Control Postpartum Hemorrhage Research Articles

Bilateral Internal iliac artery ligation: A life saving conservative management to control postpartum haemorrhage- clinical experiences

It has been since long, that severe postpartum haemorrhage (PPH) was surgically treated by peripartum hysterectomy. Bilateral ligation of Internal iliac artery is an emerging technique by which we can control PPH efficiently and can conserve uterus. The aim of our study, is to estimate the effectiveness of bilateral Internal iliac artery ligation (IILA) for conservation of uterus in the management of postpartum haemorrhage and outcome on the patients.This observational study was carried out on the admitted patients in between March, 2016 and February, 2020in a hospital having a tertiary obstetric care. Internal iliac artery ligation done to control postpartum haemorrhage of hospital admitted patients, was our study subject. Collected data were analysed in mean, median, percentage and proportion as applicable by using of SPSS version 24 statistical software.In the study population, out of forty-one patients, uterine conservation was possible in thirty-six (87.8%) patients. Most commonly sixteen (39%) patients had an indication of uterine atony for Internal iliac artery ligation. Caesarean section, thirty-four (82.9%) was the most common mode of delivery and general anaesthesia was used most commonly, thirty-seven (90.2%) for Internal iliac artery ligation. Procedure related complications were e.g. relaparotomy one (2.4%), Internal iliac vein injury two (4.9%) and wound infection two (4.9%).Internal iliac artery ligation is an effective means to control PPH. It can effectively preserve reproductive potential of women by avoiding peripartum hysterectomy in many cases. Postpartum hemorrhage is a life threatening complication of child birth. Peripartum hysterectomy is the last resort to tackle such complications. Our study, confirmed that bilateral internal iliac artery ligation can be a good alternative to tackle such disaster from postpartum hemorrhage and also conserve uterus of women for future reproduction.

EFFECTIVENESS OF UTEROVAGINAL PACKING IN CONTROL OF PRIMARY POSTPARTUM HEMORRHAGE

Objective: To determine effectiveness of uterovaginal packing in control of primary postpartum hemorrhage. Methodology: It was a prospective interventional study conducted at department of Obstetrics and Gynecology from Nov 2019 to May 2021. Sample size was calculated by WHO sample size calculator with 95% confidence interval and 5% Margin of error of estimation 16. Consecutive non probability sampling technique was utilized and 85 cases with postpartum hemorrhage were enrolled who were admitted through emergency and outpatient department. All women of reproductive age, any gravidity or parity presenting with postpartum hemorrhage due to uterine atony, coagulopathy or placental implantation site bleeding after vaginal or abdominal delivery were includ­ed. Cases with Genital tract injuries requiring repair, retained placental tissue or membranes requiring Evacuation & Curettage, uterine rupture requiring Laparotomy and secondary postpartum hemorrhage were excluded. All information was recorded in a pre-designed proforma and data was analyzed using SPSS version 20. Results: Our study included 85 women with 62.35% normal vaginal deliveries and 37.65% with cesarean section, uterine atony found to be the top most cause of postpartum hemorrhage (47.1%). Success rate of uterovaginal packing remained high i.e 95.3% Conclusion: Our study concludes that Uterovaginal packing was 95.3% effective in the controls of postpartum hemorrhage. It is a quick and effective recovery to control postpartum hemorrhage conservatively.

Management and strategies utilized by nurses in the control of postpartum haemorrhage among pregnant women in UCTH

This study sought to investigate the management and strategies utilized by nurses in the control of postpartum hemorrhage among pregnant women in UCTH. In order to successfully carry out the study, the following research questions and hypotheses were formulated. What is the proportion, proper management strategies utilized and the causes of postpartum hemorrhage among pregnant women in UCTH? The research instruments used in collecting data for analysis was in parts, records from the hospital and a four point likert scale questionnaire which was administered on 57 nurses used as sample for the study. Their responses were analyzed using appropriate statistic and the following results were obtained. Only 12 cases of postpartum hemorrhage were recorded out of 1952 cases of labour registered in 2017 in UCTH. Management strategies utilized by the nurses in the control of postpartum haemorrhage in UCTH. Prolonged labour, disease conditions, multiparity with lax uterine muscles, retained product of conception and poor management of labour resulting in lacerations among others were identified as causes of postpartum haemorrhage.

A Unique Case of Complex Pelvic Arterial Collateralization Requiring Multidisciplinary Approach to Prolapsing Submucosal Leiomyoma

Leiomyoma are the most common benign tumor of the reproductive tract in premenopausal women. Uterine artery embolization has been accepted as a minimally invasive option for the treatment of leiomyoma. While pelvic arterial embolization has shown promising safety and effectiveness in controlling postpartum hemorrhage

Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania.

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

Uterine Compression Sutures in Controlling Postpartum Haemorrhage: A Narrative Review.

Postpartum haemorrhage is still the main cause of maternal morbidity and mortality. Many treatments are available, butthey may threaten fertility potential. As a uterine sparing procedure, we aimed to review uterine compression sutures in order to betterunderstand when they should represent an appropriate option. A comprehensive search in MEDLINE and PubMed databases including the terms 'postpartum haemorrhage'and 'uterine compression sutures' was performed. Results were revised and articles reviewing or presenting case reports of uterinecompression sutures to treat postpartum haemorrhage were included. The first description of uterine compression sutures to control postpartum haemorrhage was published in 1997, by B-Lynch etal. After this publication, many others have reported successful management of postpartum haemorrhage with different suturing techniques.Most of them describe success rates above 75% and the possibility of fertility preservation, with cases of uneventful pregnancyafter uterine compression sutures already published. Complications associated with each technique are rare. Reports of use of uterine compression sutures include small series of cases or even single case reports which limits thequality of existing evidence to support one technique over another. Nevertheless, uterine compression sutures are recognized as aneffective surgical conservative strategy to control postpartum haemorrhage due to uterine atony and its use is recommended, if possible,prior to hysterectomy. Uterine compression sutures are effective, safe and simple to perform in an emergent situation and preserve fertilitypotential in cases of postpartum haemorrhage.

The Usability, Acceptability, and Performance of the Maternal PPH Wrap Device in Controlling Postpartum Hemorrhage: A Pilot Study at Kawempe National Referral Hospital, Uganda

The Usability, Acceptability, and Performance of the Maternal PPH Wrap Device in Controlling Postpartum Hemorrhage: A Pilot Study at Kawempe National Referral Hospital, Uganda

Tamponamento por balão intrauterino no tratamento da hemorragia pós-parto

Abstract Introduction: Postpartum hemorrhage is an obstetric emergency with high prevalence and significant morbidity and mortality, especially in areas with reduced access to specialized health services. Objective: To evaluate the effectiveness of intrauterine balloon tamponade in controlling postpartum hemorrhage, with the aim to reduce the need for emergency surgical interventions and decrease maternal mortality. Methods: A systematic review of randomized clinical trials, guided by the Cochrane Handbook for Systematic Reviews of Interventions and reported through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Randomized clinical trials that evaluated the use of different types of balloons for intrauterine tamponade as a strategy for reducing or stopping postpartum hemorrhage compared to other interventions (pharmacological or surgical) were considered for inclusion. Results: Four studies evaluated 498 patients. In 80% of the reported cases, hemorrhage cessation was observed within a mean interval of 15 min after device insertion. The device permanence time was 24 h. No serious adverse events were reported. Due to clinical heterogeneity between studies, it was not possible to perform a quantitative synthesis. Conclusion: We did not find enough evidence to support the routine use of uterine tamponade devices as a protocol practice in the control of refractory postpartum hemorrhage. However, the use of these devices seems to be promising in cases where first line interventions fail and may play an important role in decreasing maternal morbidity and mortality and in uterine preservation.

-Lynch suture is effective in controlling postpartum hemorrhage: a prospective observational study

-Lynch suture is effective in controlling postpartum hemorrhage: a prospective observational study

Ureter injury in obstetric hysterectomy with placenta accreta spectrum: Case report.

Introduction and importancePlacenta accreta spectrum (PAS) is a state of abnormal attachment of the placenta, including placenta accreta, placenta increta, and placenta percreta. This condition can be life-threatening due to the placenta cannot spontaneously separated, resulting in continuous bleeding. Cesarean section followed by hysterectomy is one of the treatment options for PAS. There was a great liability for urinary tract injuries during the operation of PAS patient.Case presentationWe present the case of ureter injury during subtotal hysterectomy in patient with PAS. A 30-years-old female patient was diagnosed with recurrent antepartum hemorrhage due to placenta previa accreta spectrum on G2P1 33 weeks of gestational age, singleton live breech presentation, previous c-section 1×. After uterine transverse incision, the baby was delivered. We decided to perform subtotal hysterectomy. There was severe adhesion. On the exploration after subtotal hysterectomy was performed, we found ruptured of the right ureter.Clinical discussionHysterectomy peripartum is one of the treatment of PAS, either to prevent or to control postpartum hemorrhage. In pregnant women with morbid placental adherence, there was a great liability for urinary tract injuries. Distal ureters are the most commonly injured while hysterectomy. Injuries to the ureters in this patient occurred due to severe adhesions and unclear visual organ.ConclusionAlthough it is rare, ureter injury may occur during subtotal hysterectomy in patient with placenta accreta spectrum. To prevent that condition, inserting ureter stent can be perform before the operation. Multidisciplinary approach is carried out so that patient outcomes are good.

Conservative stepwise surgical approach for management of placenta previa accreta: A prospective case series study.

To describe a stepwise surgical approach for conservative management of placenta previa accreta to preserve the uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage. A prospective case series study conducted on 62 pregnant women with one or more cesarean deliveries diagnosed with placenta previa accreta between January 2018 and June 2019 at Ain Shams University Maternity Hospital. All participants underwent a conservative stepwise surgical approach through Pfannenstiel skin incision with fetal delivery through a uterine incision just above the upper border of the placenta, followed by bilateral uterine artery ligation with myometrial excision of the remaining adherent placenta and cervico-isthmic sutures by MMG (the main surgeon) and MS. Among 62 women, the surgical approach was successful in controlling postpartum hemorrhage and preserving the uterus in 50 (80.64%) participants. Three women (4.83%) had urinary bladder injuries, all were managed intraoperatively during the cesarean section. Five women (8%) had postpartum pyrexia and five women (8%) had postpartum endometritis, all were managed conservatively with broad-spectrum antibiotics. The stepwise surgical approach can be applied to the conservative management of placenta previa accreta to avoid unnecessary cesarean hysterectomy.

Clinical Experience Over 15 Years with the B-Lynch Compression Suture Technique in the Management of Postpartum Hemorrhage.

To describe the clinical experience with the B-Lynch technique in the management of postpartum hemorrhage as well as the factors related to the indication of the technique and to present the success rates of the application of the B-Lynch technique. Observational, retrospective, cross-sectional, and analytical study. Patient data was obtained through the study of medical records. The study population comprised of patients who underwent hemostatic suture using the B-Lynch technique, including 104 patients within the period from January 1, 2005, to December 31, 2019. Of the total of 104 patients, 82.7% did not present any complications. Blood transfusion and intensive care unit admission were the most prevalent complications, with 13.5% and 15.4%, respectively. Only 1% of the patients had puerperal and surgical site infections. The factors most related to the application of the technique were the presence of previous cesarean section (30.8%), use of oxytocin (16.3%), and preeclampsia (11.6%). Puerperal hysterectomy was performed in 4.8% of the patients due to failure of the method. The clinical experience with the B-Lynch technique was satisfactory since it presented few complications, with excellent results in hemorrhagic control. Previous cesarean section, the use of oxytocin, and preeclampsia stood out as factors related to the indication of the application of the technique, and the success rate in controlling postpartum hemorrhage was 95.2%.

Knowledge and Utilisation of Anti-Shock Garment Among Midwives of Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria

Background and Aim: Postpartum Haemorrhage (PPH) is a leading cause of maternal mortality, yet it is one of the few obstetric complications, with proven and effective interventions. Non-Pneumatic Anti Shock Garment (NASG) is a high-quality, simple technology and low-cost first-aid device that reverses hypovolemic shock. While evidence has shown that this simple technology is effective in reducing PPH, the level of knowledge and utilisation is unclear. This underscored the need to assess the knowledge and utilisation of the NASG as a measure of controlling postpartum haemorrhage in Adeoyo Maternity Teaching Hospital, Yemetu, Ibadan. Methods: This study adopted a descriptive cross-sectional research design and questionnaires were used to gather data from the midwives. The convenience sampling technique was used to recruit one hundred and forty-four (144) midwives into the study. Data were analysed using version 21.0 of Statistical Package for Social Sciences (SPSS) using Chi-square. Results: The findings of this study revealed that although 97.9% of participants responded that they had seen NASG before, only about half (47.1%) could describe what it looked like. While 96.4% claimed that they knew how to use the NASG, only 73.7% of them actually use it each time there was PPH. No significant association was found between knowledge and utilisation of the equipment (p=.298). Factors associated with non-usage include non-availability, inexperience, lack of skilled personnel, and poor attitude. Conclusion: There was a good level of utilisation of the Non-Pneumatic Anti-Shock Garment for the management of postpartum haemorrhage, but only a few of the midwives were able to correctly describe it and not all were using it. Hence, refresher courses are hereby advocated to further improve NASG usage.

Role of the Uterine Artery Ligation (UAL) In Control of Postpartum Hemorrhage

Objective: To determine the efficacy and safety of uterine artery ligation (UAL) in control of Postpartum Hemorrhage.
 Methodology: This case series study was conducted at Department of Gynecology and Obstetrics Peoples University of Medical & Health Sciences for Women Nawabshah. All the women age between 20-45 years, gestation duration at and beyond 34 weeks, antepartum hemorrhage; intraoperative atonic postpartum hemorrhage and discovery of a placenta accreta; or an adherent placental part after piecemeal removal of the placenta, with bleeding from the placental site were included. After failure of treatment from medical measures, the initial surgical approach of uterine artery ligation (UAL) was done. Efficacy was defined as positive when patient improves or clinically doesn’t develop any complication throughout admission after UAL. Safety was assessed by appearance of side effects if any occurred after procedure. Data was recorded via study proforma and analysis was done by using SPSS version 20.
 Results: Out of 76 patients admitted of postpartum hemorrhage mean age was 58 years. Most of the patients 59.2% were multiparous and 40.8% were primiparous. The most common cause of postpartum hemorrhage was uterine atony 56.5% and adherent Placenta accreta 43.42%. Most of the patients 81.6% had no postoperative complications except for 11 patients, who had developed gaping of the wound from which they recovered and discharged. The patients required hysterectomy due to intractable hemorrhage and 2.3% mortality was observed due to DIC.
 Conclusion: Uterine devascularization by bilateral uterine artery ligation is a simple, effective and the safest initial surgical option with less blood loss and less surgical time for controlling postpartum hemorrhage during cesarean section. It should be used as the first surgical step of choice after medical managements fail in controlling postpartum hemorrhage due to minimal rate of complications and mortality.

Removable retropubic uterine compression suture for controlling postpartum hemorrhage

To minimize the adverse events of uterine compression suture in controlling postpartum hemorrhage (PPH) and to search for a prophylactic approach to potential PPH. A retrospective analysis was performed in 39 women with removable retropubic uterine compression suture (RRUCS) to stop PPH due to uterine atony during cesarean section (CS). The procedure was to suspend and compress the uterus to the retropubic abdominal wall using an absorbable suture. The technique was sufficient to stanch bleeding immediately in 36 patients (92.31%, 36/39). No morbidity or abnormalities occurred in women who underwent RRUCS. Subsequent pregnancies occurred in 10 cases, but the others lacked the desire for future pregnancy. RRUCS is a simple, safe, and effective technique in controlling atonic PPH; it is also used as a prophylactic application in patients with potential PPH after CS.

Control of Postpartum Haemorrhage with Uterine Balloon Tamponade Using Foley Catheter in a Rural Mission Hospital in Ebonyi State, Southeast Nigeria

Background: Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage. Aim: Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. Case Reports: We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. Conclusion: In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.

Uterine compression sutures with additional hemostatic procedures for the management of postpartum hemorrhage.

The aim of the study was to evaluate the efficacies and possible short-term complications in women receiving uterine compression sutures only and those with additional hemostatic procedures for the management of postpartum hemorrhage. It was a retrospective study carried out from year 2009 to 2019 at a tertiary obstetric hospital and included 79 women who underwent uterine compression sutures (B-Lynch sutures, Hayman's sutures and Cho's sutures) for primary postpartum hemorrhage. Thirty-six of these women had additional hemostatic procedures (uterine artery ligation or embolization) performed for bleeding control. Of the 43 women who were primarily treated with uterine compression sutures only, the success rate to preserve the uterus was 97.7% (42/43). In women with uterine compression sutures and additional hemostatic procedures performed, the success rate was 75% (27/36). Among these two groups of women without peripartum hysterectomy, there were no significant differences in the incidence of secondary postpartum hemorrhage (14.8% vs. 11.9%; P = 0.729), postoperative endometritis (14.8% vs. 14.3%; P > 0.99) and retained products of conception (3.7% vs. 9.5%; P = 0.641) during their 6-week postpartum checkup. Three women were diagnosed to have hematometra. No pyometra or uterine necrosis was noted. Uterine compression sutures with additional hemostatic procedures are effective to control postpartum hemorrhage and prevent hysterectomy. The short-term complication rate is low. Long-term monitoring is needed to identify rare but potentially dangerous complications.

The effect of foot reflexology in the fourth stage of labor on postpartum hemorrhage and after pain: Study protocol for a randomized controlled trial

BackgroundPostpartum hemorrhage is the most common midwifery hemorrhage that occurs in 1 %–5 % of childbirths, causing an estimated 140,000 deaths per year. After pain is also one of the common postpartum pains and approximately 70 % of women with vaginal delivery complain of it. Due to the side-effects of chemical medications, researchers have a particular interest in using traditional and complementary therapies. Reflexology is one such method. The present randomized clinical trial will be conducted to assess the effectiveness of reflexology on hemorrhage and after pain following vaginal delivery. MethodsThe present randomized controlled trial will be conducted on women presenting to the maternity wards of Allameh Bohlool Gonabadi and 17th Shahrivar hospitals in Gonanbd and Mashhad, Iran. After obtaining informed consent from the eligible women, sampling will begin through the convenience method. The subjects will be randomly divided into intervention and control groups by permuted blocks of four. The sample size will be 40 per group. After the removal of the placenta, the intervention group will be given a four-minute general massage on each foot, followed by two minutes of specific reflexology on the uterus, pituitary and solar plexus points by exerting rotational pressure. The control group will also be given a four-minute general massage on each foot, followed by six minutes of rotational pressure on a point on the outer edge of the heel. Ten minutes are required for each foot, and this procedure is to be repeated two hours after childbirth. After pain will be measured using the Visual Analogue Scale (VAS) and bleeding by weighing the pads every one to four hours. Data will be analyzed in SPSS 16. DiscussionThe results will provide accurate scientific evidence for the use of reflexology to control postpartum hemorrhage and after pain. If the results are favorable, the routine use of this technique will be recommended for women in the fourth stage of labor.

The Efficacy of Misoprostol in Controlling Postpartum Hemorrhage in a Sample of Iraqi Pregnant Ladies

The Efficacy of Misoprostol in Controlling Postpartum Hemorrhage in a Sample of Iraqi Pregnant Ladies

Control of postpartum hemorrhage in women with placenta accreta spectrum using prophylactic balloon occlusion combined with Pituitrin intra-arterial infusion.

The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS). This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy. A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL. Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS. • Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.