ritam, and Madhwani, Kiahore P.
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ARTERIOVENOUS malformation , *ABORTION , *UTERINE hemorrhage , *JOB absenteeism , *THERAPEUTIC embolization , *DOPPLER ultrasonography - Abstract
Background: Uterine AV malformation is a rare cause of torrential post-abortal hemorrhage, which can present with varying grades of severity. Diagnosis requires a high degree of suspicion and is done with ultrasound and Doppler. Case Series conducted in IPGMER and SSKM Hospital, Kolkata, West Bengal, India during the period April 2020 to December 2022. Ten cases of symptomatic uterine AVMs have been reported. All of them were in the reproductive age group (22-35 years), presenting with a history of miscarriage or termination of pregnancy for which curettage was done. The presentation was with recurrent bouts of torrential bleeding, some triggered by second curettage, and not controllable with regular measures. Diagnosis was by ultrasound-gray scale, color Doppler, and spectral Doppler. On follow-up, all the ten patients are presently free of symptoms. Conclusion: Uterine AV malformation should be thought of as a differential diagnosis in all cases presenting with bleeding after miscarriage or curettage, since diagnosis is simple and treatment by selective arterial embolization saves morbidity of surgery and anesthesia, and more importantly reduces hospital stay and the absence from work. [ABSTRACT FROM AUTHOR]
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- 2023
21. Uterine Artery Embolization – Vascular Emergency
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Kansagra, Kartik, Lam, Cuong H., Chand, Rajat, editor, Eltorai, Adam E. M., editor, Healey, Terrance, editor, and Ahn, Sun, editor
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- 2022
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22. Fibrinogen in Haemorrhage of Delivery (FIDEL)
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- 2020
23. Risk Factors, Management and Complications of Severe Post-partum Hemorrhage (PPH-REG)
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- 2019
24. Just the facts: precipitous deliveries in the emergency department
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Hamelin, Alexandra, Pascali, Dante, and Leppard, Jennifer
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- 2023
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25. The effect of prophylactic use of tranexamic acid for cesarean section.
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Binyamin, Yair, Orbach-Zinger, Sharon, Gruzman, Igor, Frenkel, Amit, Lerman, Sofia, Zlotnik, Alexander, Frank, Dmitry, Ioscovich, Alexander, Erez, Offer, and Heesen, Michael
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CESAREAN section , *TRANEXAMIC acid , *LENGTH of stay in hospitals , *POSTPARTUM hemorrhage , *UMBILICAL cord - Abstract
Aim: Treatment with tranexamic acid (TxA) significantly reduces maternal death due to postpartum hemorrhage. There is increasing interest in whether it can also be used as prophylaxis for postpartum hemorrhage, especially during cesarean sections (CS). This impact study is aimed to determine the effect of routine prophylactic tranexamic acid during CS on maternal hemorrhage and the rate of the associated side effects. Methods: This retrospective population-based cohort single-center impact study include 2000 women who delivered by CS divided into two groups with (n = 1000) and without (n = 1000) prophylactic administration of 1gram TxA prior to surgery. Primary outcomes were to determine the: (1) rate of women experiencing >10% or ≥2 g/dL hemoglobin drop from the preoperative concentration within 24 h after CS. (2) incidence of women having a hemoglobin drop of ≥2 g/dL. Results: Women who did not receive TxA prophylactic had a higher rate of >10% hemoglobin decrease and a higher rate of ≥2 g/dL hemoglobin decrease Than those who received TxA prophylaxis (p < .0001, for both). Mean hospital stay (p = .002) and umbilical cord pH (p < .05) were higher among those who received TxA prophylaxis than in those who were not treated. Conclusions: The finding of our study suggest that prophylactic administration of TxA prior to CS improves maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]
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- 2022
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26. Mild gestational thrombocytopenia in primiparous women, does it affect risk of early postpartum hemorrhage? A retrospective cohort study.
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Rottenstreich, Misgav, Rotema, Reut, Glick, Itamar, Shen, Ori, Grisaru-Granovsky, Sorina, and Sela, Hen Y.
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POSTPARTUM hemorrhage , *PUERPERAL disorders , *BLOOD loss estimation , *THROMBOCYTOPENIA , *PARENTERAL infusions , *BLOOD coagulation disorders , *PERIPARTUM cardiomyopathy - Abstract
Purpose: To assess whether women with mild gestational thrombocytopenia have a higher risk of postpartum hemorrhage Methods: A retrospective computerized database. Primiparous women that delivered at our center (2005–2019) were included; we excluded women with possible etiologies for thrombocytopenia such as systemic lupus or coagulation disorders, and hypertensive disorder of pregnancy. Demographics, obstetric characteristics, and maternal as well as neonatal data were compared between groups. The exposure measure of the study was mild thrombocytopenia (100,000–150,000) versus normal thrombocyte count (>150,000) at admission for labor. Postpartum hemorrhage (PPH) is defined as a clinical estimated blood loss of > 500 mL and/or a hemoglobin drop of 3 g/dl. Results: Overall, 39,886 primiparous met the study’s criteria, 5,209 (13.1%) had mild gestational thrombocytopenia (mean platelet count of 132.4 ± 13.2, study group) while 34,677 (86.9%) had normal platelet count at admission (mean of 221.6 ± 50.6, comparison group.) PPH occurred in 17.6% of the study group as opposed to 14% in the comparison group (p < .001). Similarly, all measures of increased bleeding were more common in the study group as compared to the comparison group, including rates of hemoglobin drop greater than 4 and 5 gram/dl, parenteral iron infusion, and blood products transfusion. On multivariable analysis, the aOR for PPH among women in the study group was 1.23 [1.11–1.36]. Conclusion: Primiparous women with mild gestational thrombocytopenia are at increased risk of peripartum hemorrhage, this should be considered a risk factor when assessing parturients’ risk of PPH. [ABSTRACT FROM AUTHOR]
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- 2022
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27. Effect of heat stable carbetocin vs oxytocin for preventing postpartum haemorrhage on post delivery hemoglobin–a randomized controlled trial.
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Vernekar, Sunil S., Goudar, Swati S., Metgud, Mrityunjay, Pujar, Yeshita V., Somannavar, Manjunath S., Piaggio, Gilda, Carvalho, José Ferreira D. E., Revankar, Amit, Althabe, Fernando, Widmer, Mariana, Gulmezoglu, Ahmet Metin, and Goudar, Shivaprasad S.
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POSTPARTUM hemorrhage , *OXYTOCIN , *INDUCED labor (Obstetrics) , *DELIVERY (Obstetrics) , *INTRAMUSCULAR injections , *RANDOMIZED controlled trials - Abstract
Objective To compare the effect of heat-stable carbetocin 100 μg IM versus oxytocin 10 IU IM on post-delivery hemoglobin level. Setting Hospital based study in Southern India. Population Women delivering vaginally who were enrolled in the WHO CHAMPION trial in a single facility in India. WHO CHAMPION Trial was a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin with oxytocin administered immediately after vaginal birth in women across 23 sites in 10 countries. Methods This was a nested randomized controlled trial designed to compare the effect of heat-stable carbetocin 100 μg IM versus oxytocin 10 IU IM, administered within one minute of vaginal delivery of the baby for prevention of postpartum hemorrhage, on post-delivery 48–72 h hemoglobin level, adjusted for pre-delivery hemoglobin level. 1,799 women from one hospital in India participated in this study. Results Pre-delivery hemoglobin and postpartum blood loss were not significantly different between carbetocin and oxytocin. Post-delivery hemoglobin, unadjusted or adjusted for pre-delivery hemoglobin, was slightly lower for carbetocin (10.09 g/dL) compared to oxytocin (10.21) (p value of 0.0432). The drop in hemoglobin was slightly higher for carbetocin, although the difference was very small (1.2 g/dL for carbetocin, 1.1 g/dL for oxytocin) (p value of .0786). The proportion of participants with a drop in hemoglobin of 2 g/dL or more, adjusted for pre-delivery hemoglobin, was higher for carbetocin (RR = 1.29, 95% CI 1.02–1.63). From the regression coefficients it can be derived that post-delivery hemoglobin, adjusted for pre-delivery hemoglobin, decreases on average 0.12 g/dL for each dL of blood lost, for the two treatments combined. Conclusion The present ancillary study showed that intramuscular administration of 100 µg of heat stable carbetocin can result in a slightly lower post-delivery hemoglobin, slightly higher drop and higher percentage of women having a drop of 2 g/dL or larger, compared to 10 IU of oxytocin. [ABSTRACT FROM AUTHOR]
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- 2022
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28. Uterine arteriovenous malformation (UAVM) as a rare cause of postpartum hemorrhage (PPH): a literature review.
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Salmeri, Noemi, Papale, Margherita, Montresor, Cristina, Candiani, Massimo, and Garavaglia, Elisabetta
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Purpose: Uterine arteriovenous malformations (UAVM) are rare vascular lesions characterized by an abnormal arteriovenous communication between the branches of uterine artery and the myometrial venous plexus. UAVM can be a serious cause of massive post-partum hemorrhage (PPH) leading to potentially life-threatening anemic shock. This review aims to summarize main experiences on clinical presentation and management of UAVM in the setting of unexplained PPH. Methods: A systematic review of the literature in Scopus, PubMed and MEDLINE was conducted. A case report of a PPH UAVM-related in a patient managed at the authors' center is also provided. Results: Eleven studies met the inclusion criteria. The mean age of cases was 30. In 3/11 cases, previous uterine surgeries were reported and 72.7% cases gave birth by cesarean section. Nine cases had a secondary PPH (24 h up to 12 week post-partum), whereas only one case had a primary PPH. Our case report had both a primary and a secondary PPH. Reported vaginal bleedings were profuse and blood loss entity ranged from 1000 to 2000 ml. In all cases a color Doppler ultrasound was performed first to suspect UAVM and in 10/11 cases a subsequent pelvic angiography confirmed the diagnosis of UAVM as leading cause of the unexplained PPH. In 81.8% cases a conservative management by uterine artery embolization (UAE) was adopted: bilateral UAE was always successful; in 1 out of 2 cases treated by unilateral UEA, emergency total hysterectomy was performed for a sudden hemodynamic instability. Conclusion: Maternal mortality pregnancy-correlated is a major health concern worldwide, mostly due by PPH. UAVM should be considered in clinical practice among possible causes of unexplained PPH. [ABSTRACT FROM AUTHOR]
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- 2022
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29. The Promise of the New Educational Strategy for Curriculum Development (SPICES) Model on the Development of Students’ Clinical Reasoning Ability. A Comparative Cross-Sectional Study
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Misganaw E, Yigzaw T, Tezera R, Gelitew A, and Gedamu S
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clinical reasoning skills ,ethiopia ,midwifery ,post-partum hemorrhage ,spices model curriculum ,Special aspects of education ,LC8-6691 ,Medicine (General) ,R5-920 - Abstract
Equlinet Misganaw,1 Tegbar Yigzaw,2 Robel Tezera,3 Awoke Gelitew,4 Shewatatek Gedamu5 1CIHLMU Center for International Health, University Hospital, LMU Munich, Munich, Germany; 2Jhpiego – Ethiopia, Addis Ababa, 1250, Ethiopia; 3Addis Ababa University, College of Medicine and Health Science, Addis Ababa, Ethiopia; 4Debre-Tabor University, College of Medicine and Health Science, Debre-Tabor, Ethiopia; 5Jimma University, Institute of Health Sciences, Jimma, EthiopiaCorrespondence: Equlinet Misganaw Tel +251 913173351Email equlinetm@gmail.comIntroduction: Clinical reasoning skills are a core competency that must be taught at all levels of health-care education. In the last decade, several health professional education curricula in Ethiopia have been redesigned with the goal of improving student competence in key health-care delivery skills. Despite the fact that some academic programs followed the conventional educational strategy, a significant number of academic programs adopted a new educational strategy for curriculum development: Student-centered, Problem-based, Integrated, Community-based, Elective, and Systematic (SPICES) model. More empirical evidence, however, is required to determine whether the new curricular approach is effective in improving students’ clinical reasoning. The purpose of this study is to determine whether the new educational strategy for curriculum development improves the clinical reasoning ability of midwifery students when compared to a peer institution that follows a traditional curriculum.Methods: A comparative cross-sectional study was conducted to compare the clinical reasoning skills of midwifery students who completed the new curricular approach versus students who completed a traditional curriculum. A Script Concordance Test (SCT) was used to collect data. The mean SCT score and an independent two-sample t-test were calculated to see if the two groups differed significantly in terms of clinical reasoning skills in managing Post-Partum hemorrhage (PPH).Results: A total of 77 final-year midwifery students participated (38 from the new and 39 from the traditional curriculum approach). Midwifery students who completed the new and conventional curriculum approaches had mean clinical reasoning SCT scores of 0.7 (SD = 0.35) and 0.53 (SD = 0.37), respectively. There was a statistically significant difference in the overall mean SCT score between the two study groups in terms of clinical reasoning skills (p = 0.008).Conclusion: Our study found that the new SPICES model curricular approach is promising in fostering the development of clinical reasoning skills of Midwifery students in managing PPH.Keywords: clinical reasoning skills, Ethiopia, midwifery, post-partum hemorrhage, SPICES model Curriculum
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- 2022
30. Prophylactic Administration of Tranexamic Acid Reduces Blood Products’ Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections
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Yair Binyamin, Amit Frenkel, Igor Gruzman, Sofia Lerman, Yoav Bichovsky, Alexander Zlotnik, Michael Y. Stav, Offer Erez, and Sharon Orbach-Zinger
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tranexamic acid ,cesarean section ,post-partum hemorrhage ,prevention ,hemoglobin ,hysterectomy ,Medicine - Abstract
Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.
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- 2023
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31. Impact of waterbirth on post-partum hemorrhage, genital trauma, retained placenta and shoulder dystocia: A systematic review and meta-analysis.
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Cristina, Taliento, Mara, Tormen, Arianna, Sabattini, Gennaro, Scutiero, Rosaria, Cappadona, and Pantaleo, Greco
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POSTPARTUM hemorrhage , *SHOULDER dystocia , *UNDERWATER childbirth , *PLACENTA , *PREGNANCY complications , *WATER immersion , *CHILDBIRTH , *META-analysis , *PLACENTA diseases , *GENITALIA , *SYSTEMATIC reviews , *PUERPERIUM , *LABOR complications (Obstetrics) - Abstract
Background: There is insufficient high-quality evidence to either support or discourage water birth (WB).Objectives: To examine different maternal complications of WB compared to standard land birth (LB). The primary outcomes were postpartum hemorrhage and genital trauma. The secondary outcome included the risk of retained placenta and shoulder dystocia.Methods: We searched the electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO. In addition, we searched in Google Scholar and ClinicalTrials.gov. The pooled results were used to evaluate the association between WB and obstetric outcomes. This systematic review (SR) was reported according to PRISMA statement 2020. Statistical meta-analyses were performed using Cochrane RevMan version 5.4 software (http://www.cochrane.org).Results: This systematic review included 22 studies (20 observational studies and 2 RCT). The pooled results showed lower risk of major PPH compared to the LB group (OR = 0.76, 95% CI: 0.66-0.89), no significant difference (OR: 0.94, 95% CI: 0.50-1.78) in the incidence of minor PPH (500-1000 mL blood loss) between WB and LB, no significant difference in the rate of third- and fourth-degree lacerations (OR = 0.87, 95% CI: 0.71-1.07) and in the incidence of retained placenta (OR = 1.30, 95% CI: 0.50-3,35), fewer shoulder dystocia for WB (OR = 0.42, 95% CI: 0.35-0.50). However, compared with the LB group, the rate of first-second-degree tears in the WB group increased by 45% (OR = 1.45, 95% CI: 1.16-1.81).Conclusion: We support ACOG guidelines recommendation for further RCT to assess the impact of water immersion during delivery on maternal outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2022
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32. ECMO for TACO Secondary to Massive Post-Cesarean Section Hemorrhage.
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Tafesse, Hanan, Shanmugam, Geetha, Long, Beverly, BuAbbud, Anna, Aziz, Salim, and Parr, K. Gage
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- 2022
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33. Combined Use of Misoprostol Plus Oxytocin versus Oxytocin Alone to Reduce Blood Loss during Cesarean Section.
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Amin Ibrahim, Ragab Alsayed
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CESAREAN section , *MISOPROSTOL , *OXYTOCIN , *BLOOD loss estimation , *POSTPARTUM hemorrhage - Abstract
Background: Misoprostol is thought to present several improvements over oxytocin for preventing and treating of PostPartum Hemorrhage (PPH). Objective: This study aimed to evaluate the efficacy of oxytocin alone versus combination of oxytocin–misoprostol in preventing excessive blood loss after caesarean section. Subjects and Methods: One hundred and two women were included in this study who were attending the Obstetrics and Gynecology Departments, Zagazig University Hospitals and Benha Teaching Hospital. Misoprostol 200 mcg sublingually and oxytocin 5 IU bolus intravenously were administered to 51 patients. The other 51 cases received 5 IU bolus intravenous oxytocin followed by I.V drip of 15 units' oxytocin in 500 mL of Ringer lactate solution over 1 hour. Results: There was a statistically significant difference between the misoprostol oxytocin group and the oxytocin group in terms of the requirement for more uterotonics, need for uterine massage, and the uterine tone score following therapy. Conclusion: There was no significant difference in estimated blood loss between the groups that received either oxytocin alone or a low dosage of misoprostol. However, the misoprostol-oxytocin group required more uterotonic and uterine massage during Caesarean section than the oxytocin group. [ABSTRACT FROM AUTHOR]
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- 2022
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34. Uterine inversion in retained placenta, that's why a good management of third stage of labor matters: A case report.
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Marlina D, Susandi D, and Utomo A
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Uterine inversion is characterized by the folding of the fundus into the uterine cavity. While infrequent, it ranks among the most serious complications of childbirth, posing a significant risk of mortality primarily due to hemorrhage and shock. Retained placenta after vaginal delivery is diagnosed when placenta does not spontaneously deliver within 18-60 min. Manual placenta can be considered first if retained placenta occurs. A 29-year-old woman with parity status P2A0 came to maternal emergency referred from the first health care provider with severe post-partum hemorrhage after delivering her second living 3100 g baby 2 h before admission. The midwife reported that the placenta was hard to have. There was a resistance felt inside when she tried to do umbilical cord traction. The manual placenta was not done. After several trials, the placenta finally came out, followed by fundus of uterine. Acute hemorrhage occurred, causing a decrease of hemoglobin level to 7.8 g/dl. At maternal emergency, the placenta delivered spontaneously yet the fundus still inverted. Fast reposition of uterine done by doctor on duty to stop the hemorrhage. Following successful repositioning and 4 days of observation, the patient was discharged from the hospital with no signs of hemorrhage and favorable results on abdominal ultrasonography., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)
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- 2024
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35. Approaches to the Prevention and Treatment of Postpartum Hemorrhage: A Systematic Review of Past Advances, Recent Developments, and Best Practices.
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Sadiku OD, Aina SA, Odoemene CC, Ogunmoyin TE, Adedara VO, Olasimbo O, Ashir FA, Adili SC, Kuteyi AO, Fakayode OO, Faletti DO, and Nogales Bernal MB
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Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, with uterine atony being the most significant contributing factor. Other risk factors for PPH include increased maternal age, coagulation abnormalities, retained placenta, and prolonged third-stage labor. Despite the potential for prevention through early detection and management, PPH can still occur even in the absence of known risk factors. For this reason, adequate preparation and comprehensive management strategies must be implemented. This study, which comprises research from 2006 to 2023, reviews and analyzes various prevention and management techniques for PPH, including surgical and nonsurgical approaches. Key findings indicate that the presence of well-trained critical control teams is essential for the effective management of PPH. In addition, early detection techniques have significantly reduced mortality outcomes associated with PPH, highlighting their importance in patient care., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sadiku et al.)
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- 2024
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36. Intravenous Tranexamic acid versus placebo during Caesarian section: A comparative study.
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Iqbal, Muhammad Jawad, Mazhar, Atifa, and Shabir, Alina
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TRANEXAMIC acid , *SURGICAL blood loss , *CESAREAN section , *POSTPARTUM hemorrhage , *UTERINE artery , *PLACEBOS - Abstract
Objectives: To evaluate the effectiveness of Tranexamic Acid in preventing postpartum hemorrhage against placebo in high-risk women undergoing cesarean section. Methods: A double-blinded placebo-controlled comparative trial was conducted at the Obstetrics and Gynecology Department of Nishtar Hospital for one year, from 15th June 2020 to 15th June 2021. A total of 60 women who were at high risk of postpartum hemorrhage and had to undergo elective cesarean sections were included in the study. Among them, initial 30 patients were administered Tranexamic Acid before skin incision whereas later 30 were treated as the placebo group. These women were then observed for blood loss during surgery and within 24 hrs. after surgery and any postoperative complications such as thromboembolic events, the need for additional uterotonic agents, and blood transfusions. Results: Out of 60 women, 30 were placed in each group. The groups had no significant difference in terms of baseline data and post-partum hemorrhage-associated risk factors (p>0.05). However, the occurrence rate of primary post-partum hemorrhage (blood loss greater than 1000 ml) was significantly less in a tranexamic acid group than the placebo group (16.6% vs 60%, respectively, p<0.01). Similarly, the requirement of additional uterotonic agents (13.3% vs 43.3%, respectively) and the need for blood transfusion (6.0% vs 23.3%, respectively) was lower in a tranexamic group than in the placebo group. Conclusion: The study highlighted the significance of tranexamic acid in controlling post-partum hemorrhages, the requirement of additional uterotonic agents, improving post-partum hemoglobin, and the need for blood transfusion. [ABSTRACT FROM AUTHOR]
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- 2022
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37. Placenta accreta. A review of current anesthetic considerations.
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Fiszer, Elisheva and Weiniger, Carolyn F.
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Placenta accreta spectrum (PAS) is a potentially life-threatening disorder with unique anesthetic challenges, and its incidence has increased over the past decades. We review current guidelines and best practice evidence for antenatal diagnosis and preoperative evaluation, management pathways, multidisciplinary staff coordination, and surgery location. We address specific considerations for choice of anesthesia modality, the role of interventional radiology, and various techniques for minimizing hemorrhage for both planned and unplanned cases, as well as postoperative care for the PAS patient. [ABSTRACT FROM AUTHOR]
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- 2022
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38. University of Technology Researcher Advances Knowledge in Postpartum Hemorrhage (Management of Postpartum Hemorrhage in Humanitarian Settings Using Heat-Stable Carbetocin and Tranexamic Acid).
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- 2024
39. New Postpartum Hemorrhage Research from Leiden University Medical Center Discussed (Thromboembolic events in severe postpartum hemorrhage treated with recombinant activated factor VII: a systematic literature review and meta-analysis).
- Abstract
A recent report from Leiden University Medical Center discusses the use of recombinant activated factor VII (rFVIIa) in the treatment of severe postpartum hemorrhage (PPH). The researchers conducted a systematic literature review and meta-analysis to assess the incidence of thromboembolic events (TEs) in women with PPH treated with rFVIIa compared to those not treated with it. The analysis included 55 publications reporting on 611 women treated with rFVIIa and 32,488 women not treated with it. The estimated proportions of TEs were small and similar between the two groups, indicating a need for further well-designed trials to better understand TE incidence in PPH. [Extracted from the article]
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- 2024
40. Study Results from Oregon Health & Science University (OHSU) Provide New Insights into Postpartum Hemorrhage (Third Stage of Labor: Evidence-based Practice for Prevention of Adverse Maternal and Neonatal Outcomes).
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A study conducted by Oregon Health & Science University (OHSU) provides new insights into postpartum hemorrhage, a common complication of the third stage of labor. The study examines various interventions to prevent postpartum hemorrhage and promote maternal and neonatal health. The researchers recommend the use of effective pharmacologic postpartum hemorrhage prophylaxis, delayed cord clamping, early skin-to-skin contact, and controlled cord traction at delivery. They also suggest replacing the term "active management of the third stage of labor" with "third stage care" to emphasize evidence-based interventions that prioritize the safety and well-being of both the woman and neonate. [Extracted from the article]
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- 2024
41. Research in the Area of Postpartum Hemorrhage Reported from Northwest Women and Children's Hospital (Plasmin-a2-plasmin inhibitor complex and thrombin-antithrombin complex in risk stratification of massive transfusion in patients with...).
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A recent study conducted at Northwest Women and Children's Hospital in Xi'an, China, examined the use of plasmin-a2-plasmin inhibitor complex (PIC) and thrombin-antithrombin complex (TAT) in predicting the need for massive transfusion (MT) in patients with postpartum hemorrhage (PPH). The study found that elevated levels of TAT and PIC were independent predictors of MT in PPH patients. The combined use of TAT and PIC was more effective in predicting the need for MT than using either marker alone. These findings suggest that TAT and PIC levels could be useful in risk stratification and management of PPH. [Extracted from the article]
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- 2024
42. Researcher at Department of Anaesthesiology and Critical Care Discusses Research in Postpartum Hemorrhage (Comparison of Carbetocin and Oxytocin Efficacy in Preventing Postpartum Hemorrhage after C-Section).
- Abstract
A report discusses research on postpartum hemorrhage (PPH), which is defined as excessive blood loss after childbirth. PPH is a major cause of maternal morbidity and mortality in low- and middle-income countries. The study compared the effectiveness of two drugs, carbetocin and oxytocin, in preventing PPH in women undergoing elective cesarean sections. The results showed that carbetocin was more effective in reducing blood loss and maintaining hemoglobin and hematocrit levels compared to oxytocin. The study suggests that carbetocin may be a better option for preventing PPH in these patients. [Extracted from the article]
- Published
- 2024
43. Study Results from Massachusetts General Hospital in the Area of Selective Serotonin Reuptake Inhibitors Reported (The Risk of Postpartum Hemorrhage With Selective Serotonin Reuptake Inhibitors and Serotonin Norepinephrine Reuptake Inhibitors:...).
- Abstract
A study conducted by Massachusetts General Hospital examined the association between the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) during late pregnancy and the risk of postpartum hemorrhage (PPH). The study analyzed data from the National Pregnancy Registry for Psychiatric Medications and found that overall, SSRI/SNRI exposure was associated with a slightly increased risk of PPH. The risk was higher for women who underwent cesarean section delivery compared to vaginal delivery. However, the study was underpowered to draw definitive conclusions, highlighting the need for further research with larger sample sizes. The findings emphasize the importance of increased clinical monitoring for PPH following cesarean section, particularly in women with other known risk factors for PPH who are exposed to SSRIs/SNRIs during late pregnancy. [Extracted from the article]
- Published
- 2024
44. New Von Willebrand Disease Research from University Medical Center Utrecht Discussed (Primary postpartum hemorrhage in women with von Willebrand disease and carriers of hemophilia: a retrospective analysis).
- Abstract
A recent report from the University Medical Center Utrecht in the Netherlands discusses new research on von Willebrand disease (VWD) and carriers of hemophilia. The study found that the incidence of severe primary postpartum hemorrhage (PPH) in Dutch women with VWD and hemophilia carriers was 8%, compared to 4.5% in the general population. The research also found that the risk of severe primary PPH in women with VWD and hemophilia carriers remained stable and comparable to the increasing prevalence in the general population. Further research is needed to determine the optimal pregnancy management strategy for safe delivery in these individuals. [Extracted from the article]
- Published
- 2024
45. Researchers from Nanjing Medical University Report Recent Findings in Postpartum Hemorrhage (Risk Factors for Postpartum Hemorrhage In Severe Pre-eclampsia: a Retrospective Single-centre Study of 1953 Cases).
- Abstract
A recent study conducted by researchers from Nanjing Medical University in China examined the risk factors for postpartum hemorrhage (PPH) in women with severe pre-eclampsia (sPE). The study included 1953 women with sPE who delivered at the Women's Hospital of Nanjing Medical University between April 2015 and April 2023. The results showed that twin pregnancy, placenta accreta spectrum disorders, and placenta previa were independent risk factors for PPH in women with sPE. Spinal anesthesia was found to reduce the risk of PPH in cesarean deliveries, while magnesium sulfate reduced the incidence of PPH in vaginal deliveries. The researchers concluded that magnesium sulfate should be used aggressively in women with sPE, but further investigation is needed to understand its relationship with PPH risk. [Extracted from the article]
- Published
- 2024
46. Researcher from Korea University Guro Hospital Provides Details of New Studies and Findings in the Area of Attention Deficit Hyperactivity Disorders (Association between uterine artery embolization for postpartum hemorrhage and second delivery...).
- Abstract
A recent study conducted in South Korea investigated the maternal and neonatal outcomes of second deliveries in women who had undergone uterine artery embolization (UAE) during their first delivery. The study found that women who had UAE during their first delivery had higher risks of placental problems, preterm births, and postpartum hemorrhage in their second delivery. Additionally, their second offspring had an increased risk of major congenital malformations and adverse neonatal outcomes. The study suggests that women with a history of UAE require careful prenatal care and monitoring during subsequent deliveries. Further research is needed to understand the mechanisms of complications and improve UAE procedures. [Extracted from the article]
- Published
- 2024
47. Reports Summarize Postpartum Hemorrhage Study Results from George Washington University (Oxygen Saturation During a Cesarean Identified Patients At Risk for Postpartum Hemorrhage).
- Abstract
A study conducted at George Washington University examined the use of noninvasive hemoglobin (SpHb) measurement during cesarean deliveries to identify patients at risk for postpartum hemorrhage (PPH). The study found that a decrease in SpHb was associated with an increased risk of PPH, while pre- and postoperative SpHb measurements were positively related to hemoglobin levels. Continuous SpHb measurements during surgery may allow for earlier recognition of PPH and prevent unnecessary blood transfusions. The study suggests that SpHb measurements are reflective of hemoglobin levels and could be a useful tool in PPH management. [Extracted from the article]
- Published
- 2024
48. Medical City Researcher Adds New Findings in the Area of Postpartum Hemorrhage (A Meta-analysis on the Comparison of Carbetocin Versus Oxytocin on Additional Uterotonic Use, Incidence of Postpartum Hemorrhage, and Need for Blood Transfusion...).
- Abstract
A recent study conducted in Pasig City, Philippines, compared the effectiveness of carbetocin and oxytocin in preventing postpartum hemorrhage (PPH). The study found that carbetocin showed statistically significant protection against the need for additional uterotonic administration and the need for blood transfusion. However, there was no statistically significant difference in the reduction of PPH between the two drugs. This research provides valuable insights into the prevention of PPH and may inform medical practices in the future. [Extracted from the article]
- Published
- 2024
49. Reports on Postpartum Hemorrhage from Columbia University Provide New Insights (Postpartum Hemorrhage After Vaginal Delivery Is Associated With a Decrease In Immediate Breastfeeding Success).
- Abstract
A report from Columbia University discusses the impact of postpartum hemorrhage (PPH) on breastfeeding success after vaginal delivery. The study found that women who experienced PPH had fewer breastfeeding sessions on average and required more time at each session. Additionally, neonates of women with PPH had a higher percentage of weight loss in the first few days of life. The researchers suggest that women who experience PPH may require additional support for successful breastfeeding initiation. Further research is needed to understand the mechanism behind this association. [Extracted from the article]
- Published
- 2024
50. Makerere University Researchers Focus on Postpartum Hemorrhage (Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and...).
- Abstract
A recent study conducted by researchers at Makerere University in Uganda explored the use of medicinal plants by pregnant women in rural areas for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. The study found that 90% of women in both rural and urban areas of Uganda use plants to manage pregnancy symptoms and postpartum complications. The researchers documented 104 plant species commonly used, with the most cited plants being Hoslundia opposita, Phytolacca dodecandra, and Commelina erecta. The study highlights the need to integrate herbal medicine into healthcare systems in Uganda to address the high rates of maternal mortality and morbidity. [Extracted from the article]
- Published
- 2024
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