Cases Of Postpartum Hemorrhage Research Articles

Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis.

To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

Maternal outcomes of a cohort of pregnancies affected by non-immune hydrops fetalis.

To describe the maternal outcomes of a prospective cohort of non-immune hydrops fetalis (NIHF) pregnancies with negative standard-of-care evaluations. This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work-ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre-eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. Forty pregnancies were included. Four patients developed pre-eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5(13.5%) cases of postpartum hemorrhage and an additional 3(8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new-onset or exacerbated depression or anxiety symptoms. Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard-of-care evaluations, including a high rate of postpartum pre-eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.

Awareness and use of tranexamic acid in the management of postpartum hemorrhage among health care professionals in Enugu, Nigeria.

This study was conducted to determine the knowledge, practice, and barriers regarding the use of tranexamic acid (TXA) for the prevention and treatment of postpartum hemorrhage (PPH) among health care providers in Enugu, Nigeria. A cross-sectional study was conducted among health professionals (doctors, pharmacists, and nurses) in two Nigerian tertiary teaching hospitals (one federal and one state). A total of 220 questionnaires were distributed and 207 were returned (response rate: 94%) and analyzed using SPSS for inferential statistics with a level of significance of P < 0.05. Only 23.7% of the respondents had good knowledge of TXA use in PPH (P < 0.001), and awareness of the recent World Health Organization (WHO) recommendation on the use of TXA for PPH was low (19.8%, P < 0.001). The majority of the respondents had neither prescribed nor dispensed TXA (30%, P < 0.001). Very few respondents used TXA for all cases of PPH (16.4%, P < 0.001). Barriers against its use include nonawareness of the latest WHO recommendation, preference for other uterotonics, and cost of the drug. There was poor knowledge of TXA, poor awareness of its recommendation, and low use for PPH among different cadres of health care providers.

Postpartum Hemorrhage et causa Atonia Uteri and Ruptured Portion with Complications of Shock Hemorrhagic and Anemia: A Case Report from Southwest Sumba, East Nusa Tenggara

Postpartum hemorrhage is one of the most common obstetric emergencies, and it is the most significant contributor to maternal mortality in the world. The most common cause is uterine atony, followed by laceration in the perineum or portion. P4A0 spontaneous postpartum at the primary health care facility (Puskesmas), a baby boy with a birth weight of 3000 grams cries spontaneously. After delivering the baby, the placenta was born 15 minutes later, with active bleeding afterwards of more than 1500 cc without uterine contractions. The patient was then diagnosed with spontaneous postpartum P4A0 with uterine atony, and the management of uterine atony was performed by massaging the fundus with external and internal bimanual compression, accompanied by fluid resuscitation by inserting a 2-line IV line. She was then given vaginal misoprostol, but contractions were still absent. She was then given a uterotonic drip of oxytocin (30 iu/30 dpm), and the contractions are getting better and stronger. Bleeding was evaluated, but still active then exploratorium on the birth canal and the source of the bleeding was found to be a portion of the tear from front to back, towards 5 o'clock. Then stitching was performed on the portion, and 1 hour after suturing, the bleeding was no longer active. The patient was treated at Puskesmas, with a final HB of 7.5 g/dL. To improve diagnosis accuracy and speed in handling emergency obstetric cases. Atonia uteri is caused by many factors, one of which is parturition as experienced by the patient. After active management of stage 3, bleeding continues, so that treatment is given, including the administration of crystalloid fluid, uterotonics, uterine massage, bimanual compression, and catheter condom placement. If the steps that have been taken have not stopped the bleeding, then the next intervention must be immediately taken, namely surgery. In cases of postpartum hemorrhage caused not by uterine atony but by a wound or tear in the portion, prompt actions must be taken to immediately eliminate bleeding by exploring and sewing the torn part and then re-evaluating to ensure that the bleeding stops. Establishing the right diagnosis in emergency cases of postpartum hemorrhage and providing prompt and appropriate treatment can prevent complications ranging from shock to death.

Intrauterine Vacuum-Induced Haemorrhage-Control Device: A Novel Approach For Pph.

Madam, Postpartum haemorrhage (PPH), defined as postpartum blood loss of &gt; 1000 mL, is a life-threatening emergency and the leading cause of maternal mortality accounting for 25% of maternal deaths worldwide (1). PPH can lead to significant morbidity, including shock, ARDS, coagulopathy, infertility due to hysterectomy, and even mortality (4). Uterine atony is the most common cause, accounting for 80% of all cases of PPH (1) (2). Active management of the third stage of labour consisting of a triad of oxytocin, controlled cord traction, and uterine massage can reduce the incidence of PPH by 60% (5). If abnormal uterine bleeding ensues, PPH protocols are activated, including uterine balloon tamponade, uterine packing, uterine artery embolization, or hysterectomy (1, 2). The Jada System (novel intrauterine vacuum-induced haemorrhage-control device) approved by the U.S. FDA in August 2020, utilizes a low-level vacuum to induce negative pressure in the uterine cavity that facilitates uterine contraction to constrict myometrial blood vessels that can help with uterine atony (1). The device is used in patients with PPH where standard PPH treatments have failed or are contraindicated (1). It is a soft medical-grade silicone that attenuates the risk of tissue trauma and can be placed trans-vaginally after 3 cm of cervical dilation after vaginal birth and C-section (1,2). Ultrasound is used to check correct device placement, along with real-time quantification of the expelled blood from the uterine cavity into the graduated canister. The device can be placed for 1.5 hours to 24 hours inside the uterus. The device can be removed after evaluation of evacuated blood and palpation for a firm uterus, both signifying control of the hemorrhage (2). A First-in-Human (FIH) feasibility study conducted in Indonesia on 10 participants with atony-related PPH showed that the device was placed effectively, and bleeding was controlled in under 2 minutes with no unfavorable outcome in any participants (1) (3). The study was conducted with 107 participants of which two-thirds had atony-related PPH with failed medical treatment (1). The Per Protocol showed a 99% success rate in effectively controlling PPH (2). Bleeding halted in a minimum of 3 minutes, the treatment duration was around 3.2 hours and 98% of users regarded it as convenient to use (1). Adverse events included endometritis and vaginal infections all of which were resolved with adequate treatment (2). ---Continue

Knowledge, Attitude and Practices on the Use of Uterine Tamponade in the Management of Severe Postpartum Hemorrhage in Public Health Facilities of Niger State

Background: Obstetric hemorrhage is a contributor to worldwide maternal morbidity and mortality in low-resource countries. The aim of this study was to assess knowledge, attitude and practices on the use of uterine tamponade in managing severe postpartum hemorrhage (PPH) by healthcare personnel.&#x0D; Method: The study was descriptive and cross-sectional. A self-administered, structured questionnaire was used to collect data on uterine tamponade from untrained and trained health workers who take deliveries in labour wards of selected health facilities. Respondents were selected by cluster sampling technique. Data was analyzed using SPSS version 20. Frequencies were determined and chi-square was used to test the hypothesis. A p-value of &lt;0.05 was considered statistically significant.&#x0D; Results: The mean age of the respondents was 35 years ± 11.7. Slightly less than half of the respondents 62 (42.5%) had poor knowledge of uterine tamponade. The majority of respondents 120 (82.2%) had positive attitudes about uterine tamponade. This was associated with point of service, professional group, and previous training on uterine tamponade insertion (p&lt;0.05). About 70% (46; 69.7%) of respondents who had managed cases of refractory postpartum hemorrhage, had never conducted uterine tamponade. Reasons include inadequate knowledge (29; 63.0%) and unavailability of the commodities (9; 19.6%)&#x0D; Conclusion: Though knowledge about uterine tamponade was poor, attitude towards uterine tamponade in managing severe post- partum hemorrhage was good. However, this did not translate to good practices on the use of uterine tamponade in managing severe PPH. Training and re-training on the application of uterine tamponade should be conducted and commodities made available in every health facility.

Women with severe postpartum hemorrhage have a decreased endogenous thrombin potential before delivery

BackgroundSevere postpartum hemorrhage (PPH), defined as a blood loss ≥1000 mL, is associated with maternal morbidity and mortality. ObjectivesWe aimed at characterizing coagulation properties of predelivery plasmas from pregnant women with thrombin generation assay and hemostatic biomarkers (plasminogen activator inhibitor-1, tissue factor [TF], and thrombomodulin). MethodsA nested case-control study was conducted within the “Study of Biological Determinants of Bleeding Postpartum,” a French prospective cohort study, in order to compare women with severe PPH (cases) and controls matched for age, body mass index, term, and mode of delivery. Plasma was collected at entry in the delivery room, and blood loss was measured objectively. The predelivery endogenous thrombin generation potential (ETP) was measured in plasma using calibrated automated thrombinography and low TF concentration. Hemostatic biomarkers were measured using ELISA kits. ResultsA total of 142 women (71 cases and 71 controls) were investigated. There was no difference in the median lag phase, thrombin peak, and time to peak between cases and controls. However, median predelivery ETP was lower in cases than in controls (2170 vs 2408 nM.min, P < .0001), independently of mode of delivery and PPH etiology. Median plasminogen activator inhibitor-1 and TF levels were higher in cases compared with controls (107.4 vs 68.1 ng/mL, P = .0003; 34.4 vs 27.4 pg/mL, P = .007), whereas thrombomodulin levels did not differ between the 2 groups. ConclusionAmong thrombin generation assay parameters, predelivery ETP levels may have a predictive value for severe PPH.

Incidence of postpartum hemorrhage based on the improved combined method in evaluating blood loss: A retrospective cohort study.

In view of the current clinical inaccuracies and underestimations of postpartum hemorrhage amount, this study aims to investigate the incidence, etiology, clinical characteristics of postpartum hemorrhage in different modes of delivery based on the combination of volumetric method, gravimetric method and area method in evaluating blood loss. This retrospective cohort study was conducted in Hangzhou Women's Hospital from January 2020 to June 2021, including 725 cases of postpartum hemorrhage among 18,977 parturients. Based on different modes of delivery, the participants were divided into three groups: vaginal delivery, forceps delivery, and cesarean section, for comparison. Using an improved combined assessment method for blood loss, we retrospectively analyzed a cohort of parturients with postpartum hemorrhage who underwent vaginal delivery, forceps delivery, or cesarean section and were hospitalized in Hangzhou Women's Hospital from January 2020 to June 2021. (1) Among the 18,977 parturients, 725 cases of postpartum hemorrhage occurred, with an incidence rate of 3.8%, and severe postpartum hemorrhage accounted for 0.4% of the cases. (2) The incidence of postpartum hemorrhage was significantly higher in the forceps delivery group than in the vaginal delivery group (χ2 = 19.27, P<0.001), while the incidence of severe postpartum hemorrhage was significantly higher in the cesarean section group than in the vaginal delivery group (χ2 = 8.71, P = 0.003). (3) The causes of postpartum hemorrhage were statistically different among the different delivery modes, with varying underlying factors (P<0.001). (4) Patients with postpartum hemorrhage in different delivery modes showed statistically significant differences in age, body mass index (BMI), birth weight, gestational age, gravidity, parity, the decline of postpartum peripheral blood hemoglobin concentration, and estimated blood loss (P<0.05). (5) The proportion of blood transfusion was significantly higher in the cesarean section group than in the vaginal delivery and forceps delivery groups (χ2 = 231.03, P<0.001). This study is a single-center retrospective study, which may have led to selection bias in case selection. Additionally, the implementation of the combined three blood loss assessment methods may not have been strictly followed in all cases. Moreover, due to the mixing of bleeding with amniotic and irrigation fluids, the accuracy of evaluation may have been affected, leading to the possibility of inaccuracy of blood loss. Forceps delivery and cesarean section increase the risk of postpartum hemorrhage, but forceps delivery does not significantly increase the incidence of severe postpartum hemorrhage. Uterine atony remains the leading cause of postpartum hemorrhage, while birth canal laceration and placental factors are the second most common causes of postpartum hemorrhage in forceps delivery and cesarean section, respectively. In this study, the volumetric method, gravimetric method and area method were combined to quantitatively assess postpartum hemorrhage amount. The combined method has strong clinical practicability and is less affected by subjective factors, although it also has limitations. In the future, we still need to focus on the early prediction and identification of postpartum hemorrhage, and further improve the quantitative assessment of postpartum blood loss.

Literature Study: Analysis of the Relationship Between Age and the Incidence of Postpartum Hemorrhage in Maternity Mothers

Postpartum hemorrhage is the leading cause of maternal death worldwide with an incidence of 5 – 10 percent of all deliveries. Data shows a downward trend in maternal mortality in Indonesia in 1991 from 390 to 230 in 2020 per 100,000 live births. Maternal mortality is an important concern because being one of the indicators of health status and the success of health development, the reduction in maternal mortality rate is also a target in the Sustainable Development Goals (SDGs). In the SDGs, the target of reducing the maternal mortality rate is 70 per 100,000 live births by 2030. The preliminary study found cases of postpartum hemorrhage with risk age less than 20 years as many as 90 people (6.2 percent), bleeding with age more than 35 years as many as 40 people (2.7 percent). The purpose of this study was to conduct a literature study on the relationship between maternal age and postpartum hemorrhage. This study used 13 national journals obtained through Google scholar and Garuda (Digital Referral Guard). Based on the results of the study, 10 journals stated that there was a significant relationship between maternal age and postpartum hemorrhage, while 3 other journals showed that there was no significant relationship between maternal age and postpartum hemorrhage.

Review of Current Insights and Therapeutic Approaches for the Treatment of Refractory Postpartum Hemorrhage.

Refractory postpartum hemorrhage (PPH) affects 10-20% of patients with PPH when they do not respond adequately to first-line treatments. These patients require second-line interventions, including three or more uterotonics, additional medications, transfusions, non-surgical treatments, and/or surgical intervention. Multiple studies have suggested that patients with refractory PPH have different clinical characteristics and causes of PPH when compared to patients who respond to first-line agents. This review highlights current insights into therapeutic approaches for the management of refractory PPH. Early management of refractory PPH relies on both hypovolemic resuscitation and achievement of hemostasis, with an emphasis on early blood product replacement and massive transfusion protocols. Transfusion needs can be more rapidly and accurately identified through point-of-care tests such as thromboelastography. Medical therapies for the treatment of refractory PPH involve treatment of both uterine atony as well as the underlying coagulopathy, with the use of tranexamic acid and adjunct therapies such as factor replacement. The principles guiding the management of refractory PPH include restoring normal uterine and pelvic anatomy, through the evaluation and management of retained products of conception, uterine inversion, and obstetric lacerations. Intrauterine vacuum-induced hemorrhage control devices are novel methods for the treatment of refractory PPH secondary to uterine atony, in addition to other uterine-sparing surgical procedures that are under investigation. Resuscitative endovascular balloon occlusion of the aorta can be considered for cases of critical refractory PPH, to prevent or decrease ongoing blood loss while definitive surgical interventions are performed. Finally, for patients with critical hemorrhage resulting in hemorrhagic shock, damage control resuscitation (a staged surgical approach focused on restoring normal physiologic recovery and maximizing tissue oxygenation prior to proceeding with definitive surgical management) has been shown to successfully control refractory PPH, with an overall mortality decrease for obstetric patients.

TRIAL OF LABOR AT THE MATERNITY DEPARTMENT OF THE SOUROSANOU UNIVERSITY HOSPITAL (CHUSS): CLINICAL ASPECTS, THE MATERNAL AND PERINATAL PROGNOSTICS

Aims : We aimed at studying the clinical aspects and the maternal and perinatal prognostics during trial of labor at the Gynecology and Obstetrics Unit. Patients and Methods : This is a transversal and Descriptive study over a period of 06 months from 1 st May to 30 th October 2016 in the Gynecology and Obstetrics Unit of the SourôSanou University Hospital (CHUSS). The data were collected and analyzed by the software Epi info version 3.4.5. Results : During the period of study, 109 cases of trial of labor for a total of 2124 births were registered, with an overall frequency of 5.13%. The average age of the patients was 26.6 years. In 42.2% of cases, the patients were primiparious . Admission was direct in 85.5% of cases. The coverage rate for prenatal consultation was 100%. There was vaginal delivery for 108 patients, ie a success rate of 99.08% for trial of labor. An episiotomy was performed in 18.34% of those who delivered vaginally with a labor time less than 3 hours in 65.13% of cases. The indication of the cesarean section during the failure of the trial of labor was dominated by acute fetal distress in 0.91% of cases. Among the 14 patients who had complications during the postpartum period, 06 cases of postpartum hemorrhage of 22.85%, were noted, but did not occasion any maternal death. We registered 109 newborns including 106 alive (97.2%), 10 fresh stillborn, 02 perinatal deaths and 01 macerated stillborn. Among the 13 cases of perinatal morbidity, infections, neonatal suffering and hypotrophy were largely dominant with 5.5%, 38, and 5.34% of the cases. Conclusion : The results of our study (99.08% of success) argue in favor of vaginal delivery after uterine scar, with little risk related to this scar when the pregnancies are followed closely. Indeed, with a normal and careful obstetric monitoring, a scarred uterus after one segmental cesarean section must be considered as a normal uterus that can allow the woman to deliver simply without her being exposed to any particular risk of uterine rupture.

Association of maternal anemia with perinatal outcomes

Introduction: Anemia is one of the most prevalent nutritional deficiency problems afflicting pregnant women. Anemia that complicates pregnancy threatens the life of both the mother and the fetus. Nowadays, maternal anemia is considered as a public health problem in the world, especially in developing countries. Pregnancy increases considerably the iron needs in a mother. Iron deficiency is the most common cause for anemia during pregnancy.Aims and objectives: To assess the association of maternal anemia with perinatal outcomes. To assess the association of anemia with postpartum haemorrhage, puerperal sepsis, venous thrombosis, subinvolution of uterus, lactational failure, delayed wound healing, maternal morbidity and mortality. To determine the relationship between maternal anemia during pregnancy and intrauterine death, IUGR, infant low birth weight, APGAR scores, preterm birth, stillbirth, neonatal morbidity and mortality.Methods: A prospective observational study was conducted on 100 women who attended antenatal OPD, out of which 50 women diagnosed with iron deficiency anemia and 50 women who are non anemic and delivered at kamineni institute of medical sciences, narketpally from january 2022 to june 2022. Women whose age > 19 years and < 36 years, women with multiple gestation, gestational hypertension, pre-eclampsia, oligohydramnios, gestational diabetes mellitus, hypothyroidism, previously known case of hemolytic anemia, hemoglobinopathies such as thalassemia, sickle cell anemia, chronic renal disease, chronic liver disease, aplastic anemia and women who did not give consent to participate in the study are excluded from the study. Results: In this study of 50 anemic patients, 10 of them had mild anemia (20%), 17 of them had moderate anemia (34%), 19 of them had severe anemia (38%), 4 of them had very severe anemia (8%). Distribution according to maternal outcomes out of 50 patients, was 17 patients (34%) had IUGR, 16 patients (32%) had preterm delivery, 13 patients (26%) had delayed wound healing, 9 patients (18%) had lactational failure, 2 patients (4%) had intrauterine death. There are no cases of postpartum haemorrhage, puerperal sepsis and no maternal death. In this study of 50 patients, distribution according to neonatal outcomes was 20 patients (40%) had low birth weight, 19 patients (38%) had low APGAR scores, 7 patients (14%) had neonatal sepsis and no cases of neonatal anemia and neonatal death.Conclusion: Anemia is significantly associated with adverse maternal and neonatal outcomes and as the severity of anemia is increased, its adverse effects are even worse. Routine iron and folic acid, micronutrient supplementation regularly and whenever indicated parenteral iron infusions or blood transfusions must be done during pregnancy which prevents such adverse outcomes and has beneficial effects on the pregnancy outcome. Therefore, it is necessary for identification of anemia antenatally, prompt treatment for correction of anemia and measures to reduce the incidence of anemia in pregnancy to prevent adverse maternal and neonatal outcomes.

Recent Trends in Tranexamic Acid Use During Postpartum Hemorrhage in the United States [ID: 1380480

INTRODUCTION: The United States has one of the highest rates of maternal mortality among developed regions, and postpartum hemorrhage (PPH) accounted for 14% of all pregnancy-related deaths between 2017 and 2019. Several large studies have demonstrated decreased PPH rates with the use of tranexamic acid (TXA). Consensus has not yet been reached on the when to administer use of TXA. Little data exist regarding the prevalence of TXA use in obstetric patients with and without PPH. METHODS: Using a national database, we identified over 1.2 million pregnancies between January 1, 2015, and June 30, 2021. Pregnancy and delivery information was abstracted using ICD-10 codes. The GW Institutional Review Board approved the study protocol and waived the requirement for patient informed consent. RESULTS: Overall, TXA was used 1% of the time (12,394/1,262,574), and there was a fivefold increase in TXA use (0.5–2.5%) during the study period. Patients had similar demographic characteristics. Tranexamic acid use differed by geographic region. The use of TXA increased in both patients with PPH and those without. There was a greater increase in the number of patients who received TXA for prophylaxis of PPH than those who received it as treatment of PPH. CONCLUSION: This is the largest U.S. observational study to examine patterns of TXA use in obstetrics. Tranexamic acid was only administered in approximately 10% (4,586/43,928) of cases of PPH. This represents an opportunity to increase awareness for the role of TXA in management and prevention of PPH.

Is Adenomyosis a Rare Cause of Post Partum Hemorrhage?

Post-partum haemorrhage is the leading cause of maternal mortality worldwide. The use of management guidelines has improved outcomes resulting in reduction in mortality rates. Adenomyosis is associated with infertility. Anecdotal reports of adverse pregnancy outcomes have been described. 2 cases of secondary post-partum haemorrhage are described in this report with a short discussion of its causation and impact.

Managing the coagulopathy of postpartum hemorrhage: an evolving role for viscoelastic hemostatic assays

Postpartum hemorrhage (PPH) is usually caused by obstetrical complications but may be exacerbated by hemostatic impairment. Standard laboratory tests of coagulation often take too long to become available to inform treatment in a rapidly changing clinical situation. The role of point-of-care viscoelastic hemostatic assays (VHAs) in monitoring hemostatic impairment and guiding procoagulant blood product replacement during PPH is evolving, although these technologies are not available in most maternity units. We have used VHAs during PPH in our institution for the last 8 years and have developed a simple algorithm to direct blood component replacement. VHAs are useful for reassuring clinicians that hemostasis is adequate and that procoagulant blood products are not required and an obstetrical cause for bleeding needs to be sought. VHAs can be used to detect hypofibrinogenemia due to dilution or acute obstetrical coagulopathy and to guide fibrinogen replacement. The role of VHAs in guiding fresh frozen plasma infusion is less clear, but normal results suggest that fresh frozen plasma is not required. In this review, we describe 3 cases of postpartum hemorrhage to illustrate different hemostatic scenarios and discuss the controversies and evidence gaps related to each case.

ROLE OF VARIOUS MODALITIES IN MANAGEMENT OF POSTPARTUM HAEMORRHAGE(MEDICAL+SURGICAL)

Background: PPH is responsible for 25% of all maternal deaths. In India, PPH incidence in India is 2%-4% following vaginal delivery and 6% following cesarean section. PPH as the important cause of 19.9% of maternal mortality in India. Objectives:The objectives of the study were to study the incidence, risk factors, cause,complications and management of PPH. Materials and Methods: This prospective observational study was conducted in the Department of OBGY, SVPIMSR,Ahmedabad, India. A total number of 50 cases of postpartum hemorrhage that fullled the selection criteria were included. The records were analyzed with respect to maternal Results: age, parity &amp; etiological prole and maternal consequences in cases of PPH at our tertiary care center. Main cause of PPH in this study was uterine atony i.e. 56.38%. Second common cause was traumatic i.e. 21.27%. 20% of cases were given blood transfusions. However,maternal death due to hemorrhage in our study was negligible. Conclusions: Active management of the third stage of labor is crucial.Availability of blood and blood products is very crucial. Prediction and assessment of blood loss and timely identication of uterine atony are remaining the cornerstone for prompt and effective management of PPH. 60% cases were managed by medical methods while the rest of the cases required surgical management. Among the medical management uterotonic drugs and bimanual uterine compression was used while among the surgical methods repair of cervical and vaginal laceration was mostly required.

Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study

INTRODUCTION: Continuous monitoring of the hemostasis system during postpartum hemorrhage is an essential aspect of intensive care. Rotational thromboelastometry (ROTEM) provides rapid and differentiated detection of hemostasis system disorders. OBJECTIVE: To evaluate the effect of implementing the rotational thromboelastometry on the need for blood transfusion in massive postpartum hemorrhage in the practice of perinatal centers. MATERIALS AND METHODS: A retrospective cohort multicenter study was conducted in two perinatal centers. The BEFORE group included females with massive postpartum hemorrhage (PPH) (&gt; 30 % of circulating blood volume (CBV) or &gt; 2 L) within 2 years prior to ROTEM implementation in tertiary care hospitals; the AFTER group included females with massive postpartum hemorrhage within 2 years after ROTEM implementation. The primary endpoint of the study was a comparative evaluation of the frequency of fresh frozen plasma (FFP) transfusion for hemostasis correction in massive PPH before and after ROTEM implementation as an urgent method for coagulopathy diagnosis. RESULTS: A total of 97 patients were included in the study: 48 in the BEFORE group and 49 in the AFTER group. A significant relative risk (RR) of reduced frequency of FFP transfusion RR = 0.53 (0.32, 0.85; p = 0.009) with NNT = 3.6 after implementation of ROTEM into clinical practice was found. The frequency of cryoprecipitate transfusion increased. Analysis of cases of PPH over 50 % of the CBV (PPH in the BEFORE and AFTER groups 68.2 ± 12.4 and 72.3 ± 35.9, respectively, p = 0.673) showed a twofold significant risk of reducing the number of parturient women requiring FFP transfusion: RR = 0.5 (0.25, 0.99); p = 0.049), with NNT = 2. CONCLUSION: Rapid information on the status of the hemostasis system can reduce unnecessary FFP transfusion. Introducing the ROTEM method into the clinical practice of obstetric hospitals will improve the outcomes of intensive care for one of the most challenging categories of patients — postpartum women with massive postpartum hemorrhage.

Literature Review: Perbedaan Pemberian Oksitosin Profilaksis Secara Intravena dan Intramuskular Terhadap Kejadian Perdarahan Postpartum

Postpartum Haemorrhage is a condition of blood loss of more than 500 cc that occurs within 24 hours after delivery. Postpartum hemorrhage is a significant cause of morbidity and mortality in childbirth. Postpartum Haemorrhage occurs in about 1% to 6% of all deliveries. Uterine atony, the leading cause of primary postpartum hemorrhage, accounts for 70% to 80% of all bleeding. Early prevention in postpartum hemorrhage cases is the usage of uterotonics in the third stage of labor which has become the standard of intervention worldwide. The choice of uterotonic in managing postpartum hemorrhage should be adjusted to the administration and dosage. This Study aims to analyze the difference in prophylactic administration of oxytocin injected in intramuscular and intravenous during postpartum hemorrhage. Data were searched using PICO, articles were selected using PRISMA, and critical appraisal. There is decreased postpartum hemorrhage compared to IM oxytocin administration. Intra Vena oxytocin administration could reduce the incidence of severe postpartum hemorrhage and prevent blood transfusions compared to IM oxytocin administration in the third stage of labor in postpartum hemorrhage. However, there was no significant difference in hemoglobin changes. The side effects caused by intravenous administration are still manageable compared to intramuscular administration. Intravenous oxytocin prevented postpartum hemorrhage in stage III more effectively than intramuscular administration. The side effects that emerged in the two groups of intravenous and intramuscular administration were not significantly different and were still within mild limits. The administration of oxytocin in preventing postpartum hemorrhage in the third stage of labor has become a procedure and recommendation of health organizations.

Postpartum hemorrhage management according to the underlying cause

Postpartum hemorrhage (PPH) is still a significant cause of death worldwide. This condition is classically defined as a blood loss of 500 ml or more within 24 hours after birth. Their most common causes are uterine atony, placental retention, coagulation disorders or genital trauma, and the management depends on each cause. PPH remains the leading cause of maternal mortality in low-income countries and stands out as the primary cause of nearly one quarter of all maternal deaths globally. Most deaths resulting from postpartum hemorrhage take place during the first 24 hours after birth, and the majority of these could be prevented through prophylactic uterotonics during the third stage of labor and by timely and appropriate management. Postpartum hemorrhage can occur in patients without priorly known risk factors for bleeding. The proper management of postpartum hemorrhage implies rapid diagnosis and treatment. The four Ts mnemonic can be used to diagnose and cure the four most common causes of postpartum hemorrhage: uterine atony (Tone); laceration, hematoma, inversion, rupture (Trauma); retained tissue or invasive placenta (Tissue); and coagulopathy (Thrombin). Fast-diagnosing team-based care significantly reduces the morbidity and mortality associated with postpartum hemorrhage, no matter the cause. This article plans to provide a scheme for the strategic policy and steps needed to ensure effective interventions in all PPH cases.

Factors Affecting Anemia in Pregnancy Women in Ibeju-Lekki, Lagos State, Nigeria.

Anemia progresses due to low red blood cells counts or hemoglobin. The World Health Organization (WHO) has suggested the condition to be a serious global public health problem that affects pregnant women worldwide. Anemic pregnant women may suffer post-partum hemorrhage, pre-term delivery, seizures, and severe cases of anemia that potentially lead to cardiac failure or death. However, it is pertinent for pregnant women and health service providers to have the adequate knowledge about the factors associated with anemia in pregnancy. Thus, this study assessed the factors associated with anemia in pregnancy women attending primary healthcare (PHC) centers in Ibeju-Lekki Local government area, Lagos state. This study employed descriptive cross-sectional design using multi-stage sampling method to recruit 295 pregnant women into the study. Data were collected using a semi-structured, self-administered questionnaire. The recruited participants (56.6%) were majorly in their third trimester, of which their mean age was 28.7 ± 5.9 years. About 80.7% of the participants were married, having a mean knowledge score of 6.6 ± 3.2. More than half of respondents (56.3%) were anemic and had a poor knowledge (50.5%) of anemia in pregnancy. The mean hemoglobin concentration within the population was 11.06 ± 0.73 g/dl with a range of 8.3 to 12.0. There was no significant association between the respondents' knowledge of anemia in pregnancy and anemic status (X2 = 0.549; P = .45). However, this study observed a significant association between dietary diversity score and anemic status (X2 = 8.66; P = .01) and the trimester status of respondents' first antenatal visit (X2 = 9.603; P = .008). The study concluded that anemia in pregnancy was associated with maternal factors such as their first antenatal visit and the dietary diversity score. Due to this, proper education of pregnant women on anemia by health workers during antenatal clinics or visits should be prioritize to improve their anemia status.