Management Of Atonic Postpartum Hemorrhage Research Articles

Efficacy of Intrauterine Condom Balloon in the Treatment of Atonic Postpartum Hemorrhage

Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, particularly in cases of uterine atony. Effective management is crucial to prevent severe complications and improve maternal outcomes. Intrauterine balloon tamponade techniques, such as the use of a condom balloon tamponade (CBT), have gained attention for their potential to control bleeding quickly and safely. This study aimed to assess the efficacy of intrauterine condom balloons in the treatment of atonic postpartum hemorrhage. Methods: This study is a prospective observational study conducted to assess the efficacy of intrauterine condom balloon tamponade (CBT) in the management of atonic postpartum hemorrhage (PPH). The study was carried out at the Department of Obstetrics and Gynecology in Dhaka Medical College Hospital, from January 2007 to December 2007. A total of 50 patients were selected by a purposive sampling technique. All collected data were analyzed using SPSS software (version 25.0). For continuous variables (e.g., blood loss, time to hemostasis), comparisons between groups (e.g., successful vs. unsuccessful tamponade cases) were performed using the Student’s t-test. For categorical outcomes, the Chi-square test was used to compare proportions. A p-value of < 0.05 was considered statistically significant. Result: Intrauterine condom balloon tamponade (CBT) effectively managed atonic postpartum hemorrhage in 50 participants, achieving an 84% cessation of bleeding within 30 minutes. The average saline volume used was 500 mL, with a notable 16% of cases requiring additional surgical interventions, primarily hysterectomy. Blood transfusion was necessary for 68% of participants, with higher transfusion needs in cases of failed CBT. Maternal complications were minimal, with 8% experiencing postpartum fever and 4% developing uterine infections. The mean hospital stay was 5.0 days, with 40% staying longer than 5 days, reflecting the need for ongoing ..........

Expression of Concern: Novel Modification of B-Lynch Uterine Compression Sutures for Management of Atonic Postpartum Hemorrhage: VV Uterine Compression Sutures.

Expression of Concern: Novel Modification of B-Lynch Uterine Compression Sutures for Management of Atonic Postpartum Hemorrhage: VV Uterine Compression Sutures.

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.

Use of Ellavi Balloon Tamponade Device for Management of Atonic PPH.

In this manuscript the authors describe the Ellavi balloon tamponade device and its use in the management of atonic postpartum hemorrhage. Additionally the manuscript discusses a case in which this device was used.

Peripheral limb ischemia- A rare side effect of ergometrine

: Drug induced vasculitis is an inflammation of blood vessels caused by use of various drugs like ergometrine, inotropes. The purpose of this review is to highlight the importance of ergotism as a cause of peripheral vascular ischemia and analyze the changes associated with this condition.Mrs. XX, 21 year old, P2L1 presented with history of normal delivery in PHC eight days back with complaints of breathlessness, fever and bluish grey discoloration of both lower extremities since her delivery. There was history of severe postpartum hemorrhage post delivery in the PHC and was medically managed with ergometrine and other oxytocics. On examination, patient had pallor, temperature and tachycardia. Dorsalis pedis pulsation was palpable in both lower limbs. Thorough workup was done which revealed hemoglobin 6.9 gm% and high total count. Doppler study of both lower limbs and ECHO were normal. Patient was managed conservatively after which she improved symptomatically but there was no improvement in the line of demarcation in both lower limbs. Due to financial constraints, patient decided to shift to government setup for further management.Ergometrine is recommended by ACOG and RCOG for use in the medical management of atonic postpartum hemorrhage after oxytocics. Ergometrine has a vasoconstrictive effect which causes progressive vasospasm leading to peripheral ischemia and gangrene which may lead to amputation of the limbs. Hence, management of postpartum hemorrhage with minimum effective dose of ergometrine should be emphasized and use of other oxytocics should be encouraged to prevent such major complications.

Efficacy of Hayman Suture in the Treatment of Atonic Postpartum Hemorrhage

Purpose: The study aims to investigate the effectiveness of Hayman’s suture in the management of Atonic postpartum hemorrhage. Subjects and Method: The study includes 37 patients who developed severe atonic PPH not responsive to pharmacological measures at the Department of Obstetrics and Gynecology at Aswan University hospital, in the period between Mars 2018 and December 2019. This is a case series study of 37 patients upon whom Hayman suture is applied when failed to respond to medical management, step-wise devascularization of the uterus is attempted when the suture cannot control the bleeding alone, reserving hysterectomy as a last resort when all measures are failed. Results: Results of the research None of the 37 patients of our study required hysterectomy to control the bleeding, Hayman suture succeeded solely to arrest the hemorrhage in 30 patients (81.1%), while 7 patients(18.9%) required step-wise devascularization of the uterus with Hayman suture to stop the bleeding. It is not uncommon for complications to be described with the use of uterine compression sutures. In our study, we did not report any complications. Conclusion: The application of Hayman’s suture is a fast, efficient, non-complex, lifesaving and fertility-sparing technique to control atonic postpartum hemorrhage.

Intrauterine balloon tamponade in the management of atonic postpartum haemorrhage: case study from a tertiary care hospital

Intrauterine balloon tamponade in the management of atonic postpartum haemorrhage: case study from a tertiary care hospital

Carbetocin Versus Oxytocin in Prevention of Atonic Postpartum Hemorrhage

Abstract Background: Death due to pregnancy remains an important cause of premature mortality of women worldwide. An estimated 500,000 women die from this cause every year with up to quarter of deaths occur due to hemorrhage. Aim of this study: To compare the effectiveness and safety of carbetocin versus oxytocin in the prevention of atonic postpartum Hemorrhage (PPH) after vaginal deliveries and cesarean sections. Patient and Methods: This computerized random cross sectional prospective comparative study included a total of 400 pregnant women who were going to deliver, attending at Obstetric and Gynecological Department at El-Mataria Teaching Hospital in Corporation with Obstetric and Gynecological Department, Faculty of Medicine, Al-Azhar University. This study was conducted between October 2017 to October 2018. Results: Carbetocin was proved statistically to be more effective in preventing uterus atony and thereby PPH in comparison with oxytocin. Conclusion: It could be concluded that carbetocin is a better uterotonic agent in comparison with Oxytocin in the management of atonic postpartum hemorrhage after delivery either vaginal or cesarean section as it decreases incidence of occurrence of PPH and post-partum blood loss.

A prospective study of B-Lynch suture in the management of atonic PPH at tertiary care centre

Postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity especially in the developing countries like India. Uterine compression sutures, originally described by B-Lynch et al can successfully control life-threatening PPH. With this background, we studied the use of modified B-Lynch sutures in our setup.It was a single centre, hospital based cross sectional study conducted in the department of obstetrics and gynaecology in a tertiary care hospital in Maharashtra. About 50 cases during the study period (Nov 2017 to June 2019) who failed the medical management of control of PPH were included in the study. Demographic details like age, gestational age, religion, socio economic status and gravid were noted in the case record form. Amount of blood loss, success rates, immediate complications and follow up fertility were assessed.Among the 50 study subjects, 24% had blood loss of <1000ml, 54% had loss between 1000 to 1500ml, 16% had loss of 1501 to 2000ml and 6% had loss more than 2000ml in the present study. About 80% of the cases were successful and 20% failed in the present study. About 6% of the cases had wound gaping, 12% each had fever and had hospital stay more than 5 days and 14% of the cases had wound infection in the present study. About 90% of the cases had return of regular menstruation in the present study.The success rate of B Lynch suture was 80% in the present study. There were few post operative immediate complications in our study. Follow up data also suggested that majority of them recovered with normal routine. In our experience, the B-Lynch technique is a safe, effective and easily implemented method of arresting bleeding in cases of major primary PPH due to uterine atony.

Carbetocin Versus Oxytocin in Prevention of Atonic Postpartum Hemorrhage

Background: Death due to pregnancy remains an important cause of premature mortality of women worldwide. An estimated 500,000 women die from this cause every year with up to quarter of deaths occur due to hemorrhage. Objective: The aim of this study was to compare the effectiveness and safety of carbetocin versus oxytocin in the prevention of atonic postpartum Hemorrhage (PPH) after vaginal deliveries and cesarean sections. Patient and Methods: This computerized random cross sectional prospective comparative study included a total of 400 pregnant women who were going to deliver, attending at Obstetric and Gynecological Department at El-Mataria Teaching Hospital in Corporation with Obstetric and Gynecological Department, Faculty of Medicine, Al-Azhar University. This study was conducted between October 2017 to October 2018. Results: Carbetocin was proved statistically to be more effective in preventing uterus atony and thereby PPH in comparison with oxytocin. Conclusion: It could be concluded that carbetocin is a better uterotonic agent in comparison with Oxytocin in the management of atonic postpartum hemorrhage after delivery either vaginal or cesarean section as it decreases incidence of occurrence of PPH and post-partum blood loss.

Carbetocin Versus Oxytocin in Prevention of Atonic Postpartum Hemorrhage

Background: Death due to pregnancy remains an important cause of premature mortality of women worldwide. An estimated 500,000 women die from this cause every year with up to quarter of deaths occur due to hemorrhage. Objective: The aim of this study was to compare the effectiveness and safety of carbetocin versus oxytocin in the prevention of atonic postpartum Hemorrhage (PPH) after vaginal deliveries and cesarean sections. Patient and Methods: This computerized random cross sectional prospective comparative study included a total of 400 pregnant women who were going to deliver, attending at Obstetric and Gynecological Department at El-Mataria Teaching Hospital in Corporation with Obstetric and Gynecological Department, Faculty of Medicine, Al-Azhar University. This study was conducted between October 2017 to October 2018. Results: Carbetocin was proved statistically to be more effective in preventing uterus atony and thereby PPH in comparison with oxytocin. Conclusion: It could be concluded that carbetocin is a better uterotonic agent in comparison with Oxytocin in the management of atonic postpartum hemorrhage after delivery either vaginal or cesarean section as it decreases incidence of occurrence of PPH and post-partum blood loss.

Feasibility of using a handheld tissue hardness meter to quantify uterine contractions and its clinical application for obstetric bleeding management

Postpartum haemorrhage (PPH) is a potentially life-threatening condition. Women undergoing caesarean section (CS) are at particular risk, and improvements in the management of PPH during CS are required. We investigated the use of a tissue hardness metre to quantify uterine contractions during CS with a view to its application for obstetric bleeding management. Fifty pregnant women at term who underwent elective CS were recruited. Using a tissue hardness metre, we measured uterine hardness twice during CS: after placental removal and before peritoneum closure. Each measurement was conducted at two standardised points: fundus and corpus uteri. Concurrently, obstetricians subjectively graded uterine contractions as weak, medium, or strong. The hardness metre accurately quantified the degree of uterine contraction assessed by the obstetricians, and could be an effective clinical tool for early recognition of intra-operative massive bleeding.IMPACT STATEMENTWhat is already known on this subject?Maintaining adequate uterine contraction leads to prevention of excessive blood loss, which decreases the incidence and severity of PPH. However, the assessment of uterine contraction is currently judged by obstetricians, who manually and subjectively evaluate uterine contraction according to uterine hardness. Therefore, uterine atony remains a clinical diagnosis without a universal definition.What do the results of this study add?The present study investigated the use of a tissue hardness metre to quantify uterine contractions during CS with a view to its application for obstetric bleeding management. The hardness metre was able to quantify the degree of uterine contraction perceived by obstetricians. Quantifying uterine hardness during CS correlates with the amount of intra-operative bleeding and is useful for early recognition of massive haemorrhage.What are the implications of these findings for clinical practice and/or further research?To improve the management of atonic PPH and avoid serious complications, the tissue hardness metre should be considered as a potential clinical tool during CS.

Various Modifications of Condom Balloon Tamponade and their Method, Efficacy, Outcomes in Management of Atonic Postpartum Hemorrhage in Tertiary Care Centre- A Observational Study

Various Modifications of Condom Balloon Tamponade and their Method, Efficacy, Outcomes in Management of Atonic Postpartum Hemorrhage in Tertiary Care Centre- A Observational Study

Role of condom catheter balloon tamponade in management of atonic postpartum haemorrhage in cases of failed medical management

Role of condom catheter balloon tamponade in management of atonic postpartum haemorrhage in cases of failed medical management

Calcium in the Management of Atonic Postpartum Hemorrhage

Objective: was to compare the role of methergine, misoprostol and calcium in the management of atonic postpartum hemorrhage. Design: Randomized Controlled Trial. Setting: This study was conducted in obstetrics and gynecology department of Al-azhar University Hospital, Assiut. Patients: 300 women with PPH were included in the study. Intervention: 300 women, each received 5 IU of oxytocin as prophylaxis then divided into three groups: Group A (N=100): women with atonic PPH took methergine, Group B (N=100): women with atonic PPH took misoprostol and Group C (N=100): women with atonic PPH took calcium. Outcome measures: The primary outcome was change in hemoglobin concentration before and after intervention. Results: There was no significant difference between the three study groups as regard mean hemoglobin level before and after treatment. However, a significant difference was present as regard mean change (drop) in hemoglobin level after treatment, with misoprostol group showing the highest drop in Hb% (2.07 ±0.8) compared to calcium group (1.7 ±0.8) and methergine group (1.3 ±0.5). Conclusion: Methergine is more effective in controlling the amount of blood loss during delivery giving a better chance in treatment of atonic postpartum hemorrhage followed with calcium then misoprostol. Although of that calcium is good alternative to methergine with low side effects so can be used safely and effectively when methergine is contriandicated.

Efficacy of Hayman Suture Technique in the Management of Atonic Post-Partum Hemorrhage

Objective: To study the effectiveness of Hayman suture technique to control postpartum hemorrhage.Method: Hayman suture was applied in 43 cases. A No-1 Vicryl suture was used on a round body or a straight needle. In 36 cases (83.72%) Hayman suture was the only intervention. In 4 cases (9.30%) uterine vessels and ovarian vessels were also ligated along with Hayman suture. In 3 cases (7%), along with Hayman suture, Gunashila’s circumferential sutures were taken. Results: None of the 43 patients required hysterectomy.Conclusion: Hayman suture technique is an easily and rapidly applied, effective, simple, safe, life saving and fertility preserving method to control atonic postpartum hemorrhage.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 14-17

Anesthetic Management of Atonic Postpartum Hemorrhage with Hemorrhagic Shock and Impending Cardiac Arrest for Emergency Peripartum Hysterectomy

Anesthetic Management of Atonic Postpartum Hemorrhage with Hemorrhagic Shock and Impending Cardiac Arrest for Emergency Peripartum Hysterectomy

202: Human myometrial in vitro effects of pharmacological agents used in the clinical management of postpartum hemorrhage

ObjectivePostpartum hemorrhage (PPH) is a leading cause of maternal mortality in the developed and under-developed world, and uterine atony is the major contributing factor. Clinical guidelines for drug treatment of PPH vary internationally, and there are minimal comparative pharmacological data for the various uterotonic compounds used. The aim of this study was to evaluate a range of contractile parameters in human pregnant myometrium, for the uterotonic agents used clinically in the management of atonic PPH.Study DesignMyometrial biopsies were obtained from 19 patient donors undergoing elective cesarean delivery at term. The effects of the uterotonic agents oxytocin, carbetocin, ergometrine, carboprost, syntometrine and misoprostol were investigated in 146 myometrial strips. The potency (expressed as pEC50) and maximal response values were obtained, and compared, using both maximal amplitude and mean contractile force as indices of contraction. Single EC50 concentrations of the agents were administered and both force and contraction peak parameters were compared during a 15 minute exposure.ResultsThe most important difference between the agents was in their ability to increase the mean contractile force, with oxytocin superior to all agents except syntometrine. In single dose experiments mean contractile force was the parameter that separated the agents. Oxytocin was not statistically different from carboprost or syntometrine but was superior to all other agents. There was a wide difference in potencies using both measures of contractility, with oxytocin and carbetocin being most potent. There were no significant differences in the peak amplitude of response between agents, except for misoprostol, which was inactive.Conclusion ObjectivePostpartum hemorrhage (PPH) is a leading cause of maternal mortality in the developed and under-developed world, and uterine atony is the major contributing factor. Clinical guidelines for drug treatment of PPH vary internationally, and there are minimal comparative pharmacological data for the various uterotonic compounds used. The aim of this study was to evaluate a range of contractile parameters in human pregnant myometrium, for the uterotonic agents used clinically in the management of atonic PPH. Postpartum hemorrhage (PPH) is a leading cause of maternal mortality in the developed and under-developed world, and uterine atony is the major contributing factor. Clinical guidelines for drug treatment of PPH vary internationally, and there are minimal comparative pharmacological data for the various uterotonic compounds used. The aim of this study was to evaluate a range of contractile parameters in human pregnant myometrium, for the uterotonic agents used clinically in the management of atonic PPH. Study DesignMyometrial biopsies were obtained from 19 patient donors undergoing elective cesarean delivery at term. The effects of the uterotonic agents oxytocin, carbetocin, ergometrine, carboprost, syntometrine and misoprostol were investigated in 146 myometrial strips. The potency (expressed as pEC50) and maximal response values were obtained, and compared, using both maximal amplitude and mean contractile force as indices of contraction. Single EC50 concentrations of the agents were administered and both force and contraction peak parameters were compared during a 15 minute exposure. Myometrial biopsies were obtained from 19 patient donors undergoing elective cesarean delivery at term. The effects of the uterotonic agents oxytocin, carbetocin, ergometrine, carboprost, syntometrine and misoprostol were investigated in 146 myometrial strips. The potency (expressed as pEC50) and maximal response values were obtained, and compared, using both maximal amplitude and mean contractile force as indices of contraction. Single EC50 concentrations of the agents were administered and both force and contraction peak parameters were compared during a 15 minute exposure. ResultsThe most important difference between the agents was in their ability to increase the mean contractile force, with oxytocin superior to all agents except syntometrine. In single dose experiments mean contractile force was the parameter that separated the agents. Oxytocin was not statistically different from carboprost or syntometrine but was superior to all other agents. There was a wide difference in potencies using both measures of contractility, with oxytocin and carbetocin being most potent. There were no significant differences in the peak amplitude of response between agents, except for misoprostol, which was inactive. The most important difference between the agents was in their ability to increase the mean contractile force, with oxytocin superior to all agents except syntometrine. In single dose experiments mean contractile force was the parameter that separated the agents. Oxytocin was not statistically different from carboprost or syntometrine but was superior to all other agents. There was a wide difference in potencies using both measures of contractility, with oxytocin and carbetocin being most potent. There were no significant differences in the peak amplitude of response between agents, except for misoprostol, which was inactive. Conclusion

Carbetocin versus oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery: a randomised controlled trial

The objective of this study is to compare the effectiveness and safety of carbetocin vs. oxytocin in the management of atonic post partum haemorrhage (PPH) after vaginal delivery. A prospective randomised study was conducted in which 100 pregnant women were randomised into 2 equal groups: group 1 received Carbetocin 100 µgm (Pabal(®) Ferring, UK) and group 2 received oxytocin 5 IU (Syntocinon(®), Novartis, Switzerland). The amount of blood loss and the need for other uterotonics were significantly lower in the carbetocin group (811 ± 389.17 vs. 1010 ± 525.66 and 10/50 vs. 21/50). There was no significant difference between the carbetocin and oxytocin groups regarding occurrence of major PPH (6 vs. 11), the need for blood transfusion (6 vs. 9), the difference between blood haemoglobin levels before delivery and 24 h after delivery (0.6 ± 0.28 vs. 0.56 ± 0.25), respectively. There was no significant difference between the 2 study groups regarding both systolic and diastolic blood pressure measured immediately after the drug administration and at 30 and 60 min later. Regarding the drugs side effects, there was no significant difference between the 2 groups in the occurrence of nausea, vomiting, tachycardia, flushing, dizziness, headache, shivering, metallic taste, dyspnea, palpitations and itching. Carbetocin is a better alternative to oxytocin in management of atonic PPH with non-significant hemodynamic changes or side effects .

Reflexed Compression Suture for the Management of Atonic Postpartum Hemorrhage with an Abnormally Adherent Placenta

Background/Aims: Postpartum hemorrhage (PPH) is a life-threatening condition with a worldwide occurrence. The purpose of this study is to evaluate the efficacy and safety of a reflexed compression suture in controlling severe atonic PPH with placenta accreta. Methods: Eleven women with severe PPH due to uterine inertia or placenta accreta were administered the reflexed compression suture. The procedure was to reflex the fundus onto the anterior wall of the uterus for compressing hemostasis and to form a ‘belt-like' binding suture to reinforce the effectiveness of pressing the myometrium. Results: Ten of the 11 women (90.9%) were successfully treated with the suture, and the uterus was preserved. None of these patients developed complications related to this method. Only in 1 patient with placenta increta could the bleeding not be stanched, and a peripartum hysterectomy was performed. Two women had pregnancies after the suture. Conclusion: The reflexed compression suture is a simple, swift, safe and effective technique of controlling uterine atonic bleeding, particularly in patients with an abnormally adherent placenta. The advantage of not having to conduct a hysterotomy also lies in reducing the duration of anesthesia and blood loss.