Incidence Of Primary Postpartum Hemorrhage Research Articles

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied. This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery. In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor. Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40-0.90) in group A and 0.60 g% (interquartile range, 0.40-0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group. The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery. El resumen está disponible en Español al final del artículo.

WITHDRAWN: Tranexamic acid to reduce postpartum blood loss after a vaginal delivery: a double-blinded, randomized controlled trial

To assess the effect of intravenous tranexamic acid (1 g) in reducing blood loss during the 3rd and 4th stages of labor following vaginal delivery, in addition to active management of the third stage of labor. This double-blinded randomized controlled trial included 650 women with singleton pregnancies of ≥ 34 weeks gestation undergoing vaginal delivery. Eligible women were randomly assigned to receive 1 g of tranexamic acid or placebo intravenously in addition to active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the 3rd and 4th stages of labor. Out of 886 expectant women who were approached, 650 instances that met the study's inclusion criteria were enrolled and a total of 320 women in group A and 321 in group B were analyzed. Maternal characteristics did not differ between the two groups. Mean blood loss did not differ significantly among the intervention and placebo groups (378.5±261.2 ml vs. 383±258.9 ml; p = 0.93). The incidence of primary postpartum hemorrhage was comparable in both groups (Group A: 15.9%, Group B: 15.3%, p = 0.814). The median fall in haemoglobin within 12-24 hours following delivery in both groups was comparable (group A: 0.60 g% with interquartile range (IQR) 0.4-0.9 g %; group B: 0.6 g% with IQR 0.4-0.8 g %; p = 0.95). The most common adverse effect reported was dizziness. No thromboembolic events were reported at the follow-up of three months in both groups. Prophylactic use of tranexamic acid in addition to active management of the third stage of labor does not help further reduce postpartum blood loss following vaginal delivery.

Application of a Negative Intrauterine Pressure Suction Device for Prophylactic Management of Atonic Postpartum Hemorrhage: A Quality Improvement Study.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. PPH-preventing interventions need to be prioritized and can be integrated with conventional methods of PPH prevention. The introduction of negative intrauterine pressure using a suction cannula can be one of the cheapest modalities to decrease PPH secondary to uterine atonicity. This method has brought a renaissance to practical obstetrics in low-middle income countries (LMIC), where the cost and availability of uterotonics are major health issues. It was a prospective quality improvement (QI) study conducted in the labor and delivery wards of a tertiary care medical institute and teaching center over the duration of one year. We aimed to assess the decrease in the incidence of atonic PPH with a negative intrauterine pressure suction device (NIPSD) integrated with active management of the third stage of labor (AMTSL) in the prevention of atonic PPH following normal vaginal delivery in low-risk antenatal women. In the initial six months, routine AMTSL was instituted for all consenting women (group 1). In the next six months, NIPSD was integrated with AMTSL (group 2). Data pertaining to the amount of blood loss, the incidence of primary PPH, uterine tone, fall in hemoglobin and hematocrit levels post-delivery, need for blood transfusion, and doctor and patient satisfaction were tabulated for all patients. A total of 1324 consenting women were eligible for enrollment during the study time frame. In the initial six months (baseline period, group 1), 715 participants were subjected to routine AMTSL in the third stage of labor. During the intervention phase (group 2), 609 parturient women were recruited. There was no significant difference in baseline parameters between the two groups. With the introduction of NIPSD to routine AMTSL, there was a significant decrease in the average volume of blood loss during vaginal delivery (group 1 = 389.45+65.42 ml, group 2 = 216.66+34.27 ml; p-value = 0.012). The incidence of atonic PPH was reduced by more than 75% (group 1 = 13 women, group 2 = 3 women; p-value = 0.001) after the introduction of NIPSD complementing routine AMTSL. The introduction of NIPSD has also been instrumental in reducing the cost burden on patient and hospital expenditures. The net benefit of its introduction resulted in a reduction of the overall cost burden of blood transfusions by around 70%. PPH is a public health problem, and measures to reduce PPH must be implemented to decrease this health burden. In countries with low resources, complementing routine AMTSL with NIPSD can be instrumental in decreasing the incidence of PPH. Considering its cost-effectiveness and reusability, LMIC can adopt NIPSD as a routine measure in all vaginal deliveries.

Effect of Nursing Care Practices Based on Clinical Interventions on the Incidence of Primary Post-Partum Hemorrhage in Females Undergoing Spontaneous Vaginal Delivery

Post-Partum Hemorrhage (PPH) has many reported causes such as retained placenta, genital tract lacerations and uterine atony. Objective: To see effect of Nursing Care Practices based on Clinical Interventions on the Incidence of Primary Post-Partum Hemorrhage in females undergoing spontaneous vaginal delivery (SVD). Methods: In this study Pre & Post Study design was used. Sample size 196 was used respectively for Incidence of Primary PPH. In this study Sampling Technique Purposive was used. September 2021 to May 2022 was study duration in which study was conducted. Mothers who were advised to undergo Spontaneous Vaginal Delivery by an obstetrician. Females were including in this study whose maternal age was in years 20-50years. Females admitted to gynecology ward for lower segment caesarian section (LSCS) and Females diagnosed with Preeclampsia were excluded from the study. The Incidence Checklist for PPH was adopted with (Cronbach alpha = 0.89). Results: There was a significant improvement in the incidence of Primary PPH was 27.55% in females undergoing SVD before any change in nursing practices. However, the incidence decreased to 14.48% after clinical interventions in nursing care practices. Conclusions: Nursing Care Practices based on Clinical Interventions was effective. Clinical interventions in nursing care practices showed significant improvement. Furthermore, it also reduces the incidence of Primary PPH and ultimately decreases hospital stay

Incidence, risk factors and outcome of Postpartum Hemorrhage in a Jigme Dorji Wangchuck National Referral Hospital: a retrospective case-control study.

Introduction: Primary postpartum hemorrhage is one of the leading causes of maternal death in Bhutan but data on the incidence and risk factors for primary postpartum hemorrhage are scarce. The purpose of this research is to look into the incidence, its associated risk factors and maternal outcome of primary postpartum hemorrhage among women who gave birth at the national referral hospital. Methods: The incidence of primary postpartum hemorrhage was estimated total number of primary postpartum hemorrhage cases of total deliveries during the study period. A case-control study was conducted to identify risk factors for primary postpartum hemorrhage. Cases of primary postpartum hemorrhage was defined by blood loss of greater or equal to 500ml in vaginal delivery or greater or equal to 1000ml for abdominal delivery within 24 hours of delivery. A multivariable logistic regression was used to identify associated risk factors of primary postpartum hemorrhage. Results: Among 9,221 deliveries, primary postpartum hemorrhage occurred in 180 cases (1.95%; 95% CI=1.68%-2.26%) during two year period. The significant risk factors for primary postpartum hemorrhage were, labor induction (adjusted OR=2.27; 95% CI= 1.11-31.47, p=0.005), current pregnancy complications (aOR=2.50; 95% CI: 1.32-4.74, p=0.005), and gestational age at term delivery (aOR=6.49; 95% CI:1.12-37.48, p=0.037). The significant causes of primary postpartum hemorrhage were uterine atony (aOR=72.57; 95% CI:5.95-885.76, p=0.001), retained placenta (aOR=18.08; 95% CI:2.66-122.81, p=0.003) and perineal and cervical tear (aOR=27.80; 95% CI: 15.13-51.07, p less than 0.001). Conclusions: The incidence of primary postpartum hemorrhage was 1.95% which is lower compared to other South East Asian countries. The causes and risk factors identified in this study may help predict primary postpartum hemorrhage and aid healthcare providers in better management of primary postpartum hemorrhage in all women giving birth.

Age and Parity in the Incidence Of Primary Post Partum Hemorrhage at Panembahan Senopati Hospital, Bantul Yogyakarta

Post partum hemorrhage is the main cause of 150,000 maternal deaths every year in the world and almost 4 out of 5 deaths due to postpartum hemorrhage occur within 4 hours after delivery. The direct causes of maternal death in Indonesia are bleeding 45.20%, eclampsia 12.90%, abortion complications 11.10%, postpartum sepsis 9.60%, prolonged labor 6.50%, anemia 1.60% and indirect causes of death. by 14, 10%. The purpose of this study was to determine the relationship between parity and age with the incidence of primary postpartum hemorrhage at Panembahan Senopati General Hospital. Analytical survey studies or case control surveys use a retrospective time approach. The sampling technique was purposive sampling with a ratio of the number of samples 1: 1, namely the case sample was 70 and the control sample was 70. The analysis technique was Chi Square. The results of Chi Square analysis showed that age and parity had a significant relationship with the incidence of primary postpartum hemorrhage, age (OR = 14.22 and p-value 0.000) while parity (OR 3.010 and p-value 9.643). It means that mothers with maternal age at risk (<20 and > 35 years) have a risk of 14.22 greater than the age not at risk (20-35 years). Mothers with parity at risk (1 and >3) had a 3.010 greater risk of primary postpartum hemorrhage than mothers with parity at no risk (2 and 3). This study concluded that there is a relationship between age and parity with the incidence of primary postpartum hemorrhage.

KORELASI ANTARA PARITAS DENGAN KEJADIAN PERDARAHAN POSTPARTUM PRIMER

This study aims to determine the correlation between parity and the incidence of primary postpartum hemorrhage. The research design used is a cross-sectional correlation design. This study was conducted at the Public Health Center (Puskesmas) in Pulau Untung Jawa Village, Kepulauan Seribu Selatan District, DKI Jakarta in 2021. The population in this study was mothers who experienced postpartum hemorrhage (500 ml/more) at gestational age ≥ 20 weeks in the first 24 hours after delivery. The sampling technique used in this study was saturated sampling. The data were analyzed using the Chi-squared test. From the results of the study, it was found that 29 cases of primary postpartum hemorrhage occurred. Most incidences of primary postpartum hemorrhage occurred at a high parity level (more than 1) as many as 20 cases (68.97%). After analyzing the data using the Chi-squared test based on dk = 1 and α = 0.05, the Chi-square table = 3.48 while the calculated Chi-square count = 4.16. The conclusion is obtained by comparing X² count with X² table, it is found that X² count is > X² table, which means that there is a correlation between parity and the incidence of primary postpartum hemorrhage. It means that women with high parity have a greater risk of experiencing primary postpartum hemorrhage. With the high incidence of primary postpartum hemorrhage at high parity, it is hoped that healthcare facilities can provide more intensive services. Preventive measures should be started since women are pregnant by doing good antenatal care, providing information about the occurrence of primary postpartum hemorrhage and paying attention to predisposing factors or history of primary postpartum hemorrhage.

Effect of Clinical Interventions on the Incidence of Primary Post-Partum Hemorrhage in Females Undergoing Spontaneous Vaginal Delivery

Background: Primary Post-Partum Hemorrhage (PPH) is blood loss 500ml or more commonly occurring during the 3rd and 4th stage of labour, the period is known as delivery of infant with placenta and two hours after delivery. Labor room and delivery room nurses continuously miscalculate blood loss after delivery, which could lead to delay in providing care during Primary Post-Partum Hemorrhage. Objective: To see effect of Clinical Interventions on the Incidence of Primary Post-Partum Hemorrhage in females undergoing spontaneous vaginal delivery (SVD). Methods: Quasi-Experimental study design was used with Pre & Posttest. Incidence of Primary Post-Partum Hemorrhage 196 patients sample was used in this study. Purposive sampling Technique was used in this research. Study setting was all admitted patients in gynae ward of Allied Hospital Faisalabad. The study duration was conducted in September 2021 to May 2022. Maternal age in years 20-50years were including in this study.Femlaes having previous lower segment Caesarean section (LSCS)were excluded from the study. Validated adopted checklist was used to measure incidence rate of Primary Post-Partum Hemorrhage with Cronbach Alpha (0.89). Primary Post-Partum Hemorrhage were labeled as group of “Yes” for right answer & the score was 1 and “No” for wrong answer and score was labeled as “0”. Results: Frequency & Percentages of Demographic variables were checked. During pre-intervention period 39% Incidence rate in females & on the other hand after interventions incidence rate decreases 14% after Spontaneous Vaginal Delivery. This is statistically acceptable. Paired sample t-test was conducted to evaluate the impact of the interventions on females Blood Pressure systolic Pre interventions scores Mean± SD(109.847±12.4303) & Post intervention scores (114.0306±11.30396) with Mean Difference was -4.18367, Paired t test -3.403with P value 0.001.Blood Pressure Diastolic Pre interventions scores Mean± SD(73.2143±8.96575) & Post intervention scores (76.9898±7.06163) with Mean Difference was -3.77551, Paired t test -4.560 with P value 0.000.Pulse Rate in Pre interventions scores Mean± SD(86.3163±6.21346) & Post intervention scores (85.2143±4.63819) with Mean Difference was 1.10204, Paired t test 1.891 with P value 0.060.Temperature in Pre interventions scores Mean± SD(98.1827±.44457) & Post intervention scores (98.1541±.45891) with Mean Difference was .02857, Paired t test .595 with P value 0.553.Respiration in Pre interventions scores Mean± SD(17.3367±1.51196) & Post intervention scores (17.0561±5.98047) with Mean Difference was .28061, Paired t test .625 with P value 0.533.Paired sample t-test was conducted to evaluate the impact of the interventions on females Incidence Rate Pre interventions scores Mean± SD (1.8010 ± .40026) & Post intervention scores (1.9286 ± .25820) with Mean Difference was -1.2755, Paired t test -3.767 with P value 0.00. Conclusion: Clinical Interventions was effective on the Incidence of Primary Post-Partum Hemorrhage in females undergoing spontaneous vaginal delivery. Key Words: Post-Partum hemorrhage, lower segment Caesarean section, Incidence, Females, spontaneous vaginal delivery, Miscalculate.

The Relationship of Pregnancy Anemia with Primary Postpartum Hemorrhage in Tarakan, North Kalimantan

Bleeding in childbirth is caused by anemia in pregnancy. This happens because when the mother gives birth, there will be adequate uterine contractions to be born. This study aims to determine the relationship between anemia during pregnancy and the incidence of primary postpartum hemorrhage. This type of research is analytical survey research. The subjects in this study were all pregnant women who suffered from anemia. The research place of the Juata Community Health Center in Tarakan City, North Kalimantan. From May to June 2020. The data used in this study is secondary data obtained from medical record books at the Juata Community Health Center. This study used a total sampling technique—data analysis using chi-square analysis. The statistical tests showed that pregnant women with anemia had an 11,253 times greater risk of bleeding during childbirth than women who gave birth vaginally. Pregnant women and their families should take care of their pregnancy by routinely carrying out antenatal care under antenatal care service standards

The Relationship of Pregnancy Anemia with Primary Postpartum Hemorrhage in Tarakan, North Kalimantan

Bleeding in childbirth is caused by anemia in pregnancy. This happens because when the mother gives birth, there will be adequate uterine contractions to be born. This study aims to determine the relationship between anemia during pregnancy and the incidence of primary postpartum hemorrhage. This type of research is analytical survey research. The subjects in this study were all pregnant women who suffered from anemia. The research place of the Juata Community Health Center in Tarakan City, North Kalimantan. From May to June 2020. The data used in this study is secondary data obtained from medical record books at the Juata Community Health Center. This study used a total sampling technique—data analysis using chi-square analysis. The statistical tests showed that pregnant women with anemia had an 11,253 times greater risk of bleeding during childbirth than women who gave birth vaginally. Pregnant women and their families should take care of their pregnancy by routinely carrying out antenatal care under antenatal care service standards

HUBUNGAN ANEMIA DALAM KEHAMILAN DENGAN KEJADIAN PERDARAHAN POSTPARTUM PRIMER di RSUD PUTRI HIJAU MEDAN PERIODE JANUARI 2020-JANUARI 2021

This study aims to determine the relationship between anemia in pregnancy and the incidence of primary postpartum hemorrhage at Putri Hijau Hospital, Medan for the period January 2020 - January 2021. The research method used is an analytic case-control approach. Data were taken from the Register and Patient Medical Records. The population in this study was 447 mothers who gave birth during January 2020 – January 2021. The number of case samples and control samples was made in a 1:1 ratio by following the number of case samples that met the inclusion and exclusion criteria. Bivariate analysis using the Chi Square test found the results: p = 0.000 (p <α, = 0.05), then Ho was rejected, which means that there is a relationship between Anemia in Pregnancy and Primary Postpartum Bleeding Incidence at Putri Hijau Hospital Medan. The strength of the relationship between the two variables is seen based on the contingency coefficient, which is 0.631 which means the strength of the relationship is strong. Then the results of the Odds Ratio (OR) obtained OR = 105 [95% CI 17.8 - 618.7] which means that the range of 17.8 - 618.7 does not exceed the value of 1, so mothers giving birth with anemia in their pregnancy are likely to have primary postpartum hemorrhage. 105 times greater than women who gave birth without anemia in their pregnancy. Based on the results of research and discussion on the relationship between anemia and the incidence of primary postpartum hemorrhage at the Putri Hijau Hospital, Medan for the January 2020 – January 2021 period, it is expected to increase regular health promotion regarding pregnancy and childbirth by involving the role of cadres in providing counseling and involving the role of husband/family in health. pregnant women to minimize the risk of anemia in pregnancy and primary postpartum hemorrhage.

Factors of Primary Postpartum Hemorrhage among Women Delivered at Yirgalem General Hospital Southern, Ethiopia: A case control study

Background: Primary postpartum hemorrhage continues to be the top leading cause of maternal mortality and morbidity all over the world, contributing about one third of all maternal mortality. Despite its public health importance of this problem, little is known about factors that contribute to primary postpartum hemorrhage especially in Ethiopia. The aim of this study was to assess the risk factors of primary postpartum hemorrhage. Subjects and Method: Hospital based unmatched case control study design was used. The study was conducted in July 2019, among delivered women at Yirgalem general hospital from January 1, 2014 to December 30, 2018; to all cases of primary postpartum hemorrhage (n= 218) and 436 controls selected by using simple random sampling techniques. Women with primary postpartum hemorrhage were cases and women who had not diagnosed for primary postpartum hemorrhage were controls. Descriptive statistics and logistic regression analysis were made. Statistical association was measured by AOR and its 95% CI. Results: Incidence of primary postpartum hemorrhage was 221 in 8,506 live births (2.6%) in the study period. Primiparas (AOR= 0.37 ;95% CI= 0.23 to 0.6; p= 0.001), grand multiparas (AOR= 5.80; 95% CI= 2.90 to 11.6; p <0.000) and rural maternal address (AOR= 1.90; 95% CI= 1.20 to 3.00; p= 0.008) were factors that have a statistically significant association with primary postpartum hemorrhage. Conclusion: Parity and rural residence were associated factors. Therefore, the government and other responsible stakeholders should give attention to women with grand multiparas and those women residing in rural area. Immediate identification of risk factors and management might reduce largely the occurrence of primary PPH and related maternal deaths.

Maternal Outcomes in Women with Bleeding Disorders According to Mode of Delivery: A Single-Center Retrospective Cohort Study

▪Introduction:Pregnant women with bleeding disorders (WBD) are at higher risk of postpartum hemorrhage (PPH) compared to women without bleeding disorders. Multidisciplinary care is essential to minimize bleeding and optimize maternal outcomes in pregnant WBD. The safest mode of delivery for pregnant WBD remains debated with variable clinical practices and guideline recommendations. Studies are needed to inform decision-making for pregnant WBD and their multidisciplinary team.Objectives:To describe the maternal and neonatal outcomes in pregnant WBD by mode of delivery, including spontaneous vaginal delivery (SVD), induction of labor (IOL), planned C-section (CS) and emergent CS.Methods:We performed a retrospective analysis of all pregnant WBD who delivered at our institution between 2010-2020. The comprehensive hemostasis program offered at our institution has been providing multi-disciplinary care for patients with bleeding disorders since 1985 and coordinates care for 5-10 pregnant WBD a year. Patient/disease characteristics, mode of delivery, peripartum hemostatic management, and maternal outcomes were collected. PPH was defined according to the American College of Obstetrics and Gynecology (ACOG) (doi:10.1097/AOG.0000000000002351). Primary PPH was defined as blood loss of ≥ 1000 mL or blood loss with signs and symptoms of hypovolemia within 24h delivery regardless of route of delivery, or blood loss of > 500 mL in a vaginal delivery. Secondary PPH was defined as any abnormal or excessive vaginal bleeding beyond 24h of delivery to 12 weeks postpartum as documented by healthcare professionals' clinical notes. Data is presented using descriptive statistics. Fisher's Exact test was used to measure association between the mode of delivery and PPH.Results:A total of 73 pregnancies in 50 WBD were included. The incidence of primary PPH and secondary PPH were 6.8% (5/73, 95% CI [2.5, 14.5]) and 19.0% (12/63, 95% CI [10.8, 30.1]), respectively (Table 1). According to mode of delivery, primary PPH occurred in 1/34 for SVD, 3/21 for IOL, 0/11 for planned CS and 1/7 for emergent CS, and secondary PPH occurred in 6/31 for SVD, 5/19 for IOL, 0/6 for planned CS and 1/7 for emergent CS (Table 1). When comparing combined vaginal deliveries to CS, we found a numerically higher rate of both primary PPH (4/55, 7.2% vs. 1/18, 5.6%, p = 1.0) and secondary PPH (11/50, 22.0% vs. 1/13, 7.7%, p = 0.431), but both were not statistically significant (Table 1).Discussion:Our cohort of pregnant WBD showed rates of primary PPH (6.8%) comparable to those in a 2014 study of all Canadian deliveries (6.2%) (doi:10.1016/S1701-2163(15)30680-0). This likely reflected efforts for multidisciplinary and coordinated care for WBD within a hemophilia treatment centre with readily available clinical and laboratory monitoring as well as universal access to hemostatic therapies for Canadian WBD. In our cohort, planned CS did not result in any PPH which may reflect the ability to ensure clinical and laboratory expertise in hemostasis available (like recommendations for perioperative care in hemophilia) as opposed to spontaneous or unplanned deliveries that may occur outside of regular operating hours. Rates of secondary PPH remained high and problematic especially following vaginal deliveries. Several factors may explain these delayed bleeding events such as wound healing defects inherent to some bleeding disorders and decline in factor levels back to baseline in the early postpartum period.Our study was limited by its retrospective and single-centred design, small sample size, missing secondary PPH data in 10 pregnancies, and potential confounding variables that were unaccounted for by the study. Nevertheless, we reported incidence rates of primary and secondary PPH according to the mode of delivery in women with bleeding disorders, which can be important to inform clinical practices.Conclusion:Women with bleeding disorders are at high risk of PPH. Although we did not find statistically significance correlation by mode of delivery, these findings are clinically relevant in supporting patient-centered care and shared decision-making between WBD, obstetricians and hematologists. Close monitoring and follow-up are of utmost importance and further larger prospective research focused on postpartum outcomes is much needed. [Display omitted] DisclosuresWang: Servier: Membership on an entity's Board of Directors or advisory committees; Leo Pharma: Research Funding. Khalife: Canadian Hemophilia Society: Research Funding; Pfizer Canada: Honoraria, Research Funding.

Effectiveness of Pre-operative Rectal Misoprostol in Reducing Blood Loss during Cesarean Section for Placenta Previa and Manual Removal of Retained Placenta: A Parallel Placebo-Controlled Study

BACKGROUND: Primary postpartum hemorrhage (PPH) contributes significantly to the high maternal mortality ratio, especially in the low resource nations. Placenta previa and retained placenta are major causes of postpartum hemorrhage. Uterotonics like misoprostol are medication used to improve uterine contractility with the purpose of reducing uterine bleeding after delivery of baby. Most studies on misoprostol for the prevention of obstetric hemorrhage have been focusing on its postpartum use.
 AIM: The aim of this study was to assess the effectiveness of pre-operative misoprostol in reducing blood loss during cesarean section for placental previa and manual removal of retained placenta.
 METHODS: This was a placebo-controlled study involving 154 women who were randomly assigned to the treatment and control groups. The study group received 400 ug of misoprostol rectally just before the commencement of the procedure. Estimation of blood loss was done in a standardized way. Data were analyzed using SPSS version 23. The level of significance was set at p < 0.05.
 RESULTS: The average age of the participants was 31.64 years. The overall incidence of PPH was comparable in both groups (0.070), however, misoprostol group experienced lower incidence of severe PPH compared to the placebo (p = 0.013). Other maternal and perinatal outcomes were comparable.
 CONCLUSION: Excessive intraoperative and immediate post-operative bleeding can be prevented with pre-operative misoprostol. It should be made available for high-risk obstetrics procedures.

Hubungan Paritas, Umur Ibu Dengan Perdarahan Post- Partum Primer di Rumah Sakit Panti Rapih Yogyakarta Tahun 2017- 2018

Background: The cause of AKI in DIY 2018, 11% of post-partum hemorrhage, with a gap in MMR target and achievement <102 / 100,000 live births, MMR in 2018: 111.5 / 100,000 live births, indicating an increase in MMR. In the same year at Panti Rapih Hospital, there was an increase in the incidence of post-partum hemorrhage by 6%, with 62.8% of parity at risk, 53.5% of age at risk.
 Objective: of the study was to determine the relationship between parity and maternal age with the incidence of primary post-partum hemorrhage at Panti Rapih Hospital in 2017-2018.
 Methods: observational, cross sectional design, sample 43 people. Chi Square Test data analysis.
 Results: There was a significant relationship between parity and the incidence of primary post partum hemorrhage (p-value = 0.011). There was a significant relationship between age and the incidence of primary post-partum hemorrhage at Panti Rapih Hospital (p-value = 0.014).
 Conclusion: There is a significant relationship between parity, maternal age <20 years or> 35 years with the incidence of primary post partum hemorrhage at Panti Rapih Hospital in 2017-2018.

Prophylactic Use of Tranexamic Acid in Reducing Blood Loss during Elective Cesarean Section

Background: Primary postpartum hemorrhage (PPH) plays a major role in maternal mortality and morbidity like severe anemia, blood transfusion requirement, hospital stay and infection. Tranexamic acid is now recommended in treatment of PPH, yet its prophylactic use before delivery is still not recommended. Objective: To assess the efficacy of preoperative administration of Tranexamic acid in decreasing blood loss during elective cesarean section. Patients and Methods: The study was conducted at Department of Obstetrics and Gynecology of Menoufia University Hospitals. It included 100 pregnant females who went through elective cesarean section with age >18 and < 35 years and singleton alive fetus. They were randomly allocated to two groups: the study group of which women received 1 gm of tranexamic acid 20 minutes before skin incision and the control group who did not receive tranexamic acid. The assessment included the following: measurement of blood loss amount and estimation of postoperative 1st day hemoglobin and hematocrit value. Results: There was highly statistically significant difference between both groups regarding the amount of blood loss during cesarean delivery and blood loss 2 hours from end of CS (p ≤ 0.001). This was reflected in the percentage of difference of preoperative and postoperative hemoglobin and hematocrit values, which showed highly significant statistical difference (p ≤ 0.001). Conclusion: Tranexamic acid administration before elective cesarean section was effective in decreasing intraoperative and postoperative bleeding. And in turn reduces the incidence of PPH with no immediate maternal or neonatal side effects.

Incidence and Pregnancy Outcomes of Primary Postpartum Hemorrhage Following Implementation of Postpartum Drape with a Calibrated Bag after Normal Vaginal Delivery

Objective: To evaluate the incidence, risk factors, and pregnancy outcomes of primary postpartum hemorrhage (PPH) after the implementation of postpartum drape with a calibrated bag (PDCB) after normal vaginal delivery.Methods: This retrospective chart review compared patients who had normal vaginal delivery in June 2012 prior to PDCB implementation with patients who had normal vaginal delivery in June 2014 after PDCB implementation at Siriraj Hospital.Results: In total, 856 patients were included in this study, with 458 and 398 patients delivered in June 2012 and June 2014, respectively. Baseline characteristics were comparable between the two groups. The incidence of primary PPH increased significantly after the implementation of PDCB (2.8% in 2012 vs. 8.5% in 2014; p &lt; 0.01). The incidence of severe PPH was also significantly increased (0.4% in 2012 vs. 2.3% in 2014; p = 0.02). Uterine atony was the most common cause and the diagnosis increased after PCDB implementation. The use of additional uterotonic drugs was also significantly increased after PDCB implementation (30.8% in 2012 vs. 85.3% in 2014; p &lt; 0.01). The blood transfusion rate was comparable between the two groups. No peripartum hysterectomy or ICU admission was observed in this study. After PDCB implementation, pregnancy-induced hypertension was found to be a significant risk factor for primary PPH (p &lt; 0.01).Conclusion: The incidence of primary and severe PPH, and the rate of the use of additional uterotonic drugs were all significantly increased after the implementation of PDCB. Pregnancy-induced hypertension was found to be a significant risk factor for primary PPH.

A double-blind randomized controlled clinical trial of oral misoprostol versus ergometrine in the prevention of primary postpartum hemorrhage

Objective: The study was designed to investigate the effectiveness of orally administered misoprostol versus intravenous ergometrine (stored at tropical temperatures) in the prevention of primary postpartum hemorrhage (PPH) among parturients undergoing vaginal delivery in a teaching hospital.Study Design: A double-blind randomized controlled clinical trial was conducted at the University of Benin Teaching Hospital. One hundred and fifty parturients were offered 400 ug misoprostol and an intravenous placebo for the management of the third stage of labor while another 150 parturients received oral placebo and 0.5 mg intravenous ergometrine.Results: There was no significant difference in the incidence of PPH (blood loss > 500 ml) between the two groups: 8 (5.3%) for the misoprostol group compared with 7 (4.7%) for the ergometrine group (P = 0.79, relative risk (RR) = 1.07, confidence interval (CI): 0.66–1.74). The incidence of severe PPH (blood loss > 1000 ml) was similar between the two groups: 2 (1.3%) in the misoprostol group compared with 1 (0.7%) in the ergometrine group. Similarly, the indices of postpartum blood loss (hematocrit change, need for blood transfusion, and surgical intervention) were comparable between the two groups. A subgroup analysis of high-risk parturients revealed comparable indices. The misoprostol group, however, had a significantly higher risk of shivering in the early postpartum period (P = 0.00, RR = 2.01, CI: 1.69–2.38).Conclusions: The results suggest that oral misoprostol has comparable efficacy to intravenous ergometrine at tropical conditions in the prevention of PPH. However, in view of its easier mode of administration, oral misoprostol may be preferable in rural situations in Africa.

Prevention of postpartum Hemorrhage with Sublingual Misoprostol or Oxytocin

Postpartum hemorrhage is a life threatening situation and one of the important causes of maternal mortality and morbidity, worldwide. To evaluate the effectiveness of a low dose (400ug) of misoprostol administrated sublingually compared to 10 IU of intramascular oxytocin for the reduction of postpartum blood loss. A total of 120 patients were randomized to receive either 400μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included change in pre and 24 hour post-delivery hemoglobin and hematocrit values, side effects of the used drugs, and the need for blood transfusion. Results: Although not statistically significant, mean blood loss mean in misoprostol group (301.92 ±132.95) was lower than in oxytocin group (317.58 ±120.12). Incidence of postpartum hemorrhage was (1.7%) in misoprostol group versus in oxytocin group (3.3%). We observed that 6.7% and 8.3% of women experienced a hemoglobin decline of >10% 24 hours after receiving misoprostol and oxytocin, respectively (p = 1.0), the mean of HCT drop in misoprostol group (3.43 ±2.8) and (3.38 ± 2.92) in oxytocin group ( p = 0.92) . Side effects were significantly greater in the misoprostol group than in the oxytocin group. Conclusion: Although not statistically significant, 400 ug of sublingual misoprostol is more effective than 10 IU of oxytocin administrated via the intramuscular route in reducing post delivery blood loss.

FAKTOR RISIKO YANG BERHUBUNGAN DENGAN KEJADIAN PERDARAHAN POSTPARTUM PRIMER DI RUMAH SAKIT UMUM DAERAH RADEN MATTAHER PROVINSI JAMBI TAHUN 2019

Latar Belakang: Perdarahan postpartum primer yang terjadi dalam 24 jam pertama, merupakan penyebab tertinggi kematian ibu di Indonesia. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian perdarahan postpartum primer di RSUD Raden Mattaher Provinsi Jambi Tahun 2019.&#x0D; Metode: Penelitian ini merupakan survey analitik dengan metode observasional menggunakan pendekatan case control. Sampel kasus sebanyak 48 diambil secara total sampling yang merupakan jumlah kasus yang ditemukan tahun 2013-2018 dan sampel kontrol sebanyak 48 diambil menggunakan teknik purposive sampling dengan perbandingan jumlah 1:1. Pengumpulan data dilakukan dengan cara dokumentasi. Analisis data dilakukan secara univariat dan bivariat.&#x0D; Hasil: Sebagian responden berada pada umur dan paritas yang berisiko serta mengalami anemia dan hasil bivariat menunjukkan umur (p-value= 0,002 dan OR=4,109), paritas (p-value=0,000 dan OR=7,400), anemia (p-value=0,000 dan OR=14,224) memiliki hubungan bermakna dengan kejadian perdarahan postpartum primer.&#x0D; Kesimpulan: Umur, paritas dan anemia merupakan faktor yang berhubungan secara signifikan dengan kejadian perdarahan postpartum primer di RSUD Raden Mattaher Provinsi Jambi.