High Risk Of Postpartum Hemorrhage Research Articles

Paving the way for improved management of severe immune thrombocytopenia purpura in pregnancy.

Those of us who take care of women with blood disorders have few data on which to base our management of thrombocytopenia in pregnancy, particularly immune thrombocytopenia purpura (ITP). We extrapolate from the management of ITP in non-pregnant individuals and try to raise platelet counts in an attempt to meet the bleeding challenges of childbirth. Thirty years ago we believed that ITP conferred fetal risks similar to those conferred by alloimmune thrombocytopenia. Experience and small series have taught us otherwise, but fetal let alone maternal risks have not been well quantified. Care et al. have provided us with data from the largest series of ITP patients in pregnancy to date. Using the UK Obstetric Surveillance System (UKOSS), which has been developed to study rare disorders in pregnancy, the investigators identified pregnant women with severe ITP from 1 June 2013 through to 31 January 2015. Rather than researching the diagnosis, the investigators adopted a practical definition of severe ITP, which included: (1) thrombocytopenia with a nadir platelet count of <50 × 109 l−1 after obstetric and hereditary causes had been excluded; or (2) thrombocytopenia that was treated. All 202 UK hospitals with consultant-led maternity units were queried monthly. The investigators reported on the incidence of severe ITP in pregnancy, current management, and the maternal and fetal outcomes of pregnancy. They estimated that the incidence of severe ITP in pregnancy is 1 in 10 000 pregnancies. They found that outcomes for neonates were better than expected, with no cases of intracranial haemorrhage or death. They found that there were no cases of epidural, caesarean section wound, or perineal haematoma following delivery. They also found that severe ITP in pregnancy carries a high risk of severe postpartum haemorrhage. Although this was an observational as opposed to a randomised study, the treated and untreated groups were comparable, with no difference in the lowest platelet count prior to pregnancy. Treatment [with steroids, intravenous immunoglobulin (IVIG), or both] appeared to make no difference in either maternal or fetal outcomes. These findings are surprising. Perhaps we should not be surprised that fetal outcomes were good because, in theory, maternal autoantibodies should not significantly impact fetal platelets. More surprising, however, is that the rate of postpartum haemorrhage was five times higher than estimates from the literature, and that treatment of severe ITP in pregnancy, which is targeted at raising platelet counts to achieve a ‘safe’ threshold in pregnancy or to achieve a target platelet count for delivery, appears to be ineffective in protecting women with severe ITP from postpartum haemorrhage. By providing us with evidence for this rare disorder, the investigators have paved the way for improving the management of severe ITP in pregnancy. They have shown us that existing treatments, which may improve platelet counts, may not improve platelet function, and do not appear to reduce the high risk of postpartum haemorrhage. Randomised trials in rare disorders are often not feasible, but it is time to consider alternative treatments and alternative study designs to capture the results of such treatments. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study

Objective: Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women.Materials and methods: We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28–30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta.Results: The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta.Conclusions: The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.

An increase in rates of obstetric haemorrhage in a setting of high HIV seroprevalence.

Obstetric haemorrhage (OH) is the leading cause of maternal mortality worldwide, although, indirectly, HIV is also a leading cause of maternal mortality in some settings with a high HIV seroprevalence. To determine the possible association between increasing rates of OH and HIV or its treatment. We conducted a retrospective chart review of women with OH at King Edward VIII Hospital, Durban, South Africa, over a 3-year period (2009 - 2011), during which the drug regimen for the prevention of mother-to-child transmission was evolving from single-dose nevirapine to antenatal zidovudine combined with intrapartum nevirapine (also referred to as dual therapy), and finally to a combination or highly active antiretroviral therapy (cART or HAART). Cases of OH (including abruptio placentae, placenta praevia, unspecified antepartum haemorrhage (APH), and postpartum haemorrhage (PPH)) were identified from maternity delivery records, and the relevant data extracted. We analysed the records of 448 women diagnosed with OH. Even though the incidence of OH was low, the study found an increasing number of cases during the 3-year period. PPH - not APH - was associated with HIV seropositivity (odds ratio 1.84, 95% confi-dence interval 1.14 - 2.95). cART was not associated with an increased risk of haemorrhage. HIV was associated with a high risk of PPH, and its possible association with HIV treatment needs further research.

Effects of Previous Laparoscopic Surgical Diagnosis of Endometriosis on Pregnancy Outcomes.

Background:The association between the previous history of endometriosis and obstetric outcomes is still ambiguous. This study aimed to evaluate the effects of previous history of operatively diagnosed endometriosis on pregnancy outcomes.Methods:A total of 98 primiparous women who had been diagnosed with endometriosis by previous laparoscopic surgery were included in this retrospective cohort study. Pregnancy outcomes were compared between these women (study group) who had a live birth and 300 women without endometriosis (control group) who had a live birth. In the study group, the pregnancy outcomes of 74 women who conceived naturally (no assisted reproductive technology [ART] subgroup) were simultaneously compared with 24 women who conceived by ART (ART subgroup).Results:Miscarriage was observed in 23 of 98 women with endometriosis (23.5%). There were 75 women who had a live birth after laparoscopic diagnosis of endometriosis in the study group eventually. On multivariate analysis, the postpartum hemorrhage rate increased significantly in the study group when compared with the control group (adjusted odds ratio: 2.265, 95% confidence interval: 1.062, 4.872; P = 0.034). There was an upward tendency of developing other pregnancy-related complications, such as preterm birth, placental abruption, placenta previa, cesarean section, fetal distress/anemia, and others in the study group than in the control group. However, the differences showed no statistical significance. Within the study group, the occurrence rate of postpartum hemorrhage and preterm birth was both higher in the ART subgroup than in the no ART subgroup. The differences both had statistical significance (44.4% vs. 17.5%, P = 0.024 and 27.8% vs. 1.8%, P = 0.010, respectively). At the same time, median (interquartile range) for gestational age at delivery in the ART subgroup was significantly shorter than that in the no ART subgroup (38 weeks [36–39 weeks] vs. 39 weeks [38–40 weeks]; P = 0.005).Conclusions:Endometriosis may affect obstetric outcomes. Women with endometriosis have a higher risk of postpartum hemorrhage. Women with endometriosis who conceived by ART may have a higher risk of postpartum hemorrhage and preterm birth than those conceived naturally.

A study to determine minimum effective dose of oxytocin infusion during caesarean delivery in parturients at high risk of uterine atony

Background: Oxytocin, a commonly used drug to prevent uterine atony after caesarean section, should be administered as dilute rapid infusion rather than as a bolus. This study was conducted to calculate ED90 of oxytocin infusion during caesarean delivery in parturients at high risk of postpartum haemorrhage (PPH). Materials and Methods: One hundred and twenty parturients having one or more risk factors for PPH received a blinded infusion of oxytocin following emergency caesarean delivery. The initial dose of oxytocin infusion was started as 0.4 IU min−1. The dose of oxytocin infusion for the next parturient was based on the response of preceding patient in increments or decrements of 0.1 IU min−1 as per a biased-coin design up-down sequential method (UDM). Measurements of non-invasive blood pressure and heart rate were taken at 2 min intervals from the time of oxytocin infusion. Intraoperative blood loss was noted. Side effects such as tachycardia, hypotension, nausea, vomiting, chest pain, headache and flushing were also recorded. Results: The ED90 of oxytocin infusion was found to be 0.405 IU min−1 (95% confidence interval 0.3864–0.4125) as calculated by Firth's penalised likelihood estimation using a biased-coin design UDM. Hypotension was observed for brief period of time in 25.6% of parturients and brief period of tachycardia was observed in 9.4% of parturients. No headache, flushing, chest pain and vomiting were observed in any parturients in our study. The estimated blood loss was within the normal limits. Conclusion: Our study showed that ED90 of oxytocin infusion required to achieve adequate uterine tone (UT) after an emergency caesarean delivery in parturients at high risk of uterine atony was 0.405 IU min−1. The higher doses of oxytocin did not result in further improvement of UT. Therefore, early use of alternative uterotonic therapy is preferable to achieve adequate UT.

Postpartum Hemorrhage in Women with Von Willebrand Disease - A Retrospective Observational Study.

Introductionvon Willebrand disease (VWD) is a hereditary bleeding disorder, caused by a deficiency in the levels and/or function of von Willebrand factor (VWF). Women with VWD appear to be at increased risk of experiencing postpartum hemorrhage (PPH), though the levels of VWF increase during pregnancy. There is limited knowledge of how PPH is associated with the subtype of VWD, plasma levels of other coagulations factors than VWF and given hemostatic treatment.AimsThe aims were to investigate the incidence of PPH in women with VWD and to analyse the correlation between PPH and: (1) type of VWD, (2) laboratory monitoring of VWF and FVIII and (3) hemostatic drug treatment.MethodsThis was a retrospective observational study. The study participants (n = 34) were recruited from the Coagulation Unit, Karolinska University hospital. Fifty-nine deliveries, which occurred in 14 different obstetrics units (years 1995–2012) were included in the study.ResultsThe incidence of primary PPH was 44%, severe primary PPH 20% and secondary PPH 12%. VWD type 3 was associated with a higher risk of experiencing severe primary PPH compared to other subtypes. FVIII:C in pregnancy was inversely correlated to blood loss during delivery. There was a significantly higher incidence of secondary PPH when the VWD diagnosis was unknown at time of delivery.ConclusionsThe women with VWD are at higher risk of PPH, especially those with type 3 VWD or when diagnosis is unknown prior to delivery. Identification of pregnant women with undiagnosed VWD may be of importance in order to prevent PPH.

Von Willebrand disease in pregnancy

von Willebrand disease is the most prevalent inherited bleeding disorder, affecting up to 1.3% of the population. It is caused by a defect or deficiency of the von Willebrand factor. Women with the condition may not be aware of their condition at the time of childbirth, but they are at high risk of postpartum hemorrhage even days after birth. In this article we briefly review the condition and specific considerations for the antepartum, intrapartum, and postpartum phases. It is important for nurses who care for women during childbirth to have a keen understanding of this condition.

Antenatal care visits during pregnancy and their effect on maternal and fetal outcomes in pre-eclamptic patients.

The frequency of antenatal care visits during pregnancy was examined to determine their effect on maternal and fetal outcomes in patients with pre-eclampsia. This study included 150 pregnant women with pre-eclampsia who attended the Outpatient Clinic of the Obstetrics and Gynecology Department, Ismailia General Hospital. The women were interviewed and their antenatal care visits recorded. Blood pressure control, cardiotocography, ultrasonographic and Doppler evaluations and the administration of methyldopa were recorded. We calculated the distribution of women who attended an adequate versus an inadequate number of antenatal care visits, examined the characteristics of the groups using significance tests, computed the risk of poor maternal and fetal outcomes and created regression analysis models. We also calculated the incidence rate of poor maternal and fetal outcomes, odds ratios and 95% confidence intervals. Women who attended an inadequate number of antenatal care visits had a significantly higher risk of post-partum hemorrhage, eclampsia, and intensive care unit admission compared with women who attended an adequate number of visits. Women who attended an inadequate number of visits had a 12-fold risk of a poor maternal outcome, a 53-fold risk of a poor fetal outcome and a significantly higher risk of neonatal mortality in comparison to women who attended an adequate number of antenatal visits. The frequency of antenatal care visits during pregnancy has a significant effect on maternal and fetal outcomes in patients with pre-eclampsia.

Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery.

To assess the effects of tranexamic acid among patients undergoing cesarean delivery who were at high risk of postpartum hemorrhage. Between August 1, 2012, and April 30, 2013, a randomized controlled trial was performed at a tertiary care center in India. Women undergoing an elective or emergency cesarean delivery who were at high risk for postpartum hemorrhage were enrolled. They were randomly assigned using sealed, opaque envelopes to receive 10mg/kg tranexamic acid or normal saline 10min before skin incision. Anesthesiologists were not masked to group assignment, but patients and obstetricians were. The primary outcome was need for additional uterotonic drugs within 24h after delivery. Analyses were by intention to treat. Thirty patients were assigned to each group. Additional uterotonic drugs were required in 7 (23%) patients assigned to tranexamic acid and 25 (83%) patients in the control group (P<0.001). Intravenous tranexamic acid, administered before skin incision, significantly reduced the requirement for additional uterotonics among women at increased risk for postpartum hemorrhage. Clinical Trials Registry India: CTRI/2015/05/005752.

Sublingual Misoprostol as an Adjunct to Oxytocin During Cesarean Delivery in Women at Risk of Postpartum Hemorrhage

Abstract Objective To evaluate whether a combination of misoprostol and oxytocin more effectively reduces blood loss during and after cesarean delivery than does oxytocin alone among women with known risk factors for postpartum hemorrhage (PPH). Methods A prospective, randomized, double-blind, placebo-controlled trial was performed at a tertiary care center in Kolkata, India, between October 2012 and December 2013. Women were eligible if they were undergoing emergency cesarean under spinal anesthesia and were at high risk for PPH. Participants were randomly assigned (1:1) to receive 400 μg misoprostol or matched placebo sublingually after delivery of the newborn using a computer-generated random number sequence (block size eight). Participants and providers were masked to assignment. All participants received 20 IU oxytocin. The primary outcomes were intraoperative and postoperative blood loss. Results Both groups contained 198 women. Mean intraoperative blood loss was significantly lower in the misoprostol group (505.4 ± 215.5 mL) than in the placebo group (587.3 ± 201.5 mL; P Conclusion Misoprostol as an adjunct to oxytocin seemed to more effectively reduce blood loss than did oxytocin alone. Clinical Trial Registry India: CTRI/2013/05/003645 .

Risk of postpartum hemorrhage among Native American women.

To assess whether Native American women have an increased risk of postpartum hemorrhage (PPH) after vaginal delivery. In a retrospective study, medical charts were reviewed for patients who delivered vaginally at Rehoboth McKinley Hospital in Gallup, NM, USA, between June 1, 2009, and June 30, 2012. Ethnic origin had been determined by self-report. PPH was defined as a visually estimated blood loss of more than 500 mL. Multivariable logistic analysis was undertaken to identify factors independently associated with PPH. Among 1062 eligible patients, 751 (70.7%) were Native American and 311 (29.3%) were non-native (white, African American, or Hispanic). A significantly higher proportion of Native Americans than non-native women developed PPH (87 [11.6%] vs 22 [7.0%]; P=0.02). In multivariable analysis, Native American ethnic origin was an independent predictor of PPH (odds ratio 1.8, 95% confidence interval 1.1-3.0; P=0.02). In a comparison with white women only, PPH was significantly more frequent among Native American women (87/751 [11.6%] vs 13/194 [6.7%]; P=0.01). Native American women have a higher risk of PPH after vaginal delivery than do non-native women.

A Collaboration of Providers and Registered Nurses on Early Assessment and Identification of Patients with Risk Factors for Postpartum Hemorrhage

Poster Presentation Purpose for the Program To prevent harm to the woman, health care providers and nursing staff collaborated to implement early identification triggers for women at risk of postpartum hemorrhage (PPH). Audit information was collected from six women who experienced PPH in May 2014. The obstetric units consist of 16 beds in the labor and delivery unit and 15 beds in the mother/infant unit in a community‐based medical center. During the audits, the chief of obstetrics and the administrative director questioned if the hemorrhages could have been prevented. Proposed Change Nursing staff receive education on PPH, and a hemorrhage cart is accessible on the individual units. Provider involvement became essential as concern was voiced over lack of patient information during physician hand‐off. Literature review took place and evidence was presented during a perinatal collaborative meeting consisting of physicians, nurses, quality representatives, and the risk manager. The Maternal Safety Bundle for Obstetric Hemorrhage published by the American College of Obstetricians and Gynecologists guided creation the program. Quarterly, nursing staff are taught to recognize PPH. Early recognition and prevention of PPH were ranked as top priorities that fueled the implementation of the project. Implementation, Outcomes, and Evaluation Education was performed with health care providers and nurses on a trigger tool constructed for women at risk of PPH. During initial assessment of the woman in triage or labor, the nurse is able to identify medium or high risk of PPH by using a laminated risk assessment tool found at each bedside. The trigger tool includes risk factors from the antepartum period, admission to labor and delivery, and the intrapartum period. At any time during changes in levels of care, the woman can be identified as being at medium or high risk for PPH, and a two‐dimensional magnet will placed on the doorframe outside her room. Continuous evaluation is performed to ensure trigger tool and visual cues are used. Implications for Nursing Practice The magnet is a visual cue for nursing staff and other health care providers to indicate that a woman is at risk of PPH. The visual cue is useful when entering the room of a woman who is giving birth or when performing postpartum assessment of a woman with whom the provider is not familiar. The provider is now alerted to an increased risk of hemorrhage. Nursing staff appreciate the visual cue when a call bell is activated.

Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study

ObjectiveTo assess the occurrence of severe maternal complications owing to postpartum hemorrhage (PPH) and its associated factors. MethodsA secondary analysis of data from a multicenter cross-sectional prospective surveillance study included 9555 cases of severe maternal morbidity at 27 centers in Brazil between July 2009 and June 2010. Complications of PPH, conditions of severity management, and sociodemographic and obstetric characteristics were assessed. Factors independently associated with severe maternal outcome (SMO) were identified using multiple regression analysis. ResultsOverall, 1192 (12.5%) of the 9555 women experienced complications owing to PPH (981 had potentially life-threatening conditions, 181 maternal near miss, and 30 had died). The SMO ratio was 2.6 per 1000 live births among women with PPH and 8.5 per 1000 live births among women with other complications. Women with PPH had a higher risk of blood transfusion and return to the operating theater than did those with complications from other causes. Maternal age, length of pregnancy, previous uterine scar, and cesarean delivery were the main factors associated with an increased risk of SMO secondary to PPH. ConclusionPPH frequently leads to severe maternal morbidity. A surveillance system can identify the main causes of morbidity and could help to improve care, especially among women identified as being at high risk of PPH.

Sublingual misoprostol as an adjunct to oxytocin during cesarean delivery in women at risk of postpartum hemorrhage

ObjectiveTo evaluate whether a combination of misoprostol and oxytocin more effectively reduces blood loss during and after cesarean delivery than does oxytocin alone among women with known risk factors for postpartum hemorrhage (PPH). MethodsA prospective, randomized, double-blind, placebo-controlled trial was performed at a tertiary care center in Kolkata, India, between October 2012 and December 2013. Women were eligible if they were undergoing emergency cesarean under spinal anesthesia and were at high risk for PPH. Participants were randomly assigned (1:1) to receive 400μg misoprostol or matched placebo sublingually after delivery of the newborn using a computer-generated random number sequence (block size eight). Participants and providers were masked to assignment. All participants received 20IU oxytocin. The primary outcomes were intraoperative and postoperative blood loss. ResultsBoth groups contained 198 women. Mean intraoperative blood loss was significantly lower in the misoprostol group (505.4±215.5mL) than in the placebo group (587.3±201.5mL; P<0.001). Mean postoperative blood loss was slightly lower in the misoprostol group (96.9±57.3mL) than in the placebo group (103.4±58.4mL; P=0.07). Shivering and pyrexia were more frequently associated with misoprostol (P<0.05 for both). ConclusionMisoprostol as an adjunct to oxytocin seemed to more effectively reduce blood loss than did oxytocin alone.Clinical Trial Registry India:CTRI/2013/05/003645.

Use of Bakri Balloon Tamponade in the Treatment of Postpartum Hemorrhage

Objective. Massive postpartum hemorrhage (PPH) is one of the most serious complications during delivery. Hysterectomy is commonly performed when other conventional treatment attempts fail. Bakri balloon tamponade (BBT) is a novel conservative management option for PPH. Little is known of the effectiveness of this procedure. We report a large case series from a tertiary teaching hospital. Design. Retrospective case series (October 2008–June 2011). Setting. University teaching hospital. Population. Forty-four women with massive PPH (blood loss >1000 mL) and six other women with expected high risk of PPH (blood loss <1000 mL) managed by BBT. Methods. Chart review. Main outcome measures. Achievement of definitive hemostasis by BBT among the study population. Results. Among the women treated with BBT, the cause of PPH was uterine atony (16%), cervical rupture (14%), vaginal rupture and/or paravaginal hematoma (22%), placenta previa (18%) and placental retention (30%). The overall success rate was 86%. Seven of the 50 patients needed additional procedures. Of the seven failures, supravaginal uterine amputation or hysterectomy was required in four cases and embolization of the uterine arteries in three cases. Conclusions. BBT is a simple, readily available, effective and safe procedure for the management of PPH in selective cases. BBT does not exclude the use of other procedures if necessary. Even if BBT failed, it may provide temporary tamponade and time to prepare for other interventions or transportation from local hospital to tertiary centre. We suggest that BBT should be included in the PPH protocol. Abbreviations: BBT, Bakri balloon tamponade; CS, cesarean section; PPH, postpartum hemorrhage.

Induction of Labor and Risk of Postpartum Hemorrhage in Low Risk Parturients

ObjectiveLabor induction is an increasingly common procedure, even among women at low risk, although evidence to assess its risks remains sparse. Our objective was to assess the association between induction of labor and postpartum hemorrhage (PPH) in low-risk parturients, globally and according to its indications and methods.MethodPopulation-based case-control study of low-risk women who gave birth in 106 French maternity units between December 2004 and November 2006, including 4450 women with PPH, 1125 of them severe, and 1744 controls. Indications for labor induction were standard or non-standard, according to national guidelines. Induction methods were oxytocin or prostaglandins. Multilevel multivariable logistic regression modelling was used to test the independent association between induction and PPH, quantified as odds ratios.ResultsAfter adjustment for all potential confounders, labor induction was associated with a significantly higher risk of PPH (adjusted odds ratio, AOR1.22, 95%CI 1.04–1.42). This excess risk was found for induction with both oxytocin (AOR 1.52, 95%CI 1.19–1.93 for all and 1.57, 95%CI 1.11–2.20 for severe PPH) and prostaglandins (AOR 1.21, 95%CI 0.97–1.51 for all and 1.42, 95%CI 1.04–1.94 for severe PPH). Standard indicated induction was significantly associated with PPH (AOR1.28, 95%CI 1.06–1.55) while no significant association was found for non-standard indicated inductions.ConclusionEven in low risk women, induction of labor, regardless of the method used, is associated with a higher risk of PPH than spontaneous labor. However, there was no excess risk of PPH in women who underwent induction of labor for non-standard indications. This raises the hypothesis that the higher risk of PPH associated with labor induction may be limited to unfavorable obstetrical situations.

Intrauterine balloon tamponade in the management of severe postpartum hemorrhage: A case series from a busy UK district general hospital

Objective: To evaluate the effectiveness of balloon tamponade in the management of postpartum hemorrhage (PPH). Methods: Retrospective review of 58 women who underwent balloon tamponade for severe PPH, during a period of 5 years and 10 months, at Russells Hall Hospital, a busy district general hospital in UK. Clinical success was defined as control of bleeding without need for further intervention. Results: Fifty-eight women (mean age, 30 years; range, 18 - 42) underwent balloon tamponade, of which twenty seven (46.5%) women delivered vaginally and 31 (53.5%) women were delivered by cesarean section. Uterine atony was the main cause of PPH (31 cases). Balloon tamponade was used prophylactically in 11 high risk women in anticipation of potential PPH. Rusch balloon was used in 48 cases and Bakri balloon in 10 cases. Clinical success rate of balloon tamponade was 87.2%. Three patients in this study required hysterectomy. Conclusion: Balloon tamponade is an effective means of controlling severe PPH with success rates of around 87%. There should also be a low threshold for prophylactic use of balloon tamponade in women at high risk of PPH, considering its ease of use, low complication rate and ability to maintain reproductive ability.

Carbetocin versus oxytocin in caesarean section with high risk of post-partum haemorrhage

the aims of the present study were to compare the haemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in caesarean section at high risk of primary post-partum haemorrhage. women in the carbetocin group (group A) received a bolus of 100 μg IV; women in the control group (group B) received 20 IU of oxytocin in 1000 ml of 0,9% Na-Cl solution IV (150 mL/hour). The main parameter evaluated was the haemodynamic effects of drugs and the need for additional uterotonic agents. In addition we compared the drop in haemoglobin level, the uterine tone, the uterine fundal state and the diuresis. regarding the haemodynamic effects, both drugs have a hypotensive effect, but we found a greater reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group (23,5% vs 0%, p<0.01), though there was no significant difference in estimated blood loss and in the drop haemoglobin level (p>0.05). There was a significant difference in the diuresis, higher in carbetocin group (1300 ml ± 450 ml vs 1100 ml ± 250 ml, p=0.01). a single injection of carbetocin appears to be more effective than a continuous infusion of oxytocin to prevent the PPH, with a similar haemodynamic profile and minor antidiuretic effect.

État des lieux en 2011 du respect des recommandations pour la pratique clinique du transfert maternel en cas d’hémorragie du post-partum : à propos de 84 cas

ObjectivesGuidelines for the management of post-partum haemorrhage (PPH) were defined by the “Collège National des Gynécologues Obstétriciens Français (CNGOF)” since 2004. The aim of this work was to assess whether the management of PPH before and during the transfer was in accordance with national recommendations. Patients and methodsThis is an observational monocentric prospective study concerning 84 patients transferred for PPH in a referent centre in 2011. ResultsIn 62 cases (73.8%), transfusionnal files were found. Time noted PPH for 60 (71.4%) and amount of blood loss in 55 cases (65.5%) were notified. Evacuation of retained placenta was always performed; the broad-spectrum antibiotic prophylaxis covered only 21 cases of intra uterine procedures. Less than 5% of the patients received intravenous sulprostone before the transfer; 72.6% (n=61) of the patients were transfused before transfer 25% of the patients (n=21) had a very high risk of PPH in ante partum and were not addressed to a centre with appropriate medical and technical facilities. Discussion and conclusionThus improvement can be made in the communication between the health care centre during transfer for PPH and the ante partum transfer of patients with high risk of PPH.

W314 CARBETOCIN VERSUS OXYTOCIN AFTER CAESAREAN SECTION: SIMILAR EFFICACY BUT REDUCED PAIN PERCEPTION IN WOMEN WITH HIGH RISK OF POSTPARTUM HAEMORRHAGE

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S806-S807 Poster presentations W314 CARBETOCIN VERSUS OXYTOCIN AFTER CAESAREAN SECTION: SIMILAR EFFICACY BUT REDUCED PAIN PERCEPTION IN WOMEN WITH HIGH RISK OF POSTPARTUM HAEMORRHAGE C. Voltolini, Search for more papers by this authorM. De Bonis, Search for more papers by this authorF. Vellucci, Search for more papers by this authorC. Regini, Search for more papers by this authorC. Orlandini, Search for more papers by this authorS. Vannuccini, Search for more papers by this authorM. Torricelli, Search for more papers by this authorF.M. Severi, Search for more papers by this authorF. Petraglia, Search for more papers by this author C. Voltolini, Search for more papers by this authorM. De Bonis, Search for more papers by this authorF. Vellucci, Search for more papers by this authorC. Regini, Search for more papers by this authorC. Orlandini, Search for more papers by this authorS. Vannuccini, Search for more papers by this authorM. Torricelli, Search for more papers by this authorF.M. Severi, Search for more papers by this authorF. Petraglia, Search for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)62037-2Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S806-S807 RelatedInformation