Atonic Postpartum Hemorrhage Research Articles

Efficacy of Intrauterine Condom Balloon in the Treatment of Atonic Postpartum Hemorrhage

Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, particularly in cases of uterine atony. Effective management is crucial to prevent severe complications and improve maternal outcomes. Intrauterine balloon tamponade techniques, such as the use of a condom balloon tamponade (CBT), have gained attention for their potential to control bleeding quickly and safely. This study aimed to assess the efficacy of intrauterine condom balloons in the treatment of atonic postpartum hemorrhage. Methods: This study is a prospective observational study conducted to assess the efficacy of intrauterine condom balloon tamponade (CBT) in the management of atonic postpartum hemorrhage (PPH). The study was carried out at the Department of Obstetrics and Gynecology in Dhaka Medical College Hospital, from January 2007 to December 2007. A total of 50 patients were selected by a purposive sampling technique. All collected data were analyzed using SPSS software (version 25.0). For continuous variables (e.g., blood loss, time to hemostasis), comparisons between groups (e.g., successful vs. unsuccessful tamponade cases) were performed using the Student’s t-test. For categorical outcomes, the Chi-square test was used to compare proportions. A p-value of < 0.05 was considered statistically significant. Result: Intrauterine condom balloon tamponade (CBT) effectively managed atonic postpartum hemorrhage in 50 participants, achieving an 84% cessation of bleeding within 30 minutes. The average saline volume used was 500 mL, with a notable 16% of cases requiring additional surgical interventions, primarily hysterectomy. Blood transfusion was necessary for 68% of participants, with higher transfusion needs in cases of failed CBT. Maternal complications were minimal, with 8% experiencing postpartum fever and 4% developing uterine infections. The mean hospital stay was 5.0 days, with 40% staying longer than 5 days, reflecting the need for ongoing ..........

Expression of Concern: Novel Modification of B-Lynch Uterine Compression Sutures for Management of Atonic Postpartum Hemorrhage: VV Uterine Compression Sutures.

Expression of Concern: Novel Modification of B-Lynch Uterine Compression Sutures for Management of Atonic Postpartum Hemorrhage: VV Uterine Compression Sutures.

A case report on tuberculosis in pregnancy revealing the need for an effective multidisciplinary approach and the importance of tailored therapy

Tuberculosis (TB) during pregnancy, especially with central nervous system (CNS) involvement, poses significant risks to maternal and fetal health. This case report explores the diagnostic and therapeutic challenges of managing new-onset seizures in a pregnant patient with CNS-TB.A 23-year-old primigravida presented at 36 weeks gestation with new-onset seizures. The diagnostic workup, complicated by the pregnancy, revealed a left frontal tuberculoma. The patient was started on a standard antitubercular therapy (ATT) regimen of 2HRZE followed by 4HR, taking into account the drugs’ teratogenic potential and fetal safety. Despite the development of mild atonic postpartum hemorrhage (PPH), the patient gave birth to a preterm but viable infant with satisfactory APGAR scores.The interdisciplinary team provided comprehensive care, including seizure management with Levetiracetam and postpartum follow-up for both mother and child. The patient showed neurological improvement and, alongside the newborn, had a favorable outcome. This case underlines the importance of a tailored, multidisciplinary approach to managing TB in pregnancy. It also emphasizes the need for vigilant monitoring and treatment adherence to navigate the complexities of TB with CNS involvement and concurrent pregnancy.Enhanced prenatal screening for TB, interdisciplinary protocols, research on TB medications during pregnancy, and long-term follow-up studies are recommended to improve outcomes for similar future cases.

Case-based Learning in Obstetric Hemorrhagic Emergencies

Abstract Background: Our institution’s obstetrics and gynecology course for final-year students traditionally relied solely on theoretical lectures. To bridge the gap between theory and real-world scenarios, we implemented case-based learning (CBL) that incorporates case discussions and other practical activities. This study aimed to assess the impact of these changes on students’ performance and perceptions of their learning experience. Materials and Methods: CBL was introduced for the teaching of a final year students about atonic postpartum hemorrhage. Comparisons were made with the two groups of the same batch. The students were assessed for the content retention and analytical skills. Students and faculty members were asked to rate their satisfaction with the teaching program. Results: The mean pretest score for the MCQs improved from 5 to 7.52–7.89, showing an improved content retention in both the groups. The mean score for analytical skills in CBL group was 7.96 as compared to 4.5 in the lecture group. Conclusion: CBL is helpful in improving the analytical skills of the undergraduate medical students.

The Efficacy of the B-Lynch Procedure in Reducing Labor-Related Mortality and Morbidity in Low-Income Health Facilities in Low Setting Health Facilities

Purpose: Postpartum hemorrhage is a preventable cause of maternal death, yet it is rising in underdeveloped nations with low health resources. So, this study looked into whether B-Lynch and modified B-Lynch uterine compression sutures could stop major postpartum bleeding caused by uterine atonia in EL-Obeid, Sudan. Methodology: This is a descriptive longitudinal study undertaken at the Obstetrics and Gynecology hospitals in El-Obeid and Alfayhaa, located in North Kordofan State, Sudan. The study took place from January 2019 to December 2023. This study has registered a total of 218 individuals for participation. Findings: Using uterine compression sutures resulted in a remarkably low rate of problems, with only 2.3% of individuals experiencing adverse effects. About 71.5% of the study population did not have a blood transfusion. Only 0.9% of patients undergo peripartum hysterectomy. Registrars performed surgery on around 18.8% of the patients. The majority, approximately 45.4% of the patients, underwent elective cesarean sections for delivery. The majority of the cases, amounting to 66.5%, occurred in metropolitan areas. Individuals at the primary level of education reported the majority of the instances, accounting for 36.6%. The majority of events occurred within the age range of 21 to 25 years, accounting for 24.3% of the total. Unique contribution to theory, practice and policy: When uterotonic medications fail, uterine compression sutures are a safe, effective, and simple conservative surgical method for atonic postpartum hemorrhage. Well-trained doctors, including early careerists, can execute these simple procedures

Educational results of the Japan Maternal Emergency Life-Saving (J-MELS) simulation training organized by Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS): a 12-month longitudinal follow-up study in Japan.

This study aimed to evaluate the long-term results of Japan Maternal Emergency Life-Saving (J-MELS) simulation training on obstetric healthcare providers, over a 12-month follow-up period. A total of 273 trainees from 17 J-MELS Basic courses conducted between August 2021 and October 2023 were included. The trainees' responses to the pre- and post-tests, questionnaires, and self-reports on the usefulness of the J-MELS scenarios in actual clinical settings at 1, 6, and 12 months after the training were analyzed. Multivariate logistic regression analysis was also conducted to identify the factors influencing knowledge retention. We found an overall improvement in clinical knowledge acquisition after J-MELS training and a significant retention of this improvement at least until 12 months later. However, these scores gradually declined over. Trainees reported increased usefulness of J-MELS scenarios in actual clinical practice at 1, 6, and 12 months after training, particularly in managing obstetric emergencies such as atonic postpartum hemorrhage. Knowledge retention was influenced by several specific factors, such as years of clinical experience, affiliated institutions, qualifications, and especially pre-test scores. Our longitudinal follow-up study demonstrated, for the first time, the long-term results of J-MELS simulation training using post-tests and self-report data. Our findings provide valuable insight into the impact of J-MELS simulation training on maternal emergency care. By elucidating the factors influencing knowledge retention and practical utility, the findings offer actionable recommendations for optimizing training strategies and improving maternal outcomes in actual clinical practice.

Comparison of Carbetocin and Oxytocin Efficacy in Preventing Postpartum Hemorrhage after C-Section

Introduction: Postpartum hemorrhage (PPH) is defined as a blood loss of more than 0.5 liters within 24 hours of birth, and a blood loss of more than 1 liter is considered a significant PPH. In low- and middle-income countries, PPH is a major factor causing maternal morbidity and mortality, whereas in high-income countries, the mortality is comparatively lower, but still PPH poses a major risk for postpregnancy complications. Uterine atony is the most frequent cause of the PPH, and it accounts for up to 80% of PPH cases. Aim: The aim of this study is to examine the prophylactic effects of oxytocin and carbetocin in preventing atonic PPH in individuals receiving recurrent elective CS under spinal anesthesia. Materials and Methods: A computerized, randomized, cross-sectional prospective comparative study was conducted on 100 pregnant women at Konaseema Institute of Medical Sciences and Research Foundation for the time period of an year, from October 2020 to October 2021. Inclusion Criteria: This study includes patients with singleton pregnancy, gestational age >38 weeks, spinal anesthesia and repeated C.S with cephalic, breech, or any malpresentations. Exclusion Criteria: Patients with placenta previa and placental abruption, uterine myomata, congenital uterine anomalies, gestational age before 38 weeks, women having emergency cesarean section for fetal or maternal distress, and patients with hepatic or pre-existing bleeding disorder were excluded from the study. The patients included based on the above criteria were split into two equal groups. Group I received carbetocin as a single dose of 100 microgram slow intravenous, and Group II received oxytocin as 5 IU intravenous drip followed by 20 IU of oxytocin infusion on 500 ml saline or lactated ringer with a rate of 150 ml per hour. Results: When compared to the oxytocin group, the blood loss was considerably reduced in the carbetocin group. The levels of Hb and hematocrit [HCT] were evaluated pre- and postoperative in both the groups. The levels of preoperative Hb and HCT showed nonsignificant difference between the two groups, while the levels of postoperative Hb and HCT were significantly higher in carbetocin group than oxytocin group concluding that carbetocin showed the better results in controlling the blood loss and maintaining the levels of Hb and HCT volume and the carbetocin group showed less need for administration of uterotonic agents (20%) in comparison with (32%) in oxytocin group but with no statistically significant difference. Only 8 (16%) patients showed PPH in carbetocin treatment, whereas 14 (28%) showed PPH in patients on oxytocin treatment.

Carbetocin versus oxytocin for prevention of atonic post-partum hemorrhage in high-risk patients in a tertiary care center: a pilot study

Carbetocin versus oxytocin for prevention of atonic post-partum hemorrhage in high-risk patients in a tertiary care center: a pilot study

MR imaging features of uterine necrosis following modified B-Lynch sutures: a case report

BackgroundB-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 presentationHere 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.ConclusionsThe 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.

Efficacy of Bilateral Uterine Artery Ligation Versus Uterine Fixation Suture (Modified B-Lynch) in Treatment of Atonic Post-Partum Hemorrhage

Efficacy of Bilateral Uterine Artery Ligation Versus Uterine Fixation Suture (Modified B-Lynch) in Treatment of Atonic Post-Partum Hemorrhage

Histological Features of Uterine Myometrial Dysfunction: Possible Involvement of Localized Inflammation.

The latest perspective suggests that elevated levels of inflammation and cytokines are implicated in atonic postpartum hemorrhage. Lipopolysaccharide (LPS) has been widely used to induce inflammation in animal models. Therefore, this study aimed to induce uterine inflammation using LPS to investigate whether local inflammation triggers dysfunction and atrophy in the myometrium, as well as the potential underlying molecular mechanisms involved. In vivo, an animal model was established by intraperitoneal injection of 300 μg/ kg LPS in rats on gestational day 21. Hematoxylin-eosin (H&E) staining and Masson staining were employed to determine morphological changes in the rat uterine smooth muscle. Enzyme-linked immunosorbent assay (ELISA) was used to detect inflammatory cytokines. Immunohistochemistry, tissue fluorescence, and Western blotting were conducted to assess the expression levels of the uterine contraction-related proteins Toll-like receptor 4 (TLR4) and the nuclear factor kappa-B (NF-κB) signaling pathway. In vitro, human uterine smooth muscle cells (HUtSMCs) were exposed to 2 μg/mL LPS to further elucidate the involvement of the TLR4/NF-κB signaling pathway in LPS-mediated inflammation. In this study, LPS induced uterine myometrial dysfunction in rats, leading to a disorganized arrangement, a significant increase in collagen fiber deposition, and widespread infiltration of inflammatory cells. In both in vivo animal models and in vitro HUtSMCs, LPS elevated IL-6, IL-1β, and TNF-α levels while concurrently suppressing the expression of connexin 43 (Cx43) and oxytocin receptor (OXTR). Mechanistically, the LPS-treated group exhibited TLR4 activation, and the phosphorylation levels of p65 and IκBα were notably increased. LPS triggered the TLR4/NF-κB signaling pathway, inducing an inflammatory response in the myometrium and leading to uterine myometrial dysfunction and uterine atony.

A comparative interventional study on fixed-dose versus titrated- dose oral misoprostol solution for induction of labour at term gestation in a tertiary care centre of Eastern Uttar Pradesh

Induction of labor entails the deliberate initiation of uterine contractions before the spontaneous onset of labor, irrespective of whether the amniotic membranes have ruptured or not. The Modified Bishop’s score of six or higher indicates that the cervix is ripe, or “favorable” – when there is a high likelihood of spontaneous labor or responsiveness to interventions designed to induce labor. Misoprostol being cost-effective, easily available and stable at room temperature makes itself a promising agent in future for induction of labour if the feto-maternal safety concerns are proved with evidence. The aim of our study was to compare the efficacy of titrated versus fixed dose oral misoprostol solution regimen as inducing agents and the effects on fetomaternal outcome.A comparative interventional study was conducted for one year and study population consisted of term pregnant women admitted to the labour room of the hospital. A total sample size of 150 was deemed necessary, with 75 participants required per group. Following allocation into groups, induction of labor was carried out using either oral titrated-dose misoprostol solution or fixeddose misoprostol solution.Successful induction of labour was higher in fixed -dose group (Group F) (80%) as compared to 65.53% in titrated-dose group (Group T), the difference was statistically significant (p=0.0439). The need for augmentation was lower in group F (30.67%) than in group T (56%). Statistically, this difference was significant (p = 0.0017). Uterine hyper stimulation and atonic post-partum haemorrhage were noted more in group T but this difference was not significant (p = 0.1461; p = 0.3108). Requirement of newborn resuscitation was observed higher in group T [34 (45.34%)] than group F [16(21.33%)]. Statistically, this difference was significant [p=0.0081]. NICU admissions were more in group T (21.34%) than group F (13.33%), but difference was not significant (p = 0.0574).This study concludes that both fixed- dose and titrated-dose oral misoprostol solution regimens are effective in induction of labour but fixed-dose regimen has an advantage of less mean total dose of misoprostol administered, reduced induction to delivery interval, less uterine hyperstimulation, atonic postpartum hemorrhage and better fetomaternal and neonatal safety profile.

Prevalence of intra-abdominal adhesions in patients undergoing repeat cesarean section: An observational retrospective study

: To study the prevalence of intraabdominal adhesion in repeat CS and evaluate the maternal and fetal outcome.: CS is a lifesaving procedure for the mother and fetus, but have multiple complications like adhesions, abdominal pain, prolonged duration of surgery, postoperative bleeding, and identification of these can help improve maternal and fetal outcome and care.: This retrospective study reviewed 70 pregnant women undergoing repeat CS. Data was tabulated and analyzed and adhesions were scored based on a system into dense and flimsy, and its dimensions. Chi Square test was used to observe association. P-value<0.05 was taken as significant.: Adhesions were noted in 30(42.9%) of the subjects and 40(57.1%) patients had no adhesions. Dense adhesions were noted in 19(27.1%) and flimsy in 11(15.7%) patients. Among those with adhesions – 6(20%) had atonic postpartum hemorrhage (PPH). No association was noted with fetal outcome. There was a statistically significant increase in duration of surgery in those with adhesions – 126.83 minutes +/- 19.85 than in those without adhesions – 82.35 minutes +/-12.82. Those patients with dense adhesions, the duration of surgery was – 132.63 minutes +/-21.88 and with flimsy adhesions – 116.82 minutes +/-82.: Repeat CS with adhesions increased the duration of surgery, increased the chances of PPH and had no statistically significant effect on neonatal outcome. Furthermore, duration of surgery was prolonged with dense adhesions. Further research can be done including post operative complications, details of prior CS and interpregnancy interval and thereby adhesion prevalence.

Intravenous versus intramuscular oxytocin injection for preventing uterine atonic primary postpartum haemorrhage in third stage of labour: A double-blind randomised controlled trial.

To compare the efficacy and safety of intravenous and intramuscular oxytocin in preventing atonic primary postpartum haemorrhage in the third stage of labour. A double-blind randomised clinical study on consenting women without risk factors for primary postpartum haemorrhage in labour at term. Two hundred and thirty-two women were randomly allotted into intravenous (n = 115) and intramuscular (n = 117) oxytocin groups in the active management of the third stage of labour. All participants received 10 IU of oxytocin, either IV or IM, and 1 ml of water for injection as a placebo via a route alternate to that of administration of oxytocin within 1 min of the baby's delivery. The primary outcome measures were mean postpartum blood loss and haematocrit change. Trial Registration No.: PACTR201902721929705. The baseline socio-demographic and clinical characteristics were similar between the two groups (p > 0.05). There was no statistically significant difference between the two groups with regards to the mean postpartum blood loss (254.17 ± 34.85 ml versus 249.4 ± 39.88 ml; p = 0.210), haematocrit change (2.4 (0.8%) versus 2.1 (0.6%); p = 0.412) or adverse effects (p > 0.05). However, the use of additional uterotonics was significantly higher in the intravenous group (25 (21.73%) versus 17 (14.53%); p = 0.032). Although oxytocin in both study groups showed similar efficacy in terms of preventing atonic primary postpartum haemorrhage, participants who received intravenous oxytocin were more likely to require additional uterotonics to reduce their likelihood of having an atonic primary postpartum haemorrhage. However, both routes have similar side effect profiles.

Novel biomarkers for prediction of atonic postpartum hemorrhage among 'low-risk' women in labor.

Postpartum hemorrhage (PPH) is the primary cause of maternal mortality globally, with uterine atony being the predominant contributing factor. However, accurate prediction of PPH in the general population remains challenging due to a lack of reliable biomarkers. Using retrospective cohort data, we quantified 48 cytokines in plasma samples from 40 women diagnosed with PPH caused by uterine atony. We also analyzed previously reported hemogram and coagulation parameters related to inflammatory response. The least absolute shrinkage and selection operator (LASSO) and logistic regression were applied to develop predictive models. Established models were further evaluated and temporally validated in a prospective cohort. Fourteen factors showed significant differences between the two groups, among which IL2Rα, IL9, MIP1β, TNFβ, CTACK, prenatal Hb, Lymph%, PLR, and LnSII were selected by LASSO to construct predictive model A. Further, by logistic regression, model B was constructed using prenatal Hb, PLR, IL2Rα, and IL9. The area under the curve (AUC) values of model A in the training set, internal validation set, and temporal validation set were 0.846 (0.757-0.934), 0.846 (0.749-0.930), and 0.875 (0.789-0.961), respectively. And the corresponding AUC values for model B were 0.805 (0.709-0.901), 0.805 (0.701-0.894), and 0.901 (0.824-0.979). Decision curve analysis results showed that both nomograms had a high net benefit for predicting atonic PPH. We identified novel biomarkers and developed predictive models for atonic PPH in women undergoing "low-risk" vaginal delivery, providing immunological insights for further exploration of the mechanism underlying atonic PPH.

Сравнительный анализ влияния общей и спинальной анестезии на акушерские исходы при плановом кесаревом сечении

Objective. To determine which type of anesthesia, general or spinal, causes less amount of blood loss in elective cesarean section. Patients and methods. An observational randomized controlled study including 300 women was conducted at the Al-Zahraa University Maternity Hospital. Two patient groups were identified: group G (general anesthesia) (n = 150) and group S (spinal anesthesia) (n = 150). All patients underwent elective cesarean section with identical operative steps by the same surgeon. Anesthesia, general or spinal, was standard. Data were collected, including age, parity, pre- and postoperative heart rate and blood pressure, pre- and postoperative complete blood count (on day 3), type of anesthesia, duration of surgery, complications (atonic postpartum hemorrhage, uterine extension), postoperative urinary output, need for blood transfusion, fainting and headache attacks, time to breastfeeding, ambulation, and passing flatus. Data on postoperative analgesia were also obtained, including time to first analgesic request and number of doses taken. The amount of intraoperative blood loss was estimated using the acute normovolemic hemodilution technique. Results. When using changes in hemoglobin levels to estimate blood loss, group S showed statistically significantly less blood loss than group G, with a mean difference of 103.7 mL (p < 0.05). When using hematocrit levels, group S showed statistically significantly less blood loss than group G, with a mean difference of 114 mL (p < 0.05). Headache attacks were more frequent in group S (78) than in group G (19) (p < 0.05). Group S started breastfeeding 5 hours earlier than group G (p < 0.05). Group S started postoperative ambulation 4 hours earlier than group G (p < 0.05). There were no statistically significant differences between both groups regarding time to first analgesic request, heart rate, blood pressure, urinary output, and fainting attacks in the postoperative period. Conclusion. Spinal anesthesia has certain advantages over general anesthesia: higher postoperative hemoglobin and hematocrit levels, less intraoperative blood loss, less postoperative pain, less need for analgesia, earlier ambulation, and earlier initiation of breastfeeding. Key words: spinal anesthesia, general anesthesia, cesarean section

The association between maternal vitamin D deficiency and postpartum hemorrhage and uterine atony.

Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown. This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders. Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage. In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.

Uterine Cooling During Cesarean Section an Attempt to Reduce Blood Loss and Atonic Post-Partum Hemorrhage

Uterine Cooling During Cesarean Section an Attempt to Reduce Blood Loss and Atonic Post-Partum Hemorrhage

Crucial factors for implementing treatment strategies in intractable atonic postpartum haemorrhage: early phase contrast medium extravasation on dynamic CT

To identify the relationship between contrast medium extravasation (CME) on dynamic contrast-enhanced computed tomography (DCT) and clinical information in intractable atonic postpartum haemorrhage (PPH) and its relevance to treatment with uterine artery embolisation (UAE). Of 90 patients who underwent DCT to diagnose PPH, 60 diagnosed with intractable atonic PPH were investigated retrospectively. Maternal background and clinical indicators were analysed to compare the positive and negative factors of early phase CME. Regression analysis was used to investigate the factors associated with CME. The sensitivity, specificity, and positive and negative predictive values of early phase CME for predicting UAE were calculated. Clinical outcomes were compared between the two groups according to the timing of the decision to undergo UAE. Of the 60 patients with intractable atonic PPH, 21 underwent UAE, 20 of whom had early phase CME on DCT. Pre-DCT clinical parameters and clinical indices were not significantly different in presence of early phase CME. Early phase CME was associated with UAE performance, with a sensitivity of 95%, specificity of 87%, positive predictive value of 80%, and negative predictive value of 97%. In cases where UAE was performed after conservative management, there was a significant increase in blood loss and transfusion volume. Early phase CME is not indicated by background factors or clinical findings. UAE is not required when CME cannot be detected in the uterine cavity. If early phase CME is present, UAE should be considered immediately.

The Relation between serum calcium levels and Atonic postpartum Hemorrhage

The Relation between serum calcium levels and Atonic postpartum Hemorrhage