Cause Of Postpartum Hemorrhage Research Articles

Pseudoaneurysm of the uterine artery, a rare cause of postpartum hemorrhage: Report of two cases and literature review

Pseudoaneurysm of the uterine artery is among the rare causes of postpartum secondary hemorrhage. Its diagnosis is suspected in the presence of significant uterine bleeding without any other obvious cause, and its diagnostic confirmation relies on Doppler ultrasound and angiography. We report the cases of two patients who experienced postpartum secondary hemorrhage, in whom pelvic ultrasound suspected an aneurysm, confirmed and treated by angiography. The post-embolization outcomes were favorable, marked by complete cessation of bleeding. Clinical and ultrasound follow-up at one month did not reveal recurrence of bleeding and demonstrated the disappearance of the previously described pseudoaneurysm.

Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa & Accreta.

Objective: To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients. Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical & Health Sciences for Women; Nawab shah for a period of six months from 7th June 2023 to 6th Dec 2023, after getting approval from ERB of People University of Medical & Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics & Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25. Results: The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired. Conclusion: The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care. Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.

Effect of low-intensity focused ultrasound therapy on postpartum uterine involution in puerperal women: A randomized controlled trial.

Short-term poor uterine involution manifests as uterine contraction weakness. This is one of the important causes of postpartum hemorrhage, posing a serious threat to the mother's life and safety. The study aims to investigate whether low-intensity focused ultrasound (LIFUS) can effectively shorten lochia duration, alleviate postpartum complications, and accelerate uterine involution compared with the sham treatment. A multicenter, concealed, randomized, blinded, and sham-controlled clinical trial was conducted across three medical centers involving 176 subjects, utilizing a parallel group design. Enrollment occurred between October 2019 and September 2020, with a 42-day follow-up period. Participants meeting the inclusion and exclusion criteria based on normal prenatal examinations were randomly divided into the LIFUS group or the sham operation group via computer-generated randomization. Patients in the LIFUS group received usual care with the LIFUS protocol, wherein a LIFUS signal was transmitted to the uterine site through coupling gel, or sham treatment, where no low-intensity ultrasound signal output was emitted. The primary outcome, lochia duration, was assessed via weekly telephonic follow-ups post-discharge. The involution of the uterus, measured by uterine fundus height, served as the secondary outcome. Among the 256 subjects screened for eligibility, 176 subjects were enrolled and randomly assigned to either the LIFUS group (n = 88) or the Sham group (n = 88). Data on the height of the uterine fundus were obtained from all the patients, with 696 out of 704 measurements (99%) successfully recorded. Overall, a statistically significant difference was noted in time to lochia termination (hazard ratio: 2.65; 95% confidence interval [CI]: 1.82-3.85; P < 0.001). The decline in fundal height exhibited notable discrepancies between the two groups following the second treatment session (mean difference: -1.74; 95% CI: -1.23 to -2.25; P < 0.001) and the third treatment session (mean difference: -3.26; 95% CI: -2.74 to -3.78; P < 0.001) after delivery. None of the subjects had any adverse reactions, such as skin damage or allergies during the treatment. This study found that LIFUS treatment can promote uterine involution and abbreviate the duration of postpartum lochia. Ultrasound emerges as a safe and effective intervention, poised to address further clinical inquiries in the domain of postpartum rehabilitation.

Perioperative outcomes and causes of postpartum hemorrhage in patients undergoing cesarean delivery in Thailand: A comprehensive retrospective study.

This study aimed to identify the characteristics, causes, perioperative anesthetic, and obstetric outcomes of patients experiencing postpartum hemorrhage (PPH) after cesarean delivery. We retrospectively analyzed patients who underwent cesarean delivery at the largest university hospital in Bangkok, Thailand, during a 5-year period (January 1, 2016-December 31, 2020). PPH was defined as an estimated blood loss (EBL) of ≥ 1000 ml within 24 hours postpartum. Of 17 187 cesarean deliveries during the study period, 649 patients were included for analysis. The mean EBL was 1774.3 ± 1564.4 ml (range: 1000-26 000 ml). Among the patients, 166 (25.6%) experienced massive PPH (blood loss > 2000 ml). Intraoperative blood transfusions were necessary for 264 patients (40.7%), while 504 individuals (77.7%) needed intraoperative vasopressors. The analysis revealed uterine atony as the leading cause of PPH in 62.7% (n = 407) of the patients, with abnormal placentation following at 29.3% (n = 190). Abnormal placentation was associated with a significantly higher mean EBL of 2345.0 ± 2303.9 ml compared to uterine atony, which had a mean EBL of 1504.0 ± 820.7 ml (P < 0.001). Abnormal placentation also significantly increased the likelihood of blood transfusions and hysterectomies (P < 0.001 for both) and led to more intensive care unit admissions (P = 0.032). The risk of EBL exceeding 2000 ml was markedly higher in patients with abnormal placentation (odds ratio [OR] 5.12, 95% confidence interval [CI] 3.45-7.57, P < 0.001) and in cases involving trauma to the internal organs (OR 2.33, 95% CI 1.16-4.71, P = 0.018) than in patients with uterine atony. The study documented three instances of perioperative cardiac arrest, one of which was fatal. These findings highlight the importance of comprehensive perioperative management strategies, including the ready availability of adequate blood and blood products, particularly in scenarios predisposed to significant hemorrhage. Clinical trial registration: Clinicaltrial.gov registration number NCT04833556 (April 6, 2021).

Imaging of Antepartum and Postpartum Hemorrhage.

Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.

Risk of Placenta Accreta Spectrum Following Myomectomy: A Nationwide Cohort Study

ABSTRACT Placenta accreta spectrum (PAS) is described as a partial or total lack of decidua with adherence or invasion of the placenta to the myometrium and is a major cause of postpartum hemorrhage and peripartum hysterectomy. The risk of PAS is approximately 1 in 272 in the United States. Prior uterine surgeries including myomectomy disrupt the integrity of the endometrium and myometrium and may increase the risk of PAS. However, the association between myomectomy and PAS remains controversial. This retrospective nationwide cohort study aimed to investigate the effect of myomectomy, stratified by method of myomectomy, on the risk of PAS. Data were obtained from the Taiwan National Health Insurance Research Database, which includes prenatal, perinatal, demographic, and treatment data on nearly all pregnant patients in Taiwan. All pregnant people who gave birth after 20 weeks of gestation between January 2008 and December 2017 were included. Patients with incomplete data, previous history of PAS before myomectomy, robotic-assisted myomectomy, or a diagnosis of adenomyosis were excluded. Patients were classified into 3 groups according to method of myomectomy: laparotomic, laparoscopic, and hysteroscopic. A 1:1 propensity-score estimation matching with logistic regression was used for patients with and without history of myomectomy to minimize selection bias. The primary outcome was placenta accreta, whereas secondary outcomes included placenta previa, postpartum hemorrhage, placenta abruption, uterine rupture, and preterm delivery. Logistic regression models were used to analyze the association between myomectomy and adverse pregnancy outcomes and the risk of placenta accreta for the entire population. Analysis of variance and post hoc tests were used to analyze differences in clinical characteristics and adverse pregnancy outcomes according to different methods of myomectomy. A total of 1,393,628 patients were included in this study. Among them, 11,255 patients had a history of myomectomy. Placenta accreta spectrum occurred in 0.96% of those with a history of myomectomy and 0.20% of those without. The risk of PAS was significantly higher in patients with a history of myomectomy, compared with those without (adjusted odds ratio, 2.28; confidence interval [CI], 1.85–2.81; P &lt; 0.01). There was an elevated risk of other adverse pregnancy outcomes including placenta previa, postpartum hemorrhage, cesarean hysterectomy, uterine rupture, preterm delivery, and placenta abruption among those with a history of myomectomy compared with those without. The presence of placenta previa significantly increased risk of PAS, as did the number of prior myomectomies. The propensity score–matched cohort analysis found a similar increase in PAS risk associated with myomectomy. Compared with subjects without a history of myomectomy, the risk of PAS was greater after hysteroscopic (adjusted odds ratio, 3.88; 95% CI, 2.68–5.63), laparoscopic (2.02; 95% CI, 2.79–5.62), and laparotomic myomectomy (1.86; 95% CI, 1.33–2.60). The results of this study find that a history of myomectomy is significantly associated with increased risk of PAS in subsequent pregnancies. Hysteroscopic myomectomy was associated with the highest risk of PAS, and the presence of placenta previa or history of multiple myomectomies further increased the risk.

Efficacy of Bakri Intrauterine Balloon in Managing Postpartum Hemorrhage: A Comparative Analysis of Vaginal and Cesarean Deliveries with Placenta Accreta Spectrum Disorders.

BACKGROUND The incidence of placenta accreta spectrum disorder (PAS) has been increasing in past decades, and women with PAS are a high-risk maternal population. This study aimed to explore the performance of Bakri intrauterine balloon tamponade (IUBT) in the treatment of postpartum hemorrhage (PPH), among those with and without PAS. MATERIAL AND METHODS The outcomes of 198 women who underwent treatment for PPH using IUBT were retrospectively analyzed. The demographics and maternal outcomes were analyzed for vaginal and cesarean births, with PAS and without PAS. RESULTS Compared to women with vaginal births (n=130), women who underwent cesarean births (n=68) showed a higher proportion of age ≥35 years (χ²=6.85, P=0.013), multiple births (χ²=13.60, P<0.001), preeclampsia (χ²=9.81, P=0.002), use of transabdominal IUBT (χ²=84.12, P<0.001) and pre-IUBT interventions (χ²=41.61, P<0.001), but had less infused volume of physiological saline (t=6.41, P<0.001). Women with PAS (n=105) showed a higher rate of pre-IUBT intervention (χ²=4.96, P=0.029) and transabdominal IUBT placement (χ²=9.37, P=0.002) than non-PAS women (n=93). The 36 women with PAS (n=36) showed a higher rate of preeclampsia (χ²=4.80, P=0.029), pre-IUBT intervention (χ²=5.90, P=0.015), and transabdominal IUBT placement (χ²=14.94, P<0.001) and a shorter duration from delivery to Bakri insertion (χ²=3.31, P=0.002), than non-PAS women (n=32). CONCLUSIONS PAS was a major cause of PPH at 198 vaginal and cesarean births. An accurate and timely pre-IUBT intervention and Bakri IUBT placement was critical for controlling PPH in cesarean births, especially in women with PAS.

HUBUNGAN CARA MENERAN DENGAN KEJADIAN RUPTUR PERINEUM PADA IBU BERSALIN DALAM PERSALINAN KALA II DI PMB DESA SUKASARI KECAMATAN RUMPIN KABUPATEN BOGOR

A tear of the birth canal becomes the second cause of postpartum hemorrhage. Technique straning can affect the occurrence of perineal rupture in mothers who give birth spontaneously. The biggest cause of maternal death is bleeding, which is 30.3% and old partus is the lowest cause at 1.8%, but better treatment is needed so that it does not occur during labor (Ministry of Health, 2018). This study aims to analyze how to straining with incidence of perineal rupture in maternity mothers in Kala II Labor at PMB Sukasari Village, Rumpin District, Bogor Regency. The research method used is an observational analytical with a cross sectional approach. The population in this study was 55 people with a sample of 35 primiparous mothers. This research instrument uses SOP observation sheets for how to run and partograph sheets. Data processing is carried out univariately and bivariately with Chi Square Test with the help of SPSS computer program. The results of the study indicate that there is a relationship how to straining the Valsalva technique and the perineal rupture whith a volue ρ = 0.004 &lt; α = 0.005 indicating that how to straining the valsava technique affects the incidence of perineal rupture. The results of the study concluded that the way of straining can affect the incidence of perineal rupture at the time of labor. It is recommended that pregnant women in the third trimester can learn to straining properly so that there is no perineal rupture at the time of delivery

Epidural anesthesia in a patient with placenta accreta for intra-aortic ballooning and cesarean section

Postpartum hemorrhage (PPH) is one of the main causes of maternal death besides cardiovascular disease. Among the causes of PPH is placenta accreta. Hysterectomy is usually performed in placenta accreta to save the mother's life. However, hysterectomy has a direct impact on fertility so that a new strategy was developed, namely the use of prophylaxis Intra-abdominal Aortic Balloon Occlusion (IABO). Anesthetic management plays an important role in ensuring the safety of placenta accreta patients.&#x0D; We present a case of a 34-year-old woman G3P1A1 38+3 weeks with a history of antepartum hemorrhage, complete placenta previa with moderate risk morbidly adherent placenta (MAP), oblique breech position, oligohydramnios, intrauterine growth restriction (IUGR), and previous cesarean section (CS) 4 y ago. She was ASA-II and planned cystoscopy and ureteral catheter insertion by a urologist. The aortic ballooning angioplasty was done through inguinal area by a cardiothoracic surgeon. Followed by CS for 120 minutes, and duration of arterial blockade that can be maintained for 20 min during CS. The operation was performed using epidural anesthesia. Induction with an initial epidural dose was carried out using levobupivacaine 0.5% 15 ml in 5 ml increments every 5 min.&#x0D; Placenta accreta can cause massive bleeding, disseminated intravascular coagulation (DIC), and damage to the liver and kidneys. Massive bleeding caused by placenta accreta significantly increases maternal morbidity and mortality. The latest technology called Intra-abdominal Aortic Balloon Occlusion (IABO) is an option to reduce bleeding and the need for transfusions during and after surgery. Epidural anesthesia is considered a favorable anesthetic option for these patients, as it can also be used as a good postoperative analgesia.&#x0D; Key words: Placenta Accreta; Intra-abdominal Aortic Balloon Occlusion; Epidural anesthesia&#x0D; Citation: Supraptomo RTH. Epidural anesthesia in a patient with placenta accreta for intra-aortic ballooning and cesarean section. Anaesth. pain intensive care 2023;27(6):768−771; DOI: 10.35975/apic.v27i6.2144&#x0D; Received: January 27, 2023; Revised: March 05, 2023; Accepted: October 26, 2023

The Effect of Alarm Use on the Awareness of Taking Iron Supplements (Haemoglobin Levels) as a Prevention of Haemorrhagic Postpartum

Anemia is one of the indirect causes of Postpartum Hemorrhage (HPP) during childbirth. The development of iron supplement alarm reminders can be used as an alternative intervention to increase awareness and consumption of iron supplements as a preventive measure against HPP. This study aims to analyze the Effect of Alarm Usage on Awareness in Consuming Iron Supplements (Hemoglobin Levels) as a Prevention of HPP in the Working Area of the Tempurejo Community Health Center, Jember Regency. The research employs a one-group pre-post-test design (pre-experiment) with a cross-sectional approach involving 30 respondents through Accidental Sampling. Data collection includes coding, editing, tabulation, and subsequent manual and computer-based analysis using Paired T-Test. Among the 30 respondents, the awareness of taking iron supplements before using the alarm showed non-compliance in 22 respondents (73.3%) and compliance in only 8 respondents (26.7%), with all 30 (100%) pregnant women experiencing anemia, either moderate (73.3%) or mild (26.7%). After the alarm was used, the number of respondents aware and compliant in taking iron supplements increased to 27 respondents (90%), with only 3 respondents (10%) remaining non-compliant. This was also indicated by an increase in normal Hb levels in 18 respondents (60%). The P-value was 0.000 and a = 0.05, meaning r &lt; a, indicating the influence of alarm usage on awareness in consuming iron supplements (hemoglobin levels) as a preventive measure against HPP. This is crucial for pregnant women to regularly consume iron supplements for safe and healthy childbirth. Midwives should consistently remind pregnant women to consume a minimum of 90 supplements during pregnancy and adapt to technological advancements by using gadgets familiar to the community

Effiacy of nausicaa compression sutures in terms of PPH management

ABSTRACT;&#x0D; BACKGROUND:Postpartum haemorrhage(PPH) is the most importantr cause of maternal death in Pakistan.Over 125,000 maternal deaths have been reported each year due to PPH. Major causes of PPH include uterine atony and haemorrhage from the placental bed. There is a recent increase in the rate of cesarean section which has increased the incidence of Placenta previa as well as placenta accreta spectrum. Apart from medical management, there are various conservative surgical interventions before imparting to hysterectomy such as uterine compression sutures which effectively secure hemostasis. The Nausicaa compression suture has been a new technique which effectively controls PPH in patients with uterine atony, placenta previa and accrete spectrum.&#x0D; OBJECTIVE: The objective of this study is to determine the efficacy of Nausicaa compression sutures in patientswith PPH undergoing cesarean section.&#x0D; PATIENTS AND METHOD: This study was conducted in the Obstetrics and Gynaecology department of Sir Ganga Ram Hospital,Lahore from 1st September2020 to 30th June,2022. Total of 80 patients who had PPH during cesarean section due to uterine atony or placenta previa spectrum were enrolled after informed consent. Nausicaa compression suture was applied to the anterior, posterior and both uterine walls where required.Successful procedure was those where only Nausicaa compression suture was sufficient to control PPH.&#x0D; RESULTS:The average age of patients was 30.3±4.2 years. There were 24(30%) primigravidas, 28(35%) were G2P1+0 and 28(35%) were multigravidas. The mean gestational age of patients was 37.58 weeks. 46 patients were operated on for indication of placenta previa. 6 patients had placenta accrete. 28 patients had other indications of LSCS. In 9 patients Nausicaa sutures were applied to the anterior uterine wall while in 71 patients to anterior and posterior uterine walls. In 62 patients Nausicaa suture was sufficient to control PPH. 10 patients required other interventions, while 8 patients required emergency hysterectomy due to intractable hemorrhage.&#x0D; CONCLUSION: The Nausicaa compression suture is an effective suture to control postpartum hemorrhage in patients with placenta previa and atonic uterus. It is most effective when applied to anterior and posterior both uterine walls separately.&#x0D; KEY WORDS: Post partum hemorrhage(PPH), Nausicaa Compression suture, Cesarean section.&#x0D;

Postpartum Hemorrhage

Postpartum hemorrhage (PPH) is the primary cause of maternal mortality and morbidity worldwide: in fact, about a quarter of deaths that occur during pregnancy, childbirth or the puerperium are caused by postpartum hemorrhage. There are many causes of postpartum hemorrhage, the most important are: uterine atony, lacerations of the cervix and/or perineum, retention of placental material, coagulation problems, uterine inversion, uterine rupture. This causes of PPH are represented by the ‘4Ts’ formula: tone, tissue, trauma, thrombin. An important role is played by prevention: identification of risk factors, prophylaxis with oxytocin at the time of delivery, early treatment. The first important thing is the quantification of blood loss because the clinical signs are often blurred and due to frank anemia resulting in tachycardia, small and frequent pulse, hypotension, sweating, paleness. As previously mentioned, it is important to act early in the case of PPH through maintenance of velamina and targeted therapies that differ according to the cause of PPH (the 4T algorithm is useful). Early intervention reduces the need for blood transfusions and reduces the incidence of serious complications such as DIC. However, the management of postpartum hemorrhage is not limited to the postpartum phase, but the patient must be monitored in the puerperium, a phase in which the thromboembolic risk is increased. The couple must also be informed of the risk of PPH in future pregnancies. PPH represents a serious risk for the patient and requires multidisciplinary input and proper preparation of the team working in the delivery room.

Postpartum hemorrhage: clinical features and management in a tertiary care center of Nepal

Introduction: Obstetric haemorrhage continues to account for a substantial proportion of maternal deaths in Nepal, despite implementation of different strategies. The most common type of obstetric haemorrhage is postpartum hemorrhage (PPH), mainly primary. Understanding its burden in the health care setting was the objective of this study by assessing its prevalence, associated factors and management. Method: This was a retrospective study conducted at Patan Academy of Health Sciences from Mar 2019 to Mar 2022. Demographic, obstetrical, medical factors and management of primary PPH was collected from medical record. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS-20). Results were expressed using frequencies, tables and figures. Result: From a total 17,770 deliveries, primary PPH was seen in 84(0.47%). Most of them 49(58.3%) were multipara. The frequency and impact of PPH can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased caesarean section rate which was 48(57.1%) among primary PPH. Other associated risk factors were induction of labor 32(38.1%), pre-existing medical diseases 32(38.1%), history of antepartum hemorrhage 15(17.9%), previous caesarean section 19(22.6%). Uterine atony 43(51.2%), abnormal placentation disorder 16(19%), genital trauma 9(10.71%), retained tissue 5(5.95%) were the leading causes of PPH. PPH in morbidly adherent placenta like placenta accreta spectrum was 8(9.5%) and placenta increta 1(1.2%). PPH was controlled by conservative management in 24(28.6%). Surgical intervention was required in 34(40.5%) including hysterectomy in 14(16.7%). Conclusion: PPH can be minimized by extra vigilance and planned conjoined management.

EFEKTIVITAS PENGOLESAN DAN PIJAT PERINEUM DENGAN MENGGUNAKAN MINYAK ZAITUN TERHADAP KEJADIAN RUPTURE PERINEUM

&lt;p&gt;&lt;em&gt;Perineal rupture is one of the causes of postpartum hemorrhage. This rupture is the second cause of bleeding where the most maternal deaths are bleeding (1,280 cases), and it occurs in almost every first delivery and not infrequently also in subsequent deliveries. This study aimed to determine The Effectiveness of Perineal Lubrication and Massage by Using Olive Oil toward Rupture During Labor at BPM Mawar Kerinci in 2021. The type of this study was group comparison pre-experimental design. Statistical test with Whitney Mann test. The population was primigravida pregnant women with a minimum gestational at 36 weeks. There were 30 pregnant women that chosen as the samples. It was divided into 2 groups, namely a group of pregnant women with olive oil and a group of pregnant women with perineal massage with olive oil. The results showed that in the olive oil smear group, there were 5 people (33.33%) and first-degree rupture were 6 people (40.0%), and as many as 4 people (25.67%) did not experience rupture of the perineum. In the perineal massage group with olive oil, 8 people (53.33%) did not have perineal rupture and 7 people (46.67%) experienced grade 1. Based on the analysis of the Whitney Mann test found a significant p value of 0.033 (&amp;lt; 0.05), it means that there was a significant difference between perineal rubbing and massage with olive oil on the incidence of perineal rupture. In short, it can concluded and perineal massage with olive oil can prevent perineal rupture better than applying olive oil in normal delivery. This program can be applied in midwifery clinical practice, especially for primigravida pregnant women.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Keywords: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Perineal rupture, perineal massage, olive oil&lt;/em&gt;&lt;/p&gt;

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.

Determinants of postpartum uterine atony in urban South Ethiopia: a community-based unmatched nested case–control study

BackgroundUterine 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.MethodsA 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.ResultsIn 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.ConclusionsPostpartum 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.

A Clinical Study on Management of Major Primary Postpartum Haemorrhage at Tertiary Care Centre

Introduction Postpartum Haemorrhage (PPH) remains one of the leading causes of maternal morbidity and mortality worldwide . It is estimated that about one quarter to one half of preventable maternal deaths are because of haemorrhage . It is defined by the royal college of obstetrician and gynaecologist ( RCOG) as blood loss from the genital tract within the first 24 hours after birth of at least 500ml ( minor) and at least 1000ml ( major)Early transfusion of blood and blood products prevent from developing coagulopathy . Causes of post-partum haemorrhage (PPH) are commonly ascribed to the four Ts (tone, trauma, tissue, 4 thrombin). Uterine atony is responsible for most of cases . Aims and objectives 1. To know the current clinical practice in management of major primary postpartum haemorrhage at tertiary care centre 2. To evaluate the causes of major primary postpartum haemorrhage Methodology This study aimed to assess the clinical practices used by Pannadhay Mahila Hospital, Udaipur. in managing major PPH. A retrospective study of the management of PPH over a period of 2 months from march 2023 to april 2023 was carried out. The Following criteria were examined: history of previous PPH causes of PPH, use of oxytocin in the first stage for more than 6 hours. role of blood transfusion, presence of senior faculty, and type of uterotonics used. Results: a total of 50 patients were diagnosed with major PPH among which 26 had caesarean delivery. Two major risk factors were analysed, one was Use of oxytocin in first stage for more than 6 hours and History of previous PPH. Uterine atony was commonest cause in 64% of cases followed by retained product of conception. Use of uterotonics were analysed among the patients which was consistent with current practice guideline. Conclusion: This study indicates that the management of women with major PPH in Pannadhay Mahila Hospital Udaipur is consistent with the current clinical practice. Uterine atony is responsible for most of cases. Early, aggressive, and coordinated intervention by health care professionals is critical in minimizing blood loss to ensure optimal clinical outcomes in management of women with major PPH

Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece.

Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.

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.

Risk factors of postpartum hemorrhage due to uterine atony: a retrospective cohort study

Background: Postpartum hemorrhage (PPH) continues to be a significant global burden leading to high maternal mortality and morbidity rates. Uterine atony is the most prevalent cause of postpartum hemorrhage, accounting for 75% to 90% of cases.&#x0D; Aim: Research uterine atony related PPH at Hospital of Hue University of Medicine and Pharmacy’s Department of Obstetrics and Gynecology.&#x0D; Materials and methods: In this study, we conducted a retrospective case-control study to determine the risk factors for PPH among a cohort of women who gave birth between August 2020 and June 2021 at the Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy Hospital. PPH was defined as an estimated blood loss ≥500 mL. Logistic regression analysis was used to identify independent risk factors for PPH.&#x0D; Results: After the vaginal deliveries, we collected data from 147 patients, including 49 women with PPH caused by uterine atony and 98 without PPH. Maternal characteristics significantly associated with PPH included: pre-delivery anemia (adjusted OR [aOR] 4.0, 95% Confidence interval [CI]: 1.7 - 11.2), macrosomia (aOR = 4.3; 95%CI 1.1 - 16.8) and grand parity (aOR = 4.7; 95%CI: 1.7 - 13.9).&#x0D; Conclusions: All pregnant women should have their risks associated with postpartum hemorrhage evaluated and monitored during their pregnancies’ prenatal, labor, and postpartum stages.