History Of Postpartum Hemorrhage Research Articles

A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth.

It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth. A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest. The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28-4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20-3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively. A history of cesarean birthcould be a risk factor for PPH even after successful planned vaginal delivery.

Effect of pelvic artery embolization for postpartum hemorrhage on subsequent pregnancies: a single-center retrospective cohort study

Objective Pelvic artery embolization (PAE) is a uterus-saving treatment for postpartum hemorrhage (PPH); however, subfertility or abnormal placentation for subsequent pregnancy has been a concern in several previous reports. This study aimed to investigate the impact of PAE on subsequent pregnancies in women with a history of PPH. Methods A retrospective cohort study was conducted on women transferred to the tertiary center for PPH and delivered for the next pregnancy at the same center later. The study group was divided into two groups based on PAE application to treat previous PPH. Results Of the 62 women included, 66% (41/62) had received PAE for the previous PPH, while 21 had not. Pregnancy outcomes for subsequent pregnancies were compared between the PAE and non-PAE groups. The PAE group had a higher estimated blood loss volume for the present delivery than the non-PAE group (600 vs. 300 mL, p = 0.008). The PAE group also demonstrated a higher incidence of placenta previa (4.8% vs. 24.4%, p = 0.080) and placenta accreta (0% vs. 14.6%, p = 0.082) than the non-PAE group, although the difference was not statistically significant. Conclusion These findings suggest that the use of PAE to treat PPH may increase the risk of bleeding, placenta previa, and placenta accreta spectrum in subsequent pregnancies.

A case of a 44-year-old lady presenting with Sheehan’s syndrome

Because of ischemic necrosis following postpartum hemorrhage, patients with Sheehan’s Syndrome may exhibit different degrees of anterior pituitary insufficiency. They can report a variety of obscuring clinical signs and symptoms even many years after the postpartum hemorrhage, which could lead to a delay in diagnosis and an increase in mortality and morbidity. We report a case of a 44-year-old G3P3L3 lady who presented with this syndrome with history of postpartum hemorrhage 5 years back during the birth of her last child.

Heat stable carbetocin or oxytocin for prevention of postpartum hemorrhage among women at risk: A secondary analysis of the CHAMPION trial.

To examine whether the observed non-inferiority of heat-stable carbetocin (HSC), compared with oxytocin, was influenced by biologic (macrosomia, parity 3 or more, or history of postpartum hemorrhage [PPH]) and/or pharmacologic (induction or augmentation) risk factors for PPH. The present study is a secondary analysis of the CHAMPION non-inferiority randomized trial-a two-arm, double-blind, active-controlled study conducted at 23 hospitals in 10 countries, between July 2015 and January 2018. Women with singleton pregnancies, expected to deliver vaginally with cervical dilatation up to 6 cm were eligible. Randomization was stratified by country, with 1:1 assignment. Women in the intervention and control groups received a single intramuscular injection of 100 μg of HSC or 10 IU of oxytocin, respectively. The drugs were administered immediately after birth, and the third stage of labor was managed according to the WHO guidelines. Blood was collected using a plastic drape. For this analysis, we defined a woman as being at risk if she had any one or more of the biologic or pharmacologic risk factor(s). The HSC and oxytocin arms contained 14 770 and 14 768 women, respectively. The risk ratios (RR) for PPH were 1.29 (95% confidence interval [CI] 1.08-1.53) or 1.73 (95% CI 1.51-1.98) for those with only biologic (macrosomia, parity 3 or more, and PPH in the previous pregnancy) or only pharmacologic (induced or augmented) risk factors, respectively, compared with those with neither risk factors. Findings reinforce previous evidence that macrosomia, high parity, history of PPH, and induction/augmentation are risk factors for PPH. We did not find a difference in effects between HSC and oxytocin for PPH among women who were neither induced nor augmented or among those who were induced or augmented.

An update to tranexamic acid trends during the peripartum period in the United States, 2019 to 2021

Results from the 2017 World Maternal Antifibrinolytic trial found that patients who received tranexamic acid during delivery had significantly lower rates of death and hysterectomy. Several months after the World Maternal Antifibrinolytic trial publication, American College of Obstetricians and Gynecologists endorsed the consideration of tranexamic acid usage when traditional uterotonics fail during postpartum hemorrhage. Since then, tranexamic acid usage has become more mainstream for the treatment of postpartum hemorrhage. This study aimed to evaluate tranexamic acid trends in obstetrics both temporally and geographically within the United States. Additional outcomes included patient demographics and perinatal outcomes. This retrospective cohort study included 19 hospitals divided into East, Central, and West geographic regions within the Universal Health Services, Incorporated network. Rates of tranexamic acid use were compared from July 2019 through June 2021. Patient demographics and perinatal outcomes were analyzed for tranexamic acid recipients. During the two-year study period, 3.2% (1580/50,150) of patients received tranexamic acid during delivery. The western region of the United States demonstrated increased tranexamic acid use over the 2-year study period. Recipients of tranexamic acid were more likely to have a history of postpartum hemorrhage (P<.0001), chronic hypertension (P<.0001), preeclampsia (P<.0001), and/or diabetes (P=.004). Patients who received tranexamic acid did not have an increased likelihood of venous thromboembolism in comparison with those who did not receive tranexamic acid (8 [0.5%] vs 226 [0.5%]; P=.77). Of those who received tranexamic acid, 53.2% (840/1580) had an estimated blood loss <1000 mL. Nationally, a higher percentage of patients received tranexamic acid without a postpartum hemorrhage diagnosis compared with previous studies, and the western region of the United States had an overall increased use of tranexamic acid during delivery compared with previous years. There was no increased risk of venous thromboembolism in those who received tranexamic acid, regardless of postpartum hemorrhage diagnosis.

Risk Factors for Uterine Atony in Postpartum Hemorrhage Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Uterine atony can be life-threatening for a pregnant woman in labor and bleeding after delivery. It is important to explore the risk factors that can cause uterine atony in order to detect it early and take preventive measures. This study aimed to explore the risk factors for causing uterine atony in postpartum hemorrhage patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.&#x0D; Methods: This study was an analytic observational study with a case-control approach. A total of 52 subjects (13 case group subjects and 39 control group subjects) participated in this study. Risk factor analysis was carried out with the help of SPSS version 25 in univariate and bivariate.&#x0D; Results: Maternal age at delivery is associated with the risk of uterine atony in postpartum hemorrhage patients. Mothers aged less than 20 years or more than 35 years are at risk of experiencing uterine atony by 5.8 times more at risk than mothers aged 20-35 years. The risk factors for parity, prolonged labor, macrosomia, gemelli, hydramnios, induction of labor, history of postpartum hemorrhage, and type of delivery were not associated with uterine atony in postpartum hemorrhage patients, p&gt;0.05.&#x0D; Conclusion: The age of delivery of mothers who are less than 20 years or more than 35 years is a risk factor for uterine atony in postpartum hemorrhage patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Blood salvage at the time of vaginal delivery in patients at high risk for hemorrhage

Maternal hemorrhage is the leading cause of maternal morbidity worldwide (1). Autologous transfusion of filtered blood collected at the time of vaginal postpartum hemorrhage (PPH) is safe and eliminates the risk of donor blood transfusion (2). This pilot study assesses the feasibility and potential benefit of salvaging blood at the time of vaginal delivery in patients at high risk for PPH. 30 subjects were recruited. Patients with history of PPH, grand multiparity, multiple gestation, Large for Gestational Age fetus, polyhydramnios, prolonged labor ( >18 hours of Pitocin), or known fibroid uterus were approached. Waiver of consent was obtained from the IRB. HEMAsavR (TM) suction canister was used to collect blood loss. Gem 5000 blood gas analyzer was used to determine the hematocrit (Hct) of the blood collected. Using the Hct and the total volume in the canister, we calculated the estimated percentage of a unit of blood that could be auto transfused. All patients were multiparous, with a median parity of 5. Mean age was 34 (25-42). Mean gestational age was 39w3d. Mean quantitative blood loss (QBL) was 199cc (25 - 550). There were no cases of peripartum hemorrhage. QBL could not be calculated in four cases. Reasons included suction malfunction, arrest of dilation resulting in cesarean, precipitous delivery and insufficient blood loss. The sample Hct could not be calculated in an additional five cases due to insufficient blood loss. Mean Hct of a cell salvage unit (pRBC) is ∼55% (3) and the volume of a pRBC unit is 250cc. Use of HEMAsavR resulted in salvage of 39% (4-90) of a unit that would be available for autologous transfusion. In our high risk cohort of pregnant persons, the use of the Hemasavr device allowed for salvage of > 1/3 of a unit of pRBC. Future use of autologous transfusion of vaginal blood may provide a safe and effective way to manage peripartum hemorrhage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Iron Deficiency Anemia and Von Willebrand Disease in Women with Menorrhagia

Introduction Von Willebrand disease (VWD) is the most common bleeding disorder in adolescents and adult women that causes heavy menstrual bleeding (HMB) (Blood Adv 2020;13:3209-3216). HMB is defined as bleeding lasting >7 days or > 80 mL of blood per menstrual cycle; a broader definition includes an excessive blood loss that interferes with a woman´s physical, emotional, social and material quality of life; an underlying bleeding disorder should be considered if IDA is present (Am J Obstet Gynecol 2009;201:12.e1-12.e8 and Blood 2018;132:2134-2142). Objective Identify VWD causing HBM in patients with IDA. Materials and Methods Retrospective databased study from 2017 to 2021 of 292 women with IDA due HMB referred to our Institution. HMB was not related to systemic disease, hormonal disorders, renal or hepatic disease. The IDA studies included CBC, iron panel with ferritin levels; diagnosis was based in Clinical Guidelines: Hb< 12 gr/L, transferrin saturation (TS) <20% and ferritin <15 mcg/L (Adv Ther 2021;38:201-225); in all cases sonography was performed to rule out ovarian cyst and fibroma. For VWD, personal and familiar history of bleeding were assessed, studies included bleeding time, fibrinogen, factor VIII, factor XIII, vW antigen and vW activity on first to fourth day of menstruation, all studies were performed twice in different menstrual cycle; diagnosis was based in review articles: vW below 50 IU and bleeding history, including IDA (Hematol Oncol Clin N Am 2021;35:1085-1101). Results From 292 women with IDA, 23 (7.9%) was diagnosed with VWD. Age ranges from 14 to 54 years, median 21. vW antigen levels from 3 to 47 IU, median 28 IU. vW activity 4 to 45 IU, median 27 IU. Eleven patients had vW activity levels below 30 IU and had more significant history of mucocutaneous bleeding: epistaxis 52%, cutaneous bleeding 45%, oral cavity bleeding 42%; compared with 12 patients with vW activity between 31 and 50 IU: epistaxis 35%, cutaneous bleeding 19%, oral cavity bleeding 15%. Both groups had similar frequency of bleeding after surgical and dental procedure, 46% and 44% respectively. Treatment for IDA included oral and IV iron; treatment for HMB included hormonal therapy, desmopressin and tranexamic acid. Discussion VWD has been objectively reported in México in the first systematic analysis (Haemophila 2013;19:231-235); this observation was made mainly in mestizos of Spanish heritage and the true frequency could not be determinate, as is in the case in the majority of studies in countries worldwide; from 133 patients with bleeding disorders, 53 (39.8%) had VWD. In 124 Mexican women with history of postpartum hemorrhage, VWD was diagnosed in 61 (49.2%) (Haemophilia 2020;26:97-105). In a more recently study, VWD rate was estimated in 7.2 per million inhabitants in western Mexico (Haemophilia 2022;21:e78-e87). Our study demonstrates that VWD is present in Mexican population and has almost a rate of 8% in women with HMB, similar to reported in other studies, but this rate may be underrepresented and underdiagnosed as is in general population because lack of hematologists and diagnostic test in smaller cities, and misconception of the disease, as Mexico has heritage from Spain, England and France among other European countries with higher rates of VWD. Our study also compares the levels of VW factors, and found that patients with low levels of VW (31-50 IU) has the same bleeding phenotype as patients with VWD (< 30 IU), supporting that VWD should be diagnosed in patients with bleeding manifestations and VW factor below 50 IU (Hematol Oncol Clin N Am 2021;35:1085-1101). Finally, based in our results we recommend to investigate for VWD in patients with IDA from HMB.

Postpartum Hemorrhage Complicated by Pan-hypopituitarism: Sheehan’s Syndrome; Case Report, 2022

Background: Sheehan’s syndrome is hypopituitarism due to postpartum ischemic necrosis of the pituitary gland. Due to its potentially life-threatening and very rare complications; it still remains important to pregnant women, clinicians, and public health services around the world. Case Report: 38 years parity three Eritrean mother from Ghone subzone of Gash Barka, Eritrea; had history of postpartum hemorrhage and blood transfusion before 10 years (2011) on her last delivery. She presented with history of failed lactation, amenorrhea and infertility of 10 years. She had also constipation, lethargy and generalized body weakness with her current complaint. Hormone analysis revealed pan-hypopituitarism of most anterior pituitary hormones and Magnetic Resonance Imaging of the brain revealed empty sella. She was started on Levothyroxine and fertility supplements based on her fertility desire, and on subsequent follow-ups, her menses was resumed and constipation had subsided and she was attached to endocrinology department for further followup and management. Conclusion: The history of failed lactation, amenorrhea and infertility following postpartum hemorrhage, hormone analysis and imaging findings were consistent with a rare complication of Sheehan’s syndrome. This case was reported for its rarity. Physicians should aware about this complication and should have high index of suspicion for cases with common manifestation of uncommon syndromes.

Impact of COVID 19 on Preterm Rupture of Membrane

Background: The majority of perinatal research on COVID-19 currently focuses on the pregnancy consequences of SARS-CoV-2-infected women, including as cesarean sections, fetal distress, premature delivery, and even maternal mortality. However, it is currently uncertain how the COVID-19 pandemic would negatively affect premature membrane rupture. Aim of the Study: The aim of this study was to assess the impact of Covid 19 on preterm rupture of membrane. Methods: This cross-sectional study was conducted in department of obstetrics and gynaecology, Care Medical College Hospital, Dhaka, Bangladesh from 2021 to 2022. Total 100 pregnant women were included in this study. Where group A represented Covid 19 affected (n=50) and group B represented Not affected by Covid 19 (n=50). Result: In this study, mean age was 30.9 years (SD±8.5 years) in group A and 29.3 years (SD±7.5 years) in group B. Mean gestational age was 37.55 weeks (SD±2.42 weeks) in group A and 36.10 weeks (SD±3.08 weeks) in group B. Both groups had history of preterm delivery (2%), 8% of group A and 4% of group B had history of postpartum hemorrhage, and 22% of group A and 2% of group B had other family members affected. The commonest mode of delivery in both groups; 74% and 62% in group A and group B respectively. 16% in group A and 8% in group B had premature rupture of membranes and 4% in group A and 2% in group B had preterm premature rupture of membranes. Table V shows the neonatal outcome. Neonatal Covid 19 positive was 4% in group A. 18% of group A and 10% of group B were admitted in NICU. Neonatal mortality was 4% in group A and 2% in group B. Conclusion: Preterm births are more likely to occur in pregnant COVID-19 patients and the disease has an impact on NICU admissions. Premature rupture of membranes at term and preterm are more frequent in patients with COVID-19.

Magnitude of postpartum hemorrhage and its associated factors in Ethiopia: a systematic review and meta-analysis

BackgroundPostpartum hemorrhage or postpartum bleeding (PPH) is often defined as loss of > 500 ml of blood after vaginal delivery or > 1000 ml after cesarean delivery within 24 h. Postpartum hemorrhage is a leading direct cause of maternal morbidity and mortality in Ethiopia. Therefore, the main objective of this systematic review and meta-analysis was to estimate the pooled magnitude of postpartum hemorrhage and the pooled effect size of the associated factors in Ethiopia.MethodsPrimary studies were searched from PubMed/MEDLINE online, Science Direct, Hinari, Cochrane Library, CINAHL, African Journals Online, Google and Google Scholars databases. The searching of the primary studies included for this systematic review and meta-analysis was limited by papers published from 2010 to October 10/2021. The data extraction format was prepared in Microsoft Excel and extracted data was exported to Stata Version 16.0 statistical software for analysis. A random effect meta-analysis model was used. Statistical heterogeneity was evaluated by the I2 test and Egger’s weighted regression test was used to assess publication bias.ResultA total of 21 studies were included in this meta-analysis. The pooled magnitude of postpartum hemorrhage in Ethiopia was 8.24% [(95% CI 7.07, 9.40]. Older age [OR = 5.038 (95% CI 2.774, 9.151)], prolonged labor [OR = 4.054 (95% CI 1.484, 11.074)], absence of anti-natal care visits (ANC) [OR = 13.84 (95% CI 5.57, 34.346)], grand-multiparty [OR = 6.584 (95% CI 1.902, 22.795)], and history of postpartum hemorrhage [OR = 4.355 (95% CI 2.347, 8.079)] were factors associated with the occurrence of postpartum hemorrhage.ConclusionsThe pooled magnitude of postpartum hemorrhage among post-natal mothers in Ethiopia was moderately high. The finding of this study will strongly help different stakeholder working in maternal and child health to focus on the main contributors’ factors to reduce post-partum hemorrhage among postnatal mothers. Health professionals attending labor and delivery should give more attention to advanced aged mothers, grand-multipara mothers and mothers who had a history of post-partum hemorrhage due to higher risk for postpartum hemorrhage. Encouraging to continue ANC visit and prevent prolonged labor should also be recommended to decrease postpartum hemorrhage.

Recurrence of postpartum hemorrhage, maternal and paternal contribution, and the effect of offspring birthweight and sex: a population-based cohort study

PurposeThis study examines individual aggregation of postpartum hemorrhage (PPH), paternal contribution and how offspring birthweight and sex influence recurrence of PPH. Further, we wanted to estimate the proportion of PPH cases attributable to a history of PPH or current birthweight.MethodsWe studied all singleton births in Norway from 1967 to 2017 using data from Norwegian medical and administrational registries. Subsequent births in the parents were linked. Multilevel logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PPH defined as blood loss > 500 ml, blood loss > 1500 ml, or the need for blood transfusion in parous women. Main exposures were previous PPH, high birthweight, and fetal sex. We calculated adjusted population attributable fractions for previous PPH and current high birthweight.ResultsMothers with a history of PPH had three- and sixfold higher risks of PPH in their second and third deliveries, respectively (adjusted OR 2.9; 95% CI 2.9–3.0 and 6.0; 5.5–6.6). Severe PPH (> 1500 ml) had the highest risk of recurrence. The paternal contribution to recurrence of PPH in deliveries with two different mothers was weak, but significant. If the neonate was male, the risk of PPH was reduced. A history of PPH or birthweight ≥ 4000 g each accounted for 15% of the total number of PPH cases.ConclusionA history of PPH and current birthweight exerted strong effects at both the individual and population levels. Recurrence risk was highest for severe PPH. Occurrence and recurrence were lower in male fetuses, and the paternal influence was weak.

Factors Contributing to Red Blood Cells Crossmatch and Transfusion among Obstetrics Patients in a Single Tertiary Hospital

INTRODUCTION: Transfusion of blood and blood components among obstetrics patients is a common practice but they are not without risks. This study aims to determine crossmatch to transfusion ratio (C:T ratio) and to assess the factors that influence red blood cells (RBC) transfusion among obstetrics patients in a single tertiary hospital. MATERIAL AND METHODS: This was a retrospective cohort study of RBC crossmatch requests with data collected from 350 obstetrics patients. The patients were grouped into either received RBC transfusion or did not receive transfusion. Demographics and clinical characteristics were analyzed using descriptive and multivariate analysis. RESULTS: The mean C:T ratio was 3.1. Of 350 patients, 149 (42.6%) patients did receive RBC transfusion. Patients with underlying hemoglobinopathy (75.9%), history of postpartum hemorrhage (63.6%), underwent instrumental assisted delivery (64.3%), and with hemoglobin level of &lt; 70 g/L upon crossmatch requests (90.5%) did receive RBC transfusion. Cesarean section (p=0.011), hemoglobin level &lt; 99 g/L (p&lt;0.001), estimated blood loss &gt; 1000 mL (p&lt;0.001), and symptomatic anemia (p=0.029) were the significant factors associated with RBC transfusion. CONCLUSION: The mean C:T ratio in our study was high. Identifying the factors contributing to RBC transfusion among obstetrics patients are important to reduce unnecessary crossmatch and subsequently improve blood inventory management, and thus further reduce the risks associated with allogeneic transfusion.

Development and validation of a prediction model for postpartum hemorrhage at a single safety net tertiary care center

Postpartum hemorrhage is a leading cause of pregnancy-related morbidity and mortality; however, there is limited ability to identify women at risk of this obstetrical complication. This study aimed to develop and validate a prediction model for postpartum hemorrhage based on antenatal and intrapartum risk factors. This was a retrospective cohort study of women who delivered between April 2016 and March 2019 at a single safety net hospital. The prevalence of postpartum hemorrhage, defined as blood loss of ≥1000 mL at the time of delivery, was determined, and characteristics were compared between women with and without postpartum hemorrhage. Women were randomly assigned to a prediction or a validation cohort. The selection of predictors to be included in the model was based on known antenatal and intrapartum risk factors for postpartum hemorrhage. A multivariable logistic regression with a backward stepwise approach was used to create a prediction model. Area under the receiver operating characteristic curve and 95% bootstrap confidence intervals were calculated. Using the final model, a single threshold for classifying postpartum hemorrhage was chosen, and the resulting sensitivity, specificity, and false-negative and false-positive rates were explored. The prevalence rates of postpartum hemorrhage in the prediction and validation cohorts were 6.3% (377 of 6000 cases) and 6.4% (241 of 3774 cases), respectively (P=.83). The following predictors were selected for the final model: maternal body mass index (kg/m2), number of fetuses, history of postpartum hemorrhage, admission platelets of <100,000/µL, chorioamnionitis, arrest of descent, placental abruption, and active labor duration. The predictive model had an area under the receiver operating characteristic curve of 0.82 (95% confidence interval, 0.81-0.84). When applied to the validation cohort, the model had an area under the receiver operating characteristic curve of 0.81 (95% confidence interval, 0.78-0.83), a sensitivity of 86.9%, a specificity of 74.2%, a positive predictive value of 18.6%, a negative predictive value of 98.8%, a false-negative rate of 13.1%, and a false-positive rate of 25.9%. The model performed reasonably well in identifying women at risk of postpartum hemorrhage. Further studies are necessary to evaluate the model in clinical practice and its effect on decreasing the prevalence of postpartum hemorrhage and associated maternal morbidity.

Early Identification of Risk Factors for Primary Postpartum Hemorrhage at Admission

Background: Postpartum hemorrhage (PPH) is the world‘s leading cause of maternal mortality, accounting for one-third of all maternal deaths worldwide. Aim of the Study was early identification of risk factors of primary postpartum hemorrhage. Research Design: A descriptive cross-sectional research design was utilized. Subject and setting: The study was carried out over a period of six months in obstetrics and gynecology department at Minia University Hospital for Obstetric and Pediatric. Tools for Data Collection: two tools were used; Tool I: Socio-demographic characteristics, and Tool II: Risk factors assessment tools. Results: The study revealed that, study group had low risk factors of current PPH had(previous uterine incision, History of PPH ), moderate risk factors of current PPH in women had (prior cesarean birth or prior uterine incision, History of one previous PP), high risk factors of current PPH in women ( had two or more moderate symptoms of risk factors, platelets level <100,000/mm3, hematocrit level <30, placenta previa and suspected placenta accretes) with statistically significance differences. Conclusion: previous uterine incision, previous PPH, abnormality in platelet level, hematocrit level and coagulopathy were the most significant risk factors for primary PPH. Recommendation: Encourage regular antenatal visit to early detection of risk factors of PPH, and providing the women health education about PPH risk factors.

Relationship between gestational weight gain and amount of postpartum bleeding

AbstractBackground/Aims:To evaluate the effect of gestational weight gain on the amount of postpartum bleeding.Methods: An observational study reviewed medical records of with low-risk singleton pregnancies who delivered vaginally at 37 weeks of gestation or beyond between May 1 and November 1, 2018 at a tertiary referral center. Demographic and clinical characteristics were obtained from the medical records. The relationship between the increased rate in BMI during pregnancy and amount of blood loss in the postpartum first hour was evaluated. Results:A total of 411 women was included in the study. In the study population, the mean blood loss was 57.3±43.9 ml in the 3rd stage of labor and 113.2±76.9 ml in the postpartum first hour. No correlation was found between the increase in BMI during pregnancy and blood loss during the 3rd stage of labor (r=0.006) and postpartum first hour (r=0.037). Nulliparity, history of postpartum hemorrhage in previous pregnancy, premature rupture of membranes, and episiotomy were found to be risk factors for increased postpartum blood loss during the 1st hour (p&amp;lt; 0.05). Conclusions: Increase in BMI was not related with the amount of postpartum bleeding in women with low-risk pregnancy who had a vaginal delivery.

Factors affecting third-stage management and postpartum hemorrhage in planned midwife-led home and birth center births in the United States.

Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third-stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery. Using data from the Midwives of North America 2.0 database (2004-2009), we describe the PPH incidence for women giving birth in the community, their demographic and clinical characteristics, and methods used by midwives to address PPH. We also examined PPH rates by midwifery credentials and by the presence of regulations for legal midwifery practice. Of the 17836 vaginal births, 15.9% had blood loss of over 500mL and 3.3% had 1000mL or greater blood loss. Midwives used pharmaceuticals to prevent or treat postpartum bleeding in 6.3% and 13.9% of births, respectively, and the rate of hospital transfer after birth was 1.4% (n=247). In adjusted analyses, PPH was less likely when births occurred at home vs a birth center, if the midwife had a CNM/CM credential vs a CPM/LM/LDM credential, or if the woman was multiparous without a history of PPH or prior cesarean birth. PPH was more likely in states with barriers to midwifery practice compared with regulated states (OR: 1.26; 95% CI, 1.16-1.38). Women giving birth in the community experienced low overall incidence of PPH-related hospital transfer. However, the occurrence of PPH itself would likely be reduced with improved legal access to uterotonic medication.

National trends in tranexamic acid use in the peripartum period, 2015-2019.

The purpose of this study was to measure trends in the use of tranexamic acid (TXA) during delivery in the United States and to evaluate demographic data and morbidity outcomes among these patients. This retrospective cohort study includes data from 19 hospitals in the Universal Health Services network. We compared rates of TXA use between January 2015 and June 2019 across geographic sectors. We also evaluated associations of demographic variables and perinatal outcomes of women who received TXA. 209 cases of TXA use were found from analysis of 101,564 deliveries. TXA use increased over time and rates were higher in the West than in Central and East; the slope of increase over years did not differ between regions. Women who received TXA were more likely to have a history of postpartum hemorrhage (59 (28.2%) vs. 2290 (2.2%), P < 0.0001) but were not more likely to have a chronic disease, including diabetes mellitus, hypertension and heart disease. Women who received TXA were more likely to have estimated blood loss greater than or equal to 1000mL (adjusted odds ratio (aOR) 15.3; 95% CI 11.1-21.1; P < 0.0001). Likelihood of venous thromboembolism was not significantly increased in TXA recipients (aOR 2.0; 95% CI 0.3-14.6; P = 0.49). Increasing national trends of TXA use in the peripartum period was observed, with variable increases by geographic region. Likelihood of venous thromboembolism was not significantly increased among women who received TXA. Increasing TXA use throughout the country suggests that updated hemorrhage guidelines from national obstetrical organizations can shape clinical practice.

Hypopituitarism: A Rare but Often Neglected Condition.

ABSTRACTPituitary insufficiency is an uncommon disorder. The most common cause is compression due to a pituitary mass. Other causes include inflammatory damage and vascular injury like postpartum pituitary apoplexy. Postpartum pituitary apoplexy, also known as Sheehan’s syndrome, leads to hormonal deficiencies and causes postpartum amenorrhea, lactational failure, chronic hyponatremia, hypoglycemia, and loss of secondary sexual characters. Here we are discussing the clinical course of 15 female patients of panhypopituitarism. Most of them had a history of postpartum hemorrhage. Knowledge about this entity is essential as it is a treatable condition and ignorance could prove to be fatal.How to cite this articleBhushan D, Agarwal M, Shukla RK. Hypopituitarism: A Rare but Often Neglected Condition. Indian J Crit Care Med 2020;24(5):350–352.

Developing and Validating a Prediction Model for Postpartum Hemorrhage at a Single Safety-net Tertiary Care Center [11M

INTRODUCTION: The aim of the current study is to develop and validate a prediction model for postpartum hemorrhage (PPH) based on antenatal and intrapartum risk factors in a diverse patient population at a tertiary safety-net center. METHODS: In this observational cohort of 10,025 pregnant women who delivered at Denver Health Medical Center (DHMC) between April, 2016 and March, 2019, ante- and intrapartum characteristics were compared between women with PPH and those without. A predictive multivariable model was estimated using logistic regression with a backwards stepwise approach eliminating variables when P&gt;.05 among the prediction cohort of women delivering before April 2018. The model was validated among women, who delivered after April, 2018. RESULTS: A total of 9,774 women met inclusion criteria, 6,525 in the prediction cohort and 3,249 in the validation cohort. The prevalence of PPH in the prediction and validation cohorts was 6.1% and 6.8%, respectively. Maternal age, maternal body mass index (BMI, kg/m2), parity, gestational age, history of prior cesarean, history of PPH, abnormal placentation, neonatal weight, chorioamnionitis, platelet count on admission and intrapartum magnesium administration were included in the final prediction model. The area under the curve (AUC) for the prediction model was 0.81 (95% CI 0.79-0.84) and the AUC for the validation cohort was 0.89 (95% CI 0.86-0.91). CONCLUSION: The model performed well and can be used to identify women at risk for PPH. Further studies are necessary to evaluate the effect of the model use on decreasing PPH and associated maternal morbidity.