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Background: No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment. Methods: This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26). Results: Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p < 0.001, respectively). Conversely, initial heart rate and body temperature were significantly lower in group 2 (92.5 ± 21.0 vs. 109.0 ± 28.1 beat/min, p < 0.001, and 37.3 ± 0.8 °C vs. 37.0 ± 0.9 °C, p = 0.011, respectively). Logistic regression analysis identified low initial body temperature, high lactic acid level, and shock index as independent predictors of surgical intervention (p = 0.029, p = 0.027, and p = 0.049, respectively). Regarding the causes of PPH, tone was significantly more prevalent in group 1 (57.2% vs. 35.2%, p = 0.002), whereas trauma was significantly more prevalent in group 2 (24.5% vs. 39.4%, p = 0.030). Group 2 had worse overall outcomes and prognoses than group 1. The subgroup analysis showed significantly higher rates of uterine atony combined with other causes, hysterectomy, and disseminated intravascular coagulopathy in the delayed surgical intervention group than the immediate surgical intervention group (42.2% vs. 69.2%, p = 0.027; 51.1% vs. 73.1%, p = 0.049; and 17.8% vs. 46.2%, p = 0.018, respectively). Conclusions: Patients with PPH presenting with increased lactic acid levels and shock index and decreased body temperature may be surgical candidates. Additionally, immediate surgical intervention in patients with uterine atony combined with other causes of PPH could improve prognosis and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Background No standard treatment guidelines have been established for postpartum hemorrhage (PPH). We aimed to assess the differences in outcomes and prognoses between patients with PPH who underwent surgical and non-surgical treatment. Methods This retrospective study included 230 patients diagnosed with PPH at two referral hospitals between August 2013 and October 2023. The patients were divided into non-surgical (group 1, n = 159) and surgical intervention groups (group 2, n = 71). A subgroup analysis was performed by dividing the surgical intervention group into immediate (n = 45) and delayed surgical intervention groups (n = 26). Results Initial lactic acid levels and shock index were significantly higher in group 2 (2.85 ± 1.37 vs. 4.54 ± 3.63 mmol/L, p = 0.001, and 0.83 ± 0.26 vs. 1.10 ± 0.51, p

Introduction: Postpartum hemorrhage is one of the main causes of morbidity and mortality in pregnant mothers in the world. Uterine atony is the most common cause of early postpartum hemorrhage. Considering the positive effect of calcium on uterine contraction, hypocalcemia may play a role in uterine atony. This study was conducted with aim to investigate the relationship between total calcium level and uterine atony following vaginal delivery. Methods: This prospective cohort study was conducted on 619 pregnant mothers with full- term singleton pregnancy with cephalic presentations that had referred to Qazvin Kowsar Hospital in 2022 for termination of pregnancy. 5 cc blood samples were taken from all mothers to determine total calcium levels. After delivery, atonic and non-atonic mothers were evaluated in terms of calcium levels. Data analysis was done using SPSS statistical software (version 24). P<0.05 was considered significant. Results: In this study, 45 women (7.3%) had uterine atony. The mean calcium level of mothers with uterine atony was 8.2±0.37 and non-atony mothers was 8.9±0.37 mg/dL (p<0.001). Also, 39 person (86.7%) of mothers with uterine atony had hypocalcemia (calcium level less than 8.5), while this rate was 9.9% in non-atony mothers and this difference was significant (p<0.001). Conclusion: In the present study, the calcium level of mothers with uterine atony was lower than non-atony mothers. Therefore, measuring calcium levels can be useful for predicting uterine atony. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasonography (POCUS) is a key tool in critical care, including obstetric patients in intensive care units (ICUs). Point-of-care ultrasonography can aid in pregnancy diagnosis, fetal assessment, and detection of complications. This case study is based on a 39-year-old pregnant woman, admitted to critical care for preeclampsia. After cesarean delivery, the patient experienced decreased hematocrit levels, renal dysfunction, and uterine tenderness. The POCUS demonstrated uterine atony (inability of the uterus to contract after childbirth), leading to exploratory surgery that confirmed a Couvelaire uterus (CU). Hysterectomy was performed, and histology showed necrosis and bleeding. Couvelaire uterus is a rare complication of placental abruption, caused by placental vascular damage and uterine bleeding. Conservative management and uterine contraction-stimulating drugs are typically used to treat CU. In this case, POCUS provided real-time data for the diagnosis of this obstetric emergency and perhaps other conditions. This report underscores the significance of surveillance and prompt intervention to prevent adverse outcomes for both mothers and infants. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage (PPH) represents one of the principal causes of maternal mortality and morbidity worldwide. Uterine balloon tamponade (UBT) is recommended for the treatment of postpartum hemorrhage due to uterine atony in women who do not respond to pharmacological first-line treatment. The success of UBT in bleeding control is related to the correct positioning of the device, since incorrect insertion can be associated with ineffectiveness and requires time-consuming repositioning maneuvers, with a further increase in blood loss. The use of ultrasound (US) during UBT may increase the success rate by preventing wrong positioning. This study aims to demonstrate the role of US guidance during UBT and to assess whether US guidance can ease positioning and reduce insertion times, preventing additional repositioning maneuvers, in comparison with a US check carried out after balloon insertion. Methods: This was a retrospective study including 370 women who underwent vaginal delivery, had PPH caused by uterine atony and required UBT at Sant'Anna Hospital from 2015 to 2019. The exclusion criteria were an abnormal placental site, vaginal or cervical trauma, coagulation defects, uterine anomalies, previous postpartum hemorrhage and previous caesarean section. Included subjects were divided into two groups: the US-guided group (n = 200) underwent Bakri balloon positioning under US guidance, and the non-guided group (n = 170) received a US check only after balloon insertion. The primary outcome was the success rate of the procedure, expressed as the percentage of cases with bleeding control without the need for balloon repositioning; the secondary outcomes were the length of the procedure and some parameters related to blood loss. Results: The success rate was 99% for the US-guided group vs. 86% for the non-guided group. None of the patients required hysterectomy. In the US-guided group with respect to the non-guided group, we observed a significant reduction in blood loss (1100 ± 450 vs. 1500 ± 600 mL; p < 0.001), Δhemoglobin level (1.8 ± 1.1 vs. 2.7 ± 2.0 g/dL, p < 0.001) and time required for the procedure (8 vs. 13 min, p < 0.001). Conclusions: Our data suggest that the use of US guidance for placement of UBT was associated with reduced need for balloon repositioning, lower blood loss, and faster resolution of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Ninety percent of maternal deaths are attributed to postpartum hemorrhage, with 50% being preventable. Annually, University of Mississippi Medical Center staff have more than 20,000 obstetrical encounters and deliver thousands of infants, with ∼75% being high-risk. The mother/baby unit, 3 Wiser, experienced two postpartum hemorrhages in August 2022. Post-event debriefings revealed opportunities for improvement. This project aimed to promote evidence-based practices regarding the prevention and management of postpartum hemorrhage in 3 Wiser. Methods: The project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System together with the Getting Research into Practice audit and feedback strategy. Four evidence-based practices were selected as audit criteria. After baseline audits were conducted, strategies to improve compliance with evidence-based practices were implemented. Finally, a follow-up audit was conducted, and the results of both audits were compared. Results: The baseline audits revealed 84% average compliance with the four evidence-based practices. Strategies to improve compliance included a simulation for nursing staff with a review of postpartum hemorrhage policies and skills. The post-implementation audit revealed 98% average compliance with the four evidence-based practices, a 14% increase from the baseline audit. Conclusions: This evidence implementation project utilized a clinical audit process, which led to improvements in practice related to the prevention and management of postpartum hemorrhage in the inpatient postpartum unit. [ABSTRACT FROM AUTHOR]

Objective: To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. Methods: This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. Results: Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. Conclusion: Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high‐risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH. Synopsis: Abnormal placentation is the primary indication for peripartum hysterectomy. Prenatal prevention, intrapartum monitoring, and timely control of postpartum hemorrhage are important in peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between stages of labour and the risk of postpartum haemorrhage (PPH) and provide evidence for clinical application. Material and methods: Manual searches were undertaken, and computer searches of PubMed, MEDLINE, Web of Science, CNKI, Wanfang and Wipu databases with a search window from database creation to April 2022 were conducted to procure relevant studies on the relationship between labour phase and PPH. The articles included in this study were evaluated for quality, and RevMan 5.3 software was used for meta-analysis. Results: Meta-analysis showed that the incidence of PPH in women with weak uterine contractions was 27.5%, compared with 18.1% in women with normal contractions [relative risk (RR) = 1.60; 95% confidence interval (CI) 1.38, 1.85; p < 0.01]. There was a statistically significant difference in the incidence of PPH in pregnant women with a prolonged second stage of labour (≥ 2 h) (34.5%) compared with those whose second stage of labour was normal in duration (15.9%) (RR = 0.20; 95% CI 0.15, 0.25; p < 0.01). The incidence of PPH was 52.1% in pregnant women with a prolonged third stage of labour (≥ 15 min) compared with 20.9% in those whose third stage of labour was of normal duration (RR = 3.53; 95% CI 2.75, 4.52; p < 0.01). The difference in the incidence of a prolonged third stage of labour in pregnant women with weak contractions compared with those with normal contractions was statistically significant (72.3% vs 15.5%) (RR = 0.47; 95% CI 0.35, 0.60; p < 0.01). Conclusions: Duration of labour is associated with the development of PPH, and the risk of PPH is increased in women with weak contractions or with a prolonged second or third stage of labour. [ABSTRACT FROM AUTHOR]

Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage remains a major cause of maternal mortality and morbidity worldwide with higher rates found in resource-challenged countries. Conventional use of uterotonics such as oxytocin, prostaglandins, and medications to support coagulation, such as fibrinogen and tranexamic acid, are helpful but may not be sufficient to arrest life-threatening postpartum hemorrhage. Severe postpartum hemorrhage leads to an increased need for blood transfusions and the use of invasive techniques, such as intrauterine balloon tamponade, compression sutures, and arterial ligation, as advanced steps in the management cascade. In extreme cases where hemorrhage is resistant to these therapies, a hysterectomy may be necessary to avoid possible maternal death. Uterine packing with a chitosan-covered tamponade is an emerging tool in the armamentarium of the obstetrical team, especially when resources for advance surgical and other invasive options may be limited. Modified chitosan-impregnated gauze was originally described in the management of acute hemorrhage in the field of military medicine, combining the physiological antihemorrhaging effect of modified chitosan with a compression tamponade for the acute treatment of wound bleeding. The first described use in obstetrics was in 2012, showing that the chitosan-covered tamponade is an effective intervention to arrest ongoing therapy-resistant postpartum hemorrhage. Further studies showed a reduction in hysterectomies and blood transfusions. The method is, however, underreported and is not yet an established method used worldwide. To demonstrate the step-by-step application of the intrauterine chitosan-covered tamponade in the management of therapy-resistant postpartum hemorrhage, we have produced a teaching video to illustrate the important steps and techniques to optimize the effectiveness and safety of this novel intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R).

Background: Intractable postpartum hemorrhage (PPH) during cesarean section has been a significant concern for obstetricians. We aimed to explore the effectiveness and safety of a new type of uterine compression suture, the step-wise surgical technique of knapsack-like sutures for treating intractable PPH caused by uterine atony and placenta factors in cesarean section. Methods: The step-wise surgical technique of knapsack-like sutures was established on the basis of the artful combination of vertical strap-like sutures and an annular suture-ligation technique. This novel surgical technique was applied to 34 patients diagnosed with PPH during cesarean section due to severe uterine atony and placental factors in our department. The hemostatic effects, clinical outcomes and follow-up visit results were all reviewed and analyzed. Results: This new uterine compression suture successfully stopped bleeding in 33 patients, and the effective rate was 97.06%. Only 1 patient failed and was changed to use bilateral uterine arterial embolization and internal iliac artery embolization. The follow-up visits indicated that 33 patients restored menstruation except for 1 who was diagnosed with amenorrhea. The gynecological ultrasound tests of all the patients suggested good uterine involutions, and they had no obvious complaints such as hypogastralgia. Conclusions: This step-wise surgical technique of knapsack-like uterine compression sutures can compress the uterus completely. It is a technique that can conserve the uterus and fertility function without special equipment in caesarean section for PPH, with the characteristics of being safe, simple and stable (3 S) with rapid surgery, reliable hemostasis and resident doctor to operation (3R). [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of peripartum hysterectomy (PH) in Slovakia. Additionally, we wanted to describe reasons for the procedure, associated clinical circumstances, and complications. Methods: This was a descriptive, population‐based study among women who underwent PH in Slovakia between January 2012 and December 2020. Peripartum hysterectomy was defined as surgical removal of the uterus from the peripartum period up to 42 days postpartum. Data were obtained retrospectively from the standardized questionnaires that are completed in Slovakia for any case of PH. The background population consisted of all other women who delivered during the study period. Results: Of the 436 136 births, there were 397 cases of PH, giving an incidence of 0.91 per 1000 births. It was higher with advanced maternal age, multiparity, multiple pregnancies, and cesarean deliveries. The main reasons for the procedure were placental pathologies and uterine atony in 52.9% and 33.0%, respectively. A total of 150 (37.8%) women required admission to an intensive care unit. The mortality rate was 1.5%. Conclusion: The incidence of PH is relatively high in Slovakia when compared with other European countries, highlighting the need to improve prenatal diagnosis of morbidly adherent placenta and the management of peripartum hemorrhage. Synopsis: Incidence of peripartum hysterectomy was 0.91 per 1000 births. It was higher with advanced age, multiparity, and cesarean deliveries and leading reasons were placental pathologies. [ABSTRACT FROM AUTHOR]

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Aim: To investigate the outcomes of peripartum hysterectomies (PHs) conducted to prevent maternal morbidity and mortality at a tertiary care hospital with 15,000 deliveries per year. Method: Patients who underwent PHs during delivery and/or within 24 h of delivery between the years 2011–2022 were retrospectively evaluated. Hysterectomies not performed in the peripartum period, cases that were managed by methods such as balloon tamponade, compression suture, or arterial ligation rather than hysterectomy, and hysterectomies performed before 20 weeks were excluded. Obstetric and demographic characteristics of the cases, as well as indications and outcomes of PH, were investigated. Results: Among the 130 patients who underwent PH, 4 (3.04%) patients delivered vaginally, 1 (0.7%) patient delivered vaginally after cesarean section, 12 (9.2%) patients delivered by primary cesarean section, and 113 (86.9%) patients delivered by secondary cesarean section. Placenta accreta spectrum disorder was the reason for PH in 54.6% (n = 71) of the cases while 16.1% (n = 21) underwent PH due to uterine atony. The PH rate was 0.75 per 1000 births, and the maternal mortality rate was 7.6 per 1000 hysterectomies in this study. Conclusion: Obstetricians in developed/ing countries support the active management of the third stage of labor mainly to mitigate the preventable risk factors of post-/peri-partum hemorrhage. The current study suggests that obstetricians need to focus on the placenta in order to reduce PH. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality. Timely recognition of PPH, determining the cause, and initiating treatment is critical, as almost 90 percent of deaths due to PPH occur within four hours following delivery. Methods: This is a observational study over the period of 18 months. This study includes all cases of postpartum hemorrhage. Results and conclusion: : incidence of PPH in our study was 1.03% main type of PPH was atonic, seen in total 125 out of 151 cases ( 90.1%), while traumatic PPH was second most common cause noted among total 21 cases (7.9%) . Mortality was observed in those mothers who were having high risk factors like DIC, hepatic disease, severe anaemia and abnormal placentation. Prompt diagnosis and expertise and skillful intervention by senior obstetrician by performing internal iliac ligation and uterine compression sutures could save the mother from Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Postpartum haemorrhage (PPH) is the loss of blood above 500 ml during vaginal or caesarean deliveries. It is difficult to find a PPH in an earlier stage, so pregnant women are exposed to excess blood loss that makes them suffer and die. Antenatal practices help in identifying risk factors, and modern technology is used to overcome the risk. Still, the morbidity rate and the mortality arise due to the unpredicted and unexpected cause. PPH is still a significant cause of maternal morbidity and mortality worldwide. The novelty of this research work is to alert medical practitioner about excessive bleeding of pregnant women during childbirth. We are proposing an automation system using wearable devices to prevent pregnant women from the PPH. These devices measure parameters like temperature, pulse rate, blood pressure, and sweat rate of pregnant women. Fuzzy neural technique-based rules are used for each parameter to predict the risk in developing PPH and to evaluate the performance of proposed system for reducing mortality and morbidity rates. Our findings of experiment are carried on metrics of HPPH (high-level postpartum haemorrhage), NPPH (normal-level postpartum haemorrhage), and MPPH (medium-level postpartum haemorrhage) for 15 patients. Fuzzy output value of 1 indicates patient state with NPPH, 0 indicates patient state with HPPH, and values in between 0 and 1 indicate MPPH. Based on the sensitivity of the predicted values, medical attention is taken from doctors or nurses in nearby locations using Internet of Things infrastructure. [ABSTRACT FROM AUTHOR]

Background and purpose: Uterine atony is responsible for 75-90% of postpartum hemorrhage, which will increase the probability of maternal mortality if proper measures are not taken to correct it. The aim of this study was to determine the therapeutic effect of tranexamic acid along with oxytocin in controlling postpartum hemorrhage. Materials and methods: This clinical trial study was performed on 142 pregnant women referring to Imam Sajjad Hospital in Yasouj for delivery in 2019-2020. Patients were randomly divided into two groups. The intervention group (71 people) received an ampoule of oxytocin at the rate of 40 units per liter of Ringer's serum and an ampoule of tranexamic acid at the rate of one gram per 10 cc of normal saline in a slow intravenous manner for 1 minute. The control group (71 people) received 40 units of oxytocin in one liter of serum and 10 cc of normal saline as a slow intravenous infusion for 1 minute. Then, the bleeding volume was evaluated based on the weight of gas consumed, the volume of blood collected, and the number of red blood cells received in both groups. Descriptive statistics of ratio comparison tests (chi-square) and t-test were used for data analysis. Results: The decrease of hemoglobin in the intervention group was significantly lower than the control group (P=0.007). The average change in gas weight at the end of the operation was higher in the control group (602.7±66.8) compared to the intervention group (571.7±81)(P=0.014). Also, the average bleeding volume and the number of blood bags received in the control group were higher than the intervention group, however, no significant relationship was observed (P>0.05). Conclusion: Administering tranexamic acid together with oxytocin, in the case of uterine atony, may be more effective than oxytocin alone in controlling postpartum bleeding during cesarean section.

Abstract Background Uterine atony is the most common cause of postpartum hemorrhage, which is the leading preventable cause of maternal morbidity and mortality. Despite several interventions uterine atony-related postpartum hemorrhage remains a global challenge. Identifying risk factors of uterine atony helps to reduce the risk of postpartum hemorrhage and subsequent maternal death. However, evidence about risk factors of uterine atony is limited in the study areas to suggest interventions. This study aimed to assess determinants of postpartum uterine atony in urban South Ethiopia. Methods A community-based unmatched nested case–control study was conducted from a cohort of 2548 pregnant women who were followed-up until delivery. All women with postpartum uterine atony (n = 93) were taken as cases. Women who were randomly selected from those without postpartum uterine atony (n = 372) were taken as controls. Using a case to control ratio of 1:4, the total sample size was 465. An unconditional logistic regression analysis was done using R version 4.2.2 software. In the binary unconditional logistic regression model variables that have shown association at p

Abstract Objective To explore the efficacy of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy. Methods This retrospective analysis covers the clinical data of 40 women with postpartum haemorrhage caused by uterine inertia during caesarean section in women with twin pregnancy in our hospital from January 2018 to May 2022. These women were divided into the group with modified B-Lynch sutures at the fundus and part of the corpus uteri (Group A, 20 patients) and the group with classic B-Lynch sutures (Group B, 20 patients) according to the treatment received. The treatment effect and safety of the two uterine compression sutures were compared. Results In this study, no statistically significant differences were found in the outcomes of haemostasis or intraoperative and 24-h postoperative blood loss between the two uterine compression suture groups (P > 0.05). Compared to Group B, Group A showed a significantly reduced operative time, postoperative hospital stay, puerperal morbidity rate, pain score and duration of lochia. Conclusion Modified B-Lynch sutures at the fundus and part of the corpus uteri can achieve a haemostatic effect similar to that of the classic B-Lynch suture, while it allows for a shortened operative time and reduced postoperative complications. Modified B-Lynch sutures can serve as a safe, rapid and effective haemostatic method for the prevention and treatment of postpartum haemorrhage during caesarean section in women with twin pregnancy, showing certain validity for promotion in clinics.

Background and purpose: Uterine atony is responsible for 75-90% of postpartum hemorrhage, which will increase the probability of maternal mortality if proper measures are not taken to correct it. The aim of this study was to determine the therapeutic effect of tranexamic acid along with oxytocin in controlling postpartum hemorrhage. Materials and methods: This clinical trial study was performed on 142 pregnant women referring to Imam Sajjad Hospital in Yasouj for delivery in 2019-2020. Patients were randomly divided into two groups. The intervention group (71 people) received an ampoule of oxytocin at the rate of 40 units per liter of Ringer's serum and an ampoule of tranexamic acid at the rate of one gram per 10 cc of normal saline in a slow intravenous manner for 1 minute. The control group (71 people) received 40 units of oxytocin in one liter of serum and 10 cc of normal saline as a slow intravenous infusion for 1 minute. Then, the bleeding volume was evaluated based on the weight of gas consumed, the volume of blood collected, and the number of red blood cells received in both groups. Descriptive statistics of ratio comparison tests (chi-square) and t-test were used for data analysis. Results: The decrease of hemoglobin in the intervention group was significantly lower than the control group (P=0.007). The average change in gas weight at the end of the operation was higher in the control group (602.7±66.8) compared to the intervention group (571.7±81)(P=0.014). Also, the average bleeding volume and the number of blood bags received in the control group were higher than the intervention group, however, no significant relationship was observed (P>0.05). Conclusion: Administering tranexamic acid together with oxytocin, in the case of uterine atony, may be more effective than oxytocin alone in controlling postpartum bleeding during cesarean section. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study is to find a link between the amount of calcium in the blood and how stiff the uterus is and how much blood is lost in women who are in the first and second stages of labour. Methods: Study design is cross sectional study in department of Obstetrics & Gynaecology Beni-suif University Hospital, Duration of study is from July 2021 till November 2021. Number of subjects studied: 180 women, with intrapartum estimation of serum calcium level and relationship to atonic primary PPH after vaginal delivery or caesarian delivery. Atonicity is characterised by a soft, swollen uterus and a lack of muscle tone. Results: 180 clients in total were looked at. 45 women who had a calcium level in their blood that was less than 8 mg% developed uterine atonicity. Only five of the women who had a serum calcium level of more than 8 mg% had uterine atonicity. Conclusions: Our results showed that, reduced calcium level is strongly linked to uterine atony and is therefore a risk factor for it. [ABSTRACT FROM AUTHOR]

Uterine involution has 2 major components—(1) involution of vessels; and (2) involution of myometrium. Involution of vessels was addressed by Rutherford and Hertig in 1945; however, involution of myometrium has received little attention in the modern literature. We suggest that the pathophysiology of myometrial involution may lead to uterine atony and postpartum hemorrhage. The myometrium dramatically enlarges due to gestational hyperplasia and hypertrophy of myocytes, caused by hormonal influences of the fetal adrenal cortex and the placenta. After delivery, uterine weight drops rapidly, with physiologic involution of myometrium associated with massive destruction of myometrial tissue. The resulting histopathology, supported by scientific evidence, may be termed "postpartum metropathy," and may explain the delay of postpartum menstrual periods until the completion of involution. When uterine atony causes uncontrolled hemorrhage, postpartum hysterectomy examination may be the responsibility of the perinatal pathologist. Postpartum metropathy may be initiated when delivery of the baby terminates exposure to the hormonal influence of the fetal adrenal cortex, and may be accelerated when placental delivery terminates exposure to human chorionic gonadotrophin (HCG). This hypothesis may explain why a prolonged third stage of labor, and delays in management, are risk factors for severe hemorrhage due to uterine atony. [ABSTRACT FROM AUTHOR]

Background and Aims: There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony. Methods: This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated 'success', while inadequate tone constituted 'failure'. If the response was 'failure', the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged. Results: The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3-6.0) IU for the high-risk group and 2.2 (1.3-3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar. Conclusion: Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors. [ABSTRACT FROM AUTHOR]

Objective: To compare the manufacturing, infusion, and total times of handmade balloons for uterine tamponade using the El Hennawy and Alves techniques, given the failure of initial measures and uterotonic therapy to control postpartum hemorrhage. Methods: An open clinical trial (clinical article) was conducted among 30 physicians, residents, and assistants in an Obstetrics Department. Each participant manufactured and infused one of two different balloons compared in the study, in a randomly predefined sequence. The manufacturing and infusion times were timed by the researchers and their medians were compared using the t test or Mann–Whitney U test. Results: The manufacturing time of the El Hennawy balloon was 72 s lower in relation to the Alves balloon (P < 0.010). Regarding the infusion time, the Alves balloon was filled faster than the El Hennawy balloon (P < 0.010). The total time (manufacturing and infusion) of Alves balloon was also lower than the El Hennawy device (P < 0.010). Conclusions: Although the El Hennawy balloon was manufactured more quickly, the total time of manufacturing and infusing the Alves balloon was much faster, which makes it the most suitable device to be used in critical situations of postpartum hemorrhage. Synopsis: Uterine balloon tamponade is efficient in controlling PPH. In Brazil, El Hennawy and Alves handmade devices are described; the Alves UBT is faster in use. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of intrauterine anomalies, primarily intrauterine adhesions (IUAd), after conservative surgical treatment of severe postpartum hemorrhage with uterine atony (SPPH‐UA) and determine patient eligibility for hysteroscopy. Methods: PubMed and the Cochrane Library were searched by combining keywords "postpartum hemorrhage", "uterine atony", and "hysteroscopy" to perform a literature review. Articles in French and English with more than five cases of hysteroscopy following SPPH‐UA were selected. All cases that had hysteroscopy after conservative surgical treatment of SPPH‐UA were collected. A blinded statistical analysis revealed IUAd risk factors. Results: In all, 83% of patients agreed to hysteroscopy and 38% of 71 cases had an IUAd. Age was not a risk factor (P = 0.950). Other factors included multiparity (odds ratio [OR] 1.93, P = 0.039), cesarean delivery (OR 3.58, P = 0.584) and postpartum infection (OR 3.33, P = 0.04). Risk was at 57% after uterine padding with multiple transfixing square stitches (Cho‐technique) (P = 0.001), 6% after non‐transfixing uterine folding brace suture (B‐Lynch technique) when used alone, 29% after uterine artery embolization and after internal iliac artery ligation (OR 0.98, P = 0.645); uterine vascular ligation (OR 0.69, P = 0.253) and more than two procedures (OR 0.69, P = 2.53). Disparity between authors was observed (P = 0.015) and concerned only the surgical techniques used. Conclusion: A classification is proposed for deciding post‐SPPH hysteroscopy. Further studies are required to determine appropriateness. Synposis: An eligibility criteria classification deciding post‐SPPH hysteroscopy was established: A0: hysteroscopy not immediately offered (IUAd <20%), A1: hysteroscopy proposed (20% < IUAd <50%) and A2: hysteroscopy strongly recommended (IUAd >50%). [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) is one of the well known reasons for maternal morbidity and mortality worldwide. Primary PPH occurs within 24 hours postpartum and secondary PPH between 24 hours and six weeks postpartum. The most common obstetric haemorrhage is primary PPH. Objectives: This study was aimed to estimate the prevalence and outcome of PPH in a tertiary care hospital. Methodology: The present study was a retrospective study that included 225 mothers diagnosed with PPH. Data was collected from medical records available in the hospital. Prevalence and outcome of postpartum hemorrhage was the primary outcome, and the obstetric score, mode of delivery, and etiology were considered as secondary outcomes. Results: The prevalence of postpartum hemorrhage was 0.73%. The etiologies were found to be atonic uterus (79.11%), traumatic (19.56%), and tissue/retained bits (1.33%), and the risk factors were induced labor 16%, followed by prolonged labor 11.1%, preeclampsia 4.4%. 91.11% of patients were treated medically, and 8.88% were treated surgically. The percentage of patients who were multigravida and underwent surgical management was 65%. 221 (98.22%) participants survived, and four (1.78%) participants died. The cause of death was shock (75.00%) and cardiac arrest (25%). Conclusion: In this study, a prevalence of 0.73% was noted for primary PPH. Uterine atony was the most common etiology causing PPH. The most frequently encountered risk factors were induced labor. The majority of the patients underwent conservative management. Shock was the common cause of death due to PPH.

Synopsis: The uterine tourniquet is a temporary intervention that facilitates the application of other procedures for definitive control of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage is a long-running and frequent cause of maternal death in most developing countries and is associated with uterine atony. Nowadays, balloon tamponade has gained popularity due to its advantages. It is a technically simple, safely applied, time saver, and easily removed in a low-risk method and also needs less expertise and no special equipment. Despite all advantages, the Bakri balloon is very expensive in less developed countries and not available everywhere, especially in limited resource settings. Such disadvantages prompted us to perform an innovative, cost-effective, and practical method relying on low-resource equipment and named it "Glove Balloon." A 26-year-old woman presented in her third pregnancy underwent an elective cesarean section. Following the surgeon's mention of low segment atony, the patient returned to the operating room quickly. The bleeding continued despite the administration of uterotonic drugs, and because of active bleeding, the decision was made to apply a glove balloon. After gently inserting the glove balloon into the uterus, 500 ccs of saline was inflated into the balloon, and the bleeding stopped shortly afterward. The patient was discharged on the third postoperative day and remained well after. We believe that junior obstetricians and midwives should consider all options, even new strategies, to stop hemorrhages before considering invasive surgical procedures. The "Glove Balloon" is an innovative, practical uterine tamponade balloon that can make the difference between life and death in treating postpartum hemorrhage cases and should be considered a life-saver tool in all settings. [ABSTRACT FROM AUTHOR]

Background: Uterine atony is the most common cause of postpartum hemorrhage, which is the leading preventable cause of maternal morbidity and mortality. Despite several interventions uterine atony-related postpartum hemorrhage remains a global challenge. Identifying risk factors of uterine atony helps to reduce the risk of postpartum hemorrhage and subsequent maternal death. However, evidence about risk factors of uterine atony is limited in the study areas to suggest interventions. This study aimed to assess determinants of postpartum uterine atony in urban South Ethiopia. Methods: A community-based unmatched nested case–control study was conducted from a cohort of 2548 pregnant women who were followed-up until delivery. All women with postpartum uterine atony (n = 93) were taken as cases. Women who were randomly selected from those without postpartum uterine atony (n = 372) were taken as controls. Using a case to control ratio of 1:4, the total sample size was 465. An unconditional logistic regression analysis was done using R version 4.2.2 software. In the binary unconditional logistic regression model variables that have shown association at p < 0.20 were recruited for multivariable model adjustment. In the multivariable unconditional logistic regression model, statistically significant association was declared using 95% CI and p < 0.05. Adjusted odds ratio (AOR) used to measure the strength of association. Attributable fraction (AF) and population attributable fraction (PAF) were used to interpret the public health impacts of the determinants of uterine atony. Results: In this study, short inter-pregnancy interval < 24 months (AOR = 2.13, 95% CI: 1.26, 3.61), prolonged labor (AOR = 2.35, 95% CI: 1.15, 4.83), and multiple birth (AOR = 3.46, 95% CI: 1.25, 9.56) were determinants of postpartum uterine atony. The findings suggest that 38%, 14%, and 6% of uterine atony in the study population was attributed to short inter-pregnancy interval, prolonged labor, and multiple birth, respectively, which could be prevented if those factors did not exist in the study population. Conclusions: Postpartum uterine atony was related to mostly modifiable conditions that could be improved by increasing the utilization of maternal health services such as modern contraceptive methods, antenatal care and skilled birth attendance in the community. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of modified B-Lynch sutures in the fundus uteri and part of the corpus uteri for the prevention of intraoperative haemorrhage during caesarean delivery in women with twin pregnancy. Methods: This retrospective analysis covers the clinical data of 40 women with postpartum haemorrhage caused by uterine inertia during caesarean section in women with twin pregnancy in our hospital from January 2018 to May 2022. These women were divided into the group with modified B-Lynch sutures at the fundus and part of the corpus uteri (Group A, 20 patients) and the group with classic B-Lynch sutures (Group B, 20 patients) according to the treatment received. The treatment effect and safety of the two uterine compression sutures were compared. Results: In this study, no statistically significant differences were found in the outcomes of haemostasis or intraoperative and 24-h postoperative blood loss between the two uterine compression suture groups (P > 0.05). Compared to Group B, Group A showed a significantly reduced operative time, postoperative hospital stay, puerperal morbidity rate, pain score and duration of lochia. Conclusion: Modified B-Lynch sutures at the fundus and part of the corpus uteri can achieve a haemostatic effect similar to that of the classic B-Lynch suture, while it allows for a shortened operative time and reduced postoperative complications. Modified B-Lynch sutures can serve as a safe, rapid and effective haemostatic method for the prevention and treatment of postpartum haemorrhage during caesarean section in women with twin pregnancy, showing certain validity for promotion in clinics. [ABSTRACT FROM AUTHOR]

The incidence of postpartum hemorrhage (PPH) is increasing worldwide and in the United States. Coinciding, is the increased rate of severe maternal morbidity with blood transfusion in the United States over the past 2 decades. Consequences of PPH can be life-threatening and carry significant cost burden to the health care system. This review will discuss the current trends, distribution, and risk factors for PPH. Causes of PPH will be explored in detail. [ABSTRACT FROM AUTHOR]

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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Background and Aims: There are scanty data for oxytocin dose in patients at high risk of uterine atony. We aimed to compare the effective dose (ED) 90 of oxytocin for adequate uterine tone during the caesarean section in patients at high-risk vs low-risk uterine atony. Methods: This dose-finding study was undertaken after ethical approval in non-labouring women aged >18 years with pre-defined risk factors for uterine atony (high-risk group) vs those without such factors (low-risk group) (n = 39 each). Starting dose of oxytocin in the first patient of low-risk and high-risk groups was 1 and 3 IU, respectively. Achieving adequate uterine tone at 3 min of oxytocin bolus was designated 'success', while inadequate tone constituted 'failure'. If the response was 'failure', the dose of oxytocin was increased for the next patient by 0.5 or 0.2 IU (high- and low-risk groups, respectively). In case of a successful response, the dose for the next patient was decreased with a probability of 1/9 using the same dosing intervals or otherwise kept unchanged. Results: The ED90 (95% CI) of oxytocin bolus was 4.7 (3.3–6.0) IU for the high-risk group and 2.2 (1.3–3.2) IU for the low-risk group (P = 0.044). Oxytocin-associated tachycardia (P = 0.247) and hypotension (P = 0.675) were clinically greater for the high-risk vs low-risk group but statistically similar. Conclusion: Non-labouring patients with high-risk factors for uterine atony require a greater dose of initial oxytocin bolus to achieve adequate uterine tone during the caesarean section compared to those without risk factors.

Background & Aims: Most common side effect of subarachnoid block during caesarean delivery is postspinal hypotension which can lead to increased maternal and neonatal morbidity and mortality. Phenylephrine has been shown to be effective in preventing commonly encountered hypotension associated with spinal anesthesia (60% to 70%) in obstetric patients and has become the vasopressor of choice. The following study was conducted to compare the dose requirement of intravenous oxytocin between patients receiving an infusion of prophylactic intravenous phenylephrine to those receiving a saline control infusion under spinal anesthesia in patients undergoing caesarean delivery. Material & Methods: It was a double-blinded, randomized controlled study having 48 subjects in test and control arm each. Results: The mean oxytocin dose administered was higher in the phenylephrine group than in the control group (6.1 ± 2.7 (IU) vs. 5.2 ± 2.3 IU, respectively). The proportion of patients who required a secondary uterotonic agent was higher in the phenylephrine intervention group (22% vs. 8%, respectively). Conclusion: Obstetricians and anesthesiologists must pay close attention to uterine tone for patients receiving a phenylephrine infusion for the prevention of postspinal hypotension and the increased dose requirement of oxytocin. Future multicentric studies are required to further establish the effects of continuous infusion as found in our study.